Evaluation of an International Service-Learning/Clinical Education Experience Utilizing an Existing Conceptual Model

Abstract

BACKGROUND AND PURPOSECultural competence is defined as acceptance and respect for difference, continuing self-assessment regarding culture, vigilance towards the dynamics of ongoing expansion of cultural knowledge and resources, and adaptations to services.1*?13' As the United States (US) population diversifies,2 there is an increasing need for health care providers who can provide culturally competent care. The promotion of cultural competence in physical therapist (PT) curricula is integral in preparing physical therapists to provide care that reflects consideration of individual and cultural differences, as endorsed by the American Physical Therapy Association (APTA).3*?1' One way to facilitate cultural competence is the inclusion of experiential learning opportunities in physical therapist education curricula. An important form of experiential learning is service-learning, defined as a structured learning experience that provides community service with explicit learning objectives, preparation, and reflection.4*?274' Key components of service-learning include community collaboration and focused, meaningful reflection. Specifically, service-learning responds to community concerns and is developed, implemented, and evaluated in active collaboration with a community partner. Reflection allows for a more meaningful learning experience when it is carefully connected to content and theory acquired in didactic coursework.5Two specific types of experiential learning take place outside of the country where the physical therapist program is located: international service-learning (ISL) and international clinical education (ICE).6>/ The literature reports a number of positive outcomes from international learning experiences. These include a positive impact on cross-cultural competency, improved personal development of students, and increased global awareness.6,7 Cultural immersion experiences (where students live and work within communities in another country) appear to be particularly effective in increasing cultural competence in health profession students,8'18 including physical therapist students.16,19'22 Such improvements do not seem to require long periods of time spent in the different culture. Positive effects have been noted in experiences as short as 1 week.16Recognizing the value of international experiential learning experiences, a large percentage of physical therapist education programs have incorporated some type of international experience into their curricula.6,' This trend has resulted in the need to determine best practice.23 The inclusion of international opportunities comes with a responsibility to consider the effect of the experience on all stakeholders, including students, the university/program, and the host community.24,23 In addition to measuring outcomes, emphasis must be placed on ensuring ethical practice, minimizing potential risks, and ensuring the safety of participating students and faculty members.24'26The literature reveals several recommendations for effectively structuring international experiences. Lattanzi and Pechak24 propose a model that includes cultural competency training, community coordination and communication, and a comprehensive assessment program. Pechak and Cleaver25 suggest that institutions must critically examine their programs to ensure ethical and culturally appropriate practice, and emphasize the need to research best ISL practices. This would include the identification and analysis of common structures and processes.25 Similarly, Landry et al2 describe the importance of careful selection of students, the need to establish formal relationships with host institutions, and the need to develop specific ISL objectives. The authors also argue for the importance of risk management on the part of physical therapist education programs.24'26In an effort to encourage best practice, Pechak and Thompson23 developed a conceptual model that describes 5 phases necessary for an optimal ISL experience: development, design, implementation, evaluation, and enhancement. …