The IMG Experience

Navigating the Challenges

Envision yourself stepping into the unknown, an immersive journey to a foreign land, where the unfamiliarity of a completely new healthcare landscape greets you. Now, add the complexity of communicating in a language that isn’t your native language while attempting to establish your professional foothold in an unfamiliar hospital. Can you feel the weight of the challenge?

This scene captures the ongoing challenges faced by our International Medical Graduate (IMG) colleagues—a story that stretches from the Windrush generation to today. IMGs are the backbone of the NHS, making up 19% of the workforce. Yet despite their crucial contribution, the system still faces around 120,000 vacancies. The NHS relies on them now more than ever.

I’m Imela. During my placement in the Paediatric A&E at Queen’s Medical Centre, Nottingham, I explored the challenges some of our International Medical Graduate (IMG) colleagues faced. I spoke with doctors across all levels—from SHOs to consultants—to better understand their experiences. The aim? To help supervisors and teams gain real insight into the unique hurdles IMGs face and to highlight practical ways we can support them.
In this post, we’ll explore these themes through quotes from colleagues, helpful resources, and infographics:

• Challenges that IMG colleagues face in the workplace
• Challenges outside of the workplace
• What helped IMG colleagues settle
• Recommendations for supervisors
• Cultural Humility
• Time for Action – Soft Landing

The inspiration behind this article is my mother, a nurse and midwife who immigrated to the UK from Nigeria. Witnessing her journey, I observed the challenges of settling down in a new country with her family, being the breadwinner, and navigating the complexities of a new hospital system. Instances of racism within the healthcare system added an emotional toll to her journey, as she worked to overcome stereotypes and biases. Integrating into a new hospital system demanded an intricate dance of understanding protocols, overcoming language barriers, and adjusting to the hierarchical structure of the NHS.

In an era with limited support systems for IMGs, her journey exemplifies resilience and determination in the face of multifaceted challenges.

While this article is about supporting IMG colleagues, much of it is just as applicable to British Medical Graduates, especially those who are moving to a new area.

So, now we are acquainted, let’s start with….

Challenges in the workplace

Insufficient Induction and Solo Start

The Challenge: There is often limited or no formal induction, which results in IMGs starting their roles independently.

The Impact: IMGs feel isolated. Add to this potential gaps in their understanding of the healthcare system’s intricacies, and you can see the problem.

Communication Barriers and Cultural Differences

The Challenge: IMGs must often cope with a multitude of new accents, new computer systems and unfamiliar equipment.

The Impact: This may lead to initial difficulty in communication, a sense of ‘looking different’, and potential increased self-awareness, negatively impacting one’s sense of self and confidence.

Role Allocation and Hierarchy

The Challenge: IMGs need to quickly grasp the roles of different healthcare professionals, often quite different from what they’re used to back home. They must also navigate unfamiliar hierarchies and keep pace with a fast, high-pressure environment.

The Impact: This results in confusion in the role allocation, challenges in adapting to the new environment and exacerbates the potential barriers to seeking help.    

Professional Development

The Challenge: Due to differences in professional requirements, IMGs may face difficulties navigating professional development, including portfolio management and career progression.

The Impact: This may cause frustration, a lack of clarity in expectations, and a potential impact on confidence and performance. In addition to delaying professional advancement, it will widen the attainment gap between IMGs and British graduates.

Clinical Practice Variations

The Challenge: IMGs must adapt to differences in clinical practices and guidelines.

The Impact: As a result, IMGs may struggle with self-doubt and face challenges in confident clinical decision-making.

Loneliness and Isolation

The Challenge: Unlike other trainees, IMGs are often the only new starters on the team and may struggle with feelings of loneliness.

The Impact: This isolation can result in emotional strain and a potential impact on their well-being

Some quotes:

“When I got here, it was the one induction day, and then off you go on to the shop floor. The training for prescribing came up after six months of my starting date. By then I’d learnt everything the hard way”

“I’ve never had to sit down and drink coffee or sit down and chat with my consultant. So that culture also makes it difficult when you come here to just change. I tend to discuss with the registrar more than the consultant because of the culture. So, keep the respect.”

“I had this sister laugh at me because I didn’t know how to unwrap the cannula. It’s weird, it’s not the same. Yeah so, I was in a very fragile position to start off with…So, there were these tiny micro aggressions and when you’re in that fragile mindset, and you’re faced with this, you just feel incompetent, you feel horrible.”

“Back home you’re expected to know…you get put down if you don’t know. Coming here with that mindset…you feel like, okay, maybe you don’t want to ask, but it’s really different here”

“We tend to over-investigate with either bloods or imaging, but this is not the case here…with guidelines…the decision to image or bleed is restricted to whether they need it truly or not. Not doing it because the parents are pushing you. So, these things are quite different”

“I was a bit scared…new people, different culture and you don’t know the kind of discussions to hold with them, the kind of jokes to crack. You know, things that might be accepted in Nigeria might not be here. So I was a bit more withdrawn”

“When I came here I didn’t have much of an idea about portfolios and things like that. I was thinking, I’ve done this a long time and I know how to do this. So, I didn’t even put much effort to write my application (for a training post).”

We’ve looked at challenges in the workplace. Now let’s move on to….

Challenges Outside the Workplace

Together, these challenges can lead to increased stress, affecting both well-being and professional performance.

Accommodations and logistics

The Challenge: Imaging how difficult it might be to secure permanent accommodation.

The Impact: A lack of stable residence, combined with a lack of familiarity with public transport, is a barrier to accessing essential services such as a GP. This, in turn, affects overall well-being and performance.

Financial strain

The Challenge: Imagine arriving in the UK and facing delays just to open a bank account—it’s a small hurdle with big consequences, adding financial stress to an already challenging transition.

The Impact: This delay can make managing everyday expenses and bills even harder—especially while waiting for that all-important first pay cheque.

Social isolation

The Challenge: Many IMGs make the move alone, without the comfort and support of family or friends, adding to the emotional strain of starting over in a new system.

The Impact: This can create a bubble of isolation, as IMGs find themselves without a nearby support network, navigating a major life transition entirely on their own.

Some quotes from our IMG colleagues…

‘I asked for hospital accommodation and they said it wouldn’t be available. I was supposed to start in February, and it wouldn’t be available until December.’

‘I struggled with the bank, I was trying to figure out the GP, the schools and obviously my family came in March/April time so finding a school was a big hassle. Everything settled towards August but by then they were off school for summer.’

‘One of the IMGS got on the wrong bus and she ended up an hour and a half away from her home and it was 1 o’clock in the morning.’

‘My children didn’t know a word of English. So I literally had to draw cards of a toilet, food etc. I said just show it to the teachers. But now they speak four languages. Oh my God, my kids are amazing. Yeah, so I’m really proud of them.’

‘One of our colleagues told me that they were living in an AirBnB that didn’t have a lock on and they had to pile their luggage just to feel safe. It’s really, really heart-breaking stories. And i don’t know how to fix this.’

‘I struggled to get a bank account because I didn’t have an address. I didn’t get registered with the GP either and I have hypothyroidism. So, that was a bit of a struggle. I did actually run out of medication at one stage.’

So, we’ve explored IMG colleagues’ challenges—both in and out of the workplace. But what can we do as colleagues and supervisors to offer meaningful support? Let’s hear directly from our IMG colleagues.

What helped colleagues settle?

‘What really helped me settle down and eased so much of my stress was because I had so many immigrants at my trust and they really taught me how I can cope with everything.’

‘When I was initially struggling with getting used to language or accents, the team said, ‘don’t worry, it’s gonna be a matter of time and you’ll get used to it.’

‘They were open to any questions I would ask. At the beginning I was asking lots of questions. So, not just the doctors, even the nurses were helping me to make me more familiar with the place. And then after working for a couple of months, they were helping me feel confident in myself. Now I’m more confident in seeing more complex patients because I know that now matter how complex they are I always have their support. And so, I’m not on my own.’

‘So I had a problem with my rota to start with because I commute from Leicester not all the shifts would be convenient because of the train. So my supervisor would sit with me and adjust the rota to the train times.’

‘My supervisor kept arranging meetings for us to talk through. How am I feeling? Do I feel confident enough to be on the rota? Do I need more time shadowing? So that was helpful.’

‘Seeing IMGs on the team who are consultants makes you know, okay, if they can do it, you can do it.’

‘The colleagues and the work environment is really healthy. Everyone is really willing to help. I mean I also sensed that a lot were applying for paediatric training. Everyone encouraged me. Everyone was saying we think you’ve got quite good experience. I got a lot of support in my application process from my consultants and also my colleagues who are still junior doctors.’

Working within diverse, multicultural healthcare teams is one key factor in helping International Medical Graduates (IMGs) settle in. These teams can offer vital support and reassurance as IMGs navigate the challenges of a new healthcare system and a new country.

Multicultural teams go far beyond doctors—they include nurses, clinical support workers, radiographers, and many others, helping build a truly supportive environment.

This inclusive dynamic fosters a sense of belonging and understanding, creating a workplace where they can feel part of a community. The diversity of perspectives and experiences enriches the team, helping everyone feel recognised and valued.

While the early days can be tough—adjusting to a new healthcare system, getting used to different accents, and working with unfamiliar equipment—time is a crucial ally. With support and patience, these challenges begin to ease.

Supportive Environment and Regular Communication

Creating a supportive environment within the healthcare setting is crucial for successfully integrating IMGs. A strong, inclusive team acts as a safety net, offering both security and encouragement as IMG colleagues navigate the complexities of a new healthcare system.

Supervisors and colleagues can play a vital role in this process. It starts with acknowledging the unique challenges IMGs face—challenges that often go beyond cultural differences. Demonstrating awareness and empathy lays the foundation for meaningful support.

Actively supporting professional growth is also key. This includes taking time early on to explore individual career goals, identifying areas for development, and setting achievable, realistic timelines. Supervisors should ensure that IMG colleagues understand their training pathways and portfolios and offer guidance or direct them to appropriate resources when needed.

Promoting a culture of collaboration is equally important. Encouraging colleagues to support one another helps foster a team dynamic where everyone feels valued and included.

Regular check-ins can provide a safe space for IMG doctors to discuss professional and personal challenges. These conversations should adopt a holistic approach to well-being—listening attentively, offering support within your remit, and signposting to relevant departments or resources when further help is needed. Familiarising yourself with your trust’s support systems for IMGs—or even piloting your own initiative using these suggestions—can make a meaningful difference.

Comprehensive Induction and Skills Teaching

A comprehensive induction programme acts as a roadmap, helping IMG colleagues navigate the complexities of a new healthcare system. By offering structured guidance on clinical practice, local protocols, and essential admin processes, a good induction can help demystify the system and build confidence from day one. It helps clarify roles, responsibilities, and expectations—reducing uncertainty and setting the stage for success.

Key elements of an effective induction might include:

Understanding the system:
An introduction to how the NHS works, the structure of your trust, and where your department fits in. A clear overview helps build context and confidence early on.

Clinical practice and guidelines:
Training on accessing and applying clinical guidelines, local protocols, and evidence-based resources relevant to day-to-day work.

Role-specific training:
Clear explanations of what’s expected in your role, from shift patterns and responsibilities to documentation standards and clinical duties, and hands-on sessions with systems (e.g., electronic notes, prescribing platforms) can make a big difference.

Professional development and progression:
Information on available training pathways, career progression, and how to access mentoring or supervision for long-term development.

Local policies, legal and ethical practice:
Training on UK medical law, safeguarding, consent, and other legal responsibilities ensures IMGs feel prepared and protected.

Wellbeing and support:
Signposting to available support services, employee assistance programmes, and mental health resources shows that wellbeing is taken seriously.

Meeting your team:
Time to meet colleagues and supervisors—formally and informally—can help IMGs build relationships, feel welcomed, and integrate more easily into the team.

Feedback and communication:
Encouraging open conversations from the start helps IMGs know where to go with questions, concerns, or ideas for improvement.

Life outside of work:
Support with settling in—like help finding accommodation, local amenities, and community groups—can reduce stress and promote well-being during the transition.

Recommendations for Supervisors

Sara Ahmed, a consultant in emergency medicine, embarked on her journey as an International Medical Graduate (IMG) seven years ago. Sara has emerged as a successful medical professional and a compassionate advocate for the well-being and effective support of IMGs. As the department’s IMG Lead, she shared her invaluable insights and advice based on her experiences.

On offering support… ‘Sometimes it’s just offering a listening ear. For them to share what they think and what they feel and how they are. It does take a lot of resilience. We try and tell them it’s going to be hard. But just talk to us.’

On her supervisor experience… ‘Work was a struggle when I started because I had the one day induction then was unleashed on the shop floor. I felt incompetent. My family was not there and the supervisor didn’t really appreciate or empathise with me. There was a lot of brushing it under the carpet, not engaging, not really acknowledging that it’s a struggle. Now, I try to make sure that the IMGs get supervisors who are likely to engage.’ 

On acknowledging struggles… ‘Acknowledging that it’s a struggle is key. Not brushing everything under the carpet.’

On realistic objectives… ‘Set objectives right from the beginning. Actually explain what a SMART objective is. Have realistic and achievable objectives.’

On empathy and understanding… ‘Inquiring about IMGs overall experiences signals a genuine interest in their integration and contributes to a supportive work culture.’ 

Department-Level Support: What’s Already in Place?

Cultural Humility

Throughout this article, we’ve touched on the concept of cultural humility—but what does that actually mean, and how can we apply it in our daily work?

Cultural humility goes beyond simply being aware of cultural differences. It’s about approaching others with curiosity rather than judgement, recognising that we’re all continually learning. It calls for self-reflection, acknowledging power imbalances, and being open to understanding experiences that differ from our own.

This brilliant graphic from the Office of Diversity and Equity, San Mateo County, breaks it down beautifully:

Time for Action – A few words from Nadia Baasher Co-founder of Soft Landing

Soft Landing was born from the passion and empathy of its founders, who were deeply inspired by their own experiences and firsthand understanding of the challenges faced by IMG (International Medical Graduate) paediatricians adapting to the NHS. These obstacles can hinder both personal and professional development, highlighting the need for more proactive measures.

Over the past four years, with a fantastic team of more than 30 members who volunteered their time and efforts to the ethos of Soft-Landing, our support package has offered induction workshops, career progression assistance (including the Portfolio pathway), wellbeing initiatives, and mentoring programs.

At the heart of Soft Landing is the belief in building a community where individuals can share their experiences, exchange advice, embrace vulnerabilities, and establish peer support networks across the UK.

After years of advocating for IMGs and raising awareness about the sociocultural factors affecting their progress at a national level, we believe it’s time for more concrete, institutionalised actions throughout the NHS. We are proud of our contribution to the creation of the national standardised induction document, particularly leading the paediatric section of the guidance. However, we hope to see this document implemented as a mandatory induction program across the UK.

 Although the NHS is one of the most diverse employers, it still faces challenges in fostering true inclusion within its workforce. There is significant room for improvement by revamping equality, diversity, and inclusion (EDI) training to be more meaningful and move away from tokenistic efforts.

On a broader scale, our goal is to help close the gap in differential attainment between IMGs and UK-trained doctors. Strengthening trainer-trainer relationships, which foster mutual understanding and unlock potential, is a key factor in achieving this. We plan to deliver the necessary resources to support this by the end of the year.

Conclusion

Understanding and addressing the challenges faced by IMGs is essential to creating a truly supportive and inclusive healthcare environment. By building on existing initiatives and embracing practical, thoughtful recommendations, departments can ease the transition for IMG colleagues, allowing them to thrive and make their fullest contribution to the NHS.

This isn’t just about closing gaps but building lasting bridges. Bridges that connect different experiences, strengthen teams, and contribute to a more resilient and compassionate healthcare system.

Let’s not underestimate the power of kindness and empathy as we continue championing inclusivity. By supporting the success of our IMG colleagues, we enrich not only our hospitals but the culture of care at the heart of the NHS.

We hope you’ve found this article helpful and thought-provoking. While the focus has been on supporting our IMG colleagues, many of the insights shared here are just as relevant to British Medical Graduates—particularly those relocating from different parts of the UK.

At the end of the day, we are one NHS. Let’s look after each other.

Thank you to our IMG colleagues who contributed to this article Dr Nneoma Ekweozor, Dr Nwora Oli, Dr Dina Elsanharawy and Dr Nada Nasr.