Supporting international medical graduates’ transition to their host-country: realist synthesis

Abstract

ContextMany health services and systems rely on the contribution of international medical graduates (IMGs) to the workforce. However, concern has grown around their regulation and professional practice. There is a need, in the absence of strong evidence and a robust theoretical base, for a deeper understanding of the efficacy of interventions used to support IMGs’ transition to their host countries. This study seeks to explore and synthesise evidence relating to interventions developed for IMGs. It aims to provide educators and policy makers with an understanding of how interventions should be developed to support IMGs in their transition to the workplace, particularly looking to identify how and why they are effective.MethodsThe realist synthesis involved an initial systematic search of the literature for the period January 1990 to April 2015. Secondary searches were conducted throughout the review in order to inform and test the developing programme theory. The context, mechanism and outcome data were extracted from all sources meeting the inclusion criteria. Fourteen case studies were included to further aid theory refinement.ResultsSixty‐two articles were identified, describing diverse interventions of varying intensity. A further 26 articles were identified through a secondary search. The findings illustrate that, alongside a developed programme, ongoing support and cultural awareness at organisational and training levels are crucial. Individual differences must also be taken into consideration. This will ensure that IMGs engage in transformative learning, increase their levels of self‐efficacy and cultural health capital, and reduce feelings of stress and anxiety. These factors will have an impact on work, interactions and cultural adjustment.ConclusionsOrganisational, training and individual contexts all play a role in IMGs’ adjustment during the transition process. Establishing ongoing support is critical. A list of recommendations for implementation is given.

Comparison of the British and Nigerian Medical Councils’ Codes of Practice: Implications for Postgraduate Medical Training

“…Comprehensive and mandatory induction should be provided as early as possible before IMGs begin practice; IMGs would benefit from an individualised needs assessment and their supervisors should be aware of these individual needs and provide on-going feedback. Kehoe et al (2016) also suggest the assignment of buddies to IMGs. Mentorship programmes, hosted by the receiving hospitals or training programmes could also be useful in pairing new IMG trainee doctors with more experienced doctors who share similar cultural background or social experiences.…”

“…The above comparison of codes of practice broadens our understanding of some of the systemic differences that crystallise difficulties for IMGs. By addressing these areas of differing emphases, through targeted interventions, the chances of IMGs succeeding in their training may be improved (Kehoe et al, 2016;Dahm & Cartmill, 2016).…”

“…Kehoe et al (2016), suggests that information about work, culture and general issues should be sent to IMGs at the earliest opportunity, before commencement of work. Comprehensive and mandatory induction should be provided as early as possible before IMGs begin practice; IMGs would benefit from an individualised needs assessment and their supervisors should be aware of these individual needs and provide on-going feedback.…”

“…Policies can also guarantee that diversity in postgraduate medical education is taken more seriously, with better understanding and appreciation of differing learning styles and cultural experiences. Experiential learning opportunities for IMGs are needed to ensure that new practices are adopted and transferred into practice (Kehoe et al, 2016).…”

Organisational perspectives on addressing differential attainment in postgraduate medical education: a qualitative study in the UK

“…This is important since organisational factors predict job performance and satisfaction in general,8 and because a supportive organisational culture has been found to be crucial in facilitating IMGs’ transition into UK clinical practice 9…”