International medical graduates and quality of care

British medicine and the National Health Service, probably like their counterparts in the USA, have had a complex and at times fraught relationship with international graduates.1 Within the UK, the pattern of simultaneous dependency and denigration of international medical graduates has a long history.2 Such graduates have traditionally worked in areas that were unpopular with British graduates—primary care in inner city areas, ex-mining communities, and specialties such as psychiatry and geriatrics.3 The denigration has always centred around duplicitous undertones of poor quality of care provided by the graduates based on anecdote rather than any research evidence. The tendency has always been to consider international graduates, especially if they have come from non-Western countries, to be less qualified than local graduates and by implication less likely to provide good quality care.4

It is therefore refreshing that Tsugawa and colleagues …