By Dr. Can Misel Kilciksiz
Recipient of the 2023 Grant Opportunity for J-1 Physicians: Well-being Projects Supporting Foreign National Physicians
I am Dr. Can Misel Kilciksiz, an international medical graduate (IMG) from Turkey and a PGY-4 psychiatry resident at Washington University School of Medicine in St. Louis (WashU). I am writing this blog piece on behalf of our wonderful team, the WashU IMG Wellness Initiative. Our initiative was started in July 2023 by a group of trainees and faculty, including myself, Dr. Nadia Wattad (pediatric pulmonology fellow from Israel), Dr. Callie Torres (pathology resident from the United States), Dr. Rawan Safa (emergency medicine resident from Lebanon), Dr. Jennifer Duncan (professor in pediatrics, director of GME Wellness), and Dr. Patricia Cavazos-Rehg (professor in psychiatry, vice chair for DEI). Since July 2023, many other amazing trainee members have joined the leadership committee of our initiative, including Dr. Mew Udomkittivorakul (pediatrics resident from Thailand), Dr. Esra Pehlivan (pediatrics neurology resident from Turkey), Dr. Mehul Thakkar (pediatrics hematology/oncology fellow from India), and Dr. Shao Ching Tu (pediatrics/genetics resident from Taiwan).
Like many other IMGs, I decided to pursue psychiatry training in the United States for its world-renowned medical centers, well-established medical training system, open-minded academic environment, and diverse culture. After a long journey, I matched into the general psychiatry residency program at WashU in March 2020. Unfortunately, the COVID-19 pandemic was surging at the same time, taking many lives, and leaving many others in despair and isolation. After an exhausting bureaucratic visa process amidst uncertainties and travel restrictions, I was able to book one of the first commercial flights from Turkey to the United States. I arrived at an empty St. Louis apartment a day before my orientation.
The first six months of residency were very challenging for me. Even though I was finally able to start the psychiatry training I had dreamed of for years, I was not feeling well. I was homesick and there was no possibility for me to visit home for the foreseeable future (in fact, it took two years due to travel restrictions). I felt alone since I did not have any friends, family, or community. Additionally, it was even more challenging to meet new people due to the social distancing measures of the pandemic. I felt like an imposter as the only IMG in my cohort and I was concerned that I was falling behind my co-residents in my class, who were already more familiar with the medical system, electronic medical records, medical terms, language, and cultural context. During my intern year, I overcame all these challenges gradually, even though it was painful. I slowly realized as I spoke with other IMG trainees that they had been through similar experiences during their first year(s) of their training. I began to wonder what could have been done to change and improve all of our experiences.
These considerations led me to think about possible ways to improve the wellness of IMG trainees in our residency program. I was inspired by the wellness efforts presented in the diversity, equity, and inclusion (DEI) trainee sessions by Dr. Cavazos-Rehg and her team members. I initiated further conversations with Dr. Cavazos-Rehg and her team members on possible ways to incorporate DEI efforts to leverage IMG wellness in the psychiatry department and potentially in the whole hospital. When we included Dr. Jennifer Duncan (the GME Wellness director of the hospital system) in these conversations, she told us there were other trainees from different programs who similarly expressed interest in IMG wellness recently and connected us to them. Serendipitously, I received the email regarding the Grant Opportunity for J-1 Physicians for well-being projects supporting foreign national physicians around the same time. Through emails and virtual meetings with Dr. Duncan, Dr. Cavazos-Rehg, and the other trainees, including Dr. Wattad, Dr. Safa, and Dr. Torres, we decided to develop the WashU IMG Wellness Initiative and apply for the opportunity. A few weeks later, we received the great news that we were one of the three projects selected (out of sixty applications)!
Before the WashU IMG Wellness Initiative was founded, there were no institutional support systems at WashU specifically for IMG trainees and their unique needs. Many IMG trainees were not offered the space to meet with each other so they could share and process their experience together, nor did they have the opportunity to meet intergenerational or peer mentors who could help them navigate through the complex health system and visa process. This lack of connection and support unfortunately increases the risk for burnout, isolation, imposter syndrome, negative mental health outcomes, and overall decline in the well-being of IMG trainees. The WashU IMG Wellness Initiative team aimed to use successful DEI/wellness outreach models, as well as novel approaches, to establish institutional support, foster community, drive advocacy, and create a mentorship platform for IMG trainees at our institution.
First, we hosted an inaugural event with an open discussion about the goals of the WashU IMG Wellness Initiative. We requested that IMG trainees complete baseline surveys to assess their needs and identify possible wellness intervention focuses. We created a WhatsApp group to facilitate networking and dialogue. We launched a section of the WashU GME website section specific to the IMG Wellness Initiative to maintain relevant resources (on relocation, visa information, etc.) and promote the institutional recognition of IMG trainees. To address the questions of IMG trainees, we hosted expert sessions with an immigration lawyer and a contracts lawyer, both of which received a lot of positive feedback. Most recently, we hosted a holiday gathering at an IMG program director’s house, which was well attended and enjoyed by the IMG trainees and their families. At other recent events, we served food from different countries to enjoy and celebrate our diversity. We are working on a couple of different long-term projects for the WashU IMG Wellness Initiative, including a relocation guide for incoming IMG trainees, a guide of best practices for program directors to support their IMG trainees, and a peer/faculty mentorship program.
Overall, our efforts have created excitement, a sense of community, and institutional awareness for IMG trainees and other members of the hospital. For the WashU IMG Wellness Initiative, the promotion and development of a community was the most impactful element of our project. However, we also know that there are opportunities for improvement in IMG wellness at WashU and other teaching hospitals. Based on our experience, we advise other institutions to start by assessing the specific needs of their IMG trainees, creating a platform for their IMG trainees to connect, and collaborating with other physician wellness champions at the institution. Once the needs are defined and the community is created, the solutions will follow.
We have enjoyed executing this project and working with a team of wonderful trainees from all around the world at WashU. We are grateful to Intealth and the U.S. Department of State for this grant opportunity. We are currently collaborating with the other two wonderful grant awardee teams from the Cincinnati Children’s Hospital and the University of Texas Rio Grande Valley School of Medicine. This unique experience taught us a lot about advocacy, teamwork, and improving physician wellness. We are confident that we will use this experience and knowledge to create more physician wellness opportunities wherever we go, and we hope that our experience will inspire others to take action to improve IMG well-being.
In 2023, Intealth launched the inaugural Grant Opportunity for J-1 Physicians: Well-being Projects Supporting Foreign National Physicians. This well-being initiative, led by Intealth and funded in part by the U.S. Department of State, awarded grants of up to $5,000 to three J-1 physician-led projects supporting the well-being of foreign national physicians at their host institutions. This entry is about one of those projects. For more information on this initiative and details about this project, click here.