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Not just watching: Defining core competencies for international medical observers.
Amy Yu1, Flora Kisuule1, Alhareth Al-Sagban1
1Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Journal of Hospital Medicine
|April 14, 2026
Summary
International Medical Graduates (IMGs) can enhance their US clinical journey through structured observerships. A new competency-based framework transforms passive shadowing into purposeful education, improving IMG preparation for US healthcare systems.
Area of Science:
- Medical Education
- Physician Workforce Development
Background:
- International Medical Graduates (IMGs) are crucial for the US physician workforce.
- IMGs often start clinical experiences via unstructured observerships.
- Lack of formal structure hinders IMG educational progression.
Purpose of the Study:
- To propose a competency-based framework for IMG observerships.
- To enhance observerships from passive to purposeful educational experiences.
- To align observerships with US healthcare system needs.
Main Methods:
- Adapted the Accreditation Council for Graduate Medical Education (ACGME) model.
- Defined seven core competencies with observable behaviors.
- Implemented framework in a hospital medicine observership program.
Main Results:
- Framework implementation improved faculty teaching and learner engagement.
- Fostered reflection, professional growth, and a sense of belonging for IMGs.
- Demonstrated enhanced preparation for IMGs in US healthcare.
Conclusions:
- A competency-based framework offers a structured approach to IMG observerships.
- This model provides an equitable and scalable method for IMG integration.
- Competency definition is vital for preparing IMGs for US practice.
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