‘Transitions’: A new pilot programme to support the transitions of new internationally educated clinical fellows

Abstract

International clinical fellowships are essential in advancing research and disseminating knowledge globally. Despite the positive impact of international clinical fellowship, internationally educated clinical fellows (IEF) experience social, cultural, communication, personal and learning challenges as they transition to a new training in a different country. These challenges are well-described in the literature, and they increase IEFs' stress and can negatively affect their learning experience and wellness. Most IEFs do not receive training designed to overcome these hurdles and, therefore, feel inadequately prepared for the fellowship. The authors developed a specialty-specific preparatory programme for palliative medicine IEFs, effectively easing fellows' transition.¹ However, many fellowship programmes may lack the resources to build their comprehensive preparatory education programmes. We report on a generic pan-specialty programme that can support the needs of all new IEFs that other programmes can readily adopt.

We developed a pilot educational programme, ‘Transitions’, consisting of asynchronous online modules and synchronous live virtual sessions over videoconferencing. Each week, new fellows completed a different online module followed by 1–2 hours of live sessions facilitated by existing fellows and faculty. The programme aims to improve the IEFs' readiness for their Canadian fellowship and ultimately enhance their wellness, knowledge and learning experience.

Following a needs assessment, faculty and existing fellows developed eight modules covering settlement in Canada, the Canadian healthcare system, Ontario's ethics and laws, patient safety, communication skills, working with the inter-professional team, social determinants of health, advanced care planning and enhancing fellows' wellness and inclusion. External subject matter experts and current fellows reviewed and validated the educational content.

A total of 65 new IEFs from 11 specialties and six continents completed the pilot programme before starting their fellowship. We conducted a two-phase evaluation: quantitative pre- and post-programme surveys, followed by qualitative focus groups held 3 months after the start of the fellowship. A total of 40 fellows completed pre- and post-evaluation surveys, and eight fellows participated in focus groups. About 95% of respondents agreed or strongly agreed that the programme enhanced their overall learning experience, 88% felt it reduced their anxiety about the transition and 93% recommended it to their peers. The pre- and post-surveys show that respondents have significantly improved confidence in their knowledge about the discussed topics. The analysis of qualitative focus groups, led by an external facilitator, shows that the programme successfully supported the essential learning needs for the transition of all fellows. It also demonstrates that the programme has created a community among new fellows. Participants highlighted the need for ongoing longitudinal support after the start of the fellowship. The evaluation also identified a few challenges, including technical problems and connectivity issues, fellows' time commitment and coordinating live sessions for different time zones.

Despite the lack of direct comparison with in-person and other specific programmes, new IEFs from different backgrounds and specialties felt that a single generic programme met their educational needs and provided a flexible, practical and more cost-effective learning alternative. Similar programmes can be implemented in other institutions that train internationally educated medical graduates.

Ahmed al-Awamer: Conceptualization; writing—original draft; writing—review and editing; formal analysis; supervision; resources; methodology; validation. Tushar Malavade: Writing—review and editing; supervision; resources; methodology. Jessica Jardine: Project administration; writing—review and editing; supervision; resources; formal analysis; software. Ebru Kaya: Conceptualization; writing—review and editing; supervision; methodology.

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The University Health Network (UHN) Quality Improvement Review Committee (QIRC) reviewed and approved this project as a quality improvement project and formally exempted it from the Research Ethics Board review (QIRC 23–0648).