Abstract:

Objective:
International Medical Graduates (IMGs) account for a large and important part of the United States (US) health care workforce. Prior to residency training, IMGs have limited opportunities to observe patient care and medical education within the US. We established a structured program to introduce IMGs to the US health care system and system of graduate medical education with the aim of assisting IMGs in adjusting to, learning, securing residency positions, and practicing medicine in the United States.

Methods:
After identifying goals and objectives we developed a structured observership that incorporated didactic, interactive and clinical activities. A dedicated Chief Medical Resident (CMR) was assigned to coordinate and supervise the observership. Observers were not recruited; IMGs learned about the program from peers and members of the department by word-of-mouth. Observers were not involved in direct patient management and care was taken to ensure the educational experiences of residents and medical students were not compromised.

The observership consisted of clinical and academic activities. The clinical activities were conducted on in-patient wards and in the ambulatory clinic. Academic activities included attending Morning Report, noon conferences, and special conferences. Guided interactive sessions were held weekly by the CMR using the Educational Commission for Foreign Medical Graduates (ECFMG) Acculturation program.

This report summarizes the experience of observers from May 2010 to the end of November 2010. Beginning in July of 2010 observers completed a pre- and post observership survey to assess their perceptions of the program. Observers who participated in the 2011 residency Match were contacted by email or social media to complete a post-match survey and to determine if they secured residency-training positions.

Results:
Twenty-seven observers completed the observership during the study period, 16/27 completed a pre- and post observership survey and 20/27 completed the post-match survey. Overall, 16/16(100%) observers were very satisfied with the program and 16/16(100%) answered that the program met or exceeded their expectations. Observers’ self-perceived knowledge dramatically improved in each of the ECFMG curricular areas. The area of least improvement was in understanding of billing. Seven of 27 (27%) observers matched into our own residency program. In total 11/27 (42%) are known to have matched into residency programs somewhere in the US.

Conclusion:
A structured observership was perceived by IMGs to be worthwhile and helped them adjust to the US health system. The observership introduced them to the US system of graduate medical education and may have helped them match successfully into a residency training programs.

Keywords:

International medical graduates, Observership, Residency, Internal medicine, United States Medical Licensing Examination (USMLE), ECFMG