Victor Castilla M.D . Post – Observership Participant UCLA International Medical Graduate (IMG) Program July 1 st , 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

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.

NO

NO

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, MACP Spanish 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

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.

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

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.

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

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.

YES

YES

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 2008 http://www.im.org/AAIM/Meetings/PastMeetings/2008/APDIM/workshop2.pdf

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.

Wrong choice of career Change to another specialty Unhappy with matched program Dissatisfaction with clinical & educational experience Loss of interest (Burnt out) Rigors of the specialty: long days & nights Domestic problems lllness 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

Wrong choice of career

Change to another specialty Unhappy with matched program Dissatisfaction with clinical & educational experience Loss of interest (Burnt out) Rigors of the specialty: long days & nights Domestic problems lllness or death

1. Inadequate level of medical/surgical knowledge 2. Poor command of English, both receptive and expressive 3. Difficulty in adapting to the technology/procedures in U.S. hospitals 4. Poor time management and multitasking techniques 5. Poor synthetic reasoning skills and inability to understand how to execute standard 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. Inadequate level of medical/surgical knowledge 2. Poor command of English, both receptive and expressive 3. Difficulty in adapting to the technology/procedures in U.S. hospitals 4. Poor time management and multitasking techniques 5. Poor synthetic reasoning skills and inability to understand how to execute standard surgical algorithms in patient evaluation and management

1. Interpersonal difficulties with faculty, residents, and staff 2. Lack of acceptance of deficiencies and inability to accept constructive criticism 3. Poor work ethic 4. Poor adjustment to the fast pace of residency training in large, multihospital systems 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 staff 2. Lack of acceptance of deficiencies and inability to accept constructive criticism 3. Poor work ethic 4. Poor adjustment to the fast pace of residency training in large, multihospital systems

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

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

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

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

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

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

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.

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

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.

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

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.

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.

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

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Collaboration is Paramount

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. Rodolfo A. Armas-Merino, MD, MACP Spanish 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

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.

Rodolfo A. Armas-Merino, MD, MACP Spanish 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

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