. 2020 Apr 29;21(4):109–118. doi: 10.1002/jgf2.315

Table 3.

Training culture‐associated challenges during US residency

Challenge	Representative quotes
Assertiveness	You must speak up and say that you learned something, otherwise they will say you're not doing anything, or you're not thinking. So you actually have to tell them what you are thinking and what you have done to let them trust you. (15) In the US you have to speak up. “I want this, I don't want this.” Otherwise you may receive extra work. I didn't know that… For the first one or two years, I think the duration and number of call assignments, etc was unfair. (19)
Expressing one's opinion	In Japan, we are not really trained to discuss. [In the US] I had to express my opinion [which was challenging.] … Asians, not Indians, but other [East] Asian IMGs, I think have difficulty. Just like me, they can't speak up. They can never be dominant in the group. (32) During attending teaching rounds… even if I know the topic, if I cannot communicate my knowledge well, I will be left out of the discussion and [my reputation will be affected.] (5)
Competition among residents	Most of the residents were from South Asia and Eastern Europe. It was a very competitive atmosphere… There was a lot of political jockeying. (26)

Challenge

Representative quotes

Assertiveness

You must speak up and say that you learned something, otherwise they will say you're not doing anything, or you're not thinking. So you actually have to tell them what you are thinking and what you have done to let them trust you. (15)

In the US you have to speak up. “I want this, I don't want this.” Otherwise you may receive extra work. I didn't know that… For the first one or two years, I think the duration and number of call assignments, etc was unfair. (19)

Expressing one's opinion

In Japan, we are not really trained to discuss. [In the US] I had to express my opinion [which was challenging.] … Asians, not Indians, but other [East] Asian IMGs, I think have difficulty. Just like me, they can't speak up. They can never be dominant in the group. (32)

During attending teaching rounds… even if I know the topic, if I cannot communicate my knowledge well, I will be left out of the discussion and [my reputation will be affected.] (5)

Competition among residents

Most of the residents were from South Asia and Eastern Europe. It was a very competitive atmosphere… There was a lot of political jockeying. (26)