International Medical Graduates are Comparable to American Medical Graduates as General Surgery Interns

Area of Science:

• Medical Education
• Surgical Training
• Graduate Medical Education

Background:

• International medical graduates (IMGs) often face initial placement in preliminary general surgery (GS) positions due to performance uncertainties in the U.S. healthcare system.
• This study addresses the need to compare the baseline performance and evolving trends of IMGs against American medical graduates (AMGs) during their GS internships.

Purpose of the Study:

• To conduct a comparative analysis of the performance of IMGs and AMGs in a general surgery residency program.
• To assess performance trends over the course of the internship for both IMG and AMG cohorts.

Main Methods:

• Faculty evaluations (overall performance, technical skills, interpersonal communication, medical knowledge) on a 10-point Likert scale were collected for preliminary IMG and categorical AMG interns from 2013-2017.
• Scores from the American Board of Surgery In-Training Exam, an in-house preparation test, and the United States Medical Licensing Exam (USMLE) were compared.
• Performance in biannual multistation objective assessments was also analyzed between the two groups.

Main Results:

• American medical graduates (AMGs) had higher median USMLE Step 1 and Step 2 scores than international medical graduates (IMGs).
• IMGs scored higher on an in-house preparation test, but there were no significant differences in American Board of Surgery In-Training Exam scores between groups.
• Faculty evaluations showed similar median scores for both groups, while IMGs outperformed AMGs in biannual multistation objective assessments.

Conclusions:

• The study provides reassurance that high-caliber candidates, regardless of origin (IMG or AMG), can achieve success as surgical interns.
• Performance in objective assessments and faculty evaluations indicates comparable competence between IMGs and AMGs in general surgery training.