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Thus, high salience and a positive self-image of group members promote self-categorization into these groups [ 33 ]. With this background, the self-categorization of all study participants into the group of medical students is understandable, since studying medicine has a pronounced influence on their lives and distinguishes them from other social groups.

The status as a medical student also represents a positive social role and is therefore a desirable social group. International students instead experience this separation very strongly. Also it is perceived with a negative connotation due to possible isolation and poorer academic performance. Although the focus on academic performance in medical schools [ 42 ] is perceived by all medical students, international students in particular experience this as a disadvantage in social life.

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The statements on the low academic value of contacts with international medical students in our research contradict previous studies of Lovell's research on student communities in medical schools [ 18 ]. Although he also refers to comparable behavior among medical students, he reports only little evidence on the abandonment of students with academic struggles.

Instead, his study displays a cooperative community, in which mutual work and support exist despite competition. Our results, however, indicate that this competition weakens contacts rather than promoting them. The observed abandonment from underachieving students may be an alternative explanation for quantitative network studies [ 29 ], [ 30 ]. It explains the link between the network position of medical students in their respective class and academic achievement.


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Currently this phenomenon is often described through the equalization of academic performance among befriended medical students due to mutual support [ 18 ], [ 29 ]. Our results instead suggest a previous selection of high performing students and an exclusion of low performing students. This process may therefore increase differences in academic performance and lead to a pronounced academic stratification of medical student communities. Both, the theory of social identity and our findings illustrate that the emergence of group affiliation is sensitive to the context in which it takes place [ 27 ].

The composition of the medical student community can influence this context. Here the large linguistic and cultural heterogeneity of international medical students [ 41 ] contrasts with the linguistic and cultural homogeneous majority of German medical students [ 42 ].

Given these circumstances, it can be assumed that German or professional cultural norms and expectations are rarely explicit [ 49 ]. Implicit knowledge is thus relevant, which means that students from different cultural backgrounds cannot use their potential to the same extent. This reveals limitations of the often alleged cultural neutrality [ 50 ] of medicine and medical education. The present study is limited by its location at a single university in a federal state in the eastern part of Germany.

Nevertheless, the informal exchange with research groups from other universities indicated similar impressions at their locations. The number of interviews was limited by our comparatively small research team, although we found saturation in the data. The composition of the sample is also a limitation, as we had particular difficulty in reaching out for students from non-EU countries. Last but not least, our qualitative approach allows detailed insights into the field of research, but it is limited in the quantification of these insights due to our qualitative sampling method.

Further research may overcome these limitations through surveys at other locations as well as through a more standardized and quantitative focus. Our findings indicate challenges in the social interaction among medical students. Nonetheless, they also show opportunities for intervention.

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In particular, the potential of a shared perception of an identity as medical students is impressive. Local interventions could support such successful collaboration by promoting a shared identity among medical students at their universities. The same applies to the critical questioning of the existing contextual framework conditions of the medical school as well as the student body [ 51 ].

Last but not least, faculties have the opportunity to incorporate the cultural knowledge of international medical students into medical training through specific offers and reforms of the framework conditions of their educational programs. In the case of the UMR, the project RONIAmed was initiated by students, which is intended to support contacts between international and German medical students during the study entry phase.

It is currently being tested. We thank all participating students for their willingness to give us an insight into their experiences at UMR. In addition, we would like to thank the members of the student research group on Medical Education at the Institute of Immunology for their critical comments during data analysis. National Center for Biotechnology Information , U. Published online Nov Author information Article notes Copyright and License information Disclaimer.

Zusammenfassung

Abstract Introduction: In addition to linguistic and cultural difficulties, problems with social integration are frequently found among international medical students. Keywords: International medical students, cultural diversity, minorities, qualitative methods, grounded theory, social learning, social identity. Introduction International medical students worldwide [ 1 ], [ 2 ] as well as in Germany [ 3 ], [ 4 ], [ 5 ] show lower academic performance and a longer duration of study compared to the respective national groups.

In this context, the present work pursues two central questions: How do German and international medical students perceive the development and maintenance of their personal networks during their studies? Which factors influence this perception? Methods Methodological approach Due to the limited knowledge on the subject of research at German medical faculties, an exploratory approach was chosen [ 34 ]. Data collection The present study uses the data of 27 preclinical medical students, who were interviewed in the fall term of as part of a research project on social networks among medical students at the University Medical Center Rostock UMR.

Open in a separate window. Table 1.

Sociodemographic information of the study participants based on nationality. Data analysis The interviews lasted an average of 23 minutes and were conducted by the first author, who was trained and experienced in grounded theory and in interview techniques. Figure 1. Interview guide.

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Over the course of the interview additional topics could be added in order to open up the guidline for new impressions of the study participants. Figure 2. Excerpt from the process of data analysis through contrasting comparisons between interviews.


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Codes are derived from contrasting views and perceptions between different study participants SN. Ethics All participants were informed about the subject and aim of the study and gave written consent to participate. Results Our results indicate distinct differences between German and international students in the challenges associated with development and maintenance of personal networks during the first semesters of medical school. Different perception of group affiliation All interviewed students emphasize group affiliation as a key element during the initial phase of medical school.

Figure 3. Differences in the perception between German and international medical students. Unfavorable cost-benefit analysis All students describe a change in the spirit within the medical student community after the first weeks of medical school. Framework conditions of medical school International students are a minority within the medical student community and our data indicates that they are well aware of their exposure within this asymmetric distribution.

Dealing with integration Many international students describe strategies to manage their own integration, which indicate a conscious handling of the contextual conditions mentioned above. Discussion The present study investigates the perception of the development and maintenance of personal networks by German and international medical students. Influence factor: group affiliation The theories of social identity and self-categorization provide an established theoretical framework for understanding the differently experienced group affiliations [ 25 ], [ 26 ].

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Influence factor: cost-benefit consideration Although the focus on academic performance in medical schools [ 42 ] is perceived by all medical students, international students in particular experience this as a disadvantage in social life. Influence factor: Framework conditions in medical school Both, the theory of social identity and our findings illustrate that the emergence of group affiliation is sensitive to the context in which it takes place [ 27 ].

Limitations The present study is limited by its location at a single university in a federal state in the eastern part of Germany. Conclusions Our findings indicate challenges in the social interaction among medical students. Acknowledgements We thank all participating students for their willingness to give us an insight into their experiences at UMR. Competing interests The authors declare that they have no competing interests. References 1. Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training.

Ethnicity and academic performance in UK trained doctors and medical students: systematic review and meta-analysis.

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Performance of International Medical Students In psychosocial medicine. BMC Med Educ. Examination performances of German and international medical students in the preclinical studying-term--a descriptive study. Lorenz I, Shahla H. International medical students--a survey of perceived challenges and established support services at medical faculties.