Behavioral Science Education and the International Medical Graduate

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International medical graduates (IMGs), many of whom are recent immigrants to the United States, are filling an increasing proportion of U.S. family medicine residency positions. Therefore, assumptions about the training experiences of first-year residents may no longer apply to a large percentage of incoming residents. The authors sought to improve the behavioral science education in their residency program by learning about IMGs’ previous training and experience in behavioral science before coming to the United States.


Ten first-, second-, and third-year family medicine residents, representing medical school training from India, Macedonia, Bosnia-Herzegovina, The Philippines, Egypt, and Iraq, were individually interviewed using an inductive, qualitative approach. Transcripts were reviewed and double coded. Categories and story lines were identified, and member checking was employed.


Segments were classified into seven categories: residents’ behavioral medicine training prior to coming to the United States; reflections on the inclusion of mental health and psychosocial content in clinical family medicine; training in medical interviewing; reflections on the physician–patient relationship; perceptions of U.S. family life; recommendations for improving IMGs’ understanding of psychosocial aspects of patient care; and specific challenges residents face as IMGs.


The narrative data suggested several possible modifications to the family medicine curriculum, including expanding new resident orientation content about U.S. health care, introducing behavioral science content sooner, and having IMGs observe quality physician–patient interactions. Interview data also yielded concrete suggestions for improving residents’ psychiatric interview knowledge and skills, such as instruction in specific wording of questions.

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