title: International students' experience of a western medical school: a mixed methods study exploring the early years in the context of cultural and social adjustment compared to students from the host country.
abstract: BACKGROUND
  Few studies have addressed the challenges associated with international students as they adapt to studying medicine in a new host country. Higher level institutions have increasing numbers of international students commencing programmes. This paper explores the experiences of a cohort of students in the early years of medical school in Ireland, where a considerable cohort are from an international background.
  
  
  METHODS
  A mixed exploratory sequential study design was carried out with medical students in the preclinical component of a five year undergraduate programme. Data for the qualitative phase was collected through 29 semi-structured interviews using the peer interview method. Thematic analysis from this phase was incorporated to develop an online questionnaire combined with components of the Student Adaptation to College Questionnaire and Student Integration Questionnaire. First year students were anonymously surveyed online. The Mokken Scaling procedure was used to investigate the students' experiences, both positive and negative.
  
  
  RESULTS
  Three main themes are identified; social adjustment, social alienation and cultural alienation. The response rate for the survey was 49% (467 Respondents). The Mokken Scaling method identified the following scales (i) Positive experience of student life; (ii) Social alienation, which comprised of negative items about feeling lonely, not fitting in, being homesick and (iii) Cultural alienation, which included the items of being uncomfortable around cultural norms of dress and contact between the sexes. With the threshold set to H = 0.4. Subscales of the positive experiences of student life scale are explored further.
  
  
  CONCLUSIONS
  Overall student adjustment to a western third level college was good. Students from regions where cultural distance is greatest reported more difficulties in adjusting. Students from these regions also demonstrate very good adaptation. Some students from the host country and more similar cultural backgrounds were also struggling. Acculturation is more complex than being associated with cultural distance and worthy of further exploration.
authors.affiliation: Anatomy Department, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. amcgarvey@rcsi.ie.
authors.forename: A
authors.initials: A
authors.lastname: McGarvey
authors.affiliation: Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. rbrugha@rcsi.ie.
authors.forename: R
authors.initials: R
authors.lastname: Brugha
authors.affiliation: Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. rconroy@rcsi.ie.
authors.forename: R M
authors.initials: RM
authors.lastname: Conroy
authors.affiliation: Health Professions Education Centre, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. eclarke@rcsi.ie.
authors.forename: E
authors.initials: E
authors.lastname: Clarke
authors.affiliation: Division of Population and Health Sciences, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin 2, Ireland. elainebyrne2@rcsi.ie.
authors.forename: E
authors.initials: E
authors.lastname: Byrne
mesh_terms: D000069:Acculturation; D003469:Culture; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland; D008297:Male; D012577:Schools, Medical; D012917:Social Adjustment; D012934:Social Isolation; D013337:Students, Medical / Q000523:psychology*; D011795:Surveys and Questionnaires