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4.
Br J Hosp Med (Lond) ; 83(4): 1-7, 2022 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-35506719

RESUMO

BACKGROUND/AIMS: Most international medical graduates obtain a non-training job, such as a trust grade role, when they first start work in the UK. This transition into a new healthcare system comes with many sociocultural and educational challenges. The aim of this study was to learn more about the different types of challenges and propose solutions where possible. METHOD: Qualitative data from a cohort of current or previous trust grade international medical graduates were collected at a UK teaching hospital. This was achieved through the use of questionnaires, interviews and obtaining views through a monthly forum meeting. RESULTS: Findings showed that participants lacked insight into the system and lacked clarity in relation to the role of a supervisor, career pathways, and medicolegal and ethical issues. Discrepancies in study budgets and study leave days, compared to those available to doctors in trainee posts was another issue that was raised. Communication in complex clinical scenarios was also reported to be an issue for many participants. Suggested solutions included a tailored online induction for international medical graduates in trust grade roles and a setting up a buddy system with existing or previous trust grade doctors. CONCLUSIONS: This study highlighted the challenges faced by international medical graduates in trust grade roles and proposed solutions where possible. Although responses varied, educational barriers were the most widely highlighted concern. To understand the full extent of these hurdles, perceptions of other healthcare professionals should be explored.


Assuntos
Médicos Graduados Estrangeiros , Confiança , Competência Clínica , Educação de Pós-Graduação em Medicina , Humanos , Reino Unido
5.
Hist Psychiatry ; 33(2): 163-179, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35588212

RESUMO

Graduates from foreign medical schools (FMGs) began to staff US state psychiatric hospitals after World War II, and became increasingly associated with the poor quality of those institutions. Public and professional commentary on FMGs criticized their skills and suitability for the US healthcare system in the 1970s, at the same time that state hospitals were under increasing attack. By the 1980s and 1990s, the association between international medical graduates (as they became known) and underserved populations became an argument in favour of easing restrictions on these graduates. The role of foreign-trained psychiatrists in the US public sector became a way for American psychiatry leaders to manage the problems of the seriously mentally ill, first with blame and then with neglect.


Assuntos
Médicos Graduados Estrangeiros , Psiquiatria , Hospitais Psiquiátricos , Hospitais Estaduais , Humanos , Estados Unidos
8.
JSLS ; 26(1)2022.
Artigo em Inglês | MEDLINE | ID: mdl-35444402

RESUMO

Background: International Medical Graduates (IMGs) are an important component of the US healthcare workforce. Prior studies have investigated bias against IMGs during the general surgery residency application in the United States. Minimally invasive surgery (MIS) is a growing field; The MIS fellowship match was established in 2004 and is a competitive process with a match rate of 47%. Opportunities for applicants who are non-US citizens are limited by a series of factors that are not related to their professional qualifications. Objectives: The aim of the study was to explore the challenges faced by IMG in the MIS fellowship match. Methods: This is a cross-sectional study analyzing the minimally invasive surgery application requirements of all the programs listed in the Fellowship Council. Individual program requirements were collected into a database and a descriptive analysis was performed comparing programs who accept IMGs versus those that do not. Further statistical analysis was performed to explore those differences and associated factors. Results: There were 148 MIS fellowship programs and 187 positions offered during the 2021 match year in the US. Ninety-seven programs (65.5%) were found to accept graduates of foreign medical schools if they were US-citizens, whereas only 49 programs (33.1%) were found to accept IMG and sponsor a visa for their training. University affiliated programs (88.9% vs 75.0%, p = 0.04), programs with a general surgery residency (94.4% vs 75.0%, p = 0.003), and older programs (63.0% vs 45.5%, p = 0.04) were more likely to accept IMGs requiring visa sponsorship. Conclusions: There is a significant bias against IMGs in the MIS fellowship match, with a reduced number of positions available based on factors not related to their professional performance or qualifications. Well established programs, university, and residency affiliated programs are more likely to consider these physicians for training.


Assuntos
Médicos Graduados Estrangeiros , Internato e Residência , Estudos Transversais , Educação de Pós-Graduação em Medicina , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Estados Unidos
9.
Acad Psychiatry ; 46(4): 428-434, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35486365

RESUMO

OBJECTIVE: This study describes the supply, distribution, and characteristics of international medical graduate (IMG) psychiatrists who provide services in the USA. METHODS: Cross-sectional study design, using descriptive statistics based on combined data from the American Medical Association (2020 Physician Masterfile) and the Educational Commission for Foreign Medical Graduates. RESULTS: International medical graduates continue to make significant contributions to the US physician workforce. As a group, they represent 29% of active psychiatrists in the USA, compared to 23% in all other medical specialties. Many IMG psychiatrists were US citizens who obtained their medical degrees outside the USA or Canada, often in the Caribbean. In some states (i.e., Florida, New Jersey), over 40% of active psychiatrists are IMGs. Over 30% of IMG psychiatrists graduated from medical schools in India and Pakistan. CONCLUSIONS: This study provides an overview of the psychiatric workforce in the USA, quantifying the specific contribution of IMGs. Several factors, including immigration policies, continued expansion of US medical schools, and the number of available residency positions, could impact the flow of IMGs to the US. Longitudinal studies are needed to better understand the implications for workforce composition and distribution, and their potential impact on the care of psychiatric patients.


Assuntos
Internato e Residência , Médicos , Psiquiatria , Estudos Transversais , Médicos Graduados Estrangeiros , Humanos , Estados Unidos , Recursos Humanos
10.
Minerva Surg ; 77(4): 341-347, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35230032

RESUMO

BACKGROUND: International medical graduates (IMGs) have been a critical part of the USA healthcare in the past 30 years, especially in small rural and poor counties. However, little to no publications are present on the distribution of these IMGs across general surgery residency programs. METHODS: All freely accessible information on current residents in accredited general surgery residency programs within the USA with at least a 5-year history was explored for IMGs in the current roster using the AMA residency and fellowship database in 2020. Demographic and geographic data were summarized. RESULTS: A total of 230 general surgery residency program were included. Programs were distributed among 46 (92%) states. Of a total 6304 categorical general surgery residents, 573 (9%) were IMGs. Florida (USA) had the highest total number of current IMG general surgery residents with 64. The highest percentage of current IMG residents was found in Maryland (USA) with 31%. IMGs obtained their medical degrees from 76 different countries worldwide. Grenada was the country with the highest origin of IMGs with 77 residents. Central/North America had the highest origin of IMGs with 217 (38%). CONCLUSIONS: IMGs make up a small portion of current general surgery residents in USA programs. Some states host more IMGs than others. Particular countries have contributed more IMGs than others. More research is needed to the challenges facing IMGs and come up with novel solutions for them.


Assuntos
Médicos Graduados Estrangeiros , Internato e Residência , Competência Clínica , Estudos Transversais , Avaliação Educacional , Humanos
11.
Artigo em Inglês | MEDLINE | ID: mdl-35329418

RESUMO

Taiwanese students who graduated from Polish medical schools (P-IMGs) accounted for the second-largest group of international medical graduates in Taiwan. In 2009, domestic medical students in Taiwan staged mass demonstrations against P-IMG's exemption from the qualifying test before the licensing exam. Although medical circles in Taiwan might still hold prejudices against P-IMGs, little is known about their career development. This study will analyze P-IMGs' choices of specialties and training sites from 2000 to 2020 using data from the membership section of the Taiwan Medical Journal, the monthly official publication of the Taiwan Medical Association. Of 372 P-IMGs, 34.2% chose internal medicine and 17.1% surgery. Although academic medical centers offered 76% of all available trainee positions in a year, only 49.3% of P-IMGs received training there. By contrast, 20.9% of P-IMGs were trained at nonmetropolitan hospitals that altogether accounted for only 5.8% of trainee positions. In conclusion, P-IMGs had their residency training at less favorable specialties and sites. Their long-term career development deserves further study.


Assuntos
Médicos , Faculdades de Medicina , Médicos Graduados Estrangeiros , Humanos , Medicina Interna/educação , Polônia
13.
Hum Resour Health ; 20(1): 15, 2022 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-35120549

RESUMO

BACKGROUND: Return-of-service (ROS) agreements require international medical graduates (IMGs) who accept medical residency positions in Canada to practice in specified geographic areas following completion of training. However, few studies have examined how ROS agreements influence career decisions. We examined IMG resident and early-career family physicians' perceptions of the residency matching process, ROS requirements, and how these factors shaped their early career decisions. METHODS: As part of a larger project, we conducted semi-structured qualitative interviews with early-career family physicians and family medicine residents in British Columbia, Ontario and Nova Scotia. We asked participants about their actual or intended practice characteristics (e.g., payment model, practice location) and factors shaping actual or intended practice (e.g., personal/professional influences, training experiences, policy environments). Interviews were transcribed verbatim and a thematic analysis approach was employed to identify recurring patterns and themes. RESULTS: For this study, we examined interview data from nine residents and 15 early-career physicians with ROS agreements. We identified three themes: IMGs strategically chose family medicine to increase the likelihood of obtaining a residency position; ROS agreements limited career choices; and ROS agreements delayed preferred practice choice (e.g., scope of practice and location) of an IMGs' early-career practice. CONCLUSIONS: The obligatory nature of ROS agreements influences IMG early-career choices, as they necessitate strategically tailoring practice intentions towards available residency positions. Existing analyses of IMGs' early-career practice choices neglect to distinguish between ROS and practice choices made independently of ROS requirements. Further research is needed to understand how ROS influences longer term practice patterns of IMGs in Canada.


Assuntos
Internato e Residência , Colúmbia Britânica , Canadá , Escolha da Profissão , Medicina de Família e Comunidade/educação , Médicos Graduados Estrangeiros , Humanos
15.
Arch Dermatol Res ; 314(8): 799-803, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35212769

RESUMO

International medical graduates (IMGs) comprise a quarter of the United States (US) physician workforce but are a diminishing minority among dermatologists. Studies on IMGs in other specialties have demonstrated their importance in addressing provider shortage in rural and medically underserved areas (MUAs), but this trend has not been systematically explored within dermatology. This study aims to assess the state-by-state distribution of IMG dermatologists in the US as compared to US medical graduates (USMGs) with focus on provider density in rural settings and MUAs. A national cross-sectional study was performed on actively practicing dermatologists who submitted Medicare claims within 1 year of July 2020; rural and MUA-serving status were determined based on federally designated rural-urban Continuum Codes and Census Bureau data. Nationally, the density of dermatologists has increased from 3.4 per 100,000 persons in 2016 to 3.66 per 100,000 persons in 2020. However, 70% of US states continue to have fewer than 4 dermatologists per 100,000 persons, the estimated minimum necessary to adequately care for a population. Among 12,009 dermatologists, only 576 (4.8%) are IMGs, with disparate distribution across the US: Kansas has the greatest percentage of IMGs with the latter comprising 8.3% of its state dermatology workforce, whereas 8 states have no IMGs. Notably, a significantly greater percentage of IMG dermatologists (43.9%) work in areas designated as MUAs compared to USMGs (37.4%) (P < 0.01). In contrast, a lower percentage of IMG dermatologists (2.8%) work in rural settings compared to USMGs (4.8%) (P = 0.03). Interestingly, no significant difference was observed when rural dermatologists were further stratified by MUA-serving status. These findings corroborate the importance of IMGs in providing greater access to dermatological care in areas with healthcare provider shortage. Further studies on the underlying causes of the decline of IMGs within dermatology are needed.


Assuntos
Médicos Graduados Estrangeiros , Área Carente de Assistência Médica , Idoso , Estudos Transversais , Dermatologistas , Humanos , Medicare , Estados Unidos
16.
Med Care Res Rev ; 79(5): 717-730, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35114836

RESUMO

More than a quarter of physicians in the United States are international medical graduates (IMGs). This statistic, although large, does not fully capture the importance of IMGs in certain specialties and locations. We provide a comprehensive profile of IMGs documenting where and in what specialties they work and how these distributions have changed over time. Estimates show that IMGs disproportionately work in densely populated, low-income communities with sicker residents and low physician density. IMGs are overrepresented in primary care and the lowest paying specialties, and their concentration in these specialties is growing. Calculations show that U.S. medical graduates exit the workforce at 2.5 times the exit rate of IMGs suggesting that in the near future IMGs will likely provide care for an increasingly larger share of Americans.


Assuntos
Medicina , Médicos , Médicos Graduados Estrangeiros , Humanos , Estados Unidos , Recursos Humanos
17.
BMC Med Educ ; 22(1): 36, 2022 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-35031043

RESUMO

BACKGROUND: Accreditation systems strive to ensure the quality of undergraduate (basic) medical education and encourage ongoing improvements. Despite increasing global emphasis on quality assurance activities, there is limited research linking accreditation of medical education to improved student and graduate outcomes. The purpose of this study is to compare the United States Medical Licensing Examination® (USMLE®) performance of students and graduates who attended international medical schools accredited by an agency recognized by the World Federation of Medical Education (WFME) to individuals who attended schools that did not meet this criterion. METHODS: During the 2018-2020 study period, 39,650 individuals seeking Educational Commission for Foreign Medical Graduates® (ECFMG®) certification took one or more USMLE examinations. We cross-tabulated USMLE performance (first-attempt pass/fail result) and medical school accreditation status. RESULTS: Individuals seeking ECFMG certification who attended international medical schools accredited by an agency recognized by WFME had higher or comparable USMLE first-attempt pass rates compared to individuals who attended medical schools that did not meet this criterion. CONCLUSIONS: Implementing and maintaining meaningful accreditation systems requires substantial resources. These results provide important positive evidence that external evaluation of educational programs is associated, on average, with better educational outcomes, including in the domains of basic science, clinical knowledge, and clinical skills performance.


Assuntos
Acreditação , Faculdades de Medicina , Certificação , Avaliação Educacional , Médicos Graduados Estrangeiros , Humanos , Licenciamento em Medicina , Estados Unidos
18.
Sociol Health Illn ; 44(3): 535-565, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35098550

RESUMO

Although research finds that international medical graduates (IMGs) fill gaps in US health care left by US medical graduates (USMGs), the extent to which IMGs' career outcomes are stratified along the lines of their country of medical education remains understudied. Using data from the 2019 American Medical Association Physician Masterfile (n = 19,985), I find IMGs from developed countries chart less marginalised paths in their US careers relative to IMGs from developing countries; they are more likely to practise in more competitive and popular medical specialities; to attend prestigious residency programmes; and to practise in less disadvantaged counties that employ more USMGs relative to IMGs. These findings suggest IMGs experience divergent outcomes in the United States based on their place of medical education, with IMGs from developing countries experiencing more constraints in their careers relative to IMGs from developed countries. This understudied axis of stratification in medicine has important implications for our understanding of how nativism and racism may intersect to generate inequalities in the medical profession and in US health care more broadly.


Assuntos
Internato e Residência , Médicos , Médicos Graduados Estrangeiros , Humanos , Estados Unidos
19.
Acad Med ; 97(3): 420-425, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34524136

RESUMO

PURPOSE: International medical graduates (IMGs), approximately 25% of the U.S. physician workforce, have unique needs as they enter residency programs. This study identified wellness barriers and challenges that IMGs encounter as they transition to the United States. METHOD: The authors analyzed results from 3 open-ended questions in a 21-item survey. This survey was administered in December 2019 to 11,504 IMG resident physicians sponsored by the Educational Commission for Foreign Medical Graduates' J-1 visa program. These questions asked respondents to describe challenges to their wellness, how they maintain wellness, and resources that would have aided their transition. Data were analyzed using a mixed-methods approach, including both qualitative descriptions and category frequencies. RESULTS: Of the surveys administered, 7,817 responses (68% response rate) were received. Respondents identified challenges navigating cultural differences (1,314, 17%), health care system (1,108, 14%), distance from family and friends (890, 11%), bureaucratic barriers (724, 9%), and language/communication and finances (575, 7%; 565, 7%, respectively). They also specified that friendships/relationships (2,800, 36%) followed by exercise (2,318, 30%), family (1,822, 23%), socialization (1,001, 13%), and healthy eating (775, 10%) were factors important to their wellness. Respondents requested more information about socialization (741, 9%), bureaucratic support (456, 6%), IMG support networks (427, 5%), financial support (404, 5%), and greater online resources (240, 3%). CONCLUSIONS: IMGs have needs and concerns specific to their demographic group. Participants' responses suggested that they wanted additional support in the workplace and their personal lives. Answers also indicated that IMGs experienced a unique set of stressors such as fluctuating immigration laws that U.S. medical graduates do not face. Finally, this study supports a body of research that connects social and physical wellness. By identifying and describing these challenges, the authors seek to inform the development of specific programs and resources to improve IMG resident wellness.


Assuntos
Internato e Residência , Médicos , Comunicação , Emigração e Imigração , Médicos Graduados Estrangeiros , Humanos , Estados Unidos
20.
Med Educ ; 56(5): 504-515, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-34859484

RESUMO

INTRODUCTION: International medical graduates (IMGs) represent a large portion of practising doctors in many countries. Many experience difficulties, including higher rates of complaints against them and lower exam pass rates. The UK's General Medical Council (GMC) recently set targets to 'eliminate disproportionate complaints' and 'eradicate disadvantage and discrimination in medical education'. Our timely meta-ethnography aimed to synthesise existing qualitative literature on the wider personal and professional experiences of IMGs to identify factors affecting IMGs' professional practice (either directly or indirectly). METHODS: In September 2019, we systematically searched Medline, Embase, Cochrane, PsycINFO, ERIC and EdResearch for peer-reviewed qualitative and mixed-methods articles that described experiences of IMGs. We extracted participant quotes and authors' themes from included articles and used the technique of meta-ethnography to synthesise the data and develop new overarching concepts. RESULTS: Of the 1613 articles identified, 57 met our inclusion criteria. In total, the articles corresponded to 46 studies that described the experiences of 1142 IMGs practising in all six continents in a range of settings, including primary and secondary care. We developed five key concepts: migration dimensions (issues considered by IMGs when migrating), a challenging start (the stressful early period), degree of dissonance (between the IMG and host country in relation to the four main barriers of language, culture, medical education and belonging), levelling the playing field (interventions to reduce the impact of the barriers) and survive then thrive (adjustments IMGs made). A conceptual model that brings these constructs together in a line of argument is presented. CONCLUSIONS: This meta-ethnography, based on a large amount of diverse qualitative studies, is the first to provide a comprehensive picture of the experiences and challenges that IMGs face before and after migration. Our results should be used to guide the development of interventions aiming to support IMGs and meet the GMC targets.


Assuntos
Médicos Graduados Estrangeiros , Médicos , Antropologia Cultural , Humanos , Pesquisa Qualitativa
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