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Graduation Survey of International Medical Students at Four Universities in China

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Graduation Survey of International Medical Students at Four Universities in China Perceptions of Education Quality and Inuence of Language Barrier: Graduation Survey of International Medical Students at Four Universities in China Wen Li Xuzhou Medical University Chang Liu Xuzhou Medical University Shenjun Liu Xuzhou Medical University Xin Zhang Dali University Rong-gen Shi Nanjing Medical University Hailan Jiang Nanjing Medical University Yi Ling First Aliated Hospital of Hainan Medical University Hong Sun ( [email protected] ) Xuzhou Medical University Research article Keywords: AAMC, Africa, Asia, Curriculum evaluation, Graduation questionnaire, International medical student, Language barrier, Medical education in China, Students’ perceptions Posted Date: May 12th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-27027/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/21 Version of Record: A version of this preprint was published on November 7th, 2020. See the published version at https://doi.org/10.1186/s12909-020-02340-w. Page 2/21 Abstract Background: As an increasing number of Asian and African students are studying medicine in China, it is imperative to assess the training quality of these international medical students (IMSs). The study was to gain insight into the attitudes from China-educated IMSs towards the medical curriculum and the inuence of Chinese language abilities on their clinical studies. Methods: A modied Association of American Medical Colleges Graduation Questionnaire was applied among the nal-year IMSs during the graduation season from May 2019 to July 2019 at four universities in China. The questionnaire asked IMSs to evaluate medical education quality and assess their Chinese language capacity. One-way ANOVA was used to determine whether participants' Chinese language capacity was associated with their clinical experience and clinical competence. Results: Overall, 209 valid responses were received and 76.1% were satised with the quality of the medical education. Genetics, physics, and mathematics were seen as the least helpful basic courses for practice, and 21.5% thought community-oriented medicine was a topic that lacked instruction. 58.9% were positive that discussions surrounding ethical topics were involved during their clerkships, and 71.3% believed they had acquired sucient clinical skills to begin a residency program. Chinese speaking skill and communication manner were signicant factors to inuence students' clinical experience and competence. Conclusion: The study demonstrates China-educated IMSs' perceptions of the contemporary education policy from various aspects and language inuence on their education experiences. The curriculum for IMSs in China should be more problem-based to enhance course interaction and more community- engaged to meet people's needs for health and medical care. Besides, the oral Chinese teaching and the initiative to speak need to be emphasized to facilitate the clinical training for IMSs. Our ndings can be used as a source of evidence to benchmark medical curricular codications catering for Asian and African students. Background Over the past two decades, China has experienced a dramatic growth in enrolment of international students, and clinical medicine is the most-chosen eld for academic studies [1]. Many medical schools in China provide a 6-year English-taught undergraduate program for international medical students (IMSs) and confer the bachelor of medicine degree to the qualied graduates. Delivered in different universities or colleges in China, the curricula of the program for IMSs are similar. The 1st year mainly consists of liberal arts and natural science courses (preparatory year), followed by two years of basic medical science courses (preclinical years). In the 4th and 5th years, clinical courses integrated with bedside trainings are instructed, and the 6th year is the rotating internship; this stage is known as clinical years. Aiming at producing internationally acceptable medical professionals, China trains IMSs in compliance with Global Minimum Essential Requirements in Medical Education [2] and has taken a series Page 3/21 of actions to upgrade the standard of the training quality. China International Medical Education Committee has been established [3] and national policies have also been formulated [4–6] to promote and normalize its international medical education. Currently, over 68,000 IMSs are studying in China, who are mainly from lower income countries in Asia and Africa [7]. These IMSs constitute potential medical workforce not only for their home countries, but also for the countries they intend to migrate to, such as the USA, the UK, Canada, Australia, China, and etc. [8–9]. In light of the signicant role played by these IMSs in the healthcare service of their future practice locations, it is, therefore, imperative to assess the quality of international medical education in China. Students’ feedback serves as an indispensable indicator to access the medical education [10], and the time of graduation is proposed as an appropriate moment to collect students’ voices [11]. Many researches have applied surveys among graduating students to reect various aspects of health profession education, exemplied by assessments of medical education in the UK [12] and Vietnam [13], nursing education in the USA [14], and dental education in India [15]. The Association of American Medical Colleges (AAMC) has been administering the Graduation Survey (GQ) annually since 1978 to gather opinions from nal-year medical students in the USA about their study experiences and future plans [16], which proves to be an effective tool to identify areas of strength and weakness in the medical program [17]. Developed from the version of the USA, the Canadian GQ is also applied nationally for evaluating the undergraduate MD programs in Canada [18–19]. Due to the great longitudinal stability of the AAMC GQ [20], it has been utilized by researchers to evaluate the medical education in many other countries as well, such as Nepal [21], Iran [22] and Israel [23]. There are also two studies from China, one conducted in mainland China to explore graduates’ perceptions on a medical school’s traditional and reform curricula [24] and the other conducted in Taiwan of China at 4 medical schools to collect graduates’ opinions on medical education [10]. However, to our knowledge, there is no such comprehensive graduation survey directing at IMSs in China yet, whose attitudes should have been paid due attention. During the elevation process, IMSs will provide opinions based on their pre-college experiences back home as well as future career expectations in varied countries, which are pivotal factors to be considered for the curriculum improvement. Besides, although English is the language for instruction in class, the usage of Chinese is unavoidable in the clinical environment, since most of the patients can only speak Chinese, the inuence of which on IMSs’ clerkship and internship still calls for further exploration. The study is to investigate, by using the AAMC GQ, how graduating IMSs perceive the international medical education in China and how their language abilities relate to their clinical experience and competence, hoping to provide references for helping shape the future of the education oriented to IMSs from Asian and African countries. Page 4/21 Methods Setting and participants The graduation questionnaire for IMSs (IMS GQ) was conducted among the nal-year IMSs during the graduation season from May 2019 to July 2019 at four universities in China, which are situated in four cities representing different economic and educational characteristics, aiming to present a comparatively accurate picture of international medical education in China. Instrument The IMS GQ was largely based on the AAMC GQ, modied according to the international medical education system in China, with referring to some of the previous studies [10, 21-23]. The IMS GQ contained three sections. The rst section collected students’ basic personal information, such as gender, age, nationality and university. The second section asked about students’ language capacity, including their self-evaluation of Chinese speaking skills, initiative to communicate in Chinese and information on obtaining the HSK certicate. HSK is short for Hanyu Shuiping Kaoshi, meaning Chinese language prociency test, a national written exam to test examiners’ command of Chinese in listening, reading and writing, organized by Confucius Institute Headquarters (Hanban), a subdivision of the Ministry of Education of China. The third section included 34 Likert-scale-type questions and 1 question enquiring about the internship location. These 35 questions were classied into 6 domains, namely overall satisfaction (Q11, 1 item), basic science education (Q12-Q18, 7 items), clinical education (Q19-Q31, 13 items), clinical competence (Q32-Q38, 7 items), benets of diversity (Q39-Q40, 2 items), and study hours of specic topics (Q41-Q45, 5 items). Data collection and analysis In the study, electronic questionnaire was employed, except for University A, a proportion of whose respondents completed a paper version of the questionnaire. Each of the 4 participating universities had its own questionnaire distributor(s). At the beginning of the questionnaire, it was clearly stated that the participation was completely voluntary and the result could be used for research on trends in medical education. All the participants gave consent for their opinions to be published
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