International students experience of a western medical school. A mixed methods study, exploring the impact of the clinical years of the programme in the context of adjustment to the Irish health care system.

Due to improvements in technology, transportation, and ease of access, we live in an era of unprecedented globalization and ever-increasing diversity in tertiary institutions. Internationality and multiculturalism confer numerous benefits for students, institutions, and nations. Nevertheless, it is reported that international students face challenges when adjusting to a new culture. These acculturative challenges could drastically add to the numerous challenges that students in medical school already face. This study aims to address two questions:

1. How do cultural backgrounds impact the challenges and coping mechanisms faced by sojourning medical students in their clinical years and how do these differ from that of the host medical students in the same year?
2. How, and to what extent, do sojourning medical students in their clinical years adjust to the new environment?

The study was carried out in the medical school of The Royal College of Surgeons in Ireland. Students were grouped into five regions based on their country of origin: Ireland, North America, Far East, Middle East, and Others. A mixed methods sequential study was carried out to answer the research questions. This entailed interviews with key informants, and peer interviews and a focus group discussion with final year medical students. Following thematic analysis of the interviews and the focus group discussion, items were developed and combined with validated tools in a questionnaire which was piloted and then published to final year medical students. The response rate was 50.3% (144/286). Data analysis revealed that students from Ireland (host students) were the most socially adjusted followed by students from North America and the Far East. Students from the Middle East were the least socially adjusted. Factors that affected adjustment were challenges with communication and language, consumption of alcohol at social events, befriending members of the opposite sex, cultural pressures from students belonging to the same culture, and discrimination. Based on these findings, recommendations are made in order to enhance support structures throughout the clinical years for international students studying in a western medical school.