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International Medical Graduates (IMGs) in the UK—a Systematic Review of Their Acculturation and Adaptation

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Abstract

International medical graduates (IMGs) constitute about 23–28 % of the medical workforce providing support and contribution to the UK, Canada, USA and Australia. This review will inform the need for trainers, deaneries and colleges to plan and develop strategies to enhance the potential of IMGs. The authors aim to review and inform the relevant authorities about the barriers faced by IMGs in training and career progression in the UK health service. Two hundred forty-eight studies were reviewed at step 1; 54 were excluded on the basis of selection criteria, and further 115 studies were excluded which did not focus on issues discussed in the selection criteria; and after reviewing 79 studies, a further 20 were excluded for methodological qualities, and finally, 59 were included. The results have been discussed under various themes which emerged as significant issues related to IMGs. Seeking better life and higher education and training are the main reasons for migration. The training process of IMGs in their own countries impacts on the transition process results in struggling career progression. The most crucial impediment in the path of career progression is the process of passing examinations which IMGs face during their career struggle. The psychological aspects of migration and legal and ethical issues are found to be significant for IMGs. They also struggle with the adaptations needed with reference to learning and teaching styles resulting in the change of multiple specialties. IMGs contributed significantly to not only filling the space of under-recruitment but also serving comprehensively in a variety of specialties. There has been a consistent decline in preferring some specialties as career option among UK medical graduates and medical students. IMGs migrate to foreign countries in pursuit of better medical education, desire for better income, general security and improved prospects for the family, but in doing so, they are confronted with psychosocial problems, cultural differences, hurdles in career progression and passing exams.

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References

  • Abdulrahman, K. A. (2008). The current status of medical education in the Gulf Cooperation Council countries. Annals of Saudi Medicine, 28, 83–88.

    Article  Google Scholar 

  • Abraham, R. R., Vinod, P., Kamath, M. G., Asha, K., & Ramnarayan, K. (2008). Learning approaches of undergraduate medical students to physiology in a non-PBL- and partially PBL-oriented curriculum. Advances in Physiology Education, 32, 35–37.

    Article  Google Scholar 

  • Allan, J., Clarke, K., & Jopling, M. (2009). Effective teaching in higher education: perceptions of first year undergraduate students. International Journal of Teaching and Learning in Higher Education, 21(3), 362–372.

    Google Scholar 

  • Arthur, G. K., Brooks, R., & Long, M. L. (1979). A language-cultural course for foreign psychiatric residents. American Journal of Psychiatry, 136, 1064–1067.

    Article  Google Scholar 

  • Astor, A., Akhtar, T., Matallana, M. A., Muthuswami, V., Oluwu, F. A., Tallo, V., et al. (2005). Physician migration: views from professionals in Columbia, Nigeria, India, Pakistan and the Philippines. Social Science and Medicine, 61, 2492–2500.

    Article  Google Scholar 

  • Ayres, P., Rigby, A. S., & Williams, R. (1996). Part 1 of Membership of the faculty of public health medicine. Trends over time and factors associated with success in recent years. Journal of Public Health Medicine, 18, 390–395.

    Article  Google Scholar 

  • Bates, J., & Andrew, R. (2001). Untangling the roots of some IMGs’ poor academic performance. Academic Medicine, 76, 43–46.

    Article  Google Scholar 

  • Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46(1), 5–34.

    Google Scholar 

  • Bessant, R., Bessant, D., Chesser, A., & Coakley, G. (2006). Analysis of predictors of success in the MRCP (UK) PACES examination in candidates attending a revision course. Postgraduate Medical Journal, 82(964), 145–149.

    Article  Google Scholar 

  • Bornat, J., Henry, L., & Raghuram, P. (2009). Overseas-trained South Asian doctors and the development of geriatric medicine. The Open University. http://www.open.ac.uk/hsc/__assets/GeriatricMedicineFindings.pdf.

  • Boulet, J. R., Norcini, J. J., Whelan, G. P., Hallock, J. A., & Seeling, S. S. (2006). The international medical graduate pipeline: recent trends in certification and residency training. Health Affairs, 25(2), 469–477.

    Article  Google Scholar 

  • British Broadcasting Corporation (BBC). (2000). NHS to draft in foreign doctors. http://cdnedge.bbc.co.uk/1/hi/health/917438.stm.

  • British Medical Association. (2009). Cohort study 2006 medical graduates, second report. London: BMA.

    Google Scholar 

  • British Medical Association. Clinical Attachments guidelines for International Medical Graduates. http://bma.org.uk/practical-support-at-work/immigration/doctors-new-to-the-uk/finding-a-post.

  • British Medical Association. ‘Tackling racism in medical careers: the role of consultants’ BMA Policy paper 2005. 2006 http://www.bma.org.uk/equality_diversity/ethnicity/TacklingRacisminMedicalCareers.jsp.

  • Brockington, I. F., & Mumford, D. B. (2002). Recruitment into psychiatry. British Journal of Psychiatry, 180, 307–312.

    Article  Google Scholar 

  • Brookfield, S. D. (1987). Developing Critical Thinkers. The Jossey-Bass higher education series and the Jossey-Bass management, San Francisco.

  • Brookfield, S. D. (1993). The development of critical reflection in adulthood. New Education, 13(1), 39–48.

    Google Scholar 

  • Brown, N., Vassilas, C., & Oakley, C. (2009). Recruiting psychiatrists—a sysphean task. Psychiatric Bulletin, 33, 390–392.

    Article  Google Scholar 

  • Buchanan, M. Doctor shortage sees new recruitment drive in India. British Broadcasting Corporation (BBC). Reported on 1 June 2010. http://www.bbc.co.uk/news/10202803.

  • Buske, L. (2002). Canada’s cosmopolitan medical profession. Canadian Medical Association Journal, 166(10), 1320.

    Google Scholar 

  • Camp, G. (1996). Problem-based learning: a paradigm shift or a passing fad? Medical Education Online, 1, 2. http://www.studentaffairs.columbia.edu/sites/dsa/files/PBL_Paradigm_or_Fad.pdf.

  • Cooke, L., Halford, S., & Leonard, P. (2003). Racism in the medical profession: the experience of UK graduates. Health Policy and Economic Research Unit, British Medical Association.

  • Crutcher, R., Banner, S., Szafran, O., & Watanabe, M. (2002). Characteristics of international medical graduates who apply to the Canadian Resident Matching Service (CaRMS) match. Canadian Medical Association Journal, 168(9), 1119–1123.

    Google Scholar 

  • Decker, K. (2001). Overseas doctors: past and present’. In N. Coker (Ed.), Racism in medicine. London: King’s Fund.

    Google Scholar 

  • Durey, A. (2005). Settling in: overseas trained GPs and their spouses in rural Western Australia. Rural Society, 15(1), 38–54.

    Article  Google Scholar 

  • Esmail, A., & Everington, S. (1993). Racial discrimination against doctors from ethnic minorities. British Medical Journal, 306, 691–692.

    Article  Google Scholar 

  • Fazel, S., & Ebmeier, K. P. (2009). Specialty choice in UK junior doctors: is psychiatry the least popular specialty for UK and international medical graduates? BioMed Central Medical Education, 9, 77.

    Article  Google Scholar 

  • Feifel, D., Yu Moutier, C., & Swerdlow, N. R. (1999). Attitudes toward psychiatry as a prospective career among students entering medical school. American Journal of Psychiatry, 156, 1397–1402.

    Google Scholar 

  • Fernandez, A., Wang, F., Braveman, M., Finkas, L. K., & Hauer, K. E. (2007). Impact of student ethnicity and primary childhood language on communication skill assessment in a clinical performance examination. Journal of General Internal Medicine, 22(8), 1155–1160.

    Article  Google Scholar 

  • Gadit, A. A. M. (2008). International migration of doctors from developing countries: need to follow the Commonwealth Code. Journal of Medical Ethics, 34, 67–68.

    Article  Google Scholar 

  • Galeazzi, G. M., Secchi, C., & Curci, P. (2003). Current factors affecting the choice of psychiatry as a specialty: an Italian study. Academic Psychiatry, 27, 74–81.

    Article  Google Scholar 

  • General Medical Council. (2011). English Language requirements. http://www.gmc-uk.org/doctors/registration_applications/language_proficiency.asp.

  • General Medical Council. (2011). Postgraduate Education and Training. http://www.gmc-uk.org/education/postgraduate.asp.

  • Ghanaian Doctors and Dentists Association (GDDA). (2005). Recent changes to postgraduate medical education and training in the UK. http://www.gdda-uk.com/downloads/PLAB_Warning2.pdf.

  • Goodyear, H. (2009). Career guidance: how do we inspire students and young doctors to careers in paediatrics and child health? Archives of Disease in Childhood. Education and Practice Edition, 94, 87–91.

    Article  Google Scholar 

  • Goodyear, H., Kennedy, C., & Wall, D. (2007). Career choices: foundation year trainees’ views on careers advice and information. British Journal of Hospital Medicine, 68(4), 211–215.

    Article  Google Scholar 

  • Harden, R. M., Sowden, S., & Dunn, W. R. (1984). Educational strategies in curriculum development: the SPICES model. Medical Education, 18, 284–297.

    Article  Google Scholar 

  • Hashmi, A. (2009). Communication skills of overseas doctors and training implications for psychiatry. The Psychiatrist, 33, 275.

    Google Scholar 

  • Humphrey, C., Hickman, S., & Gulliford, M. C. (2011). Place of medical qualification and outcomes of UK GMC “Fitness to Practice” process: cohort study. British Medical Journal, 342, d1817.

    Article  Google Scholar 

  • Hussain, A., & Husni, M. (2010). Preparing for the MRCPsych CASC—an insight based on experience. British Journal of Medical Practitioners, 3(2).

  • Jaques, H. (2011). Pass rate falls in PLAB test for IMG. British Medical Journal Careers.

  • Kilpatrick, S., Johns, S., Vitartas, P., & Homisan, M. (2011). Mobile skilled workers: making the most of an untapped rural community resource. Journal of Rural Studies, 27(2), 181–190.

    Article  Google Scholar 

  • Koh, G. C., Khoo, H. E., Wong, M. L., & Koh, D. (2008). The effects of problem-based learning during medical school on physician competency: a systematic review. Canadian Medical Association Journal, 178(1), 34–41.

    Article  Google Scholar 

  • Lassers, E., & Nordan, R. (1975). Difficulties in postgraduate training of foreign paediatric residents and interns in child psychiatry. British Journal of Medical Education, 9, 286–290.

    Article  Google Scholar 

  • Mahajan, J., & Stark, P. (2007). Barriers to education of overseas doctors in paediatrics: a qualitative study in South Yorkshire. Archives of Diseases in Childhood, 92(3), 219–223.

    Article  Google Scholar 

  • Majumder, A. A., D’Souza, U., & Rahman, S. (2004). Trends in medical education: challenges and directions for need-based reforms of medical training in South-East Asia. Indian Journal of Medical Sciences, 58, 369–380.

    Google Scholar 

  • Malik, A., White, O., & Bagalkote, H. (2007). Local clinical attachment scheme in psychiatry. The Psychiatrist, 31, 142–144.

    Google Scholar 

  • Martin, D. (2007). Overseas doctors ‘taking too many jobs’. Daily Mail. http://www.dailymail.co.uk/health/article-482992/Overseas-doctors-taking-jobs.html.

  • McManus, I. C., Richards, P., Winder, B. C., & Sproston, K. A. (1996). Final examination performance of medical students from ethnic minorities. Medical Education, 30, 195–200.

    Article  Google Scholar 

  • McParland, M., Noble, L. M., & Livingston, G. (2004). The effectiveness of problem-based learning compared to traditional teaching in undergraduate psychiatry. Medical Education, 38(8), 859–867.

    Article  Google Scholar 

  • Mian, T. A. (1994). Limited registration and racial discrimination. British Medical Journal, 308, 208.

    Article  Google Scholar 

  • MRCGP Statistics. (2010). Third report (January–May 2010) on the results of MRCGP AKT and CSA assessments. http://www.rcgp-curriculum.org.uk/pdf/MRCGP%20Statistics%202010%20(Jan-May)%20Third%20Report%20v070411.pdf. Pages 22.

  • Mullan, F. (2005). The metrics of the physician brain drain. New England Journal of Medicine, 353, 1810–1818.

    Article  Google Scholar 

  • Oikelome, F., & Healy, G. (2007). Second-class doctors? The impact of a professional career structure on the employment conditions of overseas- and UK-qualified doctors. Human Resource Management Journal, 17(2), 134–154.

    Article  Google Scholar 

  • Oyebode, F., & Furlong, E. (2007). MRCPsych examinations: cumulative results 1997–2002. Psychiatric Bulletin, 31, 61–64.

    Article  Google Scholar 

  • Pilotto, L. S., Duncan, G. F., & Anderson-Wurf, J. (2007). Issues for clinicians training IMGs: a systematic review. Medical Journal of Australia, 187(4), 225–228.

    Google Scholar 

  • Roberts, C., Sarangi, S., Southgate, L., Wakeford, R., Wass, V., Esmail, A., et al. (2000). Oral examinations equal opportunities, ethnicity, and fairness in the MRCGP. Commentary: oral exams get them right or don’t bother. British Medical Journal, 320, 370–375.

    Article  Google Scholar 

  • Sandhu, D. P. S. (2005). Current dilemmas in overseas doctors’ training. Postgraduate Medical Journal, 81, 79–82.

    Article  Google Scholar 

  • Scottish Committee on Postgraduate Medical and Dental Education (SCPMDE). (1996). Meeting the educational needs of staff grade doctors and dentists in Scotland. Edinburgh: SCPMDE.

    Google Scholar 

  • Scottish Council for Postgraduate Medical Education (SCOMPME). (1994). The educational needs of staff grade doctors and dentists. London: SCOPME.

    Google Scholar 

  • Selzer, R., & Ellen, S. (2010). Twelve tools for teaching medical students. Australasian Psychiatry, 18(2), 170–173.

    Article  Google Scholar 

  • Sharif, I. (2003). The learning problems of overseas. Part 2. MRCOG candidates. In J. Studd (Ed.), Progress in obstetrics and gynaecology (Vol. 15, pp. 1–15). Edinburgh: Churchill Livingstone.

    Google Scholar 

  • Shiwani, M. H. (2006). Plight of immigrant doctors in UK: grass is not that green. The Journal of Pakistan Medical Association, 56(6), 251–252. http://www.jpma.org.pk/PdfDownload/710.pdf.

  • Singh, S. (1994). Cultural adjustment and the overseas trainee. British Medical Journal, 308, 1169.

    Article  Google Scholar 

  • Singhal, K., & Ramakrishnan, K. (2004). Training needs of international medical graduates seeking residency training: evaluation of medical training in India and the United States. The Internet Journal of Family Practice, 3(1).

  • Slowther, A., Hundt, G. L., Taylor, R., & Purkis, J. (2009). Non UK qualified doctors and good medical practice: the experience of working within a different professional framework. Report for GMC. University of Warwick.

  • Stern, C. (2005). Career intentions and the impact of career advice on PRHOs in their second 6 month placement. British Journal of Hospital Medicine, 66, 477–479.

    Article  Google Scholar 

  • Stewart, E. (2003). A bitter pill to swallow: obstacles facing refugee and overseas doctors in the UK, UNHCR. http://www.unhcr.org/publ/RESEARCH/3fbb94a32.pdf.

  • Supe, A., & Burdick, W. P. (2006). Challenges and issues in medical education in India. Academic Medicine, 81(12), 1076–1080.

    Article  Google Scholar 

  • Tavakol, M., Murphy, R., Torabi, S. (2006). Medical education in Iran: an exploration of some curriculum issues. Medical Education Online, 11, 5. http://www.med-ed-online.net/index.php/meo/article/viewFile/4585/4764.

  • Terry, D., Lê, Q., Woodroffe, J., & Ogden, K. (2011). The quality of life and social needs of international medical graduates: emerging themes in research. International Journal of Innovative Interdisciplinary Research, 1(1), 59–67.

    Google Scholar 

  • The Edinburgh Declaration, Medical Education. (1988). 22, 481–482.

  • The Information Centre for Health and Social Care. (2008). NHS Staff 1997–2007. Overview and NHS Hospital and Community Health Services: medical and dental staff England 1998–2008. www.ic.nhs.uk/statistics-and-data-collections/workforce/nhs-staff-numbers/nhs-staff-1997--2007-overview.

  • The Royal College of General Practitioners. (2010). Clinical skills assessments. http://www.rcgp-curriculum.org.uk/nmrcgp/csa.aspx.

  • The Royal College of Psychiatrists. (2008a). Royal College of Psychiatrists welcomes ruling that plans to give UK-trained doctors priority in applying for jobs was “wrong and unlawful”. http://www.rcpsych.ac.uk/press/pressreleases2008/pr2.aspx.

  • The Royal College of Psychiatrists. (2008b). RCPsych news August. http://www.rcpsych.ac.uk/members/rcpsychnews/enewsletters2008/august2008.aspx.

  • The Royal College of Psychiatrists. (2011). Trainees section. http://www.rcpsych.ac.uk/specialtytraining/trainees.aspx.

  • The Royal College of Psychiatrists Annual Specialty Report 2008 / 09. http://www.rcpsych.ac.uk/pdf/ASR%20in%20Psychiatry.pdf.

  • Turner, G., Lambert, T. W., Goldacre, M. J., et al. (2007). Career choices for paediatrics: national surveys of graduates of 1974–2002 from UK medical schools. Child Care Health Development, 33, 340–346.

    Article  Google Scholar 

  • Tyrer, S. P., Leung, W. C., Smalls, J., & Katona, C. (2002). The relationship between medical school of training, age, gender and success in the MRCPsych examinations. Psychiatric Bulletin, 26, 257–263.

    Article  Google Scholar 

  • Vassilas, C., Kuruvilla, T., Gupta, V., & El-Nadeef, M. (2007). Preparing trainees for the MRCPsych examinations. Advances in Psychiatric Treatment, 13, 239–250.

    Article  Google Scholar 

  • Wong, A., & Lohfeld, L. (2008). Recertifying as a doctor in Canada: international medical graduates and the journey from entry to adaptation. Medical Education, 42(1), 53–60.

    Article  Google Scholar 

  • Woolf, K., Potts, H. W. W., & McManus, I. C. (2011). Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis. British Medical Journal, 342, d901.

    Article  Google Scholar 

  • Yedidia, M. J., Gillespie, C. C., Kachur, E., Schwartz, M. D., Ockene, J., & Chepaitis, A. E. (2003). Effect of communications training on medical student performance. The Journal of the American Medical Association, 290, 1157–1165.

    Article  Google Scholar 

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Khan, F.A., Chikkatagaiah, S., Shafiullah, M. et al. International Medical Graduates (IMGs) in the UK—a Systematic Review of Their Acculturation and Adaptation. Int. Migration & Integration 16, 743–759 (2015). https://doi.org/10.1007/s12134-014-0368-y

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