Advertisement

International Medical Graduates (IMGs) in the UK—a Systematic Review of Their Acculturation and Adaptation

  • Farooq Ahmed KhanEmail author
  • Shivaram Chikkatagaiah
  • Mohammed Shafiullah
  • Mahmood Nasiri
  • Anoop Saraf
  • Tarun Sehgal
  • Ashish Rana
  • George Tadros
  • Paul Kingston
Article

Abstract

International medical graduates (IMGs) constitute about 23–28 % of the medical workforce providing support and contribution to the UK, Canada, USA and Australia. This review will inform the need for trainers, deaneries and colleges to plan and develop strategies to enhance the potential of IMGs. The authors aim to review and inform the relevant authorities about the barriers faced by IMGs in training and career progression in the UK health service. Two hundred forty-eight studies were reviewed at step 1; 54 were excluded on the basis of selection criteria, and further 115 studies were excluded which did not focus on issues discussed in the selection criteria; and after reviewing 79 studies, a further 20 were excluded for methodological qualities, and finally, 59 were included. The results have been discussed under various themes which emerged as significant issues related to IMGs. Seeking better life and higher education and training are the main reasons for migration. The training process of IMGs in their own countries impacts on the transition process results in struggling career progression. The most crucial impediment in the path of career progression is the process of passing examinations which IMGs face during their career struggle. The psychological aspects of migration and legal and ethical issues are found to be significant for IMGs. They also struggle with the adaptations needed with reference to learning and teaching styles resulting in the change of multiple specialties. IMGs contributed significantly to not only filling the space of under-recruitment but also serving comprehensively in a variety of specialties. There has been a consistent decline in preferring some specialties as career option among UK medical graduates and medical students. IMGs migrate to foreign countries in pursuit of better medical education, desire for better income, general security and improved prospects for the family, but in doing so, they are confronted with psychosocial problems, cultural differences, hurdles in career progression and passing exams.

Keywords

International medical graduates IMGs Migrant doctors Acculturation Adaptation Training issues of IMGs 

References

  1. Abdulrahman, K. A. (2008). The current status of medical education in the Gulf Cooperation Council countries. Annals of Saudi Medicine, 28, 83–88.CrossRefGoogle Scholar
  2. Abraham, R. R., Vinod, P., Kamath, M. G., Asha, K., & Ramnarayan, K. (2008). Learning approaches of undergraduate medical students to physiology in a non-PBL- and partially PBL-oriented curriculum. Advances in Physiology Education, 32, 35–37.CrossRefGoogle Scholar
  3. Allan, J., Clarke, K., & Jopling, M. (2009). Effective teaching in higher education: perceptions of first year undergraduate students. International Journal of Teaching and Learning in Higher Education, 21(3), 362–372.Google Scholar
  4. Arthur, G. K., Brooks, R., & Long, M. L. (1979). A language-cultural course for foreign psychiatric residents. American Journal of Psychiatry, 136, 1064–1067.CrossRefGoogle Scholar
  5. Astor, A., Akhtar, T., Matallana, M. A., Muthuswami, V., Oluwu, F. A., Tallo, V., et al. (2005). Physician migration: views from professionals in Columbia, Nigeria, India, Pakistan and the Philippines. Social Science and Medicine, 61, 2492–2500.CrossRefGoogle Scholar
  6. Ayres, P., Rigby, A. S., & Williams, R. (1996). Part 1 of Membership of the faculty of public health medicine. Trends over time and factors associated with success in recent years. Journal of Public Health Medicine, 18, 390–395.CrossRefGoogle Scholar
  7. Bates, J., & Andrew, R. (2001). Untangling the roots of some IMGs’ poor academic performance. Academic Medicine, 76, 43–46.CrossRefGoogle Scholar
  8. Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46(1), 5–34.Google Scholar
  9. Bessant, R., Bessant, D., Chesser, A., & Coakley, G. (2006). Analysis of predictors of success in the MRCP (UK) PACES examination in candidates attending a revision course. Postgraduate Medical Journal, 82(964), 145–149.CrossRefGoogle Scholar
  10. Bornat, J., Henry, L., & Raghuram, P. (2009). Overseas-trained South Asian doctors and the development of geriatric medicine. The Open University. http://www.open.ac.uk/hsc/__assets/GeriatricMedicineFindings.pdf.
  11. Boulet, J. R., Norcini, J. J., Whelan, G. P., Hallock, J. A., & Seeling, S. S. (2006). The international medical graduate pipeline: recent trends in certification and residency training. Health Affairs, 25(2), 469–477.CrossRefGoogle Scholar
  12. British Broadcasting Corporation (BBC). (2000). NHS to draft in foreign doctors. http://cdnedge.bbc.co.uk/1/hi/health/917438.stm.
  13. British Medical Association. (2009). Cohort study 2006 medical graduates, second report. London: BMA.Google Scholar
  14. British Medical Association. Clinical Attachments guidelines for International Medical Graduates. http://bma.org.uk/practical-support-at-work/immigration/doctors-new-to-the-uk/finding-a-post.
  15. British Medical Association. ‘Tackling racism in medical careers: the role of consultants’ BMA Policy paper 2005. 2006 http://www.bma.org.uk/equality_diversity/ethnicity/TacklingRacisminMedicalCareers.jsp.
  16. Brockington, I. F., & Mumford, D. B. (2002). Recruitment into psychiatry. British Journal of Psychiatry, 180, 307–312.CrossRefGoogle Scholar
  17. Brookfield, S. D. (1987). Developing Critical Thinkers. The Jossey-Bass higher education series and the Jossey-Bass management, San Francisco.Google Scholar
  18. Brookfield, S. D. (1993). The development of critical reflection in adulthood. New Education, 13(1), 39–48.Google Scholar
  19. Brown, N., Vassilas, C., & Oakley, C. (2009). Recruiting psychiatrists—a sysphean task. Psychiatric Bulletin, 33, 390–392.CrossRefGoogle Scholar
  20. Buchanan, M. Doctor shortage sees new recruitment drive in India. British Broadcasting Corporation (BBC). Reported on 1 June 2010. http://www.bbc.co.uk/news/10202803.
  21. Buske, L. (2002). Canada’s cosmopolitan medical profession. Canadian Medical Association Journal, 166(10), 1320.Google Scholar
  22. Camp, G. (1996). Problem-based learning: a paradigm shift or a passing fad? Medical Education Online, 1, 2. http://www.studentaffairs.columbia.edu/sites/dsa/files/PBL_Paradigm_or_Fad.pdf.
  23. Cooke, L., Halford, S., & Leonard, P. (2003). Racism in the medical profession: the experience of UK graduates. Health Policy and Economic Research Unit, British Medical Association.Google Scholar
  24. Crutcher, R., Banner, S., Szafran, O., & Watanabe, M. (2002). Characteristics of international medical graduates who apply to the Canadian Resident Matching Service (CaRMS) match. Canadian Medical Association Journal, 168(9), 1119–1123.Google Scholar
  25. Decker, K. (2001). Overseas doctors: past and present’. In N. Coker (Ed.), Racism in medicine. London: King’s Fund.Google Scholar
  26. Durey, A. (2005). Settling in: overseas trained GPs and their spouses in rural Western Australia. Rural Society, 15(1), 38–54.CrossRefGoogle Scholar
  27. Esmail, A., & Everington, S. (1993). Racial discrimination against doctors from ethnic minorities. British Medical Journal, 306, 691–692.CrossRefGoogle Scholar
  28. Fazel, S., & Ebmeier, K. P. (2009). Specialty choice in UK junior doctors: is psychiatry the least popular specialty for UK and international medical graduates? BioMed Central Medical Education, 9, 77.CrossRefGoogle Scholar
  29. Feifel, D., Yu Moutier, C., & Swerdlow, N. R. (1999). Attitudes toward psychiatry as a prospective career among students entering medical school. American Journal of Psychiatry, 156, 1397–1402.Google Scholar
  30. Fernandez, A., Wang, F., Braveman, M., Finkas, L. K., & Hauer, K. E. (2007). Impact of student ethnicity and primary childhood language on communication skill assessment in a clinical performance examination. Journal of General Internal Medicine, 22(8), 1155–1160.CrossRefGoogle Scholar
  31. Gadit, A. A. M. (2008). International migration of doctors from developing countries: need to follow the Commonwealth Code. Journal of Medical Ethics, 34, 67–68.CrossRefGoogle Scholar
  32. Galeazzi, G. M., Secchi, C., & Curci, P. (2003). Current factors affecting the choice of psychiatry as a specialty: an Italian study. Academic Psychiatry, 27, 74–81.CrossRefGoogle Scholar
  33. General Medical Council. (2011). English Language requirements. http://www.gmc-uk.org/doctors/registration_applications/language_proficiency.asp.
  34. General Medical Council. (2011). Postgraduate Education and Training. http://www.gmc-uk.org/education/postgraduate.asp.
  35. Ghanaian Doctors and Dentists Association (GDDA). (2005). Recent changes to postgraduate medical education and training in the UK. http://www.gdda-uk.com/downloads/PLAB_Warning2.pdf.
  36. Goodyear, H. (2009). Career guidance: how do we inspire students and young doctors to careers in paediatrics and child health? Archives of Disease in Childhood. Education and Practice Edition, 94, 87–91.CrossRefGoogle Scholar
  37. Goodyear, H., Kennedy, C., & Wall, D. (2007). Career choices: foundation year trainees’ views on careers advice and information. British Journal of Hospital Medicine, 68(4), 211–215.CrossRefGoogle Scholar
  38. Harden, R. M., Sowden, S., & Dunn, W. R. (1984). Educational strategies in curriculum development: the SPICES model. Medical Education, 18, 284–297.CrossRefGoogle Scholar
  39. Hashmi, A. (2009). Communication skills of overseas doctors and training implications for psychiatry. The Psychiatrist, 33, 275.Google Scholar
  40. Humphrey, C., Hickman, S., & Gulliford, M. C. (2011). Place of medical qualification and outcomes of UK GMC “Fitness to Practice” process: cohort study. British Medical Journal, 342, d1817.CrossRefGoogle Scholar
  41. Hussain, A., & Husni, M. (2010). Preparing for the MRCPsych CASC—an insight based on experience. British Journal of Medical Practitioners, 3(2).Google Scholar
  42. Jaques, H. (2011). Pass rate falls in PLAB test for IMG. British Medical Journal Careers.Google Scholar
  43. Kilpatrick, S., Johns, S., Vitartas, P., & Homisan, M. (2011). Mobile skilled workers: making the most of an untapped rural community resource. Journal of Rural Studies, 27(2), 181–190.CrossRefGoogle Scholar
  44. Koh, G. C., Khoo, H. E., Wong, M. L., & Koh, D. (2008). The effects of problem-based learning during medical school on physician competency: a systematic review. Canadian Medical Association Journal, 178(1), 34–41.CrossRefGoogle Scholar
  45. Lassers, E., & Nordan, R. (1975). Difficulties in postgraduate training of foreign paediatric residents and interns in child psychiatry. British Journal of Medical Education, 9, 286–290.CrossRefGoogle Scholar
  46. Mahajan, J., & Stark, P. (2007). Barriers to education of overseas doctors in paediatrics: a qualitative study in South Yorkshire. Archives of Diseases in Childhood, 92(3), 219–223.CrossRefGoogle Scholar
  47. Majumder, A. A., D’Souza, U., & Rahman, S. (2004). Trends in medical education: challenges and directions for need-based reforms of medical training in South-East Asia. Indian Journal of Medical Sciences, 58, 369–380.Google Scholar
  48. Malik, A., White, O., & Bagalkote, H. (2007). Local clinical attachment scheme in psychiatry. The Psychiatrist, 31, 142–144.Google Scholar
  49. Martin, D. (2007). Overseas doctors ‘taking too many jobs’. Daily Mail. http://www.dailymail.co.uk/health/article-482992/Overseas-doctors-taking-jobs.html.
  50. McManus, I. C., Richards, P., Winder, B. C., & Sproston, K. A. (1996). Final examination performance of medical students from ethnic minorities. Medical Education, 30, 195–200.CrossRefGoogle Scholar
  51. McParland, M., Noble, L. M., & Livingston, G. (2004). The effectiveness of problem-based learning compared to traditional teaching in undergraduate psychiatry. Medical Education, 38(8), 859–867.CrossRefGoogle Scholar
  52. Mian, T. A. (1994). Limited registration and racial discrimination. British Medical Journal, 308, 208.CrossRefGoogle Scholar
  53. MRCGP Statistics. (2010). Third report (January–May 2010) on the results of MRCGP AKT and CSA assessments. http://www.rcgp-curriculum.org.uk/pdf/MRCGP%20Statistics%202010%20(Jan-May)%20Third%20Report%20v070411.pdf. Pages 22.
  54. Mullan, F. (2005). The metrics of the physician brain drain. New England Journal of Medicine, 353, 1810–1818.CrossRefGoogle Scholar
  55. Oikelome, F., & Healy, G. (2007). Second-class doctors? The impact of a professional career structure on the employment conditions of overseas- and UK-qualified doctors. Human Resource Management Journal, 17(2), 134–154.CrossRefGoogle Scholar
  56. Oyebode, F., & Furlong, E. (2007). MRCPsych examinations: cumulative results 1997–2002. Psychiatric Bulletin, 31, 61–64.CrossRefGoogle Scholar
  57. Pilotto, L. S., Duncan, G. F., & Anderson-Wurf, J. (2007). Issues for clinicians training IMGs: a systematic review. Medical Journal of Australia, 187(4), 225–228.Google Scholar
  58. Roberts, C., Sarangi, S., Southgate, L., Wakeford, R., Wass, V., Esmail, A., et al. (2000). Oral examinations equal opportunities, ethnicity, and fairness in the MRCGP. Commentary: oral exams get them right or don’t bother. British Medical Journal, 320, 370–375.CrossRefGoogle Scholar
  59. Sandhu, D. P. S. (2005). Current dilemmas in overseas doctors’ training. Postgraduate Medical Journal, 81, 79–82.CrossRefGoogle Scholar
  60. Scottish Committee on Postgraduate Medical and Dental Education (SCPMDE). (1996). Meeting the educational needs of staff grade doctors and dentists in Scotland. Edinburgh: SCPMDE.Google Scholar
  61. Scottish Council for Postgraduate Medical Education (SCOMPME). (1994). The educational needs of staff grade doctors and dentists. London: SCOPME.Google Scholar
  62. Selzer, R., & Ellen, S. (2010). Twelve tools for teaching medical students. Australasian Psychiatry, 18(2), 170–173.CrossRefGoogle Scholar
  63. Sharif, I. (2003). The learning problems of overseas. Part 2. MRCOG candidates. In J. Studd (Ed.), Progress in obstetrics and gynaecology (Vol. 15, pp. 1–15). Edinburgh: Churchill Livingstone.Google Scholar
  64. Shiwani, M. H. (2006). Plight of immigrant doctors in UK: grass is not that green. The Journal of Pakistan Medical Association, 56(6), 251–252. http://www.jpma.org.pk/PdfDownload/710.pdf.
  65. Singh, S. (1994). Cultural adjustment and the overseas trainee. British Medical Journal, 308, 1169.CrossRefGoogle Scholar
  66. Singhal, K., & Ramakrishnan, K. (2004). Training needs of international medical graduates seeking residency training: evaluation of medical training in India and the United States. The Internet Journal of Family Practice, 3(1).Google Scholar
  67. Slowther, A., Hundt, G. L., Taylor, R., & Purkis, J. (2009). Non UK qualified doctors and good medical practice: the experience of working within a different professional framework. Report for GMC. University of Warwick.Google Scholar
  68. Stern, C. (2005). Career intentions and the impact of career advice on PRHOs in their second 6 month placement. British Journal of Hospital Medicine, 66, 477–479.CrossRefGoogle Scholar
  69. Stewart, E. (2003). A bitter pill to swallow: obstacles facing refugee and overseas doctors in the UK, UNHCR. http://www.unhcr.org/publ/RESEARCH/3fbb94a32.pdf.
  70. Supe, A., & Burdick, W. P. (2006). Challenges and issues in medical education in India. Academic Medicine, 81(12), 1076–1080.CrossRefGoogle Scholar
  71. Tavakol, M., Murphy, R., Torabi, S. (2006). Medical education in Iran: an exploration of some curriculum issues. Medical Education Online, 11, 5. http://www.med-ed-online.net/index.php/meo/article/viewFile/4585/4764.
  72. Terry, D., Lê, Q., Woodroffe, J., & Ogden, K. (2011). The quality of life and social needs of international medical graduates: emerging themes in research. International Journal of Innovative Interdisciplinary Research, 1(1), 59–67.Google Scholar
  73. The Edinburgh Declaration, Medical Education. (1988). 22, 481–482.Google Scholar
  74. The Information Centre for Health and Social Care. (2008). NHS Staff 1997–2007. Overview and NHS Hospital and Community Health Services: medical and dental staff England 1998–2008. www.ic.nhs.uk/statistics-and-data-collections/workforce/nhs-staff-numbers/nhs-staff-1997--2007-overview.
  75. The Royal College of General Practitioners. (2010). Clinical skills assessments. http://www.rcgp-curriculum.org.uk/nmrcgp/csa.aspx.
  76. The Royal College of Psychiatrists. (2008a). Royal College of Psychiatrists welcomes ruling that plans to give UK-trained doctors priority in applying for jobs was “wrong and unlawful”. http://www.rcpsych.ac.uk/press/pressreleases2008/pr2.aspx.
  77. The Royal College of Psychiatrists. (2008b). RCPsych news August. http://www.rcpsych.ac.uk/members/rcpsychnews/enewsletters2008/august2008.aspx.
  78. The Royal College of Psychiatrists. (2011). Trainees section. http://www.rcpsych.ac.uk/specialtytraining/trainees.aspx.
  79. The Royal College of Psychiatrists Annual Specialty Report 2008 / 09. http://www.rcpsych.ac.uk/pdf/ASR%20in%20Psychiatry.pdf.
  80. Turner, G., Lambert, T. W., Goldacre, M. J., et al. (2007). Career choices for paediatrics: national surveys of graduates of 1974–2002 from UK medical schools. Child Care Health Development, 33, 340–346.CrossRefGoogle Scholar
  81. Tyrer, S. P., Leung, W. C., Smalls, J., & Katona, C. (2002). The relationship between medical school of training, age, gender and success in the MRCPsych examinations. Psychiatric Bulletin, 26, 257–263.CrossRefGoogle Scholar
  82. Vassilas, C., Kuruvilla, T., Gupta, V., & El-Nadeef, M. (2007). Preparing trainees for the MRCPsych examinations. Advances in Psychiatric Treatment, 13, 239–250.CrossRefGoogle Scholar
  83. 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.CrossRefGoogle Scholar
  84. Woolf, K., Potts, H. W. W., & McManus, I. C. (2011). Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis. British Medical Journal, 342, d901.CrossRefGoogle Scholar
  85. Yedidia, M. J., Gillespie, C. C., Kachur, E., Schwartz, M. D., Ockene, J., & Chepaitis, A. E. (2003). Effect of communications training on medical student performance. The Journal of the American Medical Association, 290, 1157–1165.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2014

Authors and Affiliations

  • Farooq Ahmed Khan
    • 1
    • 2
    • 3
    Email author
  • Shivaram Chikkatagaiah
    • 4
  • Mohammed Shafiullah
    • 5
  • Mahmood Nasiri
    • 5
  • Anoop Saraf
    • 6
  • Tarun Sehgal
    • 7
  • Ashish Rana
    • 8
  • George Tadros
    • 9
  • Paul Kingston
    • 2
  1. 1.Mental Health Services for Older PeopleBirmingham & Solihull Mental Health NHS Foundation TrustBirminghamUK
  2. 2.Centre for Ageing and Mental HealthUniversity of ChesterChesterUK
  3. 3.Centre for Ageing and Mental HealthStaffordshire UniversityStaffordUK
  4. 4.General Adult PsychiatryBarnet, Enfield and Haringey Mental Health NHS TrustLondonUK
  5. 5.General Adult PsychiatryBirmingham & Solihull Mental Health NHS Foundation TrustBirminghamUK
  6. 6.Old Age PsychiatrySouth London and Maudsley NHS TrustLondonUK
  7. 7.General Adult PsychiatryLeeds and York Partnership NHS TrustLeedsUK
  8. 8.General Adult PsychiatryBradford District Care TrustBradfordUK
  9. 9.Old age Liaison PsychiatryUniversity of WarwickWarwickUK

Personalised recommendations