The consequences of cultural difference: the international medical graduate journey in New Zealand

Objective: To identify how differences in cultural and pro-fessional values between New Zealand born and trained doc-tors and International Medical Graduates (IMGs) affect the practice and retention of IMGs in New Zealand.Methods: A mixed-method approach was used. An anony-mous 42-item online questionnaire was used to compare par-ticipants' cultural and professional values. Participants were 373 New Zealand doctors, 198 IMG, and 25 doctors born and raised elsewhere but who qualified in New Zealand, a group not identified prospectively. The qualitative component used interviews with 14 IMGs to identify cultural challenges faced and with nine New Zealand doctors to identify the challenges they faced working alongside IMGs. Qualitative data were transcribed and analysed thematically.Results: There were differences in power distance, with the medically qualified in New Zealand doctors having the high-est power distance, followed by the IMGs, suggesting a pref-erence for a hierarchical environment at odds with the New Zealand culture. Interviews found cultural differences in communication styles and hierarchy contributed to profes-sional challenges. The cultural transition was difficult for IMGs as they received minimal support. One-third of IMGs acknowledged their behaviours did not fit well in New Zea-land. Complaints about IMGs increased when they reverted to default behaviours regarded negatively by New Zealand colleagues or patients.Conclusions: IMGs are open to change but face a lack of ori-entation and cultural education opportunities, hindering in-tegration. Residency programs must recognise this discon-nect and incorporate cross-cultural programmes in the curriculum. Such programmes would assist the adaption and retention of IMG doctors.