Journal List > J Korean Med Sci > v.39(39) > 1516088805

TOOLS
Fedorchenko, Zimba, Gulov, Yessirkepov, and Fedorchenko: Medical Education Challenges in the Era of Internationalization and Digitization
Review Article
Editing, Writing & Publishing

Journal of Korean Medical Science 2024; 39(39): e299.

Published online: 7 October 2024

DOI: https://doi.org/10.3346/jkms.2024.39.e299

Medical Education Challenges in the Era of Internationalization and Digitization

Yuliya Fedorchenko1, Olena Zimba2, 3, 4, Makhmadshokh K. Gulov5, Marlen Yessirkepov6, Mykhailo Fedorchenko7

1Department of Pathophysiology, Ivano-Frankivsk National Medical University, Ivano-Frankivs’k, Ukraine.

2Department of Rheumatology, Immunology and Internal Medicine, University Hospital in Kraków, Kraków, Poland.

3National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland.

4Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine.

5Department of General Surgery N1, Avicenna Tajik State Medical University, Dushanbe, Tajikistan.

6Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan.

7Department of Internal Medicine No. 2 and Nursing, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine.

Address for Correspondence: Yuliya Fedorchenko, MD, PhD. Department of Pathophysiology, Ivano-Frankivsk National Medical University, Halytska Str. 2, 76018, Ivano-Frankivsk, Ukraine. juliakozubash@gmail.com

Received 21 August 2024       Accepted 12 September 2024

© 2024 The Korean Academy of Medical Sciences.

The Korean Academy of Medical Sciences

https://creativecommons.org/licenses/by-nc/4.0/
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: International Students, Medical Students, Medical Education, Language Barriers, Cultural Adaptation, Critical Thinking, Research Integration, Higher Education, Central Asia, Eastern Europe

INTRODUCTION

Prior to the onset of the coronavirus disease 2019 (COVID-19) pandemic, Central Asia and Eastern Europe witnessed a significant rise in the enrollment of international students, particularly within the realm of medical education.12 The attractiveness of these regions stemmed from their competitive tuition fees, distinguished educational institutions, and culturally diverse environments.345 Countries like Ukraine and Kazakhstan emerged as preferred destinations for those aspiring to pursue medical degrees.46 Medical education in Ukraine and Kazakhstan is known to closely adhere to the European model, placing emphasis on both theoretical knowledge and hands-on clinical training. Their academic institutions strive to maintain high standards, offering programs in English.46
Over the past decade, Kyrgyzstan has undergone substantial reforms, focusing on strengthening primary healthcare and human resources. The ongoing Medical Education Reforms project, initiated in 2007 and supported by the Swiss Agency for Development and Cooperation, has successfully addressed barriers at various education levels.7 Similarly, Tajikistan has undertaken medical education reforms, restructuring undergraduate, postgraduate, and continuing professional development programs in line with the World Medical Education Federation recommendations.8 Medical education and research activities are improving in Kazakhstan in view of the increasing publication activity.9 However, there are still numerous challenges mostly due to English language barrier, poor visibility of local medical journals, and inadequate scientific writing and editing skills.10
The COVID-19 pandemic significantly affected medical education in Eastern Europe and Central Asia. Regional academic institutions were forced to switch to online learning during lockdowns.11 The switch from traditional classrooms to online platforms posed challenges for both educators and students, particularly affecting hands-on clinical training.12
Pandemic-related travel restrictions and visa challenges significantly affected the enrollment and participation of international graduates, including those pursuing medical degrees.131415
The influence of the COVID-19 pandemic on medical education has been explored in numerous worldwide studies. A nationwide cross-sectional survey of UK medical students revealed a significant increase in online platforms use during the pandemic, with 24% of students allocating more than 15 hours per week compared with 7% in pre-pandemic period (P < 0.05).16 Although the flexibility of online teaching was acknowledged as a benefit, family distractions (27%) and internet-related issues (22%) were reported as challenges.16 Similarly, a study focusing on dental students revealed positive perceptions of online and blended learning during the pandemic, with associated social aspect viewed as a challenge.17
Notably, concerns have been voiced regarding the suitability of online learning for clinical disciplines, particularly at postgraduate level.18
Additionally, lower sleep quality and decreased quality of life during the lockdowns were linked to decreased academic performance and overall satisfaction with training courses.19 Younger age was identified as a predictor of better performance of students, whereas lockdown-related stress and fatigue were associated with poorer academic outcomes.20
After the COVID-19 pandemic, global higher education has undergone substantial transformations, witnessing a rise in the international student enrollment.21 This rise is accompanied by language barriers, psychological distress, and cultural obstacles, impacting student adaptation, socialization, and overall learning experience.22
In this context, our overview aims to comprehensively analyze challenges and perspectives of medical education for international students amid globalization and digital transformation and to provide recommendations for improving educational practices and outcomes.

SEARCH STRATEGY

We searched through Medline/PubMed, Scopus, and Directory of Open Access Journals (DOAJ) up to April 2024 in adherence with previously published recommendations.23 The following MeSH keywords were utilized for the retrieval and analysis of pertinent articles: “foreign students” OR “international students” in combination with “medical education,” “English language,” “research.” We conducted analysis on English-language original research articles, reviews, and case reports. Conference proceedings, book chapters, and preprints were filtered out.

CURRENT ISSUES OF MEDICAL EDUCATION AND STUDENTS’ CHOICE OF UNIVERSITIES

Medical education is undergoing transformation worldwide (Fig. 1), resulting in new challenges and opportunities primarily for international students studying outside their home countries.
Fig. 1

Visual summary of challenges and perspectives in medical education for the international students.

COVID-19 = coronavirus disease 2019.
jkms-39-e299-g001
In the context of selecting a medical school, the following determinants have emerged: medical school reputation, location, personal contacts, and recommendations.24 Medical school reputation stands out as a pivotal factor significantly influencing students’ choices.25 A detailed investigation into how academic reputation aligns with student expectations and outcomes provides valuable insights into the intricate decision-making process.26 Identifying and better understanding all confounding factors is paramount for medical education reforms and academic institutions adjustments to meet the needs and preferences of students. Rapid increase in medical student enrollment may strain educational resources, requiring revision of instructional standards and strategies of educating proficient and flexible educators.27
Notably, a Korean nationwide study has demonstrated a high prevalence of medical faculty burnout, associating it with gender, age, and working hours.28 Tightened control and regulation has emerged as a primary stressor.28 To mitigate medical faculty burnout, further research is imperative.28
European and Central Asian education strategies vary widely in terms of access to academic institutions, equipment standards, interdisciplinary and team work approaches, availability of highly skilled educators, etc.29 As an example, Ukraine has encountered unprecedented educational challenges over the last two years, primarily affecting international students, though their satisfaction with the quality of education remained consistent.30 Supposedly, the educators’ extra efforts, curricular adjustments, and technical assistance, and advanced online education may counteract some of the challenges.
On another extreme, post-pandemic education worldwide encounters similar challenges, necessitating adjustments in online and blended courses, advances in educators’ continuing development programmes, and more focus on information literacy and digitization.31 Current online courses require personalized approaches and support of information technology specialists.32
Emerging evidence stemming from post-pandemic surveys suggests that medical students positively perceive the evolving concept of blended learning, which is based on balanced online and face-to-face courses.33

STUDENTS’ ACTIVITIES - FOCUS ON LEARNING, RESEARCH, AND PRACTICE

Undergraduate students’ research activities are instrumental for acquiring basic skills and nurturing scientific thinking. Such activities may introduce them to mentors and other actors in the research infrastructure and facilitate acquiring science communication skills which are essential for postgraduate research and education.34 Notably, mentors’ support and guidance contribute to a high publication activity.34
Although the integration of research training into undergraduate education is mandatory in some countries, related outcomes are still unsatisfactory.3536 A survey of 215 students in Pakistan revealed that 60% acquired research experience by engaging in mandatory undergraduate activities and only 62% were aware that research is an inseparable part of their curriculum.36 Seventy-one percent of respondents identified lack of resources and lack of interest as main barriers to their research activities.36 Another survey of 704 Australian medical students revealed that only 45% contributed to a research project and only 20.5% cited an interest in academia as a motivation to engage in research.37 Finally, a longitudinal survey of 108 US-based medical students demonstrated that respondents’ attitude to research became more positive after viewing a didactic video regarding experimental medicine and its implications for safety of clinical medicine.38
Another important aspect of improving interest toward research and academia is publishing with medical student journals.39 Preliminary evidence suggests that those who publish their articles in medical student journals are more likely to publish in PubMed-indexed journals, attain PhD degree, and secure academic positions post-graduation.39
Gaining writing and publishing experience by targeting student journals and other reputable sources is particularly important in view of the proliferation of substandard, or so-called predatory, journals. The absolute majority of medical students are still unaware of predatory journals and their negative consequences for authors.40 Institutional initiatives are warranted to increase awareness in this regard.40
Interestingly, time constraints are increasingly reported as barriers to medical students’ engagement in research.41424344 Time constrain is even more stressful factor among residency students who are concerned with relevance and quantity of published articles to successfully compete with peers and engage in impactful research projects.42

CRITICAL THINKING (CT)

CT holds crucial importance for health professionals. The availability of various courses for improving CT is not always translated into students’ relevant skills.4546 Student-centered strategies with hands-on teaching methods are supposed to improve the learning environment oriented toward CT.47 Case-based learning is a prime example of gaining clinical problem-solving skills.48 Overall, continuously improving conventional teaching modalities and moving toward student-centered education may foster CT and self-sufficiency among medical students.49

LANGUAGE BARRIERS

English is currently the main language of communication, facilitated by extensive knowledge dissemination and proliferation of international medical journals.50 English language barriers are still challenging medical education and performance of both students and educators.51 Linguistic clarity, comprehension, and cultural nuances are increasingly reported confounders.52
Students from diverse linguistic backgrounds encounter difficulties with comprehending medical terminology, instructions, expressing ideas, and engaging in communication with peers and educators.53
Most students encounter challenges with adapting to internationalized educational systems due to time constraints, psychological stress, and language barriers.54 A survey of 82 Ukrainian undergraduate medical students demonstrated that educators’ English proficiency is one of the main factors associated with the overall quality of education and motivation of international students.55 Overall, tailored support for both educators and students, with advanced language courses, is gaining more and more importance in the context of the quality of internationalized education.5657

CULTURAL ISSUES

Cultural competence (CC) plays a vital role in medical education, though its teaching is still not unified and not systematic.58 Recognizing the significance of CC across all educational levels and developing individualized approaches require affective, cognitive, and behavioral measures.59 Unbiased healthcare provision is based on CC, particularly for subjects with culturally and linguistically diverse backgrounds.60
Culture shock and related factors influence international students’ adaptation to the academic environment. Successful adaptation to host country culture depends on language learning and socialization.61 In fact, international students who encounter daily life challenges rapidly adapt to the new realities, confounded by gender, language proficiency, and regional specifics.62 The host academic institutions enable their students’ adaptation by identifying and curbing challenges.62 Complex and uninterrupted support of host institutions translates into the progress in learning throughout all years in education, reduces psychological stress, and improves behavioral aspects.63

ADAPTATION AND PSYCHOLOGICAL ASPECTS

International students initially encounter moderate psychological distress that becomes less intensive over time, with visa arrangements and accommodation, engagement in academic courses, successful accomplishment of preparatory modules, and advancing language skills.6465 Departments of international students at academic institutions are capable of lessening the intensity of psychological distress by proper instructing and arranging language and medical terminology courses.66 Additional support to cope with international students’ distress may come from their families, helping emotionally to prevent burnout and maintain their motivation to continue education.67 Finally, depression, anxiety, and other manifestations of student distress can be treated by a specifically designed scheme of mindfulness meditation, body awareness, yoga, and behavioral analysis which is termed mindfulness-based stress reduction.68 In fact, accumulating evidence confirms that engaging in frequent and intensive physical activities decreases medical students’ burnout and enhances their quality of life.69
Overall, a balanced/rational approach to education and performance may well translate into less stressful and enjoyable years of students’ learning.70

ONLINE EDUCATION

The advantages of online education for international medical students have been acknowledged in the peri-pandemic period.7172 Low- and middle-income countries have encountered numerous challenges due to limited access to global information resources and online channels, shortage of educators with digital skills, and inadequate governmental support.73747576
A survey of 358 undergraduate medical students in the beginning of the COVID-19 pandemic demonstrated that switching to online education was perceived as the best solution by two-thirds of responders.77 The same survey pointed to limited access to high-speed Internet, inadequate digital skills, and lack of face-to-face interaction as factors affecting the efficiency of online learning.77 Another survey of 517 medical students and 88 educators reaffirmed benefits of students’ positive perceptions of online learning and educators’ online teaching readiness.78 The largest survey of medical students (n = 99,559) during the pandemic concluded that positive perceptions of online education are dependent on previous experience of the same and that students learning clinical disciplines are much less satisfied with online courses than those exposed to theoretical and fundamental disciplines.79 A systematic overview of 31 studies revealed that for fundamental disciplines such as anatomy online teaching cannot replace traditional teaching and that a blended approach is the most advantageous.80

CONCLUSION

The increasing internationalization of medical education has resulted in a rich tapestry of cultures and backgrounds among students. However, this diversity brings with it a set of challenges that may impact the academic and personal experiences of international students. Recognizing and addressing these challenges are essential for creating a conducive learning environment. Introducing comprehensive cultural competency training within medical curricula may enhance understanding and communication among students and faculty. Establishing mentorship programs that pair international students with experienced mentors may offer guidance on academic expectations, career development, and navigating the challenges of a new healthcare system. By adopting a multifaceted approach that addresses cultural, linguistic, and educational challenges, medical institutions may foster a more inclusive and supportive atmosphere for international students.

Notes

Disclosure: The authors have no potential conflicts of interest to disclose.

Author Contributions:

  • Conceptualization: Fedorchenko Y, Zimba O.

  • Writing - original draft: Fedorchenko Y, Zimba O.

  • Writing - review & editing: Fedorchenko Y, Zimba O, Gulov MK, Yessirkepov M, Fedorchenko M.

References

1. Jain N, Panag DS, Srivastava M, Mohan S, Chodnekar SY, Akbari AR, et al. Fate and future of the medical students in Ukraine: a silently bubbling educational crisis. Med Educ. 2022; 56(8):779–782. PMID: 35502145.
2. Lee JT, Kuzhabekova A. Reverse flow in academic mobility from core to periphery: motivations of international faculty working in Kazakhstan. High Educ. 2018; 76(2):369–386.
3. Holt E. Medical students drawn to eastern Europe. Lancet. 2013; 382(9900):1239–1240. PMID: 24137795.
4. Roy S, Bhat V, Ozair A. Overseas medical students in Ukraine and war-related interruption in education: Global health considerations from India. Ann Glob Health. 2022; 88(1):98. PMID: 36380742.
5. Adambekov S, Kaiyrlykyzy A, Igissinov N, Linkov F. Health challenges in Kazakhstan and Central Asia. J Epidemiol Community Health. 2016; 70(1):104–108. PMID: 26254293.
6. Riklefs V, Abakassova G, Bukeyeva A, Kaliyeva S, Serik B, Muratova A, et al. Transforming medical education in Kazakhstan: Successful case of internationalization from Karaganda State Medical University. Med Teach. 2018; 40(5):481–487. PMID: 29527966.
7. Orozalieva G, Loutan L, Azimova A, Baroffio A, Heller O, Lab B, et al. Reforms in medical education: lessons learnt from Kyrgyzstan. Glob Health Action. 2021; 14(1):1944480. PMID: 34330184.
8. Zavadskiy SP, Yefimova AM. Medical education state reform in Tajikistan: between tradition and modernity. Med Teach. 2020; 42(8):861–870. PMID: 32476521.
9. Kocyigit BF, Akyol A, Gulov MK, Yessirkepov M. Comparative analysis of central asian publication activity using SCImago Journal & Country Rank Data in 1996-2021. J Korean Med Sci. 2023; 38(14):e104. PMID: 37038641.
10. Yessirkepov M, Nurmashev B, Anartayeva M. A Scopus-based analysis of publication activity in Kazakhstan from 2010 to 2015: positive trends, concerns, and possible solutions. J Korean Med Sci. 2015; 30(12):1915–1919. PMID: 26713071.
11. Długosz P, Kryvachuk L. Neurotic generation of Covid-19 in Eastern Europe. Front Psychiatry. 2021; 12:654590. PMID: 34305670.
12. Mortagy M, Abdelhameed A, Sexton P, Olken M, Hegazy MT, Gawad MA, et al. Online medical education in Egypt during the COVID-19 pandemic: a nationwide assessment of medical students’ usage and perceptions. BMC Med Educ. 2022; 22(1):218. PMID: 35354406.
13. Lynch J, Gesing P, Cruz N. International student trauma during COVID-19: relationships among mental health, visa status, and institutional support. J Am Coll Health. 2023; 26:1–8.
14. Mbous YP, Mohamed R, Rudisill TM. International students challenges during the COVID-19 pandemic in a university in the United States: a focus group study. Curr Psychol. 2022; 4:1–13.
15. Gao N, Eissenstat SJ, Wacha-Montes A, Wang Y. The experiences and impact on wellness among international students in the United States during the COVID-19 pandemic. J Am Coll Health. 2022; 15:1–5.
16. Dost S, Hossain A, Shehab M, Abdelwahed A, Al-Nusair L. Perceptions of medical students towards online teaching during the COVID-19 pandemic: a national cross-sectional survey of 2721 UK medical students. BMJ Open. 2020; 10(11):e042378.
17. Khalaf ME, Ziada H, Abubakr NH. The dental educational environment of online and blended learning during COVID-19, and the impact on the future of dental education. Dent J. 2023; 11(2):41.
18. Vaca-Cartagena BF, Quishpe-Narváez E, Cartagena Ulloa H, Estévez-Chávez JP. Differences in medical education before, during, and in the post-peak period of the COVID-19 pandemic-exploring senior medical students’ attitudes. BMC Med Educ. 2023; 23(1):506. PMID: 37443057.
19. Medina-Ramirez SA, Rojas-Humpire R, Canaza JF, Hernandez F, Huancahuire-Vega S. Online academic satisfaction during the COVID-19 pandemic in medical students: role of sleep, emotions, college adjustment, and digital skills. F1000 Res. 2022; 11:241.
20. Hendriksen PA, Garssen J, Bijlsma EY, Engels F, Bruce G, Verster JC. COVID-19 lockdown-related changes in mood, health and academic functioning. Eur J Investig Health Psychol Educ. 2021; 11(4):1440–1461.
21. Du LJ. The crisis of international education students and responsive service in and after COVID-19 pandemic. Front Psychol. 2022; 13:1053512. PMID: 36478935.
22. Wilczewski M, Alon I. Language and communication in international students’ adaptation: a bibliometric and content analysis review. High Educ. 2023; 85(6):1235–1256.
23. Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD. Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int. 2011; 31(11):1409–1417. PMID: 21800117.
24. Foster K. Medical school choice: what influences applicants? Clin Teach. 2014; 11(4):307–310. PMID: 24917102.
25. D’Uggento AM, Petruzzellis L, Piper L, Gurrieri AR. In the name of the University: the choice to promote as a tool to influence decision-making. Qual Quant. 2023; 57(4):3151–3164.
26. Brown C. A qualitative study of medical school choice in the UK. Med Teach. 2007; 29(1):27–32. PMID: 17538829.
27. Kim IB, Joo KM, Song CH, Rhyu IJ. A brief review of anatomy education in Korea, encompassing its past, present, and future direction. J Korean Med Sci. 2024; 39(20):e159. PMID: 38804009.
28. Seo JH, Bae HO, Kim BJ, Huh S, Ahn YJ, Jung SS, et al. Burnout of faculty members of medical schools in Korea. J Korean Med Sci. 2022; 37(9):e74. PMID: 35257529.
29. Foley S, Paulo G, Vassileva J. Large differences in education and training of radiographers in Europe and Central Asia: results from an IAEA coordinated study. Radiography (Lond). 2022; 28(1):48–54. PMID: 34404576.
30. Goncharuk-Khomyn M, Kaliy V, Pohorilyak R, Cavalcanti A, Keniuk A, Yavuz Y, et al. Impact of war on foreign students’ satisfaction with quality of dental and medical education in Ukraine. Braz Oral Res. 2023; 37:e026. PMID: 37018808.
31. Khatatbeh H, Amer F, Ali AM, ALBashtawy M, Kurnianto A, Abu-Abbas M, et al. Challenges of distance learning encountering nursing students after the COVID-19 pandemic: a study from the Middle East. BMC Nurs. 2024; 23(1):574. PMID: 39154168.
32. Auanassova A. Online medical education perspectives in Kazakhstan and Central Asia. Cent Asian J Med Hypotheses Ethics. 2023; 4(2):112–122.
33. Agarwal A, Subramaniam G, Khattak O, Begum G, Taha A, Bayomy NA, et al. Navigating post COVID-19 education: an investigative study on students’ attitude and perception of their new normal learning environment. PeerJ. 2023; 11:e16184. PMID: 37927799.
34. Lee GS, Chin YH, Jiang AA, Mg CH, Nistala KR, Iyer SG, et al. Teaching medical research to medical students: a systematic review. Med Sci Educ. 2021; 31(2):945–962. PMID: 34457935.
35. Stone C, Dogbey GY, Klenzak S, Van Fossen K, Tan B, Brannan GD. Contemporary global perspectives of medical students on research during undergraduate medical education: a systematic literature review. Med Educ Online. 2018; 23(1):1537430. PMID: 30372403.
36. Arshad S, Huda NU, Nadeem N, Ali S, Ahmad N, Anwar S, et al. Perceptions of medical students about research at undergraduate level. J Ayub Med Coll Abbottabad. 2021; 33(1):129–133. PMID: 33774969.
37. Muhandiramge J, Vu T, Wallace MJ, Segelov E. The experiences, attitudes and understanding of research amongst medical students at an Australian medical school. BMC Med Educ. 2021; 21(1):267. PMID: 33971858.
38. Beversdorf DQ, Adams NR. Attitudes Toward toward animal research among medical students in the United States. J Am Assoc Lab Anim Sci. 2020; 59(2):120–126. PMID: 32059752.
39. Al-Busaidi IS, Wells CI, Wilkinson TJ. Publication in a medical student journal predicts short- and long-term academic success: a matched-cohort study. BMC Med Educ. 2019; 19(1):271. PMID: 31324236.
40. Alamri Y, Al-Busaidi IS, Bintalib MG, Abu-Zaid A. Understanding of medical students about predatory journals: a comparative study from KSA and New Zealand. J Taibah Univ Med Sci. 2020; 15(5):339–343. PMID: 33132804.
41. Alamri Y. Factors influencing decisions to become involved in research: a study of pre-clinical medical students from New Zealand. Med Sci Educ. 2019; 29(2):489–492. PMID: 34457505.
42. Barrios-Anderson A, Wu E, Liu DD, Snead J, Lee DJ, Robbins J, et al. A survey study examining the motivations, concerns, and perspectives of medical students engaging in neurosurgical research. Surg Neurol Int. 2021; 12:490. PMID: 34754540.
43. Parameswaran G, Bowman A, Swales C, Ooi SZ, Chan SW, Babu PR, et al. Cross-sectional Survey of Medical student perceptions of And desires for Research and Training pathways (SMART): an analysis of prospective cohort study of UK medical students. BMC Med Educ. 2023; 23(1):964. PMID: 38102619.
44. Uebel K, Iqbal MP, Carland J, Smith G, Islam MS, Shulruf B, et al. Factors determining medical students’ experience in an independent research year during the medical program. Med Sci Educ. 2021; 31(4):1471–1478. PMID: 34457986.
45. Sullivan AM, Hayes MM, Beltran CP, Cohen AP, Soffler M, Cooper S, et al. Do we teach critical thinking? A mixed methods study of faculty and student perceptions of teaching and learning critical thinking at three professional schools. Med Teach. 2024; 21:1–8.
46. Tan AJ, Davies JL, Nicolson RI, Karaminis T. Learning critical thinking skills online: can precision teaching help? Educ Technol Res Dev. 2023; 14(3):1–22.
47. Westerdahl F, Carlson E, Wennick A, Borglin G. Bachelor nursing students´ and their educators´ experiences of teaching strategies targeting critical thinking: a scoping review. Nurse Educ Pract. 2022; 63:103409. PMID: 35868062.
48. Bi M, Zhao Z, Yang J, Wang Y. Comparison of case-based learning and traditional method in teaching postgraduate students of medical oncology. Med Teach. 2019; 41(10):1124–1128. PMID: 31215320.
49. Alamrani MH, Alammar KA, Alqahtani SS, Salem OA. Comparing the effects of simulation-based and traditional teaching methods on the critical thinking abilities and self-confidence of nursing students. J Nurs Res. 2018; 26(3):152–157. PMID: 29016466.
50. Yang M, O’Sullivan PS, Irby DM, Chen Z, Lin C, Lin C. Challenges and adaptations in implementing an English-medium medical program:a case study in China. BMC Med Educ. 2019; 19(1):15. PMID: 30626387.
51. Wang J, Pan L. Role of resistance to innovation, lack of intercultural communication, and student interest on the student demotivation results towards the english education system. Front Psychol. 2022; 13:922402. PMID: 35846625.
52. Rashid MA, Xu L, Nicholson JG, Gill D. “Doctor, teacher, translator:” International medical students’ experiences of clinical teaching on an English language undergraduate medical course in China. Educ Health (Abingdon). 2020; 33(1):20–23. PMID: 32859876.
53. Huhn D, Lauter J, Roesch Ely D, Koch E, Möltner A, Herzog W, et al. Performance of international medical students in psychosocial medicine. BMC Med Educ. 2017; 17(1):111. PMID: 28693486.
54. Mitchell C, Del Fabbro L, Shaw J. The acculturation, language and learning experiences of international nursing students: implications for nursing education. Nurse Educ Today. 2017; 56:16–22. PMID: 28623678.
55. Goncharuk M, Leite Cavalcanti A, Stoika O, Hliudzyk-Shemota M, Deviatko Y, Boykiv A. Satisfaction with dental and medical education quality among foreign students considering non-native English-speaking origin of the teachers. Cumhuriyet Dental Journal. 2020; 23(4):308–317.
56. Kling J, Tolsgaard MG, Løkkegaard E, Teilmann G, Mola G, Poulsen JH, et al. Danish doctors’ reactions to ‘internationalization’ in clinical training in a public university hospital. BMC Res Notes. 2019; 12(1):411. PMID: 31307518.
57. Diamond LC, Jacobs EA. Let’s not contribute to disparities: the best methods for teaching clinicians how to overcome language barriers to health care. J Gen Intern Med. 2010; 25(Suppl 2):S189–S193. PMID: 20352518.
58. Li S, Miles K, George RE, Ertubey C, Pype P, Liu J. A critical review of cultural competence frameworks and models in medical and health professional education: a meta-ethnographic synthesis: BEME Guide No. 79. Med Teach. 2023; 45(10):1085–1107. PMID: 36755385.
59. Liu J, Gill E, Li S. Revisiting cultural competence. Clin Teach. 2021; 18(2):191–197. PMID: 33043578.
60. Horvat L, Horey D, Romios P, Kis-Rigo J. Cultural competence education for health professionals. Cochrane Database Syst Rev. 2014; 2014(5):CD009405. PMID: 24793445.
61. Majhanovich S, Deyrich MC. Language learning to support active social inclusion: Issues and challenges for lifelong learning. Int Rev Educ. 2017; 63(4):435–452.
62. Byrne E, Brugha R, McGarvey A. ‘A melting pot of cultures’ -challenges in social adaptation and interactions amongst international medical students. BMC Med Educ. 2019; 19(1):86. PMID: 30885174.
63. Katrushova L, Yalanska S, Rudenko L, Katrushov O. Peculiarities of the process of psychological adaptation of foreign students of Ukrainian higher education institutions of medical profile, role of emotional intelligence in the socialization process. Wiad Lek. 2019; 72(10):1930–1934. PMID: 31982016.
64. Huhn D, Schmid C, Erschens R, Junne F, Herrmann-Werner A, Möltner A, et al. A comparison of stress perception in international and local first semester medical students using psychometric, psychophysiological, and humoral methods. Int J Environ Res Public Health. 2018; 15(12):2820. PMID: 30544950.
65. Prasath PR, Xiong Y, Zhang Q, Jeon L. Psychological capital, well-being, and distress of international students. Int J Adv Couns. 2022; 44(3):529–549. PMID: 35730062.
66. Huhn D, Junne F, Zipfel S, Duelli R, Resch F, Herzog W, et al. International medical students--a survey of perceived challenges and established support services at medical faculties. GMS Z Med Ausbild. 2015; 32(1):Doc9. PMID: 25699112.
67. Gradiski IP, Borovecki A, Ćurković M, San-Martín M, Delgado Bolton RC, Vivanco L. Burnout in international medical students: characterization of professionalism and loneliness as predictive factors of burnout. Int J Environ Res Public Health. 2022; 19(3):1385. PMID: 35162399.
68. Alzahrani AM, Hakami A, AlHadi A, Al-Maflehi N, Aljawadi MH, Alotaibi RM, et al. The effectiveness of mindfulness training in improving medical students’ stress, depression, and anxiety. PLoS One. 2023; 18(10):e0293539. PMID: 37906599.
69. Taylor CE, Scott EJ, Owen K. Physical activity, burnout and quality of life in medical students: a systematic review. Clin Teach. 2022; 19(6):e13525. PMID: 36052814.
70. Park CH, Kwon J, Lee JT, Ahn S. Impact of criterion versus norm-referenced assessment on the quality of life in Korean medical students. J Korean Med Sci. 2023; 38(17):e133. PMID: 37128877.
71. Ahmed S, Zimba O, Gasparyan AY. Moving towards online rheumatology education in the era of COVID-19. Clin Rheumatol. 2020; 39(11):3215–3222. PMID: 32939569.
72. Goudarzi H, Onozawa M, Takahashi M. Impact of the Covid-19 pandemic and ensuing online teaching on pre-clinical medical education. BMC Med Educ. 2024; 24(1):66. PMID: 38233801.
73. Ahmed SA, Hegazy NN, Abdel Malak HW, Cliff Kayser W 3rd, Elrafie NM, Hassanien M, et al. Model for utilizing distance learning post COVID-19 using (PACT)™ a cross sectional qualitative study. BMC Med Educ. 2020; 20(1):400. PMID: 33138818.
74. Connolly N, Abdalla ME. Impact of COVID-19 on medical education in different income countries: a scoping review of the literature. Med Educ Online. 2022; 27(1):2040192. PMID: 35317712.
75. Sigdel S, Ozaki A, Dhakal R, Pradhan B, Tanimoto T. Medical education in Nepal: impact and challenges of the COVID-19 pandemic. Acad Med. 2021; 96(3):340–342. PMID: 33332910.
76. Faria I, Moura CB, Graner M, Campos LN, Gerk A, Bittencourt MM, et al. Online medical education: a student survey. Clin Teach. 2023; 20(4):e13582. PMID: 37211433.
77. Gismalla MD, Mohamed MS, Ibrahim OS, Elhassan MM, Mohamed MN. Medical students’ perception towards E-learning during COVID 19 pandemic in a high burden developing country. BMC Med Educ. 2021; 21(1):377. PMID: 34246254.
78. Sarfraz M, Hussain G, Shahid M, Riaz A, Muavia M, Fahed YS, et al. Medical students’ online learning perceptions, online learning readiness, and learning outcomes during COVID-19: The moderating role of teacher’s readiness to teach online. Int J Environ Res Public Health. 2022; 19(6):3520. PMID: 35329204.
79. Wang C, Xie A, Wang W, Wu H. Association between medical students’ prior experiences and perceptions of formal online education developed in response to COVID-19: a cross-sectional study in China. BMJ Open. 2020; 10(10):e041886.
80. Abualadas HM, Xu L. Achievement of learning outcomes in non-traditional (online) versus traditional (face-to-face) anatomy teaching in medical schools: a mixed method systematic review. Clin Anat. 2023; 36(1):50–76. PMID: 35969356.
TOOLS
Similar articles