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Navigating Psychiatry Residency in the United States

A Guide for International Medical Graduate Physicians

Cultural Factors

IMG physicians need to be familiar with evolving U.S. and Canadian cultural practices, including those regarding professionalism and medical ethics, to facilitate a smoother transition to learning and working in the U.S. medical system.

More than any other medical discipline, clinical judgments and decision-making in psychiatry require a high level of cultural and linguistic fluency. Fluency in American cultural practices and English language may be weighted more heavily by residency program directors when selecting applicants than high USMLE scores or factual knowledge base in Psychiatry.

Factors to Consider

Psychiatry and Culture

Psychiatry is heavily influenced by culture. Most IMGs are from non-Western cultures where there are varying degrees of tolerance and stigma regarding mental illness. In addition to this possible cultural gap, psychiatry often does not receive much attention in undergraduate curricula in foreign medical schools.

Understanding Misconceptions and Stereotypes

Some IMGs may be inadequately prepared to start psychiatric training and may also hold misconceptions and stereotypes about American life in general and the psychiatry field in particular. Some of the misconceptions may include notions that American healthcare professionals medicalize normal developmental crises of childhood; American marriages are unstable (and often end in divorce); and American patients abuse their doctors.

Values Systems

IMG physicians need to be fully acquainted with various aspects of U.S. value systems. For example, the emphasis on individualism, personal expression, autonomy and self-realization in the U.S. may be unfamiliar or uncomfortable to those from cultures where youths are raised not to question authority, tradition, class systems or traditional gender roles.

Beliefs and Customs

IMG physicians may require to accept and/or adopt some of the beliefs and customs of the host culture. The more dissimilar their original culture is to that of the host country, the more stressful the acculturation process. The acculturation process may involves aligning attitudes with the ways of the host country's social, academic medicine and healthcare systems. Gender relationships can be challenging for some IMGs, both in clinical settings as in taking sexual histories and in the educational supervisory system, as when a male junior resident may be supervised by a female chief resident.

Models of Psychiatry

IMGs often need to switch from a more medical model of psychiatry to the biopsychosocial model of American psychiatry which may require to drop some of the conventional practices from origin of their country. These adjustments can cause an identity crisis and "culture shock," which may have the potential to lead to anxiety and depression. In addition, adapting to the egalitarianism in the doctor-patient relationship in U.S. medicine can be a challenging task.

Suggestions for Handling Cultural Adjustment and Avoiding "Culture Shock" for IMGs

A proven method for adapting to a different culture is to immerse oneself in the community, developing friendships and gaining exposure to the local traditions, arts and foods. IMGs can attain understanding of local culture by developing a social and professional network that can provide support as well as opportunities for engaging with the local community. It will also enrich their lives and help them better meet the needs of their patients.

Following are some activities that could help IMG physicians familiarize with local culture and community:

  • Learn about the history of the area, its people and their achievements, through discussions with friends/colleagues or by research.
  • Discussing the local community’s problems, strengths, social norms and religious beliefs with friends, colleagues or local experts can help the IMG physician more rapidly assimilate and correct any existing misconceptions. The residency program could also provide formal or casual opportunities for this type of discussion (see following).
  • Participate in local cultural activities and programs. For example, residency programs can organize cultural movie-screenings with discussions for IMGs, providing enjoyable, low-stress social events that also help enhance cultural understanding.
  • Comparing the beliefs and customs of the local culture with their own heritage in a non-judgmental fashion will provide additional benefits.
  • Join IMG physician support groups and find cross-generational mentors. For example, IMG Advisors Network (IAN), which is a free service of the ECFMG Certificate Holders Office (ECHO). ECHO provides a wide range of free resources that allow IMGs to be better prepared and organized in making important career decisions.
  • Volunteer with a group that is making a charitable contribution to the community, such as Habitat for Humanity or neighborhood free health clinic.

Further resources: A Physician's Practical Guide to Culturally Competent Care

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