Training International Medical Graduates:One Physician Assistant Program’s Experience

Ruth Ballweg, MPA, PA-C; Program Director, MEDEX NorthwestUniversity 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 12different countries, since 1990. (In 1988 Washington State eliminated the option for IMGsto apply for PA licenses without formal PA training and NCCPA certification.)

Admissions: MEDEX recruits experienced health care personnel for entry into the PAprofession. MEDEX offers applicant information sessions, some of which are focused forIMGs. MEDEX interviews use full-day selection conferences, which include three groupinterviews for each candidate. Barriers to successful application include communicationissues and incomplete knowledge of or possible dissatisfaction with the PA role. SomeIMGs were admitted to the program upon reapplication.

Academics: Academic performance has been average to good, though there have beenlimited challenges with communication and role transition. IMG students have performedwell in the clinical portion of PA training.

Outcomes: All IMG-PA graduates have passed the certification exam, and half are nowworking 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 dueto the program’s experience in recruiting, selecting and training individuals with priorhealth careers. In addition, the question of supervised practice is carefully exploredduring the admissions process. These students have experienced little academic distressduring their training, though communication skills were a concern for some. IMG-PAswere 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 physicianassistants (PAs) without specific additional training in a PA program.

• There were also provisions for individuals with on-the-job training tobe licensed as PAs with a limited scope of practice.

• Over time, PA practice was limited to graduates of accreditedprograms and then to those who were NCCPA certified.

Background

• MEDEX is a second-career program, designed to build on previousclinical training.

• The program recruits experienced health care personnel for entry intothe 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 thedidactic phase of the program and tended to be averagestudents academically.

• Some IMGs did experience some complications withcommunication, role socialization and role transition.

• It was not unusual for this group to have struggles regarding alack of assertiveness and discomfort dealing with crisis.

Figure 6: Overall average program grade point averagefor IMG students (on a 4-point scale).

Academic Performance

• The MEDEX clinical training model includes close studentmonitoring including site visits.

• Clinical faculty were able to see quickly how well the IMGs wereadapting.

• The IMGs—many of whom had been working as translators orlower-level health workers in the US—generally made an easytransition 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 PANCEcertification exam on the first try.

• Of the 28 MEDEX-trained IMG-PAs, theprogram has employment data for 24.

Figure 7: Current employment specialty ofIMG-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, althoughsome required extra advising on the specifics of the US health care delivery system.

• Communication skills—especially in the areas of assertiveness and conflictresolution—were difficult for some students.

• IMG-PAs were quickly hired upon graduation and have typically stayed in the firstjob where they were employed.

• In some cases the IMG-PAs returned to the specialties in which they had practicedin their prior physician careers.

Discussion

• MEDEX interviews are based on the original PeaceCorps interview model—using full-day selectionconferences for all applicants.

• Selection conferences include 3 group interviews foreach candidate.

• Unsuccessful IMG applicants were usually ‘selectedout’ 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 programand were admitted.

Figure 1: Mingying Bonner:IMG and new PA.

• In 1988, IMG-PAs were nolonger eligible for newlicenses, at which timeMEDEX agreed to acceptIMGs as candidates foradmission.

Figure 2: Zheru Li (from China) with MEDEX ProgramDirector, Ruth Ballweg.

Figure 8: Rizwana Lott (center, from India) withher family at MEDEX graduation.

Mexico: 2

India: 2Pakistan: 1

Russia: 8

China: 3Ethiopia: 2

Philippines: 2

Ukraine: 3

Bulgaria: 2

Romania: 1

East Germany: 1

VietNam: 1

MEDEX