Learning to practice in Canada: the hidden curriculum of international medical graduates.

INTRODUCTION: There is movement of physicians internationally. In some cases, physicians are recruited from low-income countries to wealthier countries like Canada to provide medical services in underresourced communities. This needs assessment examined the clinical medicine learning challenges faced by international medical graduates (IMGs) from the perspective of both the IMGs and medical leaders (eg, Vice President-Medical for a Health Region).

METHODS: Focus groups with 25 IMGs were held in 6 regional centers. Face-to-face interviews were held with 10 medical leaders. Participants were asked about the learning associated with patient management, patient referral, and investigation, for billing and insurance, and learning about new systems of care. Qualitative data were analyzed to determine how well the perspectives on learning were aligned.

RESULTS: IMGs and medical leaders recognized that learning and support were needed by physicians without previous experience in Canada. They had similar lists of learning issues. Although medical leaders believed the new information was explicit, readily available, and could be learned from short explanations and lists; IMGs found that guidelines and expectations were implicit, confusing, and contradictory. There were mediating influences in the form of orientation programs, other IMGs, and "how to" lists in some cases, which helped the newcomer.

DISCUSSION: There was concordance about aspects of the learning that was required between IMGs and medical leaders. There was little agreement about the approach to learning or a recognition that the learning tasks were complicated.