International medical students--a survey of perceived challenges and established support services at medical faculties

The influence of occupational therapy students' preferred language on academic and clinical performance in a Canadian university program

The Occupational Therapy Program at this Canadian university is a French program however, students must be bilingual to function in English or French clinical fieldwork settings. An understanding of the role of language in successful completion of program requirements was needed to effectively support students' education. The study objectives were to identify the role of linguistic factors in students' academic and clinical performance and to provide recommendations for strategies to address areas of learning difficulty. A multimethod approach used 4 data sources: (1) Multiple Mini Interview (MMI) informal language assessment scores, (2) grade point average (GPA), (3) fieldwork evaluation reports, and (4) an online survey of program graduates. The GPA on admission and MMI scores of 140 students predicted respectively only 20% and 2% of the variation in GPA on program completion. The areas of poorest performance in failed clinical fieldwork reports were in clinical reasoning and communication competencies. Among survey respondents (n = 47), 44.5% reported that a clinical placement in their second language with related charting (51.6%) and client communication (40.9%) were the most significant difficulties encountered in the program. Clients with mental health issues (45.4%) were the most challenging population to work with, attributed to communication barriers in the students' second language. Strategies are proposed to support occupational therapy students' academic and clinical language proficiency, including conversational training courses, problem-based learning activities in students' second language, focussed teaching on the clinical reasoning process and reflective skills, and language coaching to address early signs of difficulty in clinical fieldwork.

Teaching patient-centred communication skills during clinical procedural skill training - a preliminary pre-post study comparing international and local medical students

BACKGROUND

International medical students are frequently confronted with intercultural, psychosocial, and language barriers and often receive lower marks in written, oral, and clinical-practical examinations than fellow local students. Training communication competence in procedural skills, such as blood sampling, is further challenge in this particular group of medical students. This pre-post comparative intervention study aimed to investigate the effects of training communication skills during the performance of procedural skills (taking blood samples from a silicone model) in international and local students as part of their clinical practical medical training.

METHODS

Study participants performed blood sampling on an arm prosthesis model (part-task trainer) before and after the communication skills training, focusing on accompanying communication with a simulation patient sitting next to the arm model. The pre- and post-evaluation video was assessed by two independent evaluators using a binary checklist, the Integrated Procedural Performance Instrument (IPPI) and global assessments of clinical professionalism in terms of procedural and communication performance. Linear models with mixed effects were used. Group differences regarding global competence levels were analysed with χ²-tests.

RESULTS

International medical students did not perform as well as their local counterparts in the pre- and post-examinations. Both groups improved their performance significantly, whereby the international students improved more than their local counterparts in terms of their communication performance, assessed via binary checklist. Clinical professionalism evaluated via global assessments of procedural and communication performance highlights the intervention's impact insofar as no international student was assessed as clinically not competent after the training.

CONCLUSIONS

Our results suggest that already a low-dose intervention can lead to improved communication skills in medical students performing procedural tasks and significantly increase their confidence in patient interaction.

Exam performance of different admission quotas in the first part of the state examination in medicine: a cross-sectional study

BACKGROUND

Most medical students in Germany are admitted via selection procedures, which are adjusted to the demands of the universities. At Lübeck medical school, scores from interviews that measure non-academic skills and pre-university GPAs are summed to arrive at an admission decision. This article seeks to illuminate the effectiveness of this selection procedure in comparison to other non-selected student groups.

METHODS

Quota information and exam results from the first federal exam were linked for students admitted to Lübeck medical school between 2012 and 2015 (N = 655). Five different student groups (university-specific selection quota, pre-university GPA quota, waiting time quota, ex-ante quota and foreign students) were compared regarding exam attempts, written and oral grades, temporal continuity and examination success in the standard study period.

RESULTS

While the pre-university GPA quota outperformed all other quotas regarding written and oral grades, it did not differ from the selection quota regarding exam attempts, temporal continuity and examination success in the standard study period. Students in the waiting time and ex-ante quotas performed inferior by comparison. The results of foreign students were the most problematic.

CONCLUSION

Students selected by the university show high temporal continuity and examination success. These results, and possible advantages in physician eligibility, argue for the utilisation of non-academic skills for admission.

International Peer-teaching: the LernKlinik Leipzig "Erasmus-Week" for Incoming Erasmus Students

Introduction: This project report describes the development, pilot phase, evaluation and implementation of a preparatory course week for incoming Erasmus medical students at the LernKlinik Leipzig, the Skills and Simulation Centre of the Medical Faculty, University of Leipzig. Project description: The aim of this project is to prepare Erasmus students for their year abroad using peer-assisted teaching as the method of choice. Major intended outcomes were support of language and clinical practical skill competency development, as well as enhancement of integration among international and German-speaking peer tutors. The methodological framework of Ross and Cameron [1] was used in planning the Erasmus-Week. For planning the 2012 pilot project, a survey among Erasmus students of the academic year 2011/12 was performed. All succeeding cohorts were asked to participate in pre- and post-surveys which were analyzed quantitatively and qualitatively. Results: Between 2012 and 2017, n=173 European medical students spent their Erasmus year in Leipzig. Of these, n=148 (86%) participated in the Erasmus-Week. The country of origin of most Erasmus students was Rumania (20,3%). Among the most positively received aspects of the Erasmus-Week, the active use of German for medical purposes and the use of peer-teaching as the method of choice to learn and repeat basic medical examination skills were mentioned. Students emphasized their wish for being able to participate in further course offers. Conclusions: Offering a preparatory course week for incoming Erasmus students focusing on language and clinical practical skills training using peer-teaching as the method of choice may facilitate the integration of Erasmus students into their foreign medical curriculum. Further studies are underway to elucidate if these experiences influence later professional careers and choice of employment.

Symposium "International Medical Students - Support Programs in Practical Application": Networking, best-practice examples and local representation

The new project "International Medical Students" within the German Medical Students' Association (bvmd) aims at connecting local support programs for international medical students as well as the representation of their interests within the bvmd. Within the frame of this project, the first symposium "International Medical Students - Support Programs in Practical Application" took place from the 12^th to the 14^th of May 2017 at the Hannover Medical School (MHH). Through partaking in different workshops, 31 participants discussed the framework conditions of local work (i.e. curricula, tutorials, social offers, cooperation between faculty members and student body, legal aspects), common problems (i.e. addressing the target group, funding of support programs) and possible solutions (i.e. targeted advertisement, application for public funds). This report constitutes a summary of the results of these discussions. The feedback from the participants on the need for such a regular exchange and the format of the symposium was positive. However, there were requests for further thematic specification. Based on this feedback the next symposium is planned for 2018.

An equal opportunity for everyone?! Supporting international students of medicine at the Ludwig-Maximilians-University in Munich

Objective: The following article presents OFIF, a project that has been running at the medical faculty of the Ludwig-Maximilians-University in Munich (LMU) since 2013. International students of medicine often lag behind their fellow domestic students in terms of language ability and communication skills. To compensate, OFIF offers communication skills courses with an emphasis on exam preparation. Below, we will discuss the project's success, challenges and future opportunities. Methods: In their daily academic routine, communication presents one of the greatest challenges for international students of medicine. With the aid of case scenarios and activities from clinical practice, the project courses teach strategies for effective communication. The methodical concept of the OFIF training is based on the six levels of learning of the revised edition of Bloom's taxonomy. Results: Since 2013, more than 40 trainings and classes for international medical students have been offered. In the winter term of 2017/18, 49 students representing all clinical semesters participated in the OFIF activities. An evaluation of the training classes consistently yielded positive results (95 % of the items were given a score between 9 and 10, on a scale from 1 to 10.) Conclusions: Both the amount of interest (as expressed by the number of actively participating students) and the high percentage of positive evaluations consistently demonstrate that the didactical concept underlying OFIF is useful and could serve as a best practice example for similar projects at other institutions. On the other hand, the 49 participants from all clinical semesters represented but 10 % of the total population of international students in the winter term of 2017/18. Further research examining the concrete effects of OFIF on the academic success of international students at the LMU is therefore desirable.

Same same but different - A qualitative study on the development and maintenance of personal networks among German and international medical students

Introduction: In addition to linguistic and cultural difficulties, problems with social integration are frequently found among international medical students. In contrast, the social interaction among German medical students is considered as non-problematic. Personal networks are considered as positively influencing factors for the learning environment of students as well as their academic performance and personal wellbeing. However, while general findings on the development and maintenance of personal networks among medical students are available, there is insufficient data on students with different nationality or cultural backgrounds. Therefore, we compared the perception of international and German medical students on the development and maintenance of personal networks and examined possible influencing factors. Methodology: Following the principles of theoretical sampling in qualitative research, we recruited 17 international and 10 German preclinical medical students. The survey was conducted with semi-structured interviews, which focused on the participants' experiences with the development and maintenance of personal networks in medical school. The coding and analysis of the interview transcripts was based on the principles of grounded theory. Results: We show that German participants rated the network development in medical school much more positively than the international participants. This difference was influenced by: a different perception of affiliation to the group of medical students, a low academic benefit from contacts with international students, the socio-cultural framework of medical school as well as the individual strategies of international medical students in dealing with integration. Conclusion: Our study extends existing insights into the development and maintenance of the social environment in medical school by understanding the perception of a subgroup of medical students. A better understanding of these social processes enables an effective evaluation of support and teaching for the subgroup of international medical students in Germany.

Welcome, Orientation, Language Training: a project at the Charité for new international medical students

Objective: A comprehensive, integrated support programme for new international students of medicine has been developed, implemented and evaluated at the Charité. The objectives of the programme were improved social integration, orientation on the study program and Charité campus, as well as qualification in medical specialist language. Project outline: The "Charité Orientation Module for International Students" (ChOIS) was designed by a working group with a variety of expertise in the field of international students. The programme has three stages: Recruitment (specific invitation on matriculation); Orientation week before semester start; and Parallel events during the first semester. ChoOIS was piloted in the Winter Semester 2015/16 and, following evaluation, continued in a modified form in the Summer Semester 2016. Key features were: Welcome and social integration by faculty welcome-events and student group activities; Orientation on the study program, on teaching infrastructures at the Charité and on student life in Berlin by senior medical students; and Training in language for medical communication and bedside teaching by professional lecturers. Results: Results of evaluations conducted after the orientation weeks, at the end of the semester and retrospectively in the 3rd semester produced high approval ratings of the individual features of the ChOIS-programme and of the programme as a whole by participating students. Discussion: A comprehensive, integrated support programme for new international students of medicine has been developed and implemented. The ChOIS-programme can serve as a practice model to guide other medical faculties. In future, a programme that goes beyond the start of the course and includes more involvement by senior students would be desirable.

Studienstart International of the University of Cologne: The closely supervised semester of study entry for students from third countries using the example of the model degree program for human medicine

Objective: Due to the increasing degree of internationalization and migration movements, German universities must increasingly pay attention to the cultural diversity of their students. Numerous studies have shown that there is still considerable room for improvement at German universities with regard to the integration of foreign students. Therefore, the University of Cologne aims at improving study conditions for students from third countries (especially non-EU) by introducing a compulsory study entry semester Studienstart International. In this study, we ask if effects on the dropout rates of international students before the introduction of Studienstart International can be observed after the introduction of the study entry semester. In addition, results of a survey of foreign students about familiarizing themselves with the German university educational system and on social contacts with fellow students are presented. Methods: After a one-year voluntary pilot phase in summer semester 2009 and winter semester 2009/10, Studienstart International was made compulsory for Non-EU students in preparation for the study of human medicine. 113 students of the human medicine degree program have taken part in this program since the beginning of winter semester 2016/17. The comparison of dropout rates before and after the introduction of Studienstart International as well as the results from a survey of foreign students are presented descriptively. Statistical significance of the difference in dropout rates between the two groups of students is tested using a Chi²-test. Results: The dropout rates of foreign students fell slightly from 19% to 14% following the introduction of the mandatory study entry semester, but this difference is not statistically significant (Chi²=0.785, df=1, p=0.376). According to the survey, almost three-quarters of foreign students have contact with German fellow students at the university, 55% of whom report daily contact. 68% of respondents have contact with German fellow students outside the university. 97% feel they are well prepared for the degree course and 91% say they know where to go with questions and problems during their studies. Conclusion: With the introduction of the compulsory study entry semester Studienstart International, the University of Cologne aims at improving integration of foreign students. Although dropout rates could not be significantly reduced, survey results suggest that Studienstart International can certainly support international students. Reliable statements on the success of the study cannot yet be made due to the small number of cases. A follow-up study will deal with this question.

On center field or at the sidelines? - A plea for a multimodal approach between medical schools and medical student communities while integrating international medical students

An increasing number of medical schools offer support services for international students. Their frequent focus on linguistic and academic support often reflects a rather deficit-oriented perception of international medical students. Therefore, this comment advocates a stronger focus on the integration into the local medical student communities. This happens both against the background of the expected academic benefits and the added value of intercultural learning at medical schools.

Reducing Stress and Promoting Social Integration of International Medical Students through a Tandem Program: Results of a Prospective-Program Evaluation

Medical students, and especially international medical students (IMS), have been shown to experience more psychological distress than the general student population in Germany. In order to address these issues, a structured Tandem Program (TP) to reduce stress and foster social integration of IMS has been introduced at the Medical Faculty of Tuebingen. The Tandem Program was evaluated prospectively with perceived stress (PSQ-20) as the main outcome. Secondary outcomes were ‘motives to participate’ in the TP, ‘specific stressors’, and ‘experiences made’ during the program. Stress levels of IMS at the beginning of the program (t₀) (M = 48.14, SD = 11.95) were higher than those of German participants (M = 39.33, SD = 8.31) (t (67) = −3.66, p < 0.001). At the end of the TP (t₁), stress levels of international students were significantly lower than at t₀. “Improved ability to work in a team” was seen as one of the most beneficial factors. The results indicate that tandem programs at medical faculties may be a promising curricular intervention towards reducing stress levels, improving integration of international students, and to enhance intercultural and team-oriented competencies in both international and national medical students.

Interactive peer-guided examination preparation course for second-year international full-time medical students: quantitative and qualitative evaluation

Background: It has been documented that international students face diverse challenges due to language and cultural barriers. International medical students suffer from personal distress, a lack of support and perform poorer than local fellow-students in clinical examinations. It has been documented that international medical students benefit from peer-led tutorials in their first year. We investigated the effectiveness of a tutorial offered for international medical students in their second year. Methods: A peer-guided examination preparation course with interactive elements for second year international medical students was designed, learning objectives were defined. Two evaluations were undertaken: In a quantitative assessment, students were asked to fill out five multiple-choice-questions at the beginning of every session of the tutorial (pre-test) as well as to participate in a post-test at the end of the semester in which all former multiple-choice-questions were re-used. Using a qualitative approach, participants were asked for their thoughts and comments in a semi-structured interview at the end of the semester. Results: International students (N=12) showed significantly better results in the post- than in the pre-test (t(11)=-8.48, p<.001, d=1.95). Within the interviews, international students (N=10) reported to have benefited from technical and didactic, as well as social learning experiences. The individual lectures students were asked to contribute were discussed controversially. Conclusion: Our peer-guided tutorial for second year international medical students is an effective and well accepted possibility to prepare these students for examinations.

The postgraduate medical education pathway: an international comparison

An at first sight seemingly coherent, global medical workforce, with clearly recognizable specialities, subspecialties and primary care doctors, appears at a closer look quite variable. Even within the most progressive countries as to the development of medical education, with educators who regularly meet at conferences and share major journals about medical education, the differences in structures and regulations are big. This contribution focuses on the preparation, admission policy, duration, examinations, and national competency frameworks in postgraduate speciality training in Germany, the USA, Canada, the UK, Australia and the Netherlands. While general objectives for postgraduate training programs have not been very clear, only recently competency-frameworks, created in a limited number of countries, serve harmonize objectives. This process appears to be a challenge and the recent creation of milestones for the reporting on progress of individual trainees (in the US and in Canada in different ways) and the adoption of entrustable professional activities, a most recent concept that is quickly spreading internationally as a framework for teaching and assessing in the clinical workplace is an interesting and hopeful development, but time will tell whether true harmonization across countries will happen.

International medical students' expectations and worries at the beginning of their medical education: a qualitative focus group study

BACKGROUND

The number of international students has increased substantially within the last decade. Due to cultural barriers, this specific group faces diverse challenges. In comparison to German colleagues, international medical students perform significantly lower in clinical examinations and exceed the average duration of study; they suffer from personal distress as well as insufficient support. Within the present study, their individual perspectives, expectations, hopes and fears were examined.

METHODS

Four focus groups with first-year international medical students (N = 16) were conducted in October 2013. Each 60- to 90-min discussion was audiotaped, transcribed and analysed using qualitative methods.

RESULTS

International medical students go abroad in search of good study-conditions. For the choice of place of study, affordability, social ties as well as an educational system following the achievement principle are decisive factors. While contact with German-students and other international students is seen as beneficial, international medical students are most concerned to encounter problems and social exclusion due to language deficits and intercultural differences.

CONCLUSIONS

Facilitating the access to university places, the provision of financial aid and, moreover, social support, nurturing cultural integration, would greatly benefit international medical students. Hereby, the establishment of specific medical language courses as well as programs fostering intercultural-relations could prove to be valuable.

Voluntary peer-led exam preparation course for international first year students: Tutees' perceptions

BACKGROUND

While the number of international students has increased over the last decade, such students face diverse challenges due to language and cultural barriers. International medical students suffer from personal distress and a lack of support. Their performance is significantly lower than non-international peers in clinical examinations. We investigated whether international students benefit from a peer-led exam preparation course.

METHODS

An exam preparation course was designed, and relevant learning objectives were defined. Two evaluations were undertaken: Using a qualitative approach, tutees (N = 10) were asked for their thoughts and comments in a semi-structured interview at the end of the semester. From a quantitative perspective, all participants (N = 22) were asked to complete questionnaires at the end of each course session.

RESULTS

International students reported a range of significant benefits from the course as they prepared for upcoming exams. They benefited from technical and didactic, as well as social learning experiences. They also considered aspects of the tutorial's framework helpful.

CONCLUSION

Social and cognitive congruence seem to be the key factors to success within international medical students' education. If tutors have a migration background, they can operate as authentic role models. Furthermore, because they are still students themselves, they can offer support using relevant and understandable language.