Thriving abroad: Navigating the challenges of international fellowships

Embarking on a medical fellowship abroad is a thrilling adventure mixed with feelings of uncertainty. While it offers a chance to learn new skills and explore new cultures, it also presents the overwhelming challenge of adapting to a foreign environment.

Advantages of international fellowships

There are many advantages to becoming a fellow abroad. The highly specialized and skilled training sets you apart from peers, and developing global connections and top-notch mentors opens doors to exciting opportunities, such as research partnerships, academic publications, recommendations, and even job offers. The cross-cultural exposure contributes to a broader perspective, as well. 

Challenges faced abroad

Researchers publishing in Stroke identified seven challenges faced while doing a clinical fellowship in a foreign country^[]:

1. Adjusting to new culture, including the customs and norms

2. Communication barriers

3. Adapting to differences in the healthcare system

4. Management of finances

5. Racism, xenophobia, or other forms of discrimination

6. Lack of mentorship

7. Identity crisis brought on by all of the above

These challenges, while common, are often disregarded despite their potential effect on one's academic, mental, and social well-being.

A study conducted in the UK also identified a lack of university staff support as adding to the difficulty.^[] Most importantly, it found that 43% of postgraduate international students had symptoms of depression, anxiety, and stress, and 12% reported experiencing suicidal thoughts.

Addressing mental health challenges

As an international student, you are likely to have a packed schedule with little free time, but it's imperative you create room in your schedule to properly address any mental health concerns that arise throughout your international fellowship to help make the most out of your educational journey.

There are some simple ways to do this. For one, it’s important to be proactive about making self-care a part of your daily routine: Take breaks and give yourself time to rest and recharge; prioritize workouts and meditation; get enough sleep and eat well. These self-care practices will be the first step in addressing the stress that accompanies fellowship in general, at home or abroad.

Most institutes will also offer counseling services to help manage stress and mental health concerns. Don't hesitate to consult a mental health professional if you're experiencing significant lows. They can help you develop coping skills and strategies to manage stress and improve your mood and overall well-being.

Develop cross-cultural competency

Being a foreigner, you are bound to face language barriers, unfamiliar medical practices, different healthcare systems, and difficulties understanding patient expectations. These cultural nuances can affect your ability to communicate effectively with colleagues and patients.

Start by learning the language and basic customs. Seek cultural education opportunities like language classes, workshops, and local tours. Build relationships with locals through community events, volunteer work, or cultural exchange programs.

Build your support network

Do a daily check-in by connecting with your family and friends back home. Even just 5 minutes will perk you up. Connect with other international students or communities. You can also join a support group for international students. Your institution may already have these resources in place, so reach out to your program director or coordinator for advice.

Make time for hobbies

Despite your busy schedule, setting aside some time for small moments of familiarity can provide a sense of comfort and stability amidst the chaos of a new environment. Consider activities that can be done in shorter bursts of time, like listening to music or podcasts during a commute, taking a quick walk during a break between lectures or rounds, or setting aside 30 minutes before bed to read. 

Manage your finances 

You might discover that salaries in your new country are significantly lower than what you're accustomed to. To manage your finances effectively, plan ahead before relocating. Additionally, US citizens are required to pay taxes to the US government on the income you earn, even while doing your fellowship overseas. Conducting thorough research before your move is essential to understand your expected tax obligations.

Dealing with discrimination

The prospect of encountering discrimination is a sad but all-too-real possibility for foreign fellows. This discrimination often comes from the locals, but it may also come from patients or colleagues. While speaking up can be difficult, failing to report discrimination only reinforces it.

Remember that discrimination is unacceptable, and your rights must always be respected. Promptly report such incidents to your institution's program director, coordinator, or human resources department. Even if this doesn’t solve the problem (and it is a difficult problem to solve), it at least gives you some closure.