Though they share classrooms, some students feel that national origins create distance at school.

Many international students feel a lingual and cultural disconnect in the classroom when working with domestic students.

But to help alleviate the divide, student government leaders and international student groups at the University of Minnesota are trying to figure out what can be done to make foreign-born students feel more comfortable on campus.

As of fall, international students made up more than 12 percent of the undergraduate population.

During an outreach campaign to student groups last fall, international students told the Minnesota Student Association that they sometimes feel other students don’t respect them, said Abeer Syedah, MSA’s student outreach and engagement director.

“That was something that was really shocking to me,” she said.

Bach Nguyen, chief relations officer for the Vietnamese International Student Association, said many international students feel their American peers don’t value their input, which can lead them to isolate themselves within their cultural blocks.

“They don’t reach out,” Nguyen said. “They worry about the language barrier.”

Although he said he hasn’t had problems in class himself, Nguyen said his international student friends have discussed feeling left out when working on group projects.

“She said they don’t really listen to her opinions,” Nguyen said of a friend’s experience. “She said whenever she says something, voices her opinion, no one listens to her. They just kind of ignore her.”

Because of these experiences, international students are more comfortable and confident when talking among peers from their home countries, said Tram Vu, a relations coordinator for the Minnesota International Student Association.

Students who confine themselves to their native cultures can lose out on important social experiences, said Roberth Garcia, a finance junior from Brazil and president of the Latino International Student Association.

“International students come to the United States to get an American experience, an American education,” he said, adding that domestic students can also learn new perspectives through interacting with peers from other countries.

MSA met with MISA last year and discussed the treatment of international students in classrooms, Vu said, but she doesn’t think there’s an end-all solution.

“It’s a problem with both sides,” Vu said, adding that she tries pairing with partners in classrooms outside her friend circle. “People need to be more open.”

MSA is still working on how to address international students’ concerns, Syedah said.

Some international students say events that attract all groups on campus may help solve the problem.

MISA hosts events like Feast of Nations and International Music Night that promote multicultural interactions, Vu said.

These types of events can help bridge the gap and ease misunderstandings, Nguyen said. Domestic students typically make up about 30 percent of the turnout at his group’s events, he said.

“We always invite both international and domestic students to come to our events, so we can kind of promote the beauty of the culture,” Nguyen said. “We just have a different way of thinking, a different way of looking at things and different points of view.” 

Known as "capitation fees" these effectively compulsory one-off donations may exceed 10,000,000 rupees.

Despite the Supreme Court declaring the practice illegal, capitation continues because of high demand for medical degrees. It is estimated that capitation fees paid to professional colleges last year totalled some 60bn rupees.

One undergraduate student told The BMJ that "it is almost impossible to get admission into government colleges. And in many private colleges it is difficult to get a seat without paying huge sums of money." The situation is worse for postgraduates, she added, where the number of seats are very limited, "and almost all the government seats go to reserved candidates."

The situation seems to have deteriorated recently as the regulator of medical education, the Medical Council of India, did not renew permits for at least 10 medical colleges, with 6390 seats lost, explains D'Silva. This decrease coupled with an increase in the number of students applying to medical colleges has reportedly resulted in a sharp rise in capitation fees.

"Except for a few who get into premier institutions of their choice purely on merit, many students face Hobson's choice - either pay capitation to secure admission at a college or give up on the dream of a medical degree," she writes.

And while India is in desperate need for more healthcare professionals, a global report, Education For Health Professionals for the 21st Century, states, "In India, the growth of private medical schools raises concerns about the quality and transparency of one of the world's largest medical educational systems."

Ravi Narayan, community health adviser at the Centre for Public Health and Equity, Bangalore, has consistently questioned the commercialisation of medical education in the country. He said that the big concern is that many of the newer institutions are set up with substantial political backing. "This resulting culture of having to pay your way through the system introduces financial pressures which may be in conflict with the values and ethics of medicine, which are steadily getting eroded."

Samiran Nundy, chairman of the department of surgical gastroenterology and organ transplantation at Sir Ganga Ram Hospital, Delhi, agrees. "With an increasing number of candidates paying to get into medicine, merit has taken a back seat," he says. "As a result, the overall quality of graduates is very poor."

Although officials at private medical colleges that The BMJ contacted stated that they follow all norms and regulations that govern admissions, many colleges are alleged to have developed covert methods to collect capitation.

And with such great investment in their education, students are keen to start earning as soon as possible, writes D'Silva. "As a result, we see a growing inequity in healthcare standards between the rural and urban areas. Few private colleges have mandatory rural postings."

Many experts, including Samiran Nundy, think that the admission process into medical colleges needs more stringent monitoring "to ensure complete transparency in the admission process" and "leave no room for corrupt practices like capitation."

In an accompanying article, Sanjay Nagral at Jaslok Hospital & Research Centre in Mumbai says Indian citizens need reminding that growing commercialisation in healthcare and medical education is linked to the corruption they experience in their healthcare encounters.

In 1983, he helped lead a strike by junior doctors in Maharashtra to oppose a government proposal that would permit private medical colleges, which would accept "capitation" fees. Today Maharashtra has 21 private medical colleges, he writes. So what was once perceived as unacceptable is now a gigantic and legitimised industry.

He argues that India's medical profession "is too entangled in these institutions to offer substantial resistance to their growth and sleaze" and suggests the international medical community help "by barring students from such colleges from taking training jobs abroad."

"While unpeeling the layers of corruption in Indian medicine we must look at the private medical college industry, he writes. "Besides establishing a poor benchmark for fairness and honesty, they also push students to recover their enormous investment after they start practice, fuelling unethical practices in an already monetised and competitive scenario."

Primary care physicians and nurse practitioners were both more inclined to recommend a career as a nurse practitioner, instead of as a doctor, within the field, according to a study published in December in the journal Academic Medicine. Only 46 percent of primary care physicians said they were very satisfied with their careers.

Even students interested in going to school to practice primary care – as a family physician or pediatrician, for example – may have hesitations about the profession.

"Students will go in excited about primary care and somewhere along the way that enthusiasm does get ?lost," says Carleen Eaton?, author of "Getting into Medical School for Dummies." "It would be important to be in an environment that’s really supportive of people going into primary care."

It's a tough field, experts say.

"There is a shortage of primary care physicians, and so the primary care physicians that exist are carrying heavy patient loads," says Eaton, who graduated from the Geffen School of Medicine at University of California—Los Angeles.

Specialty practices, in contrast, are often seen as more prestigious, and doctors in them usually receive a higher salary?, she says.

[Understand how the rising need for primary care fuels growth in D.O. degrees.]

Even with these challenges, many aspiring doctors are interested in primary care. In 2010, there were 109,048 internal medicine residents, a primary care doctor for adults; by 2013 there were 111,047,? according to the Association of American Medical ?Colleges. There was also a small increase ?in the number of U.S. seniors who matched with a family medicine? residency? in 2013, according to the American Academy of Family Physicians.
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Medical school applicants who are trying to decide if an institution will best prepare them for work in primary care can examine certain aspects of a school's environment.

Barbara Sheline, director of the primary care leadership track at Duke University School of Medicine?, suggests prospective students find out how many graduates of the school they? are considering pursue a residency in primary care – but not just any kind of primary care residency.

Student may do residencies in internal medicine or pediatrics, which can be considered primary care professions, but people who do these residencies often pursue a subspecialty that's not a part of primary care.

Instead, Sheline says, prospective students should find out how many graduates go into family medicine residencies.

Family medicine doctors are only eligible for a few fellowships that may give them additional training – maybe in obstetrics, for example – but these fellowships generally keep doctors in primary care?, says Sheline, who's also the assistant dean for primary care at Duke's medical school.

[Learn how medical schools prepare students for residency.]

"If you have a lot of people going into family medicine then ?you know the school is putting out primary care docs," she says.

Some schools, such as Duke, says Sheline, may have few students going into primary care, but they have programs that support students who are interested in this field.

In Duke's primary care track, which matriculated its first students in 2011, students get to spend more time than most students learning about primary care. Many schools offer rotations in family medicine or pediatrics for a few weeks. "They’re working with primary care doctors for eight months," Sheline says

Other schools, such as Mercer University in Georgia and Texas Tech University Health Sciences Program, have a ?primary care track that allow students to graduate in three years. "It’s critical for us as a medical school to produce as many family physicians as possible," says Steven Berk, dean of the Texas Tech University Health Sciences Program.

"Last year we had more students going into family medicine than any other specialty," he says.

Students in the track also receive a full scholarship? for their first year, Berk says. Schools that offer scholarships for studying primary care are likely invested in producing primary care doctors, Eaton says.

[Peek into the evolution of medical school education.]

An institution's administration can also tell prospective students how the school views primary care. Sheline suggests premed students see if the school has a dean or an assistant dean for primary care. "At least it shows somebody's paying attention to primary care," she says.

Clif Knight, vice president for education at the American Academy of Family Physicians, says aspiring doctors can also ask admissions officers "Are family physicians involved outside of their department in the medical school?"

If family physicians are also school leaders, such as deans, that may be an indicator of how much the school values primary care, he says. In addition to looking at who's running the school, medical school experts encourage prospective students to also consider what schools teach and how they teach it.

Knight suggests they ask ?"Are the primary care specialties integrated through the whole four-year medical school curriculum?" and "What will the clinical opportunities be to learn and get some hands-on? experience in primary care?"

For those that do find a school that meets their needs and turn primary care into a profession, it can be a rewarding field. One benefit can be the chance to build relationships with patients over time, says Sheline from Duke. It also gives doctors the opportunity to partner with patients while trying to improve their health.

"I love it," she says. "I wouldn’t be doing anything else."

source: http://www.usnews.com