Which Educational Programs Promote the Success of International Medical Graduates in Psychiatry Training

The exceptional importance of international medical graduates (IMGs) in academic psychiatry (1, 2) is underscored in this special theme issue of our journal. As noted by Boulet et al. in this collection, about 31% of the psychiatry workforce in the United States are IMGs, and about 32% are psychiatry residents (3). In clinical psychiatric practice, IMGs disproportionately serve poor patients and the most severely ill patient populations (4). IMGs also contribute substantially to the U.S. health system in research, leadership, and education (5). International medical graduates face the considerable challenges of emigrating to a dissimilar culture and healthcare and educational system. These challenges include navigating dual learning curves as immigrants and residents (6). In the workplace, some report having been treated insensitively (6), and wider discrimination very possibly exists (7, 8). Educational challenges include communicating in specialized ways (9), as well as rectifying any knowledge deficiencies related to the management of sexual health problems (10), and the management of illnesses and healthcare problems more commonly encountered in the U.S., as compared with other countries. This issue, consisting of nine special articles (3, 11–18), serves to contribute to our understanding of these challenges by presenting an array of ideas and formal recommendations for ameliorating them. Sockalingamet al., in a surveyof IMGs training in Canada, reported that more training preparatory to residency and targeted to need would be helpful (11), and Sacks et al. developed guidelines for observerships preparatory to residency (12). Jain et al. provide information on how training is conducted in various international settings, so as to help educators assist IMGs adapt to training in the United States (13). Two articles (14, 15), concern the practice of psychotherapy. Weerasekera recommended guidelines for teaching psychotherapy to IMGs (14), and Rao emphasizes the potential role of individual psychotherapy in facilitating a successful acculturation experience (15). Rao et al. also surveyed IMGs taking the Clinical Skills Verification Examination to learn how a better experience and better performance could be achieved (16). Broquet and Punwani provide recommendations for helping foreign-born IMGs utilize behavioral-based feedback as a cornerstone of their educational experiences (17). One additional report describes anobservership for international child mental health professionals, whowere required to take what they had learned home (18). Participants were screened carefully in order to minimize the possibility that they would stay or return to practice in the United States. This model is especially valuable in the context of an international migration of doctors and other healthcare professionals from lowand middle-income, resource-poor countries to rich countries, when this migration may severely compromise healthcare in the resource-poor countries (19–23). Training specialists for the role of strengthening themental health services in resource-poor countries represents a creative policy approach to this problem. Such creative policy approaches warrant development and further evaluation. Our primary goal for this editorial, however, is to describe published programs that support and promote IMGs, including those programs that assist in the acculturation process to clinical practice and training in North American settings. There are several reasons for adopting this focus. Received and accepted May 17, 2012. From the Dept of Psychiatry– Behavioral Sciences, Baylor College of Medicine, Houston TX; the University Psychiatric Center, Detroit, MI; and the Dept of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Send correspondence to acadpsych@gmail.com Copyright © 2012 Academic Psychiatry