Editorial
Health services administration
Volume 197 - Issue 8

Setting up international medical graduates to succeed

Authors:  Balakrishnan R Nair and Mulavana S Parvathy

Med J Aust 2012; 197 (8): 428-429. || doi: 10.5694/mja12.11325
Published online: 15 October 2012
Overseas-trained doctors need guidance through the labyrinth of providing medical care in a new countryAustralia, like many other developed countries, depends on international medical graduates (IMGs) to fill workforce shortages. About one in every three to four members of our medical workforce are trained overseas,1 and this dependency is likely to continue for many more years. IMGs are a heterogeneous group with varied skills and ...
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Overseas-trained doctors need guidance through the labyrinth of providing medical care in a new country

Australia, like many other developed countries, depends on international medical graduates (IMGs) to fill workforce shortages. About one in every three to four members of our medical workforce are trained overseas,1 and this dependency is likely to continue for many more years. IMGs are a heterogeneous group with varied skills and competencies. Their training and orientation needs differ according to the strengths and weaknesses they show within the Australian health care context. During the 2009–10 financial year, over 3000 medical graduates came to Australia from other countries.2

In this issue of the Journal, the study by Elkin and colleagues among all doctors registered in Victoria and Western Australia found that IMGs are more likely to attract medical board complaints and adverse disciplinary findings than are Australian-trained medical graduates.3 The findings of this study were that the likelihood of complaints and adverse findings varied according to the 20 countries where the IMGs were trained. Graduates from 7 of these countries had higher complaint rates than graduates trained in Australia, while graduates from 13 of the countries had the same rates as Australian graduates. The study also found that although IMGs who were most at risk of having complaints made against them did not have English as their primary language, there were other IMGs who also did not have English as their primary language and yet did not have a higher risk of complaints.3

The study did not show any clear association that might point to the cause of these findings. The authors stated that previous international research comparing IMGs with locally trained medical graduates had been very variable, with most studies showing no association between outcomes of care and risk of complaints.3

However, the key findings of the study by Elkin et al highlight the need for a proactive and tailored approach in assessing, mentoring and supporting IMGs, which, in turn, will improve patient care.4

Providing medical care is a complex process requiring medical knowledge, good communication skills and the ability to work in a collaborative way with other health professionals.5 Any assessment of IMGs should include all these domains and, ideally, should be done in the workplace, not in the classroom.6 Further, it is imperative that we provide IMGs with at least a minimal amount of time to become familiar with the system. Acculturation takes time. Even a local graduate will need time to settle into a new job in a different town or state. In our own survey of 243 IMGs, a quarter reported receiving no formal orientation, while fewer than half received orientation lasting less than one day (unpublished data).

Effective orientation processes have been shown to reduce professional isolation and to help IMGs and their families who are new to a community to integrate.7,8 Lack of acculturation and social support contribute in a significant way to the stress experienced by IMGs. Other stressors are workload and the inability to achieve a work–life balance; different work practices (including working in teams); different disease patterns; limited opportunity to continue in their specialty; being employed in an unfamiliar clinical practice setting; and loss of social status and seniority.9,10 It has been shown that English language proficiency cannot be equated with communication skills.11

Mentoring by local clinicians — providing workplace supervision, teaching and other guidance for IMGs — is important. Programs that included ongoing mentorship of IMGs after they had passed the qualifying examination have been highly successful.12

Lost in the labyrinth, the report from the recent inquiry by the Australian Parliament into registration processes and support for overseas-trained doctors, points to many of the above issues. Its 45 recommendations include workplace-based assessment, cross-cultural orientation and organising clinical supervision both before and after placement — especially for IMGs in regional, rural and remote areas.13 Some of these difficulties have been known for years, and yet, to date, it appears that many have been ignored or have been considered to be irremediable. We hope that the report will provide the impetus needed to redress this situation and lead to a much improved environment for IMGs.

Australia needs IMGs, as they form a significant proportion of the medical workforce. Their successful integration into the health system depends on a good-quality work-based assessment followed by a well rounded orientation program as well as ongoing mentoring and training.

Instead of setting IMGs up to fail, we should be doing everything to set them up to succeed. If IMGs fail, both the Australian community and the medical profession will suffer.

Authors

  • Balakrishnan R Nair AM, MD, FRACP, FRCPE1
  • Mulavana S Parvathy MB BS, FRACGP2
  • 1. Centre for Continuing Medical Professional Development, John Hunter Hospital, Newcastle, NSW.

Correspondence: kichu.nair@newcastle.edu.au

Competing interests

The Centre for Continuing Medical Professional Development has implemented the first workplace-based assessment project for overseas medical graduates for the Australian Medical Council (AMC). Our project was funded by the AMC and the Department of Health and Ageing. We are both IMGs who have passed the AMC examination and are now examiners.

References

Provenance: <p>Commissioned; externally peer reviewed.</p>

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