Educational interventions for international medical graduates: a review and agenda

Context: International medical graduates (IMGs) play key roles in the health systems of their host countries, but face unique challenges, which makes the provision of effective, tailored support for IMGs essential.

Objectives: Research on the effectiveness of educational interventions for IMGs was reviewed to characterise current knowledge and guide future research and education.

Methods: PubMed, Web of Science and EMBASE were searched for relevant articles published to October 2014, describing a systematic evaluation of educational interventions designed for IMGs that included at least one post-intervention outcome. Articles were coded independently by two or more researchers for content and methodology, and discussed to reach consensus.

Results: Twenty-two articles were identified, describing a wide variety of interventions, content and durations of intervention. Clinical topics and general principles of cross-cultural competency were the most common content areas included in curricula (13 and 12 articles, respectively). All studies deemed the interventions evaluated to be successful. However, only one study drew from theory on cross-cultural differences to guide either the curriculum or evaluation. Additionally, study designs were generally weak; no studies featured random assignment to treatment versus control groups, most studies did not use control groups at all, and no studies compared the effectiveness of different interventions.

Conclusions: Research into education for IMGs is critically important but currently underdeveloped. An abundance of justification studies and lack of clarification studies parallel other areas of medical education. Academic fields outside medical education, such as those of cross-cultural psychology and expatriate management, are highly relevant; researchers from these areas should be sought for collaboration. Future research should employ conceptual frameworks in order to facilitate a broader, more nuanced consideration of the diversity of individual IMGs, educational and medical contexts, interventions and outcomes. Rigorous comparative effectiveness research is lacking, but represents a promising avenue for future scholarship.