research electives for international medical students

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Clinical Electives Program

Eligibility

Elective Descriptions

Specialty Rotations for Combined Program Student

The NIH Clinical Electives Program is accepting applications from students attending LCME-accredited and U.S. osteopathic schools only. The program is not reviewing international applications at the present time. Please be aware that all students coming to the NIH Clinical Center may be subject to local, state, or national requirements regarding vaccination, testing, and quarantine requirements prior to rotating.

CEP Overview

To further its mission to train the next generation of physician-scientists and clinician-investigators, the NIH Clinical Center--through the Office of Clinical Research Training and Medical Education--offers short term, 4- to 12-week clinically oriented rotations in the Clinical Electives Program (CEP). Domestic or international senior-level medical or dental students meeting the eligibility criteria may apply. The focus of the CEP is enhancing the training experience for highly motivated students who are strongly interested in, or committed to, research-oriented careers in academic medicine.

NOTE: Residents or clinical fellows currently enrolled in ACGME-accredited graduate medical education training programs in the United States may apply for short-term elective rotations at the NIH Clinical Center through the Resident Electives Program (REP) administered by the Office of Clinical Research Training and Medical Education. Interested REP applicants should visit NIH's Elective Rotations for Residents and Clinical Fellows page for more information.

CEP Objectives

• Learning about the care of patients with rare or complex disorders enrolled in human subjects research protocols at the NIH Clinical Center (a 200 bed research hospital on the campus of the National Institutes of Health in Bethesda, MD)
• Enhancing understanding of how clinical research is conducted in a scientifically valid and ethically responsible way in a compassionate training environment

CEP Eligibility

View the eligibility criteria .

The CEP welcomes applications from qualified allopathic or osteopathic medical students enrolled in Liaison Committee on Medical Education (LCME) or American Osteopathic Association (AOA) accredited medical schools, and from dental students enrolled in Commission on Dental Association) accredited dental schools. International medical or dental students with a meaningful track record of scholarly activity, especially clinical or transitional research published in reputable journals, or active engagement in mentored laboratory research, are welcomed to apply.

The CEP is not optimally suited for students who intend to enter community-based clinical practice, or (for international students) as an introduction to the health care system or practice of clinical medicine in the United States. International students should also note that CEP is not designed as a vehicle to enhance competitiveness for acceptance into US specialty or subspecialty graduate medical education training programs ("residencies or fellowships").

The CEP does not accept medical or dental school graduates for observational experiences, clinical rotations or advanced graduate medical education training in a specialty or subspecialty of medicine or dentistry. Again, residents or clinical fellows currently enrolled in ACGME-accredited graduate medical education training programs in the United States may apply for short-term elective rotations at the NIH Clinical Center through the REP .

CEP Elective Descriptions

3-Month Mentored Specialty/ Subspecialty Clinical Research Rotations

The following programs are open to applicants attending US Medical Schools accredited by the LCME or the Commission on Osteopathic College Accreditation of the AOA. Prior to applying, contact the CEP coordinator to confirm availability. At the rotation coordinator's discretion, the rotation may be shortened to 2 months.

Eligibility: Combined Program Students (i.e., MD/PhD, DO/PhD)

• Biomedical Informatics
• Cancer Immunotherapy
• Genomic Medicine
• Health Services Research
• Inflammation and Inflammatory Diseases

The following programs do not accept students in July : Critical Care Medicine, Medical Genetics, Medical Oncology, Pathology, Pediatric Oncology, Rheumatology and Surgical Oncology.

The following programs are restricted to students attending accredited institutions : Addiction Medicine, Critical Care Medicine, Internal Medicine Consult Service, Medical Oncology, Pain and Palliative Care, Radiation Oncology, Surgical Oncology and Urologic Oncology.

Accredited Institutions:

• LCME-Accredited Medical Programs
• AOA-Accredited Medical Programs
• CODA-Accredited Dental Programs

The NIH Clinical Electives Program does not offer housing or travel subsidies.

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If you have further questions or need additional information regarding Clinical Electives for students, please email [email protected] .

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Elective Module Dates Learn more

In support of our educational mission, Memorial Sloan Kettering faculty provide clinical and research electives to visiting students.

If you have any questions about our program or application procedures, please see our Frequently Asked Questions page.

Students who don’t meet the criteria for a clinical elective may apply for an observership. Please see the observership page for more details.

Visiting Student Elective Applications

Domestic medical students may begin to apply for the 2024 – 2025 academic year starting on March 11, 2024 in VSLO. Visiting students should not contact departments or elective directors during the application process. Doing so will result in disqualification from the selection process.

The deadline to apply for the 2024 – 2025 academic year is Friday May 31, 2024, at 11:59PM. We will not consider any applications once the deadline has passed.

Any former MSK employees interested in clinical rotations are encouraged to contact the GME office prior to applying.

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Global Health Electives

The Center for Global Health Equity offers fourth-year medical students opportunities for clinical and research training in global health through our robust bilateral medical student exchange programs. For each of these electives, selection is made by application only. Interviews will be conducted in person or via video communication (i.e., Zoom); three references are required. Current application due dates and applications are included below each elective description.

CHONGQING, CHINA

Chongqing clinical elective in global health.

The Chongqing Clinical Elective in Global Health is available to fourth-year Geisel medical students interested in applying clinical skills in resource-limited settings. These fellowships are expected to take place for 4-8 weeks during a student’s M4 year. Up to two students are selected annually to work with an inpatient care team to appropriately diagnose and treat general medical or pediatric patients in the Chongqing Medical University teaching hospitals. Electives are available in general OB/GYN, surgery, internal medicine or pediatrics and medical subspeciality care areas such as Cardiology, Pulmonary, Neurology, Hematology, Oncology, Gastroenterology, Genetics, Neonatology, and Infectious Disease. During their elective, students will become familiar with the disease profiles and public health challenges in Chongqing and experience cultural differences in care delivery between the US and Chongqing in terms of healthcare systems and resource allocation.

Students will be provided up to $2000 to support travel costs and immunization fees. Housing in student apartments and on-site meals will be provided by CQMU.

To qualify, applicants must be an M4 and submit a completed application, CV and a copy of your official transcript by 11:59 pm EST, February 23, 2024 . Please find more details on the application form: Download application here

If you have any questions, please contact: [email protected]

DAR ES SALAAM, TANZANIA

GEISEL SCHOOL OF MEDICINE – DARDAR ELECTIVE APPLICATIONS

The Center for Global Health Equity reviews applications for both the James Strickler Clinical Elective and the Ford von Reyn Research Elective at Muhimbili University of Health and Allied Sciences in Dar es Salaam, Tanzania. These fellowships are expected to take place for 4-8 weeks during a student’s M4 year.

To qualify, applicants must be an M4 and submit a completed application, CV and a copy of your official transcript by  11:59 pm EST, February 23, 2024.

Please find more details about each DarDar program below or on the application form:  Download application here

If you have any questions, please contact: [email protected] .

Ford von Reyn Research Elective in Global Health

The Ford von Reyn Research Elective in Global Health is available to fourth-year Geisel medical students seeking to develop their research skills in resource-limited settings. One student is selected annually to conduct clinical research at the DarDar site in Dar es Salaam, Tanzania for 4-8 weeks. Student research may involve study design, data collection and data analysis in association with one of our ongoing clinical studies of HIV-associated tuberculosis involving either adults enrolled at the DarDar site or children enrolled at the DarDar Pediatric Program. In addition to becoming familiar with the portfolio of collaborative HIV and TB research being conducted by Dartmouth and our international partners, students will learn how a Good Clinical Practices (GCP) trial is conducted, and how data are collected and validated.

A stipend will be provided as follows:  $4000 for 8 weeks; $3500 for 6-7 weeks; $3200 for 4-5 weeks (inclusive of airfare, ground transportation to and from final destination, housing, registration fees, and necessary immunizations and malaria prophylaxis).

Please find more details about the Ford von Reyn Research Elective in Global Health on the application form: Download application here

James Strickler Clinical Elective in Global Health

The James Strickler Clinical Elective in Global Health is available to fourth-year Geisel medical students interested in applying clinical skills in resource-limited settings. Up to two students are selected annually to assist with the diagnostic evaluation of and provision of care to patients at Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania during a 4-8 week elective. This elective is conducted in association with Muhimbili University of Health and Allied Sciences. During their elective, students become familiar with the spectrum of disease in a tropical setting and advance their skills in recognizing acute complications of HIV and subsequent management of care. In addition, students will gain an understanding of the sociocultural issues concerning HIV care and treatment. Prior to their departure from Tanzania, students will present a case-based lecture on an Internal Medicine subject to MNH students, residents and faculty.

A stipend will be provided as follows:  $4000 for 8 weeks; $3500 for 6-7 weeks; $3200 for 4-5 weeks (inclusive of airfare, ground transportation to and from final destination, housing, registration fees, and necessary immunizations and malaria prophylaxis).

Please find more details about the James Strickler Clinical Elective in Global Health on the application form: Download application here

KIGALI, RWANDA

University of Rwanda - College of Medicine and Health

The Center for Global Health Equity reviews applications for clinical and research electives at the University of Rwanda’s College of Medicine and Health Sciences in Kigali, Rwanda. These electives are expected to take place for 4-8 weeks during a student’s M4 year.   Students will participate in the diagnosis, care, and treatment of patients with communicable and noncommunicable diseases at a national tertiary care facility in Rwanda.  They will also identify the social determinants impacting the health of individuals admitted to the hospital and their families, while gaining an understanding of the systems issues that impact healthcare delivery in Rwanda and similar resource-limited settings.

A stipend will be provided as follows:  $4000 for 8 weeks; $3500 for 6-7 weeks, $3200 for 4-5 weeks  (inclusive of airfare, ground transportation to and from final destination, housing, registration fees, and necessary immunizations and malaria prophylaxis).

To qualify, applicants must submit a completed application, CV and official transcript by  11:59 pm EST, February 23, 2024 . Please find more details on the application form: Download application here

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Explore the elective options for visiting medical student clerkships at Mayo Clinic's campuses in Arizona, Florida, and Minnesota.

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Office of International Medicine Programs

Medical research fellowship program.

The  Medical Research Fellowship Program  (MRFP) at the George Washington University (GW) School of Medicine and Health Sciences (SMHS) provides international medical graduates with the opportunity to enhance their research and clinical skills, preparing them to be strong candidates when applying for residency programs in the United States. Since the MRFP began in 2012, 86% of research fellows have successfully matched into U.S. residency positions after completion of the program.

The goals of the program include providing opportunities for research fellows to:

• Develop a rich and longstanding relationship with a GW faculty member
• Create a network of professional contacts for future support in international medicine
• Develop critical thinking, analytical, and practical inquiry skills utilizing the latest approaches in U.S. healthcare and medical research
• Build a foundation for utilizing evidence-based medicine
• Increase skills in critical appraisal, research design, and understanding of the entire medical research process
• Publish articles or abstracts in peer-reviewed journals and present research posters or papers at conferences
• Gain first-hand knowledge of the U.S. healthcare delivery and medical education system
• Develop personal and group leadership skills necessary for advancement in clinical practice and research
• Develop strategies for communicating clinical research and medical information in spoken and written English
• Gain broad public speaking and presentation experience and participate in at least one professional conference in field of interest

Research : Research fellows attend weekly critical appraisal sessions to increase their knowledge of research methods, analyze the latest in medical publications, and publish letters to the editor. Research fellows also participate in individual and group research projects alongside their faculty mentor aiming to present at a national conference and publish in a peer-reviewed journal.

Clinical observation : Research fellows actively and successfully participate as members of a clinical team. While direct, hands-on patient contact is not permitted, the research fellow engages with the team in all other clinical activities. 

One-on-one mentorship : Each research fellow is matched with a GW faculty mentor in their specialty of choice. Research fellows join the faculty mentor and are integrated into the clinical team, which includes faculty, residents, and students. The faculty mentor provides counseling and guidance through weekly meetings.

U.S. residency application preparation : Research fellows are supported by IMP staff and the Program Medical Director who provide residency preparation interviews and review of curriculum vitae and personal statements. Research fellows can obtain detailed and personalized letters of recommendation from GW faculty members when appropriate. 

Professional development : Research fellows attend regular clinical department grand rounds, conferences, and lectures with their team of faculty, residents, and students. Research fellows are key members of the team and fully participate in department activities. 

Application Process

Research fellows can participate in the program for a duration of 6 months or 12 months. The recommended start date is in May and alternative start dates are considered on a case-by-case basis. Applicants should submit the following required documents to the Office of International Medicine Programs (IMP) at  [email protected] :

• Headshot photograph
• Curriculum vitae 
• Personal statement (1 page)
• Medical school degree
• Medical school transcript
• Three letters of recommendation
• USMLE Step 1 and 2 score reports (if available)

Please contact [email protected]  with any questions or to request additional information about the program fees.

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Application.

Please see Required Documents for Visiting Student Elective Program.

Applications must be submitted through AAMC Visiting Student Learning Opportunities (VSLO) website https://students-residents.aamc.org/visiting-student-learning-opportunities/visiting-student-learning-opportunities-vslo

No, students are not allowed to re-apply once they have submitted an application and have been declined.

In most cases , applicants are notified no later than 2 months prior to the desired elective rotation.

Four (4) months prior to the desired elective rotation, however, we suggest students submit their applications six (6) months in advance. Applications submitted after the four (4) month deadline will not be considered.

Yes, the TOEFL is mandatory, however, will accept the IELTS or other Language Proficiency test such as OET, CAE or CPE only. We do not accept letters from the applicants’ home institutions, stating the medium of instruction is in English. Also, if you have completed another clinical elective or research in the US, we will consider the completion documentation. At this time, we do not accept the Duolingo English Test for our clinical elective programs.

The School of Medicine does not have a TOEFL code. Please upload a copy of your TOEFL scores through the AAMC VSLO application.

Eligibility

Participation in the Visiting International Student Elective Program does not require visiting students to obtain an F-1 or J-1 visa, and instead can be done using a visitor visa. International participants are responsible for securing the appropriate travel documents to travel to the United States for the duration of the program. The program will provide a visa support letter. Please refer to the Department of State website regarding visitor visas for more information.

Unfortunately, all applicants are required to provide documentation of completion of their required core clerkships to be eligible for our program. You can submit your application prior to completing your clerkships, however, your dean’s letter of support will need to detail when your required core clerkships will be complete. Please note, we will not be able to place you on a clinical elective rotation until after the required clerkships are complete. We will request confirmation of completion.

Unfortunately, the roster is always changing, so we cannot determine what seats are available. We encourage you to apply for the electives you plan to make a career in.

Understanding that education systems are structured differently. If the applicant has completed their required core clerkships and can provide proof of completion, they can apply to complete a clinical elective at YSM.

Our office will not be able to fully review incomplete applications. All required documentation must be submitted to make a full determination on an application. Incomplete applications will be declined.

You can find a complete listing of clinical electives offered at YSM on the Medical Education webpage: https://medicine.yale.edu/md-program/curriculum/advancedtraining/clinicalelectives/electivecataloglisting/

Please click on the individual electives to see the full elective descriptions and learning objectives.

No. Students may only take up to three (3) different elective rotations. However, the electives must be in different sub-specialties, the elective may be taken within the same department.

Unfortunately, it is difficult to give this information, as elective schedules can change on a daily and weekly basis.

No. Visiting students must apply for clinical electives in accordance with the Yale rotation schedule.

No, these are clinical electives and do not satisfy core clerkship requirements.

No, applicants must be an active medical student in good academic standing for the entire duration of their elective. Applicants must be returning to their home institution to complete graduation requirements.

Yes, however, students who withdraw less than 5 weeks prior to the start of the assigned elective may have a letter of complaint sent to the Dean of their medical school. No refunds will be made except in extenuating circumstances. All refunds are reviewed on a case-by-case basis with extenuating circumstances only and must receive approval from the Office of Global Health Education.

Observerships

Yale School of Medicine Observership Policy

Affiliate Schools

The following schools have active affiliation agreements with Yale School of Medicine:

• Makerere University
• Pontificia Universidad Catolica de Chile
• University of Ghana
• University of West Indies
• Xiangya Medical School

Yes, however, student must communicate with their designated representative at the affiliate medical school prior to applying.

Tuition & Fees

There are payable applications fees to the AAMC, however, Yale School of Medicine also charges a processing fee of $200 USD.

The tuition for a four-week clinical elective for students from international medical schools for academic year 2024-2025 is $4,500 USD. The tuition for eight weeks is $9,000 USD. The tuition for twelve weeks is $13,500 USD. Tuition is subject to increases with every new academic year. This typically happens in July.

We accept Credit Card payment. If you have questions, please email [email protected]

General Information

Students are required to have their physical passport, to obtain IDs, please note other forms of identification will not be accepted

The dress code on the wards is professional attire. Men should wear button-down shirts and ties, and women should wear dress pants or skirt. Students can bring a white coat to wear on the wards or purchase a white coat at a nearby bookstore. Please note that in the U.S. medical students wear short white coats – you must have a short white coat, long ones are worn by residents and fellows and will not be permitted for students.

Yes, please use our Medical Student Clinical Work Hours Policy .

The mandatory orientation for each clinical rotation will be held the Friday prior to the start of the clinical rotation.

COVID Requirements

All accepted students are required to provide documentation of completed primary COVID-19 series and booster dose dated after September 2022

No, you will receive specific PPE for clinical activities during your orientation, which will be included in your elective fees. You will be required to use this hospital issued PPE during your elective. You can optionally bring your own PPE for outside of the clinical setting.

Yes, you must have health insurance which covers any necessary hospitalization or doctor’s visit due to illness or injury. Proof of insurance is a requirement and must be provided before an accepted student will be approved to enter the clinical setting.

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International Visiting Student Program

The International Visiting Student Program is currently accepting applications for academic year 24-25. This program is ONLY for international students who have completed their core clinical training and are in their final year of medical education. We do not accept medical graduates.

All correspondence should be sent directly to the international visiting student coordinators at [email protected] . Please do not reach out to UPSOM/UPMC staff/faculty or department coordinators directly with unsolicited emails.

Students from schools participating in the Visiting Student Learning Opportunities (VSLO) Program (only apply once, either by VSLO or paper, not both):

Our AY 24-25 international visiting elective catalog is available in the VSLO system. Please be aware that slot availability changes on a daily and weekly basis and cannot be guaranteed. You may only apply to two electives. If more elective requests are submitted, only your first and second choices will be reviewed. Dates for clinical electives must be in accordance with the UPSOM rotation schedule (period date information can be found on the application form) and no special accommodations or exceptions will be made to change these dates. Pre-requisites are for UPSOM students and not for international visiting students.  Once your elective rotation has been confirmed,   please be advised that no change/date adjustments will be made . Students whose home institution participate in the program will be able to view our catalog for electives directly through the  VSLO® Program for Institutions | AAMC . 

Students from schools not participating in the VSLO program (only apply once, either by VSLO or paper, not both):

All requirements on the checklist must be provided with your initial submission or your application will be rejected . For students from institutions that are not participants in the VSLO, please complete our paper application process. There is a searchable course catalog for AY 24-25 offered electives and availability on the second page of the application form. International students can only apply to electives that show available to international students. Pre-requisites are for UPSOM students and not for international visiting students. The completed application and required documents should be submitted to [email protected] .  Click here to view and download the application .

The following are some answers, as well as information, to the most asked questions about our program:

1. We have a searchable   course catalog   for the offered AY 24-25 electives. You can also access the catalog on the second page of our paper application (downloadable above). Be aware that any available slot can change on a daily and/or weekly basis so we cannot guarantee slot availability. These slots are filled by UPSOM, domestic visiting and international visiting students. We encourage you to apply for the electives in which you plan to make your career.  Dates for clinical electives must be in accordance with the UPSOM rotation schedule (dates can be found on application form) and no special accommodations or exceptions will be made to change these dates. Should you apply with dates that are not congruent with the listed period dates your application will be rejected. You may only apply to two electives. Once your elective has been confirmed,   please be advised that no change/date adjustments will be made.

2. The required pro-rated tuition payment is in the amount of $4,500 per elective.   This fee is not paid upon submission of an application . Tuition will be paid by Flywire,  ONLY  after acceptance by both the Global Health Deans and the requested rotation department. If approved, you will receive an acceptance email with payment information, as well as an acceptance letter for Visa purposes. You will be given 48 hours to complete this payment. Please be aware that since this program is only for international visiting students, the payment system set-up with Flywire is only for payment from international banks to US banks and will not work with payments from US bank to US bank. A merican citizens should only apply if they have an international bank account in which to pay this fee.    Students can be accepted for up to two 4-week elective experiences. These experiences do not have to be consecutive or in the same department. Our program does not currently offer any financial grants or scholarships. Due to FERPA regulations we will not engage with any family members regarding your elective or payment requirements, we will only engage with students that have applied to our program.

PLEASE NOTE (this is only for approved and paid electives) : Cancellations made 60 days prior to the start of any approved and paid elective will result in a 25% administrative fee deducted from the pro-rated tuition paid via Flywire. Therefore, reimbursement will only be for 75% of the paid pro-rated tuition. Cancellations made 30 days prior to the start of any approved and paid elective will result in a 50% administrative fee deducted from the pro-rated tuition paid via Flywire. Therefore, reimbursement will only be for 50% of the paid pro-rated tuition. Reimbursements take up to a month to receive back to the payment platform originally paid via Flywire.

3. The malpractice insurance requirement can be purchased after you have been accepted. Please see checklist for specific information. This is on the student to purchase and cannot be purchased through MSRIS. Please see additional resources for the malpractice company used by past students. For your application, please include a memo/letter stating that you will purchase the required coverage upon acceptance. Health insurance must cover any necessary hospitalization or doctor’s visit due to illness or injury. Proof of insurance is a requirement and must be provided before an accepted student will be approved to enter the clinical setting.

4.  For the State of Pennsylvania clearance requirements, only the completed PA Act 34 and the filled-out application for the PA Act 33 are required when applying. The completed PA Act 33 will need to be submitted to us upon acceptance. Also, upon acceptance, the PA Act 73 will be completed and paid for before your arrival in Pittsburgh. When any completed certificate is received this must be sent to the [email protected]  email. Instructions for completing these State of Pennsylvania clearances can be found in additional resources. There are links on the instructions to the PA government websites for any issues that you encounter for either completion or payment. Please be aware that each of these clearances require payment and our office cannot help with payment or completion of these clearances. No international medical student has had an issue with providing all three completed clearances. These forms DO NOT get mailed to Scaife Hall.

5. Unless your medical school is located in an English-speaking country, you must provide one of the following test scores. These scores are an important factor in application review and acceptance, so it is strongly suggested that you submit either report even if your home institution states you have strong English proficiency. Official TOEFL score must be 100 or higher to apply. Official Duolingo report must be 120 or higher to apply. Please make sure that either report is provided without a password  encryption or your application will be rejected.  We also accept OET exam reports. You must attain a minimum score of 350 on the listening, reading and speaking sub-tests, and a minimum score of 300 in writing sub-test, in one test administration.

6. Your completed and signed AAMC Immunization form will need to be submitted with your application. Any vaccine series currently in process can be worked on after you apply, please just include a note on the form to clarify any situations of incomplete records. You can find additional information on the "information for required immunizations" listed in additional resources. Frequently asked questions regarding immunizations can be found on the AAMC website at:  https://www.aamc.org/media/23446/download?attachment .

7. Visa information can be found in Additional Resources. If accepted, students will receive an acceptance letter for Visa purposes.

8. All applications are reviewed on the strength of English proficiency, academic standing, statement of interest and the availability of the requested elective. Your statement of interest should be 200 words or less about why you are interested in the University of Pittsburgh School of Medicine   and the electives in which you are applying . This is another determining factor of acceptance. Please be aware that if you are applying for MED or SURG these are the most requested departments by UPSOM students, domestic visiting students as well as international visiting students.   Once your elective has been confirmed, please be advised that no change/date adjustment will be made.

9. The USMLE Step 2 exam is a requirement to apply for a Psychiatric elective. However, it is suggested that you provide this when applying for other electives as well. Please do not provide Step 1 scores as these are not necessary.

10. You must provide an up-to-date CV with a picture.

11. Neither UPSOM nor UPMC offer housing. This is the responsibility of the student. Offsite housing opportunities can be found under additional resources.

12.  The deadline to submit an application is 3 months before the start date of the elective in which you are applying. This is to allow for proper review and preparation of your application by both the Global Health Deans and the requested department. All applications must be received with the required information (see checklist) or the application will be rejected. Be assured that you will receive an acceptance/denial email no less than a month prior to the start date of the elective. Please be aware that we do not reconsider after denial.

Questions that have not been answered above? Contact the International Visiting Student coordinators at   [email protected]

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Clinical Electives Program

Eligibility

Elective Descriptions

Specialty Rotations for Combined Program Student

The NIH Clinical Electives Program is accepting applications from students attending LCME-accredited and U.S. osteopathic schools only. The program is not reviewing international applications at the present time. Please be aware that all students coming to the NIH Clinical Center may be subject to local, state, or national requirements regarding vaccination, testing, and quarantine requirements prior to rotating.

CEP Overview

To further its mission to train the next generation of physician-scientists and clinician-investigators, the NIH Clinical Center--through the Office of Clinical Research Training and Medical Education--offers short term, 4- to 12-week clinically oriented rotations in the Clinical Electives Program (CEP). Domestic or international senior-level medical or dental students meeting the eligibility criteria may apply. The focus of the CEP is enhancing the training experience for highly motivated students who are strongly interested in, or committed to, research-oriented careers in academic medicine.

NOTE: Residents or clinical fellows currently enrolled in ACGME-accredited graduate medical education training programs in the United States may apply for short-term elective rotations at the NIH Clinical Center through the Resident Electives Program (REP) administered by the Office of Clinical Research Training and Medical Education. Interested REP applicants should visit NIH's Elective Rotations for Residents and Clinical Fellows page for more information.

CEP Objectives

• Learning about the care of patients with rare or complex disorders enrolled in human subjects research protocols at the NIH Clinical Center (a 200 bed research hospital on the campus of the National Institutes of Health in Bethesda, MD)
• Enhancing understanding of how clinical research is conducted in a scientifically valid and ethically responsible way in a compassionate training environment

CEP Eligibility

View the eligibility criteria .

The CEP welcomes applications from qualified allopathic or osteopathic medical students enrolled in Liaison Committee on Medical Education (LCME) or American Osteopathic Association (AOA) accredited medical schools, and from dental students enrolled in Commission on Dental Association) accredited dental schools. International medical or dental students with a meaningful track record of scholarly activity, especially clinical or transitional research published in reputable journals, or active engagement in mentored laboratory research, are welcomed to apply.

The CEP is not optimally suited for students who intend to enter community-based clinical practice, or (for international students) as an introduction to the health care system or practice of clinical medicine in the United States. International students should also note that CEP is not designed as a vehicle to enhance competitiveness for acceptance into US specialty or subspecialty graduate medical education training programs ("residencies or fellowships").

The CEP does not accept medical or dental school graduates for observational experiences, clinical rotations or advanced graduate medical education training in a specialty or subspecialty of medicine or dentistry. Again, residents or clinical fellows currently enrolled in ACGME-accredited graduate medical education training programs in the United States may apply for short-term elective rotations at the NIH Clinical Center through the REP .

CEP Elective Descriptions

3-Month Mentored Specialty/ Subspecialty Clinical Research Rotations

The following programs are open to applicants attending US Medical Schools accredited by the LCME or the Commission on Osteopathic College Accreditation of the AOA. Prior to applying, contact the CEP coordinator to confirm availability. At the rotation coordinator's discretion, the rotation may be shortened to 2 months.

Eligibility: Combined Program Students (i.e., MD/PhD, DO/PhD)

• Biomedical Informatics
• Cancer Immunotherapy
• Genomic Medicine
• Health Services Research
• Inflammation and Inflammatory Diseases

The following programs do not accept students in July : Critical Care Medicine, Medical Genetics, Medical Oncology, Pathology, Pediatric Oncology, Rheumatology and Surgical Oncology.

The following programs are restricted to students attending accredited institutions : Addiction Medicine, Critical Care Medicine, Internal Medicine Consult Service, Medical Oncology, Pain and Palliative Care, Radiation Oncology, Surgical Oncology and Urologic Oncology.

Accredited Institutions:

• LCME-Accredited Medical Programs
• AOA-Accredited Medical Programs
• CODA-Accredited Dental Programs

The NIH Clinical Electives Program does not offer housing or travel subsidies.

• General Information
• Academic Programs and Resources Available to Students
• Application

If you have further questions or need additional information regarding Clinical Electives for students, please email [email protected] .

US ELECTIVES

How to Secure US Medical Electives and Rotations With AMO

At AMO, our mission is to create educational equality by arranging medical electives in the USA for international & domestic medical students, graduates, and trainees. 

These medical electives are created through partnerships with U.S. physicians, institutions, and hospitals with the belief that IMGs play an important part in improving the U.S. healthcare system. 

Medical electives are an essential step towards pursuing a career in the U.S. healthcare system, for the Match, and for medical school. They can cultivate valuable medical, professional, and communication skills. They can also provide clinical knowledge and skills that may be useful when taking the USMLE Step 2 CK or CS.  

Here's how to apply for your AMO medical elective:

• Create a free account with AMO. You'll submit your contact information, medical school information, clinical rotation preferences, and more.
• Search our database of 200+ clinical rotation sites. 
• Select your preferred medicine elective and apply for free.
• Once approved, Reserve your USA clinical elective rotation, observership, or virtual elective rotation.

Read More >

Benefits of Choosing AMO

AMOpportunities has helped more than 3,000 international medical students, graduates, and trainees get clinical electives in the U.S.   We offer U.S., U.K., and virtual medical elective programs in 70+ specialties and subspecialties such as internal medicine, family medicine, pediatrics, and OBGYN. Read why you should choose AMO for your elective.

• Most extensive medical student elective platform in the world.
• Partner with top U.S. hospitals
• Simple application process.
• Personalized world-class support.

Benefits of a US Medical Elective

For current international medical students and graduates hoping to practice medicine in the United States, a medical elective in the USA is essential. AMO connects IMGs with notable physicians and institutions who look forward to hosting international medical trainees. We have student electives in cities across the U.S., including New York, Chicago, and Los Angeles. Learn about the US healthcare system and practicing medicine during your Elective in the USA

We also act as a support system for IMGs during their rotation. Continue reading below for information on how USCE such as medical electives and other medical student rotations can serve your current education and your future goals.

• Interact with U.S. physicians, medical staff, and patients.
• Learn professional skills.
• Earn LoRs to apply for the Match.
• Obtain school credit for your core and medical student electives abroad.
• Build your CV/resume
• Gain knowledge and practice medical English.
• Experience the U.S. healthcare system.

Top AMO Virtual Elective

Work with the program director for the Harvard Medical School Plastic Surgery Residency Program and an associate professor from Harvard Medical School during this  virtual plastic surgery elective . Visitors receive a letter of recommendation on hospital letterhead.

Top AMO Clinical Elective

AMO offers  15 entirely inpatient clinical experiences  at Saint Anthony Hospital in Chicago, including  internal medicine, general surgery, and cardiology . The ACGME-affiliated hospital is also affiliated with a variety of hospitals such as University of Chicago Medicine and UI Health.

Top AMO Electives

Rotate in the hospital and clinic setting with our  six hospital-based student electives through Lompoc Valley Medical Center  in California in cardiology, family medicine, general surgery, and pediatrics. The cardiology, general surgery, and pediatrics programs all have inpatient exposure.

Guides and Visitor Stories

My experience with AMO was special for me. They were not only my guide abroad but also have become my family and best friends. I haven't felt lost at all not even for a minute. Thanks to their amazing communication skills and humbleness. They provide coaches and advisors who help you not only choose your rotations but also accommodation, transportation, and a lot more! I took two rotations with AMO and I am absolutely happy with my US clinical experience. 

Raad, Saudi Arabia Family Medicine and Dermatology

Attended a clinical rotation in neurology in Buffalo back in 2018 and had the experience of my life. AMO opportunity definitely helped me throughout this process. It was easy, convenient and reasonable in terms of cost. Will definitely go for another rotation through AMO.  

Bhageeta, Malaysia Neurosurgery

AMO's Guide to Letters of Recommendation

A   letter of recommendation (LoR)   is a document, generally used for the Match and written on official letterhead, that provides insight on an applicant’s character, experience, and skills from the perspective of someone other than the applicant. 

Share Your AMO Story: Margil

Medical student exchange programs can be awesome, but you don’t have to take our word for it! Margil, a medical graduate from India, shares it all in his blog post. Although he was initially unsure of whether or not to take a chance and sign up for a U.S. clinical rotation, Margil had an amazing experience.

Share Your AMO Story: Besmira

We recently got in touch with Besmira, a medical resident from Albania who completed a clinical experience with AMO in 2017. Since then, Besmira started her medical residency in Albania. She hopes to participate in another clinical experience with AMO

444 N. Wells St., Chicago IL 60654 (+1) 312 821 9020 [email protected]

Terms & Conditions

• Weill Cornell Medicine

Year-Long Global Health Opportunities and Fellowships

Fully-funded:.

• VECD Fogarty Global Health Fellowships The WCMC Center for Global Health recently received NIH Fogarty funding as a consortium with Vanderbilt (V), Emory (E), Cornell (C), and Duke (D) to train medical students and post-doctoral fellows in global health research. Support is provided for one year (stipend, travel, supplies) to conduct mentored clinical research at one of the Center for Global Health international sites (Haiti; Tanzania; Brazil). There will be 1-3 slots per year at Weill-Cornell and the application process is competitive. The start date of the one-year training will be in July. Interested WCMC students should contact  Dr. Dan Fitzgerald  and  Lindsey Reif . (Note: The Fogarty Global Health Fellowship Program has replaced the Fogarty International Clinical Research Scholars and Fellows Program.)
• Doris Duke Charitable Foundation: Clinical Research Fellowship for Medical Students The Doris Duke Clinical Research Fellowship (CRF) provides support for one year of full-time clinical research training. The main goal of the program is to encourage medical students to pursue careers in clinical research. Interested medical students must be willing to take a year out from school and conduct fellowship research and training at one of 12 hosting medical schools. Six of the 12 participating schools offer international fellowship opportunities.
• BOTUSA Project - Research Fellowship for Senior Medical Students (6+ Month Elective) The BOTUSA Project is a collaborative effort between the Botswana Ministry of Health, the  U.S. Centers for Disease Control and Prevention\Division of Tuberculosis Elimination   (CDC\DTBE), and the Global AIDS Program (GAP). The principal goal of the BOTUSA Project is to expand our knowledge of the relationship between epidemic tuberculosis (TB) and epidemic HIV disease in a resource-poor country setting so that this information can be used to develop prevention strategies for the local and global control of TB. BOTUSA staff work closely with counterparts in the Botswana National TB Programme and AIDS Control Programme. BOTUSA has a medical student fellowship to provide third or fourth-year medical students the opportunity to participate in CDC research in Botswana, as well as gain experience with clinical medicine and culture in a developing country.
• Each year, eight competitively selected medical students from around the country spend 10-12 months at the Centers for Disease Control and Prevention (CDC) in Atlanta. At CDC they gain an in-depth understanding of applied epidemiology, the role of epidemiology in medicine and health, and the role of physicians in the public health system. With the guidance of experienced CDC epidemiologists, they perform epidemiologic analyses and research, design public health interventions and assist in field investigations. Possible areas of concentration include birth defects, injury prevention, chronic disease, infectious disease, environmental health, reproductive health and minority health.
• CDC Foundation - O.C. Hubert Fellowship in International Health The year-long fellowship provides third- and fourth-year medical and veterinary students with valuable public health experience in an international setting. The main focus of the fellowship is a 6- to 12-week field assignment. Fellows are mentored by experienced CDC staff and learn through hands-on experience while working on a public health project in a developing country. Projects vary each year, and applicants may indicate a preference for up to five field assignments. The CDC-Hubert Global Health Fellowship is endowed by the O.C. Hubert Charitable Trust.
• Global Health Corps GHC provides opportunities for young professionals from diverse backgrounds to work on the frontlines of the fight for global health equity in year-long paid positions. During their fellowship year, fellows make a significant and measurable contribution to the partner organization and the target population. GHC partners with organizations that range from small grassroots organizations to large global institutions. Fellow candidates apply for specific positions with one of the partner organizations for which they have relevant skills and experience, and are selected jointly by GHC and the partner organization. In the 2013-2014 fellow class, GHC had 52 American fellows serving in Burundi, Malawi, Rwanda, Uganda, Zambia and the US.
• biomedical research training for medical, dental, and veterinary students enrolled in schools in the U.S. The fellowship research may be conducted at any academic or nonprofit institution in the United States, except the National Institutes of Health. Research may be conducted abroad if the fellow's mentor is affiliated with a U.S. institution.
• Year-Off Training Program for Graduate or Medical Students in Clinical and Translational Science The Year-off  Training  Program for Graduate and Medical Students provides opportunities for students who are enrolled in graduate or medical degree programs to engage in biomedical research at the Rockefeller Center for Clinical and Translational Science. Those selected for the program come to the Center with the understanding that they will return to their degree-granting institution and program within one year. In an environment devoted exclusively to biomedical research, trainees work under the supervision of some of the leading clinical and translational scientists in the world. The trainee can select from among the 75 different laboratories on the Rockefeller campus. In addition, trainees participate in the didactic programs and lectures developed for Clinical Scholars.

Volunteer/Partially Funded:

• American Medical Women's Association (AMWA) Overseas Assistance Grant AMWA provides small grants, up to $1,500,  for assistance with transportation costs (airfare, train fare, etc.) connected with pursuing medical studies in an off-campus setting where the medically neglected will benefit. The Grants are awarded to national AMWA members completing their second, third or fourth year of an accredited U.S. medical or osteopathic medical school or a resident who will be spending a minimum of six weeks and no longer than one year in a sponsored program which will serve the needs of the medically underserved.
• International Society of Travel Medicine  The ISTM Research  Award program provides moderate grants (between USD 5,000 and USD 10,000) each year through a peer-review process implemented by the ISTM Research and Grants Committee. These grants are designed to stimulate travel medicine research by supporting comprehensive research projects or, for larger projects, providing support for pilot studies to enable researchers to collect data/test hypotheses so that they can then apply to other agencies for more substantive research grants.
• Remote Area Medical The Remote Area Medical (RAM) Volunteer Corps is a non-profit, volunteer, airborne relief corps dedicated to serving mankind by providing free health care, dental care, eye care, veterinary services, and technical and educational assistance to people in remote areas of the United States and the world. Volunteer doctors, nurses, pilots, veterinarians and support workers participate in expeditions (at their own expense) in some of the world's most exciting places. Medical supplies, medicines, facilities and vehicles are donated. To volunteer as a student, you must have school sponsorship and supervision in the form of a licensed practitioner. RAM aims at development rather than dependence so volunteers are typically involved in education and organization as much as direct health care service.
• Volunteer Missionary Movement The Volunteer Missionary Movement (VMM)  was founded in 1969 by Edwina Gateley, an English laywoman, in response to a need for lay people to become more deeply involved in the mission life of the Church. After spending three years in Uganda, where she opened a very successful school for young girls and worked as a teacher, she returned to England and began to recruit and train volunteer missionaries to work in education, healthcare and pastoral projects in eastern Africa. As VMM became more widely known, it was able to send volunteers to communities in need throughout Africa, Asia, and Latin America. Transportation, housing, and food can be covered by the organization.
• Unite for Sight Global Impact Corps Unite For Sight supports eye clinics in  Ghana, India and Honduras by investing human and financial resources in their social ventures to eliminate patient barriers to eye care. Unite For Sight applies best practices in eye care, public health, volunteerism, and social entrepreneurship to achieve our goal of high-quality eye care for all. Global Impact Fellows are volunteers that range from undergraduate students to medical students, public health students and professionals, nurses, educators, opticians, optometrists and ophthalmologists. They receive all necessary training from Unite For Sight so that they are able to assist the local doctors with global health delivery. Global Impact Fellows participating with Unite For Sight abroad have the option to also design and pursue a global health research study.

WCM Students

International Students

Weill Cornell Medicine Office of International Medical Student Education 1300 York Avenue (C-118) New York, NY 10065 Phone: (646) 962-8058 [email protected]

Masks Strongly Recommended but Not Required in Maryland

Respiratory viruses continue to circulate in Maryland, so masking remains strongly recommended when you visit Johns Hopkins Medicine clinical locations in Maryland. To protect your loved one, please do not visit if you are sick or have a COVID-19 positive test result. Get more resources on masking and COVID-19 precautions .

• Vaccines  
• Masking Guidelines
• Visitor Guidelines  

Office of the Registrar

International students, must i enroll in the health insurance offered by jhusom.

All visiting students must have health insurance that meets the minimum requirements established by the JHUSOM. For students completing electives of 9 weeks (one quarter) or less, travel insurance that meets the J-1 exchange visitor health insurance requirements is an acceptable alternative. If you do not have acceptable alternative coverage, you will be required to enroll in the JHUSOM student health program.

For international students who can waive the JHUSOM student health program, a  health insurance waiver form  is required.

More information concerning the medical insurance plan  offered through JHUSOM is available .

What are the visa requirements?

Accepted visiting medical students will be provided with the necessary documentation to support their application for a B-1/B-2 visa [or entry under the Visa Waiver Program]. Visiting Medical Students should adhere to the guidance of the Consulate or Embassy in the home country for more information on the B-1/B-2 visa application process.

How do I apply for a visa?

The visa application process and services offered by the Office of International Student, Faculty and Staff Services will be provided once you have been accepted for an elective.

Medical School

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Visiting International Students

Due to the large number of foreign medical student applicants to the University of Minnesota Medical School, we have found it necessary to restrict registration of students to those applying from institutions with which we have affiliation agreements.

The required criteria are listed below.  Only students identified by the visiting institutions Dean's office will be considered. Two students per site are accepted per academic year.  Application and list of requirements will be sent to selected students upon notification.

Formally affiliated sites

If you attend one of these schools you may be eligible for an elective at the University of Minnesota. You should contact your international program's office for application details. 

• Makerere University, Kampala, Uganda
• Selian Lutheran Hospital, Arusha, Tanzania
• St. John’s Medical College, Bangalore, India
• Kasturba Medical College, India
• Baruch Padeh – Poriya Hospital, Tiberias, Israel
• Keio University, Tokyo, Japan
• Juntendo University, Tokyo, Japan
• Seoul National University, Seoul, Korea
• Chiang Mai University, Thailand
• Mahidol University, Thailand
• The National University of Ireland, Galway, Ireland
• Karolinska Institute, Stockholm, Sweden
• Pontificia Unversidad Catolica de Chile, Santiago, Chile
• Universidad de Ciencias Medicas (UCIMED) San Jose, Costa Rica

Universidad Nacional Autonoma de Mexico (UNAM) Mexico City, Mexico

Global Medical Education and Research Program

• Affiliated Sites
• GMER Student Travel Awards
• Years 1 & 2 Medical Students
• Year 4 Medical Students
• International Students

• School of Health Professions
• School of Medicine
• School of Nursing
• University of Kansas
• The University of Kansas Health System
• The University of Kansas Cancer Center
• Academic and Student Affairs

Office of International Programs

• School of Medicine Clinical Electives Program
• Application Process
• Application Request
• Program Requirements

Electives Offered

• Eligibility
• International Alumni Highlights
• School of Nursing International Visiting Student Program
• Immunization Requirements
• Our Campuses
• Make a Gift
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Clinical electives are offered to international students in their fourth year of medical school. Priority for these positions is given to KU School of Medicine students.

Important information

International students interested in the KU School of Medicine Clinical Electives Program should note the following before applying:

• Each elective has a maximum number of students allowed. Priority is given to students already enrolled at the University of Kansas Medical Center.
• Though the list below gives many types of clinical-rotation electives, you are only reserving a space in the program. You cannot immediately reserve a particular rotation elective and must agree to whichever rotation that becomes available.
• We will confirm a space for you in our program well in advance of your coming, if you meet our requirements and if we have an available slot.
• About 6-8 weeks prior to the start of the clinical rotation, we may be able to determine the department where you will be working. This delay should be expected due to the KU School of Medicine process.
• At the time of your acceptance, you are obligated to secure your space with the application fee and accommodation fee, both of which are non-refundable.

Electives Offered to International Students

The following is a list of electives available to international students and not a complete list of all of KU Medical Center's clinical-rotation electives.

Diagnostic Radiology

*DIAG 910 -- Diagnostic Radiology - The student will work in all phases of diagnostic radiology including gastrointestinal, neuroradiology, pediatric radiology, cardiovascular and special procedure radiology. * This elective is not offered every module. Availability will be determined on an "as received" basis.

Care Gynecology and Obstetrics

GYNO 918 - Gynecologic Oncology - Subject material consists of the clinical science of oncology as applied to malignancies of the vulva, vagina, cervix, uterus, ovary and trophoblast. The student should be able to describe and define malignancies of the female genital tract in general terms and complete a clinical study in detail in the area of gynecologic oncology. The student will be evaluated by faculty judgment for general information, and a specific assessment of student projects will be performed.

Anesthesiology

ANES 910 -- Anesthesiology - Students will work in the operating room suite in the mornings under the direct supervision of an instructor in anesthesia and will be made to feel that they are part of the cooperative, expert team caring for each patient. In addition, the basic fundamentals of anesthesiology will be taught by means of lectures, seminars, and conferences in the afternoons, as well as through clinical situations.

Internal Medicine

MED 910 -- Clinical Cardiology - The clerkship in cardiology offers experience in the clinical evaluation and treatment of patients with a variety of cardiovascular problems. The students, as subinterns, will function in the coronary care unit as an integral part in the care of the seriously ill patient with a wide range of problems. The students will make coronary care rounds with one of the members of the cardiology staff, during which time clinical skills in bedside diagnosis, auscultation and palpitation will be emphasized and developed. They will have an opportunity to develop expertise in the interpretation of electrocardiograms on a daily basis.

The treatment of arrhythmias and heart failure will be stressed. They will also have an opportunity to evaluate in-hospital consultations as well as outpatient consultations and to see postoperative follow-up patients. They will have an opportunity to follow patients through cardiac catheterization procedures and to participate in the computations and assessment of the catheterization date. Indications for cardiovascular operations will be emphasized in weekly conferences.

MED 920 -- Advanced Gastroenterology - This clerkship is directed toward specific problems of gastrointestinal disease. The clinical clerk is involved in ward care and ward work, including admission work-up of patients, their daily care, staff rounds, X-ray interpretation, treatment of specific GI disease, long term therapy, and follow-up in the outpatient clinic. The clerk is supervised by the GI resident or fellows and can participate in special GI procedures on patients, such as endoscopy and motility studies. The clerk is instructed in proctoscopy until he/she has mastered this as a routine procedure.

MED 930 -- Clinical Hematology - This will consist of inpatient and outpatient care, dealing with all types of hematologic disorders. The student will be given experience and instruction in morphology of peripheral blood and bone marrow. Weekly conferences, didactic and participating study sessions with the hematology staff will be conducted.

MED 970 -- Clinical Oncology - The student participates actively in the care of the oncology patient on an in- and outpatient basis. This includes consultation rounds. Clinical investigation with both conventional and experimental drugs will be stressed and an opportunity to treat patients by protocols will be given.

MED 980 -- Clinical Allergy, Immunology, and Rheumatology - Students will participate in the weekly KUMC allergy and rheumatology outpatient clinics, as well as assist in subspecialty inpatient consultations. They will perform medical evaluations, select appropriate diagnostic procedures and define specific therapy on assigned patients under the supervision of the staff. They will receive an orientation of clinical immunologic tests in current use and be expected to interpret the results of these appropriately. Regular lectures by the staff are given in the areas of clinical immunology. With guidance, they will choose a topic appropriate for seminar presentation at the end of this clerkship.

MED 995 -- Dermatology - This course is composed of outpatient clinic experience, tutorial sessions utilizing audiovisual aids extensively, and inpatient teaching rounds, as well as frequent review of pertinent aspects of dermatological allergy, microbiology, and histopathology. There will be opportunities to attend special weekly dermatological basic science lectures and grand rounds. Acquired skills in dermatological diagnosis (disease recognition, as well as analytical reasoning, or "problem solving") and in dermatological therapy will be evaluated by such means as oral quizzes and a written examination, but the final appraisal of each student will always be individualized.

NEUR 931 -- Clinical Neurology - Students will be responsible for working up the patients entering the neurology service at KUMC, attending general neurology clinics and working up patients on the consultation service under resident and staff supervision. Their main focus will be learning the elements of the neurological examination and its interpretation. They will also participate in conferences and seminars on topics in neurology (pediatric neurology, neuropathology) and be introduced to the use of neuroradiological procedures, electroencephalography and use of current literature.

Otolaryngology

OTOR 911 -- Clinical Otolaryngology - The objectives of this course are to acquaint the students with the examination of the anatomical areas and cavities of the head and neck. Recognition of clinical signs and symptoms peculiar to these areas would be taught with tutorial advice immediately available. To accomplish this objectively and realistically, the student will work in the outpatient clinic with residents and members of the staff The student will also participate in evening rounds and in seminars This course offers the students basic understanding of disorders of the head and neck region.

PAON 921 -- Diagnostic Pathology - This elective is designed to introduce the student to the practice of pathology and the role of the pathologist in diagnosis and management and will provide exposure to several subspecialty areas within the pathology department. An effort will be made to tailor the elective experience to the needs and interests of the individual student, including those interested in pathology as a career, and those interested in broadening their understanding of pathology in general, or in relation to their chosen field. The course consists of a two-week rotation in surgical pathology/autopsy, a one-week rotation in hematopathology, and a one-week rotation in cytopathology. The student will work closely with the pathology residents, fellows and faculty on service. In surgical pathology, students will have the opportunity to partake in a range of experiences, including supervised prosection of surgical specimens, microscopic evaluations, frozen section evaluations, ancillary techniques, and participation in the "sign-out" of surgical cases with the attending staff.

Participation in autopsy procedures will take place as available. In hematopathology, the student will participate in the diagnosis of blood and bone marrow disorders and take part in daily sign-out of bone marrow biopsy specimens. In cytology, the student will assist in the work up and sign out of gynecologic and non-gynecologic cytologic specimens and participate in FNA procedures. At the end of the rotation, each student will present an interesting case they encounter during a formal PowerPoint presentation to faculty and residents.

SURG 912 -- General Surgery - This is a clerkship at the KU Medical Center, in which the student proceeds to the study of surgical diseases and treatment in a more specific and in-depth exposure than in the Basic Surgery Clerkship (Surgery 900). The student is assigned to an instructor; studies an area of interest in-depth within the field of general surgery, i.e., gastrointestinal, peripheral vascular, endocrine, thoracic, etc; participates in the care of selected patients in the ward, clinic and operating room, and assists in the experimental laboratory if desired. The student also participates in the surgical and multidisciplinary conferences in which clinical problems are related to the basic sciences. Evaluation is based on clinical performance.

SURG 913 -- Plastic Surgery - The medical student participates as an intern, functioning in the clinics, wards and operating room as an integral part of the service. Evaluation is based on clinical performance.

SURG 914 -- Orthopedic Surgery - The principles of orthopedic evaluation and care are emphasized. Responsibility is to function as an extern in the clinics, the wards and the operating room. Evaluation is based on clinical performance.

SURG 916 -- Surgical Oncology - This rotation for medical students at a clinical level is designed to expose the student to procedures and techniques of modern surgical oncology. This experience includes: (1) Seeing all surgical oncology inpatient and outpatient consultations with the staff, (2) Operating room observation and participation with major cancer ablative procedures; e.g., radical lymphadenectomies, pelvic exenteration, major organ resections, etc., (3) Clinical and laboratory exposure to immunotherapy and basic cancer immunology, (4) Exposure to special chemotherapeutic procedures; e.g., arterial infusion and perfusion, (5) Attendance at the combined medical surgical conference. The specific duties for each individual student is defined at the beginning of each module and will be changed to fit the specific needs and desires of each student. Evaluation is based on clinical performance.

SURG 917 -- Urologic Surgery - This course is limited to one medical student at a time who has completed the Basic Surgery Clerkship, Surgery 900. Experience consists of care and evaluation of outpatients and inpatients requiring urologic diagnosis. Tutorial instruction and conferences are the prevalent means of instruction. Evaluation is based on clinical performance.

SURG 918 -- Neurologic Surgery - The principles of patient care and the physiological basis of neurological diagnosis are stressed. Experience consists of care and evaluation of outpatients and inpatients requiring neurosurgical diagnosis and treatment. Evaluation is based on clinical performance.

University of Kansas Medical Center Office of International Programs 1017, 1018 & 1019 Dykes Academic Affairs Mail Stop 3033 3901 Rainbow Boulevard Kansas City, KS 66160

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• v.10(8); 2020

Original research

Long-term contribution of international electives for medical students to professional identity formation: a qualitative study, mikio hayashi.

1 Department of Medical Education Studies, International Research Center for Medical Education, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan

Daisuke Son

2 Department of Community-based Family Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago, Japan

Keiko Nanishi

3 Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan

Associated Data

Globalisation has given medical university students the opportunity to pursue international electives in other countries, enhancing the long-term socialisation of medical professionals. This study identified the long-term effects of international electives on the professional identity formation of medical students.

This is a qualitative study.

The authors interviewed Japanese medical professionals who had completed their international electives more than 10 years ago, and analysed and interpreted the data using a social constructivism paradigm.

Participants

A total of 23 medical professionals (mean age 36.4 years; range 33–42 years) participated in face-to-face, semistructured in-depth interviews.

During the data analysis, 36 themes related to professional identity formation were identified, and the resulting themes had five primary factors (perspective transformation, career design, self-development, diversity of values and leadership). It was concluded that international electives for medical students could promote reflective self-relativisation and contribute to medical professional identity formation. Additionally, such electives can encourage pursuing a specialisation and academic or non-academic work abroad. International electives for medical students could contribute to medical professional identity formation on the basis of cross-cultural understanding.

Conclusions

This study addressed a number of issues regarding the long-term impact of international elective experiences in various countries on the professional identity formation of Japanese medical professionals. This study offers some guidance to mentors conducting international electives and provides useful information for professional identity formation development in medical professionals.

Strengths and limitations of this study

• This study identified the long-term effects of international electives on the professional identity formation of medical students.
• Qualitative data were collected from 23 medical professionals who completed their international electives more than 10 years ago and were analysed using the thematic analysis method.
• The study was limited by the focus on only Japanese medical professionals whose professional identity formation was affected by their innate cultural values and social norms.
• Further investigation of how medical professionals adopt their experiences to their environments is required.

Introduction

Globalisation has given medical university students the opportunity to pursue international electives in other countries, 1–3 which can enhance the long-term socialisation of medical professionals. Studies have found that international electives may have a transformative learning potential 4 5 as they immerse medical students in cross-cultural settings that can strengthen and challenge their professional identities. 6 However, these studies have not clarified the long-term contributions to medical professional socialisation. Therefore, this study explored the long-term effects of international electives for medical students on medical professional socialisation from a professional identity formation (PIF) perspective.

As international electives for medical students have been found to contribute to medical education internationalisation by enhancing global health competencies and encouraging global citizenship, 7 8 they are an important part of undergraduate medical training to prepare students for the globalised world. 5 International electives for medical students enhance the knowledge of medical students about areas and issues outside the traditional medical school curricula, such as current research, global clinical practices, healthcare systems around the world and cultural competencies, which often influence the students’ career choices. 6 9 10 Previous studies have found that international electives for medical students increase the probability of students choosing primary care specialties (eg, family medicine, internal medicine and paediatrics) or public health as their career paths. 2 11 However, through international electives, it is important to understand how students learn regardless of whether they choose to follow primary care specialties. 12 International electives for medical students give medical students an opportunity to reflect on their experiences by highlighting their personal and professional identities and allowing them to closely examine the health outcomes in their own countries. 10 13 Several participants who have reflected on their undergraduate careers have stated that their elective experiences were transformative, served to refresh the values that were underpinning their initial motivations to enter the profession 5 and led to valuable insights into the potential congruence of their personal and professional identities. 14 As mentioned in the PIF framework by Cruess et al 15 16 , socialisation is useful when seeking to understand the transformative learning of international electives for medical students as medical students are often in a formative state and thus more susceptible to the influences of their cultural backgrounds and learning environments. 17 Socialisation and identity formation have been found to be strongly connected. 18 Using narrative reflective reports, Sawatsky et al 4 identified some transformative learning components—disorienting experiences, emotional responses, critical reflection, perspective changes and a commitment to future action—and clarified how these were related to professional identity transformations for residents participating in international electives. However, Sawatsky et al ’s 4 study did not explain these relationships in undergraduate settings or clarify the long-term contributions to medical professional socialisation. As educational activities that foster a deep PIF-associated transformation, such as international electives, should be long term and cumulative in nature, 19 this study focused on these aspects.

In western education environments, international electives for medical students are often conducted in and focused on low-income and middle-income countries. However, in Asian countries, including Japan, these electives are generally conducted and focused on developed countries. A National Survey in Japan found that a majority of Japanese exchange students travelled to both western and Asian countries, with approximately 70% choosing to study in Europe and North America, reflecting the desire of Japanese students to acquire medical knowledge or experiences through the English language. 3 20 However, 40% of the UK’s medical students chose low-income and middle-income countries and approximately one-third of medical students in the USA, Canada and Germany selected low-income and middle-income countries to complete their international electives before graduation. 21 22

Professional identity and socialisation

Becoming a physician is challenging and transformative 23 ; therefore, medical education needs to be responsive to the changes in students’ professional identities from their experiences and from society. 24 Cruess et al 17 defined professional identity as ‘a representation of self, achieved in stages over time during which the characteristics, values and norms of the medical profession are internalised, resulting in an individual thinking, acting and feeling like a physician,’ and Holden et al 19 recommended professional identity development to be integrated with core medical knowledge, skills and attitudes. Hence, professional identity is developed through socialisation from a layperson to a professional, and it is unique to each learning environment. 15 International electives for medical students provide them with unique learning experiences that have transformative components assisting in professional and personal socialisation. Jarvis-Selinger et al 18 defined PIF as ‘an adaptive developmental process that happens simultaneously (1) at the level of the individual, which involves the psychological development of the person and (2) at the collective level.’ Studies have found that role models, mentors and experiential learning, in both clinical and nonclinical situations, were the most powerful PIF factors. 15 Therefore, international electives are expected to be part of a medical student’s long-term, cumulative education that enacts the deep transformations associated with PIF. 19 Frost and Regehr 23 suggested that the implications arising from the different professional identities of medical students needed to be explored.

Research question

Using a qualitative method, this study examined the contribution of international electives for medical students conducted in various countries, mainly high-income counties, to the PIF of Japanese medical professionals, with the primary objective being to assess the relationship between the electives and PIF to clarify their long-term effects. Therefore, the research question driving this qualitative research was ‘How do international electives for medical students contribute to the PIF of Japanese medical professionals?’ It is expected that the study findings could guide mentors when conducting international electives for medical students and provide useful information to foster PIF development in medical professionals.

We followed the Standards for Reporting Qualitative Research recommendations. 25 This study was based on the constructivist paradigm stating that human knowledge is not discovered but socially constructed. 26 The qualitative data were collected from 23 face-to-face, semistructured in-depth interviews and 16 narrative reflective reports on international electives for medical students written by the study participants to clarify the relationships between these experiences and PIF pedagogy. All of the interview data and reflective reports were inductively analysed and integrated through the data analysis. Thematic analysis was employed to elicit the subjective meanings, which involved generative coding and theoretical interpretations by several researchers. The authors were familiar with international electives because we have participated in postinternational electives presentations by medical students and continue to engage with medical students participating in international electives through teaching practices and mentoring.

The National Survey of Japan reported that 790 medical students in 2012 and 1069 medical students in 2013 were involved in clinical clerkships or short-term study abroad programmes, 3 which was approximately 2% of all Japanese medical students. The University of Tokyo’s international electives for medical students have been formal electives since 2001 and are taken by approximately 3% of the university’s medical students each year, which is considered higher than average in Japan. Similar to the national statistics results, a majority of the university’s exchange students choose to travel to western countries, with approximately 60% choosing to study in Europe and North America, every year. Although more than half of the students opt to complete their electives in the settings available to them through formal programmes offered by the institutions, some students choose to complete their electives in their own choices. As the international elective content is different at various overseas host institutions, they are decided through direct communication between the organisation and the undergraduate student. Regarding financial support, only some students with excellent grades were offered scholarships.

To understand the long-term effects of such electives, the participants in this study were University of Tokyo’s medical professionals who had been graduated for more than 10 years prior to this study, after completing their international electives. Of the viable participants, all are licensed and experienced medical professionals at a variety of institutions, including university and community hospitals, research centres, medical companies and the Ministry of Health. From 2001 to 2009, 133 University of Tokyo undergraduate students completed international electives, and 70 contactable medical professionals who had completed their international electives were invited via email to participate in the study. Overall, 23 participants (mean age 36.4 years; range 33–42 years) agreed, all of whom had taken the international electives programme more than 10 years ago. Of the 23 participant profiles given in table 1 , a majority chose to go to the USA, with only a few choosing other countries.

Characteristics of the research participants

F, female; M, male.

Patient and public involvement

No patients involved.

Data collection

The authors analysed narrative reflective reports on the international electives for medical students that had been written by the study participants more than 10 years ago. Narrative reflective reports on the international electives for medical students were instructed for each student to submit immediately after completing the international electives. In this report, the students were asked to describe what kind of training they had received in their field as well as what their feelings and struggles through their actual experience and how they interacted with the local medical students. Moreover, the reports were shared with not only the faculty but also other medical students so that they could view it with each other. These reports on international electives for medical students were originally written to take undergraduate students beyond global health facts, as a self-reflective learning process emphasising transnational competence and heightening their empathy for humanity underlying global health issues. 27 Therefore, they were considered useful in assessing the existing and potential PIF pedagogy 28 and helpful in understanding the long-term contributions of the international electives for medical students on the socialisation of the study participants. However, not all of the reports that were reflective of the medical students’ narrative of the international electives for them as written by the study participants existed, and only 16 reports reflective of the narrative were viewable. The reason why some reflections were excluded in this data collection is simply because those reports did not exist. Open-ended data were also collected, using an audio recorder, from face-to-face, semistructured in-depth interviews, wherein the participants’ feelings and beliefs were explored. 29 Interviews were conducted by the first author (MH), which lasted 40–80 min, at the participant’s place of clinical practice between December 2018 and March 2019. All of the interviews were conducted in Japanese. Total recorded data comprised 1077 min of recording. An interview guide (see box 1 ) was used to clarify how the participants viewed their experiences and how those experiences had contributed to their PIF. The authors agreed that the interview guide was suited to the research purpose; therefore, it was not changed. However, the interviews were flexible so that the participants could take the discussion in any direction. The recorded data were transcribed verbatim by the authors immediately after each interview.

Interview guide

• What is your specialty, experience (number of years) and board certification?
• Please describe the medical services you usually provide.
• What have been your major medical experiences so far?
• Describe your international elective experiences and provide details.
• Why did you choose to study international electives for medical students?
• What are your personal impressions of the international electives for medical students?
• How did the impressive episode (answer 6) impact your own medical treatment (attitudes towards medical practice or work) and career development?
• What impact did your international electives for medical students have on your professional development? Why do you think so?

Ethical concerns included maintaining confidentiality of the sensitive information revealed in the interviews and reflective reports. The participants were informed of the study’s scope and nature, and all of them provided written consent. They were also informed that all data were confidential and that the given consent could be withdrawn at any time.

Data analysis

All of the interview data and reflective reports were analysed and integrated through the data analysis. The data were analysed using the thematic analysis method, which involved generative coding and theorising to identify instances in the data set that were similar in concept. 30 31 Data analysis followed an inductive approach where the data are allowed to speak for themselves by the emergence of conceptual categories and descriptive themes. Although the research question was partly theory driven, the researchers initially conducted a primary level thematic analysis to determine themes. After the researchers found the themes and following further team discussion, we re-examined the literature to identify the conceptual perspective. The first and second authors (MH and DS, respectively) were formally trained in using NVivo V.11 for Windows (QSR International, Australia, a computer software program to support the analysis of qualitative data) and conducted all the analysis steps, including the reading and rereading of the narratives until the researchers found the themes and categorising the data from a constructivist perspective. The themes were categorised into main and subcategories and were then tabulated using NVivo V.11 to identify the theme frequencies in the interviews and reports. After the data collection and analyses, the study authors agreed that theoretical saturation had been reached as there were no new themes emerging in the data set, and a complete understanding of the identified concepts had been achieved. Member checking was conducted twice by the research participants after the interviews and analyses to confirm that there is no difference in interpretation and that it is not contrary to the intended content.

From the thematic analysis of the interviews and reports, 36 emergent themes were identified, several of which were related to PIF. The resulting themes had five primary factors: perspective transformation, career design, self-development, diversity of values and leadership (see box 2 ). International electives for medical students often lead to specialisations and further academic or non-academic work abroad. Although the contents of international electives for medical students were different between low-income and middle-income countries and developed countries, they were common in that international electives for medical students could promote reflective self-relativisation and contribute to PIF on the basis of the idea of cross-cultural understanding ( figure 1 ). It also became clear that the themes of perspective transformation, self-development and diversity of values showed a linkage between the themes.

Emergent themes

Perspective transformation (17/23).

Self-relativisation (14/23), wide perspective (10/23), contribution to others (8/23), empathy (5/23), self-transformation (3/23).

Career design (16/23).

Pursuit of interest (13/23), right of choice (10/23), role model (10/23), mindset (7/23), work–life balance (1/23), career support (1/23), insufficient information sharing (1/23).

Self-development (17/23)

Cross-boundary experiences (9/23), motivation (8/23), self-reliance (7/23), outcomes (5/23), open mind (4/23), resistance to egoism (1/23).

Diversity of values (14/23)

Cross-cultural understanding (11/23), culture shock (10/23), work style (6/23), acceptance of various values (3/23), globalisation (2/23), flexibility (1/23).

Leadership (14/23)

Decision making (9/23), systems thinking (6/23), objective thinking (4/23), critical thinking (3/23), resilience (3/23), Responsibility (2/23), uncertainty (2/23).

A schematic representation of the socialisation process. International electives for medical students could promote reflective self-relativisation and contribute to PIF on the basis of the idea of cross-cultural understanding. Five primary themes were gained from the international elective experiences. The themes of perspective transformation, self-development and diversity of values showed a linkage between the themes. PIF, professional identity formation.

Perspective transformation

Although it was difficult for most participants to specifically describe the international electives’ contents, most commented on the thinking that they had acquired, with the impressions gained being the origins for their own perspective transformations as medical professionals.

Before international electives, I had the perception that surgeons were superior than internists. However, when I met an internist during my international electives in the U.S. who systematically assessed the whole body while carefully questioning and examining the body, my perception that surgeons were superior to them changed markedly. (R7 Male—US—Clinical: Report)

In the past, there were many participants who chose a specialty that was different from what they had hoped for at the time of international electives for medical students. However, they went through a process of reflecting on their experience of international electives when pursuing their own interests. Most participants also believed that the international electives promoted self-relativisation and assisted in their identity development as medical professionals.

It was very striking to me that about half of the patients who see the ER are uninsured. On the other hand, I was able to see how doctors over-test and treat to avoid lawsuits…It was a good experience to realize the position of the Japanese healthcare system by experiencing a different healthcare environment than Japan. (R19 Male—US—Clinical: Report) After graduating, I became interested in health care policy, and now I am running a company with a vision to create a world where all people can live and die with conviction…I think this is a good opportunity to reevaluate myself. When training at university hospitals and affiliated hospitals, because these organizations are all very similar, there are few differences, so we don’t think about what might be good or bad, or what might be incorrect. I think that this could be an extremely useful opportunity for reevaluation. (R19 Male—US—Clinical: Interview)

Career design

Most participants had continued their careers in Japan but believed that their experiences abroad had some impact on their mindset and work–life balance.

What I saw during my short one month stay was a very small part of the U.S., but I felt that even if I had preconceived notions, I needed to rethink those preconceived notions based on what I had actually experienced. (R3 Female—US—Clinical: Report) I’m going to the US next year as a postdoctoral researcher…When I think about what it was like when I had the opportunity to go to the U.S. as a medical trainee, this may seem a little vague, but this is the image I was able to give—with my experience at that time, it’s not that the knowledge I learned there was of direct use, but having gone to the U.S. as a medical student was extremely useful to me in terms of planning my own life. (R3 Female—US—Clinical: Interview)

The role models the participants encountered during their international electives for medical students assisted them in developing their careers and pursuing their own interests regardless of whether they chose to follow primary care specialties or opted to work in their countries of origin or abroad.

I am interested in dementia, and during the international electives, I worked with researchers in the field to experiment at a specialized research facility in the U.S. I was struck by the fact that the specialty is extremely fragmented, and even in the same area, there is little involvement in diseases outside of their own specialty. (R18 Male—US—Clinical / Research: Report) After completing international electives, I wanted to pursue more specialized research in dementia and kept in touch with the mentors who had taught me specialized skills during my practice. I am currently conducting research in this field in the U.S., and the professors are still my direct mentors…Through my research, new therapeutics have been developed and are beginning to be used in clinical practice, so I think I can give back my knowledge in this field by adapting such a process when I return to Japan. (R18 Male—US—Clinical/Research: Interview)

Self-development

The participants said that their experiences of having to adjust to their host country and their elective content by themselves and travelling to their international electives had contributed to their motivation and future independence and had affected their educational behaviour in clinical situations.

Since the hospital had no partnership with the university, I had to do all the preparations myself, and the preparations were more difficult than I expected. It was also my first time to go to a developing country, so I was very busy just before my trip, buying insurance and getting vaccinations…When I returned home, I realized the importance of water and electricity, and how safe Japan is. (R12 Male—Nepal—Clinical: Report) Through the experience of international electives, I learned the importance of trying anything without fear of failure. Although I am now working in a different department than the one I trained in at the time, I am actively working with patients from a variety of social and economic backgrounds in a multidisciplinary approach. (R12 Male—Nepal—Clinical: Interview)

Throughout their international elective experiences, the medical professionals could not only relativise the environment wherein they had been placed but were also forced to think more deeply about their own strengths. Therefore, the international electives for medical students enhanced the participants’ future self-development.

I was interested in treating congenital diseases, so I went to a lab that was doing gene therapy for hemophilia and had already gone through several trials. I was attracted to the work of the doctors who successfully combined both clinical and research, including unique consultation methods, genetic testing and post-diagnosis follow-up, and feedback to research. (R4 Female—US—Research: Report) In my current workplace, I am a researcher conducting epidemiological studies on child development. When I grow up, I lived in the U.S. due to my parents’ work…For me in particular, I was raised over there, so I came back to Japan thinking that I could have become like them if I had stayed there. Well, I had an image of who I desired to be when I was there and the real figure of who I am today having come back to Japan.…There was a real sense that clinical training in U.S. was superior, which I wanted to fight against, thinking that we had to somehow do our best in Japan as well. (R4 Female—US—Research: Interview)

Diversity of values

Participants recognised not only the diversity of values they gained from their cross-cultural experiences but were also able to use these experiences when treating patients from other countries. Further, regardless of their specialties, they sought to imagine the patient’s background and religious views when conducting their clinical practice.

All in all, I would say that going to Brazil had a significant effect on me, but I cannot go so far as say that I would force this on Japanese people, or that I would impose my value system, which shifted slightly as a result of my time in Brazil, on Japan….I think I have become better able to respond to patients that have various views and values about life and death. (R5 Male—US/Brazil—Clinical: Interview)

Through international electives, the participants believed that their experience assisted in their identity development as medical professionals and that it contributed to their interpretive and tolerant attitude toward patients and colleagues.

What doctors take for granted and what nurses take for granted are not the same thing. I think there’s a parallel between what the Japanese take for granted and what Americans take for granted. It’s probably the same process of meeting with people who have different ways of thinking so that they can rub together and understand each other’s thoughts. (R6 Male—US—Clinical: Interview)

The international elective experiences urged the participants to be more conscious about goal-setting and policy decision making in organisations and gave them a better understanding of their own work environments and of how the working environment knowledge strengthened their awareness of target setting and development.

I decided on the content of my international electives through negotiations with the host laboratory, but I felt that the content could be changed as much as I wanted, depending on my sense of purpose. On the other hand, the U.S. has a system in place that allows researchers to devote themselves to their research, but I found it difficult to bring that to Japan. (R14 Male—US—Research: Report) I am managing several projects while developing a new medical system that I have been interested in since my electives…I am currently involved in building a rapid response system for the hospital’s needs in case of a patient’s sudden change…Of course, each person’s efforts are important, but I work based on the idea that a system that can provide high quality medical care at all times is important. (R14 Male—US—Research: Interview)

After international elective experiences, participants continued to self-evaluate their own leadership concept and considered the medical approach for the delegation of authority according to their own situation.

I learned the importance of management through my electives in the U.S.…I am now working in policy-related work at the Ministry of Health, Labour and Welfare after leaving my clinical work…I am involved in health policy practice while working with medical institutions, and I feel that my experience in overseas training is helping me to focus on the decision-making process. (R7 Male—US—Clinical: Interview)

Differences in training content and participant characteristics

The participants’ characteristics in this study included differences in training location (19 from high-income countries and five from low-income to middle-income countries), differences in training content (18 from clinical and 5 from research) and differences in gender ratios (18 males and 5 females). As described in the Methods section, the place and content of the training were not simply chosen by the students themselves but were also influenced by institutional partnerships; however, through the data analysis, it was possible to identify some differences.

First, when comparing training in high-income countries with training in low-income to middle-income countries, the theme of ‘diversity of values’ was found throughout the training in low-income to middle-income countries.

Through international electives, I was able to conduct training in two countries, Brazil and the U.S. In Brazil, I experienced a very different culture, nationality, and practice than in Japan. On the other hand, during my electives in the U.S., I experienced a variety of patients in the emergency department, but I didn’t feel that much of a difference with Japan. (R5 Male—US/Brazil—Clinical: Report)

It was also suggested that training in low-income to middle-income countries may have made them aware of the presence of socially vulnerable people and their own social responsibilities, and motivated them to work in the international health field in the future.

I am mainly involved in the international medical support department at my current hospital, where I deal with a variety of foreign patients…I think about medical care and support based on the patient’s background. In Japan, in particular, if a person comes from a developing country, even if they have a working background in Japan and we’re in Japan, they still have a different cultural background, and it good to understand that this is still true while they are living here. (R23 Female—India—Clinical: Interview)

However, the majority of the research participants who experienced research-based electives tended to pursue their own interests and expertise and to continue their careers as researchers in the future.

I was very curious about how mental illness can be studied. It was very interesting that a foreign researcher reported a decrease in the number of dendritic spines in the frontal lobe of schizophrenia, so I wanted to do an international research elective…After I returned to Japan, I joined the classroom of a teacher who is still researching in this field, and now I am also mentoring graduate students as a lecturer. (R16 Male—US—Research: Interview)

Finally, the number of female participants was not as high, but both themes, work–life balance and career support, were unique themes drawn only from female participants.

Discussions

Several constituent elements related to PIF were gained from the international elective experiences. It was evident that the experiences promoted reflective self-relativisation, which contributed to the participants’ identity formation as medical professionals. Studies have shown the potential benefits of international electives for medical students in enhancing both professional and personal development, and building transferable skills from working with people from culturally, linguistically and socioeconomically diverse backgrounds. 5 The results of this study contribute to the extant research because of its findings on the long-term influences on PIF from the perspective of international elective experiences. Previous studies have found that international electives for medical students increased the probability of students choosing primary care specialties or public health as their future career paths. 2 11 This study uncovered that there were additional long-term career influences regardless of whether the participants followed primary care specialties.

Cruess et al 16 indicated that people who went through a socialisation process with only partially developed identities emerged with enhanced personal and professional identities. PIF is a formative development continuum that instils professional values and a sense of being a medical professional. In this study, several factors were found that related to the contribution of international electives for medical students to medical professional socialisation. As the previous study 15 has shown, the study results indicated that the presence of a mentor or role model was one of the most important factors as a long-term correlation with what medical professionals considered to their own personal development and who they are 10 years later. The results also indicated that the reflective self-relativisation gained from the international electives was the basis for the medical professionals’ perspective transformations. A previous study found that PIF and socialisation required a reflective process and that individual experiences allowed for the development of ‘their own stories by which to love doctors’ through this self-reflection. 24 Therefore, it was concluded that the international elective experiences provided opportunities to medical professionals to not only advance their PIF processes but also reflect on their underlying identities. Furthermore, Cruess et al 16 also pointed out that every person’s journey from layperson to professional was unique and that each learning environment had its own characteristics and culture. In this study, the medical professionals who had undertaken international electives not only recognised the diversity of values through their cross-cultural experiences but also gained a greater understanding for patients with different backgrounds.

The findings in this study had important parallels with earlier studies. Previous studies have found that medical professionals need to acquire cultural sensitivity as part of becoming and being a professional. 32 When the students become medical professionals and the medical professionals make transitions, being culturally competent means being able to incorporate those views into day-to-day practices. 33 As indicated in the results, the cultural sensitivity gained through international electives has led to a different insight into the members of their community. The international electives provided medical students with the opportunities to gain cross-cultural understanding on their PIF journey, which over the long-term contributed to their development of appropriate empathic responses. Gosselin et al 34 proposed that medical education researchers should reconsider their assumptions and discourses about the dynamic relationships between culture, globalisation and medical education. Professional identity is also a part of a wider social identity that varies depending on the country of origin and cultural background. 33 Monrouxe 35 showed that cultural differences could be explained by considering the wider culture inhabited by the medical professionals. Although the international electives for medical students generally run from only 1 to 3 months, based on the previous results, the international electives for medical students in Asian countries could have a substantial impact on the medical students’ socialisation. This is because medical students in Japan are in a learning environment with fewer immigrants than there are in learning environments in other developed countries. As they do not have much experience in deep communication with people from other countries, we thought that the various experiences they had during their international electives would be important opportunities for them to not only acquire career and medical knowledge and skills but also grow as human beings. That would be significant. As for the uniqueness of Japanese educational culture, it has also been indicated that there is an internalisation of ‘hansei’ (introspection) or ‘kaizen’ (change for the better), which is a characteristic of Asian culture. 36 37 We believe that when medical students transfer the concepts they have learnt through their international electives to the process of socialisation, a characteristic of reflection occurs at the individual level. The results indicate that a similar process of change in understanding in the medical professionals’ community after their international electives is occurring in Japanese culture.

However, overall, individual PIF development through international electives for medical students in other cultures would need to be more comprehensively studied to assess the transferability of these results. A limitation of this study was that only Japanese medical professionals who had graduated from the University of Tokyo were included, which means that their PIF was affected by their innate cultural values and social norms. Because there are cultural differences between western models and other cultures that do not entirely focus on the individual and possess a more collective culture, 33 there are wide differences as to the appropriateness of some professional attributes, 35 which means that it is difficult to make generalised statements without knowledge of the individual PIF development in other cultures. However, based on the emergent themes in this study, it is possible that these types of experiences in other cultures would yield similar findings such as perspective transformations, self-development and leadership. Another limitation of this study was that the focus was on medical professionals who were already specialised (mean clinical experience duration was 11.9 years). As identity formation continues throughout the medical professional’s career, 18 identities are never fixed. 38 Therefore, it is necessary to investigate the socialisation gained from international electives in a younger generation, such as undergraduate students and residents. Finally, the problems that arise from the activities of participants are not clarified in this study. Although we identified the contribution of the international electives to the socialisation process as an outcome, the experiences that the participants gain from their work are complex. Therefore, further investigation of how the medical professionals adopted their experiences in their environments would be required.

This study clarified a number of issues regarding the long-term impact of international elective experiences in various countries on the socialisation of Japanese medical professionals. It was found that these experiences promote reflective self-relativisation and contribute to PIF on the basis of the idea of cross-cultural understanding. The results of this study contribute to the extant research because of their findings on the long-term influences of PIF from the perspective of international elective experiences. It is hoped that this study offers some guidance to mentors conducting international electives for medical students and provides useful information for PIF development in medical professionals.

Supplementary Material

Acknowledgments.

The authors would like to thank all the participants who gave their time and participated in this study.

Contributors: MH was the principal investigator for this study, who conducted the interviews and authored the paper. KN contributed to the design of this study. DS analysed and coded all data along with MH. ME checked the results, advised edits and approved for public release. All authors have agreed with the final version of this paper.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared.

Patient consent for publication: Not required.

Ethics approval: The Institutional Review Board of the University of Tokyo approved this study (2018001NI-(1)).

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement: No additional data are available.

• Open access
• Published: 19 September 2024

Comparative analysis of factors and barriers intervening in research participation among romanian and international medical graduates from one romanian medical faculty across three generations

• Andreea Iulia Pop 1 &
• Lucia Maria Lotrean 2  

BMC Medical Education volume  24 , Article number:  1028 ( 2024 ) Cite this article

Metrics details

This study focuses on the factors that encouraged engagement in research activities, as well as the barriers that restricted their involvement, until the final year of study at Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, Faculty of Medicine. The main objectives of this study are to investigate potential disparities in research culture and student engagement in various research opportunities between Romanian and international medical graduates, as well as to conduct an examination of the observed patterns across various graduating years (2021–2023).

Materials and methods

A cross-sectional investigation was conducted among graduate students of the Faculty of Medicine at the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. From 2021 to 2023, all graduate students from the Romanian and international programs of the faculty were asked to participate in the study by filling out an anonymous online questionnaire. The final sample included 572 participants, of whom 392 were students from the Romanian section and 180 were students from international programs.

Motivation and personal interest drive research engagement, according to over half of graduates. For over one-third of graduates, institutional elements like financial support and education also play a major role, as does the desire to enhance their curriculum vitae. More than 25% of graduates value community influence, 70% of graduates attended medical congresses, 12–15% presented papers at medical conferences, 23% wrote medical articles, 10–15% published at least one scientific paper in medical journals, and 20% participated in medical school research projects. Comparative analysis showed that Romanian students start research earlier, attend more medical conferences, present posters, collect data for studies, and are more interested in publishing graduation thesis data in scientific journals. To encourage international students to participate in research, the study found that colleagues’ examples were more important, and both time and funds were key barriers. The research also shows that 2022 and 2023 graduates will organize more scientific conferences. According to the study, 2022 graduates began their research earlier than others.

Conclusions

To increase student engagement in research activities, medical schools should prioritize the promotion of positive factors, minimize common barriers, offer customized support and resources, encourage collaborative research activities, and facilitate cross-cultural learning.

Peer Review reports

Introduction

Medical schools play a crucial role in providing professionals with the necessary knowledge and skills to excel in their careers and contribute to the healthcare system [ 1 ]. The conventional medical education structure has created skilled and scientifically grounded healthcare professionals, but it is essential to adapt learning methods to align with new technological advances, diagnostic strategies, and medical treatments [ 2 , 3 , 4 ]. As healthcare environments change, medical education must advance to meet the evolving needs of patients and healthcare professionals. To stay informed about medical innovations, medical students must develop practical skills, synthesize information, and analyze vast amounts of information. They should also maximize interprofessional learning possibilities and balance the risks and benefits of various treatment options to provide the best possible patient care [ 5 , 6 , 7 ]. Currently, the requirement for enhanced competence in evidence-based medicine and concerns regarding the declining representation of physician-scientists have emphasized the necessity of promoting and encouraging research in medical education [ 8 , 9 , 10 , 11 ].

Research involves data collection and analysis, gathering key information, and then analyzing and interpreting that information according to academic and professional procedures. This suggests that research helps students develop critical thinking and problem-solving skills, which are crucial for healthcare practitioners, and it is essential to actively involve and motivate the upcoming generation of physician-scientists from earlier stages [ 12 , 13 ]. Throughout the years, medical students have produced important innovations that have had a significant influence on current medicine through the adoption of evidence-based practice. Students made notable progress in several areas, such as the discovery of heparin, Raynaud’s disease, brachial plexus palsy, the atrioventricular node, ether anesthesia, penicillin, and insulin. Those historical examples play a crucial role in sustaining students’ motivation and developing their enthusiasm for excellence [ 14 ].

Scholarly research training programs help undergraduate medical students critically assess new information, communicate, and share research findings, making valuable contributions to the advancement of medical knowledge [ 15 ]. According to Yin et al., medical schools must prioritize research by offering enough opportunity, motivation, and assistance for student engagement [ 16 ]. Previous studies have investigated the training and participation of medical students in curricular and extracurricular research activities. Since the 1960s, some medical schools, such as Duke University and Stanford University, have offered research programs that accompany traditional education, widening students’ scientific knowledge and recruiting them to academic medicine [ 17 ]. Many medical schools nowadays offer students either mandatory or optional research alternatives that enhance their research skills. The Bologna process contributed to a restructuring of the medical undergraduate degree in Europe. It was launched in 1999 by several European countries with the goal of improving the acceptance and quality of higher education qualifications in the region. According to the Bologna process, European universities must evaluate scientific training and include research in their undergraduate medical degrees. As a result, medical students must complete a research project in order to graduate [ 8 , 18 ]. To promote supervised research, Asian universities have implemented graduation requirements, which generally require undergraduate participation for a semester or academic year, either individually or with the support of the government [ 19 ]. The Liaison Committee on Medical Education (LCME) conducted a survey among 147 medical schools in the United States between 2017 and 2018, which revealed that 65 of them mandated medical students to conduct research [ 20 ]. On the other hand, extracurricular research programs (ERPs), such as summer research programs, Honours programs, or any other student research organizations worldwide, such as Harvard College Undergraduate Research Association, Cambridge University Students’ Clinical Research Society, and John B. Graham Medical Student Research Society, have been set up by many medical schools to encourage students to do research, develop an academic mindset, and become future doctors who are also scientists [ 21 , 22 ].

Although the level to which medical graduates participate in research activities is influenced by a variety of factors and obstacles. Prior research has identified that to encourage and sustain the engagement of medical students in research, it is imperative to identify the fundamental factors that motivate their research efforts throughout the early years of their medical education [ 23 ]. In their study, Ommering et al. investigate the motivation of medical students to conduct research, and their findings suggest that students may have both intrinsic and extrinsic motivations. For extrinsic motivations, medical students may engage in research to enhance their training and career opportunities, such as securing a competitive residency. Furthermore, there is proof that students can be really interested in research and contribute out of satisfaction, as regards intrinsic motivations. Self-efficacy, curiosity, and challenge, prior training in scientific research, supportive teachers, and an environment that encourages research are the valuable motivational variables [ 23 , 24 ]. While there is a tendency to refine involvement in research during medical school, the literature highlights both institutional and non-institutional barriers to successful participation. Previous studies have found several common barriers to research involvement, such as time constraints, insufficient funds, insufficient support from mentors, and a lack of knowledge and experience. Thus, Andrea and Sarah Cuschieri found that medical graduates often receive inadequate assistance and direction from faculty members and mentors, insufficient resources for carrying out research, minimal opportunities to participate in scientific initiatives, and a lack of motivation [ 25 ]. Griffin and Hindocha also highlighted barriers perceived by medical students to publishing, such as a lack of opportunities to conduct research, insufficient support from seniors, limited education on writing manuscripts, limited time, insufficient knowledge of publication standards, and insufficient research infrastructure [ 26 ]. Stone et al. also demonstrated the existence of institutional and non-institutional barriers to conducting research during undergraduate medical school. These barriers include time constraints, a lack of mentors, inadequate support, limited access to resources, curriculum design, a lack of skills and self-efficacy, awareness and motivation, funding, internet access, and gender and cultural issues, all of which hinder medical students’ engagement in research activities [ 9 ]. Furthermore, in prior studies, the unequal attainment gap among ethnic groups begged serious concerns about performance differences, therefore affecting medical education and the medical profession. The ethnicity of medical students often influences learning and performance due to limited educational resources, unadapted curricula, and medical school populations [ 27 , 28 , 29 ].

According to our knowledge, little is known about the practices, factors, and barriers affecting research engagement among medical graduates, especially when comparing national and international students. There are no other studies on medical undergraduate research in Romania, except for our previous study, which examined the first-time research perspectives and behaviors of students in their third and fifth years of study. The previous findings indicated that Romanian medical students value research possibilities, which promotes institutional attempts to support their curricular and extracurricular research [ 30 ]. This present study can be considered a continuation of the first investigation, as it aims to examine the factors that influence the engagement of undergraduate medical students in research, as well as the research practices performed by graduates until they complete their final year at the Faculty of Medicine of Iuliu Hatieganu University of Medicine and Pharmacy in Cluj-Napoca. This is one of the most prestigious medical universities in Romania. The university’s Faculty of Medicine admits three cohorts per year, and there are programs offered in various languages: Romanian, English, and French. The student selection process varies between programs. The Romanian program selects students for admission through a written exam. International applicants to the English and French language programs are admitted based on their academic performance and personal accomplishments. Although they share clinical areas and classrooms, local and foreign students do not show up to attend the same seminars. Every cohort has different clinical rotations and class schedules, so their academic activities never cross. Each year, the university’s Faculty of Medicine admits a specific number of students into the medical program. For example, in the last ten years, the admitted number of students per year varied between 500 and 600 students per year, until recent 4 years, when the university admitted approximately 800 students per year into its medical programs. The proportion of students has an equal distribution of 50% Romanian students and 50% international students [ 31 ]. The Cluj-Napoca Faculty of Medicine offers six-year undergraduate medical education that includes, in the first year’s curricula, a module on medical biostatistics and, in the second year’s curricula, a module on scientific research methodology. Until the final year, the students must prepare and present a demanding scientific report known as a graduation research thesis in accordance with the Bologna process. Teachers also offer guidance and support throughout extracurricular research.

This study aims to investigate the factors that encourage student engagement in research, as well as the barriers that limit their decision to participate in research. Furthermore, in terms of practices, behaviors for both mandatory and optional research activities have been followed. Furthermore, socio-demographic aspects were examined. This research would be valuable in creating an overview of the research motivation, barriers, and best practices for fostering research involvement in the current situation, while there is a persistent pedlary for medical students to become physician-scientists in the context of the physician-scientist deficit worldwide. This research seeks to provide insights into the research culture, resources available, and levels of student involvement in a medical school, along with potential differences between Romanian and international students in three graduating cohorts (2021–2023). Furthermore, examining the trends across graduation years may shed light on how medical education and research opportunities are evolving. If we understand students’ perspectives, we may use evidence-based ways to increase medical students’ interest and ameliorate barriers in research to prepare the future generation of physician-scientists.

The current research aimed to use a survey with 5-point Likert scales and multiple-choice questions to evaluate factors influencing research involvement and scientific activities among graduates from 2021 to 2023, along with exploring their socio-demographic characteristics. This study provided a focused examination of the following research objectives:

Identification of socio-demographic indices: gender, section, and year of faculty graduation.

Evaluation of factors that encourage student participation in research activities: personal influence, community influence, educational influences, and financial influences.

Evaluation of the barriers that limit medical students research participation: personal influence, educational influences, and financial influence.

Identifying research behaviors: the year of debut, complexity of research activity, contributions, participation in scientific congresses, participation in the process of writing a scientific article, aspects of publishing graduation thesis data in a scientific journal, and interest in participating in research activities after graduation.

Comparing factors for involvement in research and scientific activities between Romanian and international students and analyzing them throughout time from 2021 to 2023.

Material and methods

Study sample and data collection.

This research is a component of a larger study centered around evaluating the engagement of medical students in research and voluntary activities. The project received ethical approval from the Ethics Commission of Iuliu Hatieganu University of Medicine and Pharmacy under Approval Number DEP27/03.11.2021.

A cross-sectional investigation was conducted among graduate students of the Faculty of Medicine at the Iuliu Hațieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. From 2021 to 2023, all graduate students from the Romanian and international sections of the faculty were asked to participate in the study by filling out an anonymous online questionnaire (a total of 1878 students were invited). We chose to investigate the Romanian and international cohorts separately in order to learn more about how their educational and cultural backgrounds influence their research attitudes and practices. We separately looked at these groups to identify their unique requirements and obstacles in order to create focused strategies to increase student research participation. The questionnaire was distributed using the Microsoft Teams platform, which is commonly used by all affiliated members of the University of Medicine and Pharmacy, Iuliu Hatieganu. The students received an invitation explaining that participation was voluntary, and they agreed to participate by filling out the questionnaire. Those who did not wish to participate did not complete the questionnaire.

Instrument for data collection

For this research project, we specifically designed an online survey to evaluate socio-demographic factors (age, gender), academic aspects (section, year of graduation), opinions about factors that encourage or limit involvement in research, and the research practices of undergraduate medical students. To identify common themes and factors reported in previous studies, we conducted a thorough literature review, which helped us derive the motivating factors and barriers related to student involvement in research. This influenced the development of our survey questions. Factors that encourage medical students involvement in research are the following: personal influence (motivation and personal interest, curriculum vitae improvement motivation), community influences (example of other colleagues), educational influences (teacher presentation of research participation options, teacher mentoring and support, medical research student courses or training), and financial influence (the existence of research grants for undergraduate students, monetary remuneration); The response choices were presented on a five-point scale that varied from “not at all” to “to a very high extent.” The barriers to medical students’ involvement in research are as follows: personal influence (lack of time caused by required medical training courses or internships during medical studies, lack of interest or lack of motivation for research), educational influences (difficulty finding a research coordinator, team, or research project), and financial influence (lack of or insufficient financial compensation for work done). The response choices were presented on a five-point Likert scale that varied from “not at all” to “to a very high extent.” Additionally, the questionnaire examined the research practices of medical students as follows: the year of study when students started their research activity, if they had been engaged in research projects only for their graduation thesis, or if they performed more complex research activities till graduation. The questionnaire asked about the contributions of students to research activities (data review of scientific literature, development of research ideas and hypotheses, research methodology and protocol, data gathering tools, statistical analysis, laboratory experiments, abstract and presentation development for scientific conferences, and writing medical articles). Moreover, the questionnaire asked about students’ involvement in medical congresses, if they had presentations such as oral or poster presentations (the response choices were presented on a four-point scale that varied from “not at all” to “more than three times”), if they had been involved in writing scientific articles (the response choices were presented on a four-point scale that varied from “not at all” to “more than three times”), or if they were publishing various types of scientific articles (publishing editorials or letters to the editor, reviews, original articles, clinical case presentations), and if they were first authors or co-authors. The students were asked if they had participated in research projects during medical school (the response choices were presented on a four-point scale that varied from “not at all” to “more than three times”). Additionally, the questionnaire asked about the interest in publishing graduation thesis data in a scientific publication. The questionnaire also evaluated interest in enhancing knowledge of proper scientific article writing, interest in better comprehension of abstract writing, and interest in understanding the publishing rules of a scientific paper. The questionnaire aimed to gather data on motivation and interest to participate in research activities after completing medical studies (with response options being ‘Yes,’ ‘No,’ or ‘I do not know’). Students received the questionnaire in Romanian, English, and French, and the average time to complete it was 15–20 minutes. We assessed the reliability of the questionnaire using internal consistency and found Cronbach’s alpha for each index. We found that the Research Involvement Index, which included 6 items, had a Cronbach’s alpha of 0.74; the Index of Factors Encouraging Student Research, which included 9 items, had a Cronbach’s alpha of 0.71; and the Research Involvement Barriers Index, which included 5 items, had a Cronbach’s alpha of 0.70. Each of the three indexes indicates good internal consistency. Our previous study, which examined the perspectives and behaviors of medical students in their third and fifth years of study for the first time, also tested the questionnaire. We made minor revisions to align with the actual research questions, thereby enhancing the questionnaire’s comprehensibility and reliability.

Data analyses

The prevalence and mean values were calculated for the investigated topics separately for the Romanian section and international section, as well as for graduates from the 2021, 2022, and 2023 generations. Chi2 tests and t-tests were used to analyze differences among students in the Romanian and International sections, as well as among graduates from the 2021, 2022, and 2023 generations. Three types of indexes were developed to provide greater clarity into the factors influencing involvement in research and research practices.

An index of encouraging student research factors was developed by summing the scores (to a very high extent, coded + 2, to a high extent, coded + 1, I do not know, coded 0, to a low extent, coded − 1, not at all, coded − 2) of the following criteria: motivation and personal interest, curriculum vitae improvement motivation, examples of other colleagues, teacher presentations of research participation options, teacher mentoring and support, medical research student courses or training, the existence of research grants for undergraduate students, and monetary remuneration. The minimum value was − 16, and the maximum was + 16.

An index of research involvement barriers was developed by summing the scores (to a very high extent, coded + 2, to a high extent, coded + 1, I do not know, coded 0, to a low extent, coded − 1, not at all, coded − 2) of the following criteria: lack of time caused by required medical training courses or internships during medical studies, lack of interest or lack of motivation for research, difficulty finding a research coordinator, team, or research project, and lack of or insufficient financial compensation for work done. The minimum value was − 8, and the maximum was + 8.

An index for the involvement of medical students in research (research involvement index) was developed by summing the scores of involvements in the following research activities: participation at medical congresses, presenting papers at medical congresses (oral or poster presentations), participation in writing a scientific article, article publications, and participation in research projects. The available responses for each issue are 0 (no) and 1 (yes); therefore, the minimum value obtained for each participant was 0 and the maximum value obtained was 5.

We used forward selection in two stepwise multivariate linear regression analyses to find out what factors influenced the variations in the Research Involvement Barriers Index and the Index of factors that encourage student research. The dependent variables were the index of factors that encourage student research and the research involvement barriers index. For both, the independent variables were age, gender (coded 1–males, 2–females), and sections (Romanian section, international section). The analyses were performed separately for each index. Another stepwise multivariate linear regression analysis was conducted using forward selection to determine factors that contributed to the variation in the research involvement index. The dependent variables were the research involvement index, and the independent variables were age, gender (coded 1–males, 2–females), sections (Romanian section, international section), the index of factors that encourage student research, and the Research Involvement Barriers Index.

The data were analyzed using SPSS 22 statistical software, and significant findings are presented at a significance level of 0.05.

Sociodemographic characteristics

The final sample included 572 participants, which represents a response rate of around 30%. Of the participants, 215 (37.6%) were male and 357 (62.4%) were female, aged between 22 and 54 years (mean 25.25, SD 2.1). Ranking them according to the study section, 392 (68.5%) were students from the Romanian section and 180 (31.5%) were students from the international sections. Ranking them according to the years of graduation, 232 (40.5%) students graduated in 2021, 172 (30%) in 2022, and 168 (29.5%) in 2023.

Opinions on research and comparative analysis of graduate students from Romanian and international sections of different generations

Both Romanian and international students emphasize motivation, personal interest, and teacher mentoring and support as significant factors in research participation. Romanian students, in proportion to 67%, value motivation and personal interest, and 59% value teacher mentoring, while international students, in proportion to 58%, value motivation and personal interest, and 47% value teacher mentoring. Over one-third of Romanian students highlight CV improvement, research opportunities presented by teachers, and research training. Also, among international students, 40% report research training as influential, with around one-third citing CV improvement, examples of colleagues, and student research grants. The major barriers identified by Romanian students are as follows: 53% mention a lack of time and difficulty finding a research coordinator; 41% mention a lack of interest or motivation; and 20% mention insufficient financial compensation. Regarding the international students, 63% report difficulty finding a research coordinator, and 56% cite a lack of time, with a considerable proportion also noting financial constraints. The index of factors encouraging student research shows that Romanian students have a calculated score that varies between − 14 and + 16, with a mean of 8.38, whereas international students have a score ranging from − 4 to + 16, with a mean of 7.98. No statistically significant difference was seen between the two groups. The research involvement barriers index scores for Romanian students vary between − 6 and + 8, with a mean of 3.43, and for international students, they vary from − 4 to + 8, with a mean of 4.11. No statistically significant difference was seen between the two groups. Table  1 reports detailed information about the factors and barriers that could affect Romanian and international students’ participation in research activities.

Analyzing the answers of all students in the three graduating cohorts, several key factors emerged as influencing their involvement in research activities. The students consistently identified motivation, personal interest, teacher mentoring, and support as significant factors. Between 60% and 67% of all graduates attributed high importance to these factors. Teaching staff’s presentations of research opportunities, CV improvement, and the availability of student research funds enhanced the interest of about 40% of all cohorts of graduates in research. Colleagues’ examples and financial rewards significantly influenced the engagement of about 30% of 2023 graduates and one-third of 2021 and 2022 graduates. Throughout the years, barriers to research involvement remained consistent. Around half of students in all graduating cohorts identified a lack of time and difficulty finding a research coordinator, team, or project as major obstacles. Around 40% of graduates reported a lack of interest or motivation. Between 25% and 33% of graduates identified insufficient financial compensation as a significant barrier. However, the 2023 graduates placed more importance on the influence of examples from colleagues compared to the 2022 graduates. Furthermore, 2022 graduates emphasized the lack of funds as a barrier in comparison to 2021 graduates. The index of factors encouraging student research showed mean scores of 8.45 for 2021 graduates, 7.69 for 2022 graduates, and 8.57 for 2023 graduates, with no statistically significant differences between the groups.

The index of factors encouraging student research shows that 2021 graduates scored between − 7 and + 16, with a mean of 8.45. In comparison, 2022 graduates scored between − 14 and + 16, with a mean score of 7.69, while 2023 graduates scored between − 8 and + 16, with a mean score of 8.57. There was no statistically significant difference observed between the two groups. The Research Involvement Barriers Index scores for 2021 graduates range from − 6 to + 8, with a mean of 3.44; for 2022 graduates, the scores range from − 4 to + 8, with a mean of 3.78; and for 2023 graduates, the scores vary from − 3 to + 8, with a mean of 3.77. There was no statistically significant difference observed between the groups. Table  2 provides detailed information about the factors and barriers that could affect the students’ participation in research activities in the three graduating cohorts (2021–2023).

Practicies on research and comparative analysis of graduate students from Romanian and international sections of different generations

Around one-third of students from both sections began participating in research during their sixth year, with Romanian students starting earlier on average (t-test, p  < 0.01). About 70% of Romanian and over 80% of international students engaged in research linked to their graduation thesis, with a significant difference between groups (chi-square, p  < 0.05). Less than 20% performed more complex research. Romanian students more frequently participated in data collection compared to international students who preferred performing literature reviews (chi-square, p  < 0.01). Around 80% of Romanian and less than half of international students attended medical conferences (chi-square, p  < 0.01). In proportion, 36% of Romanian and 21% of international students were on the scientific meetings organization staff (chi-square, p  < 0.01). Approximately 12% of Romanian and 5% of international students presented posters at scientific conferences (t-test, p  < 0.05). One-quarter of Romanian and 20% of international students contributed to the writing of medical research papers, with Romanian students having a higher co-authoring rate (chi-square, p  < 0.05). A proportion of 29% of Romanian and 20% of international students were interested in publishing their research data (chi-square, p  < 0.05). Overall, 7% of international students and 6% of Romanian students have published their graduation thesis output. The research engagement index was higher for Romanian students (mean 1.53) compared to international students (mean 1.06) (t-test, p  < 0.01). Over 80% of students showed interest in improving their skills in scientific writing, with higher interest among Romanian students (chi-square, p  < 0.05), and around 60% were interested in post-graduation research activities. Table  3 provides detailed information about research practices and comparative analyses of Romanian and international graduates.

Approximately one-third of each cohort began research in their sixth year, with 2022 graduates starting earlier on average (t-test, p  < 0.05). Over 70% of graduates from all years participated in thesis-linked research, while less than 20% conducted more complex research. Around 31–38% of participants reviewed scientific literature, 25% developed research ideas and methodologies, and 28–37% performed data collection. More than one-third of 2021 graduates, as well as 40% of 2022 and 2023 graduates, performed statistical analysis. Most students attended medical congresses, with 12–15% presenting papers, 9% presenting posters, and 6.5–9.9% giving oral presentations. A quarter of 2021 graduates, 42% of 2022 graduates, and 30% of 2023 graduates were on the scientific meetings organization staff, with higher engagement in 2022 and 2023 (chi-square, p  < 0.05). Around 23% of graduates contributed to writing medical research papers. About 29% of 2021 graduates and 25% of 2022 and 2023 graduates were interested in publishing their research data, while 6% of the three graduating cohorts had accepted or published articles. Approximately 20% of graduates engaged in faculty research projects, with a mean of 1.3 regarding the research index scores. Interest in improving scientific writing skills was high. Over 79% of graduates showed interest in improving their skills in scientific writing, with higher interest among 2022 and 2023 graduates (chi-square, p  < 0.05), and around 60% were interested in post-graduation research activities. Table  4 provides detailed information about practices in research and comparative analysis in the three graduating cohorts (2021–2023).

Regarding aspects associated with involvement in research, the multivariate linear regression findings show that the index of positive factors was higher among female students (standardized beta 0.146, CI = 4.715–7.322, P  < 0.01). Additionally, the negative factor index was shown to be higher among female students (standardized beta 0.144, CI = 0.363–1.308, P  < 0.01) and in international sections (standardized beta 0.131, CI = 0.296–1.282, P  < 0.01). Also, the research index was higher among the Romanian section (standardized beta − 0.174, CI = -0.688–-0.251, P  < 0.01).

This study investigates the research factors and practices of students in their final year at Cluj-Napoca’s Iuliu Hatieganu University of Medicine and Pharmacy Faculty of Medicine.

The concept of originality is related to the evaluation of the aspects perceived by medical students regarding the factors that encouraged engagement in research activities, as well as the barriers that restricted their involvement, until the final year of study. It also refers to determining potential disparities in research culture and in student involvement in different types of research opportunities among Romanian and international medical graduates. Furthermore, performing an analysis of the patterns observed across different graduating years (2021–2023) may provide valuable insights into the dynamic nature of medical education and the potential for research advancements.

Factors encouraging and maintaining interest in medical student research

Ommering et al. found that to encourage and maintain the interest of medical students in research, it is necessary to understand the motivations that drive them to engage in research as well as the specific factors that contribute to their motivation for research [ 23 ]. In this light, our study’s results indicate that personal interest, which represents intrinsic motivation, is the most important factor that significantly encourages student engagement in research. Additionally, the authors of the previous cited study found that students may undertake research for future educational and professional options, such as a desired residency position [ 23 ]. However, our study reveals that the improvement of the curriculum vitae, a representation of extrinsic motivation, appears to have a less significant impact on students’ involvement in research. It’s possible that the lower significance achieved by improving their CV is due to the fact that, in the Romanian medical system, training possibilities and jobs post-graduation are based primarily on exams rather than CVs [ 30 ]. The absence of observed discrepancies between both sections is intriguing because this aspect was anticipated to have a greater impact on students from the international sections as the curriculum vitae continues to have significant importance in the residency applicant assessment process for most graduates globally [ 32 ]. Thus, according to our findings, medical schools should prioritize their students’ personal interests and curiosity in research. This might entail both research classes and practical research activities as part of the teaching program, which should promote curiosity and foster intrinsic motivations early in medical education.

Institutional factors influencing research involvement

In this study, educational influences, such as the presentation of research participation options by teachers, their mentoring and support, and the organization of medical research student courses or training, have a significant impact on students’ involvement in research. According to Abu-Zaid, teachers who encourage research have a substantial impact on students’ views towards this area and their aspirations for future careers [ 33 ]. However, the significance of teacher mentorship and assistance is perceived to a greater extent by students in the Romanian section. The observed disparity between the sections is unexpected, as both Romanian and international students interested in medical research receive the same guidance and assistance for research participation. This is due to the fact that the “Iuliu Hatieganu” University of Medicine and Pharmacy actively promotes research activities across all fields and departments. One potential reason for this disparity could be cultural differences in the perception of mentorship. Given their different origins, international graduates could have different expectations and mentorship experiences. Although the university strives to provide comparable mentoring, the increased perceived value of teacher interaction among Romanian students indicates underlying reasons needing further investigation.

Furthermore, when considering financial factors, it is observed that students view the presence of research grants as a significant and favorable factor that encourages their engagement in research. Similar findings were also expressed by Australian students, who said that one of the main elements motivating research activities throughout medical school is financing [ 34 ]. Iuliu Hatieganu University of Medicine and Pharmacy ranks first among Romanian medical universities in the number and value of competitive research grants due to the extraordinary effort of teaching staff collectives, the institutional frame improved by creating the Department for Research and Development, and the more generous financing programs. Most research funding comes from grants and contracts [ 35 ]. However, the results of the present investigation showed that Romanian students expressed a stronger belief that the existence of funds has a higher impact on their engagement in research. Romanian students probably view financing as more significant because of their connections with local funding sources, prior expertise in financially sponsored research projects, cultural and socioeconomic issues, and favorable experiences with financed research. To enhance research engagement, it should provide customized support and resources, encourage collaborative research efforts, and promote cross-cultural learning and idea exchange.

Community influences

The benefits of collegiality and collaboration, knowledge acquisition, and career-mindedness for medical students were highlighted by Yin et al. in their investigation that examined the effects of graduates’ research experiences on their medical undergraduate colleagues. [ 16 ]. The current study found that the example of other colleagues influences their involvement in research, and the findings vary between the groups under investigation. International students place a higher importance on this factor, probably because they could be more collaborative with their colleagues in the context of their smaller number of colleagues than in the Romanian section. Thus, they could have more chances to work together on research projects and influence each other by personal example. Additionally, the cohort of 2023 graduates showed stronger confidence that the influence of their colleagues’ examples has a greater effect on their research engagement compared to the 2022 graduate cohort. This might be the result of more peer cooperation, more group research projects, or a developing university culture of common academic interests.

Barriers to research participation

The outcomes of our study correspond closely to the available literature; many of the findings regarding barriers are comparable to the results of previous investigations. Key barriers to undergraduate research participation include a lack of knowledge and skills, limited faculty support and funding, as well as structural barriers like time constraints, limited research facilities, and a lack of motivation [ 36 ]. Our findings highlighted that the time constraints caused by time-consuming internships or mandatory medical training courses are the most significant obstacle impeding students’ engagement in research activities. According to our findings, “lack of time” has a greater impact on international students, who may have less time to do research because they must adapt to new educational systems and learn a new language. It is already known that medical curricula are often too rigorous to include sufficient time for extracurricular study [ 37 ]. Siemens et al. also identified a lack of time as a major obstacle to conducting research, citing a demanding school schedule [ 38 ]. Most students perceive the challenge of finding a research coordinator or team and a research project as a significant obstacle. Similar studies on the importance of research mentorship for medical students mirrored our findings [ 38 , 39 ]. In addition, their lack of interest in research and lack of or insufficient financial remuneration are perceived as minor barriers by respondents. Hegde et al. and Kumar et al. also demonstrated similar results, describing barriers such as lack of interest, funding, and poor availability of research mentors that can hinder undergraduate participation in research [ 39 , 40 ]. Developing flexible curricula, enhancing mentoring programs, developing research skills, offering time management support, and improving funding possibilities will help students participate in research without compromising their clinical training or academic responsibilities.

Integration of research into medical curricula

The Boyer Commission’s report on undergraduate medical education emphasizes the importance of integrating scientific research training into medical curricula. This trend has evolved, and currently, research-based learning is widespread. Medical schools engage students in undergraduate research in various ways. Research-driven courses, extracurricular activities, and graduate research projects are examples [ 24 , 41 ]. Medical students at Iuliu Hatieganu University of Medicine and Pharmacy Faculty of Medicine participate in both compulsory research and extracurricular activities. Table  5 summarizes the main activities. These activities should improve abilities in critical literature evaluation, study objectives, methodology, data collection, analysis, interpretation, and oral presentation [ 30 ]. Incorporating scientific research in medical education at an early stage improves both cognitive and practical abilities, develops intellectual skills, encourages evidence-based learning, promotes the production of publications, stimulates future research, and facilitates career progression [ 33 ]. Although there are different opinions about compulsory research in the faculty. According to Abu-Ziad et al., this could lead to bad research practices that harm universities and research organizations.

Student involvement in research activities

The findings of the investigation indicated that most students commenced their research activities at a later stage, predominantly during their fifth and sixth years of study. This research commencement coincides with the most common timeframe for starting graduate research. Furthermore, the proportion of students who participated in more complex research activities varied from 12 to 18%. However, their research roles have been vast. These include a data review of scientific literature, the formulation of research ideas and hypotheses, the development of research methodology and protocol, the creation of data collection tools, data gathering in various environments, including hospitals, communities, and organizations, and data statistical analysis. The percentage of students engaged in activities such as conducting laboratory experiments, writing medical articles, and developing abstracts and presentations for scientific conferences was considerably lower. Romanian students were more involved in data collection, while international students focused more on literature reviews. The language barrier could be the key to these results, as international students could perform review-type research more easily than gathering data from local patients, while Romanian students were expected to collect information more easily due to their access to patient data and their improved interactions with local patients.

Data dissemination

Romanian students and international students have significantly different participation rates in medical conferences. Events like conferences, workshops, seminars, and symposiums offer unique learning opportunities. These events encourage medical staff to remain current on research, discuss best practices, and learn new skills, developing safety and quality [ 42 ]. Romanian students have a higher percentage of presentations, with around 15% presenting their work, while international students have around 10%. Posters were more common among Romanian students, while oral presentations were more common among international students. Our findings align with a previous study conducted in the United Kingdom, which showed that 17% of students had submitted an article for scientific meetings, which refers to their participation in poster and podium presentations [ 26 ].

Between 20% and 25% of students from the studied groups have contributed to writing medical publications at least once, while between 10% and 15% of participants published papers as authors. The Romanian section had a higher percentage of students who co-authored papers. Students from both sections contributed reviews, original articles, and clinical case presentations. Similarly, a previous investigation conducted among students from Dutch universities showed that 12% of the participants had published one or more papers either prior to or during their year of graduation [ 43 ]. In their study, Barbosa et al. showed that investigations conducted at the medical-degree level are an unexplored resource of scientific knowledge. Active participation in scientific research holds significant value in terms of enhancing one’s personal knowledge. However, it is equally crucial to share this knowledge to advance the medical field and, subsequently, improve healthcare outcomes [ 8 ]. More than one-quarter of students expressed interest in publishing their graduation research data, with Romanian students showing more interest. This may be due to the fact that most international graduates do not continue their training in Romania after graduation, making it difficult to work with the research team to disseminate graduation study results. Currently, there are international students with at least one paper at the peer review stage. Also, under 10% of students have articles approved or published already. Therefore, the publication rate for research graduation theses was lower than that of other European studies, with rates of 10.4% in Portugal, 17% in France, and 23.8% in Finland [ 8 ]. To contrast, our study exposed data collected around graduation, while these studies revealed data collected years after graduation [ 8 ].

Importance of research writing skills and career motivation

Previous investigations showed that medical students need expertise in writing papers and abstracts. Teaching these abilities would be valuable, and medical schools should provide information and knowledge about writing scientific articles and abstracts to help students develop a solid foundation for their postgraduate medical careers [ 26 ]. Our findings demonstrated that almost all the students want to improve their scientific manuscript writing (writing of the scientific article, abstract) and publishing guidelines. The 2022 and 2023 graduates were more interested in learning how to write a scientific article and abstract writing, while the Romanian students were more interested in improving their scientific manuscript writing and publishing guidelines.

According to Waaijer et al., positive experiences can drive student motivation in a research career. Thus, the present investigation showed that over half of participants express a desire to continue conducting research after graduation, and they are probably likely to have had favorable experiences related to research throughout their medical school studies [ 43 ]. Moreover, a systematic review focused on career choice demonstrated that obtaining a medical degree or participating in a fellowship program is linked to a professional path in the field of research medicine. Also, the completion of research projects and subsequent dissemination of findings within the context of medical school and residency have a strong connection to a career path in the field of research medicine [ 44 ].

Strengths and limitations of the study

There are several limitations associated with this study. The first limitation could be the fact that the study provides valuable insights into research participation among Romanian and international medical graduates; the findings could be comparable only with those of other medical schools under the Bologna process that adopt similar curricular and extracurricular research activities. Furthermore, the research sample includes exclusively medical graduates from one Romanian medical institution, so the findings could restrict the representation of many points of view and experiences in the larger community of medical graduates. Moreover, participants who are more interested in research may self-select, which could influence the findings. Another possible limitation of our study is the low response rate observed. We also observed declining participation rates over successive years. Survey fatigue, demographic changes, methodologies, perceived relevance, privacy issues, benefits, and societal trends all could help to explain declining survey participation rates. Also, uncontrollable factors such as socioeconomic status, prior research experience, or personal motivations can complicate the relationship between identified variables and barriers to research participation, thereby complicating the ability to establish causal relationships. Moreover, the cross-sectional design of the study may restrict its ability to capture changes in research participation. It is very difficult to observe patterns and experiences over time or across different stages of medical education. However, a strong point of this study can be considered a continuation of the first investigation, as it aims to examine the factors that influence the engagement of undergraduate medical students in research in their third and fifth years of study, who graduated in 2021 and were part of the study’s sample.

The findings of this study offer important perspectives into the involvement of medical undergraduates in research during medical school, as well as the factors and barriers that interfere with research participation. The results demonstrate that intrinsic motivation is the primary factor driving student engagement in research, while institutional factors, such as educational, financial, and community influences, also have a substantial impact on research involvement. Lack of interest and time restrictions are the two main barriers. Furthermore, observed were financial issues, difficulties finding a research coordinator or team, and securing a research project. Also, this study revealed the existence of research culture differences between Romanian and international students and underlined the dynamic character of medical education. This work could be used as a foundation for future research to explore methods for removing these obstacles and fostering factors that may impact research engagement. These results could be adapted by teaching staff about practical medical education to offer effective strategies for encouraging undergraduate research field involvement and promoting cross-cultural learning. Also, universities and policymakers could utilize these findings to concentrate their initiatives on reducing the main barriers to achieving high-quality research. Overall, this study not only advances academic understanding but also offers tangible benefits to all parties involved, fostering a collaborative approach to encourage research participation among medical undergraduates.

Availability of data and materials

The datasets utilized and analyzed in the present study are accesible upon resonable request from the corresponding author.

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Acknowledgements

We would like to extend our sincere thanks to all the students who participated in the survey.

This research was funded through a research project by the Iuliu Hatieganu University of Medicine and Pharmacy, Internal grant—Doctoral Research Project with registration number: 1032/49/13 January 2021.

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Contributions

A.I.P. conducted data collection, performed data analysis and interpretation, and wrote the article. L.M.L. developed the methodology, provided supervision, offered valuable insights regarding data analysis and interpretation, and contributed to the article’s writing. The authors have read and approved the submitted version of the manuscript.

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Correspondence to Andreea Iulia Pop .

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The study was approved by the Iuliu Hatieganu University of Medicine and Pharmacy Ethics Committee (Approval No. 27/03.11.2021).

The need for written informed consent was waived by the Iuliu Hatieganu University of Medicine and Pharmacy Ethics Committee due to the nature of the survey, which did not collect any personally identifiable data.

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Pop, A.I., Lotrean, L.M. Comparative analysis of factors and barriers intervening in research participation among romanian and international medical graduates from one romanian medical faculty across three generations. BMC Med Educ 24 , 1028 (2024). https://doi.org/10.1186/s12909-024-05939-5

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Received : 07 April 2024

Accepted : 21 August 2024

Published : 19 September 2024

DOI : https://doi.org/10.1186/s12909-024-05939-5

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