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

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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.

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Funding

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

Author information

Authors and Affiliations

  1. Wilson Centre for Research in Education, Toronto, ON, Canada

    Umberin Najeeb, Elisa Hollenberg, Lynfa Stroud & Ayelet Kuper

  2. Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N3M5, ON, Canada

    Umberin Najeeb, Brian Wong, Lynfa Stroud & Ayelet Kuper

  3. Faculty Lead R4 Internal Medicine Program, University of Toronto, Toronto, ON, Canada

    Umberin Najeeb

  4. Faculty Lead IMG/IFT Mentorship Program, University of Toronto, Toronto, ON, Canada

    Umberin Najeeb

  5. Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Umberin Najeeb, Brian Wong, Lynfa Stroud & Ayelet Kuper

  6. Centre of Quality Improvement and Patient Safety, University of Toronto, Toronto, ON, Canada

    Brian Wong

  7. Core Internal Medicine Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Lynfa Stroud

  8. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada

    Susan Edwards

  9. Urban Family Health Team, St. Joseph Health Centre, Toronto, ON, Canada

    Susan Edwards

  10. Resident Wellness, Postgraduate Medical Education Office, University of Toronto, Toronto, ON, Canada

    Susan Edwards

  11. Massey College, Toronto, ON, Canada

    Ayelet Kuper

Authors
  1. Umberin Najeeb
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  2. Brian Wong
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  3. Elisa Hollenberg
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  4. Lynfa Stroud
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  5. Susan Edwards
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  6. Ayelet Kuper
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Corresponding author

Correspondence to Umberin Najeeb.

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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.

Appendix: Interview guide

Appendix: Interview guide

Please Note: These are questions for a semi-structured interview. They are intended to indicate the themes to be discussed at each interview. Given the nature of semi-structured interviews, follow-up ‘probe’ questions depend very much on the answers received to the standardized initial questions as well as on the results of the concurrent analysis of previous interviews. This is standard procedure in many types of qualitative research.

Please also note that the term IMG (which stands for international medical graduate) is both a formal designation used by national bodies and university training programs as well as the common self-referential term used with the IMG community in Canada. It will, therefore, be very familiar to, understood by, and likely used by all of our study participants. We will thus be using it (and not a longer, more explicit term) in our interview questions.

  1. 1.

    Tell me why you decided to participate in this study.

  2. 2.

    What is your previous professional background?

  3. 3.

    What is your experience of being an IMG so far?

  4. 4.

    How do you feel about your residency training here as an IMG?

  5. 5.

    How would you compare it with your previous training?

  6. 6.

    What are the challenges you have faced as an IMG in a Canadian residency program?

  7. 7.

    How do you think they are different from (or similar to) the challenges your IMG peers have faced?

  8. 8.

    How do you think they are different from (or similar to) the challenges your non-IMG peers have faced?

  9. 9.

    What do you think is needed to rectify the challenges you have faced as an IMG?

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Najeeb, U., Wong, B., Hollenberg, E. et al. Moving beyond orientations: a multiple case study of the residency experiences of Canadian-born and immigrant international medical graduates. Adv in Health Sci Educ 24, 103–123 (2019). https://doi.org/10.1007/s10459-018-9852-z

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  • DOI: https://doi.org/10.1007/s10459-018-9852-z

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