Hosting displaced medical students in times of crisis: a multi-national qualitative study adapting the Consolidated Framework for Implementation Research

Catastrophic geopolitical conflicts increasingly disrupt the continuity of medical education worldwide, placing immense pressure on clinical training pipelines and forced migration student groups. While short-term, reactive, remote learning models exist, there is a profound lack of evidence-based implementation templates for medical schools within stable host nations to systematically host and integrate displaced clinical student cohorts mid-stream. This study explores the multi-level barriers and facilitators to hosting displaced medical students across diverse international learning environments, seeking to establish a model of educational sanctuary while adapting implementation science theory in crisis contexts. Employing a qualitative multi-site case study design guided by a critical realist ontology, this study analysed 66 semi-structured interviews with displaced Gazan medical students, hosting lecturers, clinical coordinators, and support staff across six national contexts, comprising five physical clinical hosting nations (the United Kingdom, Malaysia, Pakistan, South Africa, and Turkey) and one dedicated remote learning contingency context (Egypt). Transcribed data were analysed using Reflexive Thematic Analysis and mapped onto the Consolidated Framework for Implementation Research (CFIR). The analysis revealed that while restrictive immigration policies, clinical placement caps, and severe cultural distance represent substantial barriers, key facilitators include assessment considerations, flexible placement models, sanctuary institutional cultures, peer networks, and decentralized administrative trust. Strategic administrative approaches, such as considering the classification of displaced students as extended clinical elective visitors rather than full-time matriculants where permitted by relevant immigration, accreditation, institutional, and professional regulations, were perceived by institutional leaders to facilitate accommodating displaced cohorts within legal governance frameworks. This study demonstrates that public sector higher education institutions can act as vital global sanctuary networks to preserve clinical training pipelines. Crucially, the findings propose three exploratory, context-specific adaptations to the 2022 CFIR meta-framework for acute crisis settings: Agile Implementation Over Perfection within the Implementation Process domain, Protective Leadership Shielding within the Inner Setting domain, and Bidirectional Boundary Subversion at the Inner/Outer Setting interface. These exploratory, context-specific observations offer preliminary insights for adapting CFIR construct interpretations from stable clinical settings to dynamic public sector responses during complex humanitarian emergencies.