Internationalizing Medical and Health-Care Education

In 2023, OECD countries employed more than 600,000 foreign-trained physicians—representing 20 percent of the medical workforce, up from 16 percent in 2010. These numbers continue to grow. Behind those figures is a system in which health professionals are routinely trained in one country and then practice in another—with all the cultural, linguistic, and ethical complexities that entails.

But even as the health care workforce has become increasingly global, medical and health care education has been slower to adapt to that reality. Historically, most international activity has taken the form of short-term clinical trips from wealthy countries to low- and middle-income ones—a format that, scholars argue, often fails to match institutions’ stated commitments to equity and genuine exchange. Global health’s focus on research, disease surveillance, and humanitarian response has developed as a parallel and distinct field.

Anette Wu, associate professor of medical sciences and of pathology and cell biology at Columbia University’s (Columbia) Vagelos College of Physicians and Surgeons, has spent 15 years studying the internationalization of medical education. She argues that international exchange in medicine has been undervalued as a tool not just for training but for building the cross-border relationships that global health crises require—as underscored by the COVID-19 pandemic. Wu also says that access to those experiences has been far too narrow, limited largely to students at elite institutions in wealthy countries. Yet, training health professionals to work across borders involves navigating many obstacles as factors include different licensing requirements, language barriers, curriculum standards that vary widely by country, and cultural expectations that come with practicing in an unfamiliar place.

The costs of this global movement of health professionals also fall unevenly. In her 2025 book The Care of Foreigners: How Immigrant Physicians Changed U.S. Healthcare, Harvard historian Eram Alam documents how physicians from countries like India, Pakistan, and the Philippines often train at institutions funded by local taxpayers, then migrate to the United States—leaving their home countries with fewer doctors to care for their own populations. Some governments have tried to address this directly, structuring scholarship agreements that require graduates to return home to practice. This dynamic raises broader questions about how medical talent moves globally as well as who ultimately benefits.

Training health professionals to work across borders involves navigating many obstacles as factors include different licensing requirements, language barriers, curriculum standards that vary widely by country, and cultural expectations that come with practicing in an unfamiliar place.

Many institutions are beginning to work through those challenges. Some are preparing their own students to practice across borders; others are recruiting internationally to fill local workforce gaps. Still, others are building pathways for foreign-trained health workers already here. What they share is the recognition that health is global—and that medical and health care education must be too.

A Slow Process of Internationalization

When most people think about international work in medicine, they often think of global health—Doctors Without Borders, vaccine campaigns, disease surveillance. Global health has evolved into its own academic field, historically rooted in infectious disease and humanitarian work. It has long centered on sending clinicians from wealthy countries to low-income ones to treat disease and address health inequities, Wu relays. But, she adds, internationalizing medical education is something distinct: building the structures and curricula that ensure every health professional, not just those who travel, develops the cross-border competency that modern health care requires.

In Wu’s view, the principles guiding internationalization across higher education (e.g., reciprocity, access, genuine cultural exchange) have been slow to take root in medicine and health sciences specifically. In a 2022 literature review, Wu and her colleagues identified three distinct institutional motivations for internationalization. Some institutions internationalize to advance social justice, from sending students to underserved communities abroad to building partnerships with low-income countries. Others do it to compete, climbing global rankings, attracting high-achieving students, and building research prestige. A third group, smaller and less visible, does it for what Wu calls science diplomacy: the belief that health professionals who have studied and worked alongside counterparts from other countries will be better equipped to collaborate across borders when it matters most.

Internationalizing medical education is something distinct: building the structures and curricula that ensure every health professional, not just those who travel, develops the cross-border competency that modern health care requires.

Wu does not frame these motivations as mutually exclusive. In many cases, institutions do not examine whether what they are doing matches what they say they are trying to achieve. For example, a school that claims a social justice mission but runs an expensive, selective study abroad program accessible only to a handful of students is not living up to its own stated values. The stakes are concrete: Wu’s research found that medical school graduates who participated in global electives were more likely than their peers to pursue careers serving underserved populations, regardless of prior experience.

Successful international health partnerships require aligned motivations, multilateral governance, and a structure where no single institution sets the terms, says Wu. Her own exchange program, ICEP Global, connects medical students across 40 partner institutions on five continents through virtual seminars on global health topics—death and dying across cultures, climate and health, the implications of artificial intelligence in medicine—followed for some students by research exchanges. Although it is housed at Columbia, the program is deliberately structured as a consortium of equals.

Wu founded ICEP Global (ICEP) about 13 years ago out of frustration with what she saw as a gap in medical education. She wanted to create opportunities for medical students to train alongside international peers so they would be better equipped to collaborate across borders. By centering the program on virtual exchange and research rather than clinical rotations, it sidesteps the language barriers that make clinical placements difficult. “In a research lab, they have a little bit more freedom,” she explains. A 2025 study of more than 750 ICEP participants across 21 universities found measurable differences in cultural competency across student populations—with the program identified as a vehicle for building the cross-cultural skills that international health collaboration requires.

One Country’s Approach to Attracting Medical Students

Turkey offers a different model. The country’s government scholarship program draws students from more than 170 countries, with major source countries including Azerbaijan, Iran, Iraq, Syria, and Turkmenistan. Medicine, health sciences, dentistry, and pharmacy are among the most popular fields.

The country has positioned itself as a significant destination for international health and medical sciences students. Its approach also reflects elements of science diplomacy—building the cross-border relationships and clinical competencies that make international collaboration possible. To address possible brain drain, Turkey’s government scholarship recipients are generally expected to return home after completing their training.

At Ankara Yıldırım Beyazıt University (AYBÜ), international students spend the final three years of their medical training almost entirely in hospital settings. And from the first day, language is not an abstraction but a clinical tool. Picture a common scenario: a patient is in pain, there is no time for an interpreter, and the student—trained in English and still developing Turkish—must take a medical history, perform an examination, and understand patients whose Turkish may sound nothing like what they learned in the classroom. 

“Students are expected to understand patients during clinical rounds and outpatient visits, take accurate medical histories, and perform physical examinations. All of this requires strong language proficiency,” says Zeliha Koçak Tufan, a physician and professor at AYBÜ and former education counselor to the Turkish Embassy in Washington, D.C.

“Students are expected to understand patients during clinical rounds and outpatient visits, take accurate medical histories, and perform physical examinations. All of this requires strong language proficiency.” —Zeliha Koçak Tufan

Preparing students for clinical training is a structured process. AYBÜ’s medical school enrolls about 460 international students out of a total of roughly 2,700. Those in English-medium programs begin developing Turkish before they ever enter a hospital ward, supported by language courses at Turkish universities and, in some cases, preparation at Turkish language institutes abroad before arrival. In the English program, all coursework and exams are conducted in English—but during the clinical practice, when students are engaged in hands-on training and patient interactions, Turkish is commonly used. By that stage, most international students have already acquired sufficient Turkish proficiency to communicate effectively with patients. Cultural preparation matters as much as linguistic preparation. Turkish society, Tufan notes, is known for its warmth and informality—patients ask personal questions, offer food, and seek connection. “While this is generally appreciated, students from cultures with different social norms may initially find it unusual,” she says.

International accreditation provides another layer of assurance: AYBÜ’s medical program is accredited by Tıp Eğitimi Programlarını Değerlendirme ve Akreditasyon Derneği, the Turkish medical education accreditation body whose standards are recognized internationally, meaning graduates can pursue licensing and postgraduate training abroad, Tufan relays. Clinical training takes place at Ankara Bilkent City Hospital, one of the largest health care campuses in the region, with roughly 4,000 beds and approximately 30,000 outpatient visits per day.

“Previously, host institutions often expected international students to assimilate into a ‘melting pot. Now, individuals expect to be understood and accepted as they are. Institutions with low levels of inclusivity risk losing international students and academics.” —Zeliha Koçak Tufan

The partnerships that support this work don’t always emerge from formal institutional processes. When Tufan attended a NAFSA-convened summit in Tangier, she found herself in conversation with Moroccan universities—and an Erasmus agreement and memorandum of understanding between AYBÜ and Mohammed VI University grew from those discussions. The exchange enables up to five students and five staff members per year to move between the two institutions. The arrangement gives students exposure to disease patterns and clinical specialties they would not encounter at home: students trained in Turkey rarely encounter malaria or many parasitic diseases, while Morocco’s disease landscape differs considerably; Moroccan students also learn about Turkey’s transplantation centers. “Observing these variations offers significant educational value,” Tufan says.

Tufan sees the field shifting in another direction too. Where institutions once expected international students to assimilate into a single academic culture, that model is giving way. “Previously, host institutions often expected international students to assimilate into a ‘melting pot,’” Tufan shares. “Now, individuals expect to be understood and accepted as they are. Institutions with low levels of inclusivity risk losing international students and academics.”

Pathways Abroad

For some countries, sending students abroad for medical training has become standard practice driven by a shortage of domestic spots and the cost of training at home. Nearly 45 percent of doctors working in Norway trained abroad—primarily in Hungary, Poland, and Slovakia, where many medical schools offer English-medium programs specifically to attract international students. According to a University World News article, training a medical student domestically costs the Norwegian government an estimated NOK 885,000 ($95,000 USD) per year; supporting one student studying abroad costs NOK 94,500 ($10,000 USD).

Around a quarter of all doctors in the United States were trained in other countries, according to the Association of American Medical Colleges. The top sending countries for immigrant physicians and surgeons include India, China, Canada, Pakistan, and the Philippines. The United States has actively recruited foreign-trained physicians since the 1960s when the Hart-Celler Immigration Act opened the door specifically to address a physician shortage created by the passage of Medicare and Medicaid. International medical graduates have to clear several steps to practice in the United States, which can take years—passing a series of U.S. medical licensing exams, having their medical degree from abroad verified, and often completing a U.S. residency program before obtaining a full license. Graduates of foreign medical schools can match into U.S. residency programs, though at lower rates than graduates of U.S. schools.

Around a quarter of all doctors in the United States were trained in other countries, according to the Association of American Medical Colleges. The top sending countries for immigrant physicians and surgeons include India, China, Canada, Pakistan, and the Philippines. 

A growing number of physicians entering the United States are also U.S. citizens who studied abroad, many of them in the Caribbean, before returning to practice at home. St. George’s University (SGU) in Grenada was founded in 1976 and now enrolls students from more than 140 countries. The school has built its curriculum explicitly around international licensing pathways in Canada, the United Kingdom, and the United States, maintaining partnerships with teaching hospitals and clinical affiliates across those countries.

SGU works with governments around the world to sponsor students expected to return home to strengthen their national health care systems, shares Marie-Claude Svaldi, the university’s director of international government relations. Through a long-standing partnership with the government of Botswana, SGU has trained approximately 20 percent of that country’s total physician population—graduates who are required by their scholarship agreements to return home to practice. Similar partnerships with Ghana and Tajikistan are structured around the same return-service model. In Grenada itself, SGU supports clinical training partnerships with local hospitals as well as runs community health screenings and public health initiatives across the island.

Pathways into the U.S. Health Care System

For individual practitioners, moving across borders often means navigating systems that were not designed to align. Florida International University’s Nicole Wertheim College of Nursing and Health Sciences has operated an alternative pathway for foreign-educated physicians since 2001—medical doctors who trained outside the United States and cannot meet domestic requirements to practice medicine—to become licensed nurses and nurse practitioners. The central obstacle for most, says Dean Jorge A. Valdés, is not competence but competition: residency slots in the United States are limited, and foreign-trained physicians struggle to secure them regardless of prior experience. The college’s accelerated BSN/MSN program, which takes three years rather than the traditional six, has graduated 985 students since its first cohort in 2003. Students come from Cuba, Haiti, and across Latin America, as well as China, India, Ukraine, and beyond. The majority remain in South Florida after graduation, practicing in hospitals, community clinics, and specialty settings. The program leads to a nurse practitioner license rather than just the BSN, Valdés explains, to maximize the clinical potential of people who already bring extensive medical training.

Nola Holness, a clinical associate professor who has taught in the program, maintains that the students’ global backgrounds enrich the learning environment for all nursing students. “They bring a wealth of various knowledge, skills, and attitudes that enhance the undergraduate nursing experience,” she says. “Their maturity and dedication to bridge medicine and nursing create additional layers of nursing interactions and elevate the classroom and clinical experiences.” 

“They bring a wealth of various knowledge, skills, and attitudes that enhance the undergraduate nursing experience. Their maturity and dedication to bridge medicine and nursing create additional layers of nursing interactions and elevate the classroom and clinical experiences.” —Nola Holness

The challenge, Harvard historian Alam found in her research on immigrant physicians, isn’t always medical competence, rather, it’s the social and cultural side of U.S. health care that foreign-trained physicians said took the longest to learn, even after years of clinical experience in their home countries. When Methodist Health System turned to Alamo Colleges District in San Antonio, Texas, for help retaining Mexican nurses it had recruited, Alejandra Bueno, the institution’s executive director of global engagement and learning, identified the core problem: nurses were arriving without adequate preparation for the cultural expectations of U.S. health care practice.

The partnership that emerged—between Alamo Colleges District, Tecmilenio University, a network of 30 campuses across Mexico, and Methodist Health System—structured a six-month series of digital credentials around preparing Mexican nurses, already credentialed and practicing in their home country, to pass the National Council Licensure Examination nursing board examination. The pathway is delivered entirely online, allowing nurses to complete preparation in Mexico before arrival and sidestepping the visa complications that come with in-person training components. It includes micro-credentials in medical terminology, pharmacology, and clinical skills alongside a dedicated 15-hour digital badge in health care cultural competence covering professional expectations, communication norms, and teamwork in U.S. clinical settings. A second cohort is expected in 2026.

What the Field Needs

Across these approaches, a common thread is that internationalizing health care education is not simply a matter of sending students abroad or recruiting them from overseas. It requires preparing practitioners for the cultural and linguistic realities of clinical care in unfamiliar settings, building partnerships that genuinely benefit both sides, and addressing the structural mismatches in licensing and workforce planning that shape where health professionals end up and who they are able to serve.

Wu points to what would need to change for the field to keep pace: shared accreditation frameworks, medical curricula that are more transferable across borders, and global collaboration on emerging challenges like the use of artificial intelligence in clinical settings. “The future of our global healthcare world,” she wrote in University World News, “lies in the international collaborative competencies of the next generation of internationally competent healthcare leaders.”  •

 A Different Model

Not all international health education is organized around the clinical encounter. At Rajarata University of Sri Lanka (Rajarata), the Department of Health Promotion has built a program that starts from a different premise entirely.

The department’s BS in health promotion is the only undergraduate degree of its kind in South Asia. More than a third of the curriculum consists of field practical courses, and the community engagement component is the program’s defining feature, says Lalith Senarathna, head of the department. Students are assigned to rural or semi-urban communities and work there twice a week for two full years—not just observing, but identifying health priorities alongside community members, codeveloping interventions, and evaluating outcomes over time.

International postgraduate students from the University of Sydney, the University of Gothenburg, Nanyang Technological University, York University, and Keele University have completed placements of up to three months at Rajarata, always embedded within existing local student groups. What they encounter is not just a different set of health problems but a fundamentally different understanding of what public health entails—participatory, community-driven, and attentive to the social determinants of health rather than the treatment of disease.

Research has found that the voices and experiences of institutions in lower-income countries remain structurally underrepresented in how the field defines itself. Rajarata hosts international students, but its own students have not yet had the opportunity to go abroad—an imbalance Senarathna says the department is actively working to address.