International medical graduate-patient communication: a qualitative analysis of perceived barriers.
OBJECTIVE
International medical graduates (IMGs) represent a substantial portion of all medical residents in the United States. Yet, IMGs may be disadvantaged in their communications with U.S. patients for a variety of reasons. The authors conducted a qualitative study to examine IMGs' perceptions of the barriers to their communication with patients.


METHODS
A convenience sample of 12 IMGs participated in interviews that lasted 1 to 1.5 hours. Residents from the Caribbean, Colombia, Denmark, India, Iran, Pakistan, and Peru participated in individual interviews conducted on-site at one of three clinics. Interviews were transcribed and then coded independently and jointly. The authors used a qualitative analysis of interview transcripts to identify primary and secondary themes.


RESULTS
IMGs' perceptions of the barriers to communication with their Appalachian patients fit into two broad themes: educational barriers and interpersonal barriers. Within each of these themes, the authors identified secondary themes: education-related barriers were science immersion and lack of communication training, and interpersonally related barriers were unfamiliar dialects, new power dynamics, and different rapport-building expectations.


CONCLUSIONS
The analysis of the interview data yielded several important findings that residency programs should consider when designing orientations, training curricula, and communication interventions. Programs may need to address challenges related to regional dialect and "informal" English use, as well as communication barriers associated with cross-cultural differences in norms, values, and beliefs. Programs also need to draw on multilayered interventions to address the multidimensional challenges of cross-cultural physician-patient communication.
Department of Communication, East Tennessee State University, Johnson City, Tennessee 37604, USA. dorgan@etsu.edu
Kelly A
KA
Dorgan
Forrest
F
Lang
Michael
M
Floyd
Evelyn
E
Kemp
D000328:Adult; D003142:Communication; D003469:Culture; D003479:Curriculum; D004522:Educational Status; D005194:Family Practice / Q000193:education; D005260:Female; D005550:Foreign Medical Graduates / Q000523:psychology / Q000592:standards; D006801:Humans; D038622:Internationality; D007396:Internship and Residency / Q000706:statistics & numerical data; D007802:Language; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012938:Social Perception; D012959:Socioeconomic Factors; D014481:United States