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European medical schools are recruiting increasing numbers of international students. This study explores the impact of cultural backgrounds and language on the transition of international medical students to the clinical years of their training when they are predominantly based in hospitals and interacting with health professional staff and patients. A mixed-methods study was undertaken, incorporating 31 peer interviews and a focus group discussion and the development and conducting of an online survey (n = 144; 50% response rate). We compared levels of social adjustment and integration between the students on a regional basis. Overall students adjusted well, but there were statistically significant regional differences in social adjustment and integration. The impact of communication difficulties from a language and cultural practice perspective was a dominant challenge highlighted, as was the differences in hospital culture and interprofessional communication norms. International medical students experience many challenges and benefits from studying in a multicultural environment. More nuanced demographic data need to be collected on admission to assist in potentially identifying those who may experience difficulties with academic and daily life transitions. In addition, all students in a multicultural environment would benefit from a program of acculturation for personal and career development.

Purpose: Understanding navigational barriers and facilitators has the potential to advance equitable stroke care delivery. The aim of this study was to explore, using a qualitative study, the experiences of stroke survivors and their families as they journey through the stroke care system, both before and during the COVID-19 pandemic. Methods: In-depth semi-structured interviews were conducted with 18 stroke survivors and 12 family members during 2021 and 2022. Participants were recruited through voluntary organisations, social media, and stroke support groups. Data analysis followed a systematic process guided by the framework method with steps including familiarisation, coding, framework development, and charting and interpretation. Results: The experiences of navigating stroke care were particularly challenging following discharge from hospital into the community. Barriers to stroke care continuity included insufficient appropriate services and information, unsatisfactory relationships with healthcare professionals and distressed mental health. There were particular navigational challenges for survivors with aphasia. Facilitators to effective navigation included having prior knowledge of the health system, harnessing support for care co-ordination, and being persistent. Conclusion: Greater support for patient navigation, and person-centred referral pathways, particularly during times of increased pressure on the system, have the potential to improve access to services and wellbeing among stroke survivors. IMPLICATIONS FOR REHABILITATION: Interactions between practitioners and stroke survivors need to be simple, empathetic, and transparent, using communication tools when needed for older stroke survivors or those with a communication or cognitive disability Navigation of the care system is a significant challenge and source of emotional distress for stroke survivors and their families, likely leading to foregone care and inequity in access to services. This indicates a need for both clearer, more standard stroke care pathways that are easier to navigate, and evidence-based patient navigation support programmes. The development of navigational interventions and stroke care pathways would benefit from co-design with motivated and knowledgeable stroke survivors. Taking advantage of the wealth of lived experience, and stroke survivors' capacity and passion for advocacy, has the potential to empower the wider stroke community. [ABSTRACT FROM AUTHOR]