Michalski Kerstin, Farhan Nabeel, Motschall Edith, Vach Werner, Boeker Martin
Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg, Germany.
Freiburg International Academy - University of Freiburg, Freiburg, Germany.
PLoS One. 2017 Jul 17;12(7):e0181330. doi: 10.1371/journal.pone.0181330. eCollection 2017.
An increasing number of International Medical Graduates (IMG), who are defined to be physicians working in a country other than their country of origin and training, immigrate to Western countries. In order to ensure safe and high-quality patient care, they have to take medical and language tests. This systematic review aims to (1) collect all empiric research on intercultural communication of IMGs in medical settings, (2) identify and categorize all text passages mentioning intercultural issues in the included studies, and (3) describe the most commonly reported intercultural areas of communication of IMGs.
This review was based on the PRISMA-Guidelines for systematic reviews. We conducted a broad and systematic electronic literature search for empiric research in the following databases: MEDLINE, BIOSIS Citation Index, BIOSIS Previews, KCI-Korean Journal Database and SciELO Citation Index. The search results were synthesized and analyzed with the aid of coding systems. These coding systems were based on textual analysis and derived from the themes and topics of the results and discussion sections from the included studies. A quality assessment was performed, comparing the studies with their corresponding checklist (COREQ or STROBE). Textual results of the studies were extracted and categorized.
Among 10,630 search results, 47 studies were identified for analysis. 31 studies were qualitative, 12 quantitative and 4 studies used mixed methods. The quality assessment revealed a low level of quality of the studies in general. The following intercultural problems were identified: IMGs were not familiar with shared decision-making and lower hierarchies in the health care system in general. They had difficulties with patient-centered care, the subtleties of the foreign language and with the organizational structures of the new health care system. In addition, they described the medical education in their home countries as science-oriented, without focusing on psychosocial aspects.
There is a need for a better training of IMGs on culture-related and not culture-related topics in the new workplace country. The topics that emerged in this review constitute a basis for developing these courses. Further empiric research is needed to describe the findings of this review more precisely and should be in accordance with the existing reporting guidelines.
越来越多的国际医学毕业生（IMG，即那些在其原籍国和培训国以外的国家工作的医生）移民到西方国家。为确保为患者提供安全、高质量的护理，他们必须参加医学和语言测试。本系统评价旨在：（1）收集所有关于国际医学毕业生在医疗环境中跨文化交流的实证研究；（2）识别并分类纳入研究中提及跨文化问题的所有文本段落；（3）描述国际医学毕业生最常报告的跨文化交流领域。
本评价基于系统评价的PRISMA指南。我们在以下数据库中进行了广泛而系统的电子文献检索，以查找实证研究：MEDLINE、BIOSIS引文索引、BIOSIS预印本、KCI-韩国期刊数据库和SciELO引文索引。借助编码系统对检索结果进行综合分析。这些编码系统基于文本分析，并源自纳入研究的结果和讨论部分的主题。进行了质量评估，将这些研究与其相应的清单（COREQ或STROBE）进行比较。提取并分类研究的文本结果。
在10630条检索结果中，确定了47项研究进行分析。31项研究为定性研究，12项为定量研究，4项研究采用混合方法。质量评估显示，总体而言这些研究的质量较低。识别出以下跨文化问题：国际医学毕业生一般不熟悉共同决策以及医疗保健系统中的低层级结构。他们在以患者为中心的护理、外语的细微差别以及新医疗保健系统的组织结构方面存在困难。此外，他们将本国的医学教育描述为以科学为导向，而未关注社会心理方面。
有必要在新工作所在国更好地培训国际医学毕业生，使其了解与文化相关和与文化无关的主题。本评价中出现的主题构成了开发这些课程的基础。需要进一步的实证研究，以便更精确地描述本评价的结果，并且应符合现有的报告指南。
