Integration of international medical graduates into primary care settings – a systematic review and narrative synthesis

BACKGROUND: International Medical Graduates(IMGs) play a crucial role in the primary care workforce. However, they experience challenges that may affect their career progression, satisfaction,and retention. AIM: To synthesise the literature on IMG experiences of, and integration into primary care settings, and identify factors that support or hinder this process. DESIGN & SETTING: Systematic review of primary studies examining IMG integration in primary care, and narrative synthesis of evidence. METHOD: Eight databases were searched from inception to July 2025, alongside grey literature and reference checks. Eligible studies presented primary research involving IMGs across all career stages working in primary care. A narrative synthesis was conducted following quality appraisal. RESULTS: Forty studies were included. IMGs reported challenges across cultural adjustment, communication, educational processes, and understanding of UK primary care systems. Systemic bias, social isolation, and limited professional support contributed to poor well-being and career progression. Integration was facilitated by mentorship, culturally sensitive feedback, and targeted training. IMGs also used self-directed coping strategies such as proactive learning, reflection and peer networking. CONCLUSION: IMGs face multifaceted challenges in primary care. Addressing system and educational barriers through targeted support for both trainees and trainers may enhance integration, reduce differential attainment, and support workforce sustainability. Organisational and individual-level strategies to support integration are proposed. Research on long-term impact of support strategies is recommended. HOW THIS FITS IN: This review identifies common barriers and enablers of IMG integration, offering insights for policymakers, educators, and supervisors to better support development of a diverse primarycare workforce.