Striving to Meet Global Health Competencies Without Study Abroad.

INTRODUCTION: The COVID-19 (coronavirus disease 2019) pandemic has radically changed the future of study abroad, yet students require the knowledge, skills, and attitudes to provide care for diverse cultures across geographical boundaries. The purpose of this article is to facilitate innovative learning opportunities in order to meet global health competencies in the physical or virtual classroom when study abroad is not feasible. APPROACH: Based on a review of published literature related to global health competencies and nursing over the last decade, a description of suggested global learning activities is provided. RESULTS: Few research publications exist to describe activities for meeting global health competencies when travel abroad is restricted. The proposed activities provide a foundation to address the gap in literature and to establish a trajectory for future research. DISCUSSION: The challenge is to demonstrate evidence of global health competency attainment when students are confined to their local community.

Low- and Middle-Income Country Host Perceptions of Short-Term Experiences in Global Health: A Systematic Review.

PURPOSE: Stakeholders have expressed concerns regarding the impact of visiting trainees and physicians from high-income countries (HICs) providing education and/or short-term clinical care in low- and middle-income countries (LMICs). This systematic review aimed to summarize LMIC host perceptions of visiting trainees and physicians from HICs during short-term experiences in global health (STEGH). METHOD: In September 2018 then again in August 2020, the authors searched 7 databases (PubMed, Embase, Scopus, Web of Science, ERIC, Cochrane Library, Global Index Medicus) for peer-reviewed studies that described LMIC host perceptions of STEGH. They extracted information pertaining to study design, participant demographics, participant perceptions, representation of LMICs and HICs, and HIC visitors' roles and used thematic synthesis to code the text, develop descriptive themes, and generate analytical themes. RESULTS: Of the 4,020 studies identified, 17 met the inclusion criteria. In total, the studies included 448 participants, of which 395 (88%) represented LMICs. The authors identified and organized 42 codes under 8 descriptive themes. They further organized these descriptive themes into 4 analytical themes related to STEGH: (1) sociocultural and contextual differences, (2) institutional and programmatic components, (3) impact on host institutions and individuals, and (4) visitor characteristics and conduct. CONCLUSIONS: STEGH can have both beneficial and detrimental effects on LMIC host institutions and individuals. The authors translated these findings into a set of evidence-based best practices for STEGH that provide specific guidance for LMIC and HIC stakeholders. Moving forward, LMIC and HIC institutions must work together to focus on the quality of their relationships and create conditions in which all stakeholders feel empowered to openly communicate to ensure equity and mutual benefit for all parties.

Benefits and Harms of Short-Term International Academic Experiences Among Rehabilitation Students: A Systematic Review.

OBJECTIVE: More rehabilitation students are engaging in short-term international experiences to gain clinical experience with a novel population or setting. Further investigation of the impacts on the students and host populations resulting from these initiatives is needed. The purpose of this study was to examine the benefits and harms of short-term international academic experiences completed by rehabilitation students for both the student and the host populations. METHODS: PubMed, Embase, and CINAHL were searched for studies from 1998 through March 2019; any study design was eligible for review. Independent reviewers screened and selected studies. To be eligible, articles had to include a rehabilitation student participating in a short-term clinical or community-based experience. Two independent reviewers extracted data from included studies. Outcomes included benefits and harms of international academic experiences on students and host populations. Oxford Level of Evidence was used for quality assessment. Nineteen studies met eligibility criteria. RESULTS: The most prevalent benefits and harms to students were increases in cultural and clinical competence and emotional health risks. The most prevalent benefits and harms to hosts were novel training and decreased productivity. CONCLUSIONS: Highlighting benefits and harms serves a pivotal role in investigating ways to create more effective, mutually beneficial relationships between home and host populations. Future research should aim for a deeper analysis of the impact of short-term international academic experiences on host populations to develop and deepen sustainable partnerships. IMPACT: With more rehabilitation students engaging in short-term international academic experiences, this review provides important guidance for the profession, including the recommendation that outcomes regarding the potential benefits and harms for home and host populations should be collected at 3 key times: immediately pre-departure for the host country, immediately post-departure in the home country, and 1-year post-arrival in the home country.

Giving undergraduate nursing students international experiences: Issues and strategies.

Educational institutions began international student placements or exchanges in earnest in the 1990s, with varying degrees of success. Although nursing education in a number of countries has embraced giving undergraduate students the opportunity of international experiences, this is still not the norm in many countries, nor within all nursing schools within a country. In our rapidly globalizing world, it is critical that students are given opportunities internationally to be better prepared for practice, to achieve a global mindset, and to take their place as future global citizens through international experiences. Evidence from the literature shows positive effects on nurses having had international experiences to broaden their horizons, examine other cultures, grow their cultural competence, share and gain knowledge with others, and build their capacity for future practice in an increasingly globalized world. Our focus here is on providing students with short-term undergraduate exchanges or placements in international settings, and encouragement for nursing institutions to develop international partnerships that are sustainable. Some implications for nurse educators and other staff involved in international exchanges are also considered.

Finding your feet: student participation during initiation of international clinical placements : Student participation during initiation.

INTRODUCTION: International placements challenge students to find the right level of participation, as local practices, language and time pressure may affect their engagement in patient-related tasks or team activities. This study sought to unpack the initiation process during international clinical placements with the ultimate aim to achieve active student participation. METHODS: Following a constructivist grounded theory approach, we conducted two individual interviews with 15 undergraduate healthcare students (before departure and whilst on placement). To identify emerging themes, we applied an iterative process of data collection and constant comparative analysis. Several team discussions informed further analysis, allowing us to reach a more conceptual level of theory. RESULTS: From our findings we constructed a four-phase model of healthcare students' initiation of international clinical placements, which brings into focus how the phases of 'orientation', 'adjustment' and 'contribution to patient care' build up towards a 'sense of belonging'. We identified several factors that induced active student participation in practice, such as a favourable workplace setting, opportunities for learning and a local support network. DISCUSSION: Active student participation is aimed at different goals, depending on the four phases of initiation that eventually lead to a sense of belonging and support workplace learning.

Building the Bridge to Quality: An Urgent Call to Integrate Quality Improvement and Patient Safety Education With Clinical Care.

Current models of quality improvement and patient safety (QIPS) education are not fully integrated with clinical care delivery, representing a major impediment toward achieving widespread QIPS competency among health professions learners and practitioners. The Royal College of Physicians and Surgeons of Canada organized a 2-day consensus conference in Niagara Falls, Ontario, Canada, called Building the Bridge to Quality, in September 2016. Its goal was to convene an international group of educational and health system leaders, educators, frontline clinicians, learners, and patients to engage in a consensus-building process and generate a list of actionable strategies that individuals and organizations can use to better integrate QIPS education with clinical care.Four strategic directions emerged: prioritize the integration of QIPS education and clinical care, build structures and implement processes to integrate QIPS education and clinical care, build capacity for QIPS education at multiple levels, and align educational and patient outcomes to improve quality and patient safety. Individuals and organizations can refer to the specific tactics associated with the 4 strategic directions to create a road map of targeted actions most relevant to their organizational starting point.To achieve widespread change, collaborative efforts and alignment of intrinsic and extrinsic motivators are needed on an international scale to shift the culture of educational and clinical environments and build bridges that connect training programs and clinical environments, align educational and health system priorities, and improve both learning and care, with the ultimate goal of achieving improved outcomes and experiences for patients, their families, and communities.

Coping: "This Is More Than a Trip-It Is a Journey".

A 2-week community health clinical experience in Ghana, Africa, provided undergraduate nursing students a study abroad opportunity to expand their cross-cultural skills. Journal entries (N = 512) of four cohorts were analyzed for common themes using Atlas.ti 7 in this descriptive qualitative study. No emphasis was placed on how to cope with cultural shock in Ghana, nor any attempt made to teach effective coping skills during the trips. Bochner's ABC cultural learning response model provided the framework for grouping themes. Positive coping skills included the need for control, humor, normalizing, and reframing as well as a need for a break and relaxation. Venting, frustration, and physical ailments were coded as negative responses to culture shock. Due to these findings, student preparation for short-term study abroad should include discussions on effective coping with culture shock during orientation sessions and on-going debriefing.

The CNO US Healthcare Immersion Program, Part 1: A Transformational Leadership Model.

As a result of recent global health events, US health care leaders are strengthening international relationships to share best practices, health research, and support of workforce capacity. The Institute for Healthcare Improvement, the National Academies of Sciences, Engineering, and Medicine, the American Nurses Credentialing Center, and the Joint Commission International have all committed to expanding their vision and mission to improve health and health care globally. To support excellence in international health care delivery, the authors embarked on a Chief Nursing Officer (CNO) US Healthcare Immersion Program. The purpose of the program is to introduce the US nursing leadership competences to China CNO colleagues in preparation for their future role with health care reform.

The CNO US Healthcare Immersion Program, Part 2: Expanding the Footprint of Professional Nursing.

As global leaders, US nurses will have an increasingly recognized role and responsibility in shaping health care in all countries. They should be at the forefront of changing and improving health systems to achieve universal health. Currently, a major health care reform is underway that requires a shift in the professional nursing footprint of China's nurse leaders. These leaders must garner knowledge capital to reinforce ethics, regulations, and standards; use current best practices; implement a comprehensive performance evaluation process; and capture the spirit of caring within their health care environments. Therefore, China is seeking US immersion opportunities for their emerging nurse leaders. Although US Immersion Programs exist, there is scant literature related to international precepting and how transformational learning occurs within this experience. This article introduces a transformational learning experience between US International Nurse Preceptors and a Chief Nursing Officer from Yinchuan, China.

Nursing international student mobility in the University of São Paulo.

OBJECTIVE: To characterize the experiences of undergraduate students of the School of Nursing of the University of São Paulo (EEUSP) who participated in international mobility programs between January 2011 and July 2017. METHOD: Exploratory, descriptive study with quantitative approach. Of 68 reports, only 38 (56%) were considered valid and were submitted to descriptive statistical analysis. Data were categorized in general, institutional, academic and cultural aspects and cost of living. RESULTS: The main destination was Portugal and the years with most participation were 2012 and 2013. The mean stay was six months and the students took a mean of three to four courses. The main funder was the university of origin. CONCLUSION: Academic activities were limited to theoretical and practical courses, with little insertion in research. There is a need to increase investment in learning other languages and to expand partnerships with larger centers of foreign education and research.

Fortalezas y oportunidades de mejora para la movilidad internacional en la formación de Enfermería / Strengths and improvement opportunities for international mobility in nursing education

En los últimos tiempos la apuesta por la internacionalización se ha convertido en un punto clave en las agendas de las universidades a nivel mundial, que han desarrollado para ello programas que fomentan la experiencia internacional del alumnado. En el caso concreto de los estudios de Enfermería, compartir experiencias en diferentes contextos de salud y enfermedad unido a las grandes diferencias entre sistemas sanitarios y el enfoque distintivo de la profesión en cada país aporta una visión global a los estudiantes que finalmente repercutirá en el desarrollo de mejores profesionales con capacidad creativa para aportar mejoras en sus contextos habituales, así como para ejercer profesionalmente en otros lugares. La internacionalización y el contacto del estudiante con un modelo diferente de enseñanza y práctica de enfermería implican el intercambio de conocimientos, la adquisición de nuevos valores profesionales y la agregación de nuevas habilidades para el futuro de la profesión en ambos países involucrados. Sin embargo, a pesar de las fortalezas de la movilidad internacional, también es necesario que las instituciones de educación superior se concentren en oportunidades de mejora todavía no resueltas, como la necesidad de examinar los diferentes mecanismos reguladores que existen en cuanto a prácticas externas curriculares de estudiantes de Ciencias de la Salud en la legislación nacional y europea, los cuales en general son poco específicos y con pocos criterios con los que poder objetivar la calidad de los centros que reciben estudiantes en formación universitaria. A consecuencia de esta necesidad creciente ha surgido el Proyecto Europeo HEALINT (Assuring Quality in International Healthcare Traineeships), financiado por la Comisión Europea dentro de la línea de acción KA2 «Cooperation for innovation and the exchange of good practices» y también en la línea KA2O2 «Strategic partnerships for vocational education and training», cuyo objetivo se centra en desarrollar una herramienta para evaluar y acreditar los estándares de calidad de los centros de prácticas que acogen estudiantes internacionales de Enfermería y asegurar así la calidad de su formación

The internationalization commitment has become a key agenda point for universities worldwide. They develop programs that foster students' international experience. Regarding specifically nursing education, sharing experiences in different health and disease contexts will ultimately result in the development of better and more creative professionals. Getting acquainted with differences between health systems and the distinctive nursing approach professed in each country, provides students with a global vision, enabling them to improve nursing in their countries, and practice professionally in other places. Internationalization and student contact with different models of nursing education and practice involve the exchange of knowledge, the acquisition of new professional values and the aggregation of new skills in both countries involved. However, despite the strengths of international mobility, it is also necessary for higher education institutions to concentrate on opportunities for improvement, such as the need to examine at European level the different regulatory mechanisms that exist regarding external curricular practices of health sciences students in national and European legislation. These are generally not specific enough and have few criteria to objectively assess the quality of institutions receiving university students. As a result, the HEALINT Project (Assuring Quality in International Healthcare Traineeships), funded by the European Commission within KA2 action line «Cooperation for innovation and the exchange of good practices» together with the KA2O2 line «Strategic partnerships for vocational education and training», is aiming to develop a tool to evaluate and certify the quality standards of practice centers hosting international nursing students, ensuring the quality of their training

Role and impact of student pharmacists and a pharmacist on an international interprofessional medical brigade.

BACKGROUND AND PURPOSE: Colleges of pharmacy will be seeking new opportunities to provide student pharmacists with interprofessional and global experiences. The objectives of this paper are to describe an international experience to expand interprofessional and global pharmacy education and to evaluate the roles and impact of fourth-year pharmacy students and a pharmacist integrated into an interprofessional team on a medical brigade to Guatemala. EDUCATIONAL ACTIVITY AND SETTING: In August 2014, two fourth-year student pharmacists and one pharmacist/professor joined a group of 26 pre-medical students from Boston College (BC), six medical doctors and a nursing assistant as part of a one-week medical brigade to Quetzaltenango, Guatemala. An electronic survey was administered to all brigade members upon completion of travel. The survey assessed the most useful services provided by the pharmacist and pharmacy students on the brigade and changes in perspective towards the role of pharmacy on an interprofessional healthcare team. The survey also collected information describing satisfaction with communication, efficiency, professionalism and knowledge of the pharmacy staff. FINDINGS AND DISCUSSION: Pharmacy staff was utilized for knowledge of drug products, therapeutic substitution, counseling and drug dosing/calculations. The brigade directly resulted in an increased likelihood for physicians and students to refer a question to a pharmacist. After this brigade, all non-pharmacy members viewed pharmacists as important members of the medical team and felt better prepared to work as part of a team. SUMMARY: The experience was effective in fostering interprofessional relationships amongst healthcare students and professionals.

Importancia de los intercambios internacionales en la formación científica de estudiantes de medicina / Importance of international exchanges in the scientific training of medical students

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Recommendations for undergraduate medical electives: a UK consensus statement.

INTRODUCTION: Many doctors, across grades and specialities, supervise or advise students and juniors undertaking elective placements. Electives form part of medical curricula on a worldwide scale. The Medical Schools Council (MSC) Electives Committee in the UK identified a gap in the current literature in relation to provision of comprehensive recommendations for the design and management of undergraduate elective programmes. Electives afford many known benefits for medical and other health care students, but the context, and risks (impacting potentially on patient, public and student well-being) are usually different from those associated with 'home' clinical placements. AIM: The aim is to share experiences and good practice within UK Medical Schools, and inform and inspire others involved with similar programmes across the globe. METHOD: This paper reports the results of the formation of a sub-group to draft a set of recommendations, drawing on the reported experiences of academic elective leads across all UK schools, and including input from the MSC, and the student group Medsin (to capture the learner voice). The final document was the result of a national consultative process of four iterations. The end document was approved at school level, e.g. by curriculum committee, by each of the participating schools. RECOMMENDATIONS: The recommendations consolidate the experiences of 30 participating UK medical schools. The consultation process generated 17 pre-departure recommendations, seven during elective recommendations, 11 post elective recommendations and a further four recommendations relating to infectious disease. CONCLUSION: We believe developing elective programmes using collective recommendations will provide a basis for a safer and more structured approach to a medical elective without losing the uniqueness and creative experiences valued by participants. Issues relating to undergraduates leaving their home school to experience medicine in a new context or country replicate across sites, so many recommendations will be transferable internationally.

Symposium "International Medical Students - Support Programs in Practical Application": Networking, best-practice examples and local representation.

The new project "International Medical Students" within the German Medical Students' Association (bvmd) aims at connecting local support programs for international medical students as well as the representation of their interests within the bvmd. Within the frame of this project, the first symposium "International Medical Students - Support Programs in Practical Application" took place from the 12th to the 14th of May 2017 at the Hannover Medical School (MHH). Through partaking in different workshops, 31 participants discussed the framework conditions of local work (i.e. curricula, tutorials, social offers, cooperation between faculty members and student body, legal aspects), common problems (i.e. addressing the target group, funding of support programs) and possible solutions (i.e. targeted advertisement, application for public funds). This report constitutes a summary of the results of these discussions. The feedback from the participants on the need for such a regular exchange and the format of the symposium was positive. However, there were requests for further thematic specification. Based on this feedback the next symposium is planned for 2018.

International Peer-teaching: the LernKlinik Leipzig "Erasmus-Week" for Incoming Erasmus Students.

Introduction: This project report describes the development, pilot phase, evaluation and implementation of a preparatory course week for incoming Erasmus medical students at the LernKlinik Leipzig, the Skills and Simulation Centre of the Medical Faculty, University of Leipzig. Project description: The aim of this project is to prepare Erasmus students for their year abroad using peer-assisted teaching as the method of choice. Major intended outcomes were support of language and clinical practical skill competency development, as well as enhancement of integration among international and German-speaking peer tutors. The methodological framework of Ross and Cameron [1] was used in planning the Erasmus-Week. For planning the 2012 pilot project, a survey among Erasmus students of the academic year 2011/12 was performed. All succeeding cohorts were asked to participate in pre- and post-surveys which were analyzed quantitatively and qualitatively. Results: Between 2012 and 2017, n=173 European medical students spent their Erasmus year in Leipzig. Of these, n=148 (86%) participated in the Erasmus-Week. The country of origin of most Erasmus students was Rumania (20,3%). Among the most positively received aspects of the Erasmus-Week, the active use of German for medical purposes and the use of peer-teaching as the method of choice to learn and repeat basic medical examination skills were mentioned. Students emphasized their wish for being able to participate in further course offers. Conclusions: Offering a preparatory course week for incoming Erasmus students focusing on language and clinical practical skills training using peer-teaching as the method of choice may facilitate the integration of Erasmus students into their foreign medical curriculum. Further studies are underway to elucidate if these experiences influence later professional careers and choice of employment.