Many of the IEHPs we interviewed sought out opportunities to gain cultural competency and identified some important exemplars. These ranged from the informal to the formal:

Buddy up with somebody and just sort of shadow that, have a shadow person with you and just watch and as they feel more comfortable they are allowed to do things as well. Just like I had done with my student, she basically watch me for a period of time and now she is doing things hands on and by the time she gets the job, on the job then she should up to speed or at least almost up to speed in terms of.... and less likely to fail in terms of integrating herself and be able to cope with the job [Manitoba ITM #3, practicing].

Why don't you solve the problem properly like allow these doctors who have passed the LMCC to work under somebody for some months before even you can apply. ..And then we will have first hand Canadian experience. ...I passed LMCC. Now let me, allow me to examine the patient, work under the supervision of a doctor, you know, I reach my plan and then the doctor can countersign my management if he is satisfied. [Manitoba IMG #2, practicing]

More formally, the cultural components of bridging programs like CARE were identified by some of our participants. Others, however, noted that cultural competency was not something that could be taught in a course, but rather was only gained by experience, which ideally would be gained on the job:

In my opinion people who have been able to fulfill this level of education are smart enough to learn these items, to learn these subjects, in a very short time in the real life context. ... but nobody says we are not letting you in because you don't know how to deal with cultural issues in Canada. ... I believe culture is not something to be trained in a course. You know, you need to get the system to bring these people in and this is something that Canada needs to think about. ...But I don't believe you can teach culture in professional courses [Ontario IMG, in progress].

A combined formal and informal approach would enable both quick uptake, to hit the ground running, so to speak, and an opportunity to more fully flesh out 'crash' courses with some practical experiences.