International Service Learning Experience Research Articles

Impact of International Service Learning on Macro-Ethics:

To address complex problems in a globalized workplace, future engineers must understand the ethical implications of their work in the global context. International service learning is a possible approach for future engineers to gain an understanding of ethical implications in a global context. The purpose of this study is to investigate the potential benefits that international service learning may add to engineering ethics education. The quantitative study measured senior engineering students’ understanding of ethics from a national sample of students enrolled in capstone design courses (n=2095) in three types of international service learning experiences: capstone, volunteer/work, or co-curricular. Students who participated in international service learning through capstone and volunteer/work experience scored significantly (p<0.01, p<0.001 respectively) higher to questions that measured their understanding of ethics. Males compared to female engineering students showed the largest difference in their understanding of ethics. The integration of international service learning into engineering education should be more seriously considered to aid in more effectively teaching ethics. Male engineering students, who make up nearly 80% of engineering programs, can benefit the most in their ethics education from international service learning.

Measuring professional nursing value development in students participating in international service learning: A quasi-experimental study

BackgroundInternational service learning is becoming widely used in nursing education as a means to provide global learning opportunities as well as part of a clinical learning experiences. Concrete outcomes for these experiences have not been clearly supported in previous research. Professional nursing values are an important learning outcome for nursing students and development of professional nursing values has been found to occur through various learning experiences. Determining if international service learning experiences facilitate the development of professional nursing values can support the use of international service learning as a viable pedagogy. ObjectiveThe purpose of the study was to determine if there was a difference in professional nursing values development in students who participate in international service learning as part of their clinical experiences compared to those who do not. DesignThe research was a quasi-experimental study with a pre-test, post-test design. Setting/participantsUndergraduate students participating in one week international service learning as part of their clinical hours were compared with students who did not participate in international service learning. MethodsComparison of professional nursing values development between the experimental and control group was completed using the Nurses Professional Values Scale. ResultsThe study showed the use of international service learning as part of clinical was at least equivalent in the development of professional nursing values as traditional clinical. In addition, it supported the development of professional nursing values through clinical learning overall. ConclusionThe use of international service learning is a viable option for clinical experiences as a means to develop professional nursing values.

Assessing student expectations and perceptions of a short-term international service-learning experience.

Despite nursing students' need for cultural education, few studies have measured what students expect from international service-learning experiences and how their perceptions of the actual experience compare to these expectations. To increase understanding of global nursing experiences, the purpose of this study was to examine the similarities and differences between nursing students' anticipated (pre-travel) personal and professional developmental expectations and reported (posttravel) personal and developmental outcomes. This study employed a mixed descriptive research design. Quantitative data was secured through survey methodology. Written responses to open-ended questions provided qualitative data for analysis. Between 2012 and 2017, 43 undergraduate and graduate nursing students at a Midwestern university completed surveys and narratives about their participation in an international service-learning course in Kenya. Students' anticipated learning was achieved through their international experiences. Participants also experienced personal growth, professional development, cultural competency enhancement, and transformation from the educational experience. They also described how their experiences would change their personal and professional lives. The depth and breadth of the growth and learning described by students is consistent with the expectations of high-impact educational practices.

Evaluation of a Long-Term, Physical Therapy Service-Learning Partnership in Ecuador: Inclusion of the Community Voice

Background and Purpose. International service learning (ISL) is an instructional method used by physical therapist educators to increase the global perspective of students. Research exploring student experiences with ISL is plentiful, but evaluation of service outcomes from the community partner perspective is lacking. The purposes of this work were to evaluate the impact of a long-term community partnership through: (1) identification of benefits, drawbacks, and suggestions for sustaining the partnership and (2) gathering feedback on the immediate and short-term perspective of training provided to orphanage staff. Method/Model Description and Evaluation. The model consisted of a curriculum-based ISL experience involving a US-based physical therapy program and a service site at an Ecuadorian orphanage. For the current work, an evaluation component was added to the model. Three complementary approaches: the SOFAR Model, Exchange theory, and the partnership qualities of closeness, equity, and integrity informed the evaluation. Data consisted of 6 interviews conducted and 17 surveys administered to Ecuadorian community partner staff/administration. Data were analyzed using qualitative thematic content analysis, descriptive statistics, and paired t tests. Outcomes. Partnership benefits included: iterative pre-trip communication, a respectful and mutually beneficial relationship, capacity building through education, and physical therapy that positively affected the children's quality of life. Drawbacks were the potential for host site dependency due to lack of local capacity, negative impact of new technology on staff workload, and poor treatment carryover. Continued training was identified as critical for building capacity within orphanage staff. Discussion and Conclusion. As more US student teams deliver clinical services abroad, intentional evaluation approaches must include the community partner voice to maximize benefits, minimize burdens, build capacity, and addresses issues of vital importance to the service site.

International Service-Learning for Nurse Practitioner Students: Enhancing Clinical Practice Skills and Cultural Competence.

The purpose of this project was to determine whether an international service-learning nurse-led clinic was a beneficial experience for nurse practitioner (NP) students in improving diagnostic and cultural confidence, skills acquisition, and cultural competence during a clinical practicum. The sample consisted of 10 Doctor of Nursing Practice (DNP) students in various NP tracks during an international service-learning experience in Guatemala. A Likert survey was used for student evaluation of experience. An analytic grading rubric measured clinical and cultural performance. Practice competency scores were high overall (M = 3.36; SD = 0.664). All students increased their confidence in diagnostic abilities (M = 4.89; SD = 0.422) and in caring for a culturally diverse population (M = 4.89; SD = 0.333). An international service-learning nurse-led clinic used to complement clinical practice hours as a beneficial experience in assisting NP students in developing diagnostic and cultural confidence. [J Nurs Educ. 2019;58(9):548-551.].

Exploring the Value of Service Learning Study Away to Interprofessional Education and Cultural Competence

Purpose This study investigated student learning about interprofessional practices during an international service learning experience. Method The participants were selected speech-language pathology students who participated in a study away program to Nicaragua that included faculty from multiple disciplines. Following the trip, a focus group was used to gather information about the students' learning experiences relative to interprofessional education, with an emphasis on speech-language pathology and occupational therapy collaborations. Results and Conclusion Analysis of the focus group transcripts generated the following themes: different perspectives, understanding the roles and responsibilities of other professions, multiple learning strategies, and working with interpreters. The study provides insights into how international service learning can support interprofessional education and help students develop cultural competence.

Simulation Enhances Soft Skills Among Inter-Professionals Participating in an International Service-Learning Experience to a Resource-Limited Country.

This article was migrated. The article was marked as recommended. Introduction:Soft skills are the hallmark of a master healthcare provider. One of the most effective ways to teach soft skills to healthcare providers is through service-learning. Evidence suggests that adding simulation as part of a service-learning team's pre-departure training (PDT) will better prepare them to resolve ethical and cultural dilemmas often encountered in resource-limited countries, plus facilitate soft skills. We hypothesized that simulation could improve soft skills of physical and occupational therapy students and clinicians providing rehabilitation services on a one-week service-learning experience in Guatemala. Methods:A convenience sample of 21 physical and occupational therapy students and clinicians who participated in four 1-hour PDTs were included in this qualitative study using grounded-theory methods. Training consisted of didactic, reflective and simulation components designed to introduce self-awareness, team-building, cultural knowledge, and to support trip preparations. Four debriefings were recorded using open-ended questions with a thematic approach around the concepts of preparedness and cultural adaptability, which represented the dependent variables. The independent variable was a 20-minute simulation emphasizing cultural and socio-emotional challenges of the host community. Results:Six themes emerged: confidence, empathy, communication, mentorship, self-knowledge, and cultural competency. The themes described were core elements of empowering the participants towards advocacy and process improvement. As a result of the simulation experience, participants in this study were better able to respond to distressing situations encountered on site, and they expressed the service-learning experience, supported by the PDT simulation, stirred significant maturation. Discussion and Conclusion:Simulation is useful for developing self-regulatory skills, especially in response to culturally novel, emotionally-charged situations. Simulation for enriching international service-learning experiences is recommended as best practice to prepare healthcare providers in facing ethical and cultural demands of resource-limited countries.

International Service-Learning: Feedback From a Community Served

Introduction. Mutual benefit to participants and recipients of international service-learning (ISL) is often assumed by academic institutions when bringing medical/health care and education to underserved countries. Research documenting feedback from host communities is needed in all disciplines, including physical therapy. Overall, host communities seem to appreciate collaborations with ISL visiting teams; however, these communities may endure hardships unbeknownst to visiting partners such as reinforcement of negative attitudes, disruption of community relations and dynamics, interactions with culturally insensitive visitors, and poor quality care. The purpose of this study was to collect and document feedback from a host community after a 2-week ISL experience with Doctor of Physical Therapy (DPT) students and faculty. Methods. Twelve community leaders who interacted daily with DPT students and faculty were interviewed. Individual interviews were completed and transcribed. The constant comparative method was used to generate themes. Results. Overall, the community felt that their the interactions with the ISL team 1) improved local cultural attitudes about disability, 2) improved awareness of the role of physical therapy, 3) fostered strong, respectful relationships between the community and team, and 4) strengthened the desire to sustain the partnership. Discussion and Conclusion. The host community was very satisfied with the partnership and wished to strengthen relationships for long-term sustainability. Recommendations for the ISL curriculum in physical therapist education were identified or reinforced from this study.

Production of the Global Health Doctor: Discourses on International Medical Electives

This article attempts to interrupt dominant narratives in the literature about international service-learning (ISL) in the field of medicine by critically deconstructing discourse related to a common model used to teach global health in undergraduate medical education: the international medical elective (IME). Based on a study conducted in 2012, the results have not been previously published. Using a Foucauldian discourse analysis, the study interrogated the underlying assumptions behind the nature of “service” being rendered by conveying the imagery, language, and consequences of the dominant discourses used in journal articles indexed on MEDLINE between 2000 and 2011. The analysis revealed an IMEs literature steeped in problematic discursive (re)productions of colonial constructs and imagined geographies, primarily through two dominant discourses designated as “disease and brokenness” and “romanticizing poverty.” These discourses both justify and reinforce privileged subject positions for students engaged in these ISL experiences, while inadequately considering structures and systems that perpetuate marginalization and health inequities. Such discourses often marginalize or essentialize people of so-called “host” countries, while silencing subaltern perspectives, resistance struggles, knowledges, and epistemologies. Challenging current ISL practices in medicine requires educators to actively work towards decolonialization, in part by recognizing the ability of discourses to produce meaning and subjects.

Bridging Civic Engagement to Civic Responsibility Through Short-Term, International Service-Learning Experiences: A Qualitative Analysis of Student Reflections

Written reflection is a tool commonly used by faculty to assess student learning in service-learning courses, which are frequently offered as short-term international experiences. This article discusses a qualitative analysis of students’ written reflections on a short-term, international service-learning project that was conducted to determine whether undergraduate students bridged their engagement to the development of civic or social responsibility. Results of the analysis revealed that students demonstrated nominal progress toward civic responsibility when not specifically prompted by assignments. Multiple themes emerged from the analysis related to students’ goals, challenges, and lessons learned. Based on the findings, the authors recommend that faculty, to encourage students’ development of civic responsibility, be prepared to help students set goals and work through challenges, and to play an active role in supporting and guiding students in processing their experiences in a transformational manner.

Does Location Really Matter? Exploring the Role of Place in Domestic and International Service-Learning Experiences

Although increasingly popular, international/global service-learning programs are not without critique; in fact, the role of crossing national borders in service-learning is highly contested. The purpose of the study discussed in this article was to explore this role of crossing borders within the context of a particular experience: participation in an alternative break (AB) program. The authors sought to understand whether there is an aspect of learning in specific places, namely learning across national borders, that is separate (and separable) from what happens in those places. Participants reported a high level of influence of their AB experience on both their intentions to volunteer and to travel internationally, although there were a number of differences between students who participated in domestic and international ABs. Mediation analysis showed that the relationship between program location and the influence of the AB on students’ plans to volunteer was mediated completely by features of the AB program itself, while the relationship between program location and the influence of the AB on students’ plans to travel internationally was only partially mediated by program features.

Intercultural citizenship through participation in an international service-learning program: A case study from Taiwan

Byram’s (2008) intercultural citizenship framework includes the following orientations: cognitive, evaluative, comparative, action, and communicative. Using this framework as a theoretical basis, this study explored the international service-learning (ISL) experiences of four Taiwanese non-native English speakers (NNES) during a two-week trip to a poor community in the Philippines. Data collected from these students’ individual reflections, interviews, and public presentations illustrate their acquisition of the knowledge, skills and attitudes of intercultural citizenship. This study thus demonstrates that ISL allowed students to engage beneficially for themselves and their hosts with other NNES, instead of following the tradition of study abroad in countries where English is spoken natively.

International Service-Learning: Rethinking the Role of Emotions

Existing research on international service-learning (ISL) only implicitly alludes to emotions or considers emotions as a limited vehicle through which the more important work of learning occurs. This study set out to shift this focus on emotions to show how emotions are an integral part of the overall ISL experience. The aim was to understand how an ISL internship was an emotional experience for the student participants through the lens of noncognitive process theory of emotions. This was a qualitative case study of the experiences of 10 university students who engaged in an ISL internship in East Africa. Data collection instruments included preinternship surveys and emotional mind maps, postinternship surveys, and interviews. The study demonstrated that ISL can be a highly charged, emotional experience for student participants. The author argues that emotional responses are not simply a limited catalyst through which learning and transformation transpires, but constitutes forms of understanding in and of themselves. This points to the need for ISL researchers and practitioners to shift their preconceptions about the value of emotions in learning and transformation processes and attend to the emotional dimensions of ISL in their research and the implementation of these programs.

International service learning and interprofessional education in Ecuador: Findings from a phenomenology study with students from four professions

Combined international service learning (ISL) and interprofessional education (IPE) experiences can move health professional student learning beyond the traditional confines of the classroom and outside uniprofessional ethos. The purpose of this transcendental phenomenological study was to describe the shared experience of health professional students participating in an ISL trip to a small community in Ecuador. The study focused on the learning and collaboration that occurred among students from multiple health professions during the trip and the cross-cultural exchange between the students and the patients in Ecuador. Participants included 15 students from 4 health professional programmes (pharmacy, medicine, physical therapy, and nursing). Data included interviews, focus groups, observation, and written documents. The essential meaning that emerged from this study was that the ISL/IPE learning opportunity created a practical opportunity for demystifying other healthcare professions in the context of a resource-limited international patient care setting, while supporting students’ personal and professional development. Four structural themes emerged to describe the student experiences. Students had to negotiate the language barrier, limited resources, and unexpected diagnoses, while simultaneously learning about the roles and scope of other professions on the team and how to communicate effectively. Student’s perseverance when facing the challenges resulted in their personal growth. The interprofessional component strengthened the students’ knowledge of interprofessional collaboration and communication through real-world application.

International Service Learning: Occupational Therapists' Perceptions of Their Experiences in Guatemala

The U.S. is fast becoming more culturally diverse, creating a greater need for entry-level occupational therapists to be culturally competent. In order to increase students’ cultural competence, there is a growing support for international service learning (ISL). The purpose of this qualitative research study was to explore the perspectives of occupational therapy practitioners who engaged in ISL as occupational therapy students. Interviews were conducted with nine practicing occupational therapists, all of whom graduated from the same occupational therapy program in the U.S. and participated in an ISL experience in Guatemala. Phenomenological methods were used to analyze the transcribed interviews for codes, categories, and themes. The three themes that emerged were: Participants reported encountering many new experiences that led to experiencing a variety of emotions, their experiences in the Guatemalan culture further contributed to a deeper level of understanding about culture, and all of the participants reported that their ISL experiences allowed them to practice occupational therapy skills and interventions with limited resources, which facilitated creativity and resourcefulness. The findings of this study support that completing ISL as students contributes to occupational therapists’ personal and professional lives and offers a glimpse of potential long-term effects of completing an ISL experience.

Examining Developmental Readiness in an International Service-Learning Context

The authors examined students’ developmental readiness for productively negotiating the disorienting dilemmas and dissonance they experienced during an international service-learning experience. Using a case study methodology, researchers collected data from a diverse group composed of 7 graduate students and 5 undergraduates who participated in a pre-departure course and 3-week immersion in Ecuador, which instructors framed with a critical service-learning pedagogy. Findings emphasize how the complexities of the students’ in-country experience sparked disorienting dilemmas and point to the intertwined nature of developmental readiness, dissonance, and emotions during service-learning experiences.

Recent Graduates’ Perceptions of the Impact of a 1-Month International Service Learning Experience in Kenya During Their Physical Therapist Assistant Education

INTRODUCTIONThe use of international service learning (ISL) by health professions educators, including those in physical therapy, can facilitate the development of attributes to serve a global society through the provision of health care services to communities around the world.1-9 The American Physical Therapy Association strongly promotes the engagement of the profession in improving the health and quality of life of people in a global society.10 Attributes including advocacy, health promotion, social responsibility, communication, cultural competence, and citizenship are all professional practice expectations cited in the standards and required elements documents from the Commission on Accreditation in Physical Therapy Education. Both physical therapist and physical therapist assistant (PTA) graduates are required to show competence in serving others with respect regardless of cultural difierences.11-12 The Commission on Accreditation in Physical Therapy Education specifically expects PTA graduates to identify, respect, and act with consideration for patients'/clients' difierences, values, preferences, and expressed needs in all workrelated activities 11(f27) and to participate in professional and community organizations that provide opportunities for volunteerism, advocacy, andleadership.11(P37) Although approximately 43% of entry-level PT education programs in the United States and Canada have some form of ISL or other international volunteer service as part of the curriculum, there is no evidence that this same type of experience exists within PTA education programs.13In general, service learning has been defined as learning experiences that combine community service with specific learning objectives that emphasize preparation before the experience, reflection by the participant, and reciprocity of benefit for the person being served and the person who is serving.14 Pechak and Thompson specifically defined ISL as a structured learning experience where students accompanied by faculty travel to different countries and immerse themselves in a culture different than their own.15(f71)REVIEW OF LITERATUREMany health-related education programs, including occupational therapy, social work, dental hygiene, nursing, physician assistant, and medicine programs, have included ISL and have examined how the experiences influenced the development of the skills, attitudes, and awareness needed by graduates to deliver culturally competent care. The benefits of ISL in these programs were associated with improvements in cultural awareness and understanding, cross-cultural communication skills, the ability to work with people from different cultures, open-mindedness, and an appreciation for community and civic engagement.2-7,8-16-19 Other benefits included the development of cultural appreciation and sensitivity, improved clinical reasoning and leadership skills, increased confidence, and the ability to advocate for the profession and patients.16-18,20,21 Long-term benefits for nurses included a new appreciation for life, a broader view of the profession, and improved confidence and effectiveness as practitioners when working with diverse populations.22Researchers who studied the impact of ISL on physical therapist students found similar professional, emotional, and cultural changes. Both short- and long-term benefits were reported. From a professional perspective, researchers identified short-term improvements in adaptability, critical thinking, collaboration with peers, development of professional identity and role formation, leadership, communication skills, and confidence as a clinician.8,23-26 Short-term emotional changes in physical therapist students were found by Hayward and Charrette,23 who reported statistically significant positive changes in the emotional resilience category of the Cross Cultural Adaptability Inventory.27 Multiple researchers reported improvements in components of cultural competence, such as cultural readiness, ease of acknowledging and accepting diverse populations, expanded worldviews, appreciation for global issues, heightened sensitivity to others' cultural values and differences, and motivation to make culture a primary concern in future practice. …

Impact of international humanitarian service-learning on emerging adult social competence: A mixed-methods evaluation

This article presents the results from a study into international humanitarian service-learning experiences on young adult volunteers. Specifically, the service-learning experiences of emerging adults who had served in orphanages in Latin America were assessed, in a pre- and post-test design, for their development in areas of social competency such as identity, self-efficacy, self-esteem and ethnocentric attitudes. A mixed-methods design using both qualitative and quantitative measures was used. Both qualitative and quantitative results identified significant and important impacts on the development of the social competencies of these emerging adults. In addition, several qualitative themes illustrated that longer term international service-learning experiences have a profound impact on the social competence of emerging adults.Keywords: International humanitarian service, service-learning, emerging adult competency

A focus group study of chiropractic students following international service learning experiences.

One objective of chiropractic education is to cultivate clinical confidence in novice practitioners. The purpose of this qualitative study was to describe how participation in a short-term international service learning experience changed perceptions of clinical confidence in senior chiropractic students. Seventeen senior chiropractic students participated in 4 moderated focus group sessions within 4 months after a clinical educational opportunity held in international settings. Participants answered standard questions on how this educational experience may have changed their clinical confidence. Two investigators performed qualitative thematic analysis of the verbatim transcripts to identify core concepts and supporting themes. The core concept was transformation from an unsure student to a confident doctor. The service learning experience allowed students to deliver chiropractic treatment to patients in a real-world setting, engage in frequent repetitions of technical skills, perform clinical decision-making and care coordination, and communicate with patients and other health professionals. Students described increased clinical confidence in 9 competency areas organized within 3 domains: (1) chiropractic competencies including observation, palpation, and manipulation; (2) clinical competencies including problem solving, clinic flow, and decision-making; and (3) communication competencies, including patient communication, interprofessional communication, and doctor-patient relationship. Students recommended that future service learning programs include debriefing sessions similar to the experience offered by these focus groups to enhance student learning. Senior chiropractic students who participated in an international service learning program gained confidence and valuable practical experience in integrating their chiropractic, clinical, and communication skills for their future practices.

The Impact of International Service-Learning on Nursing Students' Cultural Competency.

This article reports research findings on the effect of an international immersion service-learning project on the level and components of cultural competence of baccalaureate (BSN) nursing students. A triangulated methodology was used to determine changes in components and level of cultural competence pre- and postexperience. The theoretical model The Process of Cultural Competence in the Delivery of Healthcare Services was used. It identifies five central constructs in the process of becoming culturally competent: cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. The sample of 121 BSN nursing students was gathered from three southern California universities. Data were collected from 2009 to 2013. Using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version© and Cultural Self-Efficacy Scale, constructs of cultural competency were measured in pre- and posttest participants who participated in international service-learning immersion experiences. A demographic survey and open-ended qualitative questions were completed at the posttrip meeting. Mean, frequencies, and correlations with demographic data and survey data were calculated. Pre- and posttrip means were analyzed. Qualitative analysis from six open-ended questions completed at the posttest were coded and themes emerged. The research findings demonstrated the impact of the international service-learning project on building cultural competency in nursing students. Quantitative findings revealed statistically significant differences between pre- and posttest surveys for two of the five constructs of cultural competence. Qualitative analysis supported the quantitative findings in cultural competency constructs found in the model. The research findings support nursing education program use of international service-learning immersion experiences to foster cultural competence in nursing students. Findings from student participants demonstrated and articulated that these program experiences strengthen the process of becoming culturally competent. The research findings support the inclusion of international service-learning experiences with debriefing and reflective learning as effective teaching strategies. Researchers have demonstrated that poor healthcare outcomes are a result of health disparities, which are then compounded by healthcare workers not being prepared to care for clients from differing cultures. The American Association of Colleges of Nursing identified innovative ways for nursing students to develop skills in cultural competency, which included international experiences. In nursing education, this study demonstrated that international service-learning immersion experiences are of value as they impact and improve cultural competency. Nurses graduating with enhanced cultural understanding will contribute to decreased health disparities and improved patient care quality and safety. Further research that examines nurses' cultural competency in the patient care setting who have had previous education in international nursing could further inform nursing education and contribute to the understanding of patient satisfaction.