Medical Graduates

Medical Graduates



Introduction

In 2002, the Accreditation Council for Graduate I Medical Education (ACGME) revamped post- graduate medical learning in the US, introducing six medical "competencies. Medical knowledge, professionalism, communication practice based learning, systems-based and patient care are the six domains of medical competency that are taught and evaluated by residency faculties. Since 37% of trainees in Internal Medicine are international medical graduates (IMG), and the ACGME competencies are not necessarily emphasized in all foreign medical schools, it is reasonable to hypothesize that there may be measurable differences in the degree to which IMG and their American counterparts (USMG) understand the competencies. In this study, we queried applicants for a 2010 position in our Internal Medicine Residency regarding their basic understanding of the ACGME competencies.

Methods

Bridgeport Hospital is 350-bed community teaching hospital that is affiliated Yale University School of Medicine. The Internal Medicine Residency comprises 13-14 residents at each post-graduate year level. All applicants to the hospital's Internal Medicine residency were invited to complete a modified questionnaire with two multiple-choice questions examining understanding of each of the six competencies. 13th question examined students' attitudes toward responsibility (i.e. "ownership" of care) during training. After two iterations faculty agreed that all 13 questions had unique correct answers, (questionnaires were electronically mailed to all applicants in October 2009, prior to interviews. Percent correct response rates of USMGs were compared to IMGs for the total test, for each of the 6 domains of medical competence and the question on responsibility. Analyses of variance were used for comparisons of groups (IMG vs. USMG). A P <0.05 was considered statistically significant for all analyses (Morrison, p.67).

Results

A total of 277 applicants (of 1,737 to our program) answered the questionnaire; 39 were USMGs and 238 were IMGs. Characteristics of the IMG and USMG respondents are listed in Table 1. Groups were similar except IMG was older than USMG (29 vs. 27 years; P = 0.02). Overall scores were 67% correct answers among USMG and 62% among IMG (P = 0.22). IMGs and USMGs answered equally well questions on medical professionalism, patient care, medical knowledge, communication and their responsibility to patients as trainees (Fig. 1). USMG scored significantly higher than IMG on practice-based learning (PBL; 92% vs. 63% correct, P = 0.01) and systems-based practice (SBP; 41% vs 21%; P = 0.02) (Fig. 1). The observed differences were confined to one question in each domain. USMGs scored better on question four that gauged knowledge of components of PBL (69.2% vs 47.5%; P = 0.01), and question eight which examined understanding of U.S. healthcare economics (39.5% vs 20.4%; P =0.01).

Discussion

This pilot study demonstrates that this small group of IMGs was not as familiar as USMGs with components comprising PBL and U.S. healthcare economics. These data lend some support to the notion that IMGs are less exposed to the ACGME competencies. It is not unexpected that differences were noted in PBL and SBP. SBP promotes understanding of healthcare economics and harnessing healthcare resources so to fully serve ...