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Volume 30 (1)
Volume 30, Issue 1, Winter 2010
J Contin Educ Health Prof 2010; 30(1):37-43
ORIGINAL RESEARCH
Learning to practice in Canada: The hidden curriculum of international medical graduates
Jocelyn Lockyer, Herta Fidler, Chris de Gara, James Keefe
A b s t r a c t
Introduction: There is movement of physicians internationally. In some cases, physicians are recruited from
low-income countries to wealthier countries like Canada to provide medical services in underresourced communities.
This needs assessment examined the clinical medicine learning challenges faced by international medical
graduates (IMGs) from the perspective of both the IMGs and medical leaders (eg, Vice President—Medical for a
Health Region).
Methods: Focus groups with 25 IMGs were held in 6 regional centers. Face-to-face interviews were held with 10
medical leaders. Participants were asked about the learning associated with patient management, patient referral,
and investigation, for billing and insurance, and learning about new systems of care. Qualitative data were analyzed
to determine how well the perspectives on learning were aligned.
Results: IMGs and medical leaders recognized that learning and support were needed by physicians without
previous experience in Canada. They had similar lists of learning issues. Although medical leaders believed the
new information was explicit, readily available, and could be learned from short explanations and lists; IMGs found
that guidelines and expectations were implicit, confusing, and contradictory. There were mediating influences in the
form of orientation programs, other IMGs, and “how to” lists in some cases, which helped the newcomer.
Discussion: There was concordance about aspects of the learning that was required between IMGs and medical
leaders. There was little agreement about the approach to learning or a recognition that the learning tasks were
complicated.
Lessons for Practice
- International medical graduates who relocate
their practices to Canada face many
challenges as they learn about common disease
management, referral practices, diagnostic
protocols, and billing and insurance
systems.
- International medical graduates and medical
leaders can identify the basic areas for
learning.
- International medical graduates and medical
leaders have discordant views on what
is required to learn about these areas and
how easy/difficult it is to meet expectations.
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