High- and low-achieving international medical students' perceptions of the factors influencing their academic performance at Chinese universities.

China has become an attractive destination for international medical students, particularly those from developing countries in Asia and Africa. These students are known to face difficulties in adapting to Chinese medical universities and they tend to score poorly on subsequent examinations to enter the medical profession in their home or in a third country. To date, limited research concerning the factors that affect the academic performance of this group of students in China has been conducted. In particular, there have been very few comparisons between high and low achievers to identify the factors that high- and low-achieving international medical students in all years of study perceive as affecting their academic performance. A qualitative research approach was implemented at two medical universities. Semi-structured interviews were conducted with 18 high achievers and 22 low achievers in their second, third, fourth, fifth, sixth, and post-graduation years. Interviews were audio-recorded, transcribed, and coded using a thematic analysis approach.A few key overlapping factors were identified: social support, learning motivation and interest, exam preparation and strategies, time management, and coping. The high achievers manipulated these strategies successfully while the low achievers did not. The high achievers demonstrated efficient learning methods (efficient use of class time, good note-taking habits, preview and review strategies, expanded learning, self-study and group learning, deep learning, choosing an appropriate study location, and focusing on basics and concepts). They also achieved a good balance between studying and leisure. The low achievers mentioned learning challenges, health issues, English language barriers, and problems with online classes. This study allowed us to identify important factors that international medical students at Chinese institutions perceive to influence their performance. The findings contribute to the literature on the topic and provide a solid basis for practice and policy development.

Coping Strategies of Failing International Medical Students in Two Chinese Universities: A Qualitative Study.

Phenomenon: China hosts a large number of international medical students from low-income countries, and some fail examinations in the early stage of the Bachelor of Medicine and Bachelor of Surgery (MBBS) program. Little is known about how failing international medical students cope to recover their academic performance. It would be beneficial to investigate the coping strategies they use to help them recover their academic performance and progress. Approach: Semi-structured interviews were conducted with 21 international medical students at two universities in China from September 2020 to January 2021. These students had passed make-up exams or re-sits and progressed academically. A thematic analysis approach was used to identify major themes in the interview data. Findings: After failing initial exams or re-sits, students were found to adopt seven coping strategies to help them pass future examinations and recover their academic performance: (i) increased help-seeking behaviors, (ii) improved learning motivation and attitudes, (iii) improved learning strategies, (iv) improved exam preparation, (v) utilization of library resources, (vi) enhanced time management, and (vii) enhanced English language skills. Of the seven strategies, seeking help from friends, peers, seniors, and teachers was the strategy reported most frequently. Insights: The results of this study provide insights into the coping strategies that international undergraduate medical students adopt to recover from poor academic performance in Chinese universities. Host institutions should recognize the resilience and agency of such students to make positive changes. Furthermore, institutional efforts should be made to develop contextualized intervention plans that stimulate students' learning motivation and encourage them to adopt self-help strategies by incorporating useful resources (e.g., help from peers, seniors, and teachers). Enrollment should integrate specific English language proficiency criteria, and interviews and entrance exams should be conducted. For some failing students, it may be necessary to provide academic remediation.

The adaptation of academics to the Covid-19 crisis in terms of work time allocation.

Academics have seen their work environment and routines severely affected by the Covid19 pandemic. This topic has been analyzed by the literature, mostly from personal and descriptive perspectives, that highlight the challenging transitions and adaptations that academics have endured concerning their work and life-balance. This research complements those studies, by using a sample of university academics working all around the world in all disciplinary fields and focuses on a longitudinal perspective of workload and task time allocation of academic work. The findings show that academics which in general had long working hours, further increased their time of the week dedicated to work leading possibly to the reported cases in the literature of increasing stress and burnout during the pandemic. These effects were found to be similar to all academics, independently of their gender and disciplinary field. More concerning is that this increased number of hours worked per week appears to have established itself as part of the new normal. The main driver for the increased workload is associated with teaching, and to a lesser extent with administrative duties.

International medical students' perspectives on factors affecting their academic success in China: a qualitative study.

BACKGROUND: The number of international students who choose China as their destination for quality medical education is rising, particularly those from developing countries, but little is known about their adaptation and educational experiences at Chinese universities. This study explored the factors that these students perceived to have influenced their academic success. METHODS: Semi-structured interviews were conducted with international students (N = 40) from developing countries from September 2020 to January 2021. Participants were graduates or in their second, third, fourth, fifth, or sixth academic year in two university medical schools. Interviews were audio-recorded, transcribed, and analyzed using a thematic analysis approach. RESULTS: The participants chose China to study medicine based on cost, teaching resources, quality of medical education, recommendation, and safety factors. They considered an increase in medical knowledge, clinical skills and communication skills as an indicator of academic success. Positive factors affecting academic success were the support system (family, friends, seniors) and campus resources (library, laboratories, extra-curricular activities, scholarship). Negative factors were (i) issues affecting learning (English language barrier), adjusting to the medical education system in China, learning difficulties, failing exams, internship difficulties, problems with online learning during the pandemic, (ii) sociocultural issues (lacking knowledge of the Chinese language, challenges in daily life, perceived discrimination, interpersonal relationships), (iii) wellbeing issues (physical and mental health issues), and (iv) other challenges (climate, food, finance, scholarship). The influence of teachers, administrators and classmates was perceived as both positive and negative. CONCLUSIONS: Factors affecting the academic success of international medical students at Chinese universities are multi-faceted. It is the collective responsibility of the host society, universities, teachers, administrators, classmates, families, and students themselves to address these factors in order to support and help students achieve academic success. Findings in our study support recommendations to improve teachers' English language skills and pedagogy and to invest in administrators' professional development. They also suggest that greater awareness of students' sociocultural and mental challenges and optimizing the positive influence of classmates could strengthen student support and better address student academic difficulties. The English proficiency and prior academic performance of international students should be considered during recruitment. Given the rapid growth in international MBBS programs in China, further research on the experiences of international students in China's medical programs is needed.

Factors related to university teaching that influence academic success of international medical students in China.

Background: Academic success is extremely important for international medical students enrolled in Chinese universities, as it affects their performance in their licence exams and future work opportunities. However, insufficient research has been conducted on university academic staff's awareness of teaching-related factors that affect their students' academic success. Methods: A purposive sampling approach was taken in the study to recruit academics teaching in medical universities in China. The selection of informants was based on the subject they taught and their gender, experience of teaching international medical students, educational background and career stage. Semi-structured interviews were conducted with academics ( N = 36) between November 2020 and January 2021 at two medical universities in China. Each interview lasted between 30 and 70 minutes and was audiotaped, transcribed verbatim and thematically analysed. Results: The teaching factors that academics perceived to have an important influence on the success of students were (i) pedagogy and content alignment; (ii) language barriers; (iii) resource management and the learning environment; and (iv) educator attributes and guidance. Conclusions: University faculties and departments involved in teaching international medical students should ensure that their academic staff are supported in their ongoing professional development and provided with resources to enhance their teaching quality. The four factors (and their sub-factors) listed above should be prioritised in such staff training.

Factors Influencing Life Satisfaction of International Students in Mainland China.

China is advancing in its bid to internationalize higher education, but little is known to date about the life satisfaction of overseas students in that country. Life satisfaction can be understood as the extent to which individuals' experiences in a host country help them achieve their personal goals and satisfy their expectations regarding acculturation. This paper examines past research, especially international literature, to provide an overview of factors that may influence the life satisfaction of international students in countries other than their own, and looks particularly at those matters that may also affect overseas students in China. Comparisons are made between variables identified in general and those in Asia, and specifically China. The findings have implications for policy-makers and university practitioners seeking to improve educational quality and counseling support services for international students.