IMGs Share Ways to Adapt to American Health System

Peter Buckley, M.D., recalls his first days working as a psychiatrist in America at Case Western Reserve University in Cleveland after finishing training in his native Ireland.

“The patient population was much more diverse here, and my colleagues also had different experiences,” he recalled in an interview.“ Though I came to Case as a faculty member, when I got there many of the residents were my age and had families. In Ireland, where I did my residency, I was one of the few trainees who married early, and none of us had children. We were more career focused than these American residents who were living complex lives.

“I came to Case to work with Herb Meltzer, M.D. [then a professor of psychiatry at Case and an expert in the psychopharmacology of schizophrenia], and we would have people coming to see me as a specialist in schizophrenia from all around the country,” Buckley continued. “But I had to go out of the room and ask someone else about the medications these patients were on, because the meds used in Ireland were different.”

Buckley is the chair of the Department of Psychiatry at the Medical College of Georgia.

His recollections reflect some of the challenges that international medical graduates (IMGs) coming to work in the American health care and medical education systems are likely to face. And as a native of an English-speaking country with historical and cultural ties to America, Buckley may have faced hurdles less daunting than those confronting IMG psychiatrists from Asia, Africa, and South America.

“I have great empathy for these young psychiatrists from other countries who may not experience the benefits I had as a new physician in America,” Buckley said. “It's a different world they are entering.”

Which is why when APA Director of Education Deborah Hales, M.D., approached him about participating in a daylong institute for IMGs at next month's annual meeting, Buckley “jumped at the opportunity and asked questions later,” he said.

On Saturday, May 3, at the start of APA's annual meeting in Washington, D.C., the Division of Education will be hosting the “APA Day for International Medical Graduates.” It will run from 8:30 a.m. to 6 p.m.

The goal of the institute will be to facilitate self-awareness of IMG trainees' own ethnocultural backgrounds and how those backgrounds are likely to influence their interactions with patients, teachers, health care providers, and others; provide clarity about the American health care and educational systems; and develop skills to enhance learning and promotion within this system, in particular understanding the use of one-to-one supervision and feedback in the American medical education system.

The institute will also seek to enhance skills in key areas of communication critical in the provision of excellent health care and to help IMGs understand the special communication issues in psychiatry and psychotherapy.

In addition to Hales and Buckley, institute faculty will include Raghu Rao, M.D., chair of the Department of Psychiatry and Behavioral Sciences at Nassau University Medical Center in Brooklyn; Allyn Walsh, M.D., professor and education coordinator in the Department of Family Medicine at McMaster University in Ontario, Canada; Priyanthy Weerasekera, M.D., M.Ed., an associate professor in the Department of Psychiatry and Behavioral Neurosciences at McMaster; and Gerald Whalen, M.D., director of the acculturation program at the Educational Commission for Foreign Medical Graduates in Philadelphia.

At a workshop last month for faculty at the annual meeting of the American Association of Directors of Psychiatric Residency Training in New Orleans, the format for the IMG day of learning was introduced. Hales and Rao said that the curriculum was based on a model program developed by Canada's McMaster University for its IMGs in family medicine.

“A good third of our residents in psychiatry are IMGs,” Hales told Psychiatric News. “We are trying to do the field a service by introducing our international graduates to the way the U.S. system works, both for patient care and teaching.”

Buckley added that recently announced residency match results for 2008 showing a decline in the number of medical school graduates entering psychiatry residency programs (see next issue of Psychiatric News for complete report) makes the cohort of IMGs ever more valuable.

“Between 2005 and 2008, we've had an 8.8 percent reduction [in graduates entering American residency programs],” Buckley said.“ This is of great concern, so our IMG colleagues who are always welcome are even more so now. I think it's really important to extend a warm welcome to these junior colleagues of ours who had other options but selected psychiatry at a time when fewer people were choosing our profession.”

Buckley and Walsh will lead what Hales called an “Oprah-like” panel discussion with experienced IMGs who have worked in the American health care system, discussing such questions as these: What was the most surprising thing that happened to you? What was the best thing a teacher did to help you? What was the hardest thing for you? What do you wish someone had told you before you had started?

Walsh will then lead a discussion on cultural awareness and American health care, followed by small-group, facilitated exercises in cultural awareness. later in the day Walsh and Hales will lead PGY-1s in an orientation to the U.S. medical education system—including how to relate to supervisors and fellow residents, and other issues—and Weerasekera will talk to PGY-2s about building a therapeutic alliance.

The institute will also include group exercises in communication with health care teams, attending physicians, and supervisors; therapeutic alliance; psychotherapy supervision and feedback; and confidentiality and boundary issues.

Rao will also provide an orientation on the American health care system, with an overview of Medicare, Medicaid, and the private, managed care insurance system.

The registration fee for the institute is $295; pre-enrollment is not required.

Buckley predicts the event will soon become a staple of the APA annual meeting. “This is destined to be an instant success,” he said.▪