Abstract
The primary purpose of this study was to evaluate the impact of an international fieldwork experience in Ecuador on OT students through a mixed-methods approach. Results indicate that students felt more culturally competent, had transformed personally and professionally, and were more connected with one another after the experience. Programs should strongly consider engaging students in international experiences due to the positive impact it demonstrates.
Primary Author and Speaker: Dianna Lunsford
Additional Authors and Speakers: Kristin Valdes
The primary purpose of this study was to evaluate the impact of an international fieldwork experience on occupational therapy graduate students, through a mixed methods approach. The secondary purpose was to inform curricula in occupational therapy programs on the utility of an international fieldwork experience.
Fieldwork is a necessary component of most health care professions. It is in the “field” that students begin to apply concepts, approaches, and models of practice to actual clients and experiences, thus synthesizing prior didactic knowledge with higher level application. These opportunities are vital for health care students to bridge the gap between theory and practice, to develop critical thinking skills, and gain confidence.
The United States continues to grow in ethnic and racial diversity. According to the United States Census Bureau, approximately 40% of the population reported being part of an ethnic or racial population. By 2044, more than half of the population is projected to belong to a minority group and by 2060, one in five people in the US is projected to be foreign born. Conversely, the majority of health care workers identify as White/Caucasian. With such a homogenous group of health care providers, differences are sure to arise with local patients who are from culturally differing backgrounds than that of the health care provider. One can understand then, how formal education needs to address the importance and influence of culture in providing health care services. Many studies have looked at the impact of international work this from a qualitative design but few have assessed this through a through a mixed methods approach.
This study used an exploratory convergence model of the triangulation mixed methods design as described by Creswell (1999) to determine the impact of a short term international fieldwork (level 1) experience for occupational therapy doctoral students to Ibarra, Ecuador. After IRB approval, a purposive sample of eleven graduate students participated in the study which used the Public Affairs Scale, to gather pre and post experience quantitative data. Qualitative data was gathered from an end of program reflection paper along with researcher field notes taken during the experience. Quantitative data were analyzed using SPSS version 21.0 and with a two-tailed paired t-test to compare the mean pre and posttests scores. Significance was accepted at a probability value of p<0.05. Qualitative data was analyzed using a coding and theming approach. Integration of both data sets occurred through merging, to enhance the overall findings.
Results of this study demonstrated a convergence of both data sets in the area of increased cultural competence. Two additional main themes emerged from the qualitative data: personal and professional transformation and increased connectedness among participants. No changes were identified on the questions related to community engagement and ethical leadership with the PAS from pre to post experience.
This research identified that students gained skills and awareness in the area of cultural competence. Additionally, subthemes demonstrated that students felt as though they improved critical thinking skills, demonstrated creativity, and had more confidence and gratitude after the experience. Transforming students into professionals with these skills, through an international fieldwork experience, can have a positive impact on the delivery and quality of occupational therapy services for patients and families. Having identified this positive transformation, occupational therapy programs should strongly consider integrating an international fieldwork experience into curricula.
Sim, I., & Mackenzie, L. (2016). Graduate perspectives of fieldwork placements in developing countries: Contributions to occupational therapy practice. Australian Occupational Journal 6:244-256. doi.org/10.1111/1440-1630.12282
Kumas-Tan, Z., Beagan, B., Loppie, C., MacLeod, A., & Frank, B. (2017). Measures of cultural competence: Examining hidden assumptions. Academic Medicine, 82, 548-557. doi: 10.1097/ACM.0b013e3180555a2d