Cross-cultural code-switching - the impact on international medical graduates in New Zealand

BACKGROUND

New Zealand relies on International Medical Graduates (IMGs); however, the retention of IMGs is not optimal. This research uses a lens of cross-cultural code-switching to explore how professional and cultural differences impact on International Medical Graduates' (IMGs') journeys to practise effectively and remain in New Zealand.

METHODS

Utilising theory-informing inductive analysis within a constructivist approach, framework analysis was conducted following 14 face-to-face interviews with IMGs. The analysis then explored the degree to which their experiences could be explained by cross-cultural code-switching's psychological challenges (authenticity, competence, and resentment).

RESULTS

Analysis showed there was an expectation for IMGs to code-switch. The greater the cultural and professional difference of IMGs (compared to New Zealand), the greater the intensity of psychological challenges experienced when switching. Moreover, IMGs received minimal support, making it difficult to overcome psychological challenges, especially the competence challenge. This led to feelings of frustration and vulnerability. Code-switching could also explain why complaints about IMGs were more likely when IMGs were stressed or tired.

CONCLUSION

Cross-cultural code-switching can be used to explain and identify how cultural differences cause psychological challenges. These findings inform how programmes can better support IMGs in orientation and ongoing training. Additionally, establishing, and allocating IMG cultural mentors would assist in addressing IMGs' vulnerability and isolation. With this support, the journey may prove more manageable and encourage IMGs to continue practising in their adopted country.

The consequences of cultural difference: the international medical graduate journey in New Zealand

Objectives

To identify how differences in cultural and professional values between New Zealand born and trained doctors and International Medical Graduates (IMGs) affect the practice and retention of IMGs in New Zealand.

Methods

A mixed-method approach was used. An anonymous 42-item online questionnaire was used to compare participants' cultural and professional values. Participants were 373 New Zealand doctors, 198 IMG, and 25 doctors born and raised elsewhere but who qualified in New Zealand, a group not identified prospectively. The qualitative component used interviews with 14 IMGs to identify cultural challenges faced and with nine New Zealand doctors to identify the challenges they faced working alongside IMGs. Qualitative data were transcribed and analysed thematically.

Results

There were differences in power distance, with the medically qualified in New Zealand doctors having the highest power distance, followed by the IMGs, suggesting a preference for a hierarchical environment at odds with the New Zealand culture. Interviews found cultural differences in communication styles and hierarchy contributed to professional challenges. The cultural transition was difficult for IMGs as they received minimal support. One-third of IMGs acknowledged their behaviours did not fit well in New Zealand. Complaints about IMGs increased when they reverted to default behaviours regarded negatively by New Zealand colleagues or patients.

Conclusions

IMGs are open to change but face a lack of orientation and cultural education opportunities, hindering integration. Residency programs must recognise this disconnect and incorporate cross-cultural programmes in the curriculum. Such programmes would assist the adaption and retention of IMG doctors.