Perceptions, Challenges, and Improvement Strategies of the Personal Tutor System in Sino-Foreign Cooperative Undergraduate Clinical Medicine Education: A Mixed-Methods Study (Preprint)

BACKGROUND Sino-foreign cooperative medical education cultivates globally competent healthcare professionals. Students face language, teaching and cultural challenges, making a robust support system indispensable. The personal tutorial system (PTS), as its cornerstone, is critical, yet research on tutors’ perspectives remains limited in specialized programs. OBJECTIVE This study comprehensively evaluated the implementation, effectiveness, and challenges of the PTS from tutors' perspectives in a Sino-foreign cooperative undergraduate clinical medicine program, and proposed evidence-based improvement strategies. METHODS An embedded mixed-methods design was adopted, with a quantitative survey as the primary component and qualitative open-ended questions as supplementary data. Personal tutors (PTs) at Chongqing Medical University-University of Leicester Joint Institute were invited to complete an anonymous structured questionnaire. Quantitative data were analyzed using SPSS 26.0 (descriptive and inferential statistics), while qualitative data were subjected to inductive thematic analysis following Braun and Clarke's six-phase approach. Data integration was achieved through joint display narrative. RESULTS Thirty-two PTs participated, with a response rate >95%, including 18 females (56.25%) and 14 males (43.75%), all aged ≥30 years. Most held doctoral degrees (93.75%) and had clinical backgrounds (53.13%). 90% of PTs valued the role in medical education, but 43.75% identified time/distance constraints as the top challenge. Over 90% considered student interaction or positive student feedback the most satisfying aspect. While 78.13-87.5% of PTs recognized the importance of activities like group teaching and laboratory research, monthly implementation frequency was low (only 9.38-18.75%). 60% reported the role met their expectations, and over 80% believed it benefited students' non-academic development (e.g., cross-cultural adaptation, personal growth). Over 90% received minimal or no institutional feedback. CONCLUSIONS PTs in Sino-foreign cooperative medical programs demonstrate strong teaching enthusiasm but face structural barriers (time/distance constraints, inadequate institutional support) and role ambiguity. Targeted training, optimized workload allocation, and enhanced feedback mechanisms are necessary to improve the PTS's effectiveness, ultimately supporting the cultivation of internationally competent healthcare professionals---consistent with the study's core objectives and practical implications.