The authentic professional and artificial personal development among international medical students across cultures: a mixed-methods study

The study aims to address a significant gap in the literature by moving beyond traditional discussions of cultural adaptation to examine the relationship between cultural intelligence and adaptability for personal and professional transformation, and to provide practical resources to enhance students’ personal and professional identity development and their ability to navigate the complexities of cross-cultural adaptation. The study employed a convergent parallel mixed-methods approach and included six medical universities. A total of 207 participants were involved in the quantitative analysis, while 47 individuals were interviewed for qualitative insights. For the quantitative analysis, analysis of variance and hierarchical regression were utilized, whereas thematic analysis and thematic synthesis were employed to analyze and integrate the interview data. Quantitatively, the post hoc multiple comparisons in the Cultural Intelligence Scale (CQS) revealed that Motivational CQ was significantly higher than in all other groups ( P < 0.05). In contrast, Cognitive CQ was notably lower than that of the other groups ( P < 0.05). Females demonstrated significantly higher average scores than males in Motivational CQ, Behavioral CQ, and the overall CQS ( P < 0.05). Additionally, students whose learning objective was to secure a good job scored significantly higher on Cognitive CQ and the overall CQS than their peers ( P < 0.01). Gender had a negative impact on cultural intelligence (coefficient -0.164, t = -2.390, p = 0.018). Regarding students' learning attitudes, willingness to engage in cross-cultural adaptation was significant (R 2 = 0.059 to 0.162, F = 4.783, P < 0.000), accounting for 10.3% of the variance in mean CQS scores. Qualitatively, six themes emerged: awareness, learning motivation, barriers, institutional gaps, solutions, and transformation. By integrating both quantitative and qualitative findings, the study proposed a circular, five-step model for fostering the formation of professional and personal identity. Students develop their professional identities through structured frameworks, standardized procedures, and accountability measures. A circular puzzle model consisting of five interconnected steps has been devised to enhance students' personal and professional identity development, as well as their capacity to navigate the complexities of cross-cultural adaptation. These steps include: self-awareness and cross-cultural awareness; motivation for learning goals; critical assessment of barriers; innovative solutions to empower personal agency; and reintegration for transformation. When students follow these steps in the recommended sequence, they can effectively transition towards greater awareness and personal identity development. Educators are encouraged to offer more tailored support to international students.