Exploratory study on the international medical graduate-patient relationship: patient's perceptions of the quality of care delivered by his or her non-native doctor.

OBJECTIVE: This study examined the influence of social distance upon the patients' perceptions of the quality of care delivered by their non-native international medical graduates (NNIMGs) in an inner-city primary care residency program. Within the inner city, there is a growing trend of NNIMGs providing health care services, thereby creating a situation of maximal social distance with respect to nativity, race, and socioeconomic status. DESIGN: Two female NNIMG residents, one from India and one from China, were the focus of ten hour-long in-depth interviews with patients who participated in this exploratory qualitative research. RESULTS AND CONCLUSIONS: Structural supports, communication processes, and status equalization effects emerged as three self-reported influences on the assessment of care that were particular to their physician's NNIMG status. The physician's NNIMG status seemed to exert a status equalization effect that reduced social distance and subsequently increased the perception of the quality of care.

There's no place like home: evaluating family medicine residents' training in home care.

This study examined residents' experiences in a physician home visit program and their attitudes toward working with older patients in a home setting. In-depth personal interviews were conducted with all second and third year residents in a family medicine residency program (n = 17). Most residents expressed positive attitudes about caring for patients in their homes. Residents said home visits allowed them to provide better care, and enhanced their assessment skills and understanding of community services. We identified a lack of coordination and consistency in several areas, including home visit assessments and the role of physician preceptors. The need for formal training to identify and treat elder abuse was also identified. Participation in a home visit program appears to be an effective learning experience for residents, and helps residents to understand the needs of older people living in the community.