1. Facilitating the Success of International Family Practice Residents A Pre-Orientation Program
Cheryl K.Seymour, MD & Karen Gershman, MD
Maine-Dartmouth Family Practice Residency Program
NE Regional STFM, October 2006

2. Objectives
Discuss challenges faced by international medical graduates in FP residencies
Review traditional strategies for facilitating success in our program and others
Share our Pre-Orientation program
Discuss your ideas and feedback

3. Barriers to Success Bias & Prejudice
Residency faculty & Resident colleagues
US Medical student applicants
Hospital and office staff
Patients
Variability of quality of training
Limited access to US clinical experiences

4. Facilitating Success Most interventions address prejudice
Explore cultural differences
Build relationships between co-workers
Genograms, Family histories
International dinner parties, Ropes courses

5. Facilitating Success Verbal communication skills
Interviewing techniques
Cultural differences in approach to the patient-doctor relationship
Didactics
Medical Knowledge
Structure of US Health care system

6. Pre-Orientation Themes
“The culture of medicine”
Primary barrier to success is a lack of familiarity with the process of health care delivery
These skills, unspoken rules, & traditions are “absorbed” and modeled in US third and fourth year clerkships.

7. Pre-Orientation Themes
Clinical Coaching
Real-time, interactive practice of care delivery
Survival Skills
Time and data management
Self-Assessment
Set personal goals, collaborative evaluation

8. Survival Skills Where is the bathroom? Online scavenger hunt
Flow sheets and pocket books
History of Maine-Dartmouth
What is Osteopathy?
Closed-door panel discussion

9. Clinical Coaching
Experiential integration of clinical topic with specific skills of care delivery
Chest Pain
Interactive case presentation
EKG interpretation
Telephone call to consultant
Writing H&P and admit orders

10. Clinical Coaching
Real-time practice of challenging communication scenarios
Phone calls – mothers, drug-seekers
Real phones, no visual clues
Approach to the office visit
Sign-out rounds

11. Clinical Coaching

12. Self-Assessment Personal goal setting at beginning & end
Review of In-training exam questions
Summative feedback to facilitate development of individualized learning plan with advisors

13. Logistics One month, unpaid, voluntary
No direct patient contact – no malpractice
Clinical coaches: senior residents & faculty
Integration with existing Orientation
Binder of sample notes and orders, data flow sheets, review articles, goal worksheets

14. Positive Outcomes
Improved rapport with faculty and senior residents, less fear of judgment
Improved awareness of individual needs & strengths prior to officially starting residency
Medical cultural norms and expectations clear and consistent from the outset

15. Next Steps How could we improve?
Do these ideas resonate with your experiences with international medical graduates?
How can you facilitate success in your own residency program?