title: Similarities and differences between international medical graduates and U.S. medical graduates at six Maryland community-based internal medicine residency training programs.
abstract: OBJECTIVE
  Approximately 25% of practicing physicians in the United States are graduates of medical schools in other countries; they are called international medical graduates (IMGs). Their transition into the U.S. health care system may be difficult and challenging. This study sought to identify the similarities and differences between IMGs and U.S. medical graduates (USMGs) working together in residency training programs.
  
  
  METHODS
  In 2006, the authors conducted a cross-sectional survey study of house officers (interns and residents) at six internal medicine (IM) community-based residency programs in Baltimore, Maryland. The survey asked about demographics, relocation for residency training, practice experience, and career plans and included four previously validated instruments: the Iowa Fatigue Scale, Cohen's Perceived Stress Scale, Rosenberg's Self-Esteem Scale, and the Personal Growth Scale.
  
  
  RESULTS
  Of 225 potential house officers, 176 (78%) responded. In multivariable modeling, independent characteristics that differentiated IMGs from USMGs were that IMGs had (1) a native language other than English (odds ratio [OR] 18.3, 95% CI: 5.8-57.3), (2) less debt (<$50K) upon graduation from medical school (OR 7.3, 2.5-21.2), and (3) experiences practicing medicine before residency training (OR 41.02, 1.6-1017). With modeling to control for these three differences, the authors found IMGs to have lower fatigue (OR 2.7; 1.2-6.0), higher self-esteem (OR 3.0; 1.2-7.5), and greater personal growth scores (OR 3.6; 1.6-8.2).
  
  
  CONCLUSIONS
  Differences exist between the IMGs and USMGs who are working together in community-based IM residency training programs. Considering such differences may help educators and program directors trying to support and train this diverse cadre of trainees.
authors.affiliation: Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. aysegul.gozu@medstar.net
authors.forename: Aysegul
authors.initials: A
authors.lastname: Gozu
authors.forename: David E
authors.initials: DE
authors.lastname: Kern
authors.forename: Scott M
authors.initials: SM
authors.lastname: Wright
mesh_terms: D000328:Adult; D002321:Career Choice; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D003710:Demography; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D005550:Foreign Medical Graduates / Q000523:psychology / Q000706:statistics & numerical data*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008396:Maryland; D012649:Self Concept; D013315:Stress, Psychological / Q000453:epidemiology