International medical students’ experiences of psychological safety in feedback episodes: a focused ethnographic study

Abstract

Background Feedback and psychological safety are well-established concepts within medical education, vital for student learning and progress. However, the concepts remain unexplored in the context of international students. This area deserves attention given the unique challenges faced by the overseas medical students due to cultural differences. The present study examines international students’ experiences of psychological safety in feedback interactions in a Scottish undergraduate medical programme. Methods A focused ethnographic approach was adopted to explore international students’ experiences and perceptions of psychological safety in their feedback experiences. Data were collected in the form of field observations and semi-structured interviews, involving both student and faculty participants. Approximately 13hrs of fieldwork and a total of 11 interviews were conducted. These were analysed using a combination of inductive and deductive thematic analysis. Results Data analysis identified four key themes: feedback delivery, educator attributes, cultural factors and longitudinal educational relationships. Both staff and student participants highlighted how environmental factors such as room design and group size functioned as enablers or barriers to psychological safety in feedback episodes. Additionally, students appreciated tutors who expressed vulnerability and demonstrated awareness of their cultural backgrounds. Students described significant differences between the feedback approaches in the host (UK) institute and that in their home country. Longitudinal associations fostered trust and familiarity with peers and tutors, enhancing students’ receptivity to learning and feedback. Conclusion This present study highlights cultural differences in feedback practices across countries and their impact on psychological safety among international students. It stresses the importance of integrating overseas students by considering group dynamics, environment and diverse student needs. Staff awareness of cultural variability, openness to tutor vulnerability and fostering long-term educational relationships can greatly enhance psychological safety in learning and teaching activities. These insights are relevant amidst the growing globalisation of medical education and the mobility of students across borders, advocating for tailored integration to optimise their learning experience and achievement.