Rewarding journeys: exploring medical students' learning experiences in international electives.

International electives are recognized as a high-impact practice in clinical education. However, medical students' actual learning experiences during electives have not been explored fully. Specifically, drawing on language management theory, this exploratory case study investigates students' perceived learning outcomes and the managing processes by which they gained benefits from cross-cultural learning experiences in international electives. Written reflective reports in a series of e-portfolios were collected from 43 Japanese medical students who participated in a four-week international elective. Moreover, to further explore their emotions and the reasons behind adopting a particular adjustment behaviour, follow-up interviews with 12 students were undertaken soon after they returned home. Using reflexive thematic analysis, the qualitative data were analysed. Their perceived learning outcomes were categorized into seven themes: medical knowledge and skills, communication, career management and development, international healthcare, society and culture, medical education, and personal development. During the programme, they experienced linguistic, sociolinguistic, and sociocultural difficulties, and attempted to overcome them by employing various adjustment strategies, such as meaning-focused coping, social relationship building, management of learning opportunities, communication management, and developing approaches to learning. Managing problems in academic contact situations is not a linear process; it is iterative and cyclical. Since the combination of several strategies was needed depending on the situation, the management process is a context-dependent and complex phenomenon. The findings in this study provide new insights into student participation in short-term international elective programmes in order to develop academic and social support strategies for educators at both home and host institutions.