A Psychosocial Exploration of International Medical Graduate Journeys, Perceptions, Challenges and Resulting Impacts: A Sequential Explanatory Mixed Methods Study.

Background: Several countries rely on International medical graduates (IMGs) to fill critical service gaps. IMGs experience a range of challenges related to migration, acculturation, accreditation and career. Purpose: This study aimed to explore the journeys, perceptions and challenges of IMGs based in Australia. Methods: We used a sequential explanatory mixed methods approach for design and analysis. An online survey was distributed Australia-wide to IMGs through various avenues (including snowballing) between 13th October 2023 and 31 December 2023. We later conducted individual interviews between February and April 2024. Quantitative data was descriptively analysed. Qualitative data from survey written responses and oral interviews were thematically analysed. Study data was triangulated and congruence assessed. Full Ethics approval was obtained. Results: The study comprised 286 survey participants and 36 interview participants. Working conditions, location/lifestyle and personal/family opportunities were among the reasons for Australia's popularity as a host country. The most disliked aspects were system processes (eg, bureaucracy, certifications, licencing etc) (87/199; 43.7%), and discrimination, bias, racism, or prejudice (53/199; 26.6%). Two major qualitative themes identified were: (1) IMGs have a rich and diverse set of experiences and (2) IMGs encounter unexpected challenges with widespread impacts on IMGs, family and society. We found high congruency of triangulated data from the quantitative and qualitative studies supporting concepts around IMG diversity of experience and choices, life stage priorities, privilege, mismatched expectations, criticism of bureaucracy, gaps in understanding nuances of the Australian workplace, social challenges, and impact of challenges. Conclusion: IMGs describe numerous permutations of journeys, challenges and general experiences which result from factors both inside and outside the IMG's control. Challenges, particularly those which are unexpected, may detrimentally impact IMG careers, health and desire to remain in their host country. Institutions have a role in adapting current bureaucratic processes to better support the IMG experience.