Medical Students’ Reflections on Cultural Uncertainty During an International Global Health Program: A Qualitative Study

Background: More than 40% of United States medical schools offer global health curricula designed to enhance students’ cultural awareness by exposing them to diverse populations, health inequities, and situations of systemic and interpersonal uncertainty. This study examined how medical students described changes in values, beliefs, and professional perspectives during immersive global health experiences within a structured global health program. Methods: We analyzed reflective journals from 52 Penn State College of Medicine students enrolled in the Global Health Scholars Pathway (GHSP), a longitudinal program with integrated lectures and a required international clinical elective. Students completed month-long placements at one of seven international sites (Ghana, Nepal, Vietnam, Zambia, Australia, Brazil, Ecuador). Weekly journal prompts performed at each site trip focused on experiences of intercultural uncertainty and foreignness. Three independent screeners verified completeness, and two reviewers conducted iterative, consensus-based thematic analysis informed by grounded theory principles. Results: Student reflections described responses to cultural difference across nine descriptive categories - extrinsic characteristics, language barriers, core beliefs, emotional attitudes, cultural engagement, intracultural relatedness, intrapersonal awareness, career growth, and observation & inquiry. These were then synthesized into three overarching thematic domains: Cultural Humility, Intrapersonal Resilience, and Realignment of Medical Motivations and Perspectives. Conclusions: Participation in the GHSP created conditions that supported reflection on intercultural uncertainty and professional values. Students described increased adaptability, emotional awareness, and reconsideration of professional priorities. Findings suggest that immersive global health curricula with structured reflection may support the development of culturally responsive and reflective clinicians. Future studies should examine transferability across sites and longer-term impacts on clinical practice.