Perceived Impact on Physical Therapist Students of an International Pro Bono Clinical Education Experience in a Developing Country

Journal of Physical Therapy Education, Fall 2004 by Sawyer, Karen L, Lopopolo, Rosalie

Background and Purpose. Many physical therapists (PTs) will encounter patients from various cultures and backgrounds during their careers. A challenge to professional (entry-level) PT curricula is to prepare its graduates for practice in a rapidly changing society in a shrinking world. Nursing and medical curricula have investigated the benefits of international clinical education programs to their students. No research in this area was found in the physical therapy literature. The purpose of this study was to investigate the perceived impact of a 1-week physical therapy clinical education experience in Jamaica on the student participants. Subjects. The participants were 8 third-year students in the professional Doctor of Physical Therapy (DPT) degree program of Arcadia University's class of 2002. Methods. Individual responses to an e-mailed open-ended questionnaire served as the foundation for the focus group discussion in which all eight students participated. The focus group was conducted an average of 5 months after the international experience. Data from the transcribed focus group led to the development of a conceptual model. Categories and themes emerged from additional qualitative analysis of the data. Results. Students perceived benefits of participation in an international clinical education program in four categories: an expanded worldview, an expanded view of physical therapist practice, changes within themselves, and changes within themselves in the role of PT student. Discussion and Conclusion. Results of this study agree with several findings from the nursing and medical literature concerning the perceived benefits of an international educational experience. Physical therapist students appeared to perceive that an international clinical education experience has important, broadening, and lasting benefits to them as professionals, individuals, and members of a global society.

Key Words: Developing country, Physical therapist student clinical education, Pro bono, Self-perceptions.

INTRODUCTION

A primary challenge to a physical therapist (PT) curriculum is to prepare its graduates for effective clinical practice in a wide range of health care setUnRS and cultures.1,2 The ease of travel across country boarders, the mtemationalization of corporations with offices throughout the world, and the demand for health care practitioners across the globe all suggest that the graduate might practice outside the United States during the course of his or her career.3-5 in addition to a shrinking world, the graduate will encounter patients from many cultures and backgrounds in practices within the United States.6,7 The ethnic diversity of patient populations within the American health care system and the ability of PTs to practice within the health care systems of other countries reinforce the need to prepare students for clinical practice broadly and globally.

The mission of Arcadia University is to prepare students for life In a rapidly changing global society.1 The Physical Therapy Program, in supporting the university's mission, sees its mission as the education and socialization of students who are expected to perform successfully in meeting the current and future needs of the profession and the health care system.2 Exposing PT students to different cultures, health care systems, and patient/client management models are critical ways to meet the missions of the university and program. Although exposure dues occur in the classroom and clinical education experiences within the United Stales, student participation in an international professional experience appears to have potential as an ideal way for students to internalize, own, and exhibit the stated mission.

Currently, the program offers two international clinical education experiences for its students: a clinical internship (8-12 weeks) in London, and a 1-week international clinical education experience in a developing country, Jamaica. The former focuses on the role of the PT in a different culture and health care system, whereas the latter exposes Ae student to a region of the world in which PT services are not readily available. To date, 15 students have elected to go to London over an 8-year period, and 34 students have traveled to Jamaica over a 7-year period.

Students are evaluated during and at the conclusion of their clinical education experience using the Clinical Performance Instrument.^ Physical therapist curricula are evaluated for compliance with evaluative criteria established by the Commission on Accreditation in Physical Therapy Education.10 Both documents highlight the importance of understanding individual and cultural differences as well as the economic factors of the patient populations. The ability to screen patients, educate carcgivers, and refer to other health care providers are skills students need to acquire with many patient populations and in diverse settings. Finally, a commitment to providing pro bono services is a professional responsibility outlined in the APTA Guide for Professional Conduct.11 A clinical education experience in a developing country is a way for PT students to begin providing services to individuals who cannot access or afford them. This opportunity during their professional preparation may increase the likelihood that students will seek similar opportunities as clinicians.12 In addition, active participation in pro bono or volunteer projects may continue past one's career and into retirement.13