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Navigating Psychiatry Residency in the United States

A Guide for International Medical Graduate Physicians

Languages and Communication

Factors to Consider

There were 10,000 IMGs certified by ECFMG in 2015. They graduated from 1,141 medical schools located in 139 countries or territories. Approximately 61% of these medical schools reported that English is one of their languages of instruction. English was also the most common native language (41.8%). More than 130 other native languages were reported, including Arabic (10.6%), Spanish (7.8%), Urdu (6.4%) and Hindi (2.8%).

Every IMG working as a physician in the U.S. has been assessed as being fluent in the English language. During the United States Medical Licensing Exam Step 2—Clinical Skills (USMLE Step 2CS), the IMG physician's communication skills, interpersonal skills and proficiency in English are specifically examined through a set of clinical encounters. This practice has increased the number of IMGs with capable English language skills entering training in the U.S. However, successful completion of the USMLE Step 2CS does not always help address subtle language problems that can impact the care provided by IMGs.

In some cases, patients find it difficult to communicate with an IMG physician due to the provider's accent. Similarly, IMG physicians may also experience difficulties in understanding some slang and colloquial terms used by their patients.

Nonverbal communication can also present a challenge for some IMG physicians, when it can often be essential to understanding and managing the emotions of a patient.

Despite having to overcome cultural and language barriers coupled with a lack of familiarity with American healthcare systems, IMGs have excelled in both, the USMLE and the specialty board examinations.

Strategies for Improvement in Communication

IMG physicians joining training in psychiatry face numerous challenges in forming the patient-centered, doctor–patient relationship. Their cultural, personal and educational experiences may not adequately prepare them for this important skill. Numerous strategies can be tried such as:

  • Monitor progress in spoken language.
  • Informal conversations with peers and staff to enhance conversational skills.
  • Deliberate practice of engaging in small talk.
  • Trainings in nonverbal communication using videos, practicing standard expressions of sympathy and discussing clinical vignettes involving emotion-laden situations.
  • Practice interviewing skills, such as open-ended questioning, active listening and clinical information-sharing. Methods can include interactive learning techniques such as demonstration videos and taped interviews of the resident at work.

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