Egyptian doctor Dooa Elrouby (left) was mentored by another international fellowship graduate, Dr. Umberin Najeeb (right), who began her career in Pakistan. (Photograph by Doug Nicholson)
Doctors trained abroad face hurdles in getting certified to practise in Canada. But fellowship programs help smooth the transition.
When Dr. Dooa Elrouby and her husband decided to move to Canada from Egypt, they knew there would be challenges.
A physician and assistant lecturer at Cairo University, Dr. Elrouby’s credentials wouldn’t be accepted in Canada. But they hoped for the best for themselves and their young son, moving to Mississauga, Ont., in 2010.
Dr. Elrouby wrote the necessary medical exams. Then, through online searching, she found the University of Toronto Hospitalist Fellowship Program at Sunnybrook, applied and was accepted.
A fellowship is an educational licence, with which fellows work under supervision, typically to gain a specialty. In order for physicians to practise as independent practitioners, they must also do a residency, which requires them to work under supervision in a hospital setting.
“When you start to work here, the system is new,” she recalls. “It’s very different than working in Egypt.”
A few months into her fellowship, Dr. Elrouby began chatting with another doctor on rounds. Dr. Umberin Najeeb, an internal medicine specialist, born and trained in Pakistan, had moved to Canada several years before. “It was really helpful to talk to someone who had been on a similar journey,” Dr. Elrouby says. “While Dr. Najeeb and I aren’t from the same country, we could discuss the differences we found in the Canadian health-care system to those in the country where we trained.”
If a physician was trained in Canada, Dr. Elrouby added, he or she may not be able to understand the differences or the cultural gaps that exist.
Dr. Najeeb is well aware of the differences. She moved to Canada in 2004. After arriving in Canada with her husband and two young children, like Dr. Elrouby she also took a series of exams and tried to find a residency in order to be recertified.
Luckily, Dr. Najeeb learned about fellowships from an international medical graduate (IMG) at her mosque. So she searched the programs at the University of Toronto and applied to each one with a medicine focus. She was selected for the hospitalist program at Sunnybrook six years before Dr. Elrouby.
“I think that was a good thing for me because I learned the Canadian health-care system,” Dr. Najeeb says. She quickly realized there were key differences at Sunnybrook, including the doctor-patient relationship.
“Doctors in the Middle East and Asia, for example, have a very paternalistic role. They just tell patients what to do. Here, we don’t tell patients what to do,” she says. “We discuss options with them. And the patient has autonomy in making decisions.”
After spending 10 months as a fellow, Dr. Najeeb was accepted into a two-year condensed internal medicine residency (the condensed option is no longer available in Ontario) and was later hired at the University of Toronto and at Sunnybrook. She now works – often beyond her role as a staff internist – to help internationally educated professionals (IEPs) transition into the Canadian health-care system.
“I have personal experience. It’s my major scholarly interest: What are the challenges these professionals face, and how can we support them? That’s the focus of my education research,” says Dr. Najeeb.
As a member of Sunnybrook’s Internationally Educated Professionals Committee, she has designed a series of workshops aimed at helping staff at Sunnybrook who were educated outside Canada transition into the workplace. The workshops focus on communication and providing feedback. “These are what we’d call ‘soft skills,’” she says. “You learn and use these skills at work. These skills aren’t formally taught.”
As a fellow at Sunnybrook, Dr. Elrouby attended Dr. Najeeb’s workshops. “It was confusing when I started working in Canada, to not know what people meant in some situations,” Dr. Elrouby says. “This wasn’t due to a language difference, but because the styles of communicating are different. In Egypt, people in the workplace are much more direct.”
[mks_pullquote align=”right” width=”300″ size=”24″ bg_color=”#2f56a5″ txt_color=”#ffffff”]“Supporting internationally trained professionals in turn supports Sunnybrook’s patients.”
– Christopher Townsend, Manager, Organizational Development and Leadership[/mks_pullquote]These differences are discussed in the workshops, and attendees are given new strategies for effectively communicating with colleagues, patients and their families. They also learn how to give feedback, “sandwiching” a negative comment in between two positive ones. So far, 140 professionals have attended, including IMG fellows, nurses, lab technicians, pharmacists and researchers.
The workshops and the companion course for managers on how best to support IEPs are part of the Sunnybrook Leadership Institute, which offers courses for all employees.
“The workshops are about cultural fluency,” says Christopher Townsend, manager, Sunnybrook Organizational Development and Leadership, which runs the leadership program and other staff development programs. “A person is coming into an environment where they have the clinical skills, but there are other differences in the workplace – informal things that are part of the culture. And you can’t read those in a book.”
“Supporting IEPs in turn supports Sunnybrook’s patients,” he says. “People bring different perspectives and different knowledge. Our patients represent countries all over the world, and our staff can relate. It reflects the cultural fabric that makes up Toronto.”
Dr. Elrouby is now halfway through a residency at another hospital. She is a mentor to a first-year resident via the University of Toronto IMG Mentorship Program, developed and run by Dr. Najeeb. “The mentorship program helps people at various points on their trajectory – we help them find their way,” Dr. Elrouby says.
“IMGs can include Canadian students,” Dr. Najeeb says. “Many Canadian students go abroad to medical school. The cultural shock for them on return to Canada can be quite similar. If someone is coming from Ireland, let’s say, the medical students there just shadow. They don’t have the same level of responsibility as they do here. They are shocked by the responsibilities of our thirdyear medical students.”
While designing and teaching workshops, connecting applicants with the right programs and taking on observers adds to Dr. Najeeb’s workload, she’s happy to help international graduates get on the right path in Canada.
“Someone needs to be there to at least give them the opportunity to know how the Canadian health-care system works,” she says. “I get a personal satisfaction out of it. I’m helping someone and playing a small part in their success.”
