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      Challenges for International Medical Graduates in the US Graduate Medical Education and Health Care System Environment: A Narrative Review

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          Abstract

          International medical graduates (IMGs) have become a vital part of the US graduate medical education (GME) and health care system (HCS) workforce; they contribute to essential diversity that relieves cultural and linguistic barriers to health care. The number of IMGs looking for medical training in the United States. has constantly been increasing in the last decades. The challenges they meet begin long before residency application, continue during their transition to residency programs, through early medical training, and eventually subside in senior years. IMGs' hurdles permeate the themes of navigating the US GME and HCS, adaptation to the US culture, communication skills, racial discrimination, emotional distress, and finances. This article aims to comprehensively review available information concerning the challenges encountered by IMGs in their transition to the US GME and HCS environments.

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          Supporting international medical graduates’ transition to their host‐country: realist synthesis

          Amelia Kehoe, John McLachlan, Jane Metcalf … (2016)
          Context Many health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs’ transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective. Methods The realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement. Results Sixty‐two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self‐efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment. Conclusions Organisational, training and individual contexts all play a role in IMGs’ adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given.
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            Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training.

            Peggy Guey-Chi Chen, Leslie Curry, Susannah May Bernheim … (2011)
            Despite a long history of international medical graduates (IMGs) coming to the United States for residencies, little research has been done to find systematic ways in which residency programs can support IMGs during this vulnerable transition. The authors interviewed a diverse group of IMGs to identify challenges that might be eased by targeted interventions provided within the structure of residency training.
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              Professional experiences of international medical graduates practicing primary care in the United States.

              Peggy Guey-Chi Chen, Leslie A Curry, David T. Berg … (2010)
              International medical graduates (IMGs) comprise approximately 25% of the US physician workforce, with significant representation in primary care and care of vulnerable populations. Despite the central role of IMGs in the US healthcare system, understanding of their professional experiences is limited. To characterize the professional experiences of non-US born IMGs from limited-resource nations practicing primary care in the US. Qualitative study based on in-depth in-person interviews. Purposeful sample of IMGs (n = 25) diverse in country of origin, length of practice in the US, specialty (internal medicine, family medicine and pediatrics), age and gender. Participants were currently practicing primary care physicians in New York, New Jersey or Connecticut. A standardized interview guide was used to explore professional experiences of IMGs. Four recurrent and unifying themes characterize these experiences: 1) IMGs experience both overt and subtle forms of workplace bias and discrimination; 2) IMGs recognize professional limitations as part of "the deal"; 3) IMGs describe challenges in the transition to the culture and practice of medicine in the US; 4) IMGs bring unique skills and advantages to the workplace. Our data reveal that IMGs face workplace challenges throughout their careers. Despite diversity in professional background and demographic characteristics, IMGs in our study reported common experiences in the transition to and practice of medicine in the US. Findings suggest that both workforce and workplace interventions are needed to enable IMG physicians to sustain their essential and growing role in the US healthcare system. Finally, commonalities with experiences of other minority groups within the US healthcare system suggest that optimizing IMGs' experiences may also improve the experiences of an increasingly diverse healthcare workforce.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 27 July 2022
                Publication date (Electronic, collection): July 2022
                Volume: 14
                Issue: 7
                Electronic Location Identifier: e27351
                Affiliations
                [1 ] Medicine, Autonomous University of Guadalajara, Zapopan, MEX
                [2 ] Infectious Diseases, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, MEX
                [3 ] Surgery, General Hospital of Zone No. 5, Nogales, MEX
                Author notes
                Carlos Murillo Zepeda murilloc007@ 123456gmail.com
                Article
                DOI: 10.7759/cureus.27351
                PMC ID: 9334519
                PubMed ID: 35910699
                SO-VID: b5c40570-0cc0-4896-ba1b-b39dfbd5e25a
                Copyright © Copyright © 2022, Murillo Zepeda et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 27 July 2022
                Categories
                Subject: Medical Education

                Keywords: u.s. health care system,u.s. graduate medical education,u.s. medical residency,challenges,foreign medical graduates,international medical graduates
                Data availability:
                Keywords: u.s. health care system, u.s. graduate medical education, u.s. medical residency, challenges, foreign medical graduates, international medical graduates

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