title: 'Being a foreigner, I may be punished if I make a small mistake': assessing transcultural experiences in caring for patients.
abstract: BACKGROUND
  Emotionally charged issues that arise during graduate medical education often are unrecognized and consequently not addressed by training programmes. Little attention has been given to the emotional challenges encountered by international medical graduates (IMG) in caring for patients transculturally.
  
  
  OBJECTIVE
  We aimed to examine the value of qualitative approaches to assessing the transcultural experiences of IMG residents during primary care training.
  
  
  METHODS
  Two qualitative research techniques (the critical incident and the focus group) were used to assess the transcultural challenges in caring for patients of IMG and American medical graduates (AMG) resident in a primary care residency programme. Each resident wrote a narrative describing a challenging experience and facilitators then conducted a focus group to discuss these experiences. Key themes were identified from the written narratives and from the transcript of the videotaped focus group.
  
  
  RESULTS
  Previously unacknowledged feelings emerged during the assessment. Themes of struggles for acceptance, fear of rejection, and fear of disappointing patients were identified from analysis of the written narrative, while themes of struggle to express caring transculturally were identified from the focus group transcript. Based on these findings, significant changes were made to the residency training curriculum.
  
  
  CONCLUSIONS
  Qualitative methods are useful for assessing the transcultural experiences of IMG residents and for informing curricular changes in residency training. These methods may help other training programmes to identify the particular needs of their trainees in addressing emotionally laden experiences.
authors.affiliation: Department of Family Medicine, University of Rochester School of Medicine, Highland Hospital, MN, USA.
authors.forename: K
authors.initials: K
authors.lastname: Fiscella
authors.forename: M
authors.initials: M
authors.lastname: Roman-Diaz
authors.forename: B H
authors.initials: BH
authors.lastname: Lue
authors.forename: R
authors.initials: R
authors.lastname: Botelho
authors.forename: R
authors.initials: R
authors.lastname: Frankel
mesh_terms: D001291:Attitude of Health Personnel; D003431:Cross-Cultural Comparison; D003469:Culture; D004503:Education, Medical, Graduate; D005194:Family Practice / Q000193:education; D017144:Focus Groups; D005550:Foreign Medical Graduates / Q000523:psychology*; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency