Letters to the Editor
We agree with Dr. Narumoto and Dr. Wilson that using caution when interpreting the associations described in our study is wise counsel. That said, some additional points merit consideration.
First, if cultural differences exist in the way that individuals respond to scales, that phenomenon would affect not only international medical graduates (IMGs) but also U.S. medical graduates (USMGs), who are also a cohort of individuals with unique cultural characteristics.
Second, the IMGs in our study may not be as different from one another as the authors suggest in their letter. Although the IMGs we studied come from distant lands, all are educated professionals within a fairly narrow age range who (1) chose a career in medicine, (2) elected to pursue residency training in internal medicine, and (3) decided to come to Maryland for their graduate medical education. Nonetheless, the potential limitation of considering IMGs as a single group is elaborated upon in the Discussion section of our report.
Third, we assured the respondents that their responses would be kept confidential. Thus we can only hope that the self-assessments were performed honestly and accurately by both IMGs and USMGs from diverse cultural backgrounds.
Finally, the adjustment to residency training is difficult for both IMGs and USMGs. When our results showed that the IMGs studied may be coping or adapting better than USMGs, we knew that there would be significant skepticism about the observed findings and explanations about why the findings must be incorrect. Further studies are needed to more fully understand the perceived stress, challenges to self-esteem, fatigue, and personal growth experienced by trainees from varied backgrounds, but it deserves mention that IMGs have overcome significant psychological and financial challenges just to arrive in the United States for residency training. Such obstacles and perseverance may bode well for their ability to withstand the difficulties encountered during their residencies.
At the end of the day, an individualized approach to check on the well-being of each trainee, regardless of that person's country of origin or where he or she went to medical school, is needed to increase the likelihood that each individual can evolve into a clinically excellent physician.
Aysegul Gozu, MD, MPH
Assistant professor of medicine, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; firstname.lastname@example.org.
Scott Wright, MD
Professor of medicine, Department of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.