As a U.S. citizen studying in India, I heard alot of stories about IMG's performance profiles in the U.S. when they go to residency. I wanted to know from the grads of U.S. schools what you think are the 3 biggest things that the IMG's you see that need to be changed.
I'll start it off from what I personally have heard:
1) Bedside manner -- most doctors from India that treat patients at a government hospital know that the load of patients there is so voluminous that there is no "hello, my name is..." its just get out the tools and examine.
2) Clinical skills -- some of the skills we acquire here seem to be much different than those in the U.S.
3) Attitude towards the attending -- most of the time IMG's get kicked out of residency is due to the fact that they don't listen to their attending or have an attitude.
I would like to hear U.S. trained residents speak of what they see please.
Before getting into any discussion about potential biases/complaints you hae to realize that they will differ whether or not the student/resident is an FMG or IMG. Traditionally, the former was a non-US citizen who studied abroad and the latter the US citizen training outside of the US. I am now told that everyone uses the term IMG to refer to both groups - not sure this is true and certainly the ECFMG still exists, but what people call themselves is not relevant, but the distinction in the minds of US faculty is.
Bedside manner is not just a function of cultural and training differences. There are plenty of arses here in the US who wouldn't know good bedside manner if it hit them upside the head and I've seen very gracious and tender FMGs/IMGs. Some physicians are socially awkward, some are arrogant and rude and others just pressed for time and tend to forget the niceties. But frankly, I've never heard of a generalizable bias against FMGs/IMGs because of their bedside manner. Patients may complain about accent but I cannot say I've seen wholesale rejection of physicians in either group because of this. Bedside manner is hard to teach; you either have it or you don't.
Clinical skills can vary widely even amongst US students. However, it is true that many who trained abroad are used to a professorial/mentor model where much of the clinical skills are not learned in medical school but rather as an intern and junior house officer. Many are used to simply observing rather than actually taking care of patients - this is why doing US clinical externships/electives can be so important - not just for the LORs one can get, but to see how US students function so you won't be totally lost on July 1. Many FMGs/IMGs are very book smart but haven't had the responsibility at an early stage like AMGs.
Now attitude towards attendings CAN be a factor. However, IMHO it is only a factor for those who have already done some or all of their residency training outside of the US and then come here to start all over. It can be incredibly hard to have a former attending as an intern. They *tend* to want to do things they way they used to do them and do not take to direction kindly. I am not sure that this is the case with AMGs who do a second residency - I think they understand the hierarchy a little better or at least are a little better at hiding their disdain for whatever someone is trying to teach them (that they think they already know). I am not sure that your statement that "most of the time when FMGs get kicked out of residency" it is for this reason is correct. Do you have references for that statement?
Some of the issues I see that are commonly addressed:
1) overconfidence: mostly a function of the US citizen trained abroad, but also seen in the foreign national, these are the students who assume THEY will be the 1 FMG who matches into Derm, or that they don't need to go on more interviews. Obviously most IMGs apply to every program they can afford, but there is a special breed we see here on SDN who assume because they got X on Step 1, that they will somehow rise above the chaff.
2) Not understanding the system - the medical system, the training system, the hierarchy. This is a problem when someone wants to come to the US but doesn't want to repeat training or who cannot understand the hierarchy in US medicine (see attitude above). This relates to the overconfidence in the case of the attending who wants to come to the US for training but has been out of medical school (and sometimes not even practicing in their home country) for years, decades even. They assume that having been specialty X for a century entitles them to a residency position in the US.
3) I have heard some complaints from colleagues about IMGs who are used to a different culture wherein using family connections or even bribes is common. There may be less of a tendency towards honesty for these IMGs. I have seen it enough myself to believe that this may be something that US faculty are worried about.
Another issue for the foreign national can be the tendency to isolate themselves within their culture. These are the residents who speak their foreign language in the hospital and only associate/socialize with members of their own ethnicity. We've even had some AMGs here on SDN complain that these IMG residents conduct rounds mostly in their foreign language, or frequently speak that language in front of the students and other residents. This is generally considered rude in the US. In my practice, I also tend to see ethnicity based referral patterns which makes no sense to me. I do not choose a specialist for my patients based on what country they are from, why would others?
I am sure there are plenty of biases that others can come up with. Whether changing these things means better options for the FMG/IMG I am not sure.
