Behavioral Science Education and the International Medical Graduate

Saint Louis University, Сент-Луис, Michigan, United States
Academic Medicine (Impact Factor: 2.93). 03/2006; 81(2):164-70. DOI: 10.1097/00001888-200602000-00015
Source: PubMed


International medical graduates (IMGs), many of whom are recent immigrants to the United States, are filling an increasing proportion of U.S. family medicine residency positions. Therefore, assumptions about the training experiences of first-year residents may no longer apply to a large percentage of incoming residents. The authors sought to improve the behavioral science education in their residency program by learning about IMGs' previous training and experience in behavioral science before coming to the United States.
Ten first-, second-, and third-year family medicine residents, representing medical school training from India, Macedonia, Bosnia-Herzegovina, The Philippines, Egypt, and Iraq, were individually interviewed using an inductive, qualitative approach. Transcripts were reviewed and double coded. Categories and story lines were identified, and member checking was employed.
Segments were classified into seven categories: residents' behavioral medicine training prior to coming to the United States; reflections on the inclusion of mental health and psychosocial content in clinical family medicine; training in medical interviewing; reflections on the physician-patient relationship; perceptions of U.S. family life; recommendations for improving IMGs' understanding of psychosocial aspects of patient care; and specific challenges residents face as IMGs.
The narrative data suggested several possible modifications to the family medicine curriculum, including expanding new resident orientation content about U.S. health care, introducing behavioral science content sooner, and having IMGs observe quality physician-patient interactions. Interview data also yielded concrete suggestions for improving residents' psychiatric interview knowledge and skills, such as instruction in specific wording of questions.

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Available from: Russell Searight, Sep 08, 2014
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    • "Linguistic and cultural barriers create communication problems and an interpreter is seldom present at EPHC consultations. In some cultures it is uncommon or even shameful and taboo for patients to bring psychiatric problems to the doctor [31,32]. However, when uprooted from their familiar home country these immigrants have few other options than contacting the health care system. "
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    ABSTRACT: Emigrants are often a selected sample and in good health, but migration can have deleterious effects on health. Many immigrant groups report poor health and increased use of health services, and it is often claimed that they tend to use emergency primary health care (EPHC) services for non-urgent purposes. The aim of the present study was to analyse immigrants' use of EPHC, and to analyse variations according to country of origin, reason for immigration, and length of stay in Norway. We conducted a registry based study of all immigrants to Norway, and a subsample of immigrants from Poland, Germany, Iraq and Somalia, and compared them with native Norwegians. The material comprised all electronic compensation claims for EPHC in Norway during 2008. We calculated total contact rates, contact rates for selected diagnostic groups and for services given during consultations. Adjustments for a series of socio-demographic and socio-economic variables were done by multiple logistic regression analyses. Immigrants as a whole had a lower contact rate than native Norwegians (23.7% versus 27.4%). Total contact rates for Polish and German immigrants (mostly work immigrants) were 11.9% and 7.0%, but for Somalis and Iraqis (mostly asylum seekers) 31.8% and 33.6%. Half of all contacts for Somalis and Iraqis were for non-specific pain, and they had relatively more of their contacts during night than other groups. Immigrants' rates of psychiatric diagnoses were low, but increased with length of stay in Norway. Work immigrants suffered less from respiratory and gastrointestinal infections, but had more injuries and higher need for sickness certification. All immigrant groups, except Germans, were more often given a sickness certificate than native Norwegians. Use of interpreter was reduced with increasing length of stay. All immigrant groups had an increased need for long consultations, while laboratory tests were most often used for Somalis and Iraqis. Immigrants use EPHC services less than native Norwegians, but there are large variations among immigrant groups. Work immigrants from Germany and Poland use EPHC considerably less, while asylum seekers from Somalia and Iraq use these services more than native Norwegians.
    Full-text · Article · Sep 2012 · BMC Health Services Research
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    • "For example, in the United States, behavioral sciences are commonly part of the medical school curriculum as well as the residency training in family medicine, internal medicine, and pediatrics. However in many developing countries, such as Southeast Asia, Africa, Latin America, behavioral science and psychiatry are not taught in much detail, if at all (Searight and Gafford, 2006). As a result, when dealing with psychiatric issues, many physicians will be practicing outside the bounds of their competence. "

    Full-text · Chapter · Mar 2012
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    • "The first author conducted face-to-face interviews with 12 residents completing their residency at an internal medicine residency program in a hospital in Midwestern part of the U.S. The interviews were conducted between December 2007 and May 2008. Interviews were appropriate for addressing the research question in this study because they allowed participants the opportunity to narrate their experiences and reflect on how they accommodate differences that they experience in the interaction situations [10] [12] [24] [29] [30]. Data saturation occurred after 12 interviews, meaning that no new information or themes emerged from data analysis [29] [30]. "
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    ABSTRACT: To understand the communication strategies international medical graduates use in medical interactions to overcome language and cultural barriers. In-depth interviews were conducted with 12 international physicians completing their residency training in internal medicine in a large hospital in Midwestern Ohio. The interview explored (a) barriers participants encountered while communicating with their patients regarding language, affect, and culture, and (b) communication convergence strategies used to make the interaction meaningful. International physicians use multiple convergence strategies when interacting with their patients to account for the intercultural and intergroup differences, including repeating information, changing speaking styles, and using non-verbal communication. Understanding barriers to communication faced by international physicians and recognizing accommodation strategies they employ in the interaction could help in training of future international doctors who come to the U.S. to practice medicine. Early intervention could reduce the time international physicians spend navigating through the system and trying to learn by experimenting with different strategies which will allow these physicians to devote more time to patient care. We recommend developing a training manual that is instructive of the socio-cultural practices of the region where international physician will start practicing medicine.
    Full-text · Article · Jul 2011 · Patient Education and Counseling
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