A total of six focus group interviews with 16 student participants was conducted between January to August 2024, including two males and 14 females. The participants comprised 12% of the ethnic minority student cohort (n = 135) in the institution’s healthcare programmes, reflecting the broader demographic trends in Hong Kong. They were from Years one to four from various healthcare professional programmes, including nursing (62.5%), medical health sciences (31.25%), and physiotherapy (6.25%). Details of the student participants are illustrated in Table 1.
The study identified four main themes related to learning challenges faced by the student participants in their healthcare professional studies, including: (1) Language barriers resulting in heavy workload and stress, (2) Restriction in social network and interactions, (3) Stereotypes towards ethnic minorities, and (4) Obstacles related to maintaining religious faith.
Theme 1. Language barriers resulting in heavy workload and stress
Ethnic minority students in healthcare professional studies face significant challenges due to the language barrier, which hampers their academic performance. They struggle to be engaged in learning, devoting extra time to match the course materials. Student #7 said, “…sometimes you get lost and cannot catch up.” Similarly, student #9 expressed, “…my first year was quite bad…and I had a hard time learning in Chinese… the language barrier really scares me.” Student #6 highlighted another aspect of the language barrier, which is the need to communicate with patients in Chinese. She said, “I am currently not as fluent in Chinese, and it’s obviously expected that we speak to our patients in Chinese……just adds another level of difficulty.”
Recognizing the importance of mastering proficient in Chinese language, students face a dual challenge: the pressure to excel academically combined with the additional burden caused by language barriers, which indirectly increases their workload. For instance, encounters with faculty who dismissed English preferences (e.g., insisting on Chinese despite students’ struggles) not only induced stress but also created additional labor that students reported spending extra time deciphering lectures or redoing assignments due to misunderstandings. Student #9 emphasized her efforts to master Chinese for practicums but described falling behind academically because language gaps doubled her study time. Similarly, Student #11 recounted an incident where a teacher’s response to her English-speaking preference resulted in an uncomfortable situation, with the teacher displaying annoyance and insisting on English for the lesson. Student #13 described a comparable encounter “A teacher asked the same thing in the lecture. When I told her that I mainly spoke English, she continued to speak Chinese in the lecture.” indicating their English-speaking preference, the teacher continued delivering the lecture in Chinese. Together, these experiences illustrate how language barriers extended workload pressures, as students compensated for linguistic disconnects through unpaid emotional and logistical labor.
As a result, most ethnic minority students resort to self-study and find lectures conducted in Chinese to be a waste of time. A participant from the Medical Health Sciences programme preferred self-study over lectures where the lecturer only read every word on each slide. They would read textbooks and surf the internet for related information. Student #7 acknowledged the importance of learning Chinese to prepare for her future work but hoped to learn professional terms in Chinese that would help her in her future career. Student #8 echoed this sentiment, saying, “Yes, we also need to learn more healthcare-related terminologies.”
Theme 2. Restriction in social networks and interactions
Ethnic minority students in healthcare professional studies often feel isolated or alienated due to racial and cultural differences from local students, especially during their first impressions. Language difference is the primary reason they find it challenging to approach other local students.
One student participant (#3) shared her experience, saying, “I was sitting in the lecture hall, and all students were looking at me. I was very embarrassed and just kept my face down.” Another student participant (#4) echoed this sentiment, saying, “Yes, after I entered the hall, I looked for another student like me. I found you (another student participant sitting beside her) so I was very happy.”
Some ethnic minority students in their programmes are required to speak Chinese as they need to provide care and communicate with people in Chinese while working in clinical settings. Group projects are commonly used to develop students’ collaborative skills and abilities to prepare their clinical practice. However, this format is usually challenging for ethnic minority students. Student #1 expressed feeling singled out, saying, “I feel so singled out…everyone is just so scared to talk to me because they (local students) will have to speak English…” Student #8 recalled that most classmates were reluctant to approach her when students were asked to form groups by themselves.
Language difficulties can make it intimidating to participate in class discussions or group projects. Student #9 faced this problem in group discussions, and classmates were not willing to help her translate to English as their English proficiency may not be good. Student #3 explained, “They (local students) will form a WhatsApp group and discuss the project. They will be aware of using English. However, they will change back to Chinese…I cannot understand all the Chinese because they may speak some slangs..” Moreover, most students find challenging to engage in activities in Chinese communities. Student #1 expressed, “Not all activities are inclusive for these specific students. Even if I join, I will be left out or do nothing there.”
Theme 3. Stereotypes towards ethnic minorities
Several ethnic minority students reported encountering stereotypes associated their backgrounds with assumptions about academic capability and professional suitability. Participants’ perceptions reflected broader societal biases rather than individual circumstances. For example, Student #2 shared, “The teacher assumed all mistakes were because I am an ethnic minority student, even when others made the same errors.” Student #7 described being reprimanded for speaking English to a simulation patient, with the instructor implying this compromised clinical competence. These narratives reveal how societal prejudices, particularly those conflating language proficiency or cultural background with ability, can permeate educational environments. Importantly, participants emphasized these experiences stemmed from others’ perceptions rather than objective assessments of their capabilities. While existing literature confirms that similar stereotypes operate systemically in healthcare education and academic environments [30, 31], we stress these accounts represent specific experiences rather than universal patterns among ethnic minority students. The citations are provided to contextualize these experiences within broader documented patterns of bias, not to suggest these particular students experienced the exact forms of mistreatment described in the referenced studies.
Theme 4. Obstacles related to maintaining religious faith
Subtheme 1: Avoiding physical interaction in mixed genders
Ethnic minority students who follow religious regulations face difficulties in laboratory sessions due to religious boundaries. Female students do not interact with male students, and mixed-gender touching is forbidden in their religion. However, such restrictions do not apply to clinical practice due to necessity and professional context. This highlights the importance of respecting religious and cultural differences and accommodating them where possible. Student #6 expressed the difficulties encountered during laboratory sessions due to religious boundaries. She said, “We are forbidden to have mixed-gender touch in our religion.” She needed special arrangements for laboratory skill practice to comply with her religious regulations. Student #14 explained, “We don’t talk to boys or have male friends. It’s more of a religious thing.” Student #9 stated, “We hope that the school can provide a place for prayer and allow students to wear their traditional clothes.
Subtheme 2: food restrictions limit social interactions
Muslim students face food restrictions and need access to halal food, which is challenging to find on or near campus. This can limit social interactions during mealtime with their classmates, adding to their social isolation. Student #5 shared their experience, stating, “When my friends and I go out to eat, I have to let them know I can’t eat certain foods. That’s why I tend not to eat out with them.”
Subtheme 3: faith practice in praying
Muslim students need to pray five times a day, but finding a quiet place for prayer can be challenging. It is crucial to respect and accommodate religious practices and attire, such as prayer and traditional clothing, for Muslim students. A student participant (#5) emphasized the importance of prayers and stated, “I have to inform my teacher in advance as I need to excuse myself from the lesson for praying. I sometimes go home to pray if I cannot find a quiet place.” Traditional attire, such as hijab and jilbab, is an essential part of Islam. Student #12 stated, “We have to wear this headscarf (she is showing the scarf she is wearing), even in clinical settings.” Student #15 expressed her concern about the allowance of wearing the hijab for her practicum and future work in the hospital. However, she believed that there should be a policy to allow this attire, as some ethnic minority nurses or nurse students are practicing there. Student #9 emphasized the need for a designated prayer room on campus to accommodate Muslim students’ religious practices.
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