Transitioning into the ICU team - The experience of International Medical Graduates (IMGs) during a North American Fellowship Training Program in Critical Care

• Applicant: Dr. Anne Mecklenburg
• Subject Area: Anaesthesiology
• Term: from 2017 to 2018
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 396644946

IMGs represent an integral part of many health care systems around the world, e.g. 25% of practicing physicians in Canada and 8% in Germany are IMGs. When they pursue clinical training in a different country, IMGs face the need to adapt to an unfamiliar medical system and environment, and to learn the culture, organization and processes of the new hospital and unit. The practice of critical care is complex, time-sensitive and highly dependent on inter-disciplinary teamwork. In fact, effective team work has been tied to better patient outcomes in ICU. To function as trainees in such an environment, IMGs must quickly learn how to interact within an ICU team, and how to coordinate their own clinical activities with those of other physicians and allied health professionals. Understanding the "rules of the game" may represent a unique challenge for IMGs starting their critical care fellowship. The inability or delayed ability to adapt to their new training environment may be problematic for the trainees and for patient care. In addition, the unique role of a critical care fellow within the North-American postgraduate medical system is an unfamiliar and novel experience for many IMGs who trained in countries without fellowship programs. IMGs may not fully grasp the dual, sometimes conflictual nature (supervisor-supervisee; leader-follower) of the fellow's role. A better understanding of the process of transition for IMG-fellows into their ICU team is important for optimal patient care and training.This study aims to better understand how IMGs integrate within their intra- and interdisciplinary ICU teams during the first year of their Critical Care fellowship with the University of Toronto. More specifically, this project will explore: 1.) IMG fellows' perceptions of their roles and responsibilities within intra- and inter-professional ICU teams; 2.) challenges encountered by IMG fellows as they transition into their new professional role as ICU team member; 3.) strategies used by IMG fellows to overcome these challenges. Our results will inform the development of strategies and initiatives to support IMG fellows and ICU team members during this transition period. Ultimately, a better and/or faster integration of IMG fellows within the ICU team will lead to more effective teamwork, improved team performance, and better patient care.

• DFG Programme: Research Fellowships
• International Connection: Canada
• Host: Professorin Dominique Piquette, Ph.D.