R. Akhund1, D. D. Muñoz Wilson2, M. C. McLeod1, A. Jones3, G. Sarosi4, K. Brasel5, R. M. Minter7, J. Mellinger3, J. Buyske3, B. Lindeman1 1University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA 2University Of Alabama at Birmingham, Heersink School Of Medicine, Birmingham, Alabama, USA 3American Board Of Surgery Inc, Philadelphia, PA, USA 4University Of Florida, Department Of Surgery, Gainesville, FL, USA 5Oregon Health And Science University, Department Of Surgery, Portland, OR, USA 7University of Wisconsin School Of Medicine and Public Health, Department Of Surgery, Madison, WI, USA
Introduction: International Medical Graduates (IMGs) account for nearly 25% of the United States physician workforce. Previous studies on IMGs in the US healthcare system highlight challenges faced by IMGs in graduate medical education, and differences in feedback perception. We aimed to investigate residents’ perceptions of feedback based on the proportion of IMGs within general surgery residency programs.
Methods: An optional survey following the American Board of Surgery In-Training Exam (ABSITE) was administered in January 2023. The 15-question previously-published survey combined Likert scale, multiple choice, and free-text responses to assess resident satisfaction with feedback overall, on their best, worst, and last rotation, and in the intra-operative and non-operative settings. Residents reported their feedback frequency, who initiates feedback, and percent of attendings that provide consistent feedback, as well as the time they perceive is needed for meaningful feedback. As respondents did not self-identify as US or international graduate, Spearman rank correlations were used to assess the relationship between resident satisfaction with feedback and ABS-provided proportion of IMGs per program, with sub-analysis of programs comprised of all or no IMGs.
Results: Responses from 9854 individuals at 348 programs were received. Of these, 34% of respondents (n=3326) were from 157 programs with no IMGs (45%), 75% of programs had 17% or fewer IMGs, and 5.6% of respondents (n=55) were from 3 programs comprised of 100% IMGs. Overall, very weak correlations were identified between IMG proportion and feedback satisfaction variables, though several differences were statistically significant (rs<0.1, p<0.05 for all). On sub-analysis, respondents from programs with 100% IMGs had slightly higher overall satisfaction with feedback compared to those from programs with no IMGs (7.97 ± 1.50 vs 7.33 ± 1.87, p=0.04). All correlations comparing these two groups were very weak, (rs<0.1 for all). Statistical significance (p<0.005) was reached only by perceptions of feedback on the worst rotation (rs= -0.07, where a negative correlation indicates higher satisfaction in the 100% IMG group) and receiving positive feedback intra-operatively (rs=0.04, where a positive correlation indicates more positivity in the 100% IMG group).
Conclusion: Findings from this analysis revealed there was statistical significance between the proportion of IMGs in a program and residents' satisfaction regarding feedback in different realms, however, the practical size of these relationships were negligible. Given the small nature of these correlation coefficients, there are likely unmeasured variables that account for the significant nature of these differences, which we hypothesize are program-level effects. Multi-institutional studies with individual-level data are needed to further elucidate whether a meaningful relationship exists.