BEING A FOREIGNER, I MAY BE PUNISHED IF I MAKE A SMALL MISTAKE - ASSESSING TRANSCULTURAL EXPERIENCES IN CARING FOR PATIENTS

Background. Emotionally charged issues that arise during graduate medi cal education often are unrecognized and consequently not addressed by training programmes. Little attention has been given to the emotional challenges encountered by international medical graduates (IMG) in ca ring for patients transculturally. Objectives. We aimed to examine the value of qualitative approaches to assessing the transcultural experi ences of IMG residents during primary care training. Methods. Two qual itative research techniques (the critical incident and the focus group ) were used to assess the transcultural challenges in caring for patie nts of IMG and American medical graduates (AMG) resident in a primary care residency programme. Each resident wrote a narrative describing a challenging experience and facilitators then conducted a focus group to discuss these experiences. Key themes were identified from the writ ten narratives and from the transcript of the videotaped focus group. Results. Previously unacknowledged feelings emerged during the assessm ent. Themes of struggles for acceptance, fear of rejection, and fear o f disappointing patients were identified from analysis of the written narrative, while themes of struggle to express caring transculturally were identified from the focus group transcript. Based on these findin gs, significant changes were made to the residency training curriculum . Conclusions. Qualitative methods are useful for assessing the transc ultural experiences of IMG residents and for informing curricular chan ges in residency training. These methods may help other training progr ammes to identify the particular needs of their trainees in addressing emotionally laden experiences.