The Experiences and Challenges of EM-Bound International Medical Graduates By Adebisi Adeyeye, MBBS, and Oluwarotimi Vaughan-Ogunlusi on behalf of the SAEM Global Emergency Medicine Academy Emergency medicine (EM) has grown since its inception, becoming the 4th most popular residency choice amongst senior medical students and thus increasing the competition to match. Interest is not isolated to the United States alone as EM continues to grow internationally. However, there are few international EM training programs available, leaving many international medical graduates (IMGs) searching for opportunities to train in the United States. In this article, we shed light on the experiences and challenges of EMbound students from the perspectives of a United States (U.S.) IMG and non-U.S. IMG trained in medical schools in Europe and West Africa, respectively. This article highlights the plight of IMGs striving for advanced medical training in a specialty that has not historically favored them.
Since the 1970s, EM has been recognized as a specialty in the U.S., and over the past 50 years many countries around the world have begun to offer EM residency training. South Africa was the first African country to offer EM residencies in 2004. As of 2017, an additional 11 countries, out of the 54, have introduced emergency medicine residency programs (EMRPs). According to the European Society for Emergency Medicine (EUSEM), 29 European countries recognize EM as a primary specialty. Of those, only 16 meet the European Union ‘Doctors’ Directive’ criteria, which requires training programs of at least five years. Many international medical students and doctors are left without the opportunity to pursue EM in their home countries, particularly in Lowand Middle-Income Countries (LMICs).
In Nigeria, EM became a recognized specialty in 2019, and efforts to start a residency at the University College Hospital, Ibadan are underway. As a result, there are currently no EMRPs or formal EM clerkship rotations for Nigerian medical students. Additionally, Nigerian students discover the possibility of pursuing EM late in their education or not at all. The exposure to emergency care is minimal, mostly tending to emergencies whilst on core rotations in surgery, medicine, pediatrics, or ob/gyn. For example, during a 12-week pediatrics rotation, only one week is dedicated to gaining experience in the children’s emergency room. In most cases, the patient has been assessed, resuscitated,
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