Cultures engaging cultures: international medical graduates training in the United States.

International medical graduates (IMGs) represent an increasing proportion of residents in all US residency training programs. Family practice residencies have experienced significant increases in IMG enrollment in the last 3 years. Residency programs in family practice need to make curricular adjustments to enhance the transition for IMGs. Adjusting the psychosocial curriculum, through changes in orientation, behavioral conferences, and family consultations, contributes to a culture-centered approach to teaching both IMGs and US medical graduates. Faculty need to identify both personal loss and cultural issues for IMGs in various stages of the resident's life cycle. Lifestyle changes and loss of self-esteem, country, and accessibility to family can be demoralizing for IMGs coping with the demands of internship. Specific stages of the family life cycle can exert additional stresses for IMGs and their families. Understanding the specific challenges for IMGs during each life cycle stage can be instructive and helpful. Faculty can introduce initiatives that encourage cultural pride and respect. Support groups, international meals, cultural retreats, adjusted advising systems, and ongoing faculty reflection on treatment of IMGs demonstrates residency appreciation of diversity and leads to a healthier, culturally rich learning environment for all involved in residency education.