IMGs, like other migrants, have to adjust to a different way of life and to a social system and behavioural norms that conflict, to varying degrees, with their personal and ethnic values. Perceptions of IMGs can sometimes be misguided, with prejudice and bias directed against them and their families.
IMGs face significant pressures, perhaps more so than the average migrant. They have constraints placed on them with respect to their medical registration and where they are allowed to practise; consequently, they may feel trapped. Their identity is challenged and their self-esteem may be affected because they have to study and pass exams all over again in order to prove themselves capable and competent. Many lack appropriate support and guidance and find themselves struggling to pass exams and to achieve the requisite standard of practice.
IMGs are often misunderstood and a disservice is done to them when it is rationalised that their difficulties are entirely due to a ‘lack of knowledge’, ‘cultural’ factors or ‘language’ issues. Certainly, these are important considerations, and while generalisations can sometimes be useful, great care needs to be exercised because IMGs are a disparate group.
Hofstede’s six dimensions of national culture (Appendix A) is a useful framework for comparing cultures and providing insight into the values and behaviour of IMGs. However, care needs to be exercised because the framework relates to values of ethnic cultures, not individuals.
As regards clinical performance, the issues that IMGs contend with relate primarily to:
- medical training and work experience overseas
- language and communication skills
- migration and displacement issues.