Abstract
Objective
The authors investigated whether social support and acculturation could predict the mental health of international medical graduates pursuing psychiatric residencies in the United States.
Methods
A 55-item online survey was assembled by combining three validated instruments for mental health, social support, and acculturation. A link to the survey was e-mailed to training directors of all psychiatric residency and fellowship programs. Directors were requested to forward the survey to their international medical graduate residents for completion between December 2008 and February 2009.
Results
One hundred eight international medical graduates from 70 different psychiatric residencies and fellowships completed the entire survey. Respondents’ mental health scores were normally distributed. The vast majority scored very high on survey items related to mental health. Acculturation, social support, and postgraduate training year were significant predictors of mental health.
Conclusion
Residency training programs should attempt to incorporate measures that would help boost the social support and acculturation of international medical graduates (especially junior-level trainees). Acculturation could be improved by language training and courses in American history, culture, and customs, and social support could be expanded by mentoring relationships.
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References
Educational Commission for Foreign Medical Graduates: 2011 Information Booklet-ECFMG Certification. Available at http://www.ecfmg.org/201lib/contents.html
Mullan F: The metrics of the physician brain drain. N Engl J Med 2005; 353:1810–1818
Accreditation Council for Graduate Medical Education: Data Resource Book: Academic Year 2007–2008. Available at http://www.acgme.org/acWebsite/dataBook/2007_2008_ANA_ANA_Current_ACGME_DataBook.pdf
McMahon GT: Coming to America: international medical graduates in the United States. N Engl J Med 2004; 350: 2435–2437
Blanco C, Carvalho C, Olfson M, et al: Practice patterns of international and US medical graduate psychiatrists. Am J Psychiatry 1999; 156:445–450
Bellini LM, Baime M, Shea JA: Variation of mood and empathy during internship. Int 2002; 287:3143–3146
Gaba DM, Howard SK: Fatigue among clinicians and the safety of patients. N Engl J Med 2002; 347:1249–1255
Shanafelt TD, Sloan JF, Habermann TM: The well-being of physicians. Am J Med 2003; 114:513–519
Woodside JR, Miller MN, Floyd MR, et al: Observations on burnout in family medicine and psychiatry residents. Acad Psychiatry 2008; 32:13–19
Martini S, Arfken CL, Balon R: Comparison of burnout among medical residents before and after the implementation of work hours limits. Acad Psychiatry 2006; 30:352–355
Martini S, Arfken CL, Churchill A, et al: Burnout comparison among residents in different medical specialties. Acad Psychiatry 2004; 28:240–242
Thomas NK: Resident burnout. JAMA 2004; 292:2880–2889
Al-Sharideh KA, Goe WR: Ethnic communities within the university: an examination of factors influencing the personal adjustment of international students. Res in Higher Education 1998; 39:699–725
Campbell HD: The prevalence and ramifications of psycho-pathology in psychiatric residents: an overview. Am J Psychiatry 1982; 139:1405–1411
Roback HB, Crowder MK: Psychiatric resident dismissal: a national survey of training programs. Am J Psychiatry 1989; 146:96–98
Cohen S: Social relationships and health. Am Psychol 2004; 59:676–684
Cohen S, Mermelstein R, Kamarck T, et al: Measuring the functional components of social support, in Social Report: Theory, Research and Application. Edited by Sarason IG, Sarason BR. Boston, Mass, Martinus Nijhoff, 1985, pp 73–94
House JS: Work, Stress, and Social Support. Reading, Mass, Addison Wesley, 1981
House JS, Kahn, RL: Measures and concepts of social support, in Social Support and Health. Edited by Cohen S, Syme SL. Orlando, Fla, Academic Publishers, 1981, pp 83–108
Thoits P: Stress, coping, and social support processes: where are we? What next? J Health Soc Behav 1995; Spec No: 53-79
Kawachi I, Berkman LF: Social ties and mental health. J Urban Health 2001; 78:458–467
Rogler L, Cortes D, Malgady R: Acculturation and mental health status among Hispanics: convergence and new directions for research. Am Psychol 1991; 46:585–597
Sodowsky GR, Carey JC: Asian Indian immigrants in America: factors related to adjustment. J Multicult Couns Devel 1987; 15:129–141
Sodowsky GR, Carey JC: Relationships between acculturation-related demographics and cultural attitudes of an Asian-Indian immigrant group. J Multicult Couns Devel 1988; 16: 117–136
Balon R, Mufti R, Williams M, et al: Possible discrimination in recruitment of psychiatry residents? Am J Psychiatry 1997; 154:1608–1609
Haveliwala YA: Problems of foreign-born psychiatrists. Psychiatr Q 1979; 51:307–311
Cohen S, Hoberman HM: Positive events and social supports as buffers of life change stress. J Appl Soc Psychol 1983; 13:99–125
Kessler RC, Andrews G, Colpe LJ, et al: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002; 32:959–976
Kessler RC, Barker PR, Colpe LJ, et al: Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003; 60:184–189
Stephenson M: Development and validation of the Stephenson Multigroup Acculturation Scale (SMAS). Psychol Assess 2000; 12:77–88
JC, Bernstein IH: Psychometric Theory, 3rd ed. McGraw-Hill Series in Psychology. New York, McGraw-Hill, 1994, pp 264–265
Odegaard O: Emigration and Insanity: A Study of Mental Disease Among the Norwegian-born Population of Minnesota. Copenhagen, Norway, Levib & Munksgaards Publishers, 1932
Cohen S, Wills T: Stress, social support, and the buffering hypothesis. Psychol Bull 1985; 98:310–357
Knoff WF, Oken D, Prevost JA: Meeting training needs of foreign psychiatric residents in state hospitals. Hosp Community Psychiatry 1976; 27:35–57
Berry JW, Uichol K, Thomas M, et al: Comparative studies of acculturative stress. Int Migr Rev 1987; 21:491–511
Educational Commission for Foreign Medical Graduates: Acculturation Program. Available at http://www.ecfmg.org/acculturation/index.html
Institute of Medicine: Clearing the air: asthma and indoor exposures. Washington, DC, Academy Press, 2001
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Atri, A., Matorin, A. & Ruiz, P. Integration of International Medical Graduates in U.S. Psychiatry: The Role of Acculturation and Social Support. Acad Psychiatry 35, 21–26 (2011). https://doi.org/10.1176/appi.ap.35.1.21
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DOI: https://doi.org/10.1176/appi.ap.35.1.21