International Students at the Medical University of Łódź: Adaptation Challenges and Culture Shock Experienced in a Foreign Country

Introduction

Discussions in the literature on the causes and nature of current migrations have been ongoing for many years and result in different theories explaining this process. Referring to theories focusing on transnationalism and transnational communities, it is clear that, at present, there is an increase in cyclical mobility and temporary migration – the result of the rapid expansion of transport and communication (Castles, de Haas and Miller 2014). One example of such migrations is the multi-faceted movement of people travelling from one country to another for different reasons. To this group of travellers international students also belong. Thus these new forms of migration somewhat contradict former images of a migrant as someone who usually left his or her own country in order to start living in another because life in the home country was impossible or very difficult – the push factor – and/or because another country offered much better possibilities for development and an improved standard of living – the pull factor (Lee 1966).

In the past, overseas students were usually the type of migrant preferred by the state authorities due to their non-problematic character. Such students do not usually negate the model of the dominant culture, do not enter into conflicts with the receiving society, do not benefit from the social system but contribute to economic growth, are temporary migrants who usually return to their own countries after finishing their studies and, if they do decide to stay, act as added value for the host country. However, the primary assumption that more-developed Western countries help underdeveloped countries in their economic and social development through educating their students is no longer relevant. Many third-country students prefer to stay in the country where they studied. Over time, it became a real concern for some countries – such as, for example, the UK – due to the large numbers of incoming students. The massive surge of students from third countries also does not necessarily mean that they are always those who, as was assumed earlier, would be able to form a high-skilled elite in a new country. On the contrary, as Luthra and Platt (2016) established, many of the third-country students studying in the UK only have a small elite component – they are mostly students with more ‘middling’ than elite potential.

This problem, however, does not seem to concern Poland at present due to the fact that the number of overseas students studying there is still not very significant. However, it is possible to notice certain positive facets of the presence of overseas students in Poland as they have a significant meaning for the academic environment, especially in the context of falling domestic demand for higher-level studies – to a great extent the result of demographic decline. The growth in the number of international students should also be interpreted in economic terms, due to the profits – discernible by local businesses – to be made from providing services to this group.

The main aim of this paper is to present our findings about the process of sociocultural adaptation of overseas students studying in Poland. We base this on the example of students at the Medical University of Łódź (henceforth MUL), with special emphasis given to the difficulties they encounter in their everyday contacts with Polish society. Referring to Adrian Furnham and Lora Tresize (1983, cited in Furnham 2002: 14), three types of problem encountered by international students can be distinguished related to:

• living in a foreign culture (racial discrimination, language problems, difficulties with adaptation, loneliness, stress resulting from limited financial means, dietary differences and separation from the family);
• growing up, reaching early maturity and accompanying it with the development of emotional and intellectual independence;
• managing at university (e.g. a different system of education).

The themes of the research carried out with international students at the MUL were issues related to living and managing in a foreign culture and at university. In this respect the following research questions are being addressed:

• What hinders international students’ study at the Medical University of Łódź?
• What hinders international students’ adaptation to life in Polish society?
• How are international students treated by members of the receiving culture?
• How do international students adapt to this new culture?

This paper outlines the key arguments regarding the experience of culture shock and the adaptation difficulties which international students in Poland face. First, the theoretical framework and methodological approach are presented. Then, on the basis of the research conducted with international students studying at the MUL, the adaptation challenges they experience are discussed.

Conceptualising international students as migrants

The literature distinguishes the different ways of categorising migrants, depending on a number of factors – length of stay away from the home country (migrants, sojourners, tourists), how far, in distance, they migrate, motives for leaving (education, business, resettlement) and the nature of the relationships between migrants and the dominant culture (friendly, antagonistic, etc.). Students are thus put into the category of sojourners – i.e. people who temporarily stay in a new place for between six months and five years and for whom the purpose of their stay is defined and related to performing particular tasks. Sojourners usually leave their country with the intention of returning while, at the same time, hoping to adjust well to the new culture (Furnham 2012). Students are categorised into the same group of travellers as diplomats, expatriate business people, army staff, volunteers and people working for charities or as missionaries.

Globally, studying abroad had become very fashionable by the end of the twentieth century. Currently, in accordance with OECD (2013) data, more than 4 000 000 students in the world study abroad, the majority of them in countries like the USA, Great Britain, France, Australia and Germany. Poland has not thus far been regarded as a very attractive place to study. In 1982, some 3 200 overseas students studied in Poland; by 1990 the number had risen to 7 080 (Łodziński 1993). The students came mainly from the socialist block and third-world countries. However, the last few years have brought about a significant change in this respect and a considerable increase in the number of students. In 2015, the number of international students who started their education at Polish universities was 57 119 people (CSO 2017). The increase should be considered as positive proof that Polish universities are becoming more and more open to people from outside the country. Simultaneously, the increase in the number of international students will have an impact on the development of the educational market in Poland as well as on the national and local economies. Moreover, if the growing tendency remains at the same level, it may result in the elimination of the negative effects of demographic decline. Due to the fact that diplomas obtained at Polish universities are now recognised in many countries and that studying in Poland is much cheaper than in Western Europe, Polish universities have an opportunity, as has been the case for many years in a number of EU countries, to encourage international students to come to study in Poland.

In Poland the greatest number of students is from Ukraine (30 589 students in 2015), followed by Belarusians (4 615 students). Other students come from virtually all over the world (CSO 2017).

Perspectives on culture shock

Since the second half of the twentieth century, extensive research on culture shock has been carried out. The notion of culture shock, introduced into the scientific literature by anthropologist Kalervo Oberg (1960), began to be used to describe an individual’s process of inner adjustment to the unknown environment and how this adjustment affected the individual in emotional, cognitive, psychological, behavioural or physiological ways (Pedersen 1995). Most scholars (inter alia Ferraro 1990; Kohls 1984) differentiate four primary phases of culture shock experienced by everyone in many ways: the honeymoon phase, the crisis or cultural shock phase, the adjustment phase and the adaptation phase. The honeymoon phase is characteristic of the first weeks or months of a person’s stay abroad. This period is usually accompanied by positive feelings, enthusiasm or even fascination with the new culture. The crisis phase starts when individuals begin to negatively perceive some aspects of their new surroundings such as the social or legal rules. The adjustment phase starts when the individual realises that some change towards the host country and society is needed, otherwise he or she may well end up suffering from depression. A variety of adjustments can be made – flight or isolation, for example (Winkelman 1994). The last stage is adaptation, when the foreigner realises that he/she should accept the customs of the host country as a different way of living (Oberg 1960). However, as Oberg (1960) claims, adaptation is not always the case. Not everyone goes through all phases of culture shock. The individual can stop at the second phase – the crisis or shock phase. In this situation, if the person has no choice but to remain in the new country for a longer period, serious depression may set in.

Due to criticism of its too-broad interpretation and the simultaneous difficulties connected with its research – it is not amenable to empirical testing (Ward, Bochner and Furnham 2005) – the notion of culture shock, over time, began to be replaced with more precise terms like ‘adaptation’ or ‘acculturation’ (Zhou, Jindal-Snape, Topping and Todman 2008), the aim of which was to explain the culture shock experienced by newcomers to a culture.

In research on culture shock, two perspectives grew in importance. Initially, the prevailing perspective was the one which identified culture shock with mental illness. Researchers who associated the subdued mood of migrants with illness of a mental nature highlighted certain factors predisposing a person to it – the individual characteristics of a person, mourning, a sense of fatalism, unfulfilled expectations related to the improvement in someone’s living conditions or a lack of social support (Zhou et al. 2008). In the 1980s, researchers started to step away from clinically biased theory and move towards research on the social and psychological aspects of adaptation (Ward et al. 2005). Thereby, the theory of learning a culture grew in importance (Zhou et al. 2008). The pioneer of this approach is considered to be Peter Adler (1975), according to whom positive elements of culture shock should be identified – such as learning and gaining knowledge and intercultural experience – which influence the development of cultural maturity in a migrant (Simpson 2014). From this perspective, three major approaches to examining culture shock were developed, which can be described as ABC – Affect, Behaviour, Cognition (Zhou et al. 2008). The first approach refers to the theories of stress and ways of coping with acculturation difficulties – they present contact with a foreign culture as one of the forms of psychological stress. The second approach refers to theories of learning a culture which emphasise the behavioural aspects of intercultural contact. The third approach refers to theories focusing on the change of identity of those who live in a foreign culture for a lengthy period of time (Boski 2009).

Below, three approaches to adapting to life in a new cultural milieu will be outlined, with special emphasis on the perspective of culture learning and social identity, due to the fact that they influence my further deliberations concerning foreign students studying in Łódź.

Stress and coping

A ‘stress and coping’ approach emphasises the role of life changes in the process of cross-cultural transition, the appraisal of the changes and the use of coping strategies to get through them (Ward 2001). The framework is broad and involves both the features of the individual and the characteristics of the situation, both of which have an impact on a person’s adjustment to a new culture. The factors affecting cultural adjustment involve life changes, personality factors (locus of control, extraversion, tolerance of ambiguity), cognitive appraisals, coping styles, social support, loneliness, homesickness, marital satisfaction and the quality of contacts with both home and host nationals. The success or failure of the adaptation may be the result of both personal and societal variables. The host society’s attitude towards minority ethnic groups can exert a significant influence on stress and coping strategies (Ward et al. 2005).

Culture learning

The ‘culture learning’ approach has been influenced by social and experimental psychology, primarily by Argyle’s work (1969) regarding social interaction. However, this perspective was strongly promoted by Adrian Furnham and Stephen Bochner (1986). The approach puts the emphasis on the necessity of learning about a host culture in order to attain the knowledge and skills needed to communicate effectively in a new intercultural milieu. Protagonists of this theoretical approach argue that the primary reason why migrants, including overseas students, experience adaptation difficulties is their lack of knowledge about social institutions and social structures like norms, strategies of conflict resolution, etc. Ignorance of the host culture puts obstacles in the way of forming relationships with native students. In addition, a newcomer’s insufficient knowledge of the host-country language and his or her social deficits will make social contacts very difficult (Ward 2001).

Shock is understood here as a stimulus to the acquisition of the specific cultural skills which are required for interaction in new situations. According to this approach, the process of adaptation is influenced by different factors, among which are the knowledge of the host culture that an individual possesses, his or her length of stay in the new intercultural milieu, language and cultural competence, number and quality of contacts with the members of the host culture, previous experience of living in a foreign country, friendships made and culture disparity (Zhou et al. 2008). The culture-learning approach is concerned with the processes by which sojourners learn new skills that are relevant in the new milieu (Ward 2001).

Proponents of the culture-learning approach believe that social skills as well as training and contacts with host-society members are all relevant to newcomers. Sojourners need to learn the salient traits of the new culture from host-society members. Adaptation to a new culture means, however, not only learning the language but, initially, understanding the norms, rules and customs which are binding in a given culture. Knowledge of the above allows newcomers to understand different forms of behaviour in the host society and simultaneously to avoid mistakes concerning non-verbal communication like gestures, looking at people, proxemics postures, greetings or facial expressions of emotion (Ward 2001).

Bochner, McLeod and Lin (1977) emphasised the importance of intercultural friendships in gaining the new social skills needed to live in a new culture. Ward et al. (2005) stated that student friendships are usually of a threefold nature – a mono-cultural network of sojourning compatriots, a bicultural network of both sojourners and hosts and a network of multicultural friends and acquaintances. Students who have extensive and good contacts with members of the host society usually cope much better with problems of socio-cultural adaptation; on the other hand, those who limit their contacts to those with their compatriots experience more problems of a socio-cultural nature.

The culture-learning approach also emphasises the role of cultural and ethnic similarity between groups and individuals making contact with each other. People coming from the same cultural, language or religious environment understand better and learn faster the rules of the host culture. On the other hand, host nationals are usually more open towards people who are like them. Big cultural differences between interacting groups also hinder this mutual interaction and adaptation to the host culture.

As stated, people who come from cultures of disparate values may have the greatest difficulty in adaptating (Hofstede, Hofstede and Minkov 2010). Two dimensions of culture seem to be especially meaningful in the process of adaptation – individualism–collectivism and power distance. Individualistic cultures lay the emphasis on the individual, his or her independence and the role that he or she plays in the organisation of society, whereas collectivist cultures assign a bigger role to people as a group. People brought up in an individualistic culture value their own independence. They are characterised by the need to differentiate themselves from others in their contacts with people, they clearly state their needs and are prone to express, even in public, their criticism of the opinions of others. People brought up in a collectivist culture act in a completely opposite manner to individualists and tend to fit in with others. They are not inclined to express their opinions, especially towards somebody who has a higher rank in society. Power distance, however, describes how people coming from a given culture perceive the relations between people in managerial positions and their subordinates (Hofstede et al. 2010). In societies of high power distance, a strong hierarchical division exists between those who hold power and those who are subordinate to them whereas, in societies of low power distance, relations of a horizontal nature dominate.

On the whole, the culture-learning approach highlights the role of social skills and social interactions, both of which are of great importance in any successful adaptation process to a new cultural milieu. Sojourners coming from culturally distant countries experience more adaptation problems due to their lack of knowledge about the salient facets of the new culture. However, as Ward, Okura, Kennedy and Kojima (1998) emphasise, a willingness to learn about a new culture has a positive influence on socio-cultural adaptation.

In fact, socio-cultural adaptation is a learning curve – research on foreign students has shown that socio-cultural adaptation increases significantly between the first and the sixth month of settlement and then increases only marginally in the second six months of the first year of residence (Ward 2001; Ward et al. 1998).

Social identification theories

Social identification theories concentrate on the cognitive aspects of the adaptation process and concern the changes which take place in an individual’s identity. Newcomers to a culture experience many new phenomena. Everything that takes place around a given individual – contacts with in-groups and out-groups, the individual’s own opinion of the host society as well as the attitude of the host towards the society of the sojourners and the openness to contacts with others, etc. all influence the individual’s self-perception and the perception of his/her identity. As Zhou et al. (2008) posit, in social identification two conceptual approaches are usually applied – acculturation and social identity theory.

Acculturation means the changes which occur in people and groups experiencing intercultural contacts. They concern both sojourners and members of the host culture (Ward 2001). The following models describing the changes which occur in a person’s identity can be distinguished. The first is the uni-dimensional model describing the behaviours of migrants who renounce identification with the culture of their origin and adopt the features and values represented by the new culture. The second model, two-dimensional, describes the behaviours of travellers who try to balance the influences of both cultures – i.e. what influences the shaping of a person’s social identity are the cultures of both origin and contact. The third model, known as categorical, is a more sophisticated model (Ward 2001; Zhou et al. 2008). John Berry (2005, 2009) contributed significantly to the development of the model, contending that the acculturation process involves at least two groups in contact and occurs at the cultural and the psychological level. One of the groups are migrants and the second host-country nationals, because all groups in contact experience some changes. On the cultural level of exploration, it is essential to identify the characteristics of the two groups before the contact between them is established – both groups have their own cultural and psychological qualities. The compatibility or incompatibility in values, attitudes or religion between the groups in contact may have a significant impact on the result of the acculturation process. On the psychological level, the changes that the individuals undergo in all groups – ways of eating, dressing or producing acculturative stress, etc. – need to be identified (Berry 2009).

Researching individuals and groups who acculturate, Berry (1997, 2001, 2005, 2009) concluded that they choose distinct modes of acculturation. The choices are related to different variables like gender, age, education, occupation, etc. Finally, he differentiated between four acculturation strategies that can be applied with migrants:

• marginalisation – in which the individual lives outside the culture system (including his/her own), such an exclusion not necessarily beings the individual’s own decision;
• separation – the individual isolates him/herself from the society, which is usually a protest against a policy carried out by the host authorities. Such people, however, maintain contact with their own ethnic group and organise their social life within it;
• assimilation – the individual rejects his or her own culture and accepts the patterns of the host culture;
• integration – the individual combines the norms and rules of the home culture with those of the host culture.

As mentioned earlier, the acculturation process also applies to members of the host society. Their attitudes and behaviours towards newcomers have an influence on which strategies they decide to apply. Acculturation strategies which can be used by the dominant culture are the melting pot – which means that societies tend to assimilate all cultures into a cohesive whole; segregation – when the dominant group makes different cultures or races live separately; exclusion – when the dominant group supports the marginalisation of minority groups; and finally multiculturalism – when the dominant society promotes actions aimed at the development of a diverse society (Berry 2009). In fact, the migrants’ decision on which acculturation strategy to choose is based on the dominant society’s decision on a preferable acculturation strategy.

Social identity theory

Social identity theory has its roots in social psychology. It proposes a conceptual base for researching and accounting for issues regarding social identification, which is, according to Henri Tajfel (1981), based on social categorisation and comparison, meaning that groups may be compared and the positive or negative comparison has an impact on self-esteem (Ward 2001). The key issues applied in the process of categorisation and comparison are stereotyping, prejudice and discrimination. As Stephan, Ybarra and Bachman (1999) claimed, negative outgroup stereotypes lead to prejudice and discrimination. The theory of prejudice appears to be essential to the further discussion in this article.

Analysing the issue of prejudice against minority groups, Stephan et al. (1999) pointed out four factors related to it: realistic threats, symbolic threats, intergroup anxiety and negative stereotyping. The realistic threats involve those relating to the welfare of the in-group, both economic and political or material well-being. They may take the form of competition for limited resources such as territory. Symbolic threats arise due to a person’s belief that his or her group is superior to others, mostly because of the values, attitudes and norms which we hold on to. In fact, symbolic threats lead to both hostility and symbolic racism towards specific out-groups. This is because members of the in-group are afraid that their worldview will be changed by the beliefs of out-groups. Usually, the symbolic threats appear when the worldviews of the two groups in contact are distant. Symbolic racism is understood here as a type of resistance to change in the status quo. Intergroup anxiety, in turn, deals with an individual’s own personal concerns about intergroup interactions. It may occur when the groups have little knowledge about each other, are ethnocentric and have little personal contact. Finally, negative stereotypes are those that contribute to prejudice and discrimination. They justify the in-groups’ adverse behaviour towards out-groups and allow members of the former to avoid contact with those from the out-groups (Stephan et al. 1999).

Research on international students in Poland

The first research on international students in Poland was carried out as early as the 1960s (Bielawska 1963) and continued through subsequent decades (Chodakowska 1971; Michowicz 1980; Yoka 1973). Initially, the research was with students who began their education either in the School of Polish Language for Foreign Students at Łódź University, where they came to study Polish for a year, or at the University of Warsaw, where the majority of international students were registered.

Since the 1990s, increasing numbers of academics have been undertaking research on international students (e.g. Gorbaniuk 1998; Mucha 2001; Rokicki 1998; de Carvalho 1990; Saleh 1995; Żołędowski 2010).

From the numerous studies on the problems of international students’ adaptation to life in Poland, two deserve a special distinction. The first is the study entitled Poland and Poles in My Eye carried out in 1988 under the direction of Ewa Nowicka, the results of which were published in the book Gość w dom. Studenci z krajów Trzeciego Świata (Nowicka and Łodziński 1993). The survey was carried out on a sample of 444 overseas students studying in Warsaw and Łódź.

The second study is the Master’s thesis of Paulo de Carvalho (1990), student from Angola studying at Warsaw University. He carried out a paper-based questionnaire on a representative random sample of foreigners studying in Poland in the academic year 1988–1989. In the end, 315 respondents took part in the questionnaire. The main aim of both studies was to examine the process of adaptation of overseas students to life in Poland and how the students perceive and estimate Polish society.

From the statistical data included in the studies, it appears that, in that period – i.e. at the turn of the 1980s and the early 1990s – those studying in Poland mainly came from the socialist block and developing countries where, on the whole, the level of higher education was lower than in Poland. Only a small number of citizens from countries with higher levels of economic and academic development studied in Poland; in this group, students of Polish origin predominated.

Overseas students experienced many adaptation problems; however, the scale and nature of the problems differed depending on the national minority. The biggest adaptation problems were experienced by students who differed the most from Poles in respect of their ethnic and cultural origins. The group consisted mainly of people from sub-Saharan and Arabic countries. Simultaneously, the group which had the fewest problems in adapting to life in Polish society were those who were the most similar to their hosts – students from Europe (Nowicka and Łodziński 1993).

Those from sub-Saharan countries highlighted the impossibility of leading a normal social and community life as the biggest difficulty of living in Poland (Nowicka and Łodziński 1993) this was dictated by the fear of becoming a victim of racist behaviour. Another very important problem mentioned by the research group was financial hardship as well as climatic and dietetic differences. In turn, for Arabs, who also complained about experiencing different discriminatory forms of behaviour, the process of adaptation to Polish culture was a little easier. This may be, to a great extent, the result of their better financial situation and, at the same time, the greater likelihood that they would be able to fulfil their social needs (de Carvalho 1990).

International students also differed in respect of the life difficulties which they were experiencing in Poland. While Africans and Arabs the most frequently mentioned discrimination, Europeans and Americans more frequently spoke of the difficulties of handling official matters and the impertinence of shop assistants (de Carvalho 1990).

Summing up, international students studying in Poland at the end of the 1980s, according to de Carvalho (1990), can be divided into the following groups: a) students not having major difficulty in adaptating to life in Poland (those from the USA or Eastern Europe), b) students with a middle level of adaptation (Western Europe, Asia), c) students with a low degree of adaptation (Hispanics, Arabs) and d) students with very low levels of adaptation (Africans).

Methodological approach

The empirical basis for the study was the data collected during our field research at the Medical University in Łódź. In the study mixed research methods were employed: both a paper-based questionnaire filled out by overseas students and three focus-group interviews.

The paper-based questionnaire with medical and dental students from overseas and those attending a one- or two-year PREMED or access course for medical studies was distributed at the beginning of 2016.¹ Completed questionnaires were handed in during the last class of a given course toward the end of the winter semester. Completion was voluntary and the survey was eventually filled out by 74 international students. The research was carried out in English because the vast majority of the respondents did not speak Polish. Their courses were all conducted in English, although the students were also taught basic Polish language skills in order that they may communicate in public.

Based on the survey data, semi-structured interview questions were developed for the three focus groups in order to gain in-depth data on whether and how international students adapt to their new living and learning environment. The focus-groups were composed of 24 international students. All the discussions were recorded, transcribed, encoded in Atlas.ti and analysed against the previously prepared analysis categories. In both cases the students interviewed stayed in Poland for no less than six months and, in most cases, for longer than a year. The qualitative data collected from the focus-group discussions were employed to triangulate the depth and breadth of the original survey responses.

The total number of completed questionnaires was low and thereby does not enable us to claim the validity or the generalisability of the data. However, they could be a very useful trigger for future studies on the issue of international students in Poland.

The research group

In the academic year 2015/16 at the MUL there were 567 international students (including those on the PREMED course) from over 50 countries whereas, in 2011 the number had been just 257 people – (data obtained from the university). International students studying at the MUL in 2016 came from six continents and 49 countries: Africa (Angola, Congo, Egypt, Ghana, Libya, Namibia, Nigeria, Swaziland, Sudan); Asia (Afghanistan, China, India, Iran, Iraq, Japan, Jordan, Lebanon, Malaysia, Oman, Palestine, Sri Lanka, Syria, Tajikistan, Taiwan, United Arab Emirates, Yemen, Cyprus, South Korea, Thailand); Australia; Europe (Belarus, Finland, France, Germany, Greece, Italy, Ireland, Netherlands, Norway, Portugal, Spain, Sweden, Switzerland, Ukraine, UK); North America (Canada, USA); South America (Brazil, Panama). The dominant group, however, were students from Saudi Arabia (about 26 per cent of all students) and other Muslim countries.

The sample consisted of overseas students from 21 countries (Table 2). However, the dominant participant group was Muslim (43 students), mainly from Saudi Arabia (28 students). There were also 16 students who were Christians of different faiths and four who defined themselves as followers of other religions or philosophical movements (Hinduism, Buddhism, Zoroastrianism and Agnosticism). The remaining participants did not follow any religion.

Table 1. Demographic features of the research group (N=74)

Source: Author’s survey.

Among the respondents, men outnumbered women by 55.4 per cent to 44.6 per cent (Table 1). At the same time, 63 per cent of the students had been in Poland between six months and a year, 8 per cent between one and two years and the remaining 29 per cent for more than two years. A further seven students (9 per cent), owing to their Polish origins, had more frequent contacts with Poland and used to go there in their childhood.

Our sample was very diverse. Some of the students came from multicultural families (parents with different origins) and had already experienced a longer stay away from home – a situation characteristic, for example, of citizens of countries in Western Europe. These citizens often had dual citizenship owing to the fact that both of their parents came from outside Europe but had lived in Europe for many years.

Table 2. Respondents by nationality and religion (N=74)

Source: Author’s survey.

Findings

Reasons for studying in Poland

For international students at the MUL, the most significant factor influencing their choice of university was the recommendation of family and friends or of people who had already studied at the MUL (Table 3). What were less important were the formal issues connected with taking up medical studies in Poland. Some of the students came to the country since their national governments had signed bilateral agreements with Poland and certain universities were interested in accepting students from another country. This was the case for students from Saudi Arabia, which explains why so many young people from this country study in Łódź. What also matters is the cost of medical studies in Poland, which is much lower than in other European countries. However, a less crucial reason for choosing a medical university in Poland was belief in the competitive aspect of education in the country compared to other European countries. The focus-group interviews revealed another fairly important reason for taking up studies in Poland, especially for students from Europe and in particular Scandinavia and Germany. In many countries the number of places in medical schools is strictly limited, which results in strong competition between candidates. Only those graduates who receive top grades in most subjects in school-leaving exams are eligible. This means that the possibility to study medicine in Poland, where still it is much cheaper than in Western Europe, is the only alternative way for many people to fulfil their dreams.

Table 3. Reasons for taking up medical studies in Poland (N=74)

Source: Author’s survey.

The advantages of living in Poland

Analysis of our research findings shows that the international students concentrated mostly on the difficulties experienced during their stay in Poland, which we describe below. The advantages of living in Poland, although discussed with the students during the interviews, were not given significant attention. In spite of the fact that the international students did not focus particularly on this facet of their life in Poland, a few answers describing the positive aspects are worth mentioning. Here, they mostly emphasised the positive changes which took place, such as gaining or developing certain skills, among which self- reliance – understood as the necessity to solve the problems of everyday life on their own, as illustrated in the three interview extracts below.

I learnt to be a little more independent and responsible. I learnt to catch on to things quickly to survive (S_17_Zimbabwe).²

I cook, I clean, I don’t have a driver or a maid (S_32_Saudi Arabia).

I am more independent now. I have travelled to European countries. I can deal with my own problems. I cook for myself. I get to know different people with different personalities and religions and backgrounds (S_67_Lebanon).

Another skill which they gained was openness towards people from other cultures. Many students emphasised that, before going to study in Poland, they had not had many opportunities to mix with people from different cultures. For many, it was the first time that they had travelled not only to Europe but also to a country which was culturally completely different from their own and, again for the first time, they could meet with people of many races and cultures.

I am more open to people or other cultures and religions and also tradition. I am gradually adjusting to the way of life here (S_12_Nigeria).

I never really had the chance to meet so many different races until now. My view on Muslims has become more positive as I consider them as my friends (S_43_Nigeria).

Individual students pointed to other skills or qualities which they gained as a result of living in Poland. Their responses imply that they have overcome any culture shock and are learning the norms and rules which are binding in Polish society. Understanding some of the weaknesses of Poles and accepting some of the customs of the new culture enabled the students to adjust to the new cultural milieu.

I got more patient because Polish people need a lot of time for everything (S_16_Germany).

I pay more attention to the clothes I wear and my general appearance. Polish people try to look very presentable even if they are just going out to get bread in the morning (S_34_USA).

The new academic milieu: hardships encountered

Those who came to study in Poland often took on a big challenge – they embarked on difficult and strenuous studies taught in English which, for most of the students, was not their native language. As the research shows, the biggest difficulty which students have is in assimilating vast amounts of information on every subject (Table 4). This problem might be related to another issue – the fact that the Polish education system can differ from the particular national systems to which the students were accustomed (24.3 per cent of answers). At the same time, many people did not have any previous experience of higher-level studies. The transition from high school to university, where the need for the quick assimilation of information is paramount, can be an extra problem. The students emphasised that they had problems assimilating so much detail in such a short time. It is worth noting here that, in Eastern Europe, the dominant model of teaching medicine is still the traditional model, with its overloaded syllabi, in contrast to the rest of the world, where problem-based learning is the prevailing model (Janczukowicz 2013).

Table 4. International students’ perception of hardships having impact on their studies (N=74)

Source: Author’s survey.

The approach of the lecturers towards their teaching and students was also mentioned by the international students as an essential obstacle to learning. In this case the biggest objection was the lecturers’ inability to and lack of skill in conducting classes in such a way that students would be encouraged to participate in them. The students pointed out that the prevailing form of lecture is that during which the teacher dictates the material or read out ready-made PowerPoint presentations; however, the students miss seminars conducted in a suitable way – i.e. engaging and based on discussions. International students claimed that there is a vast and simple cultural difference in the approach of the teachers towards the students. In their view, Polish teachers remain distant, do not smile, cannot or do not want to establish closer relationships with students and are not helpful when students have difficulties with learning – it is difficult to receive any extra help from them after lecture hours.

During the focus-group interviews the students emphasised another problem concerning academic life which can have an impact on their adaptation to life in Polish society. They were referring to the difficulties they had in establishing closer contacts with the academic community – with both teachers and host-country students. Some of the respondents regretted that their friendly contacts were limited mainly to those with their compatriots and other international students. Some students claimed that they miss the kind of close contacts with native-Polish students which would enable them to become more familiar with Polish culture.

I would like to know more about Polish culture and Polish students, but I don’t have the opportunity to meet anybody (FG_3_India).

According to our respondents, Polish students are not open to contacts with them as, so they claim, the latter are afraid of people who are different from them. This kind of opinion was expressed firstly by students from Arabic countries, who claimed that host-country students are prejudiced against them.

I feel bad here. I think that, because of my hijab and Islam, other students don’t want to communicate with us (FG_1_Iran).

Polish students don’t respect us; they look at us like strangers and don’t want to interact with us (FG_1_Saudi Arabia).

It seems, though, that the lack of close relations between Polish and international students is more complex and is the result of both individual and external barriers. The majority of research students admitted that they had not yet tried to establish closer contacts with Poles, justifying this kind of behaviour by the fact that the latter do not want it or that international students do not have an opportunity to make contact with members of the host community. This is perhaps because the majority of the international students do not belong to any social organisation or sports clubs where such contacts could be made. So, on the one hand, they want to get to know Polish students better but, on the other, they do nothing to initiate this, shifting the responsibility for the lack of contact onto the host-country students. Polish students in turn claimed (during classes on intercultural communication) that they would like to get to know international students better but do not have the opportunity, due to their limited contact with them – for example, in the canteen. Moreover, even many Polish students said that they were discriminated against at their own university, claiming that international students are treated better by the university authorities, have priority access to the better classrooms, are given preferential treatment (for example, Muslim women do not have to take off their hijab when entering the operating theatre) and have better learning conditions (clinical classes are conducted in smaller groups).

One example of an external barrier might be the lack of a well-thought-out university policy aimed at the integration of both groups of students. At the MUL there is the Administrative Centre for Medical Studies in English, to where international students can turn with any problems – a centre which the students think highly of.

The university initiates various activities aimed at familiarising international students with Polish culture as well as integrating them within their own group. However, there is a shortage of activities which would integrate Polish and international students. In fact, the majority of the events organised are aimed at one or the other group but not the two together. This is especially the case with medical students. One key reason may be that lessons for Polish students are conducted in Polish. Initiatives are needed for organising optional courses in English which would be directed at both groups of students. However, this lack may either be an artificially created obstacle of an administrative nature or a lack of awareness of the positive mutual influence which such classes could have on the two groups.

Communication with the host community: an overall assessment

Migration policy drawn up by state authorities can affect the acculturation strategy chosen by newcomers. It seems, though, that, for international students, relations with host community have the biggest influence on their choice of strategy. In their interviews, the respondents spoke frequently about their relations with host-country nationals, without ever mentioning discussions on migration held by politicians.

The international students found that relations with the host community were very difficult – however, their opinions differed depending on the person’s origins.

To enable examination of the differences in international students’ assessments of their encounters with the host community, detailed results are presented, both generally and separately for the four groups of students classified according to both the common features of their group and the differences between them (Table 5). Physical appearance was assumed to be the differentiating factor. As a result, the following groups were distinguished: dark-skinned people, people with white skin, Arabs and Asians who come from countries other than Arabic countries. This stereotypical division was made intentionally as it allows a better assessment of the results achieved, which indicate how international students feel in Poland and how they feel that they are perceived by the receiving society.

As the survey showed, as many as 51.4 per cent of respondents experienced aggression in Poland due to origin, religion or skin colour. At the same time, 13.5 per cent of international students met with aggression in the academic environment. Outside university this latter was experienced to the greatest degree by the Arabs, with Asians the only students who did not come up against this form of aggression. It is worth mentioning here that, in research carried out by Nowicka and Łodziński (1993) and de Carvalho (1990), Asians also coped the best in contacts with Polish society and complained the least about racist behaviour towards them.

Table 5. International students’ individual assessment of their stay in Poland (N=74)

Source: Author’s survey.

The aim of subsequent questions that the respondents were asked – ‘Do you feel safe in Poland?’ and ‘How do you feel in Poland?’ – was to verify how much the different forms of aggression which international students experienced from host-country nationals translated into either a real sense of security and satisfaction or into dissatisfaction with their stay in Poland. What is surprising is that, in spite of the aggression experienced in Poland, only 18.9 per cent of respondents claimed they did not feel safe there. Simultaneously, only four respondents (three Arabs and one sub-Saharan African) claimed to feel uncomfortable in Poland, with 60 per cent claiming that they feel good there. The explanation for this situation – on the one hand, aggression experienced from host-country nationals and, on the other, their relative satisfaction with life in Poland – is expressed here by an Arabic student of Muslim origin born in the UK. As a citizen of the UK but also a person who differs from the majority of British people in appearance and religion, he had already experienced forms of aggression and was thus able to make a more objective comparison between Poland and other EU countries than were other international students who had never spent time outside their country of origin.

(…) you can meet with acts of aggression towards minorities in almost every country nowadays. In Poland it is not so bad. It is not that I am afraid to go out, although I know I have to avoid certain parts of the city. Because I am a Muslim I prefer not to travel by public transport. However, in the place where I come from [here he mentions the name of a small town in Great Britain – PP] it is sometimes even worse. There are areas where it is really dangerous for Muslims, much more dangerous than in Łódź (FG_3_the United Kingdom).

Another factor which could affect international students’ overall opinion of Polish society could be that our focus-group participants were mainly those who had stayed in Poland for less than a year. Their opinions might lead one to presume that they were the very people who were going through the phase of culture shock on account of the different adaptation problems which they were experiencing at and outside the university.

During the focus-group interviews the respondents did not hide their frustration – the result of their stay in Poland. However, when they were asked to give the main reasons for their disappointment, it turned out that these were usually the result of culture shock caused by existing cultural differences. Among them were the earlier-mentioned issues of their inability to communicate with Polish people due to the language barrier, the impossibility of handling administrative matters, the lack of understanding of the culture code in Polish society, the dissatisfaction resulting from contacts with teachers (the too-formal attitude of teachers towards students) and even the dissatisfaction with the conditions offered by the university (one students mentioned, for example, poor training conditions in some classrooms or even a limited menu offered by the university canteens).

I expected to communicate with Poles and learn about their culture but for various reasons they don’t feel safe talking and engaging in a conversation with any of us (FG_2_Saudi Arabia).

I found it really hard to solve my problem in an office. Polish people work very slowly (FG_3_Turkey).

The only problem is that some Polish people are not well educated or they are raised in a racist family and have problems with foreigners and they always want to insult people of different skin colour and religion. But Poland also has lots of good and kind people (FG_2_ Afghanistan).

The focus-group interviews turned out to play an important therapeutic role, too. One of the female students from a Middle-Eastern country, who stated or even sometimes shouted out the reasons why she felt so bad in Poland and at the university, said at the end of the interview:

I would like to thank you for this discussion. It was very important for me that I could say this. Now I feel that somebody listened to me. I hope that this research contributes to some changes here at the university and maybe outside (FG_1_Iran).

Communication with the host community: examples of encountered racism

From research by de Carvalho (1990) and by Nowicka and Łodziński (1993) it appears that, in the 1980s, the group which had the greatest adaptation problems, caused by the intensely experienced racist behaviour due to their skin colour, were the students from sub-Saharan Africa. Another group who also met with many racist forms of behaviour were the Arabs; they, however, coped with racism based on prejudice much better. The present study shows that these two groups still experience different forms of aversion or even physical aggression most intensely. However, such negative forms of behaviour are less frequent now towards both groups. At present, Arabic students, more often than students from sub-Saharan Africa, complain about encountering racist behaviour.

I am afraid of some people who hate Arabs and Muslims and they always want to fight with us (S_25_Saudi Arabia).

I faced hatred and aggression twice since I came to Poland. Both times it was on a tram in Łódź. There were some guys who started using words (insulting my religion) only because I have a beard and moustache and I am brown (FG_2_Afghanistan).

Many times, Polish guys wanted to start a fight with us for no reason (…) (FG_3_Saudi Arabia).

Prejudice against Arabs is motivated mainly by their different religion and culture but is also influenced by the political situation in the world. The research was carried out at a time when Europe was experiencing terrorist attacks by members of Muslim terrorist organisations. At the same time, a surge of refugees from war-torn countries such as Syria arrived in Europe. The public media magnified the issue of European values being threatened by the Muslim world. Arabic students claimed that, in spite of the fact that they do not support ISIS, people are still wary of them due to their Muslim religion.

Just because there are terrorist groups that claim to be Muslim doesn’t mean that we approve of them. By the way, ISIS attacked my city twice (FG_2_Iraq).

Europeans usually hate Muslims because of ISIS. So people usually try to avoid us. I was also bad-mouthed and told to get out of Poland because it is not for Muslims (FG_1_Saudi Arabia).

I went bowling in ‘Manufaktura’ [the shopping centre in Łódź]. There was a man on another track. He came to me and asked ‘Are you Muslim?’. I said I am Muslim. And he said he was Catholic. I congratulated him. He asked me if I was a terrorist. I smiled and said I am not a terrorist. I asked him: ‘Why do you ask?’. After a minute he asked: ‘Is your brother a terrorist?’. I smiled again and tried to ignore him. After a moment he came up very close to me and started shouting that my family are terrorists and Polish people hate Muslims and all Muslims should leave Poland (FG_3_Saudi Arabia).

It is worth mentioning here that both male and female Muslim students encountered acts of aggression. However, the evidence suggests that female Muslim students were more often subjected to verbal and physical attacks than were other international students due to the fact that they wear the hijab and because women, as physically weaker, are an easier target of attacks.

One man took off my headscarf when I was getting off the train, which was unpredictable behaviour. After that other people with that man yelled and said bad words (FG1_Saudi Arabia).

Someone started taking a picture of me because I was wearing the hijab and he said some words in Polish. I didn’t understand it – but I was really scared (FG_1_Saudi Arabia).

Someone wanted to take off my scarf (young man). Even though many people were on the street nobody reacted (FG_3_Saudi Arabia).

I hear bad words because I have a different religion. I wear a scarf, I speak a different language – sometimes they even look on us as strange people. They shout at us at least twice a week. People don’t help. They don’t even speak English with us whether they know the language or not. Poland is not too safe (FG_2_Saudi Arabia).

Racially motivated aggression was also experienced by students who were different from the host community on account of their skin colour. However, it is impossible to present the scale of the problem due to the fact that only seven students from sub-Saharan Africa participated in the survey. In this group, five people claimed to have been the target of acts of racism. They claimed to experience such acts the most frequently in public places: being sworn at and people blatantly staring at them.

Men approach me and my friends and tell us to go back to our country (FG_2_Sudan).

Just a lot of staring, of taking pictures in public places (S_17_Zimbabwe).

Racial profiling, racial name-calling (FG_2_Kenya).

However, it is worth emphasising here that white people in our survey from Europe, the USA or Canada seldom complained about acts of aggression towards them. The exception were citizens of Poland’s neighbouring countries; this could be the result of national stereotypes.

A person was shouting at me because I was speaking in German on the tram (S_42_Germany).

In spite of the fact that an in-depth analysis of the attitude of Polish society towards national minorities is not the focus of this article, in order to understand the different adaptation difficulties which people experience, it is worth analysing the results of the survey carried out in 2018 on a representative random sample of adult Poles regarding their attitude towards certain nations.

The results clearly confirm what was established in this study – the fact that Arabic students feel that many Polish people are prejudiced against them. The evidence shows that Polish people mainly prefer citizens of the USA and Western Europe. Chinese people, who are culturally very different from Poles, are a group towards whom the majority of Poles have a positive or neutral attitude. Meanwhile as many as 62 per cent of Poles claimed that they do not like Arabs. The survey, carried out by the Public Opinion Research Center (Omyła-Rudzka 2018), did not include nationalities from Africa.

The reasons behind such a dislike of people of Arabic origin are many and varied. Helpful in explaining the situation is the theory of prejudices developed by Stephen et al. (1999) which was cited in the theoretical section of this paper. The authors indicated four possible factors of prejudice against other national and ethnic groups: realistic threats, symbolic threats, intergroup anxiety and negative stereotyping. It seems justified to state that all these factors play a significant role in explaining the existing prejudice against Arabs.

The main reason for the existing prejudice against Arabs is the very limited knowledge that Polish people have about Muslim culture and Islam. The Arabic minority living in Poland is quite small, which is why many Poles have never had an opportunity to get to know the real representatives of this community. This, in turn, influences a simplified and often erroneous perception of this group (intergroup anxiety), a negative and stereotypical image of Arabs which is mostly exacerbated by the media and right-wing populist politicians. Together they portray Arabs as posing a threat for Christian and democratic values (symbolic threats) owing to their different religion and the quite strong belief of Polish society that Islam is a dangerous religion supporting terrorism. Rightist politicians also show the group in a bad light, contributing thus to society’s belief that there is a real threat to the Polish population’s safety. While conducting workshops with Polish students on intercultural communication I often ask them about their perception of the different minority groups living in Poland. These students are quite often of the opinion that Arabs do not respect European values and want to transfer the principles of their culture, including Sharia, to Europe. Some Polish students also think that jihad means ‘war against infidels’ – which includes Christians – and that Islam promotes jihad, encouraging its believers to commit terrorist attacks (negative stereotypes).

Summing up this part, it is worth emphasising that accusing the host community of ‘racism’ does not always have to be consistent with the actual meaning of this word. During focus-group interviews, it was fairly evident that, occasionally, certain kinds of behaviour by host nationals towards ethnic minorities are over-interpreted. Examples of racist behaviour which the students gave included Poles staring at them, turning their back on them or gesturing with fingers. Certainly, this kind of behaviour can cause anxiety in an individual; however, it does not have to mean that it is related to negative behaviour towards ethnic minorities. An individual’s different appearance or clothes can sometimes catch some people’s attention. Poland is still a quite homogenous country. In smaller towns, people of a different race can still stand out and attract attention. What matters is the fact that, when analysing the official statistics on racist crimes in Poland, Łódź province or Łódź itself, it is noticeable that the problem does not seem to be particularly significant; however, the number of stated crimes is growing year on year. It is certain that most of the different forms of behaviour defined as racist are not reported to the police by the victims.

Conclusions

In this study I am investigating the main problems experienced by international students at the Medical University of Łódź. In the initial section of this paper, four research questions were put forward to which this study should provide the answers.

The first question regarded the difficulties faced when studying in a foreign academic environment. The study shows that the problems experienced by international students in an academic milieu other than that of their home country are very complex and mainly concern their adaptation to the new system of education and the way in which they manage the acquisition of new knowledge and make contact with host-country students. In spite of the fact that all the international students experienced problems studying in a foreign academic milieu, the degree of these difficulties varied. The hardships were related mostly to cultural differences. Students from Europe or America had fewer difficulties in Poland than students from Africa or the Middle East as a result, firstly, of the level of education and the curricula of the secondary education in the different countries. Secondly, their problems may result from cultural differences which also impact on the style of learning. What is noticeable in my teaching practice is that there are differences in the methods of learning preferred by the students: group learning, individual learning and willingness to hold discussions with their tutors, etc. Moreover, there is a noticeable difference in their attitude to learning and plagiarising. Some of the international students are not aware of such unethical conduct as plagiarism – one fairly frequent type of behaviour early on in the studies of students from some regions is submitting homework copied from the Internet. Thirdly, cultural and phenotypical differences may contribute to the problems experienced in contacts with host students. The lack of shared classes and activities is a strong barrier to communication between these two groups, which results in a separation between them.

All these factors result from the assumption that Polish students do not like certain international students – mostly those from Arab and African countries – and are prejudiced against them due to their religion, culture or race.

The second question concerns the hardships influencing students’ adaptation to the new society. The international students indicated problems such as loneliness, homesickness, dietary differences or the climate and a great many of them voiced concerns about the difficulties they have in making contact with the host society and the lack of mutual understanding. To explain these concerns a reference should be made to Hofstede’s cultural dimensions (Hofstede et al. 2010). It is well known that the factor facilitating or hampering adaptation is the cultural or even religious similarity or lack of similarity with the dominant culture. Those who come from the same cultural environment put less effort into learning the principles of a new culture, better understand the hosts and, at the same time, are usually more accepted by the host nationals. In particular, similarities or differences in such cultural dimensions as power distance and individualism–collectivism matter. Poland is considered (Hofstede Insights n.d.) as a country of high power distance, which means that it is a hierarchical society. People accept a hierarchical order in which everybody has their place and which needs no further justification. Poland is also an individualist country, which means that people prefer a loose-knit social framework. They are expected to take care of themselves and their close family in the first instance (Hofstede et al. 2010).

All these cultural similarities or differences have a significant impact on the adaptation of particular groups of international students to Polish culture. Those from Slavic nations of Central and Eastern Europe – due to the language and historical and cultural similarities – are assumed to have the fewest problems adapting to Polish culture. Students from individualist cultures (Europe or North America) also adjust more easily to the new environment than do those from collectivist cultures (Asia, Africa), with the differences primarily being seen in the case of Asian and African societies. Students from Arabic countries or, to a lesser extent, from African countries, experienced greater culture shock due to the strong cultural and religious differences, their lack of knowledge about the culture and norms binding in Polish society or to language barriers.

The third question regards overseas students’ experiences of contact with the members of Polish society. The biggest adaptation challenge for the respondents was the attitude of the receiving society towards them which they perceived as quite negative. The prejudice against international students of a different race, nationality or religion is one of the most important reasons for their negative mood. During the focus-group interviews, the students emphasised that the group the most discriminated against were the Muslim and sub-Saharan students due to the visible features of their appearance. These students claimed that they did not always feel safe in Poland. In public places they often met with different forms of verbal and sometimes even physical aggression. This kind of behaviour influences their negative image of Polish society and is the main barrier in their adaptation to the new culture.

The students who were the most disappointed with their stay in Poland usually shifted the whole responsibility for this state of affairs onto Polish society which, according to them, is closed and intolerant of people from a different culture. At the same time, they idealised countries of Western Europe as being open and tolerant – which is not necessarily true. As other studies show (e.g. Brown and Jones 2013), racial attacks also occur elsewhere in Europe. Simultaneously, the interviewed students did not feel that they may also be partly to blame for the fact that they felt uncomfortable in Poland. They did not understand that it is not only up to the receiving society to be open to foreigners but also that foreigners must be more open to and tolerant of the values of the dominant culture. The research students admitted that, at the time of making the decision to go to Poland, they usually had very limited knowledge of the country whereas, as Winkelman emphasises, people deciding on a longer stay abroad should prepare for it. They must be aware of and open to possible changes. At the same time, they must be ‘prepared to deal with personal rejection, prejudice and discrimination. (…) Psychological preparation for the outsider status is essential, because most people immersed in a foreign culture will experience a negative evaluation of their differences and a rejection by the members of the host culture’ (Winkelman 1994: 124).

The fourth question concerns the ways in which international students adapt to the new culture. Adaptation means a ‘minimum adjustment to the environment enabling survival’ (Budyta-Budzyńska 2011: 46). This means neither rejecting the receiving culture, as happens in the case of marginalisation and separation, nor excessive acceptance and assimilation of the patterns of the new culture. Such an approach is often chosen by international students at the MUL due to their pragmatic attitude to the dominant culture. The majority of them intend to return to their own cultures and they treat their stay in Poland as a task that they must carry out. Adaptation does not mean, however, that the newcomer must entirely abandon his or her own system of values, as values assimilated from the new culture can be strictly ancillary in nature (Halik and Nowicka 2002). On account of the fact that many students assume that their stay in the new culture has a task-to-perform character, they usually do not seek to build up deep and lasting relationships with the members of the receiving culture. Contacts with such people they can treat as a pragmatic approach, which will help them in their everyday life in the alien environment (Halik and Nowicka 2002).

It should be emphasised that, in case of international students at the MUL, adaptation is also influenced by the subject of their studies, since they treat their stay in Poland as a task which they must perform. These students usually do not see their future in Poland. Their stay is strongly oriented towards obtaining the desired education and returning to their own country or to another Western country, due to the fact that to practise a profession in Poland it is necessary to be fluent in the Polish language and to pass an exam to certify that they are fully qualified to practice as a doctor there. The National Medical Examination can be taken in English; however, running a medical practice in English would be difficult in Poland. Therefore, the majority of students do not feel the need to try, for example, to establish closer relations with Polish people, as was the case for many international students in the 1980s, in order to make their life in Polish society easier, to get to know the society better and maybe to start a new life there (de Carvalho 1990; Nowicka and Łodziński 1993). The economic situation of international students studying at the MUL, as well as their career prospects, are completely different to those of many international students who studied in Poland in the twentieth century, although it may still be the case for international students currently studying other subjects in Poland than medicine. Medical studies are quite expensive, therefore they are not usually chosen by people from poor families. At the same time, people studying medicine are not afraid of not finding a job in the medical profession and the studies in English let them take up employment in many countries.

Notes

¹ The participants of the PREMED course are treated as students. They have an established curriculum, classes are held on each weekday, attendance is compulsory and the course ends with an exam or another previously set form of credit.

² Meaning of symbols: S-survey, FGI-focus group interview. Next number of survey or FGI is given and the respondent’s country of origin.

Conflict of interest statement

No potential conflict of interest was reported by the author.

ORCID ID

Paweł Przyłęcki  https://orcid.org/0000-0002-9734-8518

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