The implications of being an international medical graduate (IMG) in Canadian society : a qualitative study of foreign-trained physicians' resettlement, sense of identity and health status

This qualitative research study used grounded theory methodology to explore the settlement experiences and changes in professional identity, self esteem and health status of foreign-trained physicians (FTPs) who resettled in Canada and were not able to practice their profession. Seventeen foreign-trained physicians completed a pre-survey and rated their health status, quality of life, self esteem and stress before and after coming to Canada. They also rated changes in their experiences of violence and trauma, inclusion and belonging, and racism and discrimination. Eight FTPs from the survey sample were interviewed in semi-structured qualitative interviews to explore their experiences with the loss of their professional medical identities and attempts to regain them during resettlement. This study found that without their medical license and identity, this group of FTPs could not fully restore their professional, social, and economic status and this affected their self esteem and health status. The core theme of the loss of professional identity and attempts to regain it while being underemployed were connected with the multifaceted challenges of resettlement which created experiences of lowered selfesteem, and increased stress, anxiety and depression. They identified the re-licensing process (cost, time, energy, few residency positions, and low success rate) as the major barrier to a full and successful settlement and re-establishment of their identities. Grounded research was used to develop General Resettlement Process Model and a Physician Re-licensing Model outlining the tasks and steps for the successfiil general resettlement of all newcomers to Canada with additional process steps to be accomplished by foreign-trained physicians. Maslow's Theory of Needs was expanded to include the re-establishment of professional identity for this group to re-establish levels of safety, security, belonging, self-esteem and self-actualization. Foreign-trained physicians had established prior professional medical identities, self-esteem, recognition, social status, purpose and meaning and bring needed human capital and skills to Canada. However, without identifying and addressing the barriers to their full inclusion in Canadian society, the health of this population may deteriorate and the health system of the host country may miss out on their needed contributions.

A Living Educational Theory of Knowledge Translation: Improving Practice, Influencing Learners, and Contributing to the Professional Knowledge Base

This paper captured our joint journey to create a living educational theory of knowledge translation (KT). The failure to translate research knowledge to practice is identified as a significant issue in the nursing profession. Our research story takes a critical view of KT related to the philosophical inconsistency between what is espoused in the knowledge related to the discipline of nursing and what is done in practice. Our inquiry revealed “us” as “living contradictions” as our practice was not aligned with our values. In this study, we specifically explored our unique personal KT process in order to understand the many challenges and barriers to KT we encountered in our professional practice as nurse educators. Our unique collaborative action research approach involved cycles of action, reflection, and revision which used our values as standards of judgment in an effort to practice authentically. Our data analysis revealed key elements of collaborative reflective dialogue that evoke multiple ways of knowing, inspire authenticity, and improve learning as the basis of improving practice related to KT. We validated our findings through personal and social validation procedures. Our contribution to a culture of inquiry allowed for co-construction of knowledge to reframe our understanding of KT as a holistic, active process which reflects the essence of who we are and what we do.