International Clinical Education Research Articles

The US Global Surgery Program Fair: Addressing the Demand

INTRODUCTION: Recent studies indicate that 71% of residency applicants would rank a residency program US Global Surgery Program Fair and evaluate the background of registrants and specifications of participating programs. METHODS: We structured a Global Surgery Program Fair to provide a platform for interaction between residency applicants and US-based global surgery programs. The Fair was held virtually and included an overview of the programs, followed by interactive question and answer sessions. Twenty-five programs were invited via email, and registration for attendees was promoted through social media. RESULTS: A total of 17 residency programs joined the Fair, with most programs offering a mix of international clinical rotations, education, and research opportunities in global surgery and only 1 offering an integrated global surgery residency program. Six programs offered funded positions, and 7 were cross-disciplinary. There were 128 registrants from 31 countries, with 55.5% from high-income countries (65 from the US), 9.2% from upper middle-income countries, and 35.2% from low- to middle-income countries. Most registrants were medical students (75%), followed by residents (13%) and medical graduates not currently in residency (6%). CONCLUSION: Trainees in both US- and internationally based programs are interested in academic opportunities in global surgery. The Fair allowed program applicants and program leaders to learn about available opportunities in global surgery across the US. The diverse and robust participation by programs and trainees demonstrates the need for academic program development in global surgery.

O72 - An International Delphi Study of Woman-centred Care

Woman-centred care is integral to the role of the midwife and to determining standards of practice. Few empirical studies have explored the meaning of woman-centred care, and its relationship to maternity services, how midwives perceive this concept and use it in practice, and this remains an identified gap in the evidence base. The aim of this study was to investigate the concept of woman-centred care in the context of international midwifery practice. A three round Delphi study with an international panel of expert midwives was used to gain an in-depth understanding and consensus of woman-centred care in the context of international midwifery clinical practice, maternity services, education, and research. A panel of 59 expert international midwives representing 22 countries participated in the Delphi study. A total of 59 statements about woman-centred care were developed using qualitative data obtained from the expert midwives and these statements categorised under four emergent themes. A total of 37 (63%) statements relating to woman-centred care reached the a priori consensus level of 75%. This presentation will report on those elements of woman-centred care that reached international consensus and highlight those that did not. Drawing on an international expert midwifery panel, this is the first study to investigate the concept of woman-centred care as it is experienced globally by midwives in clinical practice, maternity services, education, and research. The findings of this study will be used to contribute to the development of an internationally informed evidence-based definition of woman-centred care.

Impact of Lifestyle Modification on Quality of Life in Patients with Metabolic Syndrome: Findings from the CHANGE Program Intervention Study in Prince Edward Island, Canada.

Purpose: To assess the modification in quality of life (QoL) of patients with metabolic syndrome (MetS) after participating in Canadian Health Advanced by Nutrition and Graded Exercise (CHANGE) program and identify predictors of this modification in QoL among participants. Methods: A convenience sample of 100 patients with MetS completed the 12-month CHANGE program (diet and exercise regular counseling). 36-Item Short Form Health Survey (SF-36), International Physical Activity Questionnaire (IPAC), Physician Assessment and Clinical Education (PACE), and the Mediterranean Diet Score (MDS) questionnaires were employed to assess participants' QoL, physical activity (PA), sedentary behaviors, and quality of diet, respectively. In addition, physical fitness tests (6-Minute Walk Test, One-Leg Stance Test, and Grip Strength Test) were used. Medical history, blood tests, and anthropometric [height, weight, and waist circumference (WC)] and blood pressure measurements were performed by a nurse. Linear regression analysis was performed to identify predictors of QoL. Results: Participants' mean age was 58.3 ± 11.0, and 75.4% were females. After the CHANGE program, participants demonstrated significant reduction in the number of MetS criteria and significant improvement of physical and mental components of QoL. Moreover, there was significant increase in participants' PA, MDS, and physical fitness mean scores with corresponding significant reduction in sedentary behavior time, blood pressure, and WC measures. Linear regression analysis revealed that age, WC, screen time, PA, and physical fitness were significant predictors of QoL. Conclusion: The 12-month group-based diet and exercise counseling led to clinically significant improvement in MetS criteria and in important measures of health and fitness among participants, which improved their QoL. Age, fitness measures, and daily screen time were associated with QoL.

Case Series Comparing Physical Therapy International Clinical Education Experiences in a Developed and Developing Country and Measuring Against Professional Standards and Guidelines

Background. With a growing vision for globalization and internationalization in higher education, a number of Commission on the Accreditation of Physical Therapy Education (CAPTE)–accredited physical therapist education programs across the United States have begun to routinely place their students at international sites for one of their full-time clinical education experiences in both developed and developing countries. The purpose of this article is to compare and contrast the physical therapy international clinical education experience in both the developed and developing country and compare the experiences to professional standards and guidelines. Case Description. This case series describes the experience of 9 physical therapy students in an 8- to 10-week, full-time, international, clinical education experience. Four were placed in the developed country of Italy, and 5 were placed in the developing country of Belize. All students participated in preclinical preparation and experienced cultural immersion for the 8–10 weeks that they participated in the full-time clinical education experience. Outcomes. Evaluative materials consisted of a student weekly questionnaire, an electronic student journal, a Clinical Site Evaluation Form, and comments/ratings from the student's self-assessment on the American Physical Therapy Association's Clinical Performance Instrument. Analysis of the data demonstrated that the participants were experiencing a depth and breadth of clinical experiences commensurate with CAPTE criteria in both the developed and developing settings. Both settings afforded learning experiences in cross-cultural communication and cultural considerations with the developing country posing more cross-cultural practice challenges than the developed country. Discussion and Conclusions. Comparison of the data with a proposed model and guidelines for optimizing international clinical education experiences demonstrated alignment in both the developed and developing country experiences. Both international clinical education experiences met CAPTE standards and other professional standards and proved to be a broadening experience for the participants.

Fostering Future Lawyers in an Era of Globalization: Integrating Dispute Resolution Into Overseas Clinical Legal Education Externships

Twenty first century law students and graduates are increasingly being exposed to legal issues and disputes beyond their own domestic shores and across international jurisdictions. In order to equip students with the necessary knowledge, skills and values to seamlessly transition from law school into dispute resolution processes and legal practice set in the global context, there is a need to incorporate international clinical legal education experiences into the law school curriculum. This paper begins by reviewing the current place of dispute resolution in Australian and Chinese law school curricula and legal practice. The paper then reviews a pilot program conducted by the University of Newcastle Law School, Australia, where Newcastle students undertook a two-week clinical legal education externship in China with a focus on dispute resolution. This included both Australian and Chinese students participating in simulated negotiation and mediation exercises. The program concluded with students interviewing the key stakeholders in a dispute resolution regime based in an arbitration institute, where there were on-site ‘live client’ mediations and arbitrations. This experiential learning opportunity enabled students from both Australia and China to develop cross-cultural communication skills and sensitivities, and comparative knowledge in different legal systems. It also provided opportunities for students to reflect on ways in which the dispute resolution processes can be enhanced in Australia and China, together with a hands-on clinical experience for students at a time when law schools are seeking to further internationalize their teaching and learning. Students’ reflections on this aspect of the externship indicated a strong desire to see additional international dispute resolution learning opportunities set in a practical context.

Fostering Future Lawyers in an Era of Globalisation: Integrating Dispute Resolution into Overseas Clinical Legal Education Externships

Twenty first century law students and graduates are increasingly being exposed to legal issues and disputes beyond their own domestic shores and across international jurisdictions. In order to equip students with the necessary knowledge, skills and values to seamlessly transition from law school into dispute resolution processes and legal practice set in the global context, there is a need to incorporate international clinical legal education experiences into the law school curriculum. This paper begins by reviewing the current place of dispute resolution in Australian and Chinese law school curricula and legal practice. The paper then reviews a pilot program conducted by the University of Newcastle Law School, Australia, where Newcastle students undertook a two-week clinical legal education externship in China with a focus on dispute resolution. This included both Australian and Chinese students participating in simulated negotiation and mediation exercises. The program concluded with students interviewing the key stakeholders in a dispute resolution regime based in an arbitration institute, where there were on-site ‘live client’ mediations and arbitrations. This experiential learning opportunity enabled students from both Australia and China to develop cross-cultural communication skills and sensitivities, and comparative knowledge in different legal systems. It also provided opportunities for students to reflect on ways in which the dispute resolution processes can be enhanced in Australia and China, together with a hands-on clinical experience for students at a time when law schools are seeking to further internationalise their teaching and learning. Students’ reflections on this aspect of the externship indicated a strong desire to see additional international dispute resolution learning opportunities set in a practical context.

Development of an International Clinical Education Extracurricular Experience Through a Collaborative Partnership.

Participating in global health care through international clinical education may enhance the development of cultural competence and professionalism. Many logistical issues need to be resolved in the development of international clinical education experiences that meet program requirements. The purpose of this case report is to describe how a university developed such an experience for students by partnering with Amizade Global Service-Learning (Amizade), an organization that facilitates global learning experiences. Medical, nursing, and pharmacy students were already participating in a 4-week international health-related service learning rotation through Amizade. The preexisting relationship and contractual agreement with the university provided the necessary legal framework. Amizade staff assisted in finding a physical therapist qualified and willing to host a student. The academic coordinator for clinical education at the university and Amizade liaisons determined living arrangements, schedule, clinical settings, and patient population. The selected student had expressed interest and had met all clinical education placement requirements. The academic coordinator for clinical education had ongoing electronic communications with all parties. The student demonstrated predicted attributes of cultural competence and professionalism; through the partnership with Amizade, the student was exposed to several unique interprofessional experiences. The steps used by the university faculty in developing this interprofessional, international clinical education experience through a collaborative partnership may provide guidance for other institutions.

Targeting the globe: internationalisation in occupational therapy education

ABSTRACTThrough international placements, student occupational therapists (SOTs) provide direct services and consultation with communities, organisations and local governments. SOTs work with international partners to assess needs, develop new programs, and adopt new practices. SOTs support individuals and groups to build and sustain capacity in health, function and rehabilitation. However, more comprehensive preparation of SOTs for international involvement is required. The objectives of this paper are: (a) to develop recommendations for best practice for the educational preparation of globally bound SOTs; (b) to disseminate findings that reflect global and culturally sensitive perspectives; and (c) to provide recommendations that support engagement in international placement learning. The World Federation of Occupational Therapists (WFOT) assisted in connecting the investigators and participating countries. Data analyses outlined clear trends related to strengths and gaps in student preparation. Ongoing development of international clinical education resources and partnerships is needed to support dynamic and sustainable global learning in occupational therapy.

Development of international clinical education experiences for doctor of physical therapy students in the United States

Development of international clinical education experiences for doctor of physical therapy students in the United States

Benefits and barriers of physical therapy students participation in resource-poor international clinical education

survey consisted of 10 closed and 12 open questions and was addressed to the head of departments or head of units (PT,OT, SLT). A total number of 124 surveys were sent to members of all three professions. Quantities (closed questions) were calculated, open questions were analyzed on content. Results: Overall 64 (51%) surveys were returned and could be analyzed, 26 (41%) surveys were returned by physiotherapists. Only about 53% of institutions use the ICF as a leading idea for handling patients, barriers are seen in time and money constraints and lack of information. Specification of the ICF in the mono-professional context was slightly higher in PT (50%) than in OT (42%) and SLT (47%). ICF was applied in documentation in 46% for the PT, overall numbers were a bit lower (40%). 50% of physiotherapists are positive that implementing the ICF has changed their work, mainly in the goal-setting process (6/26) and also in more interdisciplinary treatment approaches (4/26). Conclusion(s): There is a great need within the professions to learn more about the ICF and its possible implementation in everyday practice. The results indicate that applying the ICF as an overall language among different health care professions helps to foster patient centered goals in a multi-professional context and to target treatment more on activity and participation. Further research is needed to investigate possible benefits for the patient and the health system in terms of patient satisfaction, goal attainment and cost effectiveness to promote the use of ICF specifically in a multi-professional context. Implications:Heads of institutions must support and promote applying the ICF, and allow for continuous professional development possibilities and time to work with this classification.

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

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. …

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

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. …

Analyzing international clinical education practices for Canadian rehabilitation students.

BackgroundClinical training in low-income countries has become increasingly popular among pre-licensure trainees from high-income countries. The Working Group on Ethics Guidelines for Global Health Training (“WEIGHT Guidelines”) were designed to identify and inform the complex and contentious field of international clinical education. The purpose of this study was to use the WEIGHT Guidelines to evaluate an international clinical internship programme for Master’s-level rehabilitation students at a Canadian university.MethodsIn-depth, semi-structured interviews were conducted with eight Canadian rehabilitation researchers, educations and/or clinicians responsible for administering international internships across three clinical training programmes. Interview questions were informed by the WEIGHT Guidelines. Directed content analysis was used to identify priorities for policy, practice and research.ResultsFive themes relating to strengthening international clinical education were identified: (1) from one-time internships to long-term partnerships, (2) starting a discussion about “costs”, (3) a more informed approach to student selection, (4) expanding and harmonizing pre-departure training across disciplines, and (5) investing in post-internship debriefing.ConclusionsInternational clinical education is fraught with ethical, pedagogical and logistical issues that require recognition and ongoing management. This is the first study to use the WEIGHT Guidelines as a qualitative research tool for assessing an existing global health education programme. Results highlight new priorities for action at the Canadian “sending institution”, including more explicit attention to the costs (broadly defined) borne by all parties. A crucial next step is deepened engagement with educational partners at the “receiving organizations” based in low-income countries to nurture dialogue regarding reciprocity, trust and sustainability of the partnership. Education research is also needed that evaluates models of pre-departure training and post-internship debriefing for trainees.

Proposed Guidelines for International Clinical Education in US-Based Physical Therapist Education Programs: Results of a Focus Group and Delphi Study

Physical therapist students are increasingly engaging in international clinical education (ICE). The growth of international engagement has been accompanied by appeals to ensure that these experiences are conducted in an ethical manner. Although detailed guidelines have been developed to guide global health training in general, they do not specifically address all aspects relevant to ICE in physical therapist education. The purpose of this study was to systematically develop recommendations for the implementation of ICE in physical therapist education to promote ethical practice. An initial virtual focus group of 5 physical therapist faculty with expertise in ICE provided input to review and revise global health training guidelines previously developed by non-physical therapists. The revised guidelines were distributed to a pool of 19 physical therapist faculty with ICE experience for additional review and revision through 3 online Delphi survey rounds. The participants accepted 31 of the original guidelines with or without revisions, rejected 2 guidelines, and developed 10 new guidelines or subguidelines. Most notably, they rejected a guideline related to students pursuing training outside of a structured program, stressing that ICE should never be done outside of a formal program. The primary limitation is that the study included only faculty from sending institutions and thus lacked the voices of the host institutions, students, partner organizations, or funders. This study systematically produced guidelines for ICE in physical therapist education using a range of ICE experts from sending institutions. The recommendations may be used by educators and other decision makers to optimally design new ICE opportunities or to improve existing ones. Additional validation should be done to ensure relevance for all stakeholders.

Exploring international clinical education in US-based programs: identifying common practices and modifying an existing conceptual model of international service-learning

Background: Increasingly physical therapist students complete part of their clinical training outside of their home country. This trend is understudied. The purposes of this study were to: (1) explore, in depth, various international clinical education (ICE) programs; and (2) determine whether the Conceptual Model of Optimal International Service-Learning (ISL) could be applied or adapted to represent ICE.Methods: Qualitative content analysis was used to analyze ICE programs and consider modification of an existing ISL conceptual model for ICE. Fifteen faculty in the United States currently involved in ICE were interviewed. The interview transcriptions were systematically analyzed by two researchers.Results: Three models of ICE practices emerged: (1) a traditional clinical education model where local clinical instructors (CIs) focus on the development of clinical skills; (2) a global health model where US-based CIs provide the supervision in the international setting, and learning outcomes emphasized global health and cultural competency; and (3) an ICE/ISL hybrid where US-based CIs supervise the students, and the foci includes community service. Additionally the data supported revising the ISL model’s essential core conditions, components and consequence for ICE.Conclusions: The ICE conceptual model may provide a useful framework for future ICE program development and research.

Benefits and Challenges of International Clinical Education from a US‐based Physiotherapist Faculty Perspective

The influence of internationalization on physiotherapist education in at least North American-based programmes has become more apparent. Faculty and students have been involved in various international activities. One category of activities includes international clinical education (ICE), where students earn clinical education credit for their learning activities at international sites. Although this educational strategy appears to be increasingly used in at least the United States and Canada, the related literature is limited in scope. The purpose of this portion of the present study was to investigate the benefits and challenges of ICE for US-based students, US-based physiotherapy programmes and international partners from the perspective of US-based faculty sending students for clinical education internationally. Content analysis was used for this qualitative study. Fifteen US-based faculty members who had experience in sending physiotherapist students for ICE were recruited. The primary researcher conducted semi-structured phone interviews, averaging approximately 60 minutes in length. The primary and secondary researchers completed data analysis using NVivo 8 software (QSR International Inc., Cambridge, MA). Benefits of ICE to the students included exposure to alternate health systems, broadening of student perspectives and clinical competence. Challenges consisted of funding and possible language barrier. Increased visibility, expanded global perspective and faculty collaborations were benefits to the programme. Ensuring a quality learning experience was the greatest programme challenge. Benefits to the international site included education and faculty collaborations/exchanges; challenges were language, student clinical preparation and unfamiliarity with the student evaluation tool. Because the sample was limited to 15 US-based faculty members, the results may not be relevant to all programmes inside or outside of the United States. Additionally, the study lacked perspectives from the students or international sites. The present study is an early step in the important examination of the impact of this emerging educational trend on physiotherapy education and practice.

Survey of International Clinical Education in Physical Therapist Education

Background and Purpose. International opportunities, including international clinical education (ICE), appear to be increasingly offered in education of physical therapist students. ICE encompasses experiences designed primarily for student learning at a site outside of country where physical therapist program is located. Little research exists regarding use of ICE in physical therapist education. The specific purposes of this study were to (1) explore potential program differences between those with and without ICE; (2) discover current use, locations, and durations of ICE opportunities; (3) gather general information about ICE models, including their development, implementation, and evaluation; and (4) examine faculty perceptions of barriers and benefits regarding ICE. Subjects. The participants were directors of clinical education/academic coordinators of clinical education (DCEs/ACCEs) from US-based physical therapist education programs (n = 110). Methods. Direct mailing and listserv postings were used to recruit participants who then completed an Internet-based survey. Results. Of 110 respondents, 40.9% reported that they offered ICE. Of those programs that did not offer ICE, 18.8% (12 out of 64) planned to develop such opportunities in subsequent 2 years. Most ICE programs were 6 to 8 weeks in length, and were located in high-, upper-, or middle-income countries. The majority of ICE opportunities were in outpatient and hospital settings, and most clinical instructors were non-US citizens whose education was commensurate with US-level training. Commonly perceived barriers to ICE included expense, lack of faculty time and knowledge, and difficulty with site coordination. Perceived benefits were positive impact on cross-cultural competency, student personal development, and global awareness. Discussion and Conclusion. This study was first to explore broad use of ICE in US-based physical therapist education programs. Further research and professional dialogue are warranted to explore its present use and perhaps shape future application of ICE. Key Words: International, Clinical education, Global health. BACKGROUND AND PURPOSE Many factors, including rapidly developing technology and greater ease of travel, have contributed to an increasingly connected world. In this changing environment, impact of internationalization is becoming more evident across higher education.1 Knight2 defines internationalization as the process of integrating an international, intercultural or global dimension into purpose, functions or delivery of post-secondary education.(P2) As a reflection of this integration, international opportunities appear to be more prevalent in curricula of many health care profession programs located inside and outside of United States, including medicine,3-9 nursing,1015 and physical therapist education.16-21 A wide range of models are described in this literature. While overlap occurs among them, they may be grouped into 3 broad categories: community service; (2) service and learning, often termed international service-learning (ISL); and (3) student learning. Various terms are found in literature to describe experiences developed primarily for student learning at international locations: study abroad, global or global health training/education/electives/experiences, and international or international health electives/ clinical placements/ clinical rotations/internships/clinical education.3-11,15,19 Global health education also may refer to coursework that addresses health care systems and/or common health problems in countries outside United States, but may or may not include an international experience for student.3 In discussion that follows, term international clinical education (ICE) will be used to encompass all activities focused on student learning at international sites. …

Clinician's Commentary

In this issue of Physiotherapy Canada, Crawford et al.1 provide an excellent overview of the growing phenomenon of international clinical education in physical therapy (PT) education programmes in Canada. The increased availability of international clinical internships (ICIs) reflects the “internationalization” of higher education in Canada and beyond,2–4 defined as “an institutional process that in some way internalizes the concept of openness to the world in all the activities and organizational aspects of the university and that may even launch an internal transformation to prepare the university to act more directly on the international or global scene.”2(p.2) This process affects all elements of a university's mission, including teaching and service.2 Demonstrating the effect of internationalization on teaching in PT education programmes, Crawford et al.1 reveal that approximately 4% of graduates from Canadian PT programmes from 1997 through 2007 participated in ICIs and that the number of destination countries multiplied threefold during this time.1 A 2006 study of international service-learning in PT education programmes in Canada and the United States supported the idea that internationalization may have influenced the element of service as well.5 Unlike a traditional clinical internship, service-learning includes an equal focus on community service and student learning.5,6 According to the results of the 2006 survey, 50% of Canadian faculty respondents (n=4) reported offering international service-learning in the previous 10 years, as compared to 28% (n=24) of US survey respondents. However, a significant limitation of the study was that no questions were asked specifically about international clinical education, which means that ICIs may have been included in the service-learning data. Canadian PT education programmes have included international opportunities—whether ICIs, international service-learning, or a combination thereof—in PT curricula in a greater proportion than US programmes. A 2009 survey that specifically investigated the use of international clinical education in US PT education programmes6 found that only 41% (n=46) of US programmes offered international clinical education opportunities to their students,6 as compared to 86% (n=12) of Canadian programmes, as reported by Crawford et al.1 Discussions among members of the Canadian Physiotherapy Association's International Health Division (IHD) and their US colleagues on the American Physical Therapy Association's Cross Cultural and International Special Interest Group (CCISIG) discussion list have revealed some apprehensions about the growth and quality of international service and/or learning opportunities in PT education. A collaborative commentary by IHD member Shaun Cleaver and me summarized many of the concerns shared by IHD and CCISIG members on the list about sending students to international sites, especially in developing countries where power imbalances may place disadvantaged populations at greater risk of unintended harm.7 Echoing views expressed in the medical education literature,8 we called for a critical examination of the complex ethical issues in global health initiatives in PT education. We proposed that PT educators need to (1) develop a broad and ongoing dialogue about ethics, (2) incorporate formal programme evaluation for the protection of students and of the international community partner and its clients, and (3) participate in research in order to guide best practices in international service and/or learning in PT education.7 Dialogue among many IHD and CCISIG members is ongoing on the CCISIG discussion list, but not all physical therapists involved in global health initiatives in PT education are members of this list. Similarly, although Crawford et al.1 and others9,10 have offered recent input on how the PT profession may expand its role and its positive impact in the global health arena, the body of literature is limited, and best practice guidelines have not yet been developed. The need for further in-depth inquiry into PT's role in global health is clear. Canadian programmes are arguably the North American leaders in incorporating ICIs into PT education curricula. No doubt Canadian faculty and researchers will play a key role in future research and the development of best practices. Discussing the internationalization of higher education in Canada, Lemasson stated that “Canadian universities, far from being passive institutions buffeted about in a world beyond their ken or control, have been, and will always strive to be, full players in a broad process to which no one can remain indifferent.”2(p.2) These words are equally true with respect to Canadian PT programmes and their involvement in global health initiatives, including ICIs.

Evaluating International Clinical Education Encounters in Lithuania

Since the fall of the Soviet Union in 1991, nurses from various countries have organized clinical education sessions in Lithuania to share expertise. Evaluation of these sessions has not been completed or disseminated. This study provides an evaluation of international continuing nursing education sessions in Lithuania. In the late 1990s, a group of nurses and health care professionals from a local college conducted educational symposia for Lithuanian nurses. Those who participated in at least one symposium were asked to complete questionnaires regarding the educational experience. A holistic framework was used to describe the experiences of U.S. and Lithuanian nurses. Descriptive statistics indicated the Lithuanian nurses confirmed or learned new information and adapted it to their practice. The educational material was less challenging in the larger town of Kaunas than in the smaller area of Vilkaviskis. Suggestions for improvement included teaching in smaller groups to encourage discussion and, for the U.S. nurses, acquiring more information about the Lithuanian culture before the teaching trip. The goals of the symposia, to share knowledge and establish lasting relationships with Lithuanian nurses, were met. In addition, participants provided important advice for future educational trips.

Perceived Impact on Physical Therapist Students of an International Pro Bono Clinical Education Experience in a Developing Country

Background and Purpose. Many physical therapists (PTs) will encounter patients from various cultures and backgrounds during their careers. A challenge to professional (entry-level) PT curricula is to prepare its graduates for practice in a rapidly changing society in a shrinking world. Nursing and medical curricula have investigated the benefits of international clinical education programs to their students. No research in this area was found in the physical therapy literature. The purpose of this study was to investigate the perceived impact of a 1-week physical therapy clinical education experience in Jamaica on the student participants. Subjects. The participants were 8 third-year students in the professional Doctor of Physical Therapy (DPT) degree program of Arcadia University's class of 2002. Methods. Individual responses to an e-mailed open-ended questionnaire served as the foundation for the focus group discussion in which all eight students participated. The focus group was conducted an average of 5 months after the international experience. Data from the transcribed focus group led to the development of a conceptual model. Categories and themes emerged from additional qualitative analysis of the data. Results. Students perceived benefits of participation in an international clinical education program in four categories: an expanded world-view, an expanded view of physical therapist practice, changes within themselves, and changes within themselves in the role of PT student. Discussion and Conclusion. Results of this study agree with several findings from the nursing and medical literature concerning the perceived benefits of an international educational experience. Physical therapist students appeared to perceive that an international clinical education experience has important, broadening, and lasting benefits to them as professionals, individuals, and members of a global society.