The Transition of International Medical Graduate (IMG) Fellows into the ICU Team: Identity Gain or Loss?
CCCF ePoster library. Mecklenburg A. 11/07/18; 234193; 25 Disclosure(s)(s): This project is funded with a full-time research stipend for Dr. Anne Mecklenburg by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG).
Dr. Anne Mecklenburg
Dr. Anne Mecklenburg
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IMGs play an integral part in many health care systems worldwide.When they pursue clinical training in a different country, IMGs face the need to adapt to an unfamiliar working environment.2,3 The practice of critical care is complex, time-sensitive and highly dependent on inter-disciplinary teamwork. In fact, effective team work has been tied to better ICU patient outcomes.Understanding the 'rules of the game' within an ICU team may represent a unique challenge for IMGs starting a critical care fellowship. The inability or delayed ability to adapt to their new training environment may be problematic for the trainees and for patient care. In addition, the unique role of a critical care fellow within an ICU team is foreign to many IMGs who trained in countries without fellowship programs. IMGs may initially not fully grasp the dual, sometimes conflictual nature (supervisor-supervisee; leader-follower) of their new professional role.




This study aims to better understand how IMGs experience their transition within multidisciplinary ICU teams during their critical care fellowship. More specifically, this project explores: 1) IMG fellows' perceptions of their role within the multi-professional ICU team; 2) challenges encountered by IMG fellows as they transition into their new professional role; 3) strategies used by IMG fellows to overcome these challenges. We explored how known theories on professional transition apply to the ICU environment with the ultimate goal of developing evidence-informed initiatives to support IMG fellows and ICU teams during the early transition period in the fellowship.





In this qualitative single center study, we conducted 16 individual interviews with IMG fellows who were enrolled in the adult critical care fellowship program of the University of Toronto. Fellow’s perceptions of their role and transition within the ICU team were explored and iteratively analyzed through a constructivist grounded theory approach, including purposive sampling, inductive coding, constant comparison and inter-disciplinary theoretical construction of a model. 




Participants came from Europe, Central/South America, North America, Australia, Asia and the Middle East. Our analysis revealed that most of the participants had a limited understanding of the role of a fellow. For many fellows, this uncertainty translated into an initial lack of confidence in their ability to fulfill their role. The North American model of multidisciplinary ICU team (composition and roles) was perceived as a huge challenge. As they tried to work within the ICU team, participants reported experiencing many losses: autonomy, appreciation, efficiency, skills, and personal work standards. Fellows maneuvered this period of transition by relying on honed clinical skills, building trust with ICU team members, changing attitudes towards teamwork, or seeking social support. Others described a period of resistance where they actively challenged the system, the team or their colleagues.




Our preliminary findings show that IMGs who have to transition into the role of a fellow within an inter-disciplinary ICU team encounter unique challenges. Uncertainties experienced at the beginning of the fellowship lead to a dynamic process of collapse and re-construction of their professional identity. Such findings will directly inform the design of new strategies to facilitate IMGs’ transition into North American ICU fellowships.

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