Table 1 Qualitative results of the themes on EY experience from students

 Personal benefits

1.

I was planning to go on an exchange and then travel to different countries to experience different cultures, meet people of different nationalities. (2F, Female, SH)

 Academic considerations

2.

I decided to take a whole year minor which was still related to medicine... I worried that if I explored [other] areas for a whole year, I might not be able to pick up medicine again. (2A, Male, IC)

3.

In the beginning, I did want to get a qualification, so that’s why... I registered for Master of Research in Medicine, but when I didn’t get in, I registered for this [Minor in Kinesiology] one because there was still a qualification. (2A, Male, IC)

 Foreseen hinderances

4.

I chose United Kingdom, because... I could use English to communicate. (3B, Male, IC)

 Administration process enablers

5.

It was helpful for administration, especially for intercalation year because they forged the link and the application was quite straightforward. They already set up the whole thing. (2E, Female, IC [RA])

6.

In fact, faculty gave us a lot of options, since I couldn’t get into the exchange, I could choose something else... there was still time for me to change. After they approved your plan, you could still change [it] if you could not execute it. (1A, Male, RA & IC)

 Financial enablers

7.

I want to thank my family for [financially] supporting me... the school fees [at the overseas schools] were very expensive. (1C, Female, IC & RA)

8.

Luckily, I was granted some scholarships, and which almost fully funded my project, I didn’t end up paying too much... The biggest scholarship I applied was... sponsored by The Hongkong and Shanghai Banking Corporation. I applied this one around October and November [2017]. After several rounds of interviews, I was informed of the successful result around April [2018]. Therefore... the financial concern was resolved. Indeed, I was kept informed about the results of the other scholarships as well. (3A, Male, RA)

 Programme content enablers

9.

My original expectation was that I would be only going to lectures, but the actual content of the course was not like that. There were different teaching methods, [like they] had lots of field trips, for example we went to a physical education college, we got a tour of their college. We got to go to a private gym where you could observe and teach people how do [exercise]. It really had hands on experiences. And there was also a cooking lab... in Causeway Bay... When I first got this offer, I thought this would be quite boring, but after studying for around a month, I started to think that this was quite enjoyable, the content was very interesting, [I was] very satisfied. (2A, Male, IC)

 Assistive enablers

10.

I found HRP slightly helpful for my research project, and at least I knew how to approach a lab research or whatever. If I didn’t have the course of health research project, I wouldn’t have known do the Institutional Review Board and ethics approval and etc. Like low key thing is slightly important, if you were doing research in EY. (1E, Female, IC & RA])

11.

[Laboratory Induction Course] was more focused on molecular and cellular [research], so its focus was on PCR, Western blot etc., so for me it was useful, because that was what I basically did for my research. (1B, Female, RA & IC)

 Communication barriers

12.

I had already sent emails, private messaged some doctors to see if there were any research opportunities, but there were no replies, and faculty didn’t reply [to the emails], so then I was very frustrated. (2D, Female, RA & IC)

13.

We were working with the hospitals and schools in Yunnan, I met up with the hospital director and the principal of the school... During our meeting, they were very welcoming and they said they would do their best to help support us… but when the time came for us to carry out our project... none of the front line workers knew who we were and what we were doing, they just thought that we were a group of strange people from Hong Kong... to be honest we didn’t really know if the hospital director supported us, or was if it just a half-hearted response, we just felt that there was no communication between the director and the front line workers, and we didn’t know how to communicate with the front line workers. (2B, Female, IC & SH)

 Preparation and application barriers

14.

When I was picking my minor, I did think of [choosing] other courses, however I found out that for some minors, it was impossible to finish it in 1 year, so I sent many emails to ask what courses had to be taken, as some courses need a prerequisite. (1F, Female, IC & SH)

 Academic and assessment barriers

15.

I did psychological medicine, a lot of guidelines they teach are the Scottish system, which meant that I cannot apply these back to Hong Kong. So, I’m basically just learnt it for the year... I didn’t take any academic stuff back to Hong Kong... So honestly, I think I was only studying for the purpose of exam not for the purpose of long-term enriching in the academic side. (1E, Female, IC & RA)

16.

Although my [programme] sounded like it was related to medicine, what I did was actually not relevant to the MBBS curriculum… the only problem is that now that we’re back to the clinical year, it is a bit overwhelming... I feel like I have a lot of things to catch up with after this year commenced and it may be a bit tough... I’m not sure if I’m the only one having this problem, or does everyone else? (3D, Female, IC & RA)

 Financial barriers

17.

Some people want to spend a whole year overseas, so they picked intercalation as they could afford it, if you couldn’t afford it, you might take a look at HKU Worldwide, or you would approach the schools yourself, there were many more steps in the process. (2B, Female, IC & SH)

18.

For some students this was a huge financial burden so they wouldn’t apply to these places [overseas], or they were forced to stay in Hong Kong. [And since they were forced to stay in Hong Kong,] the things they took might not be the things they wanted, they did it just to fulfil the EY requirement, it might not be something that they were interested to do, so for these people they probably thought it wasn’t worth it. (2C, Female, SH & IC)

 Personal trait barriers

19.

When we reached there, we were helping out the locals rather than initiating our programmes, because we didn’t know the actual situation, for example we were thinking of organising some tutorial classes... however we didn’t know the children’s educational level and acceptance level, we also didn’t know the arrangement of the local NGO, that’s why the things that we proposed didn’t fit the actual situation, that’s why in the end we assisted the local teaching staff rather than initiating our own activities. At the time I felt like our role was very passive. (2C, Female, SH & IC)

 Onsite adaptation barriers

20.

When I went to Yunnan, the locals, like the elderly, spoke their dialect, which resulted in some communication issues. When we distributed questionnaires, some of the elderly were illiterate. But when we read out the questionnaire to them, they still couldn’t understand what we said. (2B, Female, IC & SH)

 Personal benefits

21

Personally speaking, after experiencing the whole year, I believe this year was needed. If all you do is study, you don’t have time to stop and think, you don’t even know what you’re doing, all you’re doing is studying until you graduate, you haven’t even thought about your life direction, or how you would deal with certain situations, there is no chance for you to mature, so that’s why this year [EY] is very important. (1B, Female, RA & IC)

22.

I feel like I have become more empathetic and sympathetic. Maybe when we were studying, we were very knowledge-oriented or exam-oriented, but... when we become physicians, we will need to think from the patient’s perspectives. (2C, Female, SH & IC)

23.

In research, the level of intensity came from the workload but there was no longer the pressure of comparison. In medical school, if you hear other people quiz each other for revision, you may feel like you don’t know anything [you could neither ask nor answer a question like them]. In research, everyone is doing something different, so you can’t see what other people are doing, there is no one to compare with, and so there was no longer that pressure to compare. (1D, Male, IC & RA)

 Social benefits

24.

I met a lot of people with different nationalities over there, especially my colleagues in my laboratory who were Turkish, Indian, British, Russian and etc. After chatting with them, I found out that their life experiences and journeys were so distinctive, which gave me a life lesson that I should not limit myself. This was an unexpected benefit. (3A, Male, RA)

25.

I did get an extra degree within EY and had some experiences which were out of my expectations, such as attending conference, meeting people that I would have never met before, and learning some medically related things. After finishing, I’m grateful that I had an opportunity to do these things before graduation, the only thing is I had a hard time during Year 2. (3D, Female, IC & RA)

 Academic benefits

26.

After going to EY, I have a different perspective on [studying in] university: before I thought that studying in university was supposed to be vocationally-oriented or knowledge-based; instead now I think it has to do with self-exploration, you can define what you want to do, then find a way to do what you want to do, the purpose is to learn during the process of achieving a goal rather than to just achieve a goal. I feel like this is a huge change [in thinking]. (1C, Female, IC & RA)

27.

Like when I was in Year 1 and Year 2, I think I was not very happy, I was more stressed in Year 1 and Year 2... But after staying overseas, I think I have a more stablised mentality, so I feel more comfortable after coming back. Of course, there are still pressures and I’m worried about examinations, but I think I’m calmer and more ready to face challenges after going through the EY. (3A, Male, RA)

 Career aspect

28.

I’m very thankful for this year, it helped me realise what I wanted to do. Till now I still don’t know what [sub-]speciality I want to pick, but I think I know what type [area] of specialty is suitable for me. (1C, Female, IC & RA)

29.

Indeed, some students, who aimed to do research when they were enrolled to [the MBBS programme], might not know what research is like and may not be sure if they want to pursue research [as a career] after graduation. So, I think you can have a chance in EY to experience different types of research... so that you might have a better understanding of what you would like to do in the future. (3D, Female, IC & RA)

30.

About the service activity in Yunnan... It was like stepping into a mini society, which was very different from our study. We went to an office setting in Yunnan... [It was] very different from when we were studying, there were some conflicts between colleagues, and they would be split into different groups, different sides [office politics], you could hardly imagine that... I feel like this service [attachment] gave me the opportunity to step into society earlier, to see what it would be like to work in society, to know how to get along with others. (2C, Female, SH & IC)

 Role of Faculty

31.

I think they could have done another thing to help us, which is planning and preparation. I think the stage we needed most help was when you were planning where to go. (3D, Female, IC & RA)

 Administration procedure

32.

I feel like if we have a problem, we need to be able to reach them, like they have to respond to our emails, not wait until a month later before responding to our emails. (2F, Female, SH & SH)

 Programme application

33.

I think, if there will continuously be an additional 100 students applying for exchange programme every year, they have to increase the number of quota or coordinate better. (3G, Female, IC)

 Programme preparation

34.

I think [they] could reduce the workload from the other aspects, such as HRP, PCP [Patient Care Project], PIP [Professionalism in Practice Programme] and so on. (3B, Male, IC)

35.

About the scholarships, Faculty of Medicine has published a list of them but up until now I still don’t know if anyone received any of them. To be honest, there was no response of a successful or unsuccessful application after I applied... so I had to apply scholarships not from the Faculty. As I didn’t know when they would announce the results and award the scholarship. (3A, Male, RA)

 EY output requirements

36.

Academic output was one of the criteria, I didn’t really want to mention about those things [in the assignment], instead I wanted to talk about the life lessons [that I learnt]. (1D, Male, IC & RA)