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. 2024 Jul 5;24(1):731.
doi: 10.1186/s12909-024-05702-w.

International medical learners and their adjustment after returning to their countries of origin: a qualitative study

Itthipon Wongprom  1 , Onlak Ruangsomboon  2 , Jikai Huang  3 , Abbas Ghavam-Rassoul  4
Affiliations

International medical learners and their adjustment after returning to their countries of origin: a qualitative study

Itthipon Wongprom et al. BMC Med Educ. .

Abstract

Introduction: International medical trainees, including residents and fellows, must cope with many challenges, such as differences in cultural hierarchical systems, languages, and acceptance. Nonetheless, the need for adjustment perpetuates even after training is completed abroad. When some international trainees return to their countries of origin, they continue to face adjustment challenges due to reverse culture shock. Others must make many further readjustments. This study presents an exploration of the adjustment and coping strategies of international medical learners after returning to their countries of origin upon completion of their programs.

Method: This study employed a qualitative approach grounded in interpretivism and utilised inductive thematic analysis following Braun and Clarke's method. Semi-structured, in-depth individual interviews were employed to explore the participants' coping strategies. Participants included international medical learners who were (1) international medical graduates who had already returned to their countries of origin, (2) non-Canadian citizens or nonpermanent residents by the start of the programs, and (3) previously enrolled in a residency or fellowship training programme at the University of Toronto, Ontario, Canada.

Results: Seventeen participants were included. Three main themes and seven subthemes were created from the analysis and are represented by the Ice Skater Landing Model. According to this model, there are three main forces in coping processes upon returning home: driving, stabilising, and situational forces. The sum and interaction of these forces impact the readjustment process.

Conclusion: International medical learners who have trained abroad and returned to their countries of origin often struggle with readjustment. An equilibrium between the driving and stabilising forces is crucial for a smooth transition. The findings of this study can help stakeholders better understand coping processes. As healthy coping processes are related to job satisfaction and retention, efforts to support and shorten repatriation adjustment are worthwhile.

Keywords: Coping strategies; International medical learners; Readjustment; Repatriation; Reverse culture shock.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
“Ice Skater Landing Model”
See this image and copyright information in PMC

References

    1. Annual Census | CAPER [Internet]. [cited 2022 Apr 12]. https://caper.ca/postgraduate-medical-education/annual-census.
    1. Postgraduate Medical Educatio. Five Years of the Resident Exit Survey: 2005–06 to 2009-10 [Internet]. Postgraduate Medical Education. [cited 2022 Apr 12]. https://pgme.utoronto.ca/about-pgme/pgme-reports/.
    1. Fiscella K, Roman-Diaz M, Lue BH, Botelho R, Frankel R. Being a foreigner, I may be punished if I make a small mistake: assessing transcultural experiences in caring for patients. Fam Pract. 1997;14(2):112–6. doi: 10.1093/fampra/14.2.112. - DOI - PubMed
    1. Hall P, Keely E, Dojeiji S, Byszewski A, Marks M. Communication skills, cultural challenges and individual support: challenges of international medical graduates in a Canadian healthcare environment. Med Teach. 2004;26(2):120–5. doi: 10.1080/01421590310001653982. - DOI - PubMed
    1. Cole-Kelly K. Cultures engaging cultures: international medical graduates training in the United States. Fam Med. 1994;26(10):618–24. - PubMed

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