A review of 46 studies found that most acculturation programs for foreign-born, foreign-trained international medical graduates in high-income countries lack strong evidence of effectiveness, particularly in improving job performance or patient outcomes. This subgroup is included in projections to address physician shortages in countries such as the U.S.
The review grouped the studies into three categories: 15 evaluations of acculturation interventions, 21 studies reporting international medical graduates' (IMGs’) perspectives on helpful strategies, and 10 studies sharing insights from trainers. Although many programs reported high levels of satisfaction and perceived usefulness, only four studies included data on workplace performance, and just one study demonstrated robust evidence of impact on patient outcomes, as classified by the GRADE-CERQual tool. These studies measured outcomes such as communication with patients and interactions with colleagues.
Most interventions took place in the United Kingdom (17 of 46), followed by Australia (10), the U.S. (9), and Canada (6). The reviewed programs varied in length and delivery, ranging from intensive, full-time formats to modular sessions spread over several months. Trainings commonly included content on clinical communication, host country healthcare systems, cultural norms, and professionalism.
Educational methods used included lectures, role-plays, simulations, mentoring, and discussion groups. One Canadian program paired incoming IMGs with senior IMG mentors for 2 years of support. Other interventions included shadowing, supervised clinical attachments, and pre-arrival language development resources.
While 14 of the 18 qualitative studies identified participants’ countries of origin, none of the intervention studies customized content based on cultural or regional background. The review noted that IMGs represent more than 150 countries and that uniform approaches may limit effectiveness. Few programs addressed structural issues such as racism, discrimination, or gender-specific barriers, despite their documented influence on IMG integration.
Only 3 of the 46 studies applied structured curriculum development frameworks, such as Kern’s six-step model or grounded theory. The majority relied on experiential knowledge or informal assessments, limiting the generalizability of findings.
During the COVID-19 pandemic, some programs transitioned to digital platforms. Two studies evaluated online interventions and found that participants and trainers were satisfied with the virtual format. Use of multiple communication platforms, including internet-based tools and software, was noted to extend program reach and allow for more flexible scheduling, without increasing associated costs.
The review recommended incorporating performance metrics, structured frameworks, and longer-term support into future programs. The authors called for culturally responsive training, inclusive workplace policies, and attention to the specific challenges faced by diverse IMGs.
The authors reported no conflicts of interest.
Source: Frontiers in Medicine