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ADOSSI-DISSERTATION-2017.Pdf Copyright by Nancy Adossi May 2017 THE SYSTEM RULES US: UNDERSTANDING THE PERCEPTIONS OF FOREIGN INTERNATIONAL MEDICAL GRADUATES IN THE UNITED STATES REGARDING THE EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES’ CERTIFICATION PROCESS A Dissertation Presented to the Faculty of the College of Education University of Houston In Partial Fulfillment of the Requirements for the Degree Doctor of Education in Professional Leadership with an emphasis in Health Science Education by Nancy Adossi May 2017 THE SYSTEM RULES US: UNDERSTANDING THE PERCEPTIONS OF FOREIGN INTERNATIONAL MEDICAL GRADUATES IN THE UNITED STATES REGARDING THE EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES’ CERTIFICATION PROCESS A Dissertation for the Degree Doctor of Education in Professional Leadership with an emphasis in Health Science Education by Nancy Adossi Approved by Dissertation Committee: Dr. Sara McNeil, Chairperson Dr. Bernard Robin, Committee Member Dr. Mimi Lee, Committee Member Dr. Yehuda Sharim, Committee Member Dr. Robert McPherson College of Education May 2017 Acknowledgments This dissertation is dedicated to all those who have ever had to immigrate from their homeland to a foreign land in search of safety, whether physical, religious, cultural, or financial, for themselves or for their families. It is also dedicated to my mother, Kossiba Victoire Hinme, the stalwart feminist of my life who believed in me even before I was born. You are my strength and my peace in times of trouble. To my grandmother, who never attended school and only learned to sign her name, Aholousi Rosaline Dogbevi, I dedicate this dissertation to you, a woman whose powerful influence was felt in two countries; a woman whose very name still strikes awe in the hearts of all her descendants. To my dearest father, Della William Messan Adossi, you are the one responsible for showing me the beauty of migration and the responsibilities which come with it. You are also my inspiration for living life to the fullest. Thank you for being a male feminist and sticking up for me, your only daughter, and having great expectations for me. May your names continue to live on forever. My sincerest gratitude to Dr. Sara McNeil, my advisor and one of the most patient and reassuring professors I have encountered in my life. My deepest appreciation for Dr. Mimi Lee, whose grace and profound expertise, enabled me and sincerely empowered me, as a woman of color, to pursue and embrace my research. My sincerest gratefulness for Dr. Bernard Robin, who saw my potential before I even matriculated. Finally, my profound appreciation for Dr. Yehuda Sharim, whose amazing presence and mentorship in my life has greatly contributed to me being able to finish this study. To the lover of my soul, God, for He has indeed done great things. Ase. THE SYSTEM RULES US: UNDERSTANDING THE PERCEPTIONS OF FOREIGN INTERNATIONAL MEDICAL GRADUATES IN THE UNITED STATES REGARDING THE EDUCATIONAL COMMISSION FOR FOREIGN MEDICAL GRADUATES’ CERTIFICATION PROCESS An Abstract Of a Dissertation Presented to the Faculty of the College of Education University of Houston In Partial Fulfillment of the Requirements for the Degree Doctor of Education in Professional Leadership with an emphasis in Health Science Education by Nancy Adossi May 2017 Abstract Despite efforts to alleviate the current physician shortage, there remains a gap that is not being filled by US medical school graduates especially in under-served and rural areas. One of the solutions to this problem is to use Foreign International Medical Graduates (FIMGs) to fill residency training positions; however, the certification process for these FIMGs is lengthy and often challenging. This qualitative study sought to identify perceptions of the certification process by FIMGs and factors that they feel influence the successful completion of the U.S. certification process. Conceptually, this study was framed within critical theory as well as andragogy. The main research question was: What are the perceptions of FMIGs regarding the factors that influence or impede the ECFMG certification process? Data was collected through semi-structured interviews with six participants. Three participants were FIMGs who are currently U.S. certified practicing physicians, and three participants were FIMGs who are not currently U.S. certified practicing physicians. These interviews provided opportunities for detailed accounts of physicians’ various experiences which served as the basis for all analysis. Carspecken’s methodology was chosen based on its emphasis on systems and cultures through dialogical data collection. The results of these analyses indicated that all six FIMGs in the study perceive the certification process to be stressful due mainly to their status as immigrants and a general lack of support. Furthermore, an important contributing factor to successful certification was internal and external motivations. External motivation came from their families and communities and inner motivation came from a deep desire not to fail. This study may contribute to the field of health sciences education in that it provides insight into the unique experiences of a group of FIMGs, and what educators and leaders in the field can learn about them as adult learners. vii Table of Contents Acknowledgments................................................................................................. IV Abstract ................................................................................................................. VI List Of Tables ....................................................................................................... XI List Of Figures ..................................................................................................... XII Chapter 1: Introduction ............................................................................................1 Background ..........................................................................................................2 Statement of the Problem .....................................................................................5 Purpose of the Study ............................................................................................6 Research Question and Methodology ..................................................................6 Significance and Context of the Problem ............................................................7 Educational Value of the Study .........................................................................10 Definitions .........................................................................................................10 Limitations of the Study ....................................................................................11 Conclusion .........................................................................................................11 Chapter 2: Literature Review .................................................................................13 Definition of FIMG and Context .......................................................................14 Supply and Demand ...........................................................................................16 Aging Population. ..........................................................................................18 Proposed Solutions to Supply Shortage .............................................................19 United States Medical Graduates. ..................................................................20 Team-based Approach. ..................................................................................20 Foreign International Medical Graduates ......................................................23 From FIMG to Licensed Medical Physician......................................................23 Migration Context ..............................................................................................27 Communication Problems. .............................................................................29 Power Dynamics. ...........................................................................................31 Healthcare Workforce Context ..........................................................................32 Discrimination Against FIMGs......................................................................33 Conclusion .........................................................................................................34 Chapter 3: Methodology ........................................................................................37 Population ..........................................................................................................39 Location .............................................................................................................40 Sample Size ........................................................................................................41 Data Collection ..................................................................................................41 Method of Research ...........................................................................................43 Ethical Considerations .......................................................................................44 Data Analysis .....................................................................................................45 Limitations of the Study ....................................................................................47 Conclusion .........................................................................................................48
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