Across the UK, universities are scrambling to expand their transnational education (TNE) footprints. In the wake of declining international student enrolments at home and a domestic funding model under acute strain, offshore delivery has re-emerged as a strategic hedge.
New projects are announced almost weekly, typically centred on business, computing, and other classroom-based disciplines with low capital requirements and modest regulatory complexity. Much of this expansion is pragmatic, responsive, and seen as necessary by its proponents.
But the speed and shape of this growth obscures an uncomfortable truth: the UK has mainly defaulted to a narrow model of TNE, one optimised for rapid expansion rather than academic depth, high stakes provision or long-term national capacity building. As a result, the sector’s diversification strategies increasingly look alike – thinly spread, opportunistic, and largely confined to low-risk subject areas.
A recent visit to Bahrain has reminded me that international higher education can look very different. Just over an hour’s flight from London, the Royal College of Surgeons in Ireland (RCSI) has developed a form of TNE that stands in almost complete contrast to the dominant UK: high investment, clinically intensive, deeply embedded in national systems, and aligned to strategic workforce needs.
RCSI Bahrain opened in 2004 and is now a fully-fledged medical university with purpose-built clinical and educational facilities, deep partnerships across Bahrain’s health system, and a student and graduate community that plays a meaningful role in the country’s healthcare workforce. This is not a flying-faculty project, not a joint diploma model, and not an exercise in offshore classroom leasing. It is an institution.
A global footprint with real depth
What struck me is how long RCSI has been doing this, and how quietly. While most UK universities are only now building or acquiring capacity for offshore growth, RCSI has been operating overseas for nearly three decades. Its Malaysia campus, originally Penang Medical College, dates back to 1996. Postgraduate leadership and healthcare management education has been delivered in Dubai since 2005.
More recently, new activity has emerged in Saudi Arabia. These ventures are not opportunistic or defensive responses to market turbulence; they form part of a long-term strategy grounded in health-system needs and in a clear institutional mission.
Importantly, all of this activity sits within the high-stakes world of medical and clinical education, probably the most heavily regulated and risk-sensitive domain in the entire global HE landscape. Where many institutions are pursuing TNE in the subjects that are cheapest to deliver and fastest to scale, RCSI operates in the areas that are most demanding to deliver offshore. That difference matters.
An unexpectedly diverse and high-calibre student body
But the real revelation in Bahrain was the students. The academic calibre is extremely high, and the student body is more diverse than I had assumed. The majority come from Bahrain and the wider Gulf region, with many drawn by the RCSI brand, its teaching hospitals, and its international pathways. What surprised me is that almost 10% of the cohort is North American.
For students from the United States and Canada, choosing to study medicine in Bahrain is a bold step. Yet the rationale is compelling: a prestigious medical qualification that is portable, internationally recognised, and delivered to global standards but without the enormous financial and time of the traditional US route into medicine.
The real revelation in Bahrain was the students. The academic calibre is extremely high, and the student body is more diverse than I had assumed
In North America, students must complete a four-year bachelor’s degree before being eligible to enter medical school. This adds both significant direct cost and four additional years of living expenses and lost earning potential. Only then do they begin a four-year MD program, with total medical-school tuition routinely exceeding US $300,000 – and that’s before accommodation, insurance or clinical fees.
RCSI Bahrain, by contrast, follows the Irish and British model of direct entry from high school, enabling students to start medical training immediately and progress through a continuous five- or six-year program. This eliminates the cost of a prior undergraduate degree and reduces opportunity cost by allowing students to enter clinical practice years earlier.
The result is a stark difference in the total cost of becoming a doctor. RCSI Bahrain offers a rigorous medical program with strong clinical exposure, international accreditation pathways and a clear route back into North American licensing systems at a significantly lower overall cost. For many families, it represents a rational and high-value alternative to the US model, not a compromise.
The TNE contrast: scale vs substance
Set against this, the current UK TNE boom looks very different. Offshore campuses and partnerships are proliferating rapidly, but they overwhelmingly target business and management programs – disciplines with low regulatory barriers, minimal specialised infrastructure needs, and high domestic and international demand.
There is nothing inherently wrong with this; diversification is essential, and partnering overseas can strengthen institutional resilience and relevance. But it does highlight a structural truth: most TNE models are designed for scale, not depth. They minimise risk by limiting investment, and they expand access by lowering the cost base.
By contrast, RCSI Bahrain shows what international engagement can look like when it is mission-driven, academically demanding, and built over decades. It demonstrates that global footprints do not need to be thin, transactional, or opportunistic. They can be embedded, trusted, and strategically aligned with national health-workforce needs.
A reminder for the sector
RCSI Bahrain is not a model that every university can or should replicate. Offshore medical education requires capital, regulatory alignment, institutional patience and mission clarity. But it is a powerful counterexample at a moment when the UK is thinking urgently, and sometimes narrowly, about what TNE is for.
The sector conversation about TNE often focuses on volume, compliance, and partnership mechanics
If our offshore activity is driven primarily by income diversification and speed to market, we risk building global footprints that are wide but shallow. The sector conversation about TNE often focuses on volume, compliance, and partnership mechanics. What is missing is a discussion about purpose, discipline mix, national contribution, and the kinds of international engagement that strengthen institutional identity rather than dilute it.
RCSI Bahrain shows that TNE can be academically demanding, strategically aligned and socially impactful. It demonstrates that an overseas campus can contribute to national capacity building, not just institutional revenue; that clinical programs can be delivered to global standards offshore; and that international students, including those from North America, will travel for quality and value.
As the UK sector rethinks its international strategies, we would do well to look beyond the models that are easiest to scale, and towards those, like RCSI’s, that are deepest, most durable, and most aligned to mission.
