Skip to main content
SpringerLink
Log in

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

  • Published:
Advances in Health Sciences Education Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Bates, J., & Andrew, R. (2001). Untangling the roots of some IMG’s poor academic performance. Academic Medicine, 76(1), 43–46.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Braun, V., & Clarke, C. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101.

    Google Scholar 

  • 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 

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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.

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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.

  • 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.

  • 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.

  • 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 

  • 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 

  • 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.

  • 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.

  • 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 

  • 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 

  • 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.

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Hooks, B. (1981). Ain’t I a woman: Black women and feminism. Boston: South End Press.

    Google Scholar 

  • Huang, A. (2000). Continuing controversy over the international medical graduate. JAMA, 283(13), 1746.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Kuper, A. (2016). When I say… equity. Medical Education, 50(3), 283–284. https://doi.org/10.1111/medu.12954.

    Google Scholar 

  • Kuper, A., Lingard, L., & Levinson, W. (2008a). Critically appraising qualitative research. BMJ, 337, a1035. https://doi.org/10.1136/bmj.a1035.

    Google Scholar 

  • 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 

  • 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 

  • Kuzel, A. (1999). Sampling in Qualitative inquiry. In B. F. Crabtree & W. L. Miller (Eds.), Doing qualitative research (p. 606). London: Sage.

    Google Scholar 

  • Kvale, S. (1996). InterViews: An introduction to qualitative research interviewing. Thousand Oaks: Sage.

    Google Scholar 

  • Kwong, W. (2014). More international grads seek residency. CMAJ, 186(11), E401–E402. https://doi.org/10.1503/cmaj.109-4788.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • McDonnell, L., & Usherwood, T. (2008). International medical graduates—Challenges faced in the Australian training program. Australian Family Physician, 37(6), 481–484.

    Google Scholar 

  • 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 

  • 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 University

  • 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 

  • 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 

  • 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 

  • Monavvari, A. A., Peters, C., & Feldman, P. (2015). International medical graduates past, present, and future. Canadian Family Physician, 61(3), 205–208.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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.

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • Said, E. W. (1978). Orientalism. New York: Pantheon Books.

    Google Scholar 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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.

  • 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 

  • 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 

  • 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.

  • 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 

  • 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 

  • 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 

  • 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 

  • Walsh, A., Banner, S., Schabort, I., Armson, H., Bowmer, I., & Granata, B. (2011). International medical graduates—Current issues. Retrieved from August 5, 2017 https://www.afmc.ca/pdf/fmec/05_Walsh_IMG%20Current%20Issues.pdf.

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

  • 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 

Download references

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
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elisa Hollenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lynfa Stroud
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Susan Edwards
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ayelet Kuper
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Umberin Najeeb.

Ethics declarations

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?

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

Search

Navigation