Coping Strategies of Failing International Medical Students in Two Chinese Universities: A Qualitative Study

China hosts a large number of international medical students from low-income countries, and some fail examinations in the early stage of the Bachelor of Medicine and Bachelor of Surgery (MBBS) program. Little is known about how failing international medical students cope to recover their academic performance. It would be beneficial to investigate the coping strategies they use to help them recover their academic performance and progress. Semi-structured interviews were conducted with 21 international medical students at two universities in China from September 2020 to January 2021. These students had passed make-up exams or re-sits and progressed academically. A thematic analysis approach was used to identify major themes in the interview data. After failing initial exams or re-sits, students were found to adopt seven coping strategies to help them pass future examinations and recover their academic performance: (i) increased help-seeking behaviors, (ii) improved learning motivation and attitudes, (iii) improved learning strategies, (iv) improved exam preparation, (v) utilization of library resources, (vi) enhanced time management, and (vii) enhanced English language skills. Of the seven strategies, seeking help from friends, peers, seniors, and teachers was the strategy reported most frequently. The results of this study provide insights into the coping strategies that international undergraduate medical students adopt to recover from poor academic performance in Chinese universities. Host institutions should recognize the resilience and agency of such students to make positive changes. Furthermore, institutional efforts should be made to develop contextualized intervention plans that stimulate students' learning motivation and encourage them to adopt self-help strategies by incorporating useful resources (e.g., help from peers, seniors, and teachers). Enrollment should integrate specific English language proficiency criteria, and interviews and entrance exams should be conducted. For some failing students, it may be necessary to provide academic remediation.