Promoting Equity Among International Medical Graduates

Abstract Background

International Medical Graduates (IMGs) constitute 25-40% of the physician workforce in their host High Income Countries (HICs) (Batalova, 2020). Implementation of acculturation strategies  helps them navigate their professional careers better, contributing to high performing health systems, with better health outcomes (Kehoe et al., 2016; Kamimura et al, 2017).  A review of the current state of these targeted intervention strategies can guide the creation of context specific flexible acculturation strategies while optimizing resource utilization. Further IMGs emigrate to the US from 154+ countries, thus representing wide diversity in terms of their demographic characteristics, professional backgrounds and acculturation needs (Kehoe et al, 2016). However, current acculturation strategies treat IMGs as a homogenous group (Chen et al, 2011; Osta et al, 2016). Research recommends identifying the unique needs of this diverse group so that acculturation strategies can be effectively tailored for them. 

Methods This integrated doctoral research uses systematic review and qualitative research methodology to identify, examine and describe the acculturation strategies IMGs find useful in navigating their careers in their host High Income Countries (HICs).
The systematic review uses PRISMA guidelines. Inclusion criteria are research articles published in English between 2000 and 2021 and available in the PubMed, Embase, PsycINFO, CINAHL and Web of Science databases. Three types of studies (n=46) are included. The first are description or evaluation studies of the interventions designed to facilitate the acculturation of IMGs (n=15). The second group are studies documenting the opinions of IMGs regarding the strategies that helped them navigate their professional career in their host countries (n=21). The third group are viewpoints or commentaries by the trainers of the IMGs documenting their experiential learning of practices that help IMGs transition to life in their host countries (n=10). Next, the interpretative, qualitative study used Zoom to interview 34 IMGs from India who have been practicing in the US for at least 15 years. The interviews were conducted in English using a semi-structured questionnaire, recorded with their prior permission and transcribed verbatim. They were, encoded independently by two researchers using NVivo software. Inter-researcher differences in coding were resolved through discussion and a codebook with 59 primary codes, 27 secondary codes was created, to identify and develop three thematic areas. Results

The systematic review includes 46 heterogeneous research studies from nine host countries. These are intervention studies or their evaluations (n=21), studies of perceptions of IMGs on ‘what works’ (n=15) and commentaries by trainers of IMGs (n=10). The studies are primarily from UK (n= 17), Australia (n=10) and US (n=9). Although the studies are heterogeneous in terms of the survey recruitment and communication methods, measurement instruments, content and duration of interventions, quantum, timing of outcome measurements, and analytical methods, their findings are complementary. Results show multiple channels of communication are successful in providing support, which is maximally needed towards the start of the IMGs’ residencies in their host countries. IMGs benefit from additional targeted induction training at the start of residency. This training should include training on clinical skills, host country health system, culture & customs, communication and language skills. It should be administered by clinicians and linguistics experts. There is emerging evidence for interventions regarding provision and utilization of peer mentoring support, creation of social and professional support networks, collegial support, social integration and sensitizing organizational employees to the special needs of the IMGs.

The qualitative study finds strategies facilitating acculturation of IMGs from India form three categories: medical system strategies, cultural strategies and personal attributes. First, the medical system strategies include a strong work ethic developed during their medical training in India, professional proficiency in English language and a comparable age with their counterparts at the start of their second residency in the US. Next, the cultural strategies include both, the universality, sanctity and stability of their marriages and their strong, informal social support networks. They maintain strong ties to India while embracing American culture. All respondents had stable heterosexual marriages, which is an incidental finding. None of the respondents identified themselves as LGBTQ, possibly because the LGBTQ community remains taboo among Indians (Venugopal, 2015). Their personal attributes of a clear vision, set goals helps them persevere in a single-minded pursuit to achieving them. They came prepared to repeat their residencies, have worked hard and used emotional intelligence to handle microaggressions.

Conclusion IMGs are projected to continue to constitute a significant percentage of the physician workforce in HICs. Acculturation strategies facilitate their transition to the health systems in their host countries. These strategies need to include training on communication, provide continued support over the initial years and be disseminated through digital age channels. IMGs from India have unique strengths and hence, there is scope for tailoring these strategies to the unique needs of IMGs from different countries.



Work Title Promoting Equity Among International Medical Graduates
Open Access
  1. Sangeeta Saxena
  2. Kristin Elizabeth King Sznajder
  3. Elizabeth Jean Tisdell
  4. Elana Farace
  5. Omrana Pasha-Razzak
  6. Thomas F Godfrey III
  7. Betsy B Aumiller
  1. International Medical Gradiuates
  2. Equity
License No Copyright - U.S.
Work Type Dissertation
  1. Esther Dell, Nirmal Ahuja, Bernadette Kumar
Publication Date 2022
  1. Public Health
  1. English
Geographic Area
  1. USA
Deposited June 22, 2022




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Work History

Version 1

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  • Updated Acknowledgments Show Changes
    • Esther Dell, Nirmal Ahuja, Bernadette Kumar
  • Added Creator Sangeeta Saxena
  • Added Creator Kristin Elizabeth King Sznajder
  • Added Creator Elizabeth Jean Tisdell
  • Added Creator Elana Farace
  • Added Creator Omrana Pasha-Razzak
  • Added Creator Thomas F Godfrey III
  • Added Creator Betsy B Aumiller
  • Added Dissertation_SGS.pdf
  • Updated Keyword, Subject, Language, and 1 more Show Changes
    • International Medical Gradiuates, Equity
    • Public Health
    • English
    Geographic Area
    • USA
  • Added Dissertation_6.25.2022.pdf
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