Document Type: Letter to Editor


1 1Department of Internal Medicine, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran; 2Department of Internal Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Department of Community Health Nursing, Faculty of Nursing, Arak University of Medical Sciences, Arak, Iran


The increased number of international studentsin higher education systems is recognizedas beneficial not only economically but also interms of preparation of the workforce for theglobal environment. It is believed that diversityin the student cohort can also be beneficial fordomestic students in terms of increasing culturalawareness and achieving cultural competencygoals. Culturally and linguistically diversestudents (CALD) include students whose firstlanguage andor culture is not of the countrythey study in (1). There are 55,000 internationalstudents in Iran, of whom 26,000 have enrolled inuniversities affiliated to the Ministry of Science,10,000 in different branches of Islamic AzadUniversity, 2,000 in universities affiliated to theMinistry of Health, and 17,000 in AlmustafaInternational University (2). According to thelatest data from the UNESCO, more than 82%of the international students in Iran come fromAfghanistan, 8.7% Iraq, and 6% Syria, Lebanon,and Pakistan combined (3). Meanwhile, theMinistry of Health and Medical Educationfollows a plan for expanding internationalmedical education in eligible Iranian universitiesof medical sciences and, hence, concentrateson mechanisms to align the universities withinternational standards. Although economic,political, and societal factors in both the hostand home countries influence internationalstudents’ decision to select the host country, it isnecessary that the authorities address their needsand problems and then take some measures tosolve them in order to increase the number offoreign applicants in Iranian universities.International students’ difficulties havebeen reported as academically and socially,with cultural and language barriers impactingtheir capacity to integrate with domesticstudents. These students have problemswith language and communication, sufferfrom lack of confidence to speak out and askquestions, and approach the teaching staff.For some international students, adaptationto new environment gets so difficult andfailure to adjust will cause them to experiencepsychological symptoms such as feelings ofinferiority, confusion, homesickness, loneliness,and anxiety (4). Commonly cited key issuesaffecting international students in learningenvironments are communication difficulties,cultural differences, and lack of familiarity withsocial, educational, and professional health careenvironments (5). Most of the literature aboutinternational students comes from Englishspeaking countries, and thus challenges in theAsian and Islamic learning context have notbeen addressed enough in the existing evidence.According to the studies conducted in theinternational learning contexts, there is a greaterpower distance and uncertainty avoidance inthe Asian culture, and these cultural differencesmay create tense interrelationships among thetrainees, staff, and supervisors (6).There is a need to develop understanding,accepting and appreciating the studentsfrom diverse backgrounds in the learningenvironments. For health professional students,the challenges become particularly evident inclinical practice settings. Clinical placement isof vital importance for healthcare disciplinesand covers approximately 50% of the trainingactivities. While clinical learning experiencecan be stressful and anxiety-provoking for anystudent, evidence suggests that this situation issignificantly more complex for CALD students(7, 8). Support from the staff in the clinical areacan be a source of motivation to students andmakes them feel welcome and part of the team,thereby helping them with learning. On thecontrary, failure to provide adequate learningopportunities for these students could resultin graduates who have not met the requiredstandards and competencies of the profession(9). Therefore, the educational problems ofCALD students need to be searched and thereasons should be dealt with to increase theirmotivation for academic success. We suggestthat medical education studies should address theinternational healthcare students’ needs and findstrategies to meet their needs in the classroomand clinical learning situations.

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