title: Professional challenges of non-U.S.-born international medical graduates and recommendations for support during residency training.
abstract: OBJECTIVE
  Despite a long history of international medical graduates (IMGs) coming to the United States for residencies, little research has been done to find systematic ways in which residency programs can support IMGs during this vulnerable transition. The authors interviewed a diverse group of IMGs to identify challenges that might be eased by targeted interventions provided within the structure of residency training.
  
  
  METHODS
  In a qualitative study conducted between March 2008 and April 2009, the authors contacted 27 non-U.S.-born IMGs with the goal of conducting qualitative interviews with a purposeful sample. The authors conducted in-person, in-depth interviews using a standardized interview guide with potential probes. All participants were primary care practitioners in New York, New Jersey, or Connecticut.
  
  
  RESULTS
  A total of 25 IMGs (93%) participated. Interviews and subsequent analysis produced four themes that highlight challenges faced by IMGs: (1) Respondents must simultaneously navigate dual learning curves as immigrants and as residents, (2) IMGs face insensitivity and isolation in the workplace, (3) IMGs' migration has personal and global costs, and (4) IMGs face specific needs as they prepare to complete their residency training. The authors used these themes to inform recommendations to residency directors who train IMGs.
  
  
  CONCLUSIONS
  Residency is a period in which key elements of professional identity and behavior are established. IMGs are a significant and growing segment of the physician workforce. Understanding particular challenges faced by this group can inform efforts to strengthen support for them during postgraduate training.
authors.affiliation: Division of Health Policy and Administration, Yale University School of Public Health, New Haven, Connecticut 06520-8088, USA. peggy.chen@yale.edu
authors.forename: Peggy Guey-Chi
authors.initials: PG
authors.lastname: Chen
authors.forename: Leslie Ann
authors.initials: LA
authors.lastname: Curry
authors.forename: Susannah May
authors.initials: SM
authors.lastname: Bernheim
authors.forename: David
authors.initials: D
authors.lastname: Berg
authors.forename: Aysegul
authors.initials: A
authors.lastname: Gozu
authors.forename: Marcella
authors.initials: M
authors.lastname: Nunez-Smith
mesh_terms: D000328:Adult; D003142:Communication; D005069:Evaluation Studies as Topic; D005260:Female; D005550:Foreign Medical Graduates / Q000458:organization & administration / Q000592:standards*; D017408:Guidelines as Topic; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000458:organization & administration*; D007400:Interprofessional Relations; D007407:Interviews as Topic; D007588:Job Satisfaction; D008297:Male; D010549:Personal Satisfaction; D012657:Self-Help Groups; D012938:Social Perception; D014481:United States