1. Challenges faced by International Medical Students
Internationalisation and the Student Experience 18/12/13
Challenges faced by International Medical Students
Rebecca Lissmann
With Basego Lesego, Nunaet Liengudom, Ashna Ramdin, Dylan Tan and Omar Zibdeh;
Poorna Gunasekera and Karen Johnstone

2. Method Five first year medical students
From different areas of the world
Varying degrees of experience with British language and school system
12 weeks diaries reflecting on experiences
Two members of staff from the medical school.
12 week diaries recording predictions of student experiences
Diaries then collated and compared

3. What will we (hopefully!) achieve?
We aim to shed new light on the variety of emotional reactions international students experience, and to what extent they are understood.
Compare the two key perspectives
Pupil
Tutor.
Stimulate exploration of issues and potential resolutions

4. Do you agree with the predictions? –Some quick examples
Occupational Health Appointments (vaccinations etc) will be stressful
Small group work sessions will be difficult -confidence and communication skills
Food availability and sourcing will be a problem
Examining models of genitalia in clinical skills sessions will be a challenge
Adjusting to receiving and giving peer feedback will be tough

5. Arrival and initial thoughts
“Emotionally, I am a wreck. I cannot share this with my parents, as they are already very hesitant about sending me abroad.”
“Seeing my father tear up for the first time in my life I felt really upset. I just headed back to my room, and felt really homesick the morning after.”
“…. with exhaustion drowning out the feelings of loneliness and homesickness.”
“I still find it uncomfortable living with strangers”
“The first time I met PG and I thought ‘this is definitely gonna be fun’ and was amazed at his ability to make all of us feel at ease.”
I feel safe knowing that there are so many people to help me when things go wrong.

6. Socialising, personal identity and fitting in
“[there was] awkwardness between me and the flat peeps and I avoided them as much as I could.”
“I was not very comfortable being surround by drunk people.”
“…they could collect literally around bottles of alcohol during this two weeks.”
“I come from a [religious] family where drinking isn’t even an option. However, now that I am here and I am making my dad pay loads of money, I feel really guilty about it and about going on nights out in general because I feel I might be abusing their trust and the privilege that they gave me.”

7. “That was one of the craziest best nights of my life, and I think it gave me a solid change in perspective. The next morning I woke up with a massive smile on my face, and feeling very optimistic about this year.
“It’s amazing the way drinking connects you to people! This is a thing that I learned coming here. I NEVER used to drink back home.”
“… the parties at night were mental.”
“…everyone were very intrigued to know more about me and where I came from.”

8. Personal Identity
“I felt like I might be living a double life where I’m one person here and I’m completely a different one back home. Other than the religious reasons, generally people’s mentalities and values differ massively between here and [home]. …the worst part is that I don’t know where between the two places I’m not being myself.”
“My life has changed a lot recently it made me notice that my world used to be very small. She once told me, I did not want to tell you all the truth about everything by now because it will ruin your beautiful world. Well, alright leave me in my world then.”

9. AMK
“I had no idea how to prepare for it, and everyone seemed to be doing loads.”
“…though I did my best, I am not certain that my best will be good enough to get me the grade I need.”
“…somebody else knew a lot and I knew nothing”
It really stressed me out …I was in a really bad mood that I fought with a flat mate, and then when I got back to my room I burst out crying for the first time since I came here. Loads of different thoughts were going through my head including the fear of getting an Unsatisfactory because that would just mean I wasn’t working hard enough and that will just make me feel that my dad is wasting his money on me.

10. “I definitely have no optimism towards the outcomes of this whatsoever
AMK 1st result this seems like such a horrible start and it scares me. It really does. I don’t think I can ever handle this again. Failing is not an option from me… I am here on behalf of my family and my country as well.
Religion
“…maybe I needed that one fall so that I may seek refuge and comfort in my God.
[Having been to church] “…I felt whole again… my world didn’t seem so dark anymore.”

11. PBL- Practice Based Learning
“I felt very intimidated in PBL.”
“I simply hated it…”
‘My facilitator looked at me and gave me a very bitter smile. It was like “come on say something”.’
“My facilitator once said I understood why you were quiet, it was the culture thing, was not it? It seemed like a very kind sentence but for me I felt like being racist.”
“…always being interrupted by locals and did not felt like being respected very much during PBL.”
“The thing with it is not that I can’t talk within a group but it’s just that it is a bit hard to make myself heard.”
“In [previous country] classes were conducted mostly with teachers talking and student listening…”

12. “I’m slowly coming out of my shell, though not completely yet
“I’m slowly coming out of my shell, though not completely yet. My group is by far the…. BEST PBL group ever, definitely comprising a group of bright individuals, with a variety of complimenting characteristics.”
“Even the quietest of us are speaking up, with the loudest giving some space to listen. Loving the PBL vibe as well, eg. Our confidence that our PBL group is the best (which we are :P)”
“I’ve never really been so proud working in such a team before, the team’s enthusiasm and ability to compromise for the sake of bettering dynamic, has just been phenomenal.”

13. Peer feedback
“What I wrote were very critical and I focused on how could they improved. At the end I ended up receiving only a good comments from others but I was sure that I had lots of things that I needed to improve but no one mentioned about it. So I felt bad and I rewrote all the comments.”
“Whenever it comes to feedback I am like –Oh ow! I get this stupid feeling in my gut and my heart goes crazy.”

14. LSRC –Life Sciences Resource Centre
“…I felt a bit awkward with life patient anatomy. I sometimes wish we could do dissections…”
“I did not understand a single thing he [LSRC tutor] said.”
“…nightmare.”
“Spent almost 5 hours last night prep-ing for today’s session, seriously have no idea how to prep for tomorrows.”
“Most of the concerns I had had at the start of the course were in the past.”

15. CSRC –Clinical Skills Resource Centre
“…the Clinical skills session was incredible.”
“I do enjoy them [CSRC sessions] very much and always get hyped up whenever we have them.”
“I enjoyed CSRC the most.”

16. Plenaries “I feel even more confused after attending plenaries.”
“I do not feel very comfortable writing the truth very much, but I skipped some plenaries.”
“Although second years have told us that we can skip plenaries, I just could not do it although at times I do sincerely think that they were of no good.”
“I actually find them really useful. However, sometimes I tend to restrain from interacting in the plenary or asking a question if I have one because I have a different accent than everybody else “

17. Homesickness
“…surprisingly, I don’t feel homesick at all. Maybe that’s because I Skype with my parents twice a week, and… it’s more of an interrogation than a mutual conversation.”
“This might not sound so good but I did not feel as homesick as I thought I would. Maybe it’s the fact that my sister is here and all the events that happened kept me busy.”
“…this was not an easy week for me. I got news that my grandma had passed away… I wished I was at home…”

18. Miscellaneous
Placement: ‘…one of the mothers asked me to see in the reception area if her husband was there. I did go there and said “Is Mr.Smiths here?” …At the end I just brought the wrong Smiths in which was a bit embarrassing.’
Dwindling bank balance: “Stayed over at a friend’s place last night in an attempt to get my laundry done for free!”

19. What did the tutors miss?

20. What did the tutors miss?
Pressure to succeed
Financial burden
Representing family and country
Alcohol (as a major factor)
Speaking in front of large groups
LSRC prep
Homesickness being triggered

21. What did the tutors suggest would be problems when they weren’t?

22. What did the tutors suggest would be problems when they weren’t?
Weather being a MAJOR problem
Occupational Health shots being stressful
Examining models of genitalia in CSRC (and any stress from CSRC)
Debate and issues surrounding sex, contraception and abortion in the conception ‘case unit’.
Feeling the difference in style and pressure between their own course and those of other peers.
Differences between (not within) PBL groups.

23. Questions and Discussion