Training Needs of International Medical Graduates [IMGs] in Psychiatry

Milton Kramer

Psychiatry Department, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.

DOI: 10.4236/ojpsych.2014.44036                

Abstract

The potential shortage of psychiatrists over the next 5 - 10 years has focused attention on the need to recruit more IMGs to fill the needs rather than use nurse practitioners or physician assistants. IMGs make up about 1/3 of first year psychiatry residents. These individuals have been found to provide services to the poor, the elderly and the psychotic. The quality of their medical work has been found to be satisfactory. The training needs of these physicians require an understanding on the part of their teachers that they come from cultures with different values that we have. The extended families of these primarily Asian residents clash with our strong commitment to individualism. It leads to a We-self rather than our I-Self. This difference coupled with the stress of leaving to come to a new culture is a great stress. Their exposure to psychiatry has been limited. They request and need more interview demonstration and practice, ore feedback and examinations. They should have help in accent reduction. They should be exposed to the working of the hospital by sitting on departmental and hospital committees. The faculty should extend their social opportunities and work as mentors on joint projects. Courses on the history of American culture should be taught. Psychotherapy for them should be encouraged as well as teaching medical ethics. They must become the major educational concern for the department that they are in.

Keywords

International Medical Graduates, Psychiatric Residents, Education

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Alberti, M. (2013) Warnings of Doctor Shortage Go Unheeded/Remapping the Debate: Asking Why and Why Not. http://www.remappingdebate.org./article warning-doctor shortage-go-unheeded-1-3
[2]	Carlat, D. (2010) 45,000 More Psychiatrists, Anyone. Psychiatric Times. http://psychiatrictimes.com/blog/couchincrisis/content/article/10168/1566084
[3]	Blanco, C., Carvalho, C., Olfson, M., Finnerty, M. and Pincus, H. (1999) Practice Patterns of International and U.S. Medical Graduate Psychiatrists. American Journal of Psychiatry, 156, 445-450.
[4]	Rao, N. (1999) International Medical Graduates. In Kay, J., Silberman, E. and Pessar, L., Eds., Handbook of Psychiatric Education and Faculty Development, American Psychiatric Association, Washington, DC, 125-142.
[5]	American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders. 5th Edition, APPI Press, Washington, DC.
[6]	Gangure, D. (2002) International Medical Graduates in American Training Programs. XII World Psychiatry Congress of Psychiatry.
[7]	Knoff, W., Oken, D. and Prevost, J. (1976) Meeting Training Needs of Foreign Psychiatric Residents in State Hospitals. Hospital and Community Psychiatry, 27, 35-37.
[8]	Whelan, G., Gary, N., Kostis, J., Boulet, J. and Hallock, J. (2002) The Changing Pool of International Medical Graduates Seeking Certification in US Graduate Medical Education Programs. JAMA, 288, 1079-1084. http://dx.doi.org/10.1001/jama.288.9.1079
[9]	Mick, S. and Comfort, M. (1997) The Quality of Care of International Medical Graduates. How Does It Compare to That of U.S. Medical Graduates. Medical Care Research and Review, 54, 379-413. http://dx.doi.org/10.1177/107755879705400401
[10]	Norcini, J., Boulet, J., Dauphinee, W., Opalek, A., Kranz, I. and Anderson, S. (2010) Evaluating the Quality of Care Provided by Graduates of International Medical Schools. Health Affairs, 29, 1461-1468. http://dx.doi.org/10.1377/hlthaff.2009.0222
[11]	Kramer, M. (2005) The Educational Needs of International Medical Graduates in Psychiatric Residency. Academic Psychiatry, 29, 322-324. http://dx.doi.org/10.1176/appi.ap.29.3.322-a
[12]	Kramer, M. (2006) Educational Challenges of International Medical Graduates in Psychiatric Residencies. The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 34, 163-171. http://dx.doi.org/10.1521/jaap.2006.34.1.163
[13]	Alexander, F. and Selesnick, T. (1966) The History of Psychiatry. Harper and Row, New York.
[14]	Kandel, E. and Schwartz, J. (1985) Principles of Neural Science. 2nd Edition, Elsevier, New York.
[15]	Shorter, E. (1997) A History of Psychiatry. Wiley, New York.
[16]	Akhtar, S. (1999) Immigration and Identity. Aronson, Northvale.
[17]	Weintraub, W. (1997) International Medical Graduates as Psychiatric Residents: One Training Director’s Experience. In: Husain, S., Munoz, R. and Balon, R., Eds., International Medical Graduates in the United States, American Psychiatric Press, Washington DC, 53-64.
[18]	Balon, R. (2000) Practice Patterns of International Medical Graduates. American Journal of Psychiatry, 157, 485. http://dx.doi.org/10.1176/appi.ajp.157.3.485-a
[19]	Brody, E., Modarressi, T., Penna, M., Jegede, R. and Arana, J. (1971) Intellectual and Emotional Problems of Foreign Residents Learning Psychiatric Theory and Practice. Psychiatry, 34, 238-247.
[20]	Char, W. (1971) The Foreign Resident: An Ambivalently Valued Object. Psychiatry, 34, 234-238.
[21]	Beaubrun, M. (1971) Foreign Medical Training and the “Brain Drain”. Psychiatry, 34, 247-251.
[22]	Campbell, J. (1988) The Power of Myth. Doubleday & Co., New York, 117.
[23]	Lasch, C. (1991) The Culture of Narcissism. Norton, New York.
[24]	Vozzola, E. (2014) Moral Development: Theory and Applications. Routledge, New York.
[25]	Roland, A. (2003) Psychoanalysis across Civilizations: A Personal Journey. The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry, 31, 275-295. http://dx.doi.org/10.1521/jaap.31.2.275.22118
[26]	Desai, P. and Coelho, G. (1980) Indian Immigration in America: Some Cultural Aspects of Psychological Adaptation. In: Seran, P. and Eames, E., Eds., The New Ethics: Asian Indians in the United States, Praeger, New York, 363-386.
[27]	Desai, P. (1982) Learning Psychotherapy: A Cultural Perspective. Journal of Operational Psychiatry, 13, 82-87.
[28]	Lijtmaer, R. (2001) Countertransference and Ethnicity: The Analyst’s Psychic Changes. Journal of the American Academy of Psychoanalysis, 29, 73-83. http://dx.doi.org/10.1521/jaap.29.1.73.17194
[29]	Rao, N. (2005) Personal Communication One Day Training to Help Pass Psychiatric Boards. Unpublished Paper.
[30]	Plotnikoff, G. and Amano, T. (2007) A Culturally Appropriate, Student Centered Curriculum on Medical Professionalism. Successful Innovations at Keio University in Tokyo. Minnesota Medicine, 90, 42-43.
[31]	Van Rooyen, M. (2004) The Views of Medical Students on Professionalism in South Africa. South African Family Practice, 46, 28-31. http://dx.doi.org/10.1080/20786204.2004.10873030
[32]	Campbell, J., Roberts, M., Wright, C., Hill, J., Greco, M., Taylor, M. and Richards, S. (2011) Factors Associated with Variability in the Assessment of U.K. Doctor’s Professionalism: Analysis of Survey Results. British Medical Journal, 343, d6212. http://dx.doi.org/10.1136/bmj.d6212