International and American medical graduates in a US pediatric residency program: A qualitative study about challenges during post-graduate year 1

Background: In the United States (U.S.), international medical graduates (IMGs) and American medical graduates (AMGs) confront work-related and adjustment challenges during post-graduate year one (PGY-1) of residency. Aim: To understand the challenges that IMGs and AMGs confronted during PGY-1 of a U. S. pediatric residency program from the perspective of the residents themselves. Methods: A purposive sample of PGY-1, PGY-2, and PGY-3 residents participated in three semi-structured focus groups (N=18). The data were analyzed inductively using a grounded theory approach to identify and verify emergent themes. Results: IMGs confronted work-related and adjustment challenges during PGY-1 that included practicing medicine in the U.S., communicating with medical supervisors and nursing staff, communicating with patients, and relocating to the U.S. AMGs confronted work-related challenges that included medical decision-making and medical licensing. Conclusion: The work-related and adjustment challenges that IMGs and AMGs confronted during PGY-1 suggest that the culture of residency socializes IMGs and AMGs regarding professional expectations and responsibilities. Increased awareness of this socialization process among residency program directors, and interventions based on concrete recommendations, can help enhance PGY-1 for IMGs and AMGs across the medical specialties.