From Arrival to Adaptation: A Needs Assessment of International Medical Graduates in Residency Training

BACKGROUND: International Medical Graduates (IMGs) comprise approximately a quarter of the U.S. physician workforce and play a critical role in healthcare delivery. Despite their contributions, IMGs often face unique challenges when transitioning into residency. These include adapting to new healthcare systems, clinical workflows, and cultural environments. Few studies, however, have investigated the challenges of this transition or proposed actionable strategies to mitigate the stress. METHODS: We conducted a single-center, cross-sectional needs assessment at a large academic medical center. Surveys were distributed to 2 groups: current residents, and faculty. Participants were asked to identify their primary concern regarding the IMG transition and to identify the top 3 challenges for IMGs across domains including professional/system-based factors, social/cultural adaptation, and personal wellbeing. Responses were analyzed descriptively, with subgroup comparisons between IMGs, American Medical Graduates (AMGs) and faculty. RESULTS: A total of 75 current residents (12 IMGs, 63 AMGs) completed or partially completed the survey. IMGs more frequently identified challenges related to adapting to the U.S. healthcare system, electronic medical record (EMR) use, and cultural differences within the team. In contrast, AMGs concerns more commonly related to work-life balance and specialty-specific knowledge. A total of 27 faculty members responded; their perspectives aligned with sentiments of the IMGs and emphasized the need for structured onboarding, targeted training, and longitudinal mentorship. CONCLUSIONS: IMGs experience distinct and multifactorial challenges during the transition to residency which span professional, social, and personal domains. Institutional recognition of these stressors is essential, as generalized onboarding programs alone appear insufficient to address IMG-specific needs. Tailored orientation programs, early systems-based training, and structured mentorship may help bridge this gap and improve both trainee experience and clinical integration.