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The Émigré Physicians’ Experiences Before, While, and After Attending an American Osteopathic Medical School: A Cross-Sectional, Mixed Methods Study, Convergent Design
Burg, B. J. [2]
Goldstein, L. [7]
Sheflin, K. [1]
Jeger, A. [2]

Journal: Journal of Osteopathic Medicine Date: 2018/11, 118(11):Pages: e197-e199. doi: Subito , type of study: mixed methods study

Full text    (https://www.degruyter.com/document/doi/10.7556/jaoa.2018.163/html)

Keywords:

mixed method study [52]
osteopathic medicine [1540]
osteopathic physicians [163]
USA [1086]

Abstract:

Research Questions: We are investigating the reasons émigré physicians (EPs) leave their home countries and seek to practice medicine in the United States. We also sought to learn about their difficulties in obtaining licenses and residency matches when they arrive, their reasons for selecting the NYITCOM Émigré Physicians Program (EPP), their experiences at NYITCOM, and their abilities to match into residency programs. We are also interested in the EPs’ perceptions of NYITCOM's EPP. The purpose of our study is to discover: (1) Why the EPs in NYITCOM's EPP left their home countries; (2) Why the EPs surveyed chose to enter NYITCOM's EPP; (3) The perceptions of the survey respondents as to how well NYITCOM's undergraduate medical education prepared them to be competitive applicants in the US residency match and for clinical practice in the US; (4) The EPs’ perceptions of NYITCOM's EPP. Statement of Significance: More than 60,000 foreign-trained physicians living in the United States are not licensed in the United States.1 NYITCOM provides a unique path to residency in the United States by allowing these EPs to obtain a US osteopathic medicine degree after completing the 4-year medical school curriculum.2 Many reasons influence EPs to leave their home countries and migrate to the United States to continue their medical careers.1,3,4 However, the goal of getting licensed in the United States is inaccessible for many.4 EPs have difficulties obtaining US residencies. NYITCOM, through its EPP, provides a diverse group of students with a unique path to medical licensing and residency as osteopathic physicians. This endeavor is congruent with AACOM's efforts to increase diversity in medical schools by increasing the diversity in osteopathic medical schools and in practice. Research has identified that while the numbers of underrepresented minorities in US medical schools has increased, the racial and ethnic diversity between medical school graduates and the US population as a whole has decreased. In response, AACOM established a Diversity Committee in 2015 “with the goal of developing underrepresented minority interest in pursuing a career in osteopathic medicine, increasing the diversity of applicants to the nation's colleges of osteopathic medicine (COMs), and sharing resources to support prospective and current minority DO students as they navigate through medical school.” Methods: Current and graduate EP students are being sent an online survey via email and Facebook requesting their participation. All non-EPP students are excluded. Three follow-up requests are being sent as needed to maximize response. Quantitative data are obtained through scaled items and qualitative data through comment sections. The researchers are offering a chance to win 1 of twenty $25 gift cards as an incentive for completing the survey. As a study in progress, the 131 EPs who matriculated between 2014 and 2017 were contacted; 24 responded to date. We will be contacting over 600 EPs in total for this study. We anticipate the study will be completed and a poster prepared for OMED in October 2018. Data Analysis: Cross-sectional, mixed methods study, convergent design. Quantitative: Demographic information and scaled data of respondents perspectives on how well NYITCOM prepared them for residency matches and clinical practice were analyzed by correlation and linear regression analysis using IBM SPSS Statistics 23. Statistical significance was determined by a P value of <.05. Qualitative: Textual data were obtained from survey participants’ comments and organized on an Excel spreadsheet. Codes were derived from the text and used as an index to retrieve text. Categories were derived and themes were identified. Results: Quantitative: The respondents’ Match Prep scores were positively correlated with admission scores (r=0.49) and with Practice Prep scores (r=0.71). Admissions (β=0.40, P=0.041) and the Practice Prep (β=0.58, P=0.015) were the strongest predictors of Match Prep, based on the result of linear regression for the outcome variable of Match Prep and the predictor variables of English, Read, Admissions, Education, and Practice Prep. Qualitative: Text analysis revealed that: (1) EPs left their home countries in search of a better life/opportunities and for freedom/asylum. Typical responses were, “Better life for my children, equal opportunities and freedoms,” and “looking for a better future.” (2) EPs chose NYITCOM because: It is the only program/unique (mentioned in 6 responses), to follow dream/get residency/to practice medicine (mentioned in 11 responses), DO/holistic (mentioned in 3 responses), quality of the program (mentioned in 1 response), recommended/told about by a friend (mentioned in 2 responses), no MCAT required (mentioned in 3 responses). (3) The respondents generally had a positive perception about their preparation for residency in terms of medical knowledge and cultural competence. Typical responses were, “Best experience of my life,” “a very good program,” and “good, challenging, and interesting.” A common concern expressed by respondents was the need for more help in preparing them for the national board examinations, both COMLEX-USA and USMLE. Another common perception was that EP students should be better integrated into the NYITCOM student body. Suggestions included increasing communication about the EPP to faculty and non-EP students. Conclusion: Perceptions of preparedness as competent practicing physicians was the strongest predictor of preparedness for residency match. EPs’ perception of the admissions process was also a statistically significant predictor of preparedness for residency match. Regarding the results of the text analysis, the EPs moved to the US for a better life. They chose NYITCOM because the EPP is the only one of its kind and they heard about the quality of the program. The results of our preliminary survey of this small cohort of EPs showed the general perception was that the EPP was beneficial in preparing them for residency. AACOM researchers have identified a need for more diversity in osteopathic medical school graduates, and NYITCOM's EPP is a long-standing successful curriculum specifically tailored to the meet the medical education needs of the EPs, thereby increasing the diversity in osteopathic medical schools and in practice.

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