Challenges and strategies for international medical graduates in registration and integration into the Australian healthcare system: a systematic scoping review.

Abstract

Objective: International medical graduates (IMGs) are vital for addressing Australia's healthcare shortages but face significant barriers. This review aims to update evidence on their challenges, assess progress since the 2012 Lost in the Labyrinth report, and propose new actions.

Methods: This systematic scoping review focuses on literature from 2001 to 2025 in the databases of PubMed, Embase, Scopus, Web of Science, and Cochrane, including articles that reported quantitative or qualitative research or data analyses, opinion papers, and editorials. The study adapts the Health Systems Strengthening Framework to synthesise findings, with an emphasis on the Lost in the Labyrinth's recommendations.

Results: Fifty-four studies revealed persistent challenges, including supervision gaps, governance issues, financial burdens, visa inequities, and accreditation barriers. Emerging issues involved regulatory inefficiencies, insufficient support, and inequitable job access. Continuing strategies focus on supervision and workplace-based assessments (WBAs), and new recommendations propose shadowing programs, policy buffers, leadership reforms, mental health support, and equitable benefits. Despite progress, challenges persist in service delivery and equity. Six new recommendations emphasise government leadership, scalable assessments, and targeted support for an inclusive healthcare system.

Conclusions: Significant challenges remain in IMGs' registration and integration, particularly in service delivery and workforce equity. Six new recommendations complement the Lost in the Labyrinth recommendations, underscoring the need for consistent government leadership, scalable WBA, and targeted support for an inclusive, sustainable healthcare system.