Z. Zaidi is professor, Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, Florida.
M. Dewan is interim president and distinguished service professor of psychiatry and behavioral sciences, Upstate Medical University, Syracuse, New York.
Acad Med. 2020 Dec;95(12S Addressing Harmful Bias and Eliminating Discrimination in Health Professions Learning Environments):S82-S87. doi: 10.1097/ACM.0000000000003694.
International medical school graduates (IMGs) play a vital role in the health care system of the United States. They constitute roughly one-quarter of the physician workforce, comprising a significant proportion of the primary care providers in high-need rural and urban areas, where they provide equal and, in some instances, better care than U.S. graduates. Nonetheless, they face a series of hurdles in entering U.S. residency programs and throughout their training experiences.IMGs must expend significant resources to obtain Education Commission for Foreign Medical Graduates certification, which includes Steps 1, 2 Clinical Knowledge and 2 Clinical Skills of the United States Medical Licensing Examination. They encounter the uncertainty of matching and, if successful, obtaining a visa to enter the United States. Once here, they need to adapt to the complexities of the health care system and familiarize themselves with the cultural nuances, professional behaviors, and communication skills of another country. They encounter biases and microaggressions and lack support groups and mentors. Those who choose an academic career are less likely to obtain leadership positions.This Perspective provides an overview of these challenges and highlights opportunities for change at local and national levels. Specifically, it identifies strategies that would assist IMGs before entry, at entry, during training, at the transition to practice, and in practice. The current COVID-19 pandemic highlights the shortage of physicians in the United States and illustrates the importance of ensuring that IMGs, who are essential health care workers, feel welcome, valued, and recognized for their contributions.
国际医学院毕业生（IMG）在美国的医疗保健系统中发挥着至关重要的作用。他们构成了医生劳动力的大约四分之一，在高需求的农村和城市地区，他们构成了主要医疗服务提供者的重要组成部分，在这些地区，他们提供的医疗服务与美国本土毕业生一样平等，甚至在某些情况下更好。然而，他们在进入美国住院医师培训项目以及整个培训过程中都面临着一系列障碍。IMG 必须投入大量资源来获得外国医学毕业生教育委员会的认证，其中包括美国医师执照考试的步骤 1、2 临床知识和 2 临床技能。他们面临着匹配的不确定性，如果成功，还需要获得签证才能进入美国。一旦来到这里，他们需要适应医疗保健系统的复杂性，并熟悉另一个国家的文化细微差别、专业行为和沟通技巧。他们会遇到偏见和微侵犯，缺乏支持团体和导师。那些选择学术职业的人获得领导职位的可能性较小。本观点概述了这些挑战，并强调了在地方和国家层面上进行变革的机会。具体而言，它确定了在进入前、进入时、培训期间、过渡到实践以及实践中可以为 IMG 提供帮助的策略。当前的 COVID-19 大流行突显了美国医生短缺的问题，并说明了确保 IMG 作为基本医疗工作者感到受欢迎、有价值和得到认可的重要性，因为他们为医疗保健做出了贡献。
