Psychological predictors of medical students’ participation in international educational experiences: A retrospective study

Psychological predictors of medical students’ participation in international educational experiences: A retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychological predictors of medical students’ participation in international educational experiences: A retrospective study Stefano Ardenghi, Marco Bani, Selena Russo, Federico Zorzi, Pietro Invernizzi, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7567379/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The internationalization of medical education offers key opportunities for developing global health competencies. However, students’ participation in international educational experiences (IEEs) varies considerably. This study investigated whether psychological factors assessed at the beginning of medical training – specifically personal values, empathy, dispositional mindfulness, and emotion regulation – predict subsequent IEE participation and destination type (low-/middle-income vs. high-income countries). A total of 854 medical students (51.6% female) from six consecutive cohorts at a university in Northern Italy completed baseline self-reported measures (Personal Values Questionnaire, Interpersonal Reactivity Index, Five Facet Mindfulness Questionnaire, and Difficulties in Emotion Regulation Scale) during their first academic semester. IEE participation and destination were retrieved from institutional records after program completion. T-tests and logistic regression analyses were conducted. Students who engaged in IEEs reported higher self-transcendence and openness to change values, lower Tradition, greater Empathic concern, lower mindfulness, and more difficulties in emotion regulation. Logistic regression showed that higher Universalism and greater difficulties in goal-directed behavior increased the likelihood of IEE participation, while higher Tradition scores reduced it. No significant differences in psychological traits were found between students choosing LMICs versus HICs. Psychological profiles assessed early in medical school predicted later engagement in IEEs. These findings support the utility of early psychological assessment to inform tailored support strategies and foster global engagement in medical education. medical students international educational experiences personal values empathy dispositional mindfulness emotion regulation Introduction The internationalization of medical education has become a strategic priority for medical schools worldwide, driven by the growing demand for healthcare professionals who can work effectively across diverse cultural, social, and systemic contexts (Wu et al., 2022 ). International educational experiences (IEEs) – including clinical clerkships, research fellowships, and public health initiatives abroad – have been consistently linked to a range of benefits for medical students, such as enhanced intercultural competence, improved clinical reasoning, a stronger professional identity, and increased commitment to global health equity (Hsu & Sung, 2023 ; Li et al., 2023 , p. 79; Meaux et al., 2021 ). However, these experiences vary in destination, ranging from low- and middle-income countries (LMICs), often characterized by limited resources and cultural distance, to high-income countries (HICs), which have better-resourced systems and more familiar environments. Yet, despite the increasing availability and institutional support for IEEs, little is known about the individual psychological characteristics that influence students’ decisions to engage in them. While logistical and structural barriers have been explored, few studies have systematically investigated the role of stable psychological dispositions assessed early in training as predictors of IEE participation (Sarela et al., 2025 ). This gap in knowledge hinders our ability to effectively support and guide students in accessing these valuable opportunities. To address this gap, the present study adopts Self-Determination Theory (Deci & Ryan, 1985 ) as its guiding framework. SDT posits that optimal motivation and engagement arise from the fulfillment of three basic psychological needs: autonomy (acting in accordance with one’s values), relatedness (feeling connected to others), and competence (feeling effective and capable). When these needs are satisfied, individuals are more likely to engage in personally meaningful and intrinsically motivated activities (Chirkov et al., 2007 ; Yue & Lu, 2022 ). Within this framework, several stable individual characteristics may serve as internal resources facilitating participation in IEEs. First, personal values – broad, enduring principles that guide behavior (Schwartz, 1992 ) – are central in shaping goals and decision-making. Values oriented toward self-transcendence (e.g., universalism, benevolence) and openness to change (e.g., self-direction, stimulation) may promote autonomy by fostering curiosity, exploration, and moral engagement with global health issues (Alalawi et al., 2024 ; Fiske, 2019 ; Sonmez et al., 2019 ). Second, empathy – the capacity to affectively and cognitively relate to others’ experiences (Davis, 1983 ) – is closely tied to relatedness. Higher intercultural empathy has been linked to greater motivation for global engagement and humanitarian involvement (Assing Hvidt et al., 2022 ; Piumatti et al., 2019 ). Third, dispositional mindfulness – the ability to attend to present-moment experiences with openness and nonjudgment (Baer et al., 2006 ) – along with effective emotion regulation (Gross, 2015 ), may support perceived competence by enhancing resilience and adaptability in unfamiliar environments (Butkovic et al., 2024 ). Building on these premises, the primary aim of the present study is to investigate whether personal values, empathy, dispositional mindfulness, and emotion regulation assessed at the beginning of medical school predict participation in IEEs during training. A secondary aim is to explore whether these dispositions are associated with the type of destination chosen (LMIC versus HIC). Based on SDT and previous research, we hypothesize that: students endorsing values of self-transcendence and openness to change will be more likely to participate in IEEs than those oriented toward conservation and self-enhancement; higher levels of both affective and cognitive empathy will be associated with IEE participation; greater dispositional mindfulness and more adaptive emotion regulation will be positively related to participation; students with stronger self-transcendence values, affective empathy, and emotion regulation may be more likely to choose LMIC destinations. Method Procedure This retrospective longitudinal study involved six consecutive cohorts of medical students from a university in Northern Italy. Students completed a paper-and-pencil baseline assessment comprising validated self-report measures at the beginning of their first academic year. Participation in IEEs was assessed retrospectively using institutional records after completion of the six-year medical program. Destination countries were classified as LMICs or HICs based on World Bank criteria (2024). This retrospective design investigated of whether early psychological dispositions predicted later IEE participation and destination type. The study was approved by the local Ethics Committee (Protocol No. 707, 0066628/22) and conducted in accordance with the Declaration of Helsinki. Materials Personal values were assessed using the Italian validated version of the Portrait Values Questionnaire (PVQ) (Schwartz et al., 2001 ; Vecchione & Alessandri, 2017 ) which evaluates individuals’ endorsement of ten distinct value types, which are organized along four higher-order dimensions: self-transcendence (Benevolence, Universalism), self-enhancement (Power, Achievement), openness to change (Hedonism, Self-direction, Stimulation), and conservation (Conformity, Tradition, Security). Participants rate the extent to which each value-guiding description resembled themselves on a 6-point Likert scale, from 1 (“Not like me at all”) to 6 (“Very much like me”). Higher mean scores reflect stronger endorsement of the corresponding value dimension. In this study, the PVQ has demonstrated high internal consistency, with Cronbach’s alpha coefficients ranging from .65 to .80. Empathy was measured with the Italian validated version of the Interpersonal Reactivity Index (IRI) (Albiero et al., 2006 ; Davis, 1983 ). The IRI assesses four subscales: assessing both affective (Empathic concern, Personal distress) and cognitive (Perspective taking, Fantasy) components of empathic functioning. Items are rated on a 5-point Likert scale ranging from 0 (“Does not describe me well”) to 4 (“Describes me very well”). Higher scores indicate greater levels of empathy across its four dimensions. Cronbach’s alpha coefficients ranged from .71 to .81. Dispositional mindfulness was assessed with the Italian validated version of the Five Facet Mindfulness Questionnaire (FFMQ) (Baer et al., 2006 ; Giovannini et al., 2014 ). The FFMQ, includes five subscales: Observing, Describing, Acting with awareness, Nonjudging of inner experience, and Nonreactivity to inner experience. Items are rated on a 5-point Likert scale ranging from 1 (“Never or very rarely true”) to 5 (“Very often or always true”). Higher scores indicate greater levels of dispositional mindfulness across its five dimensions. In this study, the FFMQ has demonstrated good internal consistency, with Cronbach’s alpha coefficients ranging from .74 to .86. Difficulties in emotion regulation were assessed using the Italian validated version of the Difficulties in Emotion Regulation Scale (DERS) (Giromini et al., 2012 ; Gratz & Roemer, 2004 ). The DERS includes six subscales: Nonacceptance of emotional responses, Difficulties engaging in goal-directed behavior, Limited access to emotion regulation strategies, Impulse control difficulties, Lack of emotional clarity, and Lack of emotional awareness. Participants rate items on a 5-point Likert scale from 1 (“Almost never”) to 5 (“Almost always”). Higher scores indicate greater levels of emotion dysregulation across the six dimensions. In this study, the DERS has demonstrated high internal consistency, with Cronbach’s alpha coefficients ranging from .74 to .88. Statistical analyses Descriptive statistics were computed for all demographic variables and psychological variables. Chi-square tests examined differences in gender and household income across cohorts, IEE participants versus non-participants, and LMICs versus HICs subgroups. Group differences in psychological measures (PVQ, IRI, FFMQ, DERS) were analyzed using one-way ANOVAs and t-tests. A binary logistic regression was conducted to identify dispositional predictors of IEE participation. Only subscales that showed significant group differences in univariate differences were entered in the model. Model fit was evaluated using chi-square and Nagelkerke R²; with classification accuracy and odds ratios (95% CI) reported. Results A total of 854 (response rate = 93.64%) students from six consecutive cohorts participated in the study (Table 1 ). The mean age at entry was 19.93 years (SD = 1.39). No significant differences were found in the distribution of gender across cohorts (χ²(5) = 3.015, p = .698), between students who participated in IEEs and those who did not (χ²(1) = 2.611, p = .106), or between students who studied abroad in LMICs versus HICs (χ²(1) = .355, p = .551). Similarly, household income did not significantly differ across cohorts (χ²(6) = 8.248, p = .220), between IEE participants and non-participants (χ²(3) = 2.647, p = .449), or between LMIC and HIC subgroups (χ²(1) = .222, p = .895). No significant differences emerged in mean scores on psychological measures across cohorts (p > .05). Table 1 Socio-demographic characteristics and international study experience N % Biological sex Female 441 51.6 Male 413 48.4 Academic year 2010/2011 130 15.2 2011/2012 138 16.2 2012/2013 141 16.5 2013/2014 153 17.9 2014/2015 158 18.5 2015/2016 134 15.7 Household income Insufficient 9 1.0 Sufficient 297 34.8 More than sufficient 466 54.5 Excellent 82 9.6 IEE No 609 71.3 Yes 245 28.7 Destination LMIC 43 17.6 HIC 202 82.4 Notes. LMIC Low- and middle-income country , HIC High-income country Compared to peers who remained in their home country, students who later participated in an IEE showed significantly higher scores on the Universalism, Hedonism, and Stimulation subscales of the PVQ and significantly lower scores on the Tradition scale. They also reported greater Empathic Concern, lower mindfulness (specifically Acting with awareness and Nonreactivity to inner experience), and more pronounced difficulties in emotion regulation – particularly with goal-directed behavior, impulse control, and emotional acceptance and awareness. Overall, the effect sizes of group differences were generally small, with the largest observed for difficulties in goal-directed behavior (Table 2 ). No statistically significant differences in psychological traits were observed between students who studied in LMICs and those who studied in HICs (p > .05). Table 2 Differences between students who studied abroad and those who did not Total sample No study abroad Study abroad t(853) p Cohen’s d M SD M SD M SD PVQ Benevolence 4.75 .70 4.73 .73 4.81 .62 − .939 .348 - Universalism 4.63 .77 4.57 .79 4.78 .68 -2.464 .014 .285 Power 3.07 .99 3.09 .99 2.99 .95 .870 .385 - Achievement 4.09 1.01 4.11 1.01 4.03 1.03 .713 .477 - Hedonism 3.79 1.04 3.73 1.04 3.97 1.03 -2.074 .039 .232 Self-direction 4.67 .73 4.63 .76 4.77 .64 -1.726 .085 - Stimulation 4.12 .95 4.04 .94 4.32 .92 -2.712 .007 .301 Conformity 4.17 .79 4.19 .79 4.09 .79 1.133 .258 - Tradition 3.45 .84 3.51 .87 3.32 .76 2.023 .044 .232 Security 3.97 .76 4.01 .75 3.85 .79 1.875 .062 - IRI Empathic concern 18.57 4.29 18.31 4.30 19.14 4.24 -2.368 .018 .194 Personal distress 9.42 4.61 9.30 4.50 9.67 4.83 − .956 .340 - Perspective taking 17.84 4.65 17.82 4.72 17.88 4.51 − .135 .893 - Fantasy 17.46 5.62 17.27 5.49 17.85 5.89 -1.253 .210 - FFMQ Observing 25.65 5.21 25.80 5.19 25.29 5.27 1.051 .294 - Describing 27.83 5.46 27.91 5.40 27.64 5.62 .532 .595 - Acting with awareness 30.87 5.18 31.29 4.81 29.90 5.86 2.888 .004 .259 Nonjudging of inner experience 27.53 5.75 27.55 5.72 27.47 5.84 .154 .877 - Nonreactivity to inner experience 19.79 4.18 20.04 3.96 19.20 4.59 2.157 .031 .196 DERS Nonacceptance of emotional responses 12.43 4.79 12.10 4.73 13.29 4.86 -2.236 .026 .248 Difficulties engaging in goal-directed behavior 13.03 3.94 12.58 3.67 14.23 4.38 -3.803 < .001 .408 Limited access to emotion regulation strategies 15.53 5.68 15.22 5.46 16.33 6.19 -1.743 .082 - Impulse control difficulties 10.75 3.78 10.44 3.59 11.57 4.13 -2.692 .004 .292 Lack of emotional clarity 10.65 3.34 10.57 3.45 10.85 3.01 − .773 .440 - Lack of emotional awareness 14.28 3.74 13.60 3.84 14.53 3.67 -2.246 .025 .248 The logistic regression model was statistically significant (χ²(11, N = 854) = 40.608, p < .001), accounting for 14.5% of the variance in IEE participation (Nagelkerke R² = .145), and correctly classified 74.2% of cases. Participation in IEEs was significantly predicted by higher Universalism and greater Difficulties engaging in goal-directed behavior scores, while higher Tradition scores decreased the likelihood of participation. Specifically, each one-point increase on Universalism and Difficulties engaging in goal-directed behavior scales was associated with a 62.2% and 10.7% increase in the odds of IEE participation, respectively. Conversely, higher scores on the Tradition scale were associated with a 29.5% decrease in the odds of participating in an international experience (Table 3 ). Table 3 Binary logistic regression predicting participation in IEEs (N = 854) B SE B Wald χ 2 p OR 95% CI OR PVQ Universalism .484 .210 5.303 .021 1.622 1.075–2.448 Hedonism .095 .134 .502 .478 1.100 .845-1.431 Stimulation .208 .155 1.811 .178 1.232 .909-1.669 Tradition − .350 .154 5.182 .023 .705 .522-.953 IRI Empathic Concern .011 .038 .083 .773 1.011 .939-1.088 FFMQ Acting with awareness − .019 .026 .508 .476 .981 .932-1.033 Non-reactivity − .047 .030 2.417 .120 .954 .899-1.012 DERS Nonacceptance of emotional responses .023 .028 .667 .414 1.023 .968-1.082 Difficulties engaging in goal-directed behavior .102 .039 6.976 .008 1.107 1.027–1.194 Impulse control difficulties .029 .040 .548 .459 .971 .898 − 1.050 Lack of emotional awareness .035 .035 .988 .320 .965 .901-1.035 Discussion The present study offers novel insights into the psychological dispositions associated with medical students’ decisions to engage in IEEs, contributing to the expanding literature on student mobility in medical education. By examining early dispositional factors, this research highlights the role of personal values, affective empathy, and emotion regulation in shaping participation in IEEs. These traits were already evident at medical school entry and may influence students’ long-term engagement with global learning opportunities. The findings suggest that such individual characteristics, rather than only contextual or structural factors, may influence international mobility decisions well before formal opportunities are available. Three key predictors of engagement in IEEs were identified: higher Universalism and greater Difficulties in goal-directed behavior were associated with increased odds of IEE participation, while higher Tradition scores predicted a lower likelihood of studying abroad. These results underscore the relevance of personal values and emotion regulation skills in shaping students’ mobility trajectories. In terms of personal values, students who participated in IEEs reported higher baseline levels of Universalism, Hedonism, and Stimulation, and lower levels of Tradition. These values reflect greater orientation toward global concern and personal fulfillment, and a preference for novelty and personal growth. Conversely, higher Tradition may indicate a stronger adherence to cultural or familiar norms which could act as psychological barriers to mobility. These patterns are consistent with prior research indicating that students motivated by openness, prosocial values, and exploration are more likely to engage in IEEs (Butkovic et al., 2024 ), while those with stronger attachment to tradition may experience greater hesitation (Winkel et al., 2022 ). Among the most salient motivations for undertaking an IEE are the pursuit of personal growth, a strong interest in cross-cultural engagement, the search for greater independence, and the desire to step away from the familiar home environment. As for empathy, students who studied abroad reported greater Empathic Concern at medical school entry, indicating a tendency toward compassion and prosocial orientation. This supports the hypothesis that empathy, especially in its affective dimension, may foster interest in intercultural engagement and humanitarian involvement. This finding aligns with existing evidence. Empathy has been widely linked to global health engagement, with empathetic students more likely to participate in IEEs and demonstrate a sustained commitment to humanitarian work (Assing Hvidt et al., 2020 ). Empathy may also facilitate adjustment to culturally diverse environments by fostering intercultural competence and the ability to build meaningful relationships during international placements (Zhang & Noels, 2024 ). Furthermore, recent evidence (Bani et al., 2025 ) found that Empathic concern was directly associated with students’ interest in IEEs in HICs, whereas its influence on the choice of LMICs was mediated by motivations related to cross-cultural engagement and personal growth. Given the increasing emphasis on global health in medical education, these findings underscore the importance of cultivating empathy throughout training (Ardenghi et al., 2020 , 2022 ; Ardenghi, Rampoldi, et al., 2021 , 2023 ; Ardenghi, Russo, et al., 2021 , 2023 ; Barbaranelli et al., 2021 ; Donisi et al., 2022 ). Parallel efforts are needed to validate multidimensional measures of empathy (Ardenghi et al., 2019 ; Piumatti et al., 2024 ; Rampoldi et al., 2024 ) and to track its longitudinal development (Ardenghi et al., 2024a, 2024b), in order to better understand how empathy evolves and shapes students’ international engagement over time. Regarding dispositional mindfulness and emotion regulation, students who later studied abroad exhibited lower present-moment awareness, reduced emotional detachment, and greater difficulties in accepting emotions, maintaining focus under stress, and regulating impulses. While this might seem counterintuitive, this pattern may reflect a coping-oriented motivation, whereby students pursue IEEs not solely for academic or cultural enrichment but also as a means of escape internal stress or personal renewal. Supporting this interpretation, previous studies have linked sensation-seeking traits to a preference for immediate experiential rewards over long-term planning (Nadeem et al., 2018 ). Aresi and colleagues (Aresi et al., 2019 ) found that students studying abroad reported increased alcohol use and related consequences, associated with reduced impulse control and heightened sensation seeking. More recently, Hishida et al. (Hishida et al., 2024 ) identified psychological distress as a “push” factor for studying abroad, with students describing IEEs as opportunities for emotional reset or personal transformation. Within this framework, emotion regulation difficulties may not merely reflect impulsivity or avoidant coping, but rather a self-directed attempt to confront personal and emotional challenges within a novel and potentially transformative context. Future research should further examine this dual function of IEEs – academic and intrapersonal – through longitudinal and mixed-method designs that capture the evolution of students’ motivational and emotional trajectories over time. Notably, no significant differences in psychological dispositions emerged between students who studied in LMICs and those in HICs. This suggests that while traits such as personal values, empathy, mindfulness, and emotion regulation may influence the general decision to study abroad, destination choice is more likely driven by external factors, such as perceived safety, language proficiency, academic opportunities, or institutional networks (Abbas et al., 2021 ; Ovchinnikova et al., 2024 ). This finding challenges assumptions that altruistic, empathic or emotionally resilient students are more inclined to choose resource-limited settings such as LMICs (Hsu & Sung, 2023 ), and instead points to the complex interplay between individual motivation, practical constraints, and contextual factors (Yasin et al., 2024 ). Future studies employing qualitative or mixed-method approaches could help disentangle these decision-making processes and illuminate the interplay between dispositional traits, motivations, and contextual constraints. The present findings can be meaningfully interpreted within the framework of SDT (Deci & Ryan, 1985 ). Values such as Universalism and Stimulation and Empathic concern may support the satisfaction of SDT’s basic psychological needs. Recent research indicates that fostering autonomy, competence, and relatedness is critical for student well-being and engagement, particularly in international learning contexts (Wang et al., 2024 ). Specifically, values related to self-transcendence and openness to change may enhance a sense of autonomy, motivating students to explore unfamiliar environments and contribute to global health (Yue & Lu, 2022 ). Higher Empathic concern may promote relatedness, reinforcing the desire to connect meaningfully with others across cultures (Piumatti et al., 2019 ). Although difficulties in goal-directed behavior may appear inconsistent with the SDT dimension of competence, they may reflect a self-direct effort to restore emotional balance and control or pursue meaningful change through novel experiences (Champ et al., 2023 ; Hishida et al., 2024 ; Kritikou & Giovazolias, 2022 ). Overall, these findings suggest that students’ international mobility decisions may reflect more than pragmatic or career-driven motives; they may also express deeper motivational needs aligned with SDT’s framework, such as the pursuit of autonomy, the desire to develop competence through new academic and cultural challenges, and the need for relatedness by forming meaningful connections in diverse social contexts. Understanding these internal drivers may help educators design more supportive and psychologically attuned mobility programs. Strengths and limitations This study has several strengths. Its retrospective design – assessing psychological dispositions at medical school entry and tracking IEEs participation over six years – allows for stronger inferences than cross-sectional studies. The use of SDT as a guiding framework provides a coherent theoretical lens linking psychological traits to motivation and international engagement. Despite being conducted at a single institution in Northern Italy, the large sample size and the inclusion of six consecutive cohorts enhance the generalizability of findings within European context. The use of validated, psychometric sound instruments further supports the methodological rigor of the study. However, some limitations should be noted. The study does not account for potential intervening factors (e.g., academic performance, clinical exposure, peer influence) that may have affected mobility decisions over time. As with all self-report measures, as the risk of social desirability bias and limited introspective accuracy is present. Moreover, some of the psychological variables assessed at medical school entry – particularly empathy and emotion regulation – may not represent stable traits, as they are subject to meaningful change throughout the six-year training program (Bani et al., 2024 ). Effect sizes were generally small, indicating that psychological traits explain only part of the variance in IEE participation. Lastly, destination classification solely based on World Bank income categories may oversimplify the diversity of cultural and educational contexts encountered abroad. Conclusions This study highlights that psychological traits such as self-transcendence values, empathic concern, and emotion regulation difficulties assessed at medical school entry are associated with greater likelihood of participating in IEEs. In contrast, stronger traditional values may discourage mobility. These traits, however, did not influence the type of destination, suggesting that practical or contextual factors play a more decisive role in that shaping students’ choices of study location. These insights have practical implications. Early psychological profiling may help to identify students who are more likely to engage in international education as well as those who may be hesitant but could benefit from targeted support. Medical schools and international offices could use this information to develop tailored interventions, including mentoring, emotional preparation, and decision-making guidance. Such interventions may enhance participation and ensure students are both motivated and prepared to benefit from IEEs. Declarations AUTHOR CONTRIBUTIONS: M.B., and S.A. developed the research aims and wrote, reviewed and edited the manuscript. S.A. contributed to data analysis and wrote the results section of the manuscript. S.R., F.Z., M.G.S. and P.I. contributed to study design and manuscript review and editing. All authors read and approved the final manuscript. ACKNOWLEDGEMENTS: Thanks to Marco Parenti, Agnese Cofler, Federica Olivieri, and the staff of the Erasmus Office of University of Milano-Bicocca for their assistance in the completion of the selection of participants involved in international mobility experiences. CONFLICT OF INTEREST STATEMENT: None. DECLARATION OF GENERATIVE AI AND AI-ASSISTED TECHNOLOGIES IN THE WRITING PROCESS: During the preparation of this work the authors used Grammarly in order to improve readability. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication. DATA AVAILABILITY STATEMENT: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. 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J., Alcorta-Garza, A., Ardenghi, S., Baroffio, A., Elorduy, M., Gerbase, M. W., Gustin, M.-P., Palés, J., Quince, T., Rampoldi, G., Strepparava, M. G., Thiemann, P., Virumbrales, M., Vivanco, L., & Costa, P. S. (2024). Cross-national Psychometric Evaluation of the Jefferson Scale of Empathy-Medical Student Version. Evaluation & the Health Professions , 01632787241296540. https://doi.org/10.1177/01632787241296540 Rampoldi, G., Montelisciani, L., Jacobs, J. C. G., Russo, S., Ardenghi, S., Bani, M., Antolini, L., Consorti, F., & Strepparava, M. G. (2024). Towards a student-centered education: Validation of the Italian version of the Conceptions of Learning and Teaching questionnaire. BPA Applied Psychology Bulletin , 82 (300), 64–76. https://doi.org/10.26387/bpa.2024.00008 Sarela, S., Asim, N., Atapaka, S., Sheriff, V., & Barzyk-Sheriff, G. (2025). Understanding Barriers and Motivations: Enhancing Support for UK Medical Students’ Participation in Foreign Medical Electives. Advances in Medical Education and Practice , Volume 16 , 637–649. https://doi.org/10.2147/AMEP.S499581 Schwartz, S. H. (1992). Universals in the Content and Structure of Values: Theoretical Advances and Empirical Tests in 20 Countries. In Advances in Experimental Social Psychology (Vol. 25, pp. 1–65). Elsevier. https://doi.org/10.1016/S0065-2601(08)60281-6 Schwartz, S. H., Melech, G., Lehmann, A., Burgess, S., Harris, M., & Owens, V. (2001). Extending the Cross-Cultural Validity of the Theory of Basic Human Values with a Different Method of Measurement. Journal of Cross-Cultural Psychology , 32 (5), 519–542. https://doi.org/10.1177/0022022101032005001 Sonmez, B., Azizoglu, F., Enviromental Management Unit, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey, Hapcioglu, S. B., Department of Public Health, Istanbul Yeni Yuzyil University Faculty of Medicine, Istanbul, Turkey, Yildirim, A., & Department of Nursing Management, Istanbul University-Cerrahpasa Florence Nightingale Faculty of Nursing, Istanbul, Turkey. (2019). The Correlations Between Nursing and Medical Students’ Values and Social Innovation Tendencies. Florence Nightingale Hemşirelik Dergisi . https://doi.org/10.26650/FNJN363993 Vecchione, M., & Alessandri, G. (2017). Un contributo alla validazione italiana del Portrait Values Questionnaire-Revised (PVQ-R). Giornale italiano di psicologia , 1 , 159–180. https://doi.org/10.1421/86906 Wang, F., King, R. B., & Zeng, L. M. (2024). Supporting students’ basic needs is associated with better socio-emotional skills across cultures: A self-determination theory perspective. Learning and Individual Differences , 116 , 102535. https://doi.org/10.1016/j.lindif.2024.102535 Winkel, C., Strachan, L., & Aamir, S. (2022). From east to west and back again: The effects of reverse culture shock on female Saudi Arabian university students studying abroad. Journal for Multicultural Education , 16 (2), 108–120. https://doi.org/10.1108/JME-06-2021-0069 Wu, A., Choi, E., Diderich, M., Shamim, A., Rahhal, Z., Mitchell, M., Leask, B., & DeWit, H. (2022). Internationalization of Medical Education—Motivations and Formats of Current Practices. Medical Science Educator , 32 (3), 733–745. https://doi.org/10.1007/s40670-022-01553-6 Yasin, Y. M., Alomari, A., MacNevin, S., Kmainasi, B., Abdulla, M., & Hassanin, S. (2024). From decision to destination: Factors influencing healthcare students’ career paths in Qatar. BMC Medical Education , 24 (1), 1522. https://doi.org/10.1186/s12909-024-06527-3 Yue, Y., & Lu, J. (2022). International Students’ Motivation to Study Abroad: An Empirical Study Based on Expectancy-Value Theory and Self-Determination Theory. Frontiers in Psychology , 13 , 841122. https://doi.org/10.3389/fpsyg.2022.841122 Zhang, Y. S. D., & Noels, K. A. (2024). Understanding the interrelations between cultural empathy, intercultural communication competence, and the psychosocial adjustment of international students in Canada: A longitudinal examination. International Journal of Intercultural Relations , 102 , 102023. https://doi.org/10.1016/j.ijintrel.2024.102023 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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International educational experiences (IEEs) \u0026ndash; including clinical clerkships, research fellowships, and public health initiatives abroad \u0026ndash; have been consistently linked to a range of benefits for medical students, such as enhanced intercultural competence, improved clinical reasoning, a stronger professional identity, and increased commitment to global health equity (Hsu \u0026amp; Sung, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Li et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2023\u003c/span\u003e, p. 79; Meaux et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). However, these experiences vary in destination, ranging from low- and middle-income countries (LMICs), often characterized by limited resources and cultural distance, to high-income countries (HICs), which have better-resourced systems and more familiar environments.\u003c/p\u003e\u003cp\u003eYet, despite the increasing availability and institutional support for IEEs, little is known about the individual psychological characteristics that influence students\u0026rsquo; decisions to engage in them.\u003c/p\u003e\u003cp\u003eWhile logistical and structural barriers have been explored, few studies have systematically investigated the role of stable psychological dispositions assessed early in training as predictors of IEE participation (Sarela et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). This gap in knowledge hinders our ability to effectively support and guide students in accessing these valuable opportunities. To address this gap, the present study adopts Self-Determination Theory (Deci \u0026amp; Ryan, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1985\u003c/span\u003e) as its guiding framework. SDT posits that optimal motivation and engagement arise from the fulfillment of three basic psychological needs: autonomy (acting in accordance with one\u0026rsquo;s values), relatedness (feeling connected to others), and competence (feeling effective and capable). When these needs are satisfied, individuals are more likely to engage in personally meaningful and intrinsically motivated activities (Chirkov et al., \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Yue \u0026amp; Lu, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWithin this framework, several stable individual characteristics may serve as internal resources facilitating participation in IEEs. First, personal values \u0026ndash; broad, enduring principles that guide behavior (Schwartz, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e1992\u003c/span\u003e) \u0026ndash; are central in shaping goals and decision-making. Values oriented toward self-transcendence (e.g., universalism, benevolence) and openness to change (e.g., self-direction, stimulation) may promote autonomy by fostering curiosity, exploration, and moral engagement with global health issues (Alalawi et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Fiske, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Sonmez et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Second, empathy \u0026ndash; the capacity to affectively and cognitively relate to others\u0026rsquo; experiences (Davis, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1983\u003c/span\u003e) \u0026ndash; is closely tied to relatedness. Higher intercultural empathy has been linked to greater motivation for global engagement and humanitarian involvement (Assing Hvidt et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Piumatti et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Third, dispositional mindfulness \u0026ndash; the ability to attend to present-moment experiences with openness and nonjudgment (Baer et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2006\u003c/span\u003e) \u0026ndash; along with effective emotion regulation (Gross, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), may support perceived competence by enhancing resilience and adaptability in unfamiliar environments (Butkovic et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eBuilding on these premises, the primary aim of the present study is to investigate whether personal values, empathy, dispositional mindfulness, and emotion regulation assessed at the beginning of medical school predict participation in IEEs during training. A secondary aim is to explore whether these dispositions are associated with the type of destination chosen (LMIC \u003cem\u003eversus\u003c/em\u003e HIC). Based on SDT and previous research, we hypothesize that:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003estudents endorsing values of self-transcendence and openness to change will be more likely to participate in IEEs than those oriented toward conservation and self-enhancement;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ehigher levels of both affective and cognitive empathy will be associated with IEE participation;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003egreater dispositional mindfulness and more adaptive emotion regulation will be positively related to participation;\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003estudents with stronger self-transcendence values, affective empathy, and emotion regulation may be more likely to choose LMIC destinations.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eProcedure\u003c/h2\u003e\u003cp\u003eThis retrospective longitudinal study involved six consecutive cohorts of medical students from a university in Northern Italy. Students completed a paper-and-pencil baseline assessment comprising validated self-report measures at the beginning of their first academic year. Participation in IEEs was assessed retrospectively using institutional records after completion of the six-year medical program. Destination countries were classified as LMICs or HICs based on World Bank criteria (2024). This retrospective design investigated of whether early psychological dispositions predicted later IEE participation and destination type. The study was approved by the local Ethics Committee (Protocol No. 707, 0066628/22) and conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMaterials\u003c/h3\u003e\n\u003cp\u003ePersonal values were assessed using the Italian validated version of the Portrait Values Questionnaire (PVQ) (Schwartz et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Vecchione \u0026amp; Alessandri, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) which evaluates individuals\u0026rsquo; endorsement of ten distinct value types, which are organized along four higher-order dimensions: self-transcendence (Benevolence, Universalism), self-enhancement (Power, Achievement), openness to change (Hedonism, Self-direction, Stimulation), and conservation (Conformity, Tradition, Security). Participants rate the extent to which each value-guiding description resembled themselves on a 6-point Likert scale, from 1 (\u0026ldquo;Not like me at all\u0026rdquo;) to 6 (\u0026ldquo;Very much like me\u0026rdquo;). Higher mean scores reflect stronger endorsement of the corresponding value dimension. In this study, the PVQ has demonstrated high internal consistency, with Cronbach\u0026rsquo;s alpha coefficients ranging from .65 to .80.\u003c/p\u003e\u003cp\u003eEmpathy was measured with the Italian validated version of the Interpersonal Reactivity Index (IRI) (Albiero et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Davis, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1983\u003c/span\u003e). The IRI assesses four subscales: assessing both affective (Empathic concern, Personal distress) and cognitive (Perspective taking, Fantasy) components of empathic functioning. Items are rated on a 5-point Likert scale ranging from 0 (\u0026ldquo;Does not describe me well\u0026rdquo;) to 4 (\u0026ldquo;Describes me very well\u0026rdquo;). Higher scores indicate greater levels of empathy across its four dimensions. Cronbach\u0026rsquo;s alpha coefficients ranged from .71 to .81.\u003c/p\u003e\u003cp\u003eDispositional mindfulness was assessed with the Italian validated version of the Five Facet Mindfulness Questionnaire (FFMQ) (Baer et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2006\u003c/span\u003e; Giovannini et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2014\u003c/span\u003e). The FFMQ, includes five subscales: Observing, Describing, Acting with awareness, Nonjudging of inner experience, and Nonreactivity to inner experience. Items are rated on a 5-point Likert scale ranging from 1 (\u0026ldquo;Never or very rarely true\u0026rdquo;) to 5 (\u0026ldquo;Very often or always true\u0026rdquo;). Higher scores indicate greater levels of dispositional mindfulness across its five dimensions. In this study, the FFMQ has demonstrated good internal consistency, with Cronbach\u0026rsquo;s alpha coefficients ranging from .74 to .86.\u003c/p\u003e\u003cp\u003eDifficulties in emotion regulation were assessed using the Italian validated version of the Difficulties in Emotion Regulation Scale (DERS) (Giromini et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Gratz \u0026amp; Roemer, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). The DERS includes six subscales: Nonacceptance of emotional responses, Difficulties engaging in goal-directed behavior, Limited access to emotion regulation strategies, Impulse control difficulties, Lack of emotional clarity, and Lack of emotional awareness. Participants rate items on a 5-point Likert scale from 1 (\u0026ldquo;Almost never\u0026rdquo;) to 5 (\u0026ldquo;Almost always\u0026rdquo;). Higher scores indicate greater levels of emotion dysregulation across the six dimensions. In this study, the DERS has demonstrated high internal consistency, with Cronbach\u0026rsquo;s alpha coefficients ranging from .74 to .88.\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eDescriptive statistics were computed for all demographic variables and psychological variables. Chi-square tests examined differences in gender and household income across cohorts, IEE participants \u003cem\u003eversus\u003c/em\u003e non-participants, and LMICs \u003cem\u003eversus\u003c/em\u003e HICs subgroups. Group differences in psychological measures (PVQ, IRI, FFMQ, DERS) were analyzed using one-way ANOVAs and t-tests. A binary logistic regression was conducted to identify dispositional predictors of IEE participation. Only subscales that showed significant group differences in univariate differences were entered in the model. Model fit was evaluated using chi-square and Nagelkerke R\u0026sup2;; with classification accuracy and odds ratios (95% CI) reported.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 854 (response rate\u0026thinsp;=\u0026thinsp;93.64%) students from six consecutive cohorts participated in the study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age at entry was 19.93 years (SD\u0026thinsp;=\u0026thinsp;1.39). No significant differences were found in the distribution of gender across cohorts (χ\u0026sup2;(5)\u0026thinsp;=\u0026thinsp;3.015, p\u0026thinsp;=\u0026thinsp;.698), between students who participated in IEEs and those who did not (χ\u0026sup2;(1)\u0026thinsp;=\u0026thinsp;2.611, p\u0026thinsp;=\u0026thinsp;.106), or between students who studied abroad in LMICs versus HICs (χ\u0026sup2;(1)\u0026thinsp;=\u0026thinsp;.355, p\u0026thinsp;=\u0026thinsp;.551). Similarly, household income did not significantly differ across cohorts (χ\u0026sup2;(6)\u0026thinsp;=\u0026thinsp;8.248, p\u0026thinsp;=\u0026thinsp;.220), between IEE participants and non-participants (χ\u0026sup2;(3)\u0026thinsp;=\u0026thinsp;2.647, p\u0026thinsp;=\u0026thinsp;.449), or between LMIC and HIC subgroups (χ\u0026sup2;(1)\u0026thinsp;=\u0026thinsp;.222, p\u0026thinsp;=\u0026thinsp;.895). No significant differences emerged in mean scores on psychological measures across cohorts (p\u0026thinsp;\u0026gt;\u0026thinsp;.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSocio-demographic characteristics and international study experience\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e%\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBiological sex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e441\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e413\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAcademic year\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2010/2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e130\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2011/2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2012/2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e141\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2013/2014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2014/2015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2015/2016\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHousehold income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInsufficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSufficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e297\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMore than sufficient\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e466\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e54.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExcellent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIEE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e609\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e71.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e245\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e28.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDestination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLMIC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHIC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e82.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003eNotes. LMIC \u003cem\u003eLow- and middle-income country\u003c/em\u003e, HIC \u003cem\u003eHigh-income country\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCompared to peers who remained in their home country, students who later participated in an IEE showed significantly higher scores on the Universalism, Hedonism, and Stimulation subscales of the PVQ and significantly lower scores on the Tradition scale. They also reported greater Empathic Concern, lower mindfulness (specifically Acting with awareness and Nonreactivity to inner experience), and more pronounced difficulties in emotion regulation \u0026ndash; particularly with goal-directed behavior, impulse control, and emotional acceptance and awareness. Overall, the effect sizes of group differences were generally small, with the largest observed for difficulties in goal-directed behavior (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). No statistically significant differences in psychological traits were observed between students who studied in LMICs and those who studied in HICs (p\u0026thinsp;\u0026gt;\u0026thinsp;.05).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDifferences between students who studied abroad and those who did not\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eTotal sample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eNo study abroad\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eStudy abroad\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003et(853)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eCohen\u0026rsquo;s d\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eM\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePVQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBenevolence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.939\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.348\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversalism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.014\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.285\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePower\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.870\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.385\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAchievement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.477\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHedonism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.232\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSelf-direction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.726\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStimulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.95\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.712\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.301\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConformity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.258\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" 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colname=\"c3\"\u003e\u003cp\u003e4.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19.14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.368\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.018\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.194\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonal distress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.61\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e9.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.956\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.340\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerspective taking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.893\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFantasy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e17.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.89\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.253\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFFMQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eObserving\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e25.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.294\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDescribing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27.64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.595\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActing with awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e29.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.888\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.259\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNonjudging of inner experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e27.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e5.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.877\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNonreactivity to inner experience\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e19.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.031\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.196\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDERS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNonacceptance of emotional responses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4.73\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.248\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDifficulties engaging in goal-directed behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.94\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-3.803\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.408\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLimited access to emotion regulation strategies\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e6.19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-1.743\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.082\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImpulse control difficulties\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.78\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e11.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.692\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.004\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.292\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of emotional clarity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10.57\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10.85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.01\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.440\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of emotional awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e3.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-2.246\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.248\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe logistic regression model was statistically significant (χ\u0026sup2;(11, N\u0026thinsp;=\u0026thinsp;854)\u0026thinsp;=\u0026thinsp;40.608, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), accounting for 14.5% of the variance in IEE participation (Nagelkerke R\u0026sup2; = .145), and correctly classified 74.2% of cases. Participation in IEEs was significantly predicted by higher Universalism and greater Difficulties engaging in goal-directed behavior scores, while higher Tradition scores decreased the likelihood of participation. Specifically, each one-point increase on Universalism and Difficulties engaging in goal-directed behavior scales was associated with a 62.2% and 10.7% increase in the odds of IEE participation, respectively. Conversely, higher scores on the Tradition scale were associated with a 29.5% decrease in the odds of participating in an international experience (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBinary logistic regression predicting participation in IEEs (N\u0026thinsp;=\u0026thinsp;854)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSE B\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eWald χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eOR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95% CI OR\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePVQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversalism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.484\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.210\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.303\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.622\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.075\u0026ndash;2.448\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHedonism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.095\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.134\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.502\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.478\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e.845-1.431\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStimulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.208\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.811\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e.909-1.669\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTradition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.350\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.705\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e.522-.953\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIRI\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEmpathic Concern\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.038\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.083\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.773\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e.939-1.088\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFFMQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActing with awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.019\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.026\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.508\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.476\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.981\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e.932-1.033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNon-reactivity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.030\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.417\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.954\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e.899-1.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDERS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNonacceptance of emotional responses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.667\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.414\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e.968-1.082\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDifficulties engaging in goal-directed behavior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.102\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.039\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.976\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e1.027\u0026ndash;1.194\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImpulse control difficulties\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.040\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.548\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.459\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.971\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e.898\u0026thinsp;\u0026minus;\u0026thinsp;1.050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLack of emotional awareness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.988\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e.320\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e.965\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e.901-1.035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study offers novel insights into the psychological dispositions associated with medical students\u0026rsquo; decisions to engage in IEEs, contributing to the expanding literature on student mobility in medical education. By examining early dispositional factors, this research highlights the role of personal values, affective empathy, and emotion regulation in shaping participation in IEEs. These traits were already evident at medical school entry and may influence students\u0026rsquo; long-term engagement with global learning opportunities. The findings suggest that such individual characteristics, rather than only contextual or structural factors, may influence international mobility decisions well before formal opportunities are available. Three key predictors of engagement in IEEs were identified: higher Universalism and greater Difficulties in goal-directed behavior were associated with increased odds of IEE participation, while higher Tradition scores predicted a lower likelihood of studying abroad. These results underscore the relevance of personal values and emotion regulation skills in shaping students\u0026rsquo; mobility trajectories.\u003c/p\u003e\u003cp\u003eIn terms of personal values, students who participated in IEEs reported higher baseline levels of Universalism, Hedonism, and Stimulation, and lower levels of Tradition. These values reflect greater orientation toward global concern and personal fulfillment, and a preference for novelty and personal growth. Conversely, higher Tradition may indicate a stronger adherence to cultural or familiar norms which could act as psychological barriers to mobility. These patterns are consistent with prior research indicating that students motivated by openness, prosocial values, and exploration are more likely to engage in IEEs (Butkovic et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), while those with stronger attachment to tradition may experience greater hesitation (Winkel et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Among the most salient motivations for undertaking an IEE are the pursuit of personal growth, a strong interest in cross-cultural engagement, the search for greater independence, and the desire to step away from the familiar home environment.\u003c/p\u003e\u003cp\u003eAs for empathy, students who studied abroad reported greater Empathic Concern at medical school entry, indicating a tendency toward compassion and prosocial orientation. This supports the hypothesis that empathy, especially in its affective dimension, may foster interest in intercultural engagement and humanitarian involvement. This finding aligns with existing evidence. Empathy has been widely linked to global health engagement, with empathetic students more likely to participate in IEEs and demonstrate a sustained commitment to humanitarian work (Assing Hvidt et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Empathy may also facilitate adjustment to culturally diverse environments by fostering intercultural competence and the ability to build meaningful relationships during international placements (Zhang \u0026amp; Noels, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Furthermore, recent evidence (Bani et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) found that Empathic concern was directly associated with students\u0026rsquo; interest in IEEs in HICs, whereas its influence on the choice of LMICs was mediated by motivations related to cross-cultural engagement and personal growth. Given the increasing emphasis on global health in medical education, these findings underscore the importance of cultivating empathy throughout training (Ardenghi et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2020\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ardenghi, Rampoldi, et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Ardenghi, Russo, et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Barbaranelli et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Donisi et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Parallel efforts are needed to validate multidimensional measures of empathy (Ardenghi et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Piumatti et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Rampoldi et al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and to track its longitudinal development (Ardenghi et al., 2024a, 2024b), in order to better understand how empathy evolves and shapes students\u0026rsquo; international engagement over time.\u003c/p\u003e\u003cp\u003eRegarding dispositional mindfulness and emotion regulation, students who later studied abroad exhibited lower present-moment awareness, reduced emotional detachment, and greater difficulties in accepting emotions, maintaining focus under stress, and regulating impulses. While this might seem counterintuitive, this pattern may reflect a coping-oriented motivation, whereby students pursue IEEs not solely for academic or cultural enrichment but also as a means of escape internal stress or personal renewal. Supporting this interpretation, previous studies have linked sensation-seeking traits to a preference for immediate experiential rewards over long-term planning (Nadeem et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Aresi and colleagues (Aresi et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) found that students studying abroad reported increased alcohol use and related consequences, associated with reduced impulse control and heightened sensation seeking. More recently, Hishida et al. (Hishida et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) identified psychological distress as a \u0026ldquo;push\u0026rdquo; factor for studying abroad, with students describing IEEs as opportunities for emotional reset or personal transformation. Within this framework, emotion regulation difficulties may not merely reflect impulsivity or avoidant coping, but rather a self-directed attempt to confront personal and emotional challenges within a novel and potentially transformative context. Future research should further examine this dual function of IEEs \u0026ndash; academic and intrapersonal \u0026ndash; through longitudinal and mixed-method designs that capture the evolution of students\u0026rsquo; motivational and emotional trajectories over time.\u003c/p\u003e\u003cp\u003eNotably, no significant differences in psychological dispositions emerged between students who studied in LMICs and those in HICs. This suggests that while traits such as personal values, empathy, mindfulness, and emotion regulation may influence the general decision to study abroad, destination choice is more likely driven by external factors, such as perceived safety, language proficiency, academic opportunities, or institutional networks (Abbas et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Ovchinnikova et al., \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). This finding challenges assumptions that altruistic, empathic or emotionally resilient students are more inclined to choose resource-limited settings such as LMICs (Hsu \u0026amp; Sung, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), and instead points to the complex interplay between individual motivation, practical constraints, and contextual factors (Yasin et al., \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Future studies employing qualitative or mixed-method approaches could help disentangle these decision-making processes and illuminate the interplay between dispositional traits, motivations, and contextual constraints.\u003c/p\u003e\u003cp\u003eThe present findings can be meaningfully interpreted within the framework of SDT (Deci \u0026amp; Ryan, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e1985\u003c/span\u003e). Values such as Universalism and Stimulation and Empathic concern may support the satisfaction of SDT\u0026rsquo;s basic psychological needs. Recent research indicates that fostering autonomy, competence, and relatedness is critical for student well-being and engagement, particularly in international learning contexts (Wang et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Specifically, values related to self-transcendence and openness to change may enhance a sense of autonomy, motivating students to explore unfamiliar environments and contribute to global health (Yue \u0026amp; Lu, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Higher Empathic concern may promote relatedness, reinforcing the desire to connect meaningfully with others across cultures (Piumatti et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Although difficulties in goal-directed behavior may appear inconsistent with the SDT dimension of competence, they may reflect a self-direct effort to restore emotional balance and control or pursue meaningful change through novel experiences (Champ et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Hishida et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Kritikou \u0026amp; Giovazolias, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Overall, these findings suggest that students\u0026rsquo; international mobility decisions may reflect more than pragmatic or career-driven motives; they may also express deeper motivational needs aligned with SDT\u0026rsquo;s framework, such as the pursuit of autonomy, the desire to develop competence through new academic and cultural challenges, and the need for relatedness by forming meaningful connections in diverse social contexts. Understanding these internal drivers may help educators design more supportive and psychologically attuned mobility programs.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eThis study has several strengths. Its retrospective design \u0026ndash; assessing psychological dispositions at medical school entry and tracking IEEs participation over six years \u0026ndash; allows for stronger inferences than cross-sectional studies. The use of SDT as a guiding framework provides a coherent theoretical lens linking psychological traits to motivation and international engagement. Despite being conducted at a single institution in Northern Italy, the large sample size and the inclusion of six consecutive cohorts enhance the generalizability of findings within European context. The use of validated, psychometric sound instruments further supports the methodological rigor of the study. However, some limitations should be noted. The study does not account for potential intervening factors (e.g., academic performance, clinical exposure, peer influence) that may have affected mobility decisions over time. As with all self-report measures, as the risk of social desirability bias and limited introspective accuracy is present. Moreover, some of the psychological variables assessed at medical school entry \u0026ndash; particularly empathy and emotion regulation \u0026ndash; may not represent stable traits, as they are subject to meaningful change throughout the six-year training program (Bani et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Effect sizes were generally small, indicating that psychological traits explain only part of the variance in IEE participation. Lastly, destination classification solely based on World Bank income categories may oversimplify the diversity of cultural and educational contexts encountered abroad.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights that psychological traits such as self-transcendence values, empathic concern, and emotion regulation difficulties assessed at medical school entry are associated with greater likelihood of participating in IEEs. In contrast, stronger traditional values may discourage mobility. These traits, however, did not influence the type of destination, suggesting that practical or contextual factors play a more decisive role in that shaping students\u0026rsquo; choices of study location. These insights have practical implications. Early psychological profiling may help to identify students who are more likely to engage in international education as well as those who may be hesitant but could benefit from targeted support. Medical schools and international offices could use this information to develop tailored interventions, including mentoring, emotional preparation, and decision-making guidance. Such interventions may enhance participation and ensure students are both motivated and prepared to benefit from IEEs.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAUTHOR CONTRIBUTIONS: M.B., and S.A. developed the research aims and wrote, reviewed and edited the manuscript. S.A. contributed to data analysis and wrote the results section of the manuscript. S.R., F.Z., M.G.S. and P.I. contributed to study design and manuscript review and editing. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eACKNOWLEDGEMENTS: Thanks to Marco Parenti, Agnese Cofler, Federica Olivieri, and the staff of the Erasmus Office of University of Milano-Bicocca for their assistance in the completion of the selection of participants involved in international mobility experiences.\u003c/p\u003e\n\u003cp\u003eCONFLICT OF INTEREST STATEMENT: None.\u003c/p\u003e\n\u003cp\u003eDECLARATION OF GENERATIVE AI AND AI-ASSISTED TECHNOLOGIES IN THE WRITING PROCESS: During the preparation of this work the authors used Grammarly in order to improve readability. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.\u003c/p\u003e\n\u003cp\u003eDATA AVAILABILITY STATEMENT: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eETHICS STATEMENT: The study was approved by the Ethics Committee of University of Milano-Bicocca (Protocol No. 707, 0066628/22). All participants in this study gave informed consent to participate.\u003c/p\u003e\n\u003cp\u003eFOUNDING: None\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAbbas, J., Alturki, U., Habib, M., Aldraiweesh, A., \u0026amp; Al-Rahmi, W. M. (2021). 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Understanding Barriers and Motivations: Enhancing Support for UK Medical Students\u0026rsquo; Participation in Foreign Medical Electives. \u003cem\u003eAdvances in Medical Education and Practice\u003c/em\u003e, \u003cem\u003eVolume 16\u003c/em\u003e, 637\u0026ndash;649. https://doi.org/10.2147/AMEP.S499581\u003c/li\u003e\n \u003cli\u003eSchwartz, S. H. (1992). Universals in the Content and Structure of Values: Theoretical Advances and Empirical Tests in 20 Countries. In \u003cem\u003eAdvances in Experimental Social Psychology\u003c/em\u003e (Vol. 25, pp. 1\u0026ndash;65). Elsevier. https://doi.org/10.1016/S0065-2601(08)60281-6\u003c/li\u003e\n \u003cli\u003eSchwartz, S. H., Melech, G., Lehmann, A., Burgess, S., Harris, M., \u0026amp; Owens, V. (2001). 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From east to west and back again: The effects of reverse culture shock on female Saudi Arabian university students studying abroad. \u003cem\u003eJournal for Multicultural Education\u003c/em\u003e, \u003cem\u003e16\u003c/em\u003e(2), 108\u0026ndash;120. https://doi.org/10.1108/JME-06-2021-0069\u003c/li\u003e\n \u003cli\u003eWu, A., Choi, E., Diderich, M., Shamim, A., Rahhal, Z., Mitchell, M., Leask, B., \u0026amp; DeWit, H. (2022). Internationalization of Medical Education\u0026mdash;Motivations and Formats of Current Practices. \u003cem\u003eMedical Science Educator\u003c/em\u003e, \u003cem\u003e32\u003c/em\u003e(3), 733\u0026ndash;745. https://doi.org/10.1007/s40670-022-01553-6\u003c/li\u003e\n \u003cli\u003eYasin, Y. M., Alomari, A., MacNevin, S., Kmainasi, B., Abdulla, M., \u0026amp; Hassanin, S. (2024). From decision to destination: Factors influencing healthcare students\u0026rsquo; career paths in Qatar. \u003cem\u003eBMC Medical Education\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e(1), 1522. https://doi.org/10.1186/s12909-024-06527-3\u003c/li\u003e\n \u003cli\u003eYue, Y., \u0026amp; Lu, J. (2022). International Students\u0026rsquo; Motivation to Study Abroad: An Empirical Study Based on Expectancy-Value Theory and Self-Determination Theory. \u003cem\u003eFrontiers in Psychology\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 841122. https://doi.org/10.3389/fpsyg.2022.841122\u003c/li\u003e\n \u003cli\u003eZhang, Y. S. D., \u0026amp; Noels, K. A. (2024). Understanding the interrelations between cultural empathy, intercultural communication competence, and the psychosocial adjustment of international students in Canada: A longitudinal examination. \u003cem\u003eInternational Journal of Intercultural Relations\u003c/em\u003e, \u003cem\u003e102\u003c/em\u003e, 102023. https://doi.org/10.1016/j.ijintrel.2024.102023\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"medical students, international educational experiences, personal values, empathy, dispositional mindfulness, emotion regulation","lastPublishedDoi":"10.21203/rs.3.rs-7567379/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7567379/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe internationalization of medical education offers key opportunities for developing global health competencies. However, students\u0026rsquo; participation in international educational experiences (IEEs) varies considerably. This study investigated whether psychological factors assessed at the beginning of medical training \u0026ndash; specifically personal values, empathy, dispositional mindfulness, and emotion regulation \u0026ndash; predict subsequent IEE participation and destination type (low-/middle-income vs. high-income countries). A total of 854 medical students (51.6% female) from six consecutive cohorts at a university in Northern Italy completed baseline self-reported measures (Personal Values Questionnaire, Interpersonal Reactivity Index, Five Facet Mindfulness Questionnaire, and Difficulties in Emotion Regulation Scale) during their first academic semester. IEE participation and destination were retrieved from institutional records after program completion. T-tests and logistic regression analyses were conducted. Students who engaged in IEEs reported higher self-transcendence and openness to change values, lower Tradition, greater Empathic concern, lower mindfulness, and more difficulties in emotion regulation. Logistic regression showed that higher Universalism and greater difficulties in goal-directed behavior increased the likelihood of IEE participation, while higher Tradition scores reduced it. No significant differences in psychological traits were found between students choosing LMICs versus HICs. Psychological profiles assessed early in medical school predicted later engagement in IEEs. These findings support the utility of early psychological assessment to inform tailored support strategies and foster global engagement in medical education.\u003c/p\u003e","manuscriptTitle":"Psychological predictors of medical students’ participation in international educational experiences: A retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-24 11:37:02","doi":"10.21203/rs.3.rs-7567379/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd2bc8f6-e5dc-4385-b21c-732337d7b987","owner":[],"postedDate":"September 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-23T16:38:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-24 11:37:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7567379","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7567379","identity":"rs-7567379","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}