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

Khan, Farooq; Chikkatagaiah, Shivaram; Nasiri, Maryam; Saraf, Anoop; Sehgal, Tarun; Rana, Ashish; Tadros, George; Kingston, Paul

doi:10.1007/s12134-014-0368-y

Cited by 30 publications

(27 citation statements)

References 53 publications

(74 reference statements)

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“…Systematic reviews on migration of HRH, in the literature, have focused on trends in workforce migration [ 57 ], but not compared the motives across health care professionals. Integration studies have focused on qualitative thematic analyses of lived experiences, particularly in relation to nurses [ 54 , 58 , 59 ] and on doctors [ 60 ], but none on dentists. This review is a starting point examining the drivers of migration and integration experiences of the three professions of nursing, medicine and dentistry, which are different in relation to the professional’s control of their work environment, their professional and social identities [ 17 , 20 , 27 , 28 , 36 , 38 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis

2018

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ObjectiveThe aim of this review was to examine the migration motives, the barriers to and facilitators of integration of international dental graduates, compared with nurses and doctors in the United Kingdom.MethodsElectronic databases Ovid MEDLINE, EMBASE, PubMed, Web of Knowledge and OECD publications were systematically searched for English language publications from January 2000 to January 2017. A total of 31 qualitative studies were selected and quality appraised and meta-synthesis of the qualitative data was carried out using framework synthesis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to present the findings.ResultsThere were no studies on migration motives and one study on integration experiences of international dentists in the UK. The nursing literature had the highest volume and quality of evidence on nursing workforce, whilst there was limited literature on international doctors in the UK.Migration of health professionals to the UK is determined by personal and professional factors, together with source country-specific and UK drivers. Active recruitment, post graduate training and financial gain act as strong common macro, meso and micro drivers that perpetuate migration into the UK, but the extent to which each of these drivers influence nurses’ and doctors’ migration is different.Integration experiences for international nurses and doctors differed based on their source country experiences and the work environment they entered. Nurses reported a wider knowledge and skills gap, more multi-level discrimination and less career progression compared to the doctors. The migrants’ integration experiences depend on their cultural awareness, discrimination exposure, English language and communication skills, social and professional support networks, social integration and personal attributes.ConclusionMigration of international health professionals is motivated by macro, meso and micro drivers at the international, national, professional and personal levels. The UK has strong common macro pull factors which attract nurses, doctors and dentists and may impact on the effectiveness of policies to restrict their migration. The integration experiences of nurses and doctors differ and further research is required to understand the integration experiences of dentists, in order to retain these professionals by tailoring policies to each of these professions.Electronic supplementary materialThe online version of this article (10.1186/s12960-018-0293-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis

2018

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“…These topics also emerged in this review but were—except for patient-centered care—described as differences of the home and the new culture and not as problems. In addition, difficulties for the foreign physicians with the concept of shared decision-making as described by Khan et al (2014) [ 10 ] were not found. The results of this review indicate that the IMGs did not consider this concept as problematic.…”

Section: Discussionmentioning

confidence: 99%

Dealing with foreign cultural paradigms: A systematic review on intercultural challenges of international medical graduates

et al. 2017

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ObjectivesAn increasing number of International Medical Graduates (IMG), who are defined to be physicians working in a country other than their country of origin and training, immigrate to Western countries. In order to ensure safe and high-quality patient care, they have to take medical and language tests. This systematic review aims to (1) collect all empiric research on intercultural communication of IMGs in medical settings, (2) identify and categorize all text passages mentioning intercultural issues in the included studies, and (3) describe the most commonly reported intercultural areas of communication of IMGs.MethodsThis review was based on the PRISMA-Guidelines for systematic reviews. We conducted a broad and systematic electronic literature search for empiric research in the following databases: MEDLINE, BIOSIS Citation Index, BIOSIS Previews, KCI-Korean Journal Database and SciELO Citation Index. The search results were synthesized and analyzed with the aid of coding systems. These coding systems were based on textual analysis and derived from the themes and topics of the results and discussion sections from the included studies. A quality assessment was performed, comparing the studies with their corresponding checklist (COREQ or STROBE). Textual results of the studies were extracted and categorized.ResultsAmong 10,630 search results, 47 studies were identified for analysis. 31 studies were qualitative, 12 quantitative and 4 studies used mixed methods. The quality assessment revealed a low level of quality of the studies in general. The following intercultural problems were identified: IMGs were not familiar with shared decision-making and lower hierarchies in the health care system in general. They had difficulties with patient-centered care, the subtleties of the foreign language and with the organizational structures of the new health care system. In addition, they described the medical education in their home countries as science-oriented, without focusing on psychosocial aspects.ConclusionThere is a need for a better training of IMGs on culture-related and not culture-related topics in the new workplace country. The topics that emerged in this review constitute a basis for developing these courses. Further empiric research is needed to describe the findings of this review more precisely and should be in accordance with the existing reporting guidelines.

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“…Given that differences in medical education and learning styles exist, particularly between western and other countries, 16 it is not surprising that IMG residents were noted to experience learning challenges within the Canadian context. Medical education in Canada is based on principles of adult self-directed learning, is problem-based, focuses on the development of critical thinking skills, and emphasizes collaboration and relative equality between teacher and learner.…”

Section: Discussionmentioning

confidence: 99%

Cultural transition of international medical graduate residents into family practice in Canada

et al. 2016

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ObjectivesTo identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice.MethodsThis was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. ResultsParticipants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada’s health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. ConclusionsResidency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.

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

Cited by 30 publications

References 53 publications

Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis

Migration motives and integration of international human resources of health in the United Kingdom: systematic review and meta-synthesis of qualitative studies using framework analysis

Dealing with foreign cultural paradigms: A systematic review on intercultural challenges of international medical graduates

Cultural transition of international medical graduate residents into family practice in Canada

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