There is a significant need for IMGs to be educated in cultural issues including doctor-patient communication practices in Australia.

There is an increasing international movement of physicians, with substantial numbers of International Medical Graduates (IMGs) now seeking jobs outside the countries in which they were educated. For IMGs there are potential elements of crisis and loss associated with this transition. This article presents findings from Australian-based research which explores the IMGs' experience during entry to their chosen country and posits the need for a designated liaison officer to help support the transition. The research was based on thirty open-ended, qualitative interviews which were coded and thematically analyzed. The findings document factors associated with the decision to leave their country of origin, psycho-social aspects of stress experienced upon arrival in Australia, and the participants' perspective on the suggestion for the appointment of a hospitalbased liaison officer to assist IMGs during the transition process.

Issues associated with speech and language have been noted in the international literature as an important aspect of the process of integration for Australian International Medical Graduates (IMGs). This paper makes a contribution through the presentation of a sub-set of findings on the factors associated with speech and language practices for IMGs, taken from a qualitative study which examined the IMGs’ experience of integration into the Australian healthcare system. A purposive sample of 30 IMGs were interviewed via telephone. Participants were asked to share their experience with communicating in English with patients and other health professionals in the context of the Australian healthcare system. The taped interviews were transcribed verbatim and then coded and thematically analysed. The findings indicate that the months following the point of entry into a medical position are a critical time for the majority of IMGs in terms of difficulties with communicating in English. A range of suggestions to improve speech and language skills for IMGs is provided. The findings emphasize the importance of speech and language skills and the serious implications of this issue for the clinical practice of IMGs.

Objective. In Australia, 25% of international medical graduates (IMGs) make up the medical workforce. Concern is expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs’ education. Although there is literature alluding to difficulties IMGs face with undertaking the Australian Medical Council (AMC) examination, there is little research detailing this experience. We therefore explored IMGs’ reflections on facilitators and barriers in undertaking the AMC examination. Methods. After ethics approval, in-depth telephone interviews were conducted with 30 IMGs selected from a hospital in Queensland. Data were coded and analysed using thematic analysis principles. Results. Two facilitating themes were identified: ability to sit for the first part of the examination in country of origin; and having access to resources such as bridging courses and study groups. Three themes represented barriers: not understanding procedural steps; financial issues; and lack of information on examination content and standards. Conclusion. The themes provide new insights and add depth to existing literature that can be used to improve procedural processes and education for IMGs towards successful outcomes in the AMC examination. What is known about the topic? There is concern expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs education. The Australian work that is available only depicts educational experience of fellowships or education and training strategies after IMGs have passed their AMC examination. What does this paper add? The findings indicate that the process of sitting for the AMC examination is perceived as one of the major difficulties associated with entering and integrating into the Australian health system. The findings indicate a range of practical, financial and resource problems faced by IMGs attempting to sit for the AMC examination. What are the implications for practitioners? The detailed accounts from IMGs about their experience with undertaking the AMC examination will provide up-skilling program coordinators with the information they need to better assist IMGs to prepare for the examination. The provision of appropriate medical training and educational support will contribute to more effective integration of IMGs into the healthcare system.

Objective Herein we record the experience of clinical supervisors of international medical graduates (IMGs) working as junior staff in a district hospital by examining supervisor perspectives on IMG performance, the factors affecting their performance and the requirements of supervision under these circumstances. Methods The present study had an open-ended exploratory qualitative design. Thirteen 13 open-ended, in-depth interviews were undertaken with supervisors of IMGs employed in a public district hospital in Queensland, Australia. Results The supervisors reported that, although performance was an individual and variable characteristic, IMGs tended to perform less well than Australian graduates and required more intensive supervision. Factors that affected performance were motivation and experience, and specifically lack of familiarity with the Australian healthcare system, lack of recent of practice, education, language, communication and cultural factors. English language proficiency was regarded as crucial to performance. Conclusions The additional work required to supervise IMGs in order to enable them to perform at a satisfactory level and successfully integrate into the Australian healthcare system needs to be recognised and resourced. Assistance with attaining proficiency in English and with communication skills over and above the standard required to pass the International English Language Testing System examination should be seriously considered as a means of improving performance. What is known about the topic? To date, there is little research available about the experience of supervisors of IMGs in Australia. What does this paper add? The findings of the present study make an important contribution to the literature by examining the critical role clinical supervisors of IMGs have in helping IMGs adapt to the Australian healthcare system and ensuring that they are able to provide quality health care. It identifies current challenges and highlights areas in need of attention to ensure a strong healthcare system for Australia. What are the implications for practitioners? Supervisors of IMGs need recognition of the extra time and expertise required in their role if they are to be effectively supported in their endeavours to integrate IMGs into the Australian health workforce. More attention needs to be given to the development of English language proficiency of IMGs, including colloquial usage, and communication in medical practice.

Rates of palliative enrollment for persons with diabetes are increasing. Diabetes care providers need to prepare patients and their families for changes in diabetes management that will be beneficial as end of life approaches. Collaboration among chronic disease programs, palliative care and primary care is advised to identify persons at end of life who have diabetes and to develop and implement care guidelines for this population.

Objective. This paper presents the findings of research which explored how International Medical Graduates (IMGs) understand and integrate with the allied health system in relation to multidisciplinary care. Methods. An open-ended, exploratory qualitative design comprised of thirty (n = 30) open-ended, in-depth interviews with IMGs employed in a public hospital in Queensland, Australia. Results. Many IMGs have no experience with allied health support in their country of origin. Multidisciplinary collaboration is a new concept for IMGs integrating into the Australia healthcare system. Learning about the allied health system, including how to work effectively within the context of the multidisciplinary team, is an important topic that needs to be addressed as a matter of priority. Conclusions. There is a strong need to focus on improving strategies for integrating IMGs into the allied health system. In particular, IMGs require information to help them understand the roles and referral processes associated with interfacing with the allied health system. What is known about the topic? To date, there is no research available on the important topic of how IMGs understand and integrate with the allied health system in relation to multidisciplinary care in the Australian healthcare system. What does this paper add? The present findings make an important contribution to the literature by highlighting the need to focus on integrating IMGs into the allied health system. The findings presented in this paper indicate that, for the range of reasons summarised the IMGs’ understanding of the allied health system is limited. What are the implications for practitioners? The IMGs in this study called for assistance in understanding the allied health system, a process they considered difficult to do on their own. The strong recommendation is that it is most appropriate for allied health professionals in the hospital to take such leadership, and such efforts will be met by a readiness to learn on the part of the IMGs.

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