It might actually be harder for an international medical grad to be able to practice in this country. Your scores almost have to be twice as good as the scores of the American grad standing next to you to get into residency.
—Rachel George, MD, regional medical director for Cogent Healthcare
Issues that Surface
Program directors of ACGME-accredited residency programs rely on certification by the Educational Commission for Foreign Medical Graduates (ECGMG) to ensure that their prospective residents have met standards of eligibility.
ECGMG certification is also a prerequisite required by most states for licensure to practice medicine. Vijay Rajput, MD, associate professor of medicine and program director of Internal Medicine Residency at UMDNJ-Robert Wood Johnson Medical School in Camden, N.J., and senior hospitalist with Cooper Health System, acknowledges that depending upon their country of origin, IMGs may have difficulties becoming acculturated when it comes time to start practicing medicine. During his time as a residency program director, Dr. Rajput has encountered residents who have problems with hierarchical issues. “A resident may come from a part of the world where they do not like to take orders from women,” he says. “It will be difficult for them to work with peers who are women.”
Hospitalist directors need to exercise good judgment when hiring new members of their team, and ascertain the prospective candidate’s bedside skills with language, communication, and cultural competency, says Dr. Rajput. He believes that evaluation of residents’ interpersonal communications skills varies from program to program.
The “hard skills” pertaining to the resident’s breadth of medical knowledge and technological expertise are easily evaluated by in-service and board examinations, as well as procedures tests. However, the “soft skills” of communication, professionalism, and interpersonal skills are not as easily evaluated.
He suggests hospital program medical directors speak with program directors to glean important information about the candidates’ interpersonal skills, including areas where they might need improvement.
“I think the hospitalist director will have to recognize their own community and the cultural, language, and communication issues in their own hospital’s patient population and then acclimatize their younger hospitalists, providing specific training as part of CME,” Dr. Rajput advises. “The hospitalist director has to keep his or her eyes open and see whether their IMG might need extra training—whether it’s in cultural competencies or ethical principles—because even in our country there are different cultural issues in each community.”
Dr. Rajput, in collaboration with Gerry Whalen, MD, a former vice president at ECFMG, has conducted a pilot acculturation project for the past two years. It entails a one-day program for 40 to 50 IMG participants to acquaint them with challenges they will likely face. This “snapshot” provides an overview of Western medicine’s ethics, bedside skills, insurance issues, and peer-relationship issues.
Pave the Way
Experts suggest various ways leaders of hospital medicine groups can address perception and communication challenges when they surface.
IMGs can be encouraged, for instance, to open their dialogue when meeting patients for the first time by telling them they are welcome to ask questions if there are words or terms they do not understand. In addition, says Dr. George, IMGs can slow the pace of their conversation to be better understood.
Perhaps more important is how the hospital and the practice group introduce new members of the team to their communities. Dr. George advocates a hospital-wide announcement when a new physician joins the hospital medicine team. It’s important that the hospital clearly communicates to the hospital staff and the community at large that the IMG is a “well-trained physician, is highly regarded and respected, has good credentials, was chosen very carefully, and will be a great addition to the team.”