Advertisement

Advances in Health Sciences Education

, Volume 24, Issue 1, pp 103–123 | Cite as

Moving beyond orientations: a multiple case study of the residency experiences of Canadian-born and immigrant international medical graduates

  • Umberin NajeebEmail author
  • Brian Wong
  • Elisa Hollenberg
  • Lynfa Stroud
  • Susan Edwards
  • Ayelet Kuper
Article

Abstract

Many international medical graduates (IMGs) enter North American residency programs every year. The Canadian IMG physician pool increasingly includes Canadian-born IMGs (C-IMGs) along with Immigrant-IMGs (I-IMGs). Similar trends exist in the United States. Our objective was to understand the similarities and differences in the challenges faced by both I-IMGs and C-IMGs during residency to identify actionable recommendations to support them during this critical time. We performed a multiple case study of IMGs’ experiences at a large Canadian university. Within our two descriptive cases (I-IMGs, C-IMGs) we iteratively conducted twenty-two semi-structured interviews; we thematically analyzed our data within, between, and across both cases to understand challenges to IMGs’ integration and opportunities for curricular innovations to facilitate their adaptation process. Research team members with different perspectives contributed reflexively to the thematic analysis. Participants identified key differences between medical culture and knowledge expected in Canada and the health systems and curricula in which they originally trained. I-IMG and C-IMG participants perceived two major challenges: discrimination because of negative labelling as IMGs and difficulties navigating their initial residency months. C-IMGs described a third challenge: frustration around the focus on the needs of I-IMGs. Participants from both groups identified two major opportunities: their desire to help other IMGs and a need for mentorship. I-IMGs and C-IMGs face diverse challenges during their training, including disorientation and discrimination. We identified specific objectives to inform the design of curriculum and support services that residency programs can offer trainees as well as important targets for resident education and faculty development.

Keywords

IMGs Residency Curriculum Disorientation Adaptation 

Notes

Funding

University of Toronto Faculty of Medicine’s Education Development Fund.

Compliance with ethical standards

Conflict of interest

Authors declare no conflict of interest, including any financial interests and/or relationships or affiliations relevant to the subject of this manuscript.

Ethics approval

University of Toronto Research and Ethics Board approved this study.

References

  1. Alam, A., Matelski, J. J., Goldberg, H. R., Liu, J. J., Klemensberg, J., et al. (2017). The characteristics of international medical graduates who have been disciplined by professional regulatory colleges in Canada: A retrospective cohort study. Academic Medicine, 92(2), 244–249.  https://doi.org/10.1097/acm.0000000000001356.Google Scholar
  2. Anderson, J., Perry, J., Blue, C., Browne, A., Henderson, A., et al. (2003). “Writing” cultural safety within the postcolonial and postnational feminist project: Toward new epistemologies of healing. Advances in Nursing Science, 26(3), 196–214.Google Scholar
  3. Are, C., Stoddard, H., Carpenter, L. A., O’Holleran, B., & Thompson, J. S. (2017). Trends in the match rate and composition of candidates matching into categorical general surgery residency positions in the United States. American Journal of Surgery, 213(1), 187–194.  https://doi.org/10.1016/j.amjsurg.2016.03.015.Google Scholar
  4. Baker, D., & Robson, J. (2012). Communication training for international graduates. The Clinical Teacher, 9(5), 325–329.  https://doi.org/10.1111/j.1743-498X.2012.00555.x.Google Scholar
  5. Barer, M. L., Evans, R. G., & Hedden, L. (2014). Two wings and a prayer: Should Canada make it easier for Canadian doctors trained abroad to enter practice here? Health Policy, 9(4), 12–19.Google Scholar
  6. Bates, J., & Andrew, R. (2001). Untangling the roots of some IMG’s poor academic performance. Academic Medicine, 76(1), 43–46.Google Scholar
  7. Baxter, P., & Jack, S. (2008). Qualitative case study methodology: Study design and implementation for novice researchers. The Qualitative Report, 13(4), 544–559.Google Scholar
  8. Bleakley, A. (2013). Gender matters in medical education. Medical Education, 47(1), 59–70.  https://doi.org/10.1111/j.1365-2923.2012.04351.x.Google Scholar
  9. Boulet, J. R., Cooper, R. A., Seeling, S. S., Norcini, J. J., & McKinley, D. W. (2009). U.S. citizens who obtain their medical degrees abroad: An overview, 1992–2006. Health Affairs (Millwood), 28(1), 226–233.  https://doi.org/10.1377/hlthaff.28.1.226.Google Scholar
  10. Boulet, J. R., Norcini, J. J., Whelan, G. P., Hallock, J. A., & Seeling, S. S. (2006a). The international medical graduate pipeline: Recent trends in certification and residency training. Health Affairs (Millwood), 25(2), 469–477.  https://doi.org/10.1377/hlthaff.25.2.469.Google Scholar
  11. Boulet, J. R., Swanson, D. B., Cooper, R. A., Norcini, J. J., & McKinley, D. W. (2006b). A comparison of the characteristics and examination performances of U.S. and non-U.S. citizen international medical graduates who sought Educational Commission for Foreign Medical Graduates certification: 1995–2004. Academic Medicine, 81(10 Suppl), S116–S119.Google Scholar
  12. Braun, V., & Clarke, C. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.Google Scholar
  13. Brotherton, S. E., & Etzel, S. I. (2016). Graduate medical education, 2015–2016. JAMA, 316(21), 2291–2310.  https://doi.org/10.1001/jama.2016.13513.Google Scholar
  14. CAPER. (2014–2015). Canadian post MD education registry provincial reports 2014–2015: University of Toronto Faculty Report. Retrieved March 12th, 2018 from http://www.caper.ca/~assets/pdf_2014FacultyReport_TOR.pdf.
  15. CAPER. (2016). Canadian post-MD education registry: Re-established national IMG database. Retrieved March 12th, 2018, from https://caper.ca/~assets/documents/2016-05-Re-establishedNationalIMGDatabase.pdf.
  16. CAPER. (2017). Canadian post-MD education registry: The national IMG database report. Retrieved March 12th, 2018, from https://caper.ca/~assets/documents/2017_CAPER_National_IMG_Database_Report.pdf.
  17. CaRMS. (2010). Canadian resident matching services: Report on Canadian studying medicine abroad. Retrieved March 12th, 2018, from http://www.carms.ca/assets/upload/pdfs/2010_CSA_Report/CaRMS_2010_CSA_Report.pdf.
  18. Cavett, T. (2015). The stigmatization of internationally educated family medicine residents. Dissertation, University of Manitoba. Retrieved March 12th, 2018, from https://mspace.lib.umanitoba.ca/bitstream/handle/1993/30375/Cavett_Teresa.pdf?sequence=3.
  19. CFMS. (2015). Canadian federation of medical students—Backgrounder: International Medical Graduates and Canadian Health Care System. Retrieved March 12th, 2018, from http://www.old.cfms.org/attachments/article/1370/BACKGROUNDER%20-%20IMGs%20AND%20THE%20CANADIAN%20HEALTHCARE%20SYSTEM.pdf.
  20. Chen, P. G., Curry, L. A., Bernheim, S. M., Berg, D., & Gozu, A. (2011). Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training. Academic Medicine, 86(11), 1383–1388.  https://doi.org/10.1097/ACM.0b013e31823035e1.Google Scholar
  21. Chen, P. G., Nunez-Smith, M., Bernheim, S. M., Berg, D., Gozu, A., et al. (2010). Professional experiences of international medical graduates practicing primary care in the United States. Journal of General Internal Medicine, 25(9), 947–953.  https://doi.org/10.1007/s11606-010-1401-2.Google Scholar
  22. Coombs, A. A., & King, R. K. (2005). Workplace discrimination: Experiences of practicing physicians. Journal of the National Medical Association, 97(4), 467–477.Google Scholar
  23. Crutcher, R. A., Banner, S. R., Szafran, O., & Watanabe, M. (2003). Characteristics of international medical graduates who applied to the CaRMS 2002 match. CMAJ, 168(9), 1119–1123.Google Scholar
  24. Curran, V., Hollett, A., Hann, S., & Bradbury, C. (2008). A qualitative study of the international medical graduate and the orientation process. Canadian Journal of Rural Medicine, 13(4), 163–169.Google Scholar
  25. Dahm, M. R., Yates, L., Ogden, K., Rooney, K., & Sheldon, B. (2015). Enhancing international medical graduates’ communication: The contribution of applied linguistics. Medical Education, 49(8), 828–837.  https://doi.org/10.1111/medu.12776.Google Scholar
  26. DiCicco-Bloom, B., & Crabtree, B. F. (2006). The qualitative research interview. Medical Education, 40(4), 314–321.  https://doi.org/10.1111/j.1365-2929.2006.02418.x.Google Scholar
  27. ECFMG Reporter. (2017). For IMGs pursuing career in medicine. IMG performance in the 2017 Match. ECFMG reporter, 268. Retrieved March 12th, 2018 from https://www.ecfmg.org/reporter/issue268.html.
  28. ECFMG. (2014). Education Commission for Foreign Medical Graduates (ECFMG) 2014 annual report. Retrieved March 12th, 2018, from https://www.yumpu.com/en/document/view/38343332/ecfmg-2014-annual-report.
  29. ECFMG. (2015). Educational Commission for Foreign Medical Graduates 2015 annual report. Retrieved March 9, 2018, from https://www.ecfmg.org/resources/ECFMG-2015-annual-report.pdf.
  30. Eckhert, N. L., & Van Zanten, M. (2015). U.S.-citizen international medical graduates—A boon for the workforce? New England Journal of Medicine, 372(18), 1686–1687.  https://doi.org/10.1056/NEJMp1415239.Google Scholar
  31. Eisen, S., Sukhani, S., Brightwell, A., Stoneham, S., & Long, A. (2014). Peer mentoring: Evaluation of a novel programme in paediatrics. Archives of Disease in Childhood, 99(2), 142–146.  https://doi.org/10.1136/archdischild-2013-304277.Google Scholar
  32. FAIMER. (2010). Foundations for advancement of international medical education and research (FAIMER). United States Physicians Work Force Issues. Retrieved March 12th, 2018, from http://www.faimer.org/research/workforce.html.
  33. FAIMER. (2017). Foundation for advancement of international medical education and research short report: International medical graduates to United States health workforce. Retrieved March 12th, 2018, from https://www.faimer.org/research/faimer-short-report-workforce.pdf.
  34. Fink, K. S., Phillips, R. L., Jr., Fryer, G. E., & Koehn, N. (2003). International medical graduates and the primary care workforce for rural underserved areas. Health Affairs (Millwood), 22(2), 255–262.Google Scholar
  35. Fleming, G. M., Simmons, J. H., Xu, M., Gesell, S. B., & Brown, R. F. (2015). A facilitated peer mentoring program for junior faculty to promote professional development and peer networking. Academic Medicine, 90(6), 819–826.  https://doi.org/10.1097/acm.0000000000000705.Google Scholar
  36. FMEC. (2012). Future of medical education in Canada: A collective vision for postgraduate medical education in Canada 2012 report. Retrieved August 5, 2017, from https://www.afmc.ca/future-of-medical-education-in-canada/postgraduate-project/pdf/FMEC_PG_Final-Report_EN.pdf.
  37. Goldberg, E. (2016). Training international medical graduate clinical fellows: The challenges and opportunities for adolescent medicine programs. International Journal of Adolescent Medicine and Health, 28(3), 291–295.  https://doi.org/10.1515/ijamh-2016-5012.Google Scholar
  38. Goldszmidt, M., Kortas, C., & Meehan, S. (2007). Advanced medical communications: Support for international residents. Medical Education, 41(5), 522.  https://doi.org/10.1111/j.1365-2929.2007.02751.x.Google Scholar
  39. Hall, P., Keely, E., Dojeiji, S., Byszewski, A., & Marks, M. (2004). Communication skills, cultural challenges and individual support: Challenges of international medical graduates in a Canadian healthcare environment. Medical Teacher, 26(2), 120–125.  https://doi.org/10.1080/01421590310001653982.Google Scholar
  40. Hamarneh, A. (2015). Lack of language skills and knowledge of local culture in international medical graduates: Implications for the NHS. Hospital Practice (1995), 43(4), 208–211.Google Scholar
  41. Hamoda, H. M., Sacks, D., Sciolla, A., Dewan, M., Fernandez, A., et al. (2012). A roadmap for observership programs in psychiatry for international medical graduates. Academic Psychiatry, 36(4), 300–306.Google Scholar
  42. Harris, A., & Delany, C. (2013). International medical graduates in transition. Clinical Teacher, 10(5), 328–332.  https://doi.org/10.1111/tct.12021.Google Scholar
  43. Hashim, A. (2017). Educational challenges faced by international medical graduates in the UK. Advances in Medical Education and Practice, 8, 441–445.  https://doi.org/10.2147/amep.S126859.Google Scholar
  44. Hatzidimitriadou, E., & Psoinos, M. (2014). Cultural health capital and professional experiences of overseas doctors and nurses in the UK. Diversity and Equality in Health and Care, 11(1), 35–47.Google Scholar
  45. Hooks, B. (1981). Ain’t I a woman: Black women and feminism. Boston: South End Press.Google Scholar
  46. Huang, A. (2000). Continuing controversy over the international medical graduate. JAMA, 283(13), 1746.Google Scholar
  47. Kalra, G., Bhugra, D. K., & Shah, N. (2012). Identifying and addressing stresses in international medical graduates. Academic Psychiatry, 36(4), 323–329.  https://doi.org/10.1176/appi.ap.11040085.Google Scholar
  48. Kant, J. A. (2001). A tale of two systems: Pathology resident recruitment in and out of the National Resident Matching Program. Human Pathology, 32(7), 677–679.  https://doi.org/10.1053/hupa.2001.26314.Google Scholar
  49. Kehoe, A., McLachlan, J., Metcalf, J., Forrest, S., Carter, M., et al. (2016). Supporting international medical graduates’ transition to their host-country: Realist synthesis. Medical Education, 50(10), 1015–1032.  https://doi.org/10.1111/medu.13071.Google Scholar
  50. Ko, D. T., Austin, P. C., Chan, B. T., & Tu, J. V. (2005). Quality of care of international and Canadian medical graduates in acute myocardial infarction. Archives of Internal Medicine, 165(4), 458–463.  https://doi.org/10.1001/archinte.165.4.458.Google Scholar
  51. Kumagai, A. K., & Lypson, M. L. (2009). Beyond cultural competence: Critical consciousness, social justice, and multicultural education. Academic Medicine, 84(6), 782–787.  https://doi.org/10.1097/ACM.0b013e3181a42398.Google Scholar
  52. Kuper, A. (2016). When I say… equity. Medical Education, 50(3), 283–284.  https://doi.org/10.1111/medu.12954.Google Scholar
  53. Kuper, A., Lingard, L., & Levinson, W. (2008a). Critically appraising qualitative research. BMJ, 337, a1035.  https://doi.org/10.1136/bmj.a1035.Google Scholar
  54. Kuper, A., Reeves, S., & Levinson, W. (2008b). An introduction to reading and appraising qualitative research. BMJ, 337, a288.  https://doi.org/10.1136/bmj.a288.Google Scholar
  55. Kuper, A., Veinot, P., Leavitt, J., Levitt, S., Li, A., et al. (2017). Epistemology, culture, justice and power: Non-bioscientific knowledge for medical training. Medical Education, 51(2), 158–173.  https://doi.org/10.1111/medu.13115.Google Scholar
  56. Kuzel, A. (1999). Sampling in Qualitative inquiry. In B. F. Crabtree & W. L. Miller (Eds.), Doing qualitative research (p. 606). London: Sage.Google Scholar
  57. Kvale, S. (1996). InterViews: An introduction to qualitative research interviewing. Thousand Oaks: Sage.Google Scholar
  58. Kwong, W. (2014). More international grads seek residency. CMAJ, 186(11), E401–E402.  https://doi.org/10.1503/cmaj.109-4788.Google Scholar
  59. Laurence, C. O., Eley, D. S., Walters, L., Elliott, T., & Cloninger, C. R. (2016). Personality characteristics and attributes of international medical graduates in general practice training: Implications for supporting this valued Australian workforce. Australian Journal of Rural Health, 24(5), 333–339.  https://doi.org/10.1111/ajr.12273.Google Scholar
  60. Lillis, S., & Van Dyk, V. (2014). Workplace-based assessment for vocational registration of international medical graduates. Journal of Continuing Education in the Health Professions, 34(4), 260–264.  https://doi.org/10.1002/chp.21251.Google Scholar
  61. Lineberry, M., Osta, A., Barnes, M., Tas, V., Atchon, K., et al. (2015). Educational interventions for international medical graduates: A review and agenda. Medical Education, 49(9), 863–879.  https://doi.org/10.1111/medu.12766.Google Scholar
  62. Lockyer, J., Hofmeister, M., Crutcher, R., Klein, D., & Fidler, H. (2007). International medical graduates: Learning for practice in Alberta, Canada. Journal of Continuing Education in the Health Professions, 27(3), 157–163.  https://doi.org/10.1002/chp.119.Google Scholar
  63. Majeed, M. H., Ali, A. A., & Saeed, F. (2017). International medical graduates: From brain drain to potential gain. International Journal of Medical Education, 8, 37–38.  https://doi.org/10.5116/ijme.5869.008a.Google Scholar
  64. Malterud, K., Siersma, V. D., & Guassora, A. D. (2015). Sample size in qualitative interview studies: Guided by information power. Qualitative Health Research, 26(13), 1753–1760.  https://doi.org/10.1177/1049732315617444.Google Scholar
  65. Mathews, M., Kandar, R., Slade, S., Yi, Y., Beardall, S., et al. (2017). Examination outcomes and work locations of international medical graduate family medicine residents in Canada. Canadian Family Physician, 63(10), 776–783.Google Scholar
  66. McAvinue, M. B., Boulet, J. R., Kelly, W. C., Seeling, S. S., & Opalek, A. (2005). U.S. citizens who graduated from medical schools outside the United States and Canada and received certification from the Educational Commission for Foreign Medical Graduates, 1983–2002. Academic Medicine, 80(5), 473–478.Google Scholar
  67. McDonnell, L., & Usherwood, T. (2008). International medical graduates—Challenges faced in the Australian training program. Australian Family Physician, 37(6), 481–484.Google Scholar
  68. McGrath, P., Henderson, D., & Phillips, E. (2009). Integration into the Australian health care system—Insights from international medical graduates. Australian Family Physician, 38(10), 844–848.Google Scholar
  69. McPherson, G. (2012). Examining an orientation program for International Medical Graduates (IMGs) through the lens of critical theory a learner centered program. Dissertation, Mount Saint Vincent UniversityGoogle Scholar
  70. Michalski, K., Farhan, N., Motschall, E., Vach, W., & Boeker, M. (2017). Dealing with foreign cultural paradigms: A systematic review on intercultural challenges of international medical graduates. PLoS ONE, 12(7), e0181330.  https://doi.org/10.1371/journal.pone.0181330.Google Scholar
  71. Moberly, T. (2014). Minority report: How the UK’s treatment of foreign and ethnic minority doctors needs to change. BMJ, 348, g2838.  https://doi.org/10.1136/bmj.g2838.Google Scholar
  72. Mok, P. S., Baerlocher, M. O., Abrahams, C., Tan, E. Y., Slade, S., et al. (2011). Comparison of Canadian medical graduates and international medical graduates in Canada: 1989–2007. Academic Medicine, 86(8), 962–967.  https://doi.org/10.1097/ACM.0b013e318222e314.Google Scholar
  73. Monavvari, A. A., Peters, C., & Feldman, P. (2015). International medical graduates past, present, and future. Canadian Family Physician, 61(3), 205–208.Google Scholar
  74. Moore, R. A., & Rhodenbaugh, E. J. (2002). The unkindest cut of all: Are international medical school graduates subjected to discrimination by general surgery residency programs? Journal of Current Surgery, 59(2), 228–236.Google Scholar
  75. Morgan, J., Crooks, V. A., Sampson, C. J., & Snyder, J. (2017a). “Location is surprisingly a lot more important than you think”: A critical thematic analysis of push and pull factor messaging used on Caribbean offshore medical school websites. BMC Medical Education, 17(1), 99.  https://doi.org/10.1186/s12909-017-0936-x.Google Scholar
  76. Morgan, J., Crooks, V. A., & Snyder, J. (2017b). “We have been forced to move away from home”: Print news coverage of Canadians studying abroad at Caribbean offshore medical schools. BMC Medical Education, 17(1), 228.  https://doi.org/10.1186/s12909-017-1071-4.Google Scholar
  77. Morrow, G., Rothwell, C., Burford, B., & Illing, J. (2013). Cultural dimensions in the transition of overseas medical graduates to the UK workplace. Medical Teacher, 35(10), e1537–e1545.  https://doi.org/10.3109/0142159x.2013.802298.Google Scholar
  78. Muzzin, L., & Mickleborough, T. (2013). What does ‘race’ have to do with medical education research? Medical Education, 47(8), 760–767.  https://doi.org/10.1111/medu.12186.Google Scholar
  79. Nasir, L. S. (1994). Evidence of discrimination against international medical graduates applying to family practice residency programs. Family Medicine, 26(10), 625–629.Google Scholar
  80. Neiterman, E., & Bourgeault, I. L. (2015). The shield of professional status: Comparing internationally educated nurses’ and international medical graduates’ experiences of discrimination. Health (London), 19(6), 615–634.  https://doi.org/10.1177/1363459314567788.Google Scholar
  81. Neiterman, E., Bourgeault, I. L., & Covell, C. L. (2017). What do we know and not know about the professional integration of international medical graduates (IMGs) in Canada? Healthcare Policy, 12(4), 18–32.Google Scholar
  82. Norcini, J. J., Boulet, J. R., Dauphinee, W. D., Opalek, A., Krantz, I. D., et al. (2010). Evaluating the quality of care provided by graduates of international medical schools. Health Affairs (Millwood), 29(8), 1461–1468.  https://doi.org/10.1377/hlthaff.2009.0222.Google Scholar
  83. Norcini, J. J., Boulet, J. R., Opalek, A., & Dauphinee, W. D. (2014). The relationship between licensing examination performance and the outcomes of care by international medical school graduates. Academic Medicine, 89(8), 1157–1162.  https://doi.org/10.1097/acm.0000000000000310.Google Scholar
  84. Norcini, J. J., Boulet, J. R., Whelan, G. P., & McKinley, D. W. (2005). Specialty board certification among U.S. citizen and non-U.S. citizen graduates of international medical schools. Academic Medicine, 80(10 Suppl), 42–45.Google Scholar
  85. Osta, A. D., Barnes, M. M., Pessagno, R., Schwartz, A., & Hirshfield, L. E. (2017). Acculturation needs of pediatric international medical graduates: A qualitative study. Teaching and Learning in Medicine, 29(2), 143–152.  https://doi.org/10.1080/10401334.2016.1251321.Google Scholar
  86. PGME. (2014). Postgraduate Medical Education (PGME) University of Toronto: PGME annual reports. Retrieved August 5, 2017, from http://pg.postmd.utoronto.ca/wp-content/uploads/2016/06/PGMEAnnualReport2013-14.pdf.
  87. Pilotto, L. S., Duncan, G. F., & Anderson-Wurf, J. (2007). Issues for clinicians training international medical graduates: A systematic review. Medical Journal of Australia, 187(4), 225–228.Google Scholar
  88. Porter, J. L., Townley, T., Huggett, K., & Warrier, R. (2008). An acculturization curriculum: Orienting international medical graduates to an internal medicine residency program. Teaching and Learning in Medicine, 20(1), 37–43.  https://doi.org/10.1080/10401330701542644.Google Scholar
  89. Ragg, E., Rourke, J. O., & MacVicar, R. (2015). International medical graduates: A qualitative exploration of factors associated with success in the clinical skills assessment. Education for Primary Care, 26(6), 378–385.  https://doi.org/10.1080/14739879.2015.1101866.Google Scholar
  90. Ranasinghe, P. D. (2015). International medical graduates in the US physician workforce. Journal of the American Osteopathic Association, 115(4), 236–241.  https://doi.org/10.7556/jaoa.2015.047.Google Scholar
  91. Rao, A., Freed, C. R., & Trimm, R. F. (2013). International and American medical graduates in a U.S. pediatric residency program: A qualitative study about challenges during post-graduate year 1. Medical Teacher, 35(10), 815–819.  https://doi.org/10.3109/0142159x.2013.802297.Google Scholar
  92. Rockey, P. H., Miller, R. S., & Nasca, T. J. (2015). U.S.-citizen international medical graduates. New England Journal of Medicine, 373(5), 487.  https://doi.org/10.1056/NEJMc1507438%23SA1.Google Scholar
  93. Rosner, F., Dantzker, D. R., Walerstein, S., & Cohen, S. (1993). Intensive one-week orientation for foreign medical graduates entering an internal medicine residency program. Journal of General Internal Medicine, 8(5), 264–265.Google Scholar
  94. Said, E. W. (1978). Orientalism. New York: Pantheon Books.Google Scholar
  95. Sandbu, M., Kamps, A., Preljevic, V., & Javo, C. (2015). Foreign doctors in Norwegian psychiatry—Is there a need for a mentoring scheme? Tidsskrift for den Norske Laegeforening, 135(12–13), 1133–1137.  https://doi.org/10.4045/tidsskr.14.0764.Google Scholar
  96. Skjeggestad, E., Gerwing, J., & Gulbrandsen, P. (2017). Language barriers and professional identity: A qualitative interview study of newly employed international medical doctors and Norwegian colleagues. Patient Education and Counseling, 100(8), 1466–1472.  https://doi.org/10.1016/j.pec.2017.03.007.Google Scholar
  97. Sockalingam, S., Hawa, R., Al-Battran, M., Abbey, S. E., & Zaretsky, A. (2012). Preparing international medical graduates for psychiatry residency: A multi-site needs assessment. Academic Psychiatry, 36(4), 277–281.  https://doi.org/10.1176/appi.ap.09110219.Google Scholar
  98. Sockalingam, S., Khan, A., Tan, A., Hawa, R., Abbey, S., et al. (2014). A framework for understanding international medical graduate challenges during transition into fellowship programs. Teaching and Learning in Medicine, 26(4), 401–408.  https://doi.org/10.1080/10401334.2014.945393.Google Scholar
  99. Spivak, G. C. (1988). Can the subaltern speak? In C. Nelson & L. Grossberg (Eds.), Marxism and the interpretation of culture (pp. 271–313). Basingstoke: MacMillan Education.Google Scholar
  100. Stegers-Jager, K., & Themmen, A. (2013). Dealing with diversity in medical education. Medical Education, 47(8), 752–754.  https://doi.org/10.1111/medu.12251.Google Scholar
  101. Steinert, Y. W. A. (2006). A faculty development program for teachers of international medical graduates. Retrieved on August 5, 2017, from https://afmc.ca/timg/programoverview_en.htm.
  102. Szafran, O., Crutcher, R. A., Banner, S. R., & Watanabe, M. (2005). Canadian and immigrant international medical graduates. Canadian Family Physician, 51, 1242–1243.Google Scholar
  103. Tan, A., Hawa, R., Sockalingam, S., & Abbey, S. E. (2013). Disorientation of international medical graduates: An approach to foster teaching, learning, and collaboration (TLC). Academic Psychiatry, 37(2), 104–107.  https://doi.org/10.1176/appi.ap.11040074.Google Scholar
  104. Thompson Report. (2011). IMG SELECTION: Independent review of access to postgraduate programs by international medical graduates in Ontario, Canada. Retrieved August 5, 2017, from http://www.health.gov.on.ca/en/common/ministry/publications/reports/thomson/v1_thomson.pdf.
  105. Triscott, J. A., Szafran, O., Waugh, E. H., Torti, J. M., & Barton, M. (2016). Cultural transition of international medical graduate residents into family practice in Canada. International Journal of Medical Education, 7, 132–141.  https://doi.org/10.5116/ijme.570d.6f2c.Google Scholar
  106. Tsouroufli, M., Rees, C. E., Monrouxe, L. V., & Sundaram, V. (2011). Gender, identities and intersectionality in medical education research. Medical Education, 45(3), 213–216.  https://doi.org/10.1111/j.1365-2923.2010.03908.x.Google Scholar
  107. Tsugawa, Y., Jena, A. B., Orav, E. J., & Jha, A. K. (2017). Quality of care delivered by general internists in US hospitals who graduated from foreign versus US medical schools: Observational study. BMJ, 356, j273.  https://doi.org/10.1136/bmj.j273.Google Scholar
  108. Verma, A., Griffin, A., Dacre, J., & Elder, A. (2016). Exploring cultural and linguistic influences on clinical communication skills: A qualitative study of International Medical Graduates. BMC Medical Education, 16, 162.  https://doi.org/10.1186/s12909-016-0680-7.Google Scholar
  109. Walsh, A., Banner, S., Schabort, I., Armson, H., Bowmer, I., & Granata, B. (2011). International medical graduatesCurrent issues. Retrieved from August 5, 2017 https://www.afmc.ca/pdf/fmec/05_Walsh_IMG%20Current%20Issues.pdf.
  110. Watts, E., Davies, J., & Metcalfe, D. (2011). The Canadian international medical graduate bottleneck: A new problem for new doctors. Canadian Medical Education Journal, 2(2), e80–e90.Google Scholar
  111. Webb, J., Brightwell, A., Sarkar, P., Rabbie, R., & Chakravorty, I. (2015). Peer mentoring for core medical trainees: Uptake and impact. Postgraduate Medical Journal, 91(1074), 188–192.  https://doi.org/10.1136/postgradmedj-2014-132673.Google Scholar
  112. Whelan, G. P. (2006). Commentary: Coming to America: The integration of international medical graduates into the American medical culture. Academic Medicine, 81(2), 176–178.Google Scholar
  113. Wong, A., & Lohfeld, L. (2008). Recertifying as a doctor in Canada: International medical graduates and the journey from entry to adaptation. Medical Education, 42(1), 53–60.  https://doi.org/10.1111/j.1365-2923.2007.02903.x.Google Scholar
  114. Woodward-Kron, R., Fraser, C., Pill, J., & Flynn, E. (2015). How we developed doctors speak up: An evidence-based language and communication skills open access resource for international medical graduates. Medical Teacher, 37(1), 31–33.  https://doi.org/10.3109/0142159x.2014.909584.Google Scholar
  115. Woolf, K., Rich, A., Viney, R., Needleman, S., & Griffin, A. (2016). Perceived causes of differential attainment in UK postgraduate medical training: A national qualitative study. British Medical Journal Open, 6(11), e013429.  https://doi.org/10.1136/bmjopen-2016-013429.Google Scholar
  116. Wright, A., Regan, M., Haigh, C., Sunderji, I., Vijayakumar, P., et al. (2012). Supporting international medical graduates in rural Australia: A mixed methods evaluation. Rural and Remote Health, 12, 1897.Google Scholar
  117. Zarconi, J. (2012). Commentary: Narrative lessons from a Nigerian novelist: Implications for medical education and care. Academic Medicine, 87(8), 1005–1007.  https://doi.org/10.1097/ACM.0b013e31825ce727.Google Scholar
  118. Zulla, R., Baerlocher, M. O., & Verma, S. (2008). International medical graduates (IMGs) needs assessment study: Comparison between current IMG trainees and program directors. BMC Medical Education, 8, 42.  https://doi.org/10.1186/1472-6920-8-42.Google Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Wilson Centre for Research in EducationTorontoCanada
  2. 2.Sunnybrook Health Sciences CentreTorontoCanada
  3. 3.Faculty Lead R4 Internal Medicine ProgramUniversity of TorontoTorontoCanada
  4. 4.Faculty Lead IMG/IFT Mentorship ProgramUniversity of TorontoTorontoCanada
  5. 5.Department of Medicine, Faculty of MedicineUniversity of TorontoTorontoCanada
  6. 6.Centre of Quality Improvement and Patient SafetyUniversity of TorontoTorontoCanada
  7. 7.Core Internal Medicine ProgramSunnybrook Health Sciences CentreTorontoCanada
  8. 8.Department of Family and Community MedicineUniversity of TorontoTorontoCanada
  9. 9.Urban Family Health TeamSt. Joseph Health CentreTorontoCanada
  10. 10.Resident Wellness, Postgraduate Medical Education OfficeUniversity of TorontoTorontoCanada
  11. 11.Massey CollegeTorontoCanada

Personalised recommendations