Department of Family Medicine, McMaster University, 1280 Main Street West, DBHSC 5th floor, Hamilton, ON, L8S 4L8, Canada.
Health Research Methodology, McMaster University, Hamilton, ON, Canada.
BMC Med Educ. 2024 Aug 19;24(1):892. doi: 10.1186/s12909-024-05837-w.
International Medical Graduates (IMG) are an essential part of the international physician workforce, and exploring the predictors of success and failure for IMGs could help inform international and national physician labour workforce selection and planning. The objective of this study was to explore predictors for success for selection of IMGs into high stakes postgraduate training positions and practice and not necessarily for informing IMGs.
We searched 11 databases, including Medline, Embase and LILACS, from inception to February 2022 for studies that explored the predictors of success and failure in IMGs. We reported baseline probability, effect size in relative risk (RR), odds ratio (OR) or hazard ratio (HR) and absolute probability change for success and failure across six groups of outcomes, including success in qualifying exams, or certificate exams, successful matching into residency, retention in practice, disciplinary actions, and outcomes of IMG clinical practice.
Twenty-five studies (375,549 participants) reported the association of 93 predictors of success and failure for IMGs. Female sex, English fluency, graduation recency, higher scores in USMLE step 2 and participation in a skill assessment program were associated with success in qualifying exams. Female sex, English fluency, previous internship and results of qualifying exams were associated with success in certification exams. Retention to work in Canada was associated with several factors, including male sex, graduating within the past five years, and completing residency over fellowships. In the UK, IMGs and candidates who attempted PLAB part 1, ≥ 4 times vs. first attempters, and candidates who attempted PLAB part 2, ≥ 3 times vs. first attempters were more likely to be censured in future practice. Patients treated by IMGs had significantly lower mortalities than those treated by US graduates, and patients of IMGs had lower mortalities [OR: 0.82 (95% CI: 0.62, 0.99)] than patients of US citizens who trained abroad.
This study informed factors associated with the success and failure of IMGs and is the first systematic review on this topic, which can inform IMG selection and future studies.
PROSPERO: CRD42021252678.
国际医学毕业生（IMG）是国际医生劳动力的重要组成部分，探索 IMG 成功和失败的预测因素可以帮助为国际和国家医生劳动力的选择和规划提供信息。本研究的目的是探索 IMG 进入高风险研究生培训职位和实践中的成功预测因素，而不一定是为了告知 IMG。
我们从 1975 年 1 月至 2022 年 2 月在 11 个数据库中进行了检索，包括 Medline、Embase 和 LILACS，以探索 IMG 在资格考试、证书考试、成功匹配住院医师、保留在实践、纪律处分和 IMG 临床实践结果等六组结局中的成功和失败的预测因素。
25 项研究（375549 名参与者）报告了 93 个 IMG 成功和失败预测因素的相关性。女性、英语流利程度、最近毕业、美国医师执照考试（USMLE）第 2 步成绩较高和参加技能评估计划与资格考试的成功相关。女性、英语流利程度、以前的实习和资格考试结果与证书考试的成功相关。在加拿大工作的保留与多种因素有关，包括男性、过去五年内毕业和完成住院医师培训而不是奖学金。在英国，PLAB 第 1 部分考试≥4 次的 IMG 和考生与首次考生相比，PLAB 第 2 部分考试≥3 次的 IMG 和考生与首次考生相比，在未来的实践中更有可能受到谴责。由 IMG 治疗的患者的死亡率明显低于由美国毕业生治疗的患者，由 IMG 治疗的患者的死亡率[比值比：0.82（95%置信区间：0.62，0.99）]低于由国外培训的美国公民治疗的患者的死亡率。
本研究提供了与 IMG 成功和失败相关的因素信息，是该主题的第一个系统评价，可为 IMG 选择和未来研究提供信息。
PROSPERO：CRD42021252678。
