Table 1
Ten recommendations for hosting IMGs within US institutions.
| Recommendation 1: Gain Institutional Support by Demonstrating the Added Value of Hosting |
| Recommendation 2: Develop a Programmatic Checklist and Administrative Timeline |
| Recommendation 3: Become Familiar with Visa Types, Restrictions, and Allowable Roles for Visitors |
| Recommendation 4: Understand State Medical Licensing Restrictions for IMGs |
| Recommendation 5: Understand Tax Liabilities for Host Programs and Visiting Observers |
| Recommendation 6: Securing Programmatic Funding and Creating a Budget |
| Recommendation 7: Understand Institutional Requirements for Visitors |
| Recommendation 8: Ensure Adequate Program Administrative Support |
| Recommendation 9: Take Steps to Protect Visiting Observers in Emergencies |
| Recommendation 10: Adequately Consider Cultural and System Differences |
Table 2
Benefits of hosting foreign colleagues.
| No Travel Required: Creates a local Global Health opportunity |
| Satisfaction: Facilitates recruitment, retention, and satisfaction of trainees and faculty |
| Well‑being: Creates global community and philanthropic opportunities |
| Professional Development: Expands global networks and global engagement |
| Scholarship: Promotions and advancement through international collaborations |
| Global Preeminence: Global recognition for all partner institutions |
| Culturally Informed Care: Understanding diverse patient populations |
| Systems‑Based Practice: Greater understanding of various healthcare systems, complexities, and unique solutions |
| Equity: Stimulates innovation in addressing health barriers and constraints |
| Patient Advocacy: Globalizes the reach of patient advocacy |
| Practice‑Based Improvements: Facilitate adaptations to resource constraints and supply chain disruptions |
| Environmental Health: Advances “green” solutions, smart resource utilization, decreased environmental impact |
| International Health and Diplomacy: Heightens awareness of complex international health issues; greater understanding of stakeholders and governance |
Table 3
Example checklist for hosting IMG visiting observers (VOs).
| Ongoing Advocacy | |
| □ | Advocate for bidirectional programs as mission, vision, values; Highlight value of academic and workforce recruitment; Framing relevant to local, state, national, and international initiatives and policies, such as World Health Organization Sustainable Development Goals |
| □ | Foster global engagement with colleagues from other countries and diverse practice settings at educational events, professional networking events, and conferences |
| □ | Join working groups to advocate for standardizing access for hands‑on clinical education across countries and (US) states (e.g., Consortium of Universities for Global Health, professional society committees on legislative affairs) |
| 9–12 months in advance | |
| □ | Secure commitment from stakeholders including international offices, department chair, division chief, fellow faculty members |
| □ | Determine length of stay for VOs to create the budget and confirm funding |
| □ | Confirm buy‑in from staff management and assigned administrative support |
| □ | Verify VO approval process at the institution/hospital and any other clinical locations across the health system; Identify managers in each clinical unit for approval as necessary |
| 6–9 months in advance | |
| □ | Establish selection criteria and application process for VOs; Create an application form, selection committee, and scoring rubric; Publicize the opportunity across appropriate academic networks and partners or open to public; Promote on websites and social media |
| □ | Send selection emails to VOs with program details, initial requirements for visa application, and steps involved in observing within the program |
| □ | Confirm payment method to be used for program‑related transactions; Consider an institutional credit card, or purchase orders; Reimbursement may be an acceptable payment method but not recommended, whenever possible |
| 3 months in advance | |
| □ | Confirm visa has been obtained |
| □ | Begin health clearance process with individual visitors |
| □ | Assess VOs’ specific clinical and academic interests and coordinate specialty hosts |
| □ | Buy plane tickets and reserve lodging (local housing, Airbnb, dormitories, or hotel) |
| □ | Create or update an orientation manual |
| □ | National conference registration (optional, but recommended) |
| 4–6 weeks in advance | |
| □ | Create hosting and social schedule (including phone numbers and email list) |
| □ | Research and buy health insurance policy, if needed |
| □ | Plan a welcome dinner (especially for those staying for more than a couple of weeks) |
| □ | Create evaluation forms |
| □ | Create combined schedule of lectures (didactics, grand rounds, university lectures, etc.); can utilize shared calendar (e.g., Google Calendar or Outlook) |
| 1 week in advance of arrival | |
| □ | Health clearance and visiting observer paperwork signed off for each location and approved; ready for security badge |
| □ | Food plan is ready (cafeteria dining plans or vouchers, grocery shopping or delivery, pre‑paid credit cards) |
| □ | Cell phone plan or loaner phones ready (institutional plan vs. external) |
| □ | Ground transportation plan is ready (host pick‑up, rideshare, other airport transportation) |
| □ | Online collaborative workspace set up for sharing documents and collecting feedback (e.g., Google Drive) |
| First day/week | |
| □ | Receive badge |
| □ | Hospital orientation ‑ dress codes, scrubs, locker room, hosting schedule and protocol; review workplace cultural differences |
| □ | Campus and neighborhood tour (public transportation, grocery shopping, cell phone activation, laundry) |
| □ | Set up rideshare account (i.e., Uber or Lyft, some institutions may have business Uber accounts) |
| □ | Outline expectations for VO’s (e.g., write a daily or weekly report) |
| □ | Host welcome dinner or event |
| During stay | |
| □ | Assign team member for daily or frequent check‑ins, review weekly reports |
| □ | Set up informational meetings with institutional leaders and colleagues with similar interests and goals |
| □ | Invite to present at and attend departmental and organizational lectures and events |
| □ | Invite for social activities in the evenings and on the weekends (site seeing, sports games, happy hours, dinners, worship services) |
| □ | Begin writing impact report for reporting back to leadership |
| After departure | |
| □ | Work with finance to process financial transactions related to visit (documentation related to program should be collected before and during stay) |
| □ | Send evaluation forms and surveys on impact and how to improve program |
| □ | Follow up on ideas for collaboration (research, conference submission, QI project, future virtual and in‑person exchange of knowledge) |
| □ | Inspire other internal and external programs to host foreign medical graduates for short‑term clinical education through storytelling and presenting data |
| □ | Send notes of gratitude and impact report to leadership and administrators supporting the program |
Table 4
Preparation for visa interviews.
Table 5
Example budget‑visiting observer (B‑Visa), Palo Alto, California.
| EXPENSES (1 VISITOR/ 1 MONTH) | NOTES | COST (BEST ESTIMATES) |
|---|---|---|
| Flights | Economy class | $2000 |
| Lodging for 1 month | Shared if more than 1 person | $3000 |
| Visa fee reimbursement | If approved | $185 |
| Conference registration | Low‑income country discounts available | $215 |
| Ground transportation | Car hiring services or Taxis | $400 |
| Travel/Health insurance | Emergency/Evacuation only | $300 |
| Health clearance | Vaccines or Titers | $300 |
| Meals | Consider as business meals | $2250 |
| Phone + service | Pre‑paid with loaner phone | $200 |
| Total | $8850 |