Canadian-International Medical Graduates: The Journey Back Home Umberin Najeeb Elisa Hollenberg, Brian Wong, Lynfa Stroud Khalil Sivjee, Susan Edwards, Ayelet Kuper
I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Je n ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d appareils médicaux ou un cabinet de communication. Author:Dr. Umberin Najeeb Date: Sep 2013
Immigrant IMGs are immigrants to Canada with medical degrees from other countries Canadian IMGs (C-IMG) are Canadian citizens and permanent residents who have gone overseas for medical education
C-IMGS 3500 Canadian students CSAs are studying medicine in schools all over the world CARMS 2010
C-IMGs Approximately 80 schools in almost 30 countries >50% are in Caribbean Med schools CARMS 2010
Needs Assessment Follow up of previous study of I-IMGs To enhance our understanding of similar or unique challenges faced by Canadian-IMGs To identify the ideal targets and learning objectives for curricular innovations
Methods C-IMG residents at various levels of training Internal Medicine(4), General Surgery(3), Family Medicine(4) Semi structured interviews (n=11) Interview guide was open-ended but included synthesis of known challenges & was iteratively adjusted
Methods Attention to power dynamics Sampling was conducted to saturation Analysis of transcribed data was performed iteratively Research team members with different perspectives discussed emergent themes
Structural Differences All fresh grads & younger (similar ages to CMGs) All articulate in English Culturally normal : to stand up for themselves to vocalize their concerns Caribbean(4), Ireland(3), Australia(2), South Africa, Israel
Results We identified multiple challenges as well as opportunities for interventions as recognized by C-IMGs themselves Results will be discussed in comparison with themes from our previous study of I-IMGs
Challenges
Similar to I-IMGs Stress of complex process of entering residency & AVP It was a very stressful process trying to match, there s very few spots for IMGs (C#4) It s just a lot tougher to get into, if you re an IMG (C#8)
Similar to I-IMGs Intense desire to prove themselves You do have to kind-of prove yourself that you do know what you re talking about, and you re not just an IMG. So that if you make a mistake, they re not going to think, oh, they re an IMG, they don t know what they re doing (C#7)
Similar to I-IMGs Perception of being treated differently and labelled as an IMG I don t know how to describe it, but there was almost like a bias, there was definitely a stereotype that came with the IMG. (C#11) If they do find out you re a CIMG, sometimes they ll change, I don t know if they ll adjust their expectations, you get different impressions from different people. (C#3)
Similar to I-IMGs Perception of being treated differently and labelled an IMG Having the IMG tag associated with you, is a cause for them to ask more questions, and sort-of, investigate further (C#4) It s hard enough, without having to think that someone else thinks you re incompetent just because you went to medical school outside of Canada (C#9)
Appears Similar but Different Context Reporting a clear disorientation phase despite comfort in general Canadian culture it s almost like you re a hidden minority, and no one would recognize that you re an IMG, but you re certainly trying to adjust to a new system (C#3) Because your medical school training was a bit different, the challenges are learning what the differences are, and compensating for them (C#11)
Definitely Different Frustration around focus of mandatory IMG orientation programs on Immigrant-IMGs I thought it was a big waste of time. It was insulting that I had to be re-acclimatized to my own country. (C#11) Sitting in a classroom 8 hours per day, you know, learning about how to hold someone s hand, it was very frustrating. It was terrible. I can t believe I did that (C#9)
Definitely Different Frustration around focus of mandatory IMG orientation programs on Immigrant-IMGs I feel like it really took away a lot of our confidence, I didn t feel singled out at first until I started the (orientation) program (C#7) I found it was just going through the motions of being involved in a four-week program, or however long it was, and I didn t get a lot from it, other than physically occupying my time before residency to participate in this program (C#4)
Opportunities
Similar to I-IMGs Intense desire to help others Anything I could do to help my future IMGs would be appreciated. So I m just trying to help out people who are behind me (C#8)
Similar to I-IMGs An Identified Need for Mentorship I knew it was going to be difficult, but I still, like, wanted someone to talk to about it, and there wasn t enough of that (C#3) I wish there was someone who s a bit senior who could give me this information (C#9) it was difficult to acclimate to the Canadian system. I had a lot of questions. So just a mentor to help you with the general issues (C#8)
Next Steps Mentorship Program: Collaboration with stakeholders, designed & implemented a pilot mentorship program in one Department Orientation Program: (Pre-residency) Local orientation program piloted this past summer Beginning discussions with the provincial stakeholders about ways to improve these programs for this group of IMGs
Next Steps Perception of treated differently Talk to Faculty Transition / Disorientation Residents trained in other universities
Thank You Affiliations: Department of Medicine and Department of Family & Community Medicine, University of Toronto Sunnybrook Health Sciences Centre Office of Resident Wellness, PGME, UofT The Wilson Centre, UHN/UofT Funded by a grant from the Education Development Fund, Faculty of Medicine, University of Toronto