Essential Competencies for the Success of International Medical Graduates in Surgical Training: A Comparative Study of Trainee and Faculty Perspectives

Abstract

BACKGROUND

International Medical Graduates (IMGs) occupy a third of all non-designated preliminary general surgery training positions in the United States, but fewer than half complete surgical training. Previous research has shown discrepancies between evaluators and trainees on various aspects of medical training, impacting educational outcomes. Understanding any potential divergence in perceptions between faculty and trainees on essential competencies could help trainees improve their clinical performance and their chances of obtaining categorical training positions.

OBJECTIVE

To assess differences in perceptions between IMGs and evaluators on essential competencies during general surgery training.

DESIGN

Cross-sectional, survey-based using a nonvalidated electronic survey instrument, with 13 questions aimed to assess the competencies considered essential for IMGs in preliminary PGY-1 or PGY-2 training positions to succeed in general surgery residency. Responses were collected using a snowball sampling method.

SETTING

The survey was distributed via X (formerly known as Twitter), WhatsApp, the American College of Surgeon Online Communities, and email between June and August 2023. Responses were captured in RedCap.

PARTICIPANTS

The first group (“the evaluatees") comprises IMGs and medical students applying for general surgery residency positions in the U.S. and IMGs in PGY-1 and PGY-2 preliminary general surgery training positions in the U.S. The second group (“the evaluators”) included faculty in general surgery programs in the U.S. and senior general surgery residents in the U.S.

RESULTS

There were 196 respondents, including 70 “evaluators” and 126 “evaluatees”. Most evaluators identified as male (78.5%), whereas 65.1% of evaluatees identified as female. Ethnic diversity varied widely between groups. Evaluators identified mainly as white (67.1%), while evaluatees were mostly Asian/South Asian (46%) or Hispanic/Latino (30.1%). Most evaluators worked at university-affiliated hospitals (61.4%). Both groups ranked “Knowledge Application/Critical Thinking Skills” as the most essential competency for preliminary IMG residents to do well in training. “Research Skills” followed by “Technical Skills” were rated as the least essential. The highest concordance (>80%) between groups for mandatory competencies was found for “Interpersonal and Communication Skills”, “Professionalism,” and “Learning, Teaching, and Teamwork”. Significant differences were found between the groups' perceptions of clinical, research, and technical skills (p < 0.01).

CONCLUSIONS

The value of nontechnical skills in surgical training transcends cultural and educational backgrounds. IMGs place greater importance on clinical and technical skills. Future educational initiatives must bridge the gap between perceptions and expectations to enhance training outcomes for IMGs.