title: International medical students' expectations and worries at the beginning of their medical education: a qualitative focus group study.
abstract: BACKGROUND
  The number of international students has increased substantially within the last decade. Due to cultural barriers, this specific group faces diverse challenges. In comparison to German colleagues, international medical students perform significantly lower in clinical examinations and exceed the average duration of study; they suffer from personal distress as well as insufficient support. Within the present study, their individual perspectives, expectations, hopes and fears were examined.
  
  
  METHODS
  Four focus groups with first-year international medical students (N = 16) were conducted in October 2013. Each 60- to 90-min discussion was audiotaped, transcribed and analysed using qualitative methods.
  
  
  RESULTS
  International medical students go abroad in search of good study-conditions. For the choice of place of study, affordability, social ties as well as an educational system following the achievement principle are decisive factors. While contact with German-students and other international students is seen as beneficial, international medical students are most concerned to encounter problems and social exclusion due to language deficits and intercultural differences.
  
  
  CONCLUSIONS
  Facilitating the access to university places, the provision of financial aid and, moreover, social support, nurturing cultural integration, would greatly benefit international medical students. Hereby, the establishment of specific medical language courses as well as programs fostering intercultural-relations could prove to be valuable.
authors.affiliation: Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 2, 69115, Heidelberg, Germany. Daniel.Huhn@med.uni-heidelberg.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Huhn
authors.affiliation: Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 2, 69115, Heidelberg, Germany. Julia.Huber@med.uni-heidelberg.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Huber
authors.affiliation: Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 2, 69115, Heidelberg, Germany. Franziska.Ippen@gmx.de.
authors.forename: Franziska M
authors.initials: FM
authors.lastname: Ippen
authors.affiliation: Institute for History and Ethics in Medicine, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. Wolfgang.Eckart@histmed.uni-heidelberg.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Eckart
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tubingen, Tubingen, Germany. Florian.Junne@med.uni-tuebingen.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Junne
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tubingen, Tubingen, Germany. Stephan.Zipfel@med.uni-tuebingen.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zipfel
authors.affiliation: Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 2, 69115, Heidelberg, Germany. Wolfgang.Herzog@med.uni-heidelberg.de.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Thibautstraße 2, 69115, Heidelberg, Germany. Christoph.Nikendei@med.uni-heidelberg.de.
authors.forename: Christoph
authors.initials: C
authors.lastname: Nikendei
mesh_terms: D003144:Communication Barriers; D018864:Cultural Diversity; D004504:Education, Medical, Undergraduate / Q000191:economics / Q000379:methods / Q000592:standards*; D005260:Female; D017144:Focus Groups; D005858:Germany; D006801:Humans; D007393:International Educational Exchange; D007802:Language; D008297:Male; D036301:Qualitative Research; D012944:Social Support; D012959:Socioeconomic Factors; D013337:Students, Medical / Q000523:psychology*; D055815:Young Adult
references.citation: J Psychol. 2007 May;141(3):263-80
references.pmid: 17564257
references.citation: Med Educ. 2006 Apr;40(4):389-93
references.pmid: 16573676
references.citation: Proc Nutr Soc. 2004 Nov;63(4):655-60
references.pmid: 15831139
references.citation: Med Educ. 2004 Feb;38(2):187-98
references.pmid: 14871389
references.citation: Med Teach. 2014 Nov;36(11):923-39
references.pmid: 25072306
references.citation: JAMA. 1999 Sep 1;282(9):875-80
references.pmid: 10478695
references.citation: Med Educ. 2010 Aug;44(8):786-94
references.pmid: 20633218
references.citation: GMS Z Med Ausbild. 2014 Aug 15;31(3):Doc29
references.pmid: 25228931
references.citation: BMC Med Educ. 2006 Feb 21;6:11
references.pmid: 16504048
references.citation: J Natl Med Assoc. 1994 May;86(5):373-7
references.pmid: 8046766
references.citation: Med Teach. 2009 Jul;31(7):591-600
references.pmid: 19811144
references.citation: Med Educ. 2005 Nov;39(11):1126-8
references.pmid: 16262808
references.citation: Can Fam Physician. 1995 Oct;41:1713-6
references.pmid: 8829581
references.citation: BMJ. 2002 Apr 20;324(7343):952-7
references.pmid: 11964342
references.citation: GMS Z Med Ausbild. 2015 Feb 11;32(1):Doc9
references.pmid: 25699112
references.citation: BMC Med Educ. 2015 Jun 18;15:106
references.pmid: 26084490
references.citation: Acad Med. 2003 Jun;78(6):615-22
references.pmid: 12805042
references.citation: Med Teach. 2004 Mar;26(2):150-9
references.pmid: 15203524