Date of Award

January 2019

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Darin Latimore

Second Advisor

Erica Herzog

Abstract

Background: International medical students (IMS) represent a group of students with unique issues that have largely been ignored in the medical literature. This invisibility is because international students make up a very small percentage of the total number of students matriculating into medical school in the US and because most international students are grouped together with domestic underrepresented minority (URM) students and hence are treated as if they were domestic minority students.

Aim: We aim to determine what are the career interests of international and domestic underrepresented minority medical students and what factors influence their choices. We also aim to explore these students’ perceptions about their mentoring experiences during medical school. We hypothesize that since international students have different life experiences and unique issues that are separate from URM students there would be differences in career interests, factors influencing their career aspirations and perceived mentorship experiences between these two student groups. Furthermore, for international students, we aim to establish their plans about practicing in their home countries and views about visa requirements for residency training. We hope to help bridge the knowledge gap that currently exists about what exclusively affects international and not domestic URM medical students.

Methods: A survey was sent out to US medical schools that matriculate internationals applicants. We also conducted a convenience sampling at the Latino Medical Students Association (LMSA) National Conference to increase the number of LatinX participants. Participants ranked 19 items coded on a Likert scale from 1 (not at all important) to 5 (extremely important important) about factors influencing their career aspirations. These factors were personal reasons, intellectual challenge, previous clinical experience, lifestyle and work hours during residency and after training, financial rewards after training, job opportunities in that specialty in the US and in their country of origin, mentors in that specialty, mentors that have similar background as the student in that specialty, prestige and specialty reputation, length of residency, ability to obtain a residency position in that specialty, ease of obtaining an employment visa in that specialty, health needs of the community you grow up in, having people you can relate to in that specialty, academic opportunities and patient relationships or interactions. Participants also ranked on 5 point Likert scale from 1 (not at all helpful) to 5 (extremely helpful) how helpful their formal and informal mentors were with the following six topics: academic advice, career planning, professional development, personal issues, research and general guidance. Perceived quality of the students’ most influential mentor was measured using a modified Mentorship Effectiveness Scale. Students were also asked to provide demographic data that included gender, age, year in medical school, region of origin for internationals, race or ethnicity for domestic URMs and choice of specialty. International participants were also asked about their plans to practice in their home countries and views about visa issues during residency applications.

Results: 96 respondents were included in the analysis, 15 (15.7%) were international students and 81 (84.3%) were URMs. The most common specialty choices for internationals were surgery 6 (40.0%) and 3 (20.0%) internal medicine, and for domestic minorities were internal medicine 16 (20.5%) and pediatrics 16 (20.5%).

Among IMS, the top factors influencing career choice were having people you can relate to in that specialty, patient interactions, academic career opportunities, future job opportunities in the US, ability to obtain a residency position and ease of obtaining an employment visa. Among URM students, the top influencing factors were personal reasons, clinical exposure, lifestyle and works hours after training; and like IMS, patient interaction, having people you can relate to and feeling welcome in that specialty. IMS valued financial rewards after training and prestige/specialty reputation as influential factors more significantly positive than URMs (p = 0.021 and p = 0.020 respectively).

Both international and domestic minorities students generally perceived that their informal mentors were more help with academic advice, career planning and professional development than their formal mentors were. The total help that URMs perceive to get from informal mentors (19.74 ± 5.65), on all 6 items ranked, was significantly more than from formal mentors (17.02 ± 6.35), p = 0.029. In ranking the perceived quality of their most influential mentor IMS scored ‘mentors providing useful advice, resources or support to help with unique issues’ significantly lower compared to URM students, p = 0.012.

Majority of IMS express interest in practicing at least part-time in their country of origin and plan to first go back within 10 years of completing postgraduate training. 6 out of 13 (46.2%) IMS reported receiving some form of advice about visa requirements for residency. Every international student that indicated they are currently applying for residency reported they have discussed this topic with program directors during their interview and felt that their immigration status would impact how they are ranked in the National Residency Matching Program.

Conclusion: International students choose more competitive specialties and care more about financial rewards and prestige when choosing a career compared with domestic minority medical schools. Internationals are interested in practicing in their home country and they fear that visa requirements for postgraduate training pose a barrier when applying for residency. These findings suggest that IMS choices, influencers and plans are different from domestic URM students. Medical school administrator and educators need to be aware of these differences in order to better address the specific needs of both student communities especially when it comes to advising them about career aspirations and the residency application process.

We also show that both IMS and URM generally perceive informal mentors to be more helpful with advising and professional development. IMS perceive that mentors do poorly with providing them with advice, resources and support for the unique challenges that they face as internationals. This suggest that formal advisors and mentors might benefit from professional development about what international versus domestic URM students perceive to be helpful to them so that formal mentorship programs become as helpful to students as informal mentoring.

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This is an Open Access Thesis.

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