# Pathways to Clinical Training Opportunities for International Medical Students and IMGs: The California Experience

## TL;DR

The paper explores ways to create fair clinical training opportunities in California for international medical students and graduates from low- or middle-income countries.

## Contribution

It identifies institutional barriers and enablers, and proposes practical strategies to expand equitable clinical training exchanges.

## Key findings

- Key challenges include liability concerns, limited program capacity, and restrictive visa policies.
- Enablers include innovative funding and the use of Medical Board of California’s Special Permits for hands-on training.
- The study suggests a new visa category to support bidirectional clinical training exchanges.

## Abstract

Many global health initiatives involve partnerships between US academic institutions and low- or middle-income country (LMIC) institutions, but substantial inequities exist in short-term clinical education exchange opportunities for LMIC institutions. US medical students and physicians frequently participate in clinical experiences abroad; however, equivalent opportunities in the US for LMIC medical students and international medical graduates (IMGs) are limited, inconsistent across states, and, for IMGs, typically restricted to observerships.

The authors aimed to identify pathways that facilitate clinical training and educational exchanges between California academic medical centers (CA AMCs) and LMIC institutions, and to explore the barriers and enablers for international medical students and IMGs to engage in clinical training in California. The authors conducted 16 semi-structured interviews with global health education stakeholders at CA AMCs and performed a desk review using PubMed, gray literature, and resources from the US State Department, Medical Board of California, and CA AMC websites to ensure the accuracy of information presented.

Key institutional challenges include liability concerns, limited program capacity, and funding constraints; additional barriers specific to IMGs include restrictive visa policies and medical board regulations. Enablers included innovative funding mechanisms, existing administrative infrastructure, and, for IMGs, familiarity with visa processes, and the use of the Medical Board of California’s Special Permits to enable participation in hands-on patient care.

Several potential approaches emerged to reduce barriers and support hosting international medical students and IMGs in hands-on clinical roles at CA AMCs. While these findings offer practical strategies for expanding such exchanges within California, they also highlight the need for broader policy changes, including advocacy for a new visa category dedicated to short-term clinical training exchanges.

This article advances the discourse on decolonizing global health by identifying mechanisms to allow equitable, bidirectional clinical training opportunities.