Mental Health of Foreign Medical Graduates in Tamil Nadu, India: A Mixed-methods Study

Introduction: Over the last five years in India, there has been a three-fold increase in the number of candidates taking the Foreign Medical Graduate Examination (FMGE). Foreign Medical Graduates (FMGs) have recently experienced the Coronavirus Disease-2019 (COVID-19) pandemic and wars/internal conflicts in the countries where they study. Aim: To assess the mental health status of FMGs and analyse the associated socio-demographic, economic, and academic factors, as well as the impact of COVID-19 on their mental health. Materials and Methods: This explanatory mixed-method study utilised a quantitative method (Phase 1 - Self-administered questionnaire GHQ-12) followed by a qualitative method {Phase 2 - Focus Group Discussion (FGD)}. The study included 169 FMGs doing their internship (academic year 2022-23) at Government Medical College Krishnagiri, Tamil Nadu, India, and their colleagues/batchmates who were willing to participate in the study. Descriptive statistics and student t-test were used to analyse the variables. Results: In the present study, 99 (58.6%) study participants were male, 130 (76.9%) were in the age group of 23-25 years, and 114 (67.5%) belonged to the upper socio-economic class. About 80 (47.3%) respondents scored higher than the overall mean GHQ-12 score, indicating mental distress. FMGs who had not yet joined the internship reported significant mental health issues compared to those currently in internship. FGD participants felt a lack of confidence in patient care, academic burden, financial burden, family bereavement, and personal health issues were the impacts of the COVID-19 pandemic on their mental health. Conclusion: Almost half of the FMGs in the present study were under stress, which could be attributed to the financial burden in the family, lack of academic confidence, and personal loss during the COVID-19 pandemic.