CC BY
7
DOI: 10.12731/2658-4034-2022-13-5-82-98 UDC 159.9.072
RUSSIAN MEDICAL EDUCATION FROM INTERNATIONAL STUDENTS' VIEW POINT: CHALLENGES AND COPING STRATEGIES
L.A. Khokhlova, E.A. Andreeva, L.G. Kiseleva, E.V. Tikhonova, A.S. Andreeva
Purpose. The manuscript is devoted to the burning issue of education internationalization in modern society. Having come to study in Russia, many international students face a number of difficulties concerning various aspects of their life activity. The authors aim to study international students' opinion regarding their residence in the European North and their study at the Russian medical university.
Methodology. Survey findings of 149 Indian students studying at the International Faculty of General Practitioners of the Northern State Medical University (NSMU), Arkhangelsk compose the research basis.
Results. Main challenges encountered by international students in the conditions of the European North, their attitude to the organization and quality of the educational process in the university were revealed. Cold climate, language barrier, the lack of traditional foods and separation from family are believed to be the main factors that make it difficult for junior students to learn. Senior students express their disappointment at the lack of clinical practice due to the distance learning during the pandemic and different level of students and teachers' language proficiency. In general, students speak positively about university educational process and are satisfied with Russian education quality.
Practical implications. Research findings can be used to develop recommendations for improving the socio-pedagogical adaptation of international students in Russian universities.
Keywords: international students; European North; Russian higher medical education; challenges
РОССИЙСКОЕ МЕДИЦИНСКОЕ ОБРАЗОВАНИЕ ГЛАЗАМИ СТУДЕНТОВ-ИНОСТРАНЦЕВ: ПРОБЛЕМЫ И СТРАТЕГИИ РЕШЕНИЯ
Л.А. Хохлова, Е.А. Андреева, Л.Г. Киселева, Е.В. Тихонова, А.C. Андреева
Цель. Статья посвящена актуальной в условиях современного общества теме интернационализации образования. Приезжая на обучение в Россию, многие иностранные студенты сталкиваются с рядом трудностей, касающихся различных аспектов их жизнедеятельности. Авторы ставят целью изучить мнение иностранных студентов относительно их проживания на Европейском Севере и обучения в российском медицинском вузе.
Метод или методология проведения работы. Основу исследования составляют результаты анкетирования 149 индийских студентов, обучающихся на международном факультете врача общей практики Северного государственного медицинского университета (г. Архангельск).
Результаты. Выявлены основные трудности, с которыми сталкиваются иностранные студенты, находясь в условиях Европейского Севера, их отношение к организации и качеству учебного процесса в вузе. Холодный климат, языковой барьер, отсутствие традиционной, национальной пищи, разлука с семьей - основные факторы, осложняющие процесс обучения студентов первых курсов. Студенты старших курсов среди негативных моментов отмечают нехватку клинической практики (в связи с необходимостью перехода на дистанционное обучение в период пандемии), различную языковую подготовку студентов и преподавателей. В целом студенты положительно высказываются об образовательном процессе иудовлет-ворены качеством российского образования.
Область применения результатов. Результаты исследования могут быть использованы для разработки рекомендаций по улучшению социально-педагогической адаптации иностранных студентов в российском вузе.
Ключевые слова: иностранные студенты; Европейский Север; российское высшее медицинское образование; проблемы
Introduction
The Northern State Medical University (NSMU), Arkhangelsk, has an extensive practical experience with international students. According to the official website, the university has more than a thousand international students from eleven countries, including Nigeria, Thailand, Peru, and others. Indians constitute a significant proportion of international students coming to get a medical degree. According to MBBS Expert, the minimum tuition fee in Indian medical universities is a million rupees per year (about $12,500) without accommodation, while a year of study at NSMU costs $6,000 including accommodation.
The educational migration patterns of Indian students are significantly different from those of the Russian ones. According the Russian Federal State Statistics Service [5], a third of all Russian graduates don't work in their degree field. They are often motivated to go to a big city and enter a prestigious university paying no attention to the academic program track. Indian students go to Russia, Arkhangelsk and NSMU to become physicians.
Social and financial prestige of the medical profession differs greatly in Russia and India. According to the Tinkoff Journal's study [1], the average salary of a doctor in Russia without COVID-19 Pandemic Payment is 40,000 rubles (about $655 at the August 2022 exchange rate). Experienced health care professionals can earn several times as much. A doctor in India is a much more prestigious and well-paid profession than a doctor in Russia. Moreover, Indian doctors have a strong sense of their own prestige. As Manash Firaq Bhattacharjee writes, "Doctors in India behave like they are a caste." The author refers to the incident when doctors with stethoscopes draped around their shoulders protested with brooms in hand to show "who deserved the stethoscope and who was fit only for the broom" [6].
Indian students constitute an essential part of NSMU student community. The university's priority is the educational process quality, including that of international students. It requires increased attention from
the administrative and teaching staff. With this background we've considered it relevant to conduct the study to find ways to improve international students' learning experience at NSMU.
Material and Methods
The study was conducted at the Northern State Medical University. An anonymous questionnaire survey was administered to 149 Indian students of the first (n=20), third (n=17), fourth (n=25), fifth (n=31), and sixth (n=56) years of study receiving training at the International Faculty of General Practitioners. Informed consent was obtained from all students who participated in the study The questionnaire was developed by the authors of the study. It included 37 open-ended questions aimed to determine the learning experience specificity of international students and to identify problems of the socio-communicative, adaptive and psychological nature as well as those related to methods of the educational process students face while studying at NSMU. The majority of international students had been living in Arkhangelsk for 6 years (37.5%) at the time of the survey. Residence duration for the rest of students was 4 (37.5%), 3 (11.4%) and less (13.4%) years.
Results and Discussion
For the majority of Indian students Arkhangelsk continues to be a favourite destination to study medicine due to affordable fee structure, quality education and the opportunity to study in English which is the second official language in India. By these two factors, the Northern State Medical University having an extensive practical experience with international students is a competitive university in Russia. NSMU high reputation in the educational services market was of great significance for Indian students. According to Webometrics Ranking of World Universities, NSMU was among the top five Russian medical universities in 2019.
In 18 % of the cases, Indian students chose NSMU based on the recommendations of their friends and siblings, who had graduated from the university. There were also those who mentioned the regional component and the global factor including good Russian-Indian relations.
One Indian student chose NSMU due to the university location in the North and the opportunity to gain experience living in cold and snowy weather conditions. In this case the North acted as an attraction region.
First-year students mean age was 20.1±1.2, which is slightly higher than that of Russian students entering the university at the age of 17-18. It's probably due to the time of life and professional principles formation characteristic of Indian students.
Moving to Arkhangelsk became the cause of a number of difficulties for international students. Cold weather (75%), language barrier (66.1%), lack of vegetarian cuisine and familiar foods (29.2%), separation from the family (18.7%), and difficulties adapting to hostel life (the necessity to cook their own food) (9.7%) are among them.
One of the most significant stress factors was the need to adapt to climatic conditions greatly differing from those of India. According to the responses of those surveyed, adaptation duration to the new ecological and climatic conditions of the North ranged from one month to one year depending on individual characteristics, psychological attitudes and respondents' physiological functions condition. Even among sixth-year students having the longest experience of living in Arkhangelsk there were those who felt uncomfortable in the North due to a cold climate.
After a period of acute adaptation, 47.4% of Indian students got used to living in the North. The exception was the period from December to January, when quite a large percentage of respondents (67.3%) suffered from colds, headaches, muscle pains, respiratory and skin problems.
University material and technical infrastructure has a significant effect on international students' satisfaction with a learning experience. Their opinions concerning dormitories conditions are contradictory. It can be explained by the difference in the level of comfort and available facilities in various NSMU dormitories. Conditions of common areas (toilets, showers, kitchens), frequent lack of hot water or poor water supply, noisy neighbors, sanitary and hygienic conditions and pass control were named as major housing disadvantages. In a number of dormitories, there was no kitchen and possibility to cook food. 7.2% of respondents noted discomfort in communicating with dormitory staff, which is probably
due to a significant difference between the Russian and foreign mentality, national character and behavior peculiarities. Annual rehousing from one dormitory to another was negatively mentioned by some sixth-year students. Nevertheless, 78.3% of international students felt comfortable in university dormitories. They felt much supported by senior international students and it made their transition through medical school easier.
Current political background, changes in currency exchange rates and difficulties with bank cards have led to the presence of financial problems in 57.1% of respondents.
25.4% of international students expressed dissatisfaction with the work of the university cafeteria and canteen. 39.2% expressed their desire for a variety of vegetarian cuisine and 14.5% pointed out the high cost of dishes at university canteen.
17.3% ofthose surveyed experienced isolated incidents of aggression. According to the questionnaire responses it was motivated by xenophobia ("biased hostel," as one of the respondents wrote). Some students answering "yes, of course" were ready to face aggression and took it for granted as a part of the international student's experience. Others, on the contrary, were not ready for these situations and such questionnaire answers as "for no reason" were likely to demonstrate students' frustration.
Series of questions on the organization of the educational process were generally answered positively. According to the answers concerning the assessment of the quality and dynamics of the socio-pedagogical adaptation, the educational process at NSMU is well organized, faculty members are helpful and approachable when there are difficulties in mastering the course content. 84.3% of respondents said that studying at NSMU was interesting and they usually did well in their studies.
Senior students were more likely to report learning problems than first-year ones. It's probably due to a more tolerant attitude of the university administration, theoretical and humanities departments to junior students. In their senior years, during the period of the so-called re-adaptation to clinical departments requiring both theoretical training and practical skills in performing diagnostic manipulations, 9.2% of international students face difficulties leading to academic deficiency.
Senior students consider therapy and its fields (endocrinology, in particular) (36.7%), surgery (21.1%), neurology (17.1%), pharmacology (14.1%) and pathologic anatomy (11.3%) to be the most difficult subjects. First-year students have difficulties in mastering biology, anatomy, and chemistry.
Despite the fact that instruction for international students is entirely in English, students are limited in their ability to communicate with teachers. Different level of teachers linguistic training, dialect peculiarities of Indian English and poor knowledge of Russian by international students prevent from successful academic and interpersonal communication between students and faculty members.
Long-term language immersion has a beneficial effect on the level of language proficiency of international students. While first-year students assess their level of Russian as basic, 82.3% of senior students consider it to be sufficient ("extremely good", "normal Russian language" according to their questionnaire answers).
At the same time, instruction in English and isolated dormitories for international and Russian students leads to the fact that 21 of 56 sixth-year students assess their knowledge of Russian as satisfactory only and 4 of 56 consider it insufficient for academic and professional communication.
The educational process largely depends on communication between students and faculty members. Meanwhile, the question on communication effectiveness with the teaching staff got conflicting responses. The majority of students stated that they understood their lecturers and so did they. But there were those who declared complete misunderstanding. It seems that successful communication depends not only on teachers linguistic training but on their engagement with the learning process. It's evidenced by the respondents' answers, which range from "they are very helpful" to "they don't try to understand us at all". Studies on international students' learning [8; 13] tend to focus on their cultural background and declare it the cause of the peculiarities and/or difficulties of the educational process. International students' participation in classroom discussions is not given the attention it deserves. To make educational communication successful, one needs to look not for specificities mak-
ing international students different, but for similarities that can be the basis for mutual understanding [3; 17].
A considerable part of the questionnaire was devoted to the problems complicating the learning process. According to the respondents' answers, North climatic features (cold weather triggering catarrhal diseases, short daylight hours in autumn and winter) prevent students from successful studies. Feeling unwell is a dominant cause of the students being late for classes and missing them (74.7% of the answers). Bad weather accounts for 61.1% and difficulties with waking up in the morning make 17.2%. The problem with transport takes the final position in this list (4.5%). The absence of home comfort that students got used to (need for laundry, cooking) and the lack of motivation were also mentioned as reasons interfering with the learning process. Due to being late or missing practical classes and/or lectures some students (8.8%) had experience of disagreements with their instructors during the study period.
To build effective communication between faculty members and international students, administrative and teaching staff must be sensitive to students' socio-cultural specificities. Within Hall typology, Indian culture is defined as a low-context and polychronous one [7]. It means that Indians don't pay particular attention to daily routines and their punctuality. According to V.A. Fedotova [4], Indian students need to be trained in time management, informed about schedules, and warned about upcoming deadlines. They find it difficult to predict complicated hostel and academic situations and need both intergroup and cross-group social support.
Due to the COVID-19 pandemic the issue of distance learning has become highly topical. A number of students indicated the presence of problems associated with the access to on-line study materials. Problems with the Internet and its low speed were mentioned. 17 of 56 sixth-year students were dissatisfied with the university organization of e-learn-ing. There is a free access to the Internet in the NSMU main academic building and simulation center. But there is no access to the Internet in university dormitories. Preparing for classes most international students (98.2%) use Internet resources, lecture materials (54.6%) and English-lan-
guage textbooks (51.7%). A small proportion of senior students (5.3%) use Indian educational platforms (e.g., PredLadder). All the students use study materials of the university Moodle electronic system. In these circumstances, the majority of first-year students (73%) note difficulties in understanding on-line lectures.
The pandemic had also a negative effect on the students' opportunities to develop their practical skills. Sixth-year students spent five semesters (2020-2022) studying remotely. Even those in-patient departments, where "red zones" were not organized, were closed to students. All senior students expressed their disappointment at the lack of practical training at clinical settings. Medical education requires students to be proficient in communication skills. Evidence-based studies show that effective interpersonal and communication skills are associated with improved health outcomes [16]. Ineffective communication skills are often associated with medication errors [14]. Due to the pandemic international students were not exposed to clinical scenarios, they were not present during daily rounds and had no opportunity to interact with real patients [11]. Practical skills were practiced in the university simulation center only. At the same time, 11 of 56 sixth-year students were pleased with their clinical practice before the COVID-19 pandemic.
Psychological comfort is an important factor in students' positive educational experience. Good communication with Russian students and the locals makes it easier for international students to adapt to the region making Arkhangelsk an attractive place to live in. Participation in university extracurricular activities has as much effect on students' experience as learning process does. According to the questionnaire responses of the international students, they are usually communicatively isolated within their group ("intercultural communication only"). For the majority (63.8%) of the respondents international students are their main social circle. Only 40.1% of them communicate with Russian students. This situation is not unique to NSMU or the North: international students at Astrakhan State Medical University have little contact with local residents as well [2]. According to Glass et.al. [9], international students interacting with those from their own culture have a more posi-
tive perception of the psychological campus climate. On the other hand, those who communicate with people of various cultural backgrounds demonstrate higher levels of education and development [12]. According to Sawir et al. [15], support within the cultural group helps international students cope with their "cultural loneliness" due to the lack of a familiar cultural and/or linguistic environment.
It cannot be said that international students are unwilling to participate in university extra-curricular life and informal communication. Most respondents (77,8%) indicated their engagement in leisure, scientific, cultural and sports activities. Of these, 27 students took part in conferences, 14 participated in the preparation of scientific presentations, 46 respondents took part in sports, dance and music events, flash mobs and Faculty Day (29 people). 9 respondents expressed their readiness to attend students' scientific societies, which is not always possible due to the language barrier.
Main recommendations to the university administration expressed by international students concerned the organization of clinical practice with real patients; improvement of living conditions in dormitories, including organization of class preparation rooms and sports facilities; increasing the number of hours to study Russian and upgrading the level of linguistic competence of the faculty members teaching international students. Some students would like to have a variety of menus in the university canteen including dishes from a traditional national cuisine. Indian students' serious approach to studies is evidenced by the fact that some of them stand for stricter discipline in classes and exams. At the same time, 8.9% of the respondents would not change anything in current circumstances.
The question of recommending the university to friends was met with mixed responses. The number of positive and negative ones demonstrated certain flactuations depending on the course of study. The question: "Would you recommend NSMU to your friends?" was answered positively by all first-year students. There was a change in the Yes/No ratio among senior students. 40.2% responded "Yes," while 32.8% of the respondents answered "No." Some students (3.5%) explained the lack of recommendations for studying at NSMU by high education fees.
Conclusions
The research findings have shown that both academic and non-academic factors influence students' progression through the medical training program. International students studying at the university made an informed choice when applying to NSMU to receive higher professional medical education. According to the majority of respondents, the university enjoys a high reputation due to quality education. International students positively perceive the Russian medical educational system and demonstrate their willingness to communicate with Russian students and jointly participate in university mass cultural events. The majority of respondents rated the experience of staying and studying in Arkhangelsk as positive.
Main difficulties faced by international students during their studies in the North are adaptation to the climate, food, new lifestyle pattern and language barrier. Despite the presence of some disadvantages in dormitory living conditions, hostel life has a beneficial effect on international students' adaptation to university reality.
Despite Arkhangelsk harsh climatic conditions, the socio-pedagogical adaptation of Indian students is believed to be constructive. According to the majority of respondents, the organization of the educational process at NSMU is at a high level. Most students are satisfied with it and even proud of their chosen specialty.
Medical education specificity is its high "attachment" to clinical settings. Students need to pay attention to both theoretical training and the formation of practical skills in communicating with patients and medical staff and gaining experience in clinics and hospitals [10; 11]. International students access to Arkhangelsk in-patient departments even in the context of the ongoing COVID-19 pandemic must therefore be arranged. This problem must be solved by both the university administration and the regional Ministry of Health. In addition, the issue of upgrading the level of linguistic competence of the faculty members working with international students remains relevant.
Thus, working with international students, it is necessary to take into account the students' cultural and linguistic specifics as well as their recommendations.
References
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8. Garvey G., Rolfe I.E., Pearson S-A., Treloar C. Indigenous Australian medical students' perception of their medical school training // Medical Education, 2009, vol. 43(11). https://doi.org/1047-1055.10.1111/j.1365-2923.2009.03519.x
9. Glass R.C. Educational Experiences Associated with International Students' Learning, Development, and Positive Perceptions of Campus Climate // Journal of Studies in International Education, 2011, vol. 16(3), pp. 228-251.
10. Khokhlova L.A., Dynkov S.M., Kiseleva L.G., Tikhonova E.V., Trok-hova M.V., Kolodkina O.F. Problems of teaching academic disciplines to foreign students at the Northern State Medical University // Modern Studies of Social Issues, 2018, vol. 9(11), pp. 6-14.
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12. Luo J., Jamieson-Drake D. Examining the Educational Benefits of Interacting with International Students // Journal of International Students, 2013, vol. 2(2), pp. 85-101.
13. Marlina R. "I don't talk or I decide not to talk? Is it my culture?" - International students' experiences of tutorial participation // International Journal of Educational Research. 2009, vol. 48(4), pp. 235-244.
14. Rider E.A., Lown B.A., Hinrichs M.M. Teaching communication skills // Medical Education, 2004, vol. 38, pp. 558-559. https://doi.org/10.1111/ j.1365-2929.2004.01866.x
15. Sawir E., Marginson S., Deumert A., Nyland C. Loneliness and International Students: An Australian Study // Journal of Studies in International Education, 2007, vol. 12(2), pp. 148-180.
16. Stewart S.M., Lam T.H., Betson C.L., Wong C.M., Wong A.M. A prospective analysis of stress and academic performance in the first two years of medical school // Medical Education, 1999, vol. 33, pp. 24350. https://doi.org/10.1046/j.1365-2923.1999.00294.x
17. Straker J. International Student Participation in Higher Education: Changing the Focus from "International Students' to "Participation" // Journal of Studies in International Education, 2016, vol. 20(4), pp. 299-318.
DATA ABOUT THE AUTHORS
Larissa A. Khokhlova, Associate Professor, Foreign Language Department, Doctor of psychology
Northern State Medical University
51, Troitskiy Ave., Arkhangelsk, 163000, Russian Federation lkhokhlova@rambler. ru SPIN-code: 8698-0280
Elena А. Andreeva, Associate Professor, Institute of Family Medicine, PhD in medicine
Northern State Medical University
51, Troitskiy Ave., Arkhangelsk, 163000, Russian Federation
klmn.69@mail.ru
SPIN-code: 3543-4005
ORCID: https://orcid.org/0000-0002-3917-154X ResearcherID: J-7662-2017 Scopus AuthorID: 56537990200
Larissa G. Kiseleva, Associate Professor, Neonatology and Perinatology Department, PhD in medicine
Northern State Medical University
Troitskiy Ave., 51, Arkhangelsk, 163000, Russian Federation
kis272@yandex.ru
SPIN-code: 9774-3360
Elena V. Tikhonova, Associate Professor, Pathologic Physiology Department, PhD in medicine
Northern State Medical University
51, Troitskiy Ave., Arkhangelsk, 163000, Russian Federation
tiholog@mail.ru
SPIN-code: 7400-0146
ORCID: https://orcid.org/0000-0001-8792-5847
Anastasiia S. Andreeva, research assistant
National Research University "Higher School of Economics", Centre for Youth Studies
16, Soyuz Pechatnikov Str., St. Petersburg, 190008, Russian Federation
as.andreeva@hse.ru
ORCID: https://orcid.org/0000-0002-0222-2112 ResearcherID: GQB-0955-2022
ДАННЫЕ ОБ АВТОРАХ Хохлова Лариса Александровна, доцент кафедры иностранных языков, доктор психологических наук
Северный государственный медицинский университет пр. Троицкий, 51, г. Архангельск, 163000, Российская Федерация lkhokhlova@rambler. ru
Андреева Елена Александровна, доцент Института семейной медицины, кандидат медицинских наук
Северный государственный медицинский университет
пр. Троицкий, 51, г. Архангельск, 163000, Российская Федерация
klmn.69@mail.ru
Киселева Лариса Григорьевна, доцент кафедры неонатологии и перинатологии, кандидат медицинских наук
Северный государственный медицинский университет
пр. Троицкий, 51, г. Архангельск, 163000, Российская Федерация
kis272@yandex.ru
Тихонова Елена Васильевна, доцент кафедры патологической физиологии, кандидат медицинских наук
Северный государственный медицинский университет
пр. Троицкий, 51, г. Архангельск, 163000, Российская Федерация
tiholog@mail.ru
Андреева Анастасия Сергеевна, стажер-исследователь
Национальный исследовательский университет "Высшая школа экономики", Центр молодежных исследований ул. Союза Печатников, 16, г. Санкт-Петербург, 190008, Российская Федерация as.andreeva@hse.ru
Поступила 29.08.2022 Received 29.08.2022
После рецензирования 22.09.2022 Revised 22.09.2022
Принята 03.10.2022 Accepted 03.10.2022
