International students' perspectives on medical school and internship: 'Oh international? Are you international?'

BACKGROUND: International students account for a significant proportion of medical graduates Australia-wide, and most opting to remain in Australia for their first year of practice (Internship). Hence, understanding this particular demographic's perspectives is crucial for curriculum and workforce planning. Despite this, very few studies have addressed this demographic, and none have explored the impact of the COVID-19 pandemic on international medical students specifically. AIM: A qualitative design was used to explore the perspectives of final-year international medical students at an Australian medical school as they prepared for transition to internship during the COVID-19 pandemic. METHODS: Participants engaged in a semi-structured interview about the pandemic's personal and professional implications. The data were analysed using inductive thematic analysis. RESULTS: Seven out of 34 final-year international medical students at the University of Adelaide participated. The main themes identified were that isolation was magnified, institutional support was lacking and that uncertainty was challenging. The pandemic did not deter participants from pursuing an Australian internship, as Australia was considered a desirable place for internship compared to their home countries. CONCLUSIONS: While the COVID-19 pandemic exacerbated the situation, many of the challenges identified by international students already existed. Issues such as social isolation, racial discrimination, financial hardship and lack of institutional support have been prevalent for decades. Insights from this study reveal a need to improve the medical school experience. Australian Universities have a responsibility to ensure fair treatment of international students by training faculty, implementing support programmes and ensuring an inclusive and culturally safe learning environment.

Data from four consecutive cohorts of students in Australia (2019-2022) show the impact of the COVID-19 pandemic on domestic and international university students' mental health.

INTRODUCTION: COVID-19 and related travel and social restrictions caused significant stress for university students in Australia and globally. Learning quickly moved online and many students (particularly international students) were separated from social and economic support. This study examined the impact of the pandemic from pre-pandemic (2019) to the COVID-19 Omicron wave (2022) on domestic and international students' mental health. METHODS: Participants were 1540 students (72% females, 28% international) in four first-year cohorts (2019, 2020, 2021, 2022). We screened for mental health concerns (% positive) and symptom scores for depression, anxiety and somatic distress using the PsyCheck, and general wellbeing using the Warwick-Edinburgh Mental Well-being scale. RESULTS: From pre-COVID (2019) to the first wave of COVID-19 (2020), the proportion of students screening positive for mental health problems rose in both domestic students (66-76%) and international students (46-67%). Depression symptoms and wellbeing were worse in 2020 than in 2019, 2021 and 2022. Anxiety symptoms increased from 2019 to 2020 and continued to rise in 2021 and 2022. Somatic symptoms did not show an effect of cohort. Contrary to expectations, domestic students reported higher distress and lower wellbeing than international students across cohorts. CONCLUSION: The pandemic was associated with a marked increase in psychological distress in first-year university students, not all of which settled with the easing of restrictions. Post-pandemic recovery in the Australian university sector must include university-wide access to mental health information and support for incoming students.

Media and Interpersonal Channels Uses and Preferences Among International Students in the U.S. During the COVID-19 Pandemic.

This chapter provides an overview of how international students in the United States used media and interpersonal channels to communicate with family, friends, and each other during the COVID-19 pandemic. The chapter starts by discussing the challenges of international students during the health pandemic. It then provides a review of the role of media during a crisis. Factors influencing media use during the COVID-19 crisis include culture, personality, and time spent in a foreign country. Finally, the chapter ends by providing suggestions for how universities can better equip their international offices to deal with international students during challenging times such as the COVID-19 pandemic.

Medical Education Challenges in the Era of Internationalization and Digitization.

Prior to the coronavirus disease 2019 (COVID-19) pandemic, Central Asia and Eastern Europe saw a significant rise in international medical student enrollment, driven by competitive tuition fees, prestigious institutions, and culturally diverse environments. The pandemic forced a rapid shift to online learning, disrupting student mobility and compromising clinical training quality. Online education for international medical students during the COVID-19 pandemic has proven beneficial, though low- and middle-income countries struggled with access to information infrastructure and resources. While 64% of students preferred online learning, challenges like limited internet access and lack of in-person interaction persisted, making a blended approach of online and traditional methods most effective. Despite a rebound in post-pandemic enrollment, persistent challenges such as linguistic obstacles, psychological stress, and cultural adaptation issues remain. Active research engagement during undergraduate studies is essential for skill development. Integrating research into education curricula and fostering motivation are crucial for enhancing academic outcomes. Critical thinking and cultural competence are vital, necessitating explicit instruction and collaborative learning strategies. Addressing language barriers through comprehensive support systems for both instructors and students is imperative. Tailored strategies and robust institutional support are essential to enhancing the educational experiences and success of international medical students.

Sociocultural adjustment and social support as predictors for international medical sciences students' anxiety during COVID-19.

BACKGROUND: The prevalence of anxiety is high among international medical sciences students and it increased even more during the COVID-19 pandemic due to different restrictions and social isolation. Successful sociocultural adjustment and social support could be important factors in overcoming those challenges, however, there is a lack of studies which would investigate the role of those factors among inter- national medical students. This study aimed to assess the role of sociocultural adjustment and social support as predictors for international medical students' anxiety during COVID-19. METHODS: Two measurements were conducted via self-reported questionnaires which consisted of three scales - SCAS, MSPSS and GAD-7. In total, 82 international medical students participated in both measurements in this longitudinal study. RESULTS: The findings indicated that 37% of international students had symptoms of moderate or severe anxiety during their first year of studies at university. In the second year, during the COVID-19 pandemic and an official lockdown, 35% of international students had symptoms of moderate or severe anxiety. In addition, this study showed that gender and sociocultural adjustment did not play a role as predictors of students' anxiety during the second year of studies. However, this study revealed that social support provided by family during the first year of studies, as well as having friends or family members who had been ill with COVID-19 predicted higher levels of anxiety at second measurement, while sociocultural adjustment was an even stronger predictor of anxiety in the second year of studies of international medical students. CONCLUSIONS: This knowledge can help to better understand how international medical students felt during the COVID-19 pandemic and what role the above- mentioned factors played in the students' anxiety. As the anxiety level is quite high among international medical students, universities and mental health service providers should take it into consideration and help them to overcome those challenges.

Factors associated with acculturative stress among international medical students in an Egyptian university.

BACKGROUND: International students frequently face difficulties that are specific to the typical college experience, in addition to facing other factors of acculturative stress, including cultural differences, language barriers, and comfortability in accommodation. AIM: The study aims to measure the prevalence of acculturative stress among first-year international students enrolled at Faculty of Medicine in an Egyptian University and aims to reveal the factors that are associated with acculturative stress in these students. METHODOLOGY: A cross-sectional study was conducted on 422 international students in the academic year 2021-2022, using the Acculturative Stress Scale for International Students (ASSIS). The factors associated with acculturative stress were examined using the following criteria: comfort in accommodation, student adjustment to college, language proficiency, and academic pressure. RESULTS: This study showed that 28.7% of the international students were "above the warning sign" of acculturative stress (above 109). The major stressors of acculturative stress among international students were the non-specific concerns, homesickness, and perceived discrimination, while the least reported stressors were fear and guilt. International students who scored in the "above the warning sign" in the (ASSIS) were mostly females (35.3%) and non-Arab students (37.8%). Having a friend or a family member living in Egypt significantly reduced the level of acculturative stress. Moreover, the ASSIS total score showed a negative correlation with the scores for overall language proficiency, comfort in accommodation, academic adjustment, and student adjustment to college. CONCLUSION: Acculturative stress among the studied groups is influenced by several factors, including nationality, English and Arabic language proficiency, academic adjustment, and comfort of living. That being said, the most significant stressor is the country of origin, which is defined in terms of nationality or language proficiency. Consequently, resources that ensure the sustainability and growth of international students throughout their educational process must be made available to a multicultural environment in order to support and retain those students. CLINICAL TRIAL NUMBER: Not applicable.

Challenges facing international students at Iranian universities: a cross-sectional survey.

BACKGROUND: This study examines the challenges faced by international students at Tehran University of Medical Sciences (TUMS) and provides insights into their experiences and needs. METHODOLOGY: A self-developed structured questionnaire was administered to international students who completed their first year at TUMS. Data were collected from 165 participants (76% response rate) and analyzed using SPSS 22.0. RESULTS: The study reveals that international students encounter various challenges, including difficulties accessing information, language barriers, ineffective communication, administrative inefficiencies, cultural issues, financial constraints, and limited scholarship opportunities. Analysis of students' characteristics indicates that the length of study at TUMS is significantly associated with the challenges experienced. The findings highlight the importance of enhancing support services and resources for international students, such as language classes, academic counseling, scholarships, and cultural exchange programs. CONCLUSION: Addressing these challenges can foster a more supportive environment, contributing to the academic success and well-being of international students at TUMS and similar universities.

Based case based learning and flipped classroom as a means to improve international students' active learning and critical thinking ability.

BACKGROUND: International student education has become an important part of higher education and an important symbol to measure the level of higher education. To change the traditional teaching model, here we introduced a combination of Case-Based Learning (CBL)and Flipped Classroom (FC) into the pathophysiology course for international students. This study aimed to explore whether the active learning ability and critical thinking ability of international students can be improved, based on this new teaching model, improving the innovation ability of teachers' team and students' attitude to the reform. METHODS: The two chapters of Cardiac Insufficiency and Apoptosis in Pathophysiology are designed as a CBL + FC teaching method. Distribute the Self-assessment Scale on Active Learning and Critical Thinking (SSACT) and satisfaction questionnaire to international students to evaluate teaching reform based on CBL + FC. RESULTS: Compared with the traditional classroom, the online flipped classroom based on CBL has significantly improved the learning enthusiasm, as these students are required to independently complete literature review, actively participate in classroom teaching, learn to use multiple learning strategies, and collaborate with other students to complete PowerPoint (PPT)production. At the same time, the students' ability to raise problems and solve problems has been greatly improved by analyzing clinical cases; By consulting the literature, the theoretical knowledge learned can be better applied to clinical analysis. The results of the satisfaction survey also show that international students are more likely to accept the flipped classroom teaching mode. CONCLUSIONS: This teaching mode will stimulate the learning motivation of international students, enhance teaching attraction and increase teaching interaction; At the same time, the CBL + FC teaching method can strengthen the evaluation of international students' in and out of class and online learning, enhance students' active learning ability and critical thinking ability, promote the development of personalized learning, and integrate with international medical education.

Culture of patient care among international nursing students: a focused ethnographic study.

BACKGROUND: This study was conducted to describe and explain the culture of patient care in international nursing students. METHODS: This qualitative study was conducted using focused ethnography. Participants (n = 21) were purposefully selected from non-Iranian international students and their nursing instructors. Data collection included semi-structured interviews, and field-note taking. Data were analyzed with the Roper and Shapira inductive approach of ethnographic content analysis. RESULTS: The cultural model of the study included the acquisition of cultural competence through acceptance of differences and finding commonalities. Subcategories were: "avoiding cultural bias", "trying to be on the path of adaptation", "appealing to the support and companionship of colleagues", "coping with culture shock", "acculturation", "getting help from cultural intelligence", "cultural empathy", and "language and communication enhancement". CONCLUSION: Cultural competence is teachable. The pattern of formation is through accepting differences and searching for commonalities. Suggestions for promoting the culture of care among international students include effective use of peer groups and teaching different national ethnicities and cultures.

International tertiary education students experienced difficulties in dietary transitions in Australia: A qualitative study.

ISSUE ADDRESSED: More attention to the diet and nutritional status of international students in Australian universities is indicated. This qualitative research aimed to provide an in-depth understanding of dietary changes among international students after they arrived in Australia. METHODS: Semi-structured interviews were conducted with international students from China and India who were studying at a large urban Australian university. An approach of interpretative phenomenological analysis was employed for coding and data analysis. RESULTS: A total of 14 interviews were included. International students were able to consume more international foods, dairy products and animal proteins in Australia as a result of increased exposure to a larger variety of these foods compared with their home countries. However, they experienced some difficulties in eating vegetables and authentic traditional foods due to limited availability and higher prices in Australia. It was challenging for these students to live independently and cook for themselves for the first time and with a limited food budget and time, but many students improved their cooking skills over time. Less frequent main meals with more snacking sessions were reported. Weight fluctuations were commonly experienced and craving for traditional foods no longer accessible may negatively impact mental health. CONCLUSIONS: International students adapted to the Australian food environment but believed the food choices available did not meet their food preferences or perhaps nutritional requirements. SO WHAT: Some intervention from universities and/or government may be needed to ease the barriers to consumption of affordable and desirable meals in a time-saving manner for international students.

Investigating the impact of COVID-19 on international student wellbeing in Australia.

ISSUE ADDRESSED: International students are at a heightened risk of experiencing negative health and wellbeing outcomes, which was further exacerbated during the COVID-19 lockdowns. This research sought to explore the impact of the COVID-19 pandemic on the health and wellbeing of international students in Australia. METHODS: Thirty-one international students participated in qualitative in-depth interviews between March and April 2022 to explore their experiences of health and wellbeing during 2020-2021 while they lived and studied in Australia. Interviews were coded and analysed thematically using NVivo software. RESULTS: Findings highlight the impact of the pandemic on international students' mental, social and financial wellbeing, including worry about loved ones, social isolation, financial and employment insecurity and challenges related to online learning. The pandemic exacerbated and brought more attention to existing issues and placed students in unequal positions in relation to domestic students and each other. CONCLUSIONS: The COVID-19 pandemic has increased students' vulnerability to poor mental health and to a range of social and financial issues. SO WHAT?: The findings of this study highlight the need for support strategies to improve international students' mental health and social wellbeing outcomes in Australia.

Placement educators' perspectives of international social work students' sociopragmatic communication skills.

International students who speak English as an additional language report experiencing communication issues while completing their studies and work-integrated learning placements in a range of Anglophone countries, including Canada, the United Kingdom, the United States of America and Australia. To address this issue, accreditation and registration bodies for a number of health professions, such as social work and nursing, have advocated for increasing the test score requirements for university English language entry. However, from a sociolinguistic perspective, decisions concerning ways to address communication challenges need to take into account the unique communication skills required for functioning in specific workplace settings. It is therefore essential to identify the types of communication issues occurring during work-integrated learning opportunities (e.g. placement) and to then assess whether these should be addressed by raising general English proficiency or providing structured learning opportunities for profession-specific communication development within the course content. The present study uses sociolinguistic theory to examine placement educators' perspectives on international students' communication issues using the context of social work placement. It draws on the thematic analysis of interviews with 15 placement educators in Australia. One major finding is that international students' general proficiency or ability to use specific linguistic tools (pragmalinguistic competence) is not a key area of concern for educators. The main challenge seems to involve the students' understanding of sociocultural norms underlying workplace communication (sociopragmatic competence). This finding suggests that, rather than increasing English language entry requirements, universities need to provide international students opportunities to develop their sociopragmatic competence both before and during placement. The paper concludes with a set of recommendations aimed at supporting international students who speak English as an additional language to develop their workplace communication during their studies.

Association between psychological distress and mental help-seeking intentions in international students of national university of Singapore: a mediation analysis of mental health literacy.

BACKGROUND: International students encounter a wide range of challenges that can have a significant impact on their mental health. Seeking help is one of the primary means of managing mental health, and more attention is required. This study aimed to investigate the psychological distress(PD), mental health literacy(MHL), and mental help-seeking intentions(MHSI) in international students of National University of Singapore(NUS), to explore the correlation between the three and to verify the mediating role of MHL in PD and MHSI. METHODS: This cross-sectional study was conducted between May and July 2023 using the Mental Help Seeking Intention Scale(MHSIS), Patient Health Questionnaire-9(PHQ-9), Generalized Anxiety Disorder-7(GAD-7), and Mental Health Literacy Scale(MHLS). 281 international students(177 males, 104 females;) in NUS completed self-report questionnaires. SPSS 25.0 was applied to the data for descriptive analysis, Pearson correlation analysis and stepwise regression analysis. Mediation analysis fully for all potential confounding factors were conducted. RESULTS: Significant correlations were found between PD, MHL and MHSI. MHLS- knowledge of how to seek professional information(MHLS- H) completely mediated the association of anxiety with MHSI[B=-0.271; 95% confidence interval(CI): (-0.067, 0.0037)]; MHLS- attitude that promote recognition or appropriate help-seeking behavior(stigma)(MHLS- H) partially mediated the association of PD with MHSI[B = 0.104, 95% CI: (0.008, 0.179)]; with mediating effects accounting for 100% and 24.847% of the total effect. In addition, demographic variables such as gender, years in Singapore and residence type mediated both the direct and indirect effect of the mediation model. CONCLUSIONS: MHL mediated both the direct and indirect effects on the association between PD and MHSI, especially, the mediator of the MHLS- H and MHL-A. It means that MHSI in this population can be improved by increasing MHL and thus the PD. The findings suggest that, such as providing information about how to access to professional services and promoting disorder recognition to the international students, may help them develop their psychological well-being and good mental health care decisions.

The Relationship Between Duration of Stay and Self-rated Health Among International College Students in South Korea.

This study examined relationships between duration of stay and self-rated health among international students in South Korea and compared participants' health-related characteristics according to duration of stay. The study recruited a convenience sample of 165 international students enrolled in undergraduate or graduate programs. For this cross-sectional, descriptive study, participants were recruited at one South Korean university. Data were subjected to ordinal logistic regression analyses. After controlling for covariates, a stay of 6 months or less was a significant predictor of better self-rated health. Compared to those in their first semester, international students staying more than 6 months more frequently experienced short sleep duration, physical health symptoms, healthcare utilization, unmet healthcare needs, and perceived discrimination. Study findings indicate that international students' health tends to deteriorate after their first semester. To promote the health and academic success of international students, universities should provide timely health promotion programs.

Contraceptive decision making among Chinese international students in Melbourne: findings from a qualitative investigation.

Compared to their non-Chinese peers in Australia, Chinese international students have very low rates of effective contraceptive use and this combined with other factors impacts unintended pregnancy rates. There is limited research exploring Chinese international students in Australia's decision-making with respect to contraceptive choices. In early 2020, 26 individual semi-structured interviews were conducted with 18-25-year-old Chinese international students to explore factors influencing their contraceptive choices. Using both deductive and inductive analysis, seven primary themes were identified. Of note was the identification of the strongly expressed cultural value of (ài xi, cherishing). Cherishing was used to describe the promotion of self-protection and the protection of loved ones from any negative outcomes related to contraceptive methods. Findings suggest that cherishing has an important role to play in Chinese students' decision-making around contraception. In particular, notions of cherishing may make it difficult for Chinese international students to accept and trust the advantages of hormonal contraceptives. Moreover, the confusing and inconsistent terminology students use to describe contraceptive options may hamper their ability to access effective forms of contraception in Australia.

Sexual health in a new cultural context: a resource for international students in regional Australia.

A large number of international students enrol in Australian higher education and contribute to Australia's multicultural population. Diverse cultural backgrounds and life experiences impact international students' knowledge of sexual health and healthy relationships. Along with unfamiliarity of the Australian healthcare system, this may place international students at risk of poor sexual health. We explored the sexual health priorities of international students with 12 male and 16 female international students aged between 18 and 49 years, for the development of a sexual health and relationship information resource for international students. Interviews were recorded, transcribed verbatim and coded thematically in Nvivo 12. Students noted that cultural norms about sex inhibited their ability to access information and they had concerns about their relationship behaviours within the Australian cultural context. Some participants noted challenges with accessing information and care and were enthusiastic about increasing international student access to reliable information and access to services. Based on the findings from these interviews, we developed a resource specifically for international students and evaluated its design and content through three focus group discussions with international students. This evaluation data informed refinements made to the resource. The resource Kit contains sexual health and relationship information and provides links to reputable online sexual health information. The Kit has been widely distributed to international students and is currently being further evaluated for use and acceptability.

Transnational online education in biochemistry during and after the COVID-19 pandemic in Binzhou Medical University: challenges, strategies and outcome.

BACKGROUND: Due to the global outbreak of the COVID-19 epidemic, schools were forced to shift teaching from face-face to online. During this period, a large number of studies on how to better carry out online teaching emerged. However, these studies were basically conducted with domestic students as teaching objects. The research on transnational online education conducted by overseas students is very limited. METHODS: We first conducted a questionnaire survey on the obstacles of transnational online learning of 64 international students from our school who were staying abroad at the beginning of the fall semester of 2020, analyzed the results using the two-tailed student's t-test and changed the teaching platform accordingly and compared the results of the biochemistry exams conducted for 2018 spring class with those of 2018 fall class and the 2019 fall class, so as to verify the superiority of the DingTalk as a transnational online education platform. RESULTS: The results showed that the main difficulties of overseas students in transnational online learning are poor network conditions and time difference. By using DingTalk as an online teaching platform, these difficulties were overcome. In the spring class of 2018, the results of online study students' biochemistry were significantly lower than those of students in face-face study (t-test, p = 0.01). However, after the switch to the DingTalk platform, online students' results in the 2018 fall class (t-test, p = 0.35) and the 2019 fall class (t-test, p = 0.7) were equivalent to the academic performance of face-face students. CONCLUSION: Our exploration and application of DingTalk software in transnational online education successfully solved the dilemma of overseas students' online learning, and provided a feasible method to guarantee the efficacy of online teaching.

Measurement invariance and psychometric properties of the CCAPS-62 and -34 for international student clients.

OBJECTIVES: International students attending universities in the United States may encounter psychological distress related to their adjustment and experiences studying in a new context and seek services from university counseling centers. Many centers use the Counseling Center Assessment of Psychological Symptoms (CCAPS) to measure psychological distress in college counseling centers. However, this scale has not been tested for measurement invariance with international students. Our purpose was to explore the measurement invariance of the CCAPS-62 and -34 for international students. METHODS: We tested measurement invariance for both versions of the scale using data from over 107,000 university students in psychotherapy at university counseling centers. We also examined construct validity and internal consistency. RESULTS: Invariance testing indicated the measurement models of the CCAPS-62 and -34 are equivalent between both groups. CONCLUSION: These findings are discussed in light of utilizing this widely-used scale in United States university/college counseling centers with international student clients.

Study of nonsynchronous online teaching of regional anatomy for international students integrated with medical humanities and local culture during COVID-19 pandemic.

PURPOSE: The COVID-19 pandemic imposed unexpected disruptions to anatomical educational practice, the teaching of regional anatomy for international students which has changed to an online format and faces various challenges. The challenges include creating online education homogeneous/equivalent to offline education, introducing local culture to international students, and educating students in medical humanities and ethics. METHODS: To address these problems, the teaching staff integrated medical humanities and local culture into nonsynchronous online teaching of regional anatomy. RESULTS: The nonsynchronous online teaching with interpreted videos of dissections does not significantly affect the experimental and total scores of regional anatomy courses for international students. Integrating medical humanities and local culture into this teaching model is appreciated by them and also has a good teaching effect. CONCLUSION: Students not only gained professional knowledge but also obtained enhanced exposure to local culture and professional spirit from this regional anatomy education.

Market mechanisms' distortions of higher education: Punjabi international students in Canada.

This study explores the experiences of Punjabi (i.e., from the Punjab region in India) international undergraduate students (hereafter PS) attending Canadian higher education through a case study of a teaching university in British Columbia. The primary focus is on unpacking how PS' experiences were underlined by labor mobility, immigration policies, and the marketization of international higher education. To recruit international students, many lower-tier Canadian universities apply a business model that relies heavily on agents. The outcome is that educational considerations are not central to admission and retention processes. The findings critique the Canadian education-migration model by identifying the complicity of Canadian higher education in lower-skill immigration and the negative educational and professional outcomes for PS that result from this complicity. The study highlights PS' voices and experiences that can go overlooked in the context of market-driven higher education.