Outpatient precepting of international medical graduates in family medicine.

BACKGROUND: The purpose of this study was to examine outpatient precepting for international medical graduates (IMGs) in family medicine residencies. The education of IMGs in residency programs has been a subject of concern. Multiple obstacles in acculturation may negatively influence IMGs' thoughts/feelings and subsequently affect their learning in teacher-learner interaction especially during a time-constrained environment like outpatient precepting. However, there is no research on IMGs' thoughts and feelings during outpatient precepting.

METHODS: We used qualitative research using multiple methods, primarily semi-structured individual interview during Interpersonal Process Recall (IPR). We purposefully sampled IMGs from three family medicine residency programs and videotaped their outpatient precepting. As a standard for comparison, we also videotaped US medical graduates (USMGs). We used multiple methods to explore their thoughts/feelings during precepting: brief interview, preceptor questionnaire, video review, and IPR debriefing of the precepting encounter. For analysis, we developed thematic codes from IPR transcripts and explored their consistency with data from the three other sources.

RESULTS: Seven themes emerged: cultural differences, language barriers, clinical performance, relationship, preceptor's teaching behaviors/attitudes, internalized process, and external factors. IMGs experienced various negative thoughts and feelings related to language barriers and cultural differences. These internalized processes adversely influenced their learning attitudes, precepting behaviors, and clinical performance.

CONCLUSIONS: Precepting is more stressful for IMGs than for USMGs. IMGs need more specific orientation for outpatient precepting, and preceptors need further opportunity to reflect on their precepting skills for IMGs. Residency programs may do well to develop and test a curriculum and learning environment to meet IMGs' special needs.