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Table 3 Summary of published articles

From: Experiences of foreign medical graduates (FMGs), international medical graduates (IMGs) and overseas trained graduates (OTGs) on entering developing or middle-income countries like South Africa: a scoping review

Title/reference

Design

Location

Aims and objectives

Issues reported

Employment, psychosocial work environment and well-being among migrant and native physicians in Finnish health care [36].

Mixed method study

Finland

The study focuses on integration of migrant physicians into Finnish health care by comparing their employment situation, perceptions of work-related stressors and well-being with the experiences of native physicians in a large representative survey study.

Migrant physicians are more likely to be employed in primary care and work more often on-call than native Finns. Lack of professional support burdened migrant physicians more than the native Finns, while stress related to poorly functioning information systems was reported more often by native physicians. Migrant physicians evaluated the management in health care organisations as more fair, but they reported more work-related distress compared with native Finns.

Integrating international medical graduates: The Canadian approach to the brain waste problem. Wanted and Welcome? [17]

Qualitative

Canada

This chapter describes the Canadian approach to the brain waste problem associated with IMGs and maps out some of the recent efforts to address the problem of “brain waste” in the Canadian medical sector with a specific focus on the province of Ontario.

The chapter maps the recent efforts to address the problem of Brain waste in the Canadian medical sector. An increasing number of policies that have been developed to assist in integrating IMGs into the Canadian labour market. Many of the difficulties IMGs confront in trying to enter the Canadian health care system come as a result of the lack of coordination, not only between the provincial and federal governments but also between different stakeholders with very different mandates vis-à-vis IMGs, therefore solutions to these problems require coordinated approaches. As other countries move toward a Canadian-style immigration system, the difficulties faced by IMGs in Canada may serve as a cautionary tale. All countries should have in place more formal mechanism for facilitating the integration of highly skilled immigrants into their labour markets so as to avoid (as much as possible) brain waste problems.

Professional experiences of international medical graduates practising primary care in the United States [30].

Qualitative

USA

To characterise the professional experiences of non-US born IMGs from limited-resource nations practising primary care in the USA.

Four recurrent themes: IMGs experience overt and subtle forms of workplace bias and discrimination; IMGs recognise professional limitations as part of “the deal”; IMGs describe challenges in the transition to the culture and practice of medicine in the USA; IMGs bring unique skills and advantages to the workplace.

A qualitative study of the international medical graduate and the orientation process [26].

Qualitative

Canada

The purpose of this qualitative study was to explore perceptions of, and experiences with, orientation processes for new IMGs.

New IMGs need to learn about the health care system and the peculiarities of the specific practice context in which they will be working. Orientation needs to include opportunities for reflecting on one’s own cultural biases and for learning about the cultural background and beliefs of a new patient population. Mentoring and effective integration within the community also emerged as important components of effective orientation processes

“If it wasn’t for OTDs, there would be no AMS”: overseas-trained doctors working in rural and remote Aboriginal health settings [32].

Qualitative

Australia

This paper focuses on recent research carried out in Australia to analyse factors affecting OTS’s professional, cultural and social integration and examine their training and support needs.

The need to better address recruitment, orientation and cross-cultural issues; the importance of effective communication and building community and institutional relationships, both with the local health service and the broader medical establishment.

Communication skills, cultural challenges and individual support: challenges of international Fmedical graduates in a Canadian health care environment [24].

Qualitative

Canada

Conducted a needs assessment to assess Canadian IMGs communication skills needs.

IMGs required a combination of language skills, teaching on how to get things done in the health care system, opportunities to practise specific skills, support systems, faculty and staff education in relation to cultural challenges.

Overseas-trained doctors in Australia: community integration and their intention to stay in a rural community [25].

Qualitative

Australia

The aim of this study was to identify the factors that influence foreign doctors’ community integration and examine how these affect their intention to stay in the rural community.

Maintaining cultural and religious values, as well as relationships to their respective ethnic communities is important to OTDs. While they do not expect excessive support from the community they appreciated the cultures of welcoming or “embracing differences”. Supportive communication and supervisory support positively influence OTDs’ appreciation of what the rural community can offer them and how they might overcome any difficulties that they face with their rural practice and life.

Barriers and facilitating factors in the professional careers of international medical graduates [18].

Qualitative

Netherlands

This article concerns IMGs who enter the Netherlands and as their non-European medical qualifications are not considered equivalent to the Dutch qualifications, they are required to undertake additional medical training. Because little is known about their professional careers, we set out to identify the barriers that confront and the facilitating factors that support IMGs before, during and after their supplementary medical training

Difficulties were reported in accessing information on complementary medical education and lack of (financial) support. Perseverance was reported to be essential. Financial and social support were also reported as facilitating factors. Lack of command of the Dutch language and age were seen as barriers to securing employment and entrance to specialisation

A cycle of brain gain, waste and drain-a qualitative study of non-EU migrant doctors in Ireland [27].

Qualitative

Ireland

This paper provides insight into the experiences of non-EU migrant doctors in the Irish health workforce.

Respondents believed they had been recruited to fill junior hospital doctor “service” posts. These posts are unpopular with locally trained doctors due to the limited career progression they provide. Respondents felt that their hopes for career progression and postgraduate training in Ireland had gone unrealised and that they were becoming de-skilled. As a result, most respondents were actively considering onward migration from Ireland.

“Why should I have come here?”-a qualitative investigation of migration reasons and experiences of health workers from sub-Saharan Africa in Austria [19].

Qualitative

Austria

The objective was to explore foreign medical graduates’ reasons for migration to Austria, as well as their personal experiences concerning the living and work situation in Austria.

For most participants, the decision to migrate was not professional but situation dependent. Austria was not their first choice as destination country. Several study participants left their countries to improve their overall work situation. The main motivation for migrating to Austria was partnership with an Austrian citizen. Other immigrants were refugees. Most of the immigrants found the accreditation process to work as a health professional to be difficult and hindering. This resulted in some participants not being able to work in their profession, while others were successful in their profession or in related fields. Participants report experiences of discrimination, but also positive support.

Difficulties experienced by migrant physicians working in German hospitals: a qualitative interview study [20].

Qualitative

Germany

This study provided an overview of the multifaceted difficulties migrant physicians face in German hospitals.

Participants described difficulties relating to health care institutions, own competencies, and interpersonal interactions. Participants experienced certain legal norms, the regulation of licensure and application for work, and the organisation of the hospital environment as inadequate. Most struggled with their lack of setting-specific (language, cultural, clinical, and system) knowledge. Furthermore, behaviour of patients and co-workers was perceived as discriminating or inadequate.

Inflows of foreign-born physicians and their access to employment and work experiences in health care in Finland: qualitative and quantitative study [21].

Mixed methodology

Finland

This study (i) examined the numbers of foreign-born physicians migrating to Finland and their employment sector, (ii) examined, based on qualitative interviews, the foreign-born GPs’ experiences of accessing employment and work in primary care in Finland and (iii) compared experiences based on a survey of the psychosocial work environment among foreign-born physicians working in different health sectors (primary care, hospitals and private sectors).

The number of foreign-born physicians has increased dramatically in Finland since the year 2000. In 2000, a total of 980 foreign-born physicians held a Finnish licence and lived in Finland, accounting for less than 4% of the total number of practising physicians. In 2009, their proportion of all physicians was 8%, and a total of 1 750 foreign-born practising physicians held a Finnish licence and lived in Finland. Non-EU/EEA physicians experienced the difficult licencing process as the main obstacle to access work as a physician. Most licenced foreign-born physicians worked in specialist care. Half of the foreign-born GPs could be classified as having an “active” job profile (high job demands and high levels of job control combined) according to Karasek’s demand-control model. In qualitative interviews, work in the Finnish primary health centres was described as multifaceted and challenging, but also stressful.

Perceptions of migrant doctors joining the New Zealand medical workforce [23].

Qualitative

New Zealand

This study identified and explored issues of concern to OTDs when first integrating into the New Zealand medical system through the New Zealand Registration Examination (NZREX) pathway.

Work issues which included difficulty finding employment and difficulty integrating into their work role; a bridging programme which improved the ability of OTDs to gain knowledge and experience of the New Zealand medical working environment; financial difficulties included a major impediment to attaining registration and a career pathway in New Zealand; and bureaucratic barriers (including examinations and information availability), which were seen as necessary but unsympathetic processes in gaining registration

Doctor-patient communication issues for international medical graduates: research findings from Australia [35].

Qualitative

Australia

This study presented a sub-set of findings on the factors associated with speech and language practices for IMGs, taken from a qualitative study which examined the IMGs’ experience of integration into the Australian health care system.

Findings indicated that the months following the point of entry into a medical position were a critical time for the majority of IMGs in terms of difficulties with communicating in English. The findings emphasise the importance of speech and language skills and the serious implications of this issue for the clinical practice of IMGs.

Liaison Officer for International Medical Graduates: Research Findings from Australia [33].

Qualitative

Australia

This article presents findings from Australian-based research which explores the IMGs’ experience during entry to their chosen country and posits the need for a designated liaison officer to help support the transition.

The findings document factors associated with the decision to leave their country of origin, psycho-social aspects of stress experienced upon arrival in Australia, and the participants’ perspective on the suggestion for the appointment of a hospital-based liaison officer to assist IMGs during the transition process

Navigating otherness and belonging: A comparative case study of IMGs’ professional integration in Canada and Sweden [28].

Qualitative

Canada and Sweden

This paper explores the othering processes and feelings of belonging among international medical graduates (IMGs) who seek to practise medicine in Canada and Sweden. Building on the theoretical literature on othering, belonging, and the conceptualisation of status dilemmas, they explore how IMGs in Canada and Sweden negotiate their professional identity, how they cope with being othered and how they establish a path to belonging.

Feelings of belonging to a professional group Canadian or Swedish do not seem to be static but rather fluid ephemeral and changing depending on the context. They demonstrate that the construction of professional identity among IMGs necessitates constant comparison between the differences and similarities among “us”—immigrant physicians, and “them”—local doctors. In this process, one’s ethnicity, gender, and professional status are intertwined with the experience of being seen as “the Other”. They also show that in negotiating their professional status, IMGs actively interpret the meaning of being a Canadian/Swedish physician. They conclude that feelings of belonging to a professional group (Canadian or Swedish) do not seem to be static but rather fluid, ephemeral and changing, depending on the context. Our analysis suggests that more attention should be paid to the social context in which experiences of processes of being othered and feeling belonging are being constructed and interpreted by people themselves

Professional integration as a process of professional resocialization: Internationally educated health professionals in Canada [28].

Qualitative

Canada

The study examined the process of professional resocialization among internationally educated health care professionals (IEHPs) in Canada

During professional integration, internationally educated health care providers modify their approach to professional work. This process can be conceptualised as professional resocialization. While some aspects of professional identity are modified, others persist. Professional resocialisation takes time. While the reliance on international health care providers will most likely remain a feature of the majority of health care systems of the developed world, various stakeholders need to recognise the cultural specificity of professional practice in the international health care providers’ integration process.

Experiences of non-UK-qualified doctors working within the UK regulatory framework: a qualitative study [29].

Qualitative

United Kingdom

This study explored the experience of non-United Kingdom-qualified doctors in working within the regulatory framework of the General Medical Council (GMC) document for Good Medical Practice

Information and support for non-United Kingdom qualified doctors has little reference to the ethical and professional standards required of doctors working in the United Kingdom. Recognition of the ethical, legal and cultural context of United Kingdom health care occurs once doctors are working in practice. Non-United Kingdom qualified doctors reported clear differences in the ethical and legal framework for practising medicine between the United Kingdom and their country of qualification, particularly in the model of the doctor-patient relationship. The degree of support for non-United Kingdom-qualified doctors in dealing with ethical concerns is related to the type of post they work in.

“That’s your patient. There’s your ventilator”: exploring induction to work experiences in a group of non-UK EEA trained anaesthetists in a London hospital: a qualitative study [34].

Qualitative

United Kingdom

This study explored the acclimatisation experience of EU doctors with qualifications in anaesthesia arriving in the United Kingdom to take up clinical employment in the NHS

Acclimatisation conceived of as transfer of clinical expertise was problematic for doctors who felt they lacked the right kind of support. Doctors sought different opportunities to share wider perspectives on care deriving from their previous experience.

Recertifying as a doctor in Canada: international medical graduates and the journey from entry to adaptation [22].

Qualitative

Canada

This study aims to describe the recertification training experiences of IMGs in Canada in order to help medical training programmes understand how to facilitate the integration of IMGs into recipient medical communities

4 themes that typified IMG recertification training experiences: training entry barriers; and a 3-phase process of loss, disorientation and adaptation. International medical graduates must complete this 3-phase process in order to feel fully integrated into their professional environments