Transitioning into the ICU team - The experience of International Medical Graduates (IMGs) during a North American Fellowship Training Program in Critical Care

img是世界上许多卫生保健系统的组成部分，例如，加拿大25%的执业医生和德国8%的执业医生是img。当他们在另一个国家接受临床培训时，img面临着适应不熟悉的医疗系统和环境的需要，并学习新的医院和单位的文化、组织和流程。重症监护的实践是复杂的，时间敏感的，高度依赖于跨学科的团队合作。事实上，有效的团队合作与ICU更好的患者预后有关。为了在这样的环境中发挥实习生的作用，img必须迅速学会如何在ICU团队中互动，以及如何与其他医生和联合卫生专业人员协调自己的临床活动。了解“游戏规则”可能是img开始他们的重症监护奖学金的一个独特挑战。不能或延迟适应新的培训环境的能力可能是学员和病人护理的问题。此外，在北美研究生医疗系统中，重症监护研究员的独特角色对于许多在没有奖学金项目的国家接受培训的img来说是一种陌生而新颖的经历。img可能无法完全理解员工角色的双重、有时是冲突的性质（管理者-被管理者；领导者-追随者）。更好地了解img研究员进入ICU团队的过渡过程对于优化患者护理和培训非常重要。本研究旨在更好地了解img在多伦多大学重症监护奖学金的第一年如何融入他们的内部和跨学科ICU团队。更具体地说，这个项目将探讨：1.)IMG研究员对其在ICU内部和跨专业团队中的角色和责任的看法；2) IMG研究员在过渡到ICU团队成员的新职业角色时遇到的挑战；3) IMG学员克服这些挑战的策略。我们的研究结果将为在这一过渡时期支持IMG研究员和ICU团队成员的战略和举措的制定提供信息。最终，IMG成员在ICU团队中的更好和/或更快的整合将导致更有效的团队合作，提高团队绩效和更好的患者护理。

IMGs represent an integral part of many health care systems around the world, e.g. 25% of practicing physicians in Canada and 8% in Germany are IMGs. When they pursue clinical training in a different country, IMGs face the need to adapt to an unfamiliar medical system and environment, and to learn the culture, organization and processes of the new hospital and unit. The practice of critical care is complex, time-sensitive and highly dependent on inter-disciplinary teamwork. In fact, effective team work has been tied to better patient outcomes in ICU. To function as trainees in such an environment, IMGs must quickly learn how to interact within an ICU team, and how to coordinate their own clinical activities with those of other physicians and allied health professionals. Understanding the "rules of the game" may represent a unique challenge for IMGs starting their critical care fellowship. The inability or delayed ability to adapt to their new training environment may be problematic for the trainees and for patient care. In addition, the unique role of a critical care fellow within the North-American postgraduate medical system is an unfamiliar and novel experience for many IMGs who trained in countries without fellowship programs. IMGs may not fully grasp the dual, sometimes conflictual nature (supervisor-supervisee; leader-follower) of the fellow's role. A better understanding of the process of transition for IMG-fellows into their ICU team is important for optimal patient care and training.This study aims to better understand how IMGs integrate within their intra- and interdisciplinary ICU teams during the first year of their Critical Care fellowship with the University of Toronto. More specifically, this project will explore: 1.) IMG fellows' perceptions of their roles and responsibilities within intra- and inter-professional ICU teams; 2.) challenges encountered by IMG fellows as they transition into their new professional role as ICU team member; 3.) strategies used by IMG fellows to overcome these challenges. Our results will inform the development of strategies and initiatives to support IMG fellows and ICU team members during this transition period. Ultimately, a better and/or faster integration of IMG fellows within the ICU team will lead to more effective teamwork, improved team performance, and better patient care.