Psychiatric residents' attitudes toward and experiences with the clinical-skills verification process: a pilot study on U.S. and international medical graduates.

OBJECTIVE: The authors report on a pilot study of the experiences and perceptions of foreign international medical graduate (F-IMG), United States international medical graduate (US-IMG), and United States medical graduate (USMG) psychiatric residents with the newly mandated Clinical Skills Verification (CSV) process. The goal was to identify and suggest remedies to any problems with the implementation of CSV in order to facilitate its success as an evaluation tool with all the three groups of residents. METHOD: The authors designed a 51-item survey questionnaire to gather demographic data and information about three principal content areas: 1) views on the effectiveness of the program; 2) the assessment experience; and 3) evaluation and feedback. A link to the survey was e-mailed to the directors of nine general-psychiatry residency programs in the United States with a request to forward it to the residents. The data were collected from February 2010 through March 2010. RESULTS: Sixty-three general-psychiatry residents (51.2% of 123 eligible residents) from nine selected programs completed the entire survey. Both IMG and USMG residents felt that the CSV was helpful in improving their clinical skills. Both groups of IMG residents, in contrast to their USMG counterparts, wanted more supervised interviews and were more likely to experience feedback as excessively negative and critical. In comparison to USMGs and US-IMGs, F-IMGs were less comfortable conducting an observed interview. They also had had less exposure to and experience with the CSV processes before their residency. CONCLUSIONS: Most residents reported positive experiences with the CSV. The survey also revealed notable commonalities and differences between IMG and USMG residents in their experiences and perceptions of the CSV process, mostly related to their cultural and medical school backgrounds. Authors recommend that residency programs take definitive steps toward addressing the unique needs of these groups of residents.

A roadmap for observership programs in psychiatry for international medical graduates.

OBJECTIVE: International medical graduates (IMGs) constitute a significant proportion of the psychiatric workforce in the United States. Observership programs serve an important role in preparing IMGs for U.S. residency positions; yet there are limited resources with information available on establishing these observerships, and none specific to psychiatry. In this article, authors present a roadmap for observership programs in psychiatry for IMGs. METHOD: This article draws on the experience of the IMG committee of the Group for Advancement of Psychiatry in establishing observership programs. RESULTS: Authors highlight the benefits of observership programs to IMGs, psychiatry departments, and the U.S. medical system as a whole. The different components of an observership program are presented, along with core competencies that need to be acquired. The authors discuss challenges that observership programs may encounter as well as recommendations for overcoming them. CONCLUSION: Observership programs provide a unique opportunity to integrate IMGs into the U.S. medical system. This article provides a framework for establishing such programs in a way that will optimize their benefits and avoid potential pitfalls.

Indian medical students' views on immigration for training and practice.

PURPOSE: To assess the attitudes of medical students in India about participating in graduate medical education in the United States and other countries and in subsequent clinical practice in those countries. METHOD: A total of 240 students who were attending their final year at two medical schools in Bangalore, India, were surveyed during 2004. Surveys were completed by 166 (69%) of the students. RESULTS: Among the responding students, 98 (59%) thought of leaving India for further training abroad. Of those who wished to leave, 41 (42%) preferred the United States, 42 (43%) preferred the United Kingdom, and 9 (9%) preferred Canada, Australia or New Zealand. Only two students preferred the Middle East. Most who favored training in the United States indicated that they intended to remain after training, whereas fewer than 20% of those who favored training in the United Kingdom had such intentions. While more than 60% perceived greater professional opportunities in the United States than in India, approximately 75% were concerned that the United States had become less welcoming after the terrorist attacks of 9/11, and similar numbers were concerned about the examination administered by the Educational Commission on Foreign Medical Graduates. Conversely, the majority of respondents felt that opportunities for physicians in India were improving. CONCLUSIONS: While optimism about future medical careers in India is increasing, the interest of Indian medical students in training and subsequently practicing in the United States remains high.

International medical graduates in child and adolescent psychiatry: adaptation, training, and contributions.

This article reviews, consolidates, and enhances current knowledge about the issues and problems child and adolescent psychiatry international medical graduates face. Their training, work force issues, and establishment and advancement of professional identity are presented. Acculturation and immigration dynamics include facing prejudice and discrimination, social mirroring, and difficulties with language. Treatment issues are discussed with a special focus on therapeutic alliance, resistance, transference, countertransference, and child rearing practices. Recommendations for training and future goals are considered.

Recent trends in psychiatry residency workforce with special reference to international medical graduates.

OBJECTIVE: This study examines trends in the supply, distribution, and demographics of psychiatry residents during the 1990s. It evaluates the extent to which the predicted downsizing of psychiatry residency training programs actually occurred and how it affected training programs of different sizes and locations. METHOD: Data for this study were obtained from the American Medical Association's (AMA) Annual Survey of Graduate Medical Education (GME) Programs, the AMA GME directory, and the APA Graduate Medical Census. The study compares the roles played by international medical graduates (IMGs) in contrast to U.S. medical graduates (USMGs) in these trends. RESULTS: There was a significant decline in the number of residents during the years studied. The median training program size also decreased. International medical graduates found broad acceptance in training programs of all locations and sizes, including medical school based programs. Implications of the findings are discussed regarding the impact of current graduate medical education (GME) and immigration policies on future workforce patterns. CONCLUSION: The field will have to decide whether it can afford anymore residency downsizing in light of emerging evidence of a shortage of psychiatrists.