International Students and Clinical Placement Susan Jackson Occupational Therapy Practice Placement Co-ordinator University of Bradford
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Outline • Context • Challenges • Potential solutions
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Definitions International students Those students who ‘travel to a country different from their own for the purpose of higher education’ (Coles & Swami 2012:87) Clinical educators
Clinicians (Occupational Therapists, Physiotherapists, Nurses, Midwives, Radiographers) in a clinical environment responsible for supporting and assessing students undertaking placement.
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Context • Increasing numbers of International Students (IS) studying in the UK (Verbik & Lasanowski 2007, UK Council for International Student Affairs (UKCISA) 2016) • Internationalisation deemed as a priority strategy across the Higher Education Institute Sector (HM Government 2013, de Wit et al 2015)
• IS’s account for 18% of students studying in UK HEI’s, with the UK being the second most popular destination after the USA (UKCISA 2016) • University of Bradford (UOB) had 1,746 IS from 139 countries studying on campus in 2016/17 (UOB 2016a). • Thirty nine students, mainly from Hong Kong, China and Malaysia, studying in the Division of Allied Health Professions and Sport in 2016/17 4
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Context • Clinical placements are a mandatory element of all courses leading to registration on a professional register (Health and Care Professions Council (HCPC), Nursing and Midwifery Council (NMC), British Association of Sport Rehabilitators and Trainers (BASRaT)) • Anecdotal evidence from clinical educators suggests that International Students struggle more with some elements of placement compared to their home peers.
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1. Language - context • Entry level Occupational Therapist’s should be able to, ‘Build effective therapeutic relationships as the foundation for occupational therapy’ (COT 2014: 7). • Professional communication leads to higher levels of patient satisfaction and co-operation with treatment (Betancourt et al 2003, Wanzer et al, 2004) • BSc. (Hons) Occupational Therapy programme requires an International English Language Test System (ILETS) of 6.5, with no element lower than 6 for entry to the programme (UOB 2016b)
• Language difficulties associated with academic studies are well documented (Andrade 2006, Wu & Hammond 2011) 6
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Cummins model of language acquisition (1984) 1. Basic interpersonal communication skills (BICS) What’s everyone eating for tea tonight?
Development at this level is based on the premise that students will interact socially with peers from the host environment Two Years 7
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2. Cognitive academic language proficiency (CALP) Developed through exposure to situations demanding higher levels of cognitive function such as clinical placement and interactive academic situations such as group work.
Clinical reasoning inextricably linked to CALP Five to seven years 8
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So……. We require students to…..
Achieve an ILETS of 6.5 before they are accepted on to the programme Then….
We expect them to be able to converse with their fellow students in a colloquial manner ………. And… And ……. Begin to use profession specific language (Wook et al. 2016)
Understand, speak and write in ‘academic’ English
wikiHow (no date)
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Thoughtful Minds Web Services PVT Ltd. (2017)
California State University (2017)
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And then…. We send them on placement and expect them to …….. Talk to service users in a non-condescending, yet professional manner using terminology that they will understand and which will help develop a therapeutic relationship…….. Greetings Madam. Please describe your independence in activities of daily living?
• Fear of conversation • Understanding service users
• Selecting the ‘correct’ words in response • Wait time (Ladyshewsky 1996)
Who’s thee callin’ Madam? What’s thee on abaht?
• Selecting topics of conversation • Speed of conversation • Local accents, colloquialisms & metaphors Abu-Arab et al, 2015, Wook et al 2016
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And ……. Converse in a professional manner using clinical terminology with the multi-disciplinary team and clinical educator……..
• Profession specific terminology Fred is an elderly with a dodgy leg
• Incongruent non-verbal communication (Abu-Arab & Parry 2015, Wang & Greenwood 2015)
Is it surprising that difficulties may arise?! 11
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2. Culture Confucian philosophy The idea of a set of ‘norms’ for behaviour Relationships with specific roles and responsibility Respect and deference to authority figures Influence on interpersonal and societal relationships Concept of mianzi (‘face’) (Wang et al. 2005) ‘Ruling by man’ (Wang et al. 2005) ‘Insiders’ and ‘outsiders’ (Wang & Greenwood 2015) Diligence and application of self (Starr 2012) 12
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The Biography.com (2017)
Strategies - University • Identification of ‘at risk’ students with sign posting to support services (O’Reilly & Milner 2015, Chan et al. 2016) • Buddying or mentoring schemes involving home students and ‘senior’ International Students (Boughton et al. 2010, Jeong et al. 2011, O’Reilly & Milner 2015) • Specific placement preparation (Harvey et al. 2013) • Immersion in the local community (Crawford & Candlin 2013) • Language support programmes role play (Abu-Arab & Parry 2015) videos and scenarios (San Miguel et al. 2006) practical application of communication skills (O’Reilly & Milner, 2015) including specific technical language and colloquialisms (Chan et al. 2016) clinical communication strategies replicating clinical tasks, i.e. note writing (Choi 2005). 13
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Strategies - Placement • Sharing of basic information in relation to language and cultural issues with clinical educators during initial educator training and updates • Identification of educator needs in relation to teaching a diverse student population (Yoder 1996)
• Events to share understanding of cultures between students, clinical educators and faculty staff (Edgecombe et al. 2013) • Designated staff to support International Students within the university and whilst on placement (O’Reilly & Milner 2015) • Regular supportive supervision, early and clear settings of expectations and smaller caseloads (Hansen & Beaver 2012)
• Structured induction, time for orientation and time for reflection (Mikkonen et al. 2016)
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Conclusion • Issues of culture discussed in this presentation relate to students from Hong Kong, China and Malaysia • Care must be taken not to generalise issues to all International Students – the notion of the ‘Chinese Learner’ (Clark and Gieve 2006, Signorini 2009) • Many of the issues relating to communication and culture could relate equally to ‘home’ students from diverse backgrounds • Identify the specific needs of your students and educators and formulate targeted support strategies
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Next steps….. MSc. Dissertation working title…. ‘A retrospective, cross-sectional study examining the relationship between duration of residency in the United Kingdom (UK), academic achievement (including clinical placement) and support mechanisms utilised by Occupational Therapy (OT) students studying in a UK Higher Education Institute (HEI).’
Thank you Any questions?
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References Abu-Arab., A & Parry, A. (2015) Supervising culturally and linguistically diverse (CALD) nursing students: A challenge for clinical educators. Nurse Education in Practice 15 e1-e9
Andrade, M.S. (2006) International students in English-speaking universities. Adjustment factors. Journal of Research in International Education. 5(2) 131- 154 Betancourt, J.R., Green, R.A., Carrillo, J.E. & Ananeh-Firempong, O. (2003) Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports 118(4) 293–302. Boughton, M.A., Halliday, L.E. & Brown, L. (2010) A tailored program of support for culturally and linguistically diverse (CALD) nursing students in a graduate entry Masters of Nursing course: A qualitative evaluation of outcomes. Nurse Education in Practice 10, 355-360. California State University (2017) Occupational Therapy word cloud [Image] http://libguides.csudh.edu/OT Accessed 16 August 2017 Chan, A., Purcell, A. & Power, E. (2016) A systematic review of assessment and intervention strategies for effective clinical communication in culturally and linguistically diverse students. Medical Education in Review 50, 898-911. Choi, L.L.S. (2005) Issues surrounding education of English –as-a-second language (ESL) nursing students. Journal of Transcultural Nursing 16(3), 263-267. Clark, R. & Gieve, S.N. (2006) On the discursive construction of ‘The Chinese learner’. Language, Culture and Curriculum 19(1) 54-73 Coles, R. & Swami, V. (2012) The sociocultural adjustment trajectory of international university students and the role of university structures: a qualitative investigation. Journal of Research in International Education 11 87-100 College of Occupational Therapists (2014) College of Occupational Therapists’ learning and development standards for pre-registration education. College of Occupational Therapists. Crawford, T. & Candlin, S. (2013) A literature review of the language needs of nursing students who have English as a second/other language and the effectiveness of English language support programmes. Nurse Education in Practice 13, 181-185. Cummins, J. (1984) Bilingualism and special education: Issues in assessment and pedagogy. College Hill Press. Cited in: Abriam-Yago, K., Yoder, M. & Kataoka-Yahiro, M. (1999) The Cummins model: A framework for teaching nursing students for whom English is a second language. Journal of Transcultural Nursing 10(2) 145.
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References de Wit, H., Hunter, F., Howard, L. & Egron-Polak, E. (2015) Internationalisation of higher education.
http://www.europarl.europa.eu/RegData/etudes/STUD/2015/540370/IPOL_STU(2015)540370_EN.pdf Accessed 3 January 2017 Edgecombe, K., Jennings, M. & Bowden, M. (2013) International nursing students and what impacts their clinical learning: Literature review. Nurse Education Today 33, 138-142. Harvey, T., Robinson, C. & Frohman, R. (2013) Preparing culturally and linguistically diverse nursing students for clinical practice in the health care setting. Journal of Nurse Education 52(7), 365-370. Hansen, E. & Beaver, S. (2012) Faculty support for ESL nursing students: Action plan for success. Nursing Education Perspectives 33(4), 246250. HM Government (2013) International education: global growth and prosperity. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/340600/bis-13-1081-international-education-globalgrowth-and-prosperity-revised.pdf Accessed 3 January 2017 Jeong, Y.S., Hickey, N., Levett-Jones, T., Hoffman, K., Norton, C. & Ohr, S. (2011) Understanding and enhancing the learning experiences of culturally and linguistically diverse nursing students in a bachelor of nursing programme. Nurse Education Today 31(3), 238-244. Ladyshewsky, R. (1996) East meets West: The influence of language and culture in clinical education. Australian Physiotherapy. 42(4) 287-294 Mikkonen, K., Elo, S., Kuivila, H., Tuomikoski, A. & Kaarianinen, M. (2016) Cuturally and linguistically diverse healthcare students’ experiences of learning in a clinical environment. A systematic review of qualitative studies. International Journal of Nursing Studies 54, 173-187. O’Reilly, S. & Milner, J. (2015) Supporting culturally and linguistically diverse students during clinical placement: strategies form both sides of the table. BioMed Central 15, 175 1-12 San Miguel, C. & Rogan, F., Kilstoff, K. & Brown, D. (2006) Clinically speaking: A communication skills program for students from non-English speaking backgrounds. Nurse Education in Practice 6, 268- 274.
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References Signorini, P., Wiesemes, R., Murphy, R. (2009) Developing alternative frameworks for exploring intercultural learning: a critique of Hofstede’s cultural difference model. Teaching in Higher Education 14(3) 253-264 Starr, D. (2012) China and the Confucian Education Model. Universitas 21. http://www.universitas21.com/RelatedFile/Download/300 Accessed 8 December 2016 The Biography.com (2017) Confucius [Image] https://www.biography.com/people/confucius-9254926 Accessed 16 August 2017 Thoughtful Minds Web Services PVT Ltd. (2017) Academic writing word cloud [Image] https://www.thoughtfulminds.org/academic-writing Accessed 16 August 2017 Verbik, L. & Lasanowski, V. (2007) International student mobility: patterns and trends. The Observatory on Borderless Higher Education. https://nccastaff.bournemouth.ac.uk/hncharif/MathsCGs/Desktop/PGCertificate/Assignment%20%2002/International_student_mobility_abridged.pdf Accessed 20 November 2016 United Kingdom Council for International Student Affairs (2016) UKCISA Briefing on international students. http://institutions.ukcisa.org.uk/Info-for-universities-colleges--schools/Publications--research/resources/94/UKCISA-Briefing-oninternational-students Accessed 2 October 2016. University of Bradford (2016 a) Internationalisation Strategy. http://www.bradford.ac.uk/about/media/about/InternationalisationStrategy.pdf Accessed 20 November 2016 University of Bradford (2016 b) Occupational Therapy. http://www.bradford.ac.uk/study/media/courses/ug/booklets/201607/Occupational-Therapy-BSc.pdf Accessed 22 November 2016 Wang, J., Wang, G.G., Ruona, W.E.A. & Rojewski, J.W. (2005) Confucian values and the implications for international HRD. Human Resource Development International 8(3) 311-326 Wang, C.C. & Greenwood, K.M. (2015) Chinese nursing students’ culture-related learning styles and behaviours: A discussion paper. International Journal of Nursing Science 253-258 Wanzer, M. B., Booth-Butterfield, M. & Gruber, K. (2004). Perceptions of health care providers’ communication: Relationships between patient-centered communication and satisfaction. Health Care Communication 16(3) 363-384.
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References wikiHow (no date) Ey up. How’s tha doing? [Image] http://www.wikihow.com/Speak-With-a-Yorkshire-Accent Accessed 16 August 2017 Wook, L J., Honey, A., Du Toit, S., Chen, YW, & Mackenzie, L. (2016) Experiences of international students from Asian backgrounds studying occupational therapy in Australia. Australian Occupational Therapy Journal 63 303-311 Wu, W. & Hammond, M. (2011) Challenges of university adjustment in the UK: a study of East Asian masters degree students. Journal of Further and Higher Education. 35(3) 423-438 Yoder, M. (1996) Instructional responses to ethnically diverse nursing students. Journal of Nursing Education 35(7) 315-321
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Susan Jackson Occupational Therapy Lecturer and Practice Placement Tutor Faculty of Health Studies University of Bradford Richmond Road Bradford West Yorkshire BD7 1DP
[email protected] 01274 235124
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