Training International Medical Graduates: One Physician Assistant Program’s Experience Ruth Ballweg, MPA, PA-C; Program Director, MEDEX Northwest University of Washington, Seattle Abstract Background: MEDEX Northwest, the University of Washington’s Physician Assistant (PA) Program, has trained 28 international medical graduates (IMGs), who originated from 12 different countries, since 1990. (In 1988 Washington State eliminated the option for IMGs to apply for PA licenses without formal PA training and NCCPA certification.) Admissions: MEDEX recruits experienced health care personnel for entry into the PA profession. MEDEX offers applicant information sessions, some of which are focused for IMGs. MEDEX interviews use full-day selection conferences, which include three group interviews for each candidate. Barriers to successful application include communication issues and incomplete knowledge of or possible dissatisfaction with the PA role. Some IMGs were admitted to the program upon reapplication. Academics: Academic performance has been average to good, though there have been limited challenges with communication and role transition. IMG students have performed well in the clinical portion of PA training. Outcomes: All IMG-PA graduates have passed the certification exam, and half are now working in primary care settings. Approximately 35% are working in specialty practice. Discussion: MEDEX training of IMGs as PAs has been positive overall. This is partly due to the program’s experience in recruiting, selecting and training individuals with prior health careers. In addition, the question of supervised practice is carefully explored during the admissions process. These students have experienced little academic distress during their training, though communication skills were a concern for some. IMG-PAs were quickly hired upon graduation and have typically stayed in their first job. • MEDEX Northwest has trained 28 international medical graduates (IMGs) since 1990. • Washington State originally allowed IMGs to practice as physician assistants (PAs) without specific additional training in a PA program. • There were also provisions for individuals with on-the-job training to be licensed as PAs with a limited scope of practice. • Over time, PA practice was limited to graduates of accredited programs and then to those who were NCCPA certified. Background • MEDEX is a second-career program, designed to build on previous clinical training. • The program recruits experienced health care personnel for entry into the PA profession. • A minimum of 2 years of full-time clinical experience is required. • The competitive applicant pool means accepted students average 8 years of clinical exposure. • MEDEX offers information sessions for program applicants, some of which are offered for specific groups such as IMGs. Recruitment & Admissions Figure 3: Applications, invitations to interview and acceptance data. Figure 4: Age at entry to the program. Figure 5: Geographic origin of MEDEX IMG-PAs. • MEDEX IMGs generally experienced few difficulties during the didactic phase of the program and tended to be average students academically. • Some IMGs did experience some complications with communication, role socialization and role transition. • It was not unusual for this group to have struggles regarding a lack of assertiveness and discomfort dealing with crisis. Figure 6: Overall average program grade point average for IMG students (on a 4-point scale). Academic Performance • The MEDEX clinical training model includes close student monitoring including site visits. • Clinical faculty were able to see quickly how well the IMGs were adapting. • The IMGs—many of whom had been working as translators or lower-level health workers in the US—generally made an easy transition to the clinical phase of training. • They were grateful to be back in significant clinical roles. • They all graduated on schedule and none were required to repeat any clinical rotations. Clinical Performance • The IMG-PAs passed the NCCPA PANCE certification exam on the first try. • Of the 28 MEDEX-trained IMG-PAs, the program has employment data for 24. Figure 7: Current employment specialty of IMG-PA program graduates. Outcomes • Overall, the MEDEX experience in training IMGs as PAs has been positive. • A major factor in this success has been the program’s experience in recruiting, screening, selecting and training individuals with prior health careers. • The IMGs enrolled in MEDEX are chosen partly for their realistic perceptions of the PA career and their perceived flexibility in adapting to a different medical role. • The issue of supervised practice (physician assistants) as compared to independent practice (physicians) is carefully explored during the admissions interviews. • The IMG-PAs experienced little academic distress during their training, although some required extra advising on the specifics of the US health care delivery system. • Communication skills—especially in the areas of assertiveness and conflict resolution—were difficult for some students. • IMG-PAs were quickly hired upon graduation and have typically stayed in the first job where they were employed. • In some cases the IMG-PAs returned to the specialties in which they had practiced in their prior physician careers. Discussion • MEDEX interviews are based on the original Peace Corps interview model—using full-day selection conferences for all applicants. • Selection conferences include 3 group interviews for each candidate. • Unsuccessful IMG applicants were usually ‘selected out’ due to: • language issues, • incomplete knowledge of the PA role, • interviewer concerns about potential dissatisfaction with the PA role, • general communication concerns. • Some IMGs subsequently reapplied to the program and were admitted. Figure 1: Mingying Bonner: IMG and new PA. • In 1988, IMG-PAs were no longer eligible for new licenses, at which time MEDEX agreed to accept IMGs as candidates for admission. Figure 2: Zheru Li (from China) with MEDEX Program Director, Ruth Ballweg. Figure 8: Rizwana Lott (center, from India) with her family at MEDEX graduation. Mexico: 2 India: 2 Pakistan: 1 Russia: 8 China: 3 Ethiopia: 2 Philippines: 2 Ukraine: 3 Bulgaria: 2 Romania: 1 East Germany: 1 VietNam: 1 MEDEX