Abstract
There is a continued need to communicate global perspectives in occupational therapy education, but the literature addressing how to incorporate firsthand global experiences into campus learning environments is scant. This article describes how course-based synchronous interactions between U.S. undergraduate occupational science students and Swedish undergraduate occupational therapy students occur via online technology. In a 2014 pilot study, we thematically analyzed students’ open-ended survey responses to discern what students learned through the interactive sessions. We also performed a content analysis of four audio-recorded interactive sessions to understand the content and nature of students’ learning. Our findings suggest that course-based online synchronous interactions provide a positive way for students to learn about other cultures and global differences in occupational therapy practice. The findings also highlight needs for improvement relative to the structure and aims of the interactive sessions. We relate these findings to the global availability of technology and occupational therapists’ cultural competence.
Keywords
As globalization continues to make the world seem smaller, occupational therapy educators must increasingly incorporate international perspectives into their courses (Horton, 2009). The reasons for globalizing occupational therapy education have primarily been related to, first, the need for culturally competent practice (Asher, Estes, & Hill, 2014) and, second, the recognition that occupational therapy’s models and frameworks are not universally applicable (Iwama, 2007). Thanks to globalization, there is also a need to develop cultural competence among occupational therapists (Aldrich, 2015) who may find themselves working together in any number of international contexts. Cultural competence (Awaad, 2003; Bonder, Martin, & Miracle, 2004) and culturally relevant professional terms and ideas (Creek et al., 2010) take time and repeated exposure to develop; therefore, providing opportunities for concept-focused international interactions early in occupational therapy education is essential.
Although the call to globalize occupational therapy education is not new (Thibeault, 2006; Westcott & Whitcombe, 2003), the possibilities for answering that call are greater than ever before because of the rapid evolution of interactive technologies. The prohibitive cost, time, and logistical requirements for in-person international exchanges (Kinsella, Bossers, & Ferreira, 2008) further demonstrate the need to explore technology-based options for international educational interactions. Online learning continues to be a promising format for occupational therapy education (Armitt, Slack, Green, & Beer, 2002; Hollis & Madill, 2006), especially when combined with a constructivist educational approach (Trujillo, 2007) that emphasizes active, experiential learning (Jeffery, 2010). As recent examples have illustrated (Aldrich, 2015; Asher et al., 2014; Sood, Cepa, Dsouza, & Saha, 2014), online learning can be beneficial for both occupational therapy and occupational science student learning.
This article describes course-based interactions in which U.S. undergraduate occupational science students connected with Swedish undergraduate occupational therapy students. After a brief description of the student groups and curricula in which those students are enrolled, we present data generated during one 4-wk sequence of interactive sessions. The discussion situates the findings relative to student learning and occupational therapy education.
Description of Interactive Sessions
Since 2013, undergraduate students from a Midwestern U.S. occupational science program have been participating in synchronous (i.e., “real-time”) interactive sessions with undergraduate occupational therapy students from Sweden. Every February and March, a new group of students in each location spends 1 hr/wk for 4 wk discussing topics including culture, occupational justice, and political aspects of occupational therapy practice. Such topics represent shared themes of the courses (“Critical Perspectives of Culture, Occupation, and Justice” [U.S. course] and “Health, Culture, and Lifestyle” [Swedish course]) in which the students are enrolled. The synchronous interactive sessions are embedded in existing for-credit coursework, and all discussions are conducted in English. The U.S. students begin the interaction in the 7th wk of their course, and the Swedish students begin the interaction in the 1st wk of their course. The goals of the interactions are to connect students with international peers and help them understand how occupational science and occupational therapy concepts are taken up in different global contexts.
The U.S. students who participate in these interactions are typically enrolled in their 3rd yr of undergraduate occupational science studies and planning to transition into a graduate occupational therapy program the following year. The Swedish students are typically enrolled in the 1st yr of undergraduate studies, which culminate in an occupational therapy degree 2 yr later. Students are matched by education level (e.g., undergraduate) rather than program type (e.g., occupational science or occupational therapy) because of international differences in entry-level occupational therapy degree requirements and a preference for matching students in courses that have similar content. Both student groups are in their 1st yr of core or major course content and just beginning to learn the basic concepts of occupational therapy and occupational science.
For each course, we divide the students into two groups in each context and pair those groups across contexts, resulting in two interactive sessions (one per pair) each week. The sessions occur by means of web conferencing software to allow the student groups to see and hear each other. As illustrated in Figure 1, although the U.S. students complete the interactive sessions in a technology-rich learning studio, the Swedish students participate in a regular campus classroom with a laptop, webcam, and external microphone. As reported elsewhere (Aldrich, 2015), we prepare discussion questions based on particular topics and readings and send them to students in advance of each interactive session. During the sessions, we act as facilitators for student discussions within and across our respective contexts and also prompt students to ask their own questions. The following transcription of dialogue from the final week of interactions illustrates the ways in which these sessions typically unfold.
Aldrich: So, the first question is pretty basic: What do you think of when you hear the word political? And I’d like maybe to start over here with the [U.S.] students. So what sorts of words or phrases or descriptions come to mind when you think of the word political?
U.S. Student 1: I think of strong different views . . . maybe some type of conflict.
Aldrich: Okay, so strong differing views, maybe some type of conflict? Okay, [Student 2], you had your hand up, too?
U.S. Student 2: I just a lot of times think of the government.
Aldrich: The government? Okay, what about the government?
U.S. Student 2: Just like the different views that they have.
Aldrich: Okay, other people? Yes, [Student 3].
U.S. Student 3: I kind of think of it as a conversational type of rule, like you don’t really discuss it with someone you meet on the street or even with your friends because of some of the conflicting views that are out there.
Aldrich: Okay, so picking up on that idea of conflict: Politics is taboo, we don’t talk about it in polite company, right? . . . What do you think of in [Sweden] when you hear the word political?
Johansson: Do you think what they said in [the United States] is quite similar to here? . . . You talked about the distance between ordinary life and politics, that it’s difficult to influence politics.
Swedish Student 1: What you do every day is not a political act.
Swedish Student 2: Well, it could be a political act, but when we heard the word political, the first thing that came to mind was high powers that are hard to affect. But we know it’s like everyday things as well, but it’s not the first thing that comes to mind when you say political. Not to me, anyway.
U.S.–Swedish interactive session.
After each interactive session, we help our students debrief the content and process of the interactions before preparing them for the next session.
Method
This article reports data that were generated with students during the 2014 interactive sessions, which included 48 U.S. students and 41 Swedish students. Approximately 98% of both student groups were female, and students’ ages ranged from 20 to 45 yr, with a mean age of 21 for the U.S. students and 23 for the Swedish students.
We conducted a pilot study to answer two questions: (1) What did students learn from the interactive sessions? and (2) In what ways were the sessions positive or negative learning experiences? Two data sources from the 2014 sessions helped us answer those questions. As part of normal course procedures, we asked students to voluntarily complete an open-ended anonymous survey after the final interactive session. The survey asked each student to describe the purpose of the interactions; the ways in which the interactions were (or were not) learning experiences; and how the interactions influenced the student’s knowledge about culture, power, occupational therapy, and other topics. The survey also asked the students to suggest ways to improve the interactions and share other thoughts about the interactions.
Twenty-five U.S. students and 6 Swedish students—representing respective response rates of 52% and 15%—provided feedback via the surveys. We analyzed those students’ responses by grouping them into themes under each question topic. We also performed a directed conceptual content analysis (Hsieh & Shannon, 2005) of four audio-recorded interactive sessions: both sessions from the 1st wk of interactions and both sessions from the last week of interactions. This content analysis illuminated themes of student-generated questions and responses and also helped us retrospectively examine the flow of the interactions. Because these data were generated as part of normal classroom procedures and stripped of identifying information, the institutional ethics review boards at both authors’ universities exempted this study from review.
Findings
Survey Results
Purpose of the Interactions: Learning About Culture, Occupational Therapy, and Concepts.
Both sets of students interpreted the purpose of the interactive sessions as providing exposure to other cultures and the practice of occupational therapy in other countries. The U.S. students also saw the sessions as a way to develop their definition of terms such as culture and occupation as well as to generate “insight[s] on the class readings.” For instance, 1 U.S. student wrote, “I believe the purpose was to expose ourselves to a different culture in order to learn about typical Swedish occupations, as well as the students’ occupational therapy program,” and another student wrote that the purpose of the interactions was “to see how future OTs are developing their occupational science knowledge. To understand how their perception of the world, or environment, may differ from ours. To recognize the similarities and differences of the practice.” Likewise, 1 Swedish student wrote, “In my opinion, the purpose of the seminars was to exchange experiences that we as students have had so far in our education, but also to talk about OT in general and gain knowledge of how OT works in Sweden and in the US.” Another Swedish student expressed that “the purpose of these seminars were [sic] to meet with one other culture and see similarities and differences.”
Content of Learning: Culture and Educational–Practice Trajectories.
The students perceived the content of their learning as in line with the purpose of the interactive sessions. Both the U.S. and Swedish students wrote that the interactions helped them learn about a different culture and the practice of occupational therapy in that culture. Students mentioned specific examples related to those topics. For instance, the U.S. students noted that the Swedish students seemed to share many values with them but were less “affiliated with religious following,” and the Swedish students highlighted specific differences in cultural customs, such as U.S. students not removing their shoes when entering a home. Likewise, both groups of students wrote that they learned about differences in their educational preparation and possibilities for future areas of professional practice.
Evaluation of the Learning Experience: Positive yet Awkward.
Although a few students wrote that the interactive sessions were superficial, most students characterized the interactive sessions as positive learning experiences. Many U.S. students wrote that they enjoyed or found it eye-opening, fun, or interesting to learn about Swedish culture and Swedish occupational therapy practice. One student even noted, “I learned more about my own culture by answering their questions,” signaling that the learning was not unidirectional. Several U.S. students labeled the sessions as an opportunity apart from what they had typically experienced in school; for example, 1 student shared that the interactions were “unlike anything I have ever encountered before in a class,” and another student noted that the sessions represented “an incredible opportunity to take advantage of current technology” to learn about another culture and that culture’s practice of occupational therapy.
The Swedish students reported that the sessions provided information about culture and occupational therapy in the United States, but they were more circumspect in their evaluation of the interactions as positive learning experiences. Both U.S. and Swedish students noted that the sessions were sometimes “awkward” or “uncomfortable” because of lengthy pauses in dialogue or a perceived lack of student interest in certain conversations. The Swedish students’ feedback illuminated one possible reason for such pauses: One student wrote that the sessions “were not learning experiences. It wasn’t an exchange of thoughts since none of us Swedish students were confident enough in our English skills to speak and get a discussion going.” Another Swedish student shared that she lacked the courage to speak up in English, and yet another Swedish student wrote that
it’s hard to discuss the subject in Swedish; how do you expect us to discuss such important matters in a language that many of us [haven't mastered]? Even if we understood what the American students were saying, it was really hard to express your own thoughts.
Although the U.S. students noted a language barrier in their comments, that barrier seemed related to their interpretation of Swedish students’ behavior rather than an inability to understand what Swedish peers were saying. In addition to the perceived language barrier, the U.S. students noted that it was sometimes difficult to hear the Swedish students because of technological difficulties. A few U.S. students also commented that the conversation seemed to be slanted toward their perspective because they spoke up more readily than their Swedish peers.
Suggested Improvements.
Both student groups highlighted the need to minimize technological difficulties to improve the interactions. The Swedish students also communicated a desire for more preparation before the interactions and a need to translate discussion questions into Swedish for preparation purposes. Both student groups suggested that the sessions could be more student led and that smaller group interactions before the large-group sessions would be beneficial. In support of these findings, 1 U.S. student suggested that “having people assigned to be our class ambassador to start off each discussion would be helpful,” and 1 Swedish student wrote that “it would have been fun to interact with one student a couple of times to ask questions about this stuff to really get to know the culture more.”
Content Analysis Results
Content of Interactions: Occupational Therapy Education and Culture-Specific Occupations.
During the 1st wk of interactions, students began to learn about each other by describing their respective educational processes. Students discussed five topics related to their education: demographic information, living situations, areas of future occupational therapy employment, schooling costs, and transportation. After that discussion, students in each context asked follow-up questions to explore peers’ education and culturally specific occupations. For instance, 1 Swedish student asked, “What has been most interesting so far in your education?” and a U.S. student responded by highlighting the process of learning about “how our culture and background influence what we do in everyday life” through occupational science courses. In a separate discussion, a U.S. student asked the Swedish students to “explain more about the fika thing” 1 because she had learned about the Swedish coffee-drinking tradition through in-class research on Swedish culture. Two Swedish students shared that “you can always fika” and that “in a new workplace, it is important to find out where and when fika is.”
Student discussions continued to relate to these two themes—occupational therapy education and culture-specific occupations—even in later sessions, when the content of the interactions was more directed. In the final week of interactions, student discussion focused primarily on the assigned topics of politics and occupational justice. Relative to those topics, students discussed the following issues: access to occupational therapy services within broader health care systems, needs for advocacy, the ability to “be political” in different work environments, the idea that being political might conflict with patient care, the fact that seeking occupational justice is inherent to occupational therapy, and everyday examples of occupational injustice. During the open discussion that followed, students returned to their focus on understanding peers’ educational and cultural experiences. The students discussed educational requirements for volunteering, practice placements in their curricula, interprofessional learning, and the culture of their respective educational institutions.
Flow of Interactions.
The content analysis revealed that the flow of interactions was similar from the 1st week to the last week of sessions. Throughout the interactions, the first author was the primary driver of conversation, posing questions to students from each context, summarizing their responses, and prompting follow-up comments throughout the sessions. Long pauses of 5–10 s were common during the interactions, and the U.S. students were more active contributors to the dialogue than the Swedish students.
Discussion
Mirroring previous findings (Aldrich, 2015) as well as findings from other pilot projects (Asher et al., 2014), this study demonstrates that students had positive learning experiences related to international peers’ culture, occupational therapy practice, and education. These outcomes were reflected in students’ perceptions of the purpose and content of the interactions, their evaluation of the learning experience, and the kinds of questions they raised during the interactive sessions. Both student groups highlighted needs for improvement relative to audio quality, preinteraction preparation, and the student-led nature of the experience.
The two student groups also appreciated different aspects of the interactions. Whereas the U.S. students perceived the interactions as opportunities to deepen their knowledge about occupation, the Swedish students viewed the sessions more in relation to developing cultural competence and comparing global occupational therapy practices. These divergent appraisals may be due to the different programs in which the U.S. and Swedish students were enrolled (occupational science and occupational therapy, respectively). The U.S. students’ more active contributions to the sessions may have resulted from their longer duration of study relative to their Swedish peers: They were in their 3rd yr of education and 7 wk into the course in which the interactions were embedded, whereas the Swedish students were in their 1st yr of study and 1st wk of their corresponding course. The U.S. students also benefited from being native speakers of the language in which the interactive sessions were conducted (English), which may have facilitated their more positive outlook on the sessions relative to their Swedish peers.
Limitations
Because these interactive sessions linked U.S. and Swedish students, this pilot study’s findings are most relevant to occupational therapy and occupational science education programs in the Global North. Further research is needed to understand the ways in which this educational approach is useful for connecting programs across the Global North and South, where language and technological differences may be greater.
Implications for Occupational Therapy Education
The results of this study have the following implications for occupational therapy education:
Students perceive synchronous online peer interactions as positive opportunities to learn about culture, occupation, and global occupational therapy practice and education.
Synchronous online peer interactions can be integrated into existing courses with minimal technology if appropriate Internet and audio infrastructure is present.
Student perceptions of synchronous online peer interactions may relate to whether they speak the language in which the interactions occur, how far they are in their educational process, and the extent to which they desire control over the progression of the interactions.
Conclusion
This pilot study demonstrates the potential that can be harnessed when using technology to bridge occupational therapy and occupational science students from around the world. The results of this study show that students can increase their perceived cultural competency and simultaneously learn about the diversity that characterizes their chosen profession through first-hand experiences with international peers. Students can also develop understandings about occupation through such experiences even if international peers are not enrolled in occupational science programs. Given appropriate technological infrastructure, synchronous international interactions are a relatively easy and low-cost way to infuse education with global perspectives. Seeking and acting on student feedback is essential to implementing and improving international interactions in occupational therapy and occupational science curricula.
Footnotes
Fika is a tradition of daily coffee breaks which are as much—or perhaps more—about slowing down and/or socializing with others as they are about consuming coffee.
Acknowledgments
We are grateful to our students for embarking on this adventure with us. We appreciate Lenin Grajo’s thoughtful comments on an earlier version of this article as well as the feedback we received when presenting a portion of our findings at the 2014 Joint Conference of the Society for the Study of Occupation: USA; the Canadian Society of Occupational Scientists; and the International Society for Occupational Science in Minneapolis, MN.