ECFMG Acculturation Program
The One Dozen Most Important Things You May Not Have Known, Understood, or Realized About American Medicine
The One Dozen Most Important Things You May Not Have Known, Understood, or Realized About American Medicine is a series of modules designed to introduce international medical graduates (IMGs) who are entering the U.S. medical education and health care systems to the medical culture in which they will be working. This includes concepts, issues, perspectives, and values that may differ significantly from those of their native medical culture. The series is certainly not exhaustive but includes the areas in which newly arriving IMGs most frequently have questions.
Each module includes:
- A brief narrative description of the topic and its implications
- One or more video scenarios demonstrating interactions and behaviors related to the topic. Some scenarios demonstrate model behaviors, while others clearly demonstrate inappropriate behaviors.
- An analysis of the scenario(s) that highlights specific aspects of the physician’s interactions and behaviors. The analysis acknowledges model behaviors and proposes alternatives to poor behaviors.
- A set of discussion questions. Since the questions are designed to generate discussion (if being used in a group) or provide an opportunity for self reflection (if being used by an individual), answers are not provided.
- A script of the video scenario(s)
Topic Modules:
- The Doctor-Patient Relationship
- The Role of the Patient’s Family
- Confidentiality
- The Health Care Team
- America Is a Litigious Society
- Document, Document, Document!
- Who Pays the Bills?
- Gender Issues and Discrimination
- Safety and Errors
- Informed Consent
- U.S. Graduate Medical Education
- Above All, Professionalism
Suggestions for Use
These materials may be used by individual IMGs at any stage of their journey into U.S. graduate medical education (GME) programs. Reviewing these modules before coming to the United States may provide IMGs with a general sense of the medical culture they will be entering. Subsequent review after they have had some actual experience in the U.S. medical system may be of additional value.
The One Dozen Things modules may also be useful for Program Directors and other faculty who are responsible for orienting new IMG residents and introducing them to U.S. medical culture.
The materials are particularly effective in group settings where active participation in discussion of the topics is to be encouraged. Within a group setting, it has proven effective to first present the video scenario for a topic, followed by the discussion questions. A group leader should try to ensure that all points highlighted in the analysis are covered. Participants can be given copies of the materials to take home for further reference and review. Withholding those materials until after the discussion may increase spontaneity, but that option would be at the discretion of the group leader or faculty.
Scripts for each of the scenarios are provided in the event that discussion leaders would like to present the scenarios using live participants (standardized patients, actors or even orientation participants themselves) in a role-playing format.
Users can also download text and video(s) for each module from the Downloads page.
Based on past experience with the One Dozen Things, working through all 12 modules will likely take at least two hours, so discussions must be well-paced. Specific issues not addressed in either the analysis or the discussion questions may arise and should be encouraged as allowed by time constraints. Obviously, individual topic modules may be selected in any order and all 12 need not be used.
Finally, as with all materials offered by the ECFMG Acculturation Program, orientation leaders may reproduce or adapt the materials according to their individual needs, provided that ECFMG is given attribution as the original source of the material.
The ECFMG Acculturation Program welcomes any comments, suggestions, or additional materials related to these topics by e-mail at acculturation@ecfmg.org.
