This study has recorded the wide variety of international collaborations that UK medical schools are currently engaged in, demonstrating that these collaborations vary from comprehensive arrangements such as overseas medical programmes and campuses, some of which are regulated by the UK regulator the GMC[23], through to much more limited relationships, such as student exchange programmes. It reaffirms that despite the sparse academic literature about international collaborations in medical schools, especially in the UK context, there is in fact a significant degree of activity in this space. Of note, the activity is not evenly spread across UK medical schools and is especially concentrated in older medical schools compared to newer ones, and in schools based in London.
The findings of this study align with other studies that have noted an increasing trend of internationalisation and collaboration in both higher education, and in medical education specifically[30, 31]. Understanding the growth of globalisation in this space is critical to evaluation of these collaboration, both in their existence, but also in their utility and benefit to both institutions. The literature references globalisation and internationalisation terms which are linked but have distinct meanings which are important to define. Globalisation is the interdependence and interconnectedness of countries and cultures, which in higher education involves the integration of students, studies, and knowledge on a global scale. Internationalisation is the process of incorporating international perspectives and content into the core functions of an institution, for example recruiting international students and faculty, developing student exchange programmes, and fostering collaborations with institutions in other countries. Globalisation is a broad concept encompassing a greater interconnectedness, whereas internationalisation is one example of how to integrate the international aspects into one institution, so can be viewed as a specific strategy to encourage globalisation. Much of the discourse around globalisation highlights the mutual benefits to both parties, often including strengthened academic outputs (such as research collaboration), strengthening institutional relationships, improved staff and student mobility and increased attractiveness to international students[32].
There is also discussion about the wider impact of globalisation including potential harms, and unintended outcomes, as well as efforts to understand how potential power imbalances may affect the collaboration[33]. Whilst our study did not explore these details due to the limited information available, we did find descriptions of collaborations seemed to focus more on the benefits for the international medical school, with little description of the benefits to the UK medical schools. The lack of information on the benefits to UK medical schools and universities is a noteworthy absence and may indicate either that such benefits are not expected, or else that there may be other perceived benefits to the UK medical schools that are not considered suitable for public discussion, such as monetary gain. This warrants further study, particularly in the light of historical power dynamics between the UK and low- and middle-income countries (LMIC), and how this may affect the positioning of the UK medical school as the donor, or expert, and the international medical school as the recipient in the collaboration, especially when the stated intended benefits include use of branding. As commercial knowledge transfer in higher education becomes an increasingly lucrative income stream for many institutions, it has opened up debate about academic capitalism, and whether this could ever be truly aligned with the partnership model where both parties are seen as equal contributors[3]. Despite the clear message from the literature on globalisation is that its primary driver is economic, the webpages reviewed in this study rarely used economic language. This is surprising given the financial implications for the UK institutions, and the potential benefits of this revenue stream to the wider university community.
Another focus in the current literature is how to successfully deliver collaborative partnerships, which is almost exclusively focussed on post-contractual practical tips including curriculum development, faculty development, and quality assurance[7, 34]. Whilst important areas such as cultural nuances, preparation and support of staff, and logistical barriers, are considered, there is little mention of the legal contracts that underpin collaborations and determine the nature of the relationship. Such contracts can form a crucial part of the foundation of a relationship, and whilst guidance for business collaboration agreements for universities exists[35], given the growth of medical education collaboration in the last decade, it may be beneficial to develop a consensus statement or best-practice guidance of specific areas to consider when approaching such collaborations. This could increase transparency around costing, more efficient use of resources, and the breadth of services that could be included.
The strength of this study lies in the systematic identification of UK medical schools and the independent data collection by two researchers. An important limitation is that the study relies on information on webpages, and it is likely that not all collaborations are captured on medical school webpages and that some information may not be accurate or complete. Further research in this area should focus on requesting information from medical schools, for example using a survey, although the commercial nature of some collaborations may limit the responses to such an approach.
This study can help education leaders and policymakers considering future collaborations in medical education to identify the current nature and scope of relationships to consider possible approaches. In particular, the case studies help to illuminate some possible models that may be replicated or developed further in the future. It also forms the basis for a wide range of future research programmes that can examine these collaborations through various lenses. Creative approaches to gather further information about commercial activities at UK medical schools should also be explored. There may be a role, for example, for a structured network or community of UK medical schools who are more actively involved in the international space, who could work together to share best practices and further develop scholarship in this space. Such scholarship should seek to serve partner medical schools, which are often from lower income countries, as well as the UK schools.
Despite the sparse academic literature about international collaborations in medical schools, especially in the UK context, this study highlights a significant degree of activity that warrants further investigation to examine consequences for students, teachers, and institutions involved on both sides of these relationships.