Enhancements to an International Service-Learning Model: Integration of Program Alumni and Global Stakeholder Feedback

Abstract

BACKGROUND AND PURPOSEThe United States (US) continues to diversify with 37% of the population currently comprised of minority groups and with census projections for growth in minority residents to 57% by 2060.1 Increased diversity in the US population and the globalization of risks and requires alignment of our health professions education system with 21st century practice needs.2(pI926^ Educators of health care practitioner students, including those in nursing,3,4 occupational therapy,4'6 medicine,1,4,7 and physical therapy4,6,8'12 realize cultural competence and collaboration are essential 21st century skills required for providing quality patient care. Research supports the need for cultural competence in patient-provider interactions to prevent a compromise in care due to different ethnic or cultural (cross-cultural) backgrounds.2,7,13,14 Providers, including physical therapists (PT), without the aptitude for working in crosscultural situations may experience communication breakdown with either patients or family members, which could impede the management of the diseases or conditions characteristic of a population.14 Effective care incorporates the patients values, family structure, and culture.2,8,9,13One strategy for promoting cultural competence and for increasing a students global perspective is through study abroad (SA) experiences. The growing trend in SA is supported by statistics documenting a tripling of the number of US college students studying abroad since 1993, with campuses reporting over 273,000 participants in 2011.15 During 2011, 14,522 health professions students studied abroad, representing an increase in participation of 14% from 2010.15 Professional leaders in physical therapy support inclusion of global educational opportunities to facilitate cultural competence development in PT students.16 Essential documents such as the Professionalism in Physical Therapy Core Values17 contain culturally competent patient care outcomes. In addition, A Normative Model of Physical Therapist Professional Education delineates practice expectations targeting individual and cultural differences.18 For the purposes of this work, cultural competence is defined as acceptance and respect for difference, continuing self-assessment regarding culture, vigilance towards the dynamics of differences, ongoing expansion of cultural knowledge and resources, and adaptations to services.19*1113*PT educators have responded to the need for promoting cultural competence in students educated in the US.4'8'12,20'26 Two burgeoning approaches are either through international service-learning (ISL) or international clinical education (ICE) opportunities.11 Authors of a study conducted in 20 1 220 reported on the scope of international programs in physical therapy where, of 201 US schools (110 responded), 40.9% (45) offered ICE. In addition, 54% (21 of 39) of programs with ICE also provided additional short-term international exposure.Service-learning has been defined as an experiential learning pedagogy in which students participate in activities that incorporate response to community needs, collaboration, meaningful service, reflection, and institutional commitment.2729 ISL is a service opportunity that occur[s] outside of the country where a physical therapy educational program is located.1 **p73* Service-learning (SL), whether domestic or international, and ICE have benefits for physical therapy students, including increased cultural competence,4,12,21-22-24-25 appreciation of professionalism and the Core Values,12,21,24'30 and improved collaboration among peers.3,12'25 Contact with people from diverse cultures is an effective strategy for promoting cultural competence, as students are situated within authentic situations that foster selfawareness of personal beliefe and opportunities to administer patient care.8,22,31The physical therapy literature is replete with articles documenting the development and implementation of ISL programs. …