International Medical Students Research Articles

Virtual dissection applications in learning human anatomy: international medical students' perspectives.

Understanding human anatomy is fundamental to building medical competencies. This study explored the diverse perceptions of medical students in Saudi Arabia and Egypt concerning virtual dissection applications. Students from different Saudi and Egyptian governmental universities were invited. The online questionnaire covered the sociodemographic characteristics, students' perception of the advantages of virtual anatomy applications, satisfaction with their efficiency, and their recommendation to use them. Comparisons were performed in country-wise and then university-wise patterns. Significance was considered with a P < 0.05. The mean age of 401 participants was 20 ± 1.6. Females were 63% and the males were 37%. Saudi universities participated by 47% and Egyptian universities by 53% with various academic levels. The traditional program covers 25% of the participants and 75% are in integrated programs. Virtual dissection applications were used by 84% of the sample while the remaining 16% did not use them. No significant differences between Saudi participants and those from Egypt in the adopted teaching methods and the usual use of virtual dissection applications. However, significant differences in considering the ease of virtual applications (P = 0.016), their perfectness in lectures (P = 0.04), and their perception (P = 0.034). Also, there was no significant difference in satisfaction while their recommendation differed significantly (P = 0.034). The university-wise comparisons elaborated significant differences in the feasibility, reality, usefulness, preference, and perfectness of virtual dissection applications in lecturing. Technology can be an efficient complementary, not a replacement resource to support the educational process. Also, students' perceptions are valuable in maximizing the educational benefits of curricula.

Can positive emotional writing improve the emotional health level of international medical students? Evidence from a randomized controlled trial

BackgroundDepression and anxiety are common psychological issues among international medical students in universities, which have serious negative impacts on their learning and life. The present study aimed to evaluate the efficacy of positive emotional writing in alleviating symptoms of anxiety and depression, as well as enhancing subjective well-being among this population.MethodThis study was conducted at an international college of a comprehensive university in central China. A total of ninety-two participants who met the inclusion criteria were recruited to participate in a single-blind randomized controlled trial, in which participants were not aware that there was an experimental group and a control group. Participants in control received daily psychological care weekly for 8 weeks (n = 46). Correspondingly, participants in experimental group received the positive emotional writing intervention on the basis of daily psychological care. Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS) and General Well-being Scale (GWB) were used to evaluate the effect of the intervention. Data from 89 students who completed the entire study (experimental group, n = 44; control group, n = 45) were analyzed.ResultsAfter the intervention, the scores of SDS and SAS in the experimental group significantly decreased, while the subjective well-being score significantly increased. Although the SAS score of the control group after intervention was significantly lower than before, the decrease in SDS and SAS scores, as well as the increase in GWB score, were significantly greater in the experimental group than in the control group.ConclusionThe findings suggest that positive emotional writing can effectively reduce the depression and anxiety of international medical students, and significantly enhance their subjective well-being, providing ideas for management to solve the psychological problems of international medical students.Trial registration numberChiCTR2400087815. Registered at Chinese Clinical Trial Registry.

A national DREEM: exploring medical and dental students’ perceptions on their learning environment across Hungary

BackgroundHungarian medical schools attract a diverse student body, enrolling numerous international and Hungarian students annually. The learning environment, encompassing all facets of their academic experience, significantly influences the overall educational experience at the medical schools. As the first nationwide survey, this study aimed to assess and compare the perceptions of international and Hungarian medical and dental students regarding their learning environment across the four medical schools in Hungary.MethodsThe Dundee Ready Education Environment Measure (DREEM) tool was used to get a better insight into the perceptions of international and Hungarian medical and dental students on their learning environment (LE). The questionnaire was distributed via social media platforms and the Neptun Educational System across the four medical schools in Hungary. To gain deeper insights into the participants’ perceptions, a qualitative component was also added to the survey, comprising five open-ended questions. The research was carried out between April and October 2022. To analyse quantitative data, IBM SPSS was used, while the transcription and exploration of the qualitative data was performed using the Sketch Engine software.ResultsA total of 1164 valid responses were received. The results illuminate similarities and differences in perceptions of the learning environment between international and Hungarian medical and dental students. As anticipated, international students’ perceptions were somewhat less favourable compared to their domestic counterparts, who are generally more accustomed to the workings of the Hungarian higher educational system (total DREEM score was 118.1 for the former, and 122.6 for the latter student population). Notably, significant differences were observed in perceptions of teachers and the overall atmosphere.ConclusionThe total score of the DREEM questionnaire was interpreted as “more positive than negative” for both international and Hungarian students, consistent with findings from other DREEM surveys, suggesting overall satisfaction with the learning environment. However, regular and ongoing evaluation of the learning environment is recommended in order to identify areas for improvement, ensure high standards of education, and continuously enhance the overall student experience.

International medical students in Türkiye: a cross-sectional study on their reasons for choosing Türkiye and their demographic and socioeconomic characteristics

The aim of this study is to investigate the reasons why international medical students choose Türkiye, which has one of the largest higher education capacities in Europe and is also among the top 10 most preferred countries in the world by international students, and their demographic and socioeconomic characteristics. The data of this cross-sectional study were collected through an online survey that included questions such as students’ gender, age, ethnicity, monthly income, pre-school education, parental education level and professions, number of siblings, rural status of the region where they grew up, and reasons for choosing Türkiye. 482 students at various grade levels from 30 medical schools participated in the study. Data were analyzed using descriptive statistics, chi-square, and ANOVA tests. The results revealed that there are significant differences in the participants’ parents’ education levels, occupations and economic levels according to their ethnicity. Besides, the participants’ reasons to choose Türkiye significantly differ according to their ethnicity while the value of medical education offered in Turkish higher education institutions is emphasized.

International medical students’ experiences of psychological safety in feedback episodes: a focused ethnographic study

BackgroundFeedback and psychological safety are well-established concepts within medical education, vital for student learning and progress. However, the concepts remain unexplored in the context of international students. This area deserves attention given the unique challenges faced by the overseas medical students due to cultural differences. The present study examines international students’ experiences of psychological safety in feedback interactions in a Scottish undergraduate medical programme.MethodsA focused ethnographic approach was adopted to explore international students’ experiences and perceptions of psychological safety in their feedback experiences. Data were collected in the form of field observations and semi-structured interviews, involving both student and faculty participants. Approximately 13hrs of fieldwork and a total of 11 interviews were conducted. These were analysed using a combination of inductive and deductive thematic analysis.ResultsData analysis identified four key themes: feedback delivery, educator attributes, cultural factors and longitudinal educational relationships. Both staff and student participants highlighted how environmental factors such as room design and group size functioned as enablers or barriers to psychological safety in feedback episodes. Additionally, students appreciated tutors who expressed vulnerability and demonstrated awareness of their cultural backgrounds. Students described significant differences between the feedback approaches in the host (UK) institute and that in their home country. Longitudinal associations fostered trust and familiarity with peers and tutors, enhancing students’ receptivity to learning and feedback.ConclusionThis present study highlights cultural differences in feedback practices across countries and their impact on psychological safety among international students. It stresses the importance of integrating overseas students by considering group dynamics, environment and diverse student needs. Staff awareness of cultural variability, openness to tutor vulnerability and fostering long-term educational relationships can greatly enhance psychological safety in learning and teaching activities. These insights are relevant amidst the growing globalisation of medical education and the mobility of students across borders, advocating for tailored integration to optimise their learning experience and achievement.

Effective Clinical Externships for International Medical Students: A Qualitative Study.

International student exchanges are a significant part of medical education, and experiences of North American and European medical students abroad have been extensively examined. By contrast, knowledge of visiting medical students in the United States (US) is limited largely to surveys of administrators and course directors. To understand US attending physicians' thoughts on visiting international student clinical externships. Three clinician-educator physician focus groups were conducted across two US medical schools with broad representation of training backgrounds, clinical disciplines, and career stages. Focus groups and constant comparison analysis of transcripts were performed iteratively to identify emerging themes. Qualitative themes and subthemes. Two main themes emerged from the data: (1) administrative requirements for success: hosting international students requires careful planning and coordination, which is daunting amidst demanding faculty responsibilities. Externships must address experiences of the people directly involved in the clinical setting, leadership, communication, and institutional, financial, physical, and personnel resources. (2) Impact of student qualities: When working with international students, the importance of administrative details and student characteristics increases due to higher student variability overall, inconsistent language and cultural fluency, and the consequent recognition of the student as an ambassador for their home institution and country. Amidst already busy schedules, clinician educators identify the hosting of international medical students as a commitment resembling that for their own trainees. Linguistic and cultural distances, and the overall variability of international students amplify the importance of effective administration. The findings have influenced related processes at the University of Pittsburgh.

The Impact of Medical Education Quality on Career Adaptability for International Students in China: The Mediating Role of Proactive Career Planning Behavior

Background: The quality of medical education plays a significant role in shaping the career outcomes of international students. As they navigate the challenges of their studies and career paths in a foreign country, understanding the elements that influence their career adaptability is essential. Objective: This study aims to examine the impact of medical education quality on career adaptability among international students in China and to emphasize the mediating role of proactive career planning behavior. It also investigates challenges related to cultural adjustment. Methodology: A quantitative technique is employed in a cross-sectional survey of international medical students in China. Information was collected from 575 valid responses through structured questionnaires. The research utilizes regression analysis and Structural Equation Modeling (SEM) to assess the relationships between medical education quality, career adaptability, proactive career planning behavior, and cultural adjustment challenges. Result: The evaluation revealed that medical education quality positively influences career adaptability (p &lt; 0.001, β = 0.45). Proactive career planning behavior was found to positively influence career adaptability (p &lt; 0.001, β = 0.38). Medical education quality positively influences proactive career planning behavior (p &lt; 0.001, β = 0.50), and proactive career planning behavior mediated the connection between medical education quality and career adaptability (p = 0.013, β = 0.20). Cultural adjustment challenges moderated the relationship between medical education quality and career adaptability, with a significant interaction effect (p = 0.032, β = -0.15). Conclusion: The research emphasizes the significance of high-quality medical education in promoting career adaptability among international students, highlighting proactive career planning and examining cultural adjustment challenges for optimal career outcomes. These insights can inform educational practices and support services for international medical students, aiming to enhance their career readiness and adaptability in a global context.

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

BackgroundInternational 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.AimThe 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.MethodologyA 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.ResultsThis 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.ConclusionAcculturative 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 numberNot applicable.

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

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. 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. Participants engaged in a semi-structured interview about the pandemic's personal and professional implications. The data were analysed using inductive thematic analysis. 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. 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.

Evaluating panel discussions in ESP classes: an exploration of international medical students’ and ESP instructors’ perspectives through qualitative research

This study investigates the effectiveness of panel discussions, a specific interactive teaching technique where a group of students leads a pre-planned, topic-focused discussion with audience participation, in English for Specific Purposes (ESP) courses for international medical students. This approach aims to simulate professional conference discussions, preparing students for future academic and clinical environments where such skills are crucial. While traditional group presentations foster critical thinking and communication, a gap exists in understanding how medical students perceive the complexities of preparing for and participating in panel discussions within an ESP setting. This qualitative study investigates the perceived advantages and disadvantages of these discussions from the perspectives of both panelists (medical students) and the audience (peers). Additionally, the study explores potential improvements based on insights from ESP instructors. Utilizing a two-phase design involving reflection papers and focus group discussions, data were collected from 46 medical students and three ESP instructors. Thematic analysis revealed that panel discussions offer unique benefits compared to traditional presentations, including enhanced engagement and more dynamic skill development for both panelists and the audience. Panelists reported gains in personal and professional development, including honing critical thinking, communication, and presentation skills. The audience perceived these discussions as engaging learning experiences that fostered critical analysis and information synthesis. However, challenges such as academic workload and concerns about discussion quality were also identified. The study concludes that panel discussions, when implemented effectively, can be a valuable tool for enhancing critical thinking, communication skills, and subject matter knowledge in ESP courses for medical students. These skills are transferable and can benefit students in various academic and professional settings, including future participation in medical conferences. This research provides valuable insights for ESP instructors seeking to integrate panel discussions into their curriculum, ultimately improving student learning outcomes and preparing them for future success in professional communication.

Impact of Native and Nonnative Study Partners on Medical Students’ Confidence and Collaborative Strategies in Second Language Medical Dutch Learning

Abstract Objective This study explored how native and nonnative study partners impact medical students’ confidence, learning strategies, and perceptions of learning experiences in second language (L2) medical Dutch learning using Kolb’s experiential learning framework. Methods Twelve third-year international bachelor medical students participated in a mixed-methods pre-post quasi-experimental design. Four students were paired with highly proficient native Dutch partners in a mixed group, and eight nonnative students formed pairs in a homogeneous group. The need satisfaction competence scale was used for pre- and post-tests, and individual interviews were analyzed for content and themes. Code co-occurrence and network analyses were carried out to identify the relationships between themes in the two groups. Results Common themes in both groups included a positive atmosphere, collaboration, and confidence. The mixed group prioritized language learning and motivation, while the homogeneous group emphasized interpersonal relationships and feedback-seeking behaviors. Nonnative students in homogeneous groups gained confidence, while confidence of those in mixed groups decreased, possibly due to comparing themselves with native partners. Homogeneous groups have communication focused collaborative strategies, while the mixed group emphasized personal growth with fewer drawbacks. Conclusions Our findings suggest that initiating the course with homogeneous nonnative student groups fosters collaboration and builds confidence among participants. However, to maintain motivation and further enhance language proficiency, it is advisable to introduce native Dutch partners at a later stage of the course. This approach allows students to benefit from both the positive collaborative atmosphere and interpersonal growth fostered in homogeneous groups, as well as the language learning and motivation gains associated with mixed-group experiences. Overall, our study highlights the importance of considering the stage of language learning and student needs in designing effective second language learning environments for medical students.

Comparing Level of Happiness and Depression Between Turkish and International Medical Students

This cross-sectional study was aimed to compare happiness and depression levels among group Turkish and international medical students in Istanbul, Turkey. Data were collected through an online survey that included demographic inquiries, the Oxford Happiness Scale, and Beck’s Depression Inventory II. Significant contrasts emerged in demographic and lifestyle factors between Turkish and international students. Turkish medical students displayed a higher prevalence of unhappiness, although this difference was not statistically significant (66.3% for Turkish students vs. 59.1% for international students; χ² = 2.472, p = 0.116). Conversely, no marked differences were observed in the severity of depression between the two groups (χ² = 0.028, p = 0.986). Conversely, no marked differences were observed in the severity of depression between the two groups (χ2 = 0.028, p = 0.986). Logistic regression analyses revealed noteworthy associations. Factors such as age, academic phase, family history of psychiatric illness, and prior psychiatry treatment were linked to heightened odds of experiencing unhappiness among students. Similarly, significant predictors of depression included a family history of depression and prior psychiatry treatment. However; gender, age, relationship status, accommodation, alcohol consumption, smoking habits, and repeated academic years did not exhibit significant associations with unhappiness among the sampled medical students. While the models demonstrated modest explanatory power, these findings emphasize the urgent need to address mental health issues among medical students. Tailored interventions targeting specific vulnerable subgroups are crucial and further research is needed to identify additional factors contributing to psychological distress in this demographic.

Adrift down under: An integrative review of international students’ experiences in Australian higher education including shaping factors

Australia is currently one of the leading destination countries for International Students (IS), ranking third in popularity as a study destination. There is sparse research into the experience of IS including the factors influencing their experience within the Australian higher education system. This integrative review aims to synthesize knowledge on the IS’ experience in Australian higher education, including the factors influencing their experience. The review included 15 qualitative studies, three quantitative studies, three mixed methods studies and two literature reviews. IS perceived their study experience in Australia as challenging. They reported English unproficiency, poor academic performance, lack of academic support, low-quality courses, and work-study imbalance as factors that lead to insufficient learning engagement. IS reported difficulties in adjusting to the culture due to language barrier, negative emotions, and stronger acculturation orientation toward their heritage culture. IS reported the difficulties in establishing rapport with both domestic students, university teachers, and obstacles in building meaningful relationships within the local community as factors hindering the development of rapport with these entities. Despite encountering the challenges, IS have recognised the imperative of seeking avenues to foster connections with their fellow peers, their teachers, and the broader Australian community. They noted that their proactive efforts to connect with others, participation in work integrated learning, engagement in extracurricular activities, and prolonged residency in Australia were influential factors that facilitated opportunities for connectedness. These findings emphasise the significance of fostering networks between international students, domestic peers, university educators, and the Australian community. Such networks facilitate cultural understanding, elevate academic achievements, and contribute to the holistic well-being of students. The findings offer valuable assistance in equipping stakeholders and higher educational institutions with essential insights to effectively support IS and address their needs comprehensively. These insights are significant for global education providers aiming to support IS and cultivate a positive study environment. Further research should explore the experiences of international nursing, medical, and healthcare students, considering their involvement with patients and the healthcare team in the Australian system, potentially influencing their experience.

Stressors and Solutions: Addressing the Needs of International Medical Students in Malaysia

Stressors and Solutions: Addressing the Needs of International Medical Students in Malaysia

Rosacea awareness among med students: In-depth survey analysis

Objectives: The main aim of this cross-sectional study is to assess the knowledge of medical students of Tbilisi State Medical University for creating awareness about rosacea among healthcare professionals and the community. Materials and Methods: A cross-sectional study in an online survey style was conducted over 2 months among international medical students to assess rosacea awareness. Participants (n = 86) answered questions covering etiology, epidemiology, pathophysiology, clinical expression, treatment modalities, and personal encounters with rosacea patients. Statistical analysis categorized responses by gender, academic year, and awareness levels. Results: Survey results revealed varying awareness levels among participants. While most recognized rosacea and its symptoms exist, knowledge gaps exist in identifying types, severity signs, genetic links, dietary influences, and treatment modalities. Clinical-year students exhibited superior awareness compared to their preclinical counterparts, indicating the influence of clinical exposure. Conclusion: The study highlights inconsistent awareness of rosacea among medical students, emphasizing the need for comprehensive education. Limited exposure to real-world cases underscores the importance of clinical training. Bridging knowledge gaps through updated curricula and practical training can enhance future health-care professionals’ preparedness to diagnose and manage rosacea effectively, thereby improving patient outcomes and quality of life. Further, research and educational interventions are warranted to address these gaps and promote a better understanding of and management of rosacea.

The competing role of English and Chinese in the ‘practiced’ language policies for international medical students in a Chinese hospital

ABSTRACT Informed by the theoretical concepts of ‘practiced’ language policy and space, the study investigates the language practices of English-medium Bachelor of Medicine and Bachelor of Surgery (MBBS) programs for international students, focusing on the interactional norms of language choice in a Chinese hospital where international students are interned. In accordance with the tenets of Interactional Sociolinguistics, data were gathered through observation, audio recordings, and interviews with 15 international medical students and clinical supervisors over the course of one year. The study found that three mediums of interaction were adopted across different spaces in the hospital: an English monolingual medium, a Chinese monolingual medium, and an English and Chinese bilingual medium. The findings suggest that ‘practiced’ language policies are never static or prescribed, but rather constructed in relation to personhood, type of activity and place in multiple social spaces. The study offers implications for international medical education and the promotion of an inclusive language environment.

A Medical Student Experience as an Acting Intern in Colorectal Surgery

Gaining hands on clinical experience in the US as a medical student is an important prerequisite for securing a residency spot in the US. These clinical electives in surgery enable the medical student to witness the process of providing healthcare to patients from the time of the first clinic visit to the post operative recovery phase of the patient after surgery. This is especially crucial for international medical students who are used to a different type of medical system back in their home country. Getting an opportunity to rotate in the department of Colorectal surgery at the Cleveland Clinic is an opportunity of a lifetime. This is my experience at the Cleveland Clinic as an acting intern.

Investigating the Job Burnout Levels and Related Factors in Medical Interns of Guilan University of Medical Sciences

Introduction: Job burnout is a state of mental fatigue resulting from a person's professional life and consists of three dimensions: emotional exhaustion, depersonalization, and decreased personal accomplishment. This study was conducted with the aim of determining the levels of job burnout and its related factors in medical internship students of Guilan University of Medical Sciences. Methods: This cross-sectional analytical study involved 71 medical interns of Guilan University of Medical Sciences participating by census in 2022. The Maslach Burnout Inventory and a socio-economic status questionnaire were completed by the students. The data were analyzed using descriptive statistical tests (percentage, frequency, mean, and standard deviation) and inferential statistics tests (Chi-square and Fisher's exact test) through SPSS (version 25). The P-value &lt; 0.05 was regarded as statistically significant. Results: Out of 71 medical interns, 47.9% of medical students were female, while 52.1% were male. The findings showed that 44.1% of female (15 individuals) and 51.4% of male (19 individuals) experienced severe burnout, and 55.9% of female (19 people) and 48.6% of male (18 people) had moderate burnout. Participants earned high scores in emotional exhaustion (76.1%), depersonalization (67.6%), and decreased personal accomplishment (26.8%). There was a significant relationship between the internship level (P=0.00), the medical school GPA (P=0.011), the pre-internship test score (P=0.003), and the father's education rate (P=0.023) and the emotional exhaustion score. There was also a significant relationship between the depersonalization score and the internship level (P=0.003). Results indicated a significant statistical relationship between variables of maternal education (P=0.026), economic status (as assessed by the student or family regarding housing prices) (P=0.047), and medical school GPA (P=0.004) and the decreased personal accomplishment dimension score. ConclusionThe results of this study showed a high level of burnout among interns, with students scoring high in emotional exhaustion and depersonalization components. Therefore, according to the results of the present study, further research on preventive interventions and strategies to mitigate exposure to burnout factors would be beneficial.

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

BackgroundThe 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.MethodsTwo 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.ResultsThe 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.ConclusionsThis 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.

A qualitative study of career decision making among African and Asian international medical students in China: process, challenges, and strategies.

China hosts around 68,000 international medical students (IMSs) primarily from lower income countries in Africa and Asia, who have the potential to contribute to international medical services. Understanding how these IMSs make career decisions can help better address the issue of global medical workforce shortage. However, such research is limited. Our study aims to explore the career decision-making process of China-educated IMSs, the challenges they experienced and the strategies they employed.In this exploratory qualitative study, we conducted semi-structured interviews with IMSs educated in China in 2022 using purposeful sampling. Twenty virtual one-on-one interviews were conducted, and data were analysed through directed qualitative content analysis. Cognitive Information Processing (CIP) theory was applied as the guiding framework for organising and analysing the data.The career decision-making process of the participants generally followed the stages of decision-making cycle in CIP theory, with a combination of urgent migration decisions and specialisation considerations adding layers of complexity to their career trajectories. Identified challenges encompassed lack of knowledge about oneself and career options, lack of decision-making skills, concerns of contextual complexities that limited the career decision-making process, low motivation and negative thoughts. Specific challenges due to their role as IMSs arose, which were related to career information access, self-capability evaluation, degree accreditation, employment competitiveness and mental states. Participants' proposed strategies were categorised into personal and institutional aspects, providing insights into addressing these challenges.This study substantiates and expands the application of the CIP theory within the sphere of the particular cultural and educational context of IMSs educated in China. It highlights the significance of integrating migration decision-making into career guidance for IMSs, and contributes to the literature by proposing an evidence-based tiered career intervention programme for IMSs.