The influence of mixing international and domestic students on competency learning in small groups in undergraduate medical education

Abstract

Background Medical curricula are increasingly internationalized, with international students being mixed with domestic students in small group learning. Small group learning is known to foster competency learning in undergraduate medical education, specifically Communication, Collaboration, Leadership, and Professionalism. However, it is unclear what happens with the learning of competencies when international students are introduced in small groups. This study explores if students in international small groups master the competencies Collaboration, Leadership and Professionalism at the same level as students in domestic groups in an undergraduate medical curriculum. Method In total, 1215 Students of three academic year cohorts participated in the study. They were divided into four learning communities (LCs), per year cohort, in which tutor groups were the main instructional format. The tutorials of two learning communities were taught in English, with a mix of international and Dutch students. The tutorials of the other two learning communities were taught in Dutch with almost all domestic students. Trained tutors assessed three competencies (Collaboration, Leadership, Professionalism) twice per semester, as ‘Not-on-track’, ‘On-track’, or ‘Fast-on-track’. By using Chi-square tests, we compared students’ competencies performance twice per semester between the four LCs in the first two undergraduate years. Results The passing rate (‘On-track’ plus ‘Fast-on-track’) for the minimum level of competencies did not differ between the mixed and domestic groups. However, students in the mixed groups received more excellent performance evaluations (‘Fast-on-track’) than the students in the homogenous groups of Dutch students. This higher performance was true for both international and Dutch students of the mixed groups. Prior knowledge, age, gender, and nationality did not explain this phenomenon. The effect could also not be explained by a bias of the tutors. Conclusion When students are educated in mixed groups of international and Dutch students, they can obtain the same basic competency levels, no matter what mix of students is made. However, students in the mixed international groups outperformed the students in the homogenous Dutch groups in achieving excellent performance scores. Future research should explore if these findings can be explained from differences in motivation, perceived grading or social network interactions.

Challenges to acquire similar learning outcomes across four parallel thematic learning communities in a medical undergraduate curriculum

“…The other side of these assessment results is that those TLCs show relatively lower competencies performance than TLC SC and TLC GH. In contrast to the previous study where we showed that the two English taught TLCs showed higher competencies assessment results than two Dutch taught TLCs [ 21 ], we now found that the Dutch TLCs had better written test scores than two English TLCs in the first year. There seems to be a clear trade-off between the focus on competencies or knowledge development, especially in the first year.…”

“…Table 3 shows that students’ competencies performance became higher at the end of the second year in all TLCs, which is similar to what is observed earlier in the competencies result of the shared program [ 21 ]. The percentages of FOT for all competencies together varied from 16.21% to 41.63% and the percentages of FOT became higher at the end of the second year although there were some variations over time.…”

“…Considering the globalization of the curriculum and the number of international students, two TLCs are taught in Dutch containing domestic students only and another two were taught in English containing both domestic and international students. In our previous study, we focused on the assessment results of three competencies (collaboration, leadership, and professionalism) that are trained on the same content in four parallel programs to avoid the direct influence of the differences in the programs of the TLCs [ 21 ]. From that study, we learned that diverse groups with mixtures of international and domestic students achieved better results.…”

The quality of group interactions in medical problem–based learning in China: the roles of intercultural sensitivity and group ethnic composition

“…The possible influencing factors included the lack of language proficiency, familiarity with the cultural environment, and experience in collaborative groups [ 18 ]. However, many studies have found that mixed ethnic groups enhance student interactions across diverse boundaries and that students in such groups receive better performance evaluations than students in homogenous groups [ 4 , 5 , 16 ]. What remains unknown is how multiethnic groups affect student learning outcomes or group interactions in a PBL learning model.…”

Determinants of peer selection for collaborative group work of third-year bachelor students in a medical degree programme with learning communities

“…Notwithstanding the positive effects of informal relationship formation based on homophily, it may also lead to negative effects on learning, especially when the clustering takes place based on background and academic achievement. In international settings, for instance, it is known that both international and domestic students tend to form relationships mostly with peers of the same nationality [ 30 , 31 ], while the diversity of students’ backgrounds in classrooms or groups is known to benefit students’ academic performance [ 38 ]. Another negative side effect of homophily may be that low achievers have more problems building their own social groups because they seem to be excluded from the high achievers’ peer relationships to some extent [ 39 ].…”