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Integration of International Medical Graduates in U.S. Psychiatry: The Role of Acculturation and Social Support

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Abstract

Objective

The authors investigated whether social support and acculturation could predict the mental health of international medical graduates pursuing psychiatric residencies in the United States.

Methods

A 55-item online survey was assembled by combining three validated instruments for mental health, social support, and acculturation. A link to the survey was e-mailed to training directors of all psychiatric residency and fellowship programs. Directors were requested to forward the survey to their international medical graduate residents for completion between December 2008 and February 2009.

Results

One hundred eight international medical graduates from 70 different psychiatric residencies and fellowships completed the entire survey. Respondents’ mental health scores were normally distributed. The vast majority scored very high on survey items related to mental health. Acculturation, social support, and postgraduate training year were significant predictors of mental health.

Conclusion

Residency training programs should attempt to incorporate measures that would help boost the social support and acculturation of international medical graduates (especially junior-level trainees). Acculturation could be improved by language training and courses in American history, culture, and customs, and social support could be expanded by mentoring relationships.

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References

  1. Educational Commission for Foreign Medical Graduates: 2011 Information Booklet-ECFMG Certification. Available at http://www.ecfmg.org/201lib/contents.html

  2. Mullan F: The metrics of the physician brain drain. N Engl J Med 2005; 353:1810–1818

    Article  CAS  PubMed  Google Scholar 

  3. Accreditation Council for Graduate Medical Education: Data Resource Book: Academic Year 2007–2008. Available at http://www.acgme.org/acWebsite/dataBook/2007_2008_ANA_ANA_Current_ACGME_DataBook.pdf

  4. McMahon GT: Coming to America: international medical graduates in the United States. N Engl J Med 2004; 350: 2435–2437

    Article  CAS  PubMed  Google Scholar 

  5. Blanco C, Carvalho C, Olfson M, et al: Practice patterns of international and US medical graduate psychiatrists. Am J Psychiatry 1999; 156:445–450

    CAS  PubMed  Google Scholar 

  6. Bellini LM, Baime M, Shea JA: Variation of mood and empathy during internship. Int 2002; 287:3143–3146

    Google Scholar 

  7. Gaba DM, Howard SK: Fatigue among clinicians and the safety of patients. N Engl J Med 2002; 347:1249–1255

    Article  PubMed  Google Scholar 

  8. Shanafelt TD, Sloan JF, Habermann TM: The well-being of physicians. Am J Med 2003; 114:513–519

    Article  PubMed  Google Scholar 

  9. Woodside JR, Miller MN, Floyd MR, et al: Observations on burnout in family medicine and psychiatry residents. Acad Psychiatry 2008; 32:13–19

    Article  PubMed  Google Scholar 

  10. Martini S, Arfken CL, Balon R: Comparison of burnout among medical residents before and after the implementation of work hours limits. Acad Psychiatry 2006; 30:352–355

    Article  PubMed  Google Scholar 

  11. Martini S, Arfken CL, Churchill A, et al: Burnout comparison among residents in different medical specialties. Acad Psychiatry 2004; 28:240–242

    Article  PubMed  Google Scholar 

  12. Thomas NK: Resident burnout. JAMA 2004; 292:2880–2889

    Article  CAS  PubMed  Google Scholar 

  13. Al-Sharideh KA, Goe WR: Ethnic communities within the university: an examination of factors influencing the personal adjustment of international students. Res in Higher Education 1998; 39:699–725

    Article  Google Scholar 

  14. Campbell HD: The prevalence and ramifications of psycho-pathology in psychiatric residents: an overview. Am J Psychiatry 1982; 139:1405–1411

    CAS  PubMed  Google Scholar 

  15. Roback HB, Crowder MK: Psychiatric resident dismissal: a national survey of training programs. Am J Psychiatry 1989; 146:96–98

    CAS  PubMed  Google Scholar 

  16. Cohen S: Social relationships and health. Am Psychol 2004; 59:676–684

    Article  PubMed  Google Scholar 

  17. Cohen S, Mermelstein R, Kamarck T, et al: Measuring the functional components of social support, in Social Report: Theory, Research and Application. Edited by Sarason IG, Sarason BR. Boston, Mass, Martinus Nijhoff, 1985, pp 73–94

  18. House JS: Work, Stress, and Social Support. Reading, Mass, Addison Wesley, 1981

    Google Scholar 

  19. House JS, Kahn, RL: Measures and concepts of social support, in Social Support and Health. Edited by Cohen S, Syme SL. Orlando, Fla, Academic Publishers, 1981, pp 83–108

  20. Thoits P: Stress, coping, and social support processes: where are we? What next? J Health Soc Behav 1995; Spec No: 53-79

  21. Kawachi I, Berkman LF: Social ties and mental health. J Urban Health 2001; 78:458–467

    Article  CAS  PubMed  Google Scholar 

  22. Rogler L, Cortes D, Malgady R: Acculturation and mental health status among Hispanics: convergence and new directions for research. Am Psychol 1991; 46:585–597

    Article  CAS  PubMed  Google Scholar 

  23. Sodowsky GR, Carey JC: Asian Indian immigrants in America: factors related to adjustment. J Multicult Couns Devel 1987; 15:129–141

    Article  Google Scholar 

  24. Sodowsky GR, Carey JC: Relationships between acculturation-related demographics and cultural attitudes of an Asian-Indian immigrant group. J Multicult Couns Devel 1988; 16: 117–136

    Article  Google Scholar 

  25. Balon R, Mufti R, Williams M, et al: Possible discrimination in recruitment of psychiatry residents? Am J Psychiatry 1997; 154:1608–1609

    CAS  PubMed  Google Scholar 

  26. Haveliwala YA: Problems of foreign-born psychiatrists. Psychiatr Q 1979; 51:307–311

    Article  CAS  PubMed  Google Scholar 

  27. Cohen S, Hoberman HM: Positive events and social supports as buffers of life change stress. J Appl Soc Psychol 1983; 13:99–125

    Article  Google Scholar 

  28. Kessler RC, Andrews G, Colpe LJ, et al: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002; 32:959–976

    Article  CAS  PubMed  Google Scholar 

  29. Kessler RC, Barker PR, Colpe LJ, et al: Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003; 60:184–189

    Article  PubMed  Google Scholar 

  30. Stephenson M: Development and validation of the Stephenson Multigroup Acculturation Scale (SMAS). Psychol Assess 2000; 12:77–88

    Article  CAS  PubMed  Google Scholar 

  31. JC, Bernstein IH: Psychometric Theory, 3rd ed. McGraw-Hill Series in Psychology. New York, McGraw-Hill, 1994, pp 264–265

    Google Scholar 

  32. Odegaard O: Emigration and Insanity: A Study of Mental Disease Among the Norwegian-born Population of Minnesota. Copenhagen, Norway, Levib & Munksgaards Publishers, 1932

    Google Scholar 

  33. Cohen S, Wills T: Stress, social support, and the buffering hypothesis. Psychol Bull 1985; 98:310–357

    Article  CAS  PubMed  Google Scholar 

  34. Knoff WF, Oken D, Prevost JA: Meeting training needs of foreign psychiatric residents in state hospitals. Hosp Community Psychiatry 1976; 27:35–57

    CAS  PubMed  Google Scholar 

  35. Berry JW, Uichol K, Thomas M, et al: Comparative studies of acculturative stress. Int Migr Rev 1987; 21:491–511

    Article  Google Scholar 

  36. Educational Commission for Foreign Medical Graduates: Acculturation Program. Available at http://www.ecfmg.org/acculturation/index.html

  37. Institute of Medicine: Clearing the air: asthma and indoor exposures. Washington, DC, Academy Press, 2001

    Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, University of Texas Health Sciences Center, 1941 East Rd., Room 3236, Houston, Texas, 77054

    Ashutosh Atri M.D., M.S.

  2. Baylor College of Medicine, Houston

    Anu Matorin M.D.

  3. Miller School of Medicine, University of Miami, Miami, Florida

    Pedro Ruiz M.D.

Authors
  1. Ashutosh Atri M.D., M.S.
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  2. Anu Matorin M.D.
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  3. Pedro Ruiz M.D.
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Correspondence to Ashutosh Atri M.D., M.S..

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Atri, A., Matorin, A. & Ruiz, P. Integration of International Medical Graduates in U.S. Psychiatry: The Role of Acculturation and Social Support. Acad Psychiatry 35, 21–26 (2011). https://doi.org/10.1176/appi.ap.35.1.21

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  • DOI: https://doi.org/10.1176/appi.ap.35.1.21

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