international medical graduate: collaboration key for success

Victor Castilla M.D.Post – Observership Participant

UCLA International Medical Graduate (IMG) Program

July 1st , 2008

Though obtaining a residency in United States is quite competitive for IMGs, but by no means impossible. Directed hard work and perseverance are the keys to achieving this goal.

DR SYED FARAZ KAZIM Karachi, Pakistan.The Road to Residency in United States: Dilemma of International Medical Graduates (IMGs)

Journal of The College of Physicians and Surgeons Pakistan 2008, Vol. 18 (1): 66-67

You will be facing difficult days. Starting your life in a North American neighborhood and your work in a North American hospital, you will face differences from which you are accustomed. Habits and culture, language, religion, styles of life, food, timing of the day's activities, scale of values, etc. will all be different.

Rodolfo A. Armas-Merino, MD, MACPSpanish Speaking International Medical Graduates Applying for a Residency in the USA: Some Thoughts

http://www.acponline.org/about_acp/international/graduates/training_in_us/merino.htm

The celebrated American dream of “freedom and opportunity” has attracted immigrants for centuries, but the current reality may be less than egalitarian for doctors trained outside the US and Canada. Instead, the US healthcare system may be designed such that international graduates aren’t competing on a level playing field for access to graduate medical education and the jobs that come afterward.

Ellen M SoffinMind the gap.

STUDENTBMJ | Volume 14 | October 2006http://student.bmj.com/search/pdf/06/10/sbmj374.pdf

Although we are certain that residency programs exist that embrace IMGs, treat them with full respect, reflect on there potential and value their unique experiences, they may not reflect the status quo in the US graduate medical education system.

Scott E. Woods MD, MPH, M.Ed., FAAFP. Aaron Harju MD, Shoba Rao MD, Julie Koo MD, Divya Kini MD Perceived Biases and Prejudices Experienced by International Medical Graduates

in the US Post-Graduate Medical Education System Med Educ Online [serial online] 2006;11:20

In August, you are alerted that Dr. F, who struggled on his first floor rotation, is now having a “tough time” in the MICU. The director of the MICU has just met with the program director demanding that this intern be removed from his rotation immediately. Your program director calls you in and requests that you intervene with this intern. You have not yet worked closely with Dr. F. You know he is a recently graduated IMG and has very high board scores, but no prior work experience in the United States. He is thought to be slow, always late to conferences, and does not present well during rounds or sign out.

Mukta Panda, M.D. Andrew C. Yacht, M.D.Working with International Medical Graduates

APDIM Chief Residents’ Conference New Orleans, Spring 2008http://www.im.org/AAIM/Meetings/PastMeetings/2008/APDIM/workshop2.pdf

Wrong choice of careerChange to another specialtyUnhappy with matched programDissatisfaction with clinical & educational experienceLoss of interest (Burnt out)Rigors of the specialty: long days & nightsDomestic problemslllness or death

Adebonojo SA, Mabogunje OA, Pezzella AT,Residency Training in the United States: What Foreign Medical Graduates Should Know

West African J. Medicine 2003; 22: 79-87

1. Inadequate level of medical/surgical knowledge2. Poor command of English, both receptive and expressive3. Difficulty in adapting to the technology/procedures in U.S. hospitals4. Poor time management and multitasking techniques5. Poor synthetic reasoning skills and inability to understand how to executestandard surgical algorithms in patient evaluation and management

Karen Horvath MD, Gina Coluccio, Hugh Foy MD and Carlos Pellegrini MD. A program for successful integration of international medical graduates (IMGs) into U.S. surgical residency training.

Current Surgery Volume 61, Issue 5, September-October 2004, Pages 492-498

1. Interpersonal difficulties with faculty, residents, and staff2. Lack of acceptance of deficiencies and inability to accept constructive criticism3. Poor work ethic4. Poor adjustment to the fast pace of residency training in large, multihospitalsystems

Karen Horvath MD, Gina Coluccio, Hugh Foy MD and Carlos Pellegrini MD. A program for successful integration of international medical graduates (IMGs) into U.S. surgical residency training.

Current Surgery Volume 61, Issue 5, September-October 2004, Pages 492-498

Most IMGs do make the necessary transitions and eventually become comfortable working in U.S. hospitals and clinics and living in the United States. However, ECFMG’s discussions with focus groups of IMGs indicate that this transition could be facilitated

IMG Advisors Network (IAN)http://www.ecfmg.org/acculturation/ian.html#ian

Hard work Perseverance Good Guidance Advice from other IMGs Create Networks Realistic Picture of the process

Proper preparation and good guidance can make this task a lot easier

DR SYED FARAZ KAZIM Karachi, Pakistan.The Road to Residency in United States: Dilemma of International Medical Graduates (IMGs)

Journal of The College of Physicians and Surgeons Pakistan 2008, Vol. 18 (1): 66-67

Advice from other IMGs who have entered U.S. training programs and can provide very practical and useful answers to questions and concerns on a wide range of topics.

IMG Advisors Network (IAN)http://www.ecfmg.org/acculturation/ian.html#ian

It is extremely important to network with friends, family, and professional colleagues regarding the subjective and objective aspects of pursuing GME in the USA. Though, at times, frustrating and depressing, the ultimate goal of achieving a superb training and experience is experienced by the majority.

Adebonojo SA, Mabogunje OA, Pezzella AT,Residency Training in the United States: What Foreign Medical Graduates Should Know

West African J. Medicine 2003; 22: 79-87

For international medical graduates, a realistic picture of what it means to go to the US for residency training may be part of what will make that process a success.

Ellen M SoffinMind the gap.

STUDENTBMJ | Volume 14 | October 2006http://student.bmj.com/search/pdf/06/10/sbmj374.pdf

The issue of Latino IMGs requires special attention, and may provide a temporary solution to the Latino physician shortfall.

Hayes-Bautista, David E. PhD; Hsu, Paul; Hayes-Bautista, Maria RN, MPH; Stein, Robert M. PhD; Dowling, Patrick MD; Beltran, Robert MD; Villagomez, Juan MD Latino Physician Supply in California: Sources, Locations, and Projections.

Academic Medicine. 75(7):727-736, July 2000.

Collaboration is Paramount

Remember that medicine is very important but not everything. It is easy to understand that your residency will be very important and a great preoccupation, but do not forget that it is also the time to go on with your personal development.



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international medical graduate: collaboration key for success

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