http://www.biomedcentral.com/1472-6920/10/5
We found three relevant studies. Two were directed at the application process and used similar paired data designs, while a third surveyed surgical residency program directors for their perceptions about IMGs (cross-sectional study design).
One study sent applications to 146 family practice residency programs randomly selected from the 384 programs in the
Directory of Graduate Medical Education Programs, 1991-1992 (38% sampled) [
9]. The letters requested information and an application. All letters were identical except that the author of the first set was described as "a foreign medical graduate" while the author of the second was described as "a fourth-year medical student at the University of Nebraska Medical Center". Pseudonyms were used and surnames were selected that "would not suggest any particular ethnic group". Only a first initial was used to eliminate the possibility of gender bias. The letters from the IMG were sent first, and those from the USMG followed one week later. Of the 146 requests, 143 were received by programs.
When analyzed at 6 weeks by any response, 102 programs (71%) responded to the fourth-year medical student and 57 (40%) to the foreign graduate (relative response, U.S. medical student to foreign graduate: 1.8). Of the 46 programs responding to both, 9 required the foreign graduate to meet standards that exceeded requirements set by the ECFMG. When analyzed by reception of application forms, 39 programs sent applications to both (27%), 60 to only the U.S. medical student applicant (42%), 10 to only the foreign graduate (7%) and 34 to neither (24%) (relative application response, U.S. medical student to foreign graduate: 2.0; p < .01).
The second study sent identical requests (details not provided) for a program application to 193 psychiatry residency training programs, omitting those in Michigan since the persons requesting applications were enrolled in a Michigan program. The letters differed in only two respects: the names of the writers (one "American" and one "Pakistani") and the medical schools from which they graduated (Wayne State University School of Medicine and King Edward Medical College). Letters were sent one week apart. Five programs reported they were closed, leaving 188 for analysis.
When analyzed by any response, 99 programs (53%) responded to both applicants, 60 only to the USMG (32%), 6 only to the IMG (3%) and 23 to neither requestor (12%) (p < .001; relative response, USMG to IMG: 1.5). When analyzed by reception of application forms, the USMG received 159 responses with application forms (85% response rate) while the IMG received 87 responses with application forms (46%) (p < .001; relative application response, USMG to IMG: 1.8) [
10]. The authors also report that in the year prior to their study, psychiatry residency slots remained empty, with only 84 percent of available positions filled.
The third study surveyed all 283 members of the Association of Program Directors of Surgery in 2007 [
11]. Of these, they determined that 261 were active at the time of the survey and this was their targeted study population; 125 directors responded (48%) and 112 were analyzed. Most of the program directors were male (95%). They were 52 years of age (range: 37, 71 years) on average and their median tenor as program directors was 7 years; 90% reported being USMGs and 8% IMGs; and 49% were university-based and 47% community-based.
In response to five-point Likert-scale questions, 69 (59, 77) (95% binomial confidence interval) percent of directors strongly agreed, agreed or were neutral to the statement that on standardized exams IMGs perform as well as USMGs and 79 (70, 85) percent strongly agreed, agreed or were neutral to the statement that surgical skill level, as measured by performance in the operating room, is equal or better for IMGs compared to USMGs. For the statement, "In reality, all things being equal, our program would rather offer positions to USMGs than to IMGs", 97 (92, 99) percent agreed or were neutral (strongly agreed [47%], agreed [40%], neutral [10%]). In response to a yes or no question, 18 (11, 26) percent of directors answered that they had felt external pressure not to rank a better qualified IMG over a USMG and 71 percent felt that IMGs are discriminated against.
