Going Global: International WIL building future health work force capacity

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1 Going Global: International WIL building future health work force capacity KRISTY TOMLINSON BK TAN HELEN FLAVELL Curtin University, Perth, Australia In recognition of escalating globalisation and a growing diversity in local populations, there is demand for healthcare professionals with cultural competence. Universities have therefore begun incorporating international work-integratedlearning (WIL) experiences into their curricula to produce employable graduates for the global environment. While anecdotal evidence suggests students develop practical skills and capabilities as a result of international WIL, there is little empirical research investigating the degree to which this occurs, the specific learning benefits, and the components of international WIL that contribute to this learning. This study aimed to investigate how Health Science graduates and teaching staff perceived the value of an international WIL experience in building generic graduate attributes. Questionnaires using the Graduate Employability Indicators were completed by graduates and teaching staff to measure their perceptions of the extent to which international WIL contributes to the attainment of graduate attributes. Findings of this study indicate that graduates and teaching staff perceive that international WIL experiences enhance important graduate attributes including intercultural understanding, understanding different social contexts, contributing to the welfare of communities, teamwork, problemsolving and thinking critically and analytically. This suggests that international WIL can facilitate the development of key graduate attributes that will serve to build the capacity of the future health workforce for a global environment. Keywords: Work-integrated-learning, students, international fieldwork, employability, graduate attributes INTRODUCTION With the increasing spotlight on work integrated learning (WIL) as a means to provide authentic learning experiences for students to develop their graduate capabilities, fieldwork programs are becoming more important within the curriculum. Fieldwork is seen as the main instrument of integrating theory and practice, enabling students to deal with the real world and to apply and test theories and principles of their chosen profession (Bonello, 2001; WFOT, 2002). The forces of internationalisation and globalisation have caused higher education institutions to recognise the importance of incorporating international elements into their graduate attribute statements (Harvey & Bowers-Brown, 2004; Cranmer, 2006); to produce capable and employable graduates. Many tertiary institutions have responded by augmenting learning experiences through the internationalisation of curricula and by offering students opportunities to participate in international practice placement education (Westcott & Whitcombe, 2003, Kinsella et al., 2008). In light of the growing demand for globalised graduates, the prospect of international WIL fieldwork programs has become a favourable option. Despite the professional and personal benefits that have been attributed to international fieldwork, the recognition that employers value an international perspective and the increasing focus of Australian higher education on employability, little has been written about how international fieldwork experiences impact on graduate employability (Crossman & Clarke, 2010). Employability encompasses a range of capabilities and attributes, additional to cultural sensitivity and global perspective, that have not been explored in research pertaining to international fieldwork. It is therefore necessary to systematically investigate whether international fieldwork programs support the attainment of the suite of generic graduate attributes that contribute to employability in Health Science graduates. The aim of this study was to determine whether graduates and teaching staff perceive that participation in an international WIL program enabled the development of generic university graduate attributes. METHODOLOGY Research Setting The international WIL fieldwork program explored in this study is Curtin University s Go Global program. The Go Global program is a nationally recognised international and interprofessional program that offers crosscultural clinical placement opportunities for final year students from different disciplines across the Faculty of 1

2 Health Science. This program received the Australian Learning and Teaching Council (ALTC) Award in 2010 for a program that enhances learning as it creates opportunities for students to develop skills and apply knowledge in a service-learning context, with the aim to work with host partners to improve health care service delivery to the local communities. Placements currently occur at four international partner sites in China, India, Cambodia and the Ukraine and are four weeks in duration. Participants and recruitment Go Global graduates were selected from the Go Global Alumni membership database. To participate, graduates were required to have more than six months work experience since completing their degree and must have completed a Go Global placement within the last five years. All academic staff members involved in the Go Global program were invited to participate. These included Fieldwork Coordinators, Country Coordinators for the four host countries, and clinical supervisors. An was sent directly to the relevant graduates and teaching staff inviting them to complete the questionnaire electronically using Qualtrics software, Version [2013], (Provo, UT). A participant information sheet and informed consent form were also included in the . Approval for this study was granted by the Human Research Ethics Committee of Curtin University (HR173/2011). Tools and procedures The Graduate Employability Indicators (GEIs) was developed as a result of an Australian Learning and Teaching Council (ALTC) Competitive Grant, Building course team capacity to enhance graduate employability led by Beverley Oliver (2011). The GEIs comprise of three online employability surveys which capture the perceptions of graduates, employers and teaching staff on the importance of key capabilities to new graduates early professional success, and the extent to which those capabilities are demonstrated by new graduates. The GEIs were designed to provide valuable information about the effectiveness of a course in nurturing employability capabilities from the perspectives of each of the relevant stakeholders (Oliver et al., 2011). The questionnaires gather data on: a. The extent to which new graduates demonstrate each of the graduate capabilities as a result of participating in their course b. The importance of each capability to the employment success of new graduates For this study, modified versions of the GEIs were used to capture graduate and teaching staff perceptions of the extent to which Curtin University s Go Global program contributes to the attainment of important graduate attributes for employability. Go Global graduates were asked to rate the importance of 15 graduate attributes to the employment success of new graduates in their chosen profession (e.g., Occupational Therapy). Teaching staff were asked to rate the importance of these attributes to the employment success of new graduates of a Health Science degree in general. Options were very little importance, some importance, quite important or very important. The 15 attributes (Appendix 1) address the range of skills and personal qualities evident in pre-existing surveys currently recognised by various universities Graduate Attributes across Australia (Oliver, 2010). Graduates were also asked to give a rating of the extent to which their Go Global experience contributed to their development of the same 15 graduate attributes. Teaching staff were also asked to rate the extent that new graduates generally demonstrate each of the attributes as a result of participating in Go Global. Options were very little, some, quite a bit and very much. Responses to this question therefore aimed to collect data on the type of skills, attributes and qualities that Go Global offers students who participate in the program. Data analysis For ease of interpretation, responses regarding importance to employability were collapsed into two categories: i) more important which included responses indicating quite important and very important or ii) less important which included responses indicating very little importance and some importance. Similarly, responses to the extent to which attributes are demonstrated/developed as a result of participating in the Go Global were grouped as i) more ( quite a bit and very much ) or less ( very little and some ). 2

3 Data were analysed using descriptive statistics to present frequencies. Radar charts are presented to visually demonstrate any difference and the size of the gap between the respondents ratings of important attribute to employability and extent to which the attribute was developed through Go Global for each of the graduate attributes. RESEARCH FINDINGS Go Global graduates A total of 152 questionnaires were distributed to Go Global graduates, of which 49 (32.24%) were returned and used for data analysis. The majority of respondents were female (96%) with about 70% of them within the age range (Table 1). The majority of the respondents were either Occupational Therapists (67%) Speech Pathologists (18%) or Physiotherapists (12%). About half (51%) of the respondents graduated within the last 2 years and 84% of them are currently in full-time employment (Table 1). TABLE 1. Demographic characteristics of Go Global graduates (N=49) Characteristics N % Gender Female 47 96% Male 2 4% Age group 21 or younger 2 4% % % 30 or older 2 4% Number of years since completion of Go Global Less than 1 1 year ago 11 22% 2 years ago 14 29% 3 years ago 7 14% 4 years ago 7 14% 5 years ago 8 16% More than 5 years ago 2 4% Course enrolled in at time of Go Global placement Physiotherapy 6 12% Occupational Therapy 33 67% Speech Pathology 9 18% Pharmacy 1 2% Current employment status Full-time 41 84% Part-time 4 8% Not currently employed 4 8% Current location of employment Australia 39 87% Europe 5 11% Other 1 2% Location category of current employment Rural/Remote 5 11% Urban/Suburban 40 89% At least 65.3% of the Go Global graduates indicated that all 15 attributes were more important to the employment success of new graduates. More than 90% of graduates identified that the attributes of 1. Understanding people of other racial and ethnic backgrounds, 2. Understanding different social contexts, 3. Contributing to the welfare of communities, and 4. Working effectively with others were demonstrated more as a result of participating in Go Global. At least 63.3% indicated that 10 out of the 15 attributes were demonstrated more as a result of participating in Go Global. A summary of the graduate attributes that graduates considered more developed or less developed as a result of participating in Go Global is presented in Tables 2 and 3. 3

4 TABLE 2. A summary of the graduate attributes that graduates considered more developed as a result of participating in Go Global Graduate attribute Percentage of Go Global graduates identifying the attribute as more developed Understanding people of other racial and ethnic 98% backgrounds Understanding different social contexts 95.9% Contributing to the welfare of communities 93.9% Working effectively with others 91.8% Solving complex, real-world problems 87.7% Thinking critically and analytically 83.7% Developing a personal code of values and ethics 79.6% Overall work-readiness 67.3% Learning effectively on your own 65.3% Speaking clearly and effectively 63.3% TABLE 3. A summary of the graduate attributes that graduates considered less developed as a result of participating in Go Global Graduate attribute Percentage of Go Global graduates identifying the attribute as less developed Using computers and information technology 83.7% Writing clearly and effectively 77.5% Work related knowledge and skills 65.3% Analysing quantitative problems 57.1% Developing general industry awareness 55.1% A graphical comparison between the perceived importance of each attribute for employability and the extent to which the attributes were developed as the result of Go Global identified four graduate attributes that were very consistent, that is, there were no gap or only a small gap between these two responses (Figure 1). These attributes were teamwork, intercultural understanding, problem solving and social context (Figure 1). Three attributes were however perceived as more developed as a result of Go Global than their importance in contributing to employability and these were intercultural understanding, community engagement and social contexts. FIGURE 1. Radar chart of Go Global graduates perceptions Figure 1 contains a Radar chart comparing the Go Global graduates perceptions of the extent the Go Global program contributes to capability development (blue line) with the importance of those capabilities for employability (red line). Quantitative items = percentage of graduates who stated more agreement to statements regarding importance/developed in Go Global. 4

5 Teaching Team Twenty questionnaires were distributed to Go Global teaching team members, of which 15 (75%) were returned. The majority of the teaching staff in this study were females (80%) with varying years of working experience in the university setting (Table 4). Most of the staff considered themselves as having extensive industry experience (73.33%), having worked in a Health Science related field for more than five years either as a clinician, a researcher or a consultant. Of the 15 staff who responded, 14 (93.3%) indicated very recent experience (in the last 1-2 years) with Go Global (Table 4). TABLE 4. Demographic characteristics of Teaching Team involved with the Go Global program (N=15) Question Possible responses N % Gender Male 3 20% Female 12 80% Type of contract Full-time continuing contract Full-time fixed-term contract Part-time continuing contract Part-time fixed contract % 27% 7% 33.3% Sessional/casual contract 1 7% Years teaching at the university 3 years or less % Between 4 and 7 years % More than 7 years % Extent of industry experience* More extensive % Moderately extensive % Recentness of experience related to the Go past 1-2 years % Global program** 3-5 years ago 1 7% Note. *Extent of industry experience refers to participants experience in industries either as a full time, part-time clinician, researcher or consultant related to a Health Science degree (e.g. Occupational Therapy) and were categorised as: More extensive, if they have had experience for more than 5 years; Moderately extensive, between 1 and 5 years or Less extensive less than a year. At least 80% (n = 12) of the teaching team members indicated that all 15 attributes were more important to the employment success of new graduates. 100% of the teaching team respondents identified seven attributes as being demonstrated more as a result of participating in Go Global. At least 53.8% of teaching team members (n = 7) indicated that 12 out of the 15 attributes were demonstrated more as a result of participating in Go Global. A summary of the graduate attributes that the teaching team members considered more developed or less developed as a result of participating in Go Global is presented in Tables 5 and 6. TABLE 5. A summary of the graduate attributes that teaching staff considered more developed as a result of participating in Go Global Graduate attribute Percentage of Go Global graduates identifying the attribute as more developed Understanding people of other racial and ethnic 100% backgrounds Understanding different social contexts 100% Contributing to the welfare of communities 100% Working effectively with others 100% Solving complex, real-world problems 100% Learning effectively on your own 100% Developing a personal code of values and ethics 100% Overall work-readiness 92.3% Speaking clearly and effectively 84.6% Thinking critically and analytically 84.6% Work related knowledge and skills 69.2% Developing general industry awareness 53.8% 5

6 TABLE 6. A summary of the graduate attributes that teaching staff considered less developed as a result of participating in Go Global Graduate attribute Percentage of Go Global graduates identifying the attribute as less developed Using computers and information technology 84.6% Writing clearly and effectively 62.2% Analysing quantitative problems 61.5% A graphical comparison between the perceived importance of each attribute for employability and the extent to which the attributes were developed as the result of Go Global identified seven graduate attributes that were very consistent, that is, there were no gap or only a small gap between these two responses (Figure 2). These attributes were teamwork, independent learning, intercultural understanding, problem solving, values and ethics, industry awareness and social context (Figure 2). The attribute, community engagement, was however perceived as more developed as a result of Go Global than its importance in contributing to employability (Figure 2). Figure 2 illustrates the perceived extent to which learning opportunities provided by the Go Global program are enabling the development of desired/important attributes for employment from the teaching staffs perspectives. FIGURE 2. Radar chart of teaching team members perceptions Figure 2 contains a Radar chart comparing the teaching team s perceptions of the extent the Go Global program contributes to capability development (blue line) with the importance of those capabilities for employability (red line). Quantitative items = percentage of teaching team members who stated more agreement to statements regarding importance/developed in Go Global. DISCUSSION The impact of international fieldwork programs on the attainment of the suite of generic graduate attributes that contribute to employability is currently not well documented. This study investigated the perception of both graduates and teaching staff regarding the impact of an international WIL program (Go Global) on the attainment of graduate attributes that will contribute to employability. According to the graduates in this study, the main graduate attributes that are perceived as important for graduate success and were developed through the Go Global experience were 1) intercultural understanding, inferring understanding people of other racial and ethnic backgrounds, 2) understanding different social contexts, 3) contributing to the welfare of communities, 4) teamwork, that is the ability to work effectively with others, 5) solving complex, real-world problems and 6) thinking critically and analytically. These findings were supported by teaching team members who perceived consistently similar main graduate attributes that are important for graduate success and those developed through the Go Global experience. The teaching staff identified more attributes compared to the graduates and 6

7 this possibly could be due to exposure to more students and across different years and therefore based their perception on a wider range of students they have encountered in their teaching experience. The findings suggest that the Go Global experience provided learning opportunities that facilitated the development of key attributes for employment. These findings support those found in other earlier studies that have investigated the learning benefits of international fieldwork. Studies of various international fieldwork programs often indicate that students report an increase in their cultural sensitivity as a result of participating in the experience (Anderson et al., 2006; Gilin & Young, 2009; Tesoriero, 2006; Simonelis et al., 2011), which is reflected in the attribute of understanding people of other racial and ethnic backgrounds in this study. Furthermore, students and teaching staff reported that the Go Global experience developed students understanding of different social contexts, which is reflected in studies by Callister & Harmer (2006) and DeDee & Stewart (2003). The findings of this study also add to the current literature on international WIL fieldwork, as new employability attributes are identified. For example, additional attributes to the commonly reported cultural sensitivity, personal and professional growth and the development of professional identity have been identified as being developed through an international WIL placement. This study, however, focussed on Health Science students and a health-related international fieldwork program, therefore making direct comparisons to other international WIL programs e.g. business (Crossman & Clarke, 2010) or environmental science (Lumkes et al., 2012) not possible. The design of the Go Global program may potentially facilitate in the development of these graduate attributes. The interprofessional nature of the placement may contribute to the students development of effective teamwork and communication, when compared to other international WIL experiences where students travel independently or in uni-professional groups (Simonelis et al., 2011, Barker et al., 2010, Gilin &Young, 2009). While the duration of the placement, being four weeks, may facilitate greater community engagement and understanding of the social context (identified by both staff and graduates) when compared to other international WIL experiences where students spend a shorter duration in the host country (DeDee & Stewart, 2003) and, hence, have little opportunity to develop an engagement with the local community or understanding of the social context. In addition, the distant-supervision structure of the program may also serve to support students develop problem-solving skills and the ability to think critically and analytically, which was identified by both staff and graduates. The ethos of the program may further contribute, as the service-learning model may support the development of skills of contributing to the welfare of communities and understanding people of other racial and ethnic backgrounds. These findings could serve to shape and inform teaching practice across other universities, as other international WIL programs could replicate these elements in their program design to facilitate the attainment of graduate attributes. This study is limited by its small sample size - particularly that of the teaching staff members and the relatively low response rate from the graduates. The small staffing structure of the Go Global program made this unavoidable and the data consequently represented a small cohort. The study was also limited to the Go Global context, and therefore the results have reduced generalisability to other international WIL programs. Future studies should include multiple international WIL programs across faculties and universities. Given that internationalisation of tertiary education programs across Australia is likely to continue to increase in future years, there needs to be collective vigilance regarding the development of such programs with respect to quality and impact on graduate employability. CONCLUSION This study suggests that international WIL fieldwork programs are highly valuable learning experiences that can facilitate the development of key graduate attributes beyond those reported in the literature. Important attributes for new graduate success including intercultural understanding, understanding different social contexts, contributing to the welfare of communities, teamwork, problem-solving and thinking critically and analytically can be developed through participation in the Go Global program. This suggests that international WIL can be a means of building the capacity of the future health workforce for a global environment. REFERENCES Anderson, P., Lawton, L., Rexeisen, R. & Hubbard, A. (2006). Short-term study abroad and intercultural sensitivity: A pilot study. International Journal of Intercultural Relations, 30(4),

8 Barker, A., Kinsella, E., Bossers, A., (2010). Learning in international practice placement education: a grounded theory study. The British Journal of Occupational Therapy, 73, 1, 29-37(9) 2010 Bonello, M. (2001). Fieldwork within the context of higher education: a literature review. British Journal of Occupational Therapy, 64, Clark Callister, L. and Harmer Cox, A. (2006), Opening our hearts and minds: The meaning of international clinical nursing electives in the personal and professional lives of nurses. Nursing & Health Sciences, 8: Cranmer, S. (2006). Enhancing graduate employability: Best intentions and mixed outcomes. Studies in Higher Education, 31(2), Crossman, J. E. and Clarke, M. (2010). International experience and graduate employability. Higher Education, 59(5), DeDee, L. S., & Stewart, S. (2003). The effect of student participation in international study. Journal of Professional Nursing, 19(4), Gilin, B., & Young, T. (2009). Educational benefits of international experiential learning in an MSW program. International Social Work, 52, Harvey, L., & Bowers-Brown, T. (2004).Employability cross country comparisons. Graduate Market Trends. Winter 2004/5. Kinsella, E., Bossers, A. & Ferreira, D. (2008). Enablers and challenges to international practice education: A case study. Learning in Health and Social Care, 7, Lumkes, J.H., Hallett, S. & Vallade, L. (2012). Hearing versus experiencing: The impact of a short-term study abroad experience in China on students perceptions regarding globalization and cultural awareness. International Journal of Intercultural Relations. 36(1), Oliver, B. (2010). Teaching Fellowship: Benchmarking Partnerships for Graduate Employability. Sydney: Australian Learning and Teaching Council. Oliver, B., Whelan, B., Hunt, L., Hammer, S., Jones, S., Pearce, A., & Henderson, F. (2011). Introducing the graduate employability indicators. Australian Learning and Teaching Council. Qualtrics software, Version [2013], (Provo, UT) Simonelis, J., Njelesani, J., Novak, L., Kuzma, C., & Cameron, D. (2011). International fieldwork placements and occupational therapy: Lived experiences of the major stakeholders. Australian Occupational Therapy Journal, 58(5), Tesoriero,F. (2006). Personal Growth Towards Intercultural Competence Through an International Field Education Programme. Australian Social Work, 59(2): Westcott,.L, & Whitcombe. SW. (2003) Globalisation and occupational therapy: poles apart? British Journal of Occupational Therapy, 66(7), World Federation of Occupational Therapists (2002). Revised minimum standards for the education of occupational therapists. In: C Hocking, NE Ness, eds. The Council of the World Federation of Occupational Therapists WFOT. Copyright 2014 Kristy Tomlinson, Bk Tan & Helen Flavell The author(s) assign to the Australian Collaborative Education Network Limited, an educational non-profit institution, a nonexclusive licence to use this article for the purposes of the institution, provided that the article is used in full and this copyright statement is reproduced. The author(s) also grant a non-exclusive licence to the Australian Collaborative Education Network to publish this document on the ACEN website, and in other formats, for the Proceedings of the ACEN National Conference, Gold Coast Any other use is prohibited without the express permission of the author(s). 8

9 APPENDIX 1 Graduate capabilities (Oliver, 2010) Abbreviated title Full text in survey 1. Knowledge Work related knowledge and skills 2. Writing Writing clearly and effectively 3. Speaking Speaking clearly and effectively 4. Thinking Thinking critically and analytically 5. Quantitative Analysing quantitative problems 6. Using ICT Using computing and information technology 7. Teamwork Working effectively with others 8. Independent Learning Learning effectively on your own 9. Intercultural Understanding Understanding people of other racial and ethnic backgrounds 10. Problem-solving Solving complex, real-world problems 11. Values & Ethics Developing a personal code of values and ethics 12. Community Engagement Contributing to the welfare of your community 13. Industry awareness Developing general industry awareness 14. Social contexts Understanding different social contexts Appendix 1. List of 15 graduate attributes identified by Oliver (2010) that are used in this study. 9

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