IMGs training med students in Midwest?

[tegs15]

Preface: It is not my intention to degrade or belittle anyones culture or heritage.

I'm at a Allo med school in the midwest where there appears to be trend in the importation of foreign residents and physicians at our university hospital. It appears as many has half the IM residents and >65% of the Surgery residents are IMGs from India. Additionally at least half of our 3rd and 4th year attendings and instructors are also IMGs from India.

Recently I have noticed a increasing tension between said residents/attendings and the med students, for instances; last week in a small group PBL environment a female student asked a IMG attending to repeat her question b/c she didn't understand at which time the attending came unglued- yelling and belittling the student in front of the rest of the group (the med student was very polite in her request to repeat the question). Again this week, different student and IMG attending but similar event at the hospital during clinical exposure (it didn't occur in front of pts thank goodness). Finally I have two M4s who state they have been yelled and screamed at in front of pts by their IM and Surgery Attendings (both of which happen to be IMGs).

I post this hoping to determine if these are unusual experiences localized to OUR med school training or if it is becoming the norm in medical education. Please respond with any constructive comments or insights.

(ex. in the last two years we have had students match in surg at Mayo,Denver, Hennipen, U of Iowa, U of Neb and Baylor just to name a few and had a total of 22 students go surgery but at our OWN Surgery Residency only 3 US grads were matched and 7 IMGs were matched, does this sound odd? Similar ratios are present in IM as well.

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[doctorFred]

I've seen quite a few IMGs from India at Albany Med (although I haven't had any negative experiences.) It's more of a national trend. When you mix a rising physician shortage with an admissions process that rejects half of the students that apply, most large hospitals have no choice but to hire from the international pool.

 

[Flaxmoore]

We have one, a Brazilian graduate who's been here since the 1970s. Honestly, he's one of the best anatomists we have- the guy has a Yoda-like ability to make structures rise from the fascia in lab.

 

[Twitch]

Stop the presses. This is "hawt" news:

Attending/Resident/Intern Yells at M3/M4.

 

[tegs15]

Of course yelling be damned. It happens and will always happen. I'm more interested in the fact that most of "these" type of experiences seem to be centered around IMGs and where med education is trending towards.

 

[tegs15]

Our undergrad and graduate programs pride themselves in developing a special culture due to the academic and outside focuses of the university and that same culture which was once present within the med center seems to be disappearing. That is what prompted this post. The changes are becoming so drastic that by the time I graduate and finish residency I don't know if I'll want anyone to know where I went to school and I'm a little frustrated by that.

 

[tegs15]

... as my initial post gave the example of the our Surgery residency taking foreign grads instead of our own students or even American grads seems to show the impending changes to our program. Is anybody else noticing this type of drastic shift in their institution?

 

[flumazenil]

regardless of the angle of your intention and approach to this question, my answer will be the same- Live With It. IMG's AMGS, FMG's DO's they are all docs- we are M3/M4's , and we arent the ones hiring people- we just rotate, and try to learn the most. FMG's wil be everywhere and you will get yelled at almost anywhere you go to. Just have thick skin and learn to move on. As far as the FMG's fillin up your surgery spots- go cry about it

 

[tegs15]

regardless of the angle of your intention and approach to this question, my answer will be the same- Live With It. IMG's AMGS, FMG's DO's they are all docs- we are M3/M4's , and we arent the ones hiring people- we just rotate, and try to learn the most. FMG's wil be everywhere and you will get yelled at almost anywhere you go to. Just have thick skin and learn to move on. As far as the FMG's fillin up your surgery spots- go cry about it

That certainly is one approach, thanks for the constructive criticism. No doubt right now you just roll with the punches and learn as much as you can even though 3/4 of the time I should have an interpreter present so I can glean that expensive knowledge. Not to mention the great impression it makes on our patients and excellent healthcare that is provided, just as when the 60yr old greying man wearing overalls and a green John Deere cap who owns 10k acres of farmland and who regularly donates to our univerisity because both of his children are alumni, is asked 4 times if he has any pain by the attending before he can figure out what she's asking, and only then with help of the med student present. It must only be a localized problem and I'll not worry my little head about it.

 

[SocialistMD]

tegs15-

I think your experience is more at your institution than anything, at least in terms of academic programs. If you are where I think you are, your surgery program has recently been on or near probation, is in a city that has another medical school and is in a state that is a hard sell to many of the top candidates who want to live on the coasts. Those things make it hard to recruit US grads. That said, your institution is still going to take the best candidates it can get for its residency spots, even if it means taking foreign grads over US grads (especially considering, if you are where I think you are, I think your surgery program director went to medical school overseas). Nationally, foreign medical grads are filling the vacancies in underserved areas where US grads don't want to work, and your institution may be one of those areas (no insult of your school or its residency programs intended; I'm just saying that, based on what I said above, it is hard for your institution to recruit and most of your state is in the same boat).

As others have alluded to, I don't think the tension developing has anything to do with the fact that your faculty and residents are foreign medical grads as much as it has to do with that is what happens in medical school. You've said it yourself, there are more non-US grads than there are US grads, so the odds are the yelling will come from the majority. Your classmates may also be more sensitive to it coming from that subset of faculty/residents (for whatever reason), much as comments made by women have a different interpretation as the same comments made by men.

...even though 3/4 of the time I should have an interpreter present so I can glean that expensive knowledge...
...just as when the 60yr old greying man wearing overalls and a green John Deere cap who owns 10k acres of farmland and who regularly donates to our univerisity because both of his children are alumni, is asked 4 times if he has any pain by the attending before he can figure out what she's asking, and only then with help of the med student present.

I see.

As a product of Texas and a current resident of Missouri, I have patients (and also hear it from my family, most of whom live in the country) who tell me about their "foreign doctor" who, while being nice, they can't understand. Again, it comes down to underserved areas being serviced by foreign grads because US doctors are too good to live and work in those areas. I'm gulity of the same; I'll never go back to my home town (where most of the physicians are now foreign grads) because I hate it there.

 

[tegs15]

I guess in the future I can try to alleviate this language difficulties in some small corner of the US by returning to a underserved area. I don't know if SW MO is counted as underserved? Thanks again for the constructive comments.

 

[njbmd]

I post this hoping to determine if these are unusual experiences localized to OUR med school training or if it is becoming the norm in medical education. Please respond with any constructive comments or insights.

(ex. in the last two years we have had students match in surg at Mayo,Denver, Hennipen, U of Iowa, U of Neb and Baylor just to name a few and had a total of 22 students go surgery but at our OWN Surgery Residency only 3 US grads were matched and 7 IMGs were matched, does this sound odd? Similar ratios are present in IM as well.

IMGs have been part of teaching hospitals for ages. This is nothing new and most likely, your school did not import these folks but rather they immigrated to this country which is a natural process just like many Americans emigrate to other countries if they desire. IMGs are a part of the health system in this country and will continue to be so. Nothing new.

Matching is a very personal decision and quite likely, the program director and faculty ranked those 7 IMGs. Many Americans may not have wanted those positions and didn't apply or interview. Again, this is nothing new for many programs. Some programs do not have any AMGs at all and often do not participate in the MATCH but sign IMGs outside of the MATCH. Again, this is nothing new and likely to continue.

If you don't understand anyone, regardless of ethnicity or language, then asking for them to repeat what they said is crucial. I don't understand the need for shouting. At my medical school, we had a Korean pathology professor who had a very thick accent. She knew that it was difficult for us to understand her in lecture so she gave the most wonderful handouts I have ever seen. I still use her handouts for some things.

If you are having difficulty with any professor's accent, pitch or anything else that is preventing you from full understanding, let the course coordinator/dept chair know of your difficulties so that something can be done without getting into a shouting match which is counterproductive for good learning.

Goodness knows, I have been shouted at by plenty of my American attendings in surgery. IMGs have no corner on the shouting; I just try not to perpetuate or escalate the shouting.

 

[NonTradMed]

I go to med school in the midwest, and there is not that many IMGs as far as I can see. Most of our professors are American and the few that aren't are ok to listen to. I think your problem is a local issue.

 

[t33sg1rl]

My hospital doesn't take large numbers of IMGs, but there are a few, and here's what I've observed (possibly offensive generalizations ahead-be warned).
IMG's do tend to be arrogant/brusque. If you think about it, though, there's lots of reasons for it. First, they went to med school in countries where doctors get a lot more respect than we're used to. Second, these people really are the best of the best in their countries, and the ones that match into my IMG-unfriendly hospital are smarter than most of the American grads-and they know it. Lots of them were attendings in their home countries and yet we make them into interns. That would definitely make me a little irritable. Third, they get treated like crap by patients who HATE foreign doctors. Fourth, there's a big cultural difference. My med school in particular is very touchy-feely-Patch-Adams-y. I have never seen a med student get yelled at, ever, by someone higher up on the totem pole (though I did get dressed down by an administrative assistant once) and I think our IMGs are used to a much more rigid heirarchy and a more strict code of professional behavior. They probably think that American med students are disrespectful little whippersnappers.

But they definitely adjust to the new culture and loosen up, so my only advice is to make sure that you model the best of American manners, so they can learn our ways that much faster.

 

[NonTradMed]

My hospital doesn't take large numbers of IMGs, but there are a few, and here's what I've observed (possibly offensive generalizations ahead-be warned).
IMG's do tend to be arrogant/brusque. If you think about it, though, there's lots of reasons for it. First, they went to med school in countries where doctors get a lot more respect than we're used to. Second, these people really are the best of the best in their countries, and the ones that match into my IMG-unfriendly hospital are smarter than most of the American grads-and they know it. Lots of them were attendings in their home countries and yet we make them into interns. That would definitely make me a little irritable. Third, they get treated like crap by patients who HATE foreign doctors. Fourth, there's a big cultural difference. My med school in particular is very touchy-feely-Patch-Adams-y. I have never seen a med student get yelled at, ever, by someone higher up on the totem pole (though I did get dressed down by an administrative assistant once) and I think our IMGs are used to a much more rigid heirarchy and a more strict code of professional behavior. They probably think that American med students are disrespectful little whippersnappers.

But they definitely adjust to the new culture and loosen up, so my only advice is to make sure that you model the best of American manners, so they can learn our ways that much faster.

I'm not sure the doctors in other countries feels they had more respect in their native countries as compared to here. I mean, crappy patients exist everywhere, but physicians, as a general rule, are seen as knowledgable workers everywhere. In fact, I would say, given the relatively higher wages and longer education that doctors experience in this country, that doctors in other countries may actually feel less respected in their own country since in those other countries, they are seen as no better than any other college graduate (that is the case in China).

But there is a certain formality that Americans don't observe in the workplace (such as not addressing people by last names/sir/ma'am) that can be translated into disrespect by IMGs (just speculating).

 

[Doublecortin]

Preface: It is not my intention to degrade or belittle anyones culture or heritage.

I'm at a Allo med school in the midwest where there appears to be trend in the importation of foreign residents and physicians at our university hospital. It appears as many has half the IM residents and >65% of the Surgery residents are IMGs from India. Additionally at least half of our 3rd and 4th year attendings and instructors are also IMGs from India.

Recently I have noticed a increasing tension between said residents/attendings and the med students, for instances; last week in a small group PBL environment a female student asked a IMG attending to repeat her question b/c she didn't understand at which time the attending came unglued- yelling and belittling the student in front of the rest of the group (the med student was very polite in her request to repeat the question). Again this week, different student and IMG attending but similar event at the hospital during clinical exposure (it didn't occur in front of pts thank goodness). Finally I have two M4s who state they have been yelled and screamed at in front of pts by their IM and Surgery Attendings (both of which happen to be IMGs).

I post this hoping to determine if these are unusual experiences localized to OUR med school training or if it is becoming the norm in medical education. Please respond with any constructive comments or insights.

(ex. in the last two years we have had students match in surg at Mayo,Denver, Hennipen, U of Iowa, U of Neb and Baylor just to name a few and had a total of 22 students go surgery but at our OWN Surgery Residency only 3 US grads were matched and 7 IMGs were matched, does this sound odd? Similar ratios are present in IM as well.

just another example of "jobs Americans won't do" thumbdown. In stead of increasing the number of seats in American med schools and building new med schools, they choose to import foreign doctors. Why??? I don't know, but I am guessing it's cheaper to import foreign trained doctors than train our own.

Nicely done, State Department

 

[SocialistMD]

In stead of increasing the number of seats in American med schools and building new med schools, they choose to import foreign doctors.

Not true. Several states have added medical schools with the sole purpose of increasing primary care physicians. There are also scholarships offered for those who plan to go into primary care, especially in underserved areas.

 

[Moniker]

Not true. Several states have added medical schools with the sole purpose of increasing primary care physicians. There are also scholarships offered for those who plan to go into primary care, especially in underserved areas.

more relevantly - MD schools are increasing enrollment, albeit somewhat gradually. but you can't just bump up class sizes 50% in the turn of a year, nor would that translate into more American attendings for another 15. still, they've been told to increase enrollment and they are.

but i agree - we should be maximizing American doctors, trained in the american model, practicing in our own hospitals. preferably MD, if you ask me.

 

[NonTradMed]

just another example of "jobs Americans won't do" thumbdown. In stead of increasing the number of seats in American med schools and building new med schools, they choose to import foreign doctors. Why??? I don't know, but I am guessing it's cheaper to import foreign trained doctors than train our own.

Nicely done, State Department

I think it's easier to turn off the foreign doctor spigot than to tell medical schools to decrease enrollment if there is a surplus of doctors. The people who benefit most from this form of controlled market are doctors themselves since it keeps demand at a relatively high rate. It's also cheaper to import educated foreign nationals since the US do not have to pay for the expense of educating doctors.

 

[Doublecortin]

I think it's easier to turn off the foreign doctor spigot than to tell medical schools to decrease enrollment if there is a surplus of doctors. The people who benefit most from this form of controlled market are doctors themselves since it keeps demand at a relatively high rate. It's also cheaper to import educated foreign nationals since the US do not have to pay for the expense of educating doctors.

yeah, I can see how that would make financial sense.

I know here in CA, it costs the state 40K to educate med students at UCs but the tuition is 25K

 

[spreebee]

... as my initial post gave the example of the our Surgery residency taking foreign grads instead of our own students or even American grads seems to show the impending changes to our program. Is anybody else noticing this type of drastic shift in their institution?

I'm guessing most of these people that are IMG's do really good on the USMLE... Don't forget the Caribbean. Alot of U.S. citizens that are Indian don't get into medical school in the U.S. and attend an international school. They then make their way back to their home--> THE U.S.... Residency gets competitive and just cause you went to a "homeland" school doesn't secure jack now adays...The spot goes to the most proven "most of the time (aka high step scores)."

 

[anthroguy]

Being yelled at as a medical student is a part of the process. Attendings, residents, interns will always get annoyed at something the medical student cannot fathom. Its just the way it is.

I still remember a video from college where they play a tape to one group of an Asian man, and the other group of a white man. But they keep the same voice tract. The number of people who said they couldnt understand the Asian man was shockingly higher than those who said they couldnt understand the white man.

Sometimes the attitude one has when approaching diversity is all important.

 

[Depakote]

We have one, a Brazilian graduate who's been here since the 1970s. Honestly, he's one of the best anatomists we have- the guy has a Yoda-like ability to make structures rise from the fascia in lab.

you must become one with The Fascia, young Flaxmoore.

 

[Cirrus83]

Well I don't know about you, but most of the IMG/FMG's I know speak pretty decent english. But then again one of them's my uncle and he did his PhD stateside.

At my school I think maybe a couple (1-2?) of our current instructors for the clinical stuff are IMGs (for MS1 and MS2). I'm sure there'll be IMGs when we do rotations though, there's a huge shortage of IM docs after all.

Anyways, maybe the IMGs in your case are kinda pissed off because they expect to be treated with hella respect like back in the day or something. If I were you I'd just learn to understand accented english better, from cockney to croatian =p

 

[TMP-SMX]

It's worse when the patients can't understand the IMGs.

 

[Flaxmoore]

you must become one with The Fascia, young Flaxmoore.

You know exactly who I'm talking about.

 

[SomeDoc]

Recently I have noticed a increasing tension between said residents/attendings and the med students, for instances; last week in a small group PBL environment a female student asked a IMG attending to repeat her question b/c she didn't understand at which time the attending came unglued- yelling and belittling the student in front of the rest of the group (the med student was very polite in her request to repeat the question).

(ex. in the last two years we have had students match in surg at Mayo,Denver, Hennipen, U of Iowa, U of Neb and Baylor just to name a few and had a total of 22 students go surgery but at our OWN Surgery Residency only 3 US grads were matched and 7 IMGs were matched, does this sound odd? Similar ratios are present in IM as well.

A) Sad.

B) Re: Surgery residency; comes down to board scores and the total package. Some USG's made it, some didn't. The IMG's must have been stellar applicants.

 

[jvin2006]

any chance the OP is from Indiana? Because this situation is similar to midwest Indiana.

 

[tegs15]

Not Indiana, but have heard via PM that our situation is not unique in the midwest.

Ladynice (kinda a misnomer in your case)
1. -
2. Well my father is actually dead and so I must pay for all of medschool via loans just as the majority of AMGs do. Actually even if my father was living I still would have to use loans.
3.It always becomes a race issue! As I see it its a culture/nationality issue, call it what it is!
4. Maybe cultural insensativity works both ways? Maybe Federal Resources provided by generations of American families should not be used to pay the salaries of FMGs who have not paid into the system in anyway. I think they should work for free and if they become citizens later then their children can be paid by tax funds during their residencies.
5. I'm really pleased that FMGs might speak better spanish then me, if so they might be of more use in Mexico or another spanish speaking country, yet they still come here.
6. Maybe instead of sending FMGs here and "incompetent" AMGs to India, India should just keep their exceptional, high achieving, mother teressa-like FMGs to themselves, heavens knows their life expectancy and poverty levels could use them!

 

[jdh71]

EDIT

"Holy cow Batman!"

"What Robin?! Did you see the Joker?!"

"Cripes NO Batman . . . it was a CHIP!"

"A Chip? Those can get ugly, Robin. Where was it?"

"On a shoulder! It was ugly!"

"To the Batmobile!"

 

[SocialistMD]

[EDIT]

Watch out; njbmd may be on the prowl...

 

[Moniker]

[EDIT]

this is a really insulting post and i hope you're not serious.

 

[cfdavid]

regardless of the angle of your intention and approach to this question, my answer will be the same- Live With It. IMG's AMGS, FMG's DO's they are all docs- we are M3/M4's , and we arent the ones hiring people- we just rotate, and try to learn the most. FMG's wil be everywhere and you will get yelled at almost anywhere you go to. Just have thick skin and learn to move on. As far as the FMG's fillin up your surgery spots- go cry about it

Whoa. Just deal with it??? Deal with what? Being berated and YELLED at as a STUDENT?

I'll accept some harshness. I'll accept some criticism as long as it's constructive, or warranted. But, I will not accept blatent rudeness. But, that's me. I'll look the dude right in the eye and tell him never to "yell" at me again. It's worked in many other situations. Never underestimate the strength of maintaining the moral high ground. But, this requires an appropriate, non-hostile response. But, that doesn't mean you can't be firm and get the point across.

Again, if it's warranted or is done to make an educational point, or even an efficiency point, well it comes with the territory. But, blatant abuse of hierarchical power is different, counterproductive, unprofessional, and unacceptable.

Sure, some will say "well, you're in for a rude awakening".... "go in with that attitude and you'll lose...." Whatever. My experience is that the vast majority of academics in positions of power ARE professional, and ARE interested in maintaining a non-malignant culture. So, there's no reason to accept outright abuse as "just part of the program, man, so suck it up". I don't buy it, and won't put up with it. And, I seriously don't care about any consequences. I'm not going to sell my soul for this.

That being said, if I "forgot" an order, was late, wasn't paying attention, misanswered a question that was just addressed..... Whatever. I'll take it like the best of em. Hell, I'll even bend over to facilitate the insertion, if it's justified..... LOL What I'm refering to is rampant malignancy, and unprovoked unprofessional or blatantly abusive behavior. That, I simply will NOT put up with.

 

[supa76]

I'll accept some harshness. I'll accept some criticism as long as it's constructive, or warranted. But, I will not accept blatent rudeness. But, that's me. I'll look the dude right in the eye and tell him never to "yell" at me again. It's worked in many other situations. Never underestimate the strength of maintaining the moral high ground. But, this requires an appropriate, non-hostile response. But, that doesn't mean you can't be firm and get the point across.

Again, if it's warranted or is done to make an educational point, or even an efficiency point, well it comes with the territory. But, blatant abuse of hierarchical power is different, counterproductive, unprofessional, and unacceptable.

right on brother/sister.

 

[SocialistMD]

I'll look the dude right in the eye and tell him never to "yell" at me again.

Good luck with that.

It's true that there aren't that many malignant personalities left, but I would suggest biting your tongue at the time and then addressing it with the clerkship director (or your program director if it happens as a resident) rather than becoming confrontational or taking it up personally with the person. There is usually a history with those people and the clerkship director has more leverage. Also, if you get confrontational with yellers, things can escalate rapidly and you definitely don't want to find yourself in that situation. Ever.

 

[cfdavid]

Good luck with that.

It's true that there aren't that many malignant personalities left, but I would suggest biting your tongue at the time and then addressing it with the clerkship director (or your program director if it happens as a resident) rather than becoming confrontational or taking it up personally with the person. There is usually a history with those people and the clerkship director has more leverage. Also, if you get confrontational with yellers, things can escalate rapidly and you definitely don't want to find yourself in that situation. Ever.

Nope. Not confrontational, and most likely not in front of others. But, pulling someone aside, and calmly explaining to them that they were out of line is the way to go. If they want to escalate the situation, then walk away. The point will be made regardless.

 

[SocialistMD]

Nope. Not confrontational, and most likely not in front of others. But, pulling someone aside, and calmly explaining to them that they were out of line is the way to go. If they want to escalate the situation, then walk away. The point will be made regardless.

That's great.

Still, as someone who works with a couple of these malignant personalities (and who worked with a couple more as a medical student) in the medical field and has seen what happens when one gets confrontational (again, you could say it in the most calm voice possible, but any challenge to their authority will be taken as confrontational), I still say the best route is to just bite your tongue and talk with your clerkship director.

But you do what you want to; all you med students now seem to know better than everyone else...

 

[cfdavid]

That's great.

Still, as someone who works with a couple of these malignant personalities (and who worked with a couple more as a medical student) in the medical field and has seen what happens when one gets confrontational (again, you could say it in the most calm voice possible, but any challenge to their authority will be taken as confrontational), I still say the best route is to just bite your tongue and talk with your clerkship director.

But you do what you want to; all you med students now seem to know better than everyone else...

I respect what you're saying. It depends on the circumstances ofcourse. And I don't pretend to know more than others that have come before me.

But, there are people that will avoid a confrontation at any cost. For them, there's nothing more uncomfortable than any type of confrontation. So, they get walked over, throughout life. I've seen it. Like the rest of the population, there are medicals students, residents, and even doctors that are this way

I'm not one of those people. So, if someone mistakes my addressing their being out of line as me being confrontational and challenging their authority, then that's their problem. Again, I'll take pretty much anything if it's justified. But, the OP was speaking to outright abuse, which is never acceptable to those that won't sell their soul or integrity simply to avoid what someone may mistake as a confrontation.

 

[SocialistMD]

...if someone mistakes my addressing their being out of line as me being confrontational and challenging their authority, then that's their problem.

Right, but it can rapidly become your problem if you challenge them. I'm just saying it is wiser to err on the conservative (passive) side initially and address it through administrative channels. I'm all for sticking up for one's self, but in cases such as these, the tactful thing to do would be to take the less aggressive approach.

There are always ways to address these issues without getting in someone's face, even if you are doing it with your biggest smile and your most humble tone. These channels are established to prevent exactly what you are against (passive people "just taking it") while keeping everyone directly involved safe and level-headed.

 

[deuist]

bah, lots of the residents at my program are IMG's. Some are good. Some aren't. The same ratio of good:bad applies to the American grads, too.

 

[MacGyver]

Fear not guys, there are 36 new medical schools in the pipeline which will account for well over 5,000 new med school graduates per year.

Since residency slots are capped by the federal govt, that means you can say bye-bye to most of those IMGs. Right now they get a decent shot at matching in the US because american grads account for only about 70% of all residency slots.

Well that cushion is about to dissapear, and I suspect that the # of IMGs will plummet over hte next 5-10 years as all these new med schools come online.

The days of any random bum in some ****ty med school overseas walking into an IM/FP residency slot are numbered. Of course there will still be a few IMGs who come in, since they are exceedingly well qualified.

If your surgery residency program still has a 70% IMG fill rate in 10 years, then it means the your FMG program director is discriminating against american medical grads. It will not be because there are few AMGs who want to match there.

 

[smq123]

Whoa. Just deal with it??? Deal with what? Being berated and YELLED at as a STUDENT?

Um, yeah. What else did you plan on doing?

You won't be the first medical student who is expected to shut-up-and-take-it if you're being yelled at. You certainly won't be the last.

You'll save yourself a lot of trouble by just letting it roll off your back. You might think that sticking up for yourself by asking the attending to never yell at you again will buy you your dignity back, but it won't. It just invites more trouble and much, much more humiliation.

So, if someone mistakes my addressing their being out of line as me being confrontational and challenging their authority, then that's their problem.

Until they give you a crappy grade for it. And trying to contest that grade turns into "I said, he said." And until the lousy evals that they give you show up on your dean's letter.

Don't plan on sticking up for yourself now. You might be able to, you probably won't be able to. But it's really hard to "plan" on sticking up for yourself when you're not on the wards.

(We're not trying to tell you to "compromise your integrity" or anything. It's just that we've seen some med students turn into sinking ships in front of our eyes at work rounds, and it's not pretty.)

Socialist's suggestion of using official channels is a good idea. They often do work, and students using those channels have managed to remove toxic attendings. But shooting yourself in the foot is not the way to go.

 

[deuist]

I've used official channels before. All of those crappy attendings are still here. One even got promoted. I don't see any benefit to complaining anymore.

 

[Doublecortin]

Fear not guys, there are 36 new medical schools in the pipeline which will account for well over 5,000 new med school graduates per year.

Since residency slots are capped by the federal govt, that means you can say bye-bye to most of those IMGs. Right now they get a decent shot at matching in the US because american grads account for only about 70% of all residency slots.

Well that cushion is about to dissapear, and I suspect that the # of IMGs will plummet over hte next 5-10 years as all these new med schools come online.

The days of any random bum in some ****ty med school overseas walking into an IM/FP residency slot are numbered. Of course there will still be a few IMGs who come in, since they are exceedingly well qualified.

If your surgery residency program still has a 70% IMG fill rate in 10 years, then it means the your FMG program director is discriminating against american medical grads. It will not be because there are few AMGs who want to match there.

36, hah holy siht!

 

[DrFraud]

Fear not guys, there are 36 new medical schools in the pipeline which will account for well over 5,000 new med school graduates per year.

Since residency slots are capped by the federal govt, that means you can say bye-bye to most of those IMGs. Right now they get a decent shot at matching in the US because american grads account for only about 70% of all residency slots.

Well that cushion is about to dissapear, and I suspect that the # of IMGs will plummet over hte next 5-10 years as all these new med schools come online.

The days of any random bum in some ****ty med school overseas walking into an IM/FP residency slot are numbered. Of course there will still be a few IMGs who come in, since they are exceedingly well qualified.

If your surgery residency program still has a 70% IMG fill rate in 10 years, then it means the your FMG program director is discriminating against american medical grads. It will not be because there are few AMGs who want to match there.

Well, there are two groups that I know of that make up IMGs. MDs born and raised abroad, and US born and raised.

The MDs born abroad that I have encountered so far are outstanding. Yes, you have to be a little flexible, but you can learn lots from them if you keep an open mind.

The group born and raised in the US who go abroad will instead stay home and go to US schools once the new schools go online but I find what you said funny because some posters like to say that US IMGs are inferior and the solution is to open more spots at US med schools - which of course will be filled with the very students that you call bums.

 

[Ashers]

I've used official channels before. All of those crappy attendings are still here. One even got promoted. I don't see any benefit to complaining anymore.

I used official channels to complain about a resident after being yelled at for not having the dose of the medicine on the list (no other meds had doses -- it was a new rule), for not remember every single topic I looked up for an article presentation (and she wouldn't let me change into clinic clothes from scrubs until I told her most of the topics I looked up), I didn't know the answer to some pimp questions, and I got yelled at; I did know the answer to other questions, and she shut up and looked bitter.

So about every other student that's interacted with her also complained about her for basically the same stuff, getting yelled at for really stupid reasons. Now her comments about us aren't counted in our grades. A fellow on another service was put on probation after having a bad reputation of mistreating anyone not as high-ranking as she. I had to deal with her too.

She's not an IMG though. The IMGs I've worked with so far have been nice.

 

[GreenShirt]

Fear not guys, there are 36 new medical schools in the pipeline which will account for well over 5,000 new med school graduates per year.

Since residency slots are capped by the federal govt, that means you can say bye-bye to most of those IMGs. Right now they get a decent shot at matching in the US because american grads account for only about 70% of all residency slots.

Well that cushion is about to dissapear, and I suspect that the # of IMGs will plummet over hte next 5-10 years as all these new med schools come online.

The days of any random bum in some ****ty med school overseas walking into an IM/FP residency slot are numbered. Of course there will still be a few IMGs who come in, since they are exceedingly well qualified.

If your surgery residency program still has a 70% IMG fill rate in 10 years, then it means the your FMG program director is discriminating against american medical grads. It will not be because there are few AMGs who want to match there.

No, I think it will mean the unpopular residencies (ie primary care) will still go to FMGs while the competitive residencies will become more competitive with more students going unmatched.

 

[MacGyver]

No, I think it will mean the unpopular residencies (ie primary care) will still go to FMGs while the competitive residencies will become more competitive with more students going unmatched.

Uhh that doesnt make any sense. With the number of residency slots staying flat, the people who dont match into the competitive slots will be FORCED to match into primary care.

do you think that after 4 years of med school, they are going to go to law school instead?

 

[Moniker]

Uhh that doesnt make any sense. With the number of residency slots staying flat, the people who dont match into the competitive slots will be FORCED to match into primary care.

do you think that after 4 years of med school, they are going to go to law school instead?

I think you two are talking about 2 different (but related) issues.
1) # of unmatched US grads going into primary care
2) # of US grads matching into primary care

It's likely there'll be an increase in unmatched US grads as the US grads/spots ratio increases...this may or may not translate into more US grads in primary care residencies (via the Scramble). It probably would, but who knows, those individuals may scramble into transitional years and reapply with stronger chances. There are a lot of X factors, but yeah you could probably speculate that "increase in # US scramblers -> increase in US primary care matches".

It's also likely there'll be an increase in competitiveness of the more competitive specialties and even the moderately competitive, which means there are likely to be more people putting less competitive specialties on their rank list....this would likely translate into more US grads in primary care residencies, as at least some of them (who ordinarily would have a better shot at matching in their preferred [higher ranked] specialty) will end up matching primary care.

But again - I think the real (politically correct) message is that the US is doing right by its citizens by training enough doctors domestically to fill our own residency spots as much as possible. While I certainly don't blame IMG's from wanting to be trained & practice medicine here, it's not good economics or healthcare practice to be relying on foreign graduates to fill residency spots. Further, it's not really fair to other countries to drain them of the physicians they train domestically.

And I know a lot of people complain that the US is increasing med student enrollment without increasing residency spots, but I don't think that's a bad thing. Residency spots should follow physician demand, and that demand should be satisfied by US students. I mean the ideal situation should be that all the allopathic residency spots should be filled by US allopathic medical school grads. All the osteopathic residency spots should be filled by US osteopathic medical school grads. I think increasing MD enrollment more than residency spot increases would move in that direction.

 

[ronin12]

Preface: It is not my intention to degrade or belittle anyones culture or heritage.

I'm at a Allo med school in the midwest where there appears to be trend in the importation of foreign residents and physicians at our university hospital. It appears as many has half the IM residents and >65% of the Surgery residents are IMGs from India. Additionally at least half of our 3rd and 4th year attendings and instructors are also IMGs from India.

Recently I have noticed a increasing tension between said residents/attendings and the med students, for instances; last week in a small group PBL environment a female student asked a IMG attending to repeat her question b/c she didn't understand at which time the attending came unglued- yelling and belittling the student in front of the rest of the group (the med student was very polite in her request to repeat the question). Again this week, different student and IMG attending but similar event at the hospital during clinical exposure (it didn't occur in front of pts thank goodness). Finally I have two M4s who state they have been yelled and screamed at in front of pts by their IM and Surgery Attendings (both of which happen to be IMGs).

I post this hoping to determine if these are unusual experiences localized to OUR med school training or if it is becoming the norm in medical education. Please respond with any constructive comments or insights.

(ex. in the last two years we have had students match in surg at Mayo,Denver, Hennipen, U of Iowa, U of Neb and Baylor just to name a few and had a total of 22 students go surgery but at our OWN Surgery Residency only 3 US grads were matched and 7 IMGs were matched, does this sound odd? Similar ratios are present in IM as well.

I read this post while browsing though the forum. I am not surprised to read this comment as i am awfully aware of this institution and city. Having being trained as FMG resident from this institution in specialty other than IM or surgery. I know there is large percentage of FMG's in IM and surgery.
During my training I can feel the discomfort among US medical students and Attendings to deal with FMG's for reasons unknown. I think the way you portrayed the yelling incidences are way over the top and it seems more to do with underlying bias against FMG's then actual incidences . I am quite familiar with the overall working of this particular institution. Being an FMG resident I can go on and on how on several occasions I was made aware intentially or unintentially by my American attendings , not to accept same level of courtesy and respect which they gave to AMG's.
The tragedy of the city and institution is that they can not attract many AMG's for their residencies.Especially in your school most of the students are out of state and they leave once they are done with their school. So they rely on FMG's for their recruitment and then suffer through the misery of simply seeing them working in hospital. While I was there some of the graduates from other medical college in town joined the IM residency because they thought FMG attendings are better teachers.
I do not doubt the accent and cultural aspects and resulting confusions, but i am quite confident they are way over blown. which have more to do with geography and culture of this part of USA. I am still thankful to institute for training me. I am definitely not excited to look back at the experiences I had during my training. I am thankful to move out of this place. please pardon me being blunt . I think you need to look into mirror and get out of mentality of this particular town and state. America is great country and offers lot more diversity and acceptance to those are different than this town.