Global health-based virtual exchange to improve intercultural competency in students: Long-lasting impacts and areas for improvement

Introduction

As public health expands its role in global settings, the need to develop intercultural competency for public health students also grows. One initiative being applied to promote global awareness is the use of virtual exchange (VE) programs. VE programs promote collaborative online international learning (COIL) and allow students from different countries to connect and work together on projects related to their field of study; however, there is little research around the long-term impacts of these programs.

Methods

Undergraduate pre-health students from the United States who participated in a VE program a year prior were interviewed about their experiences engaging with undergraduate medical students in Egypt. They were asked if the experience impacted their current behaviors, skills, or knowledge, and what improvements could be made to the program. Mezirow's Transformative Learning Theory (TLT) served as the theoretical framework, grounding interview instrument development and directed content analysis procedures. Researchers also engaged in inductive analysis to capture other salient themes.

Results

Ten students were interviewed with a majority engaging in either of the two final stages of Mezirow's TLT: "building of self-confidence and self-competence" (60%) and "reintegration" (50%). Other salient themes found were intercultural interactions, VE appreciation, and VE improvements. When describing their experience in one word, students overwhelmingly provided words with positive connotations (80%), with the negative responses being explained by the structure and presentation of the VE.

Discussion

Students were able to apply lessons they learned during the VE within a 1-year follow-up period. This is beneficial, as health professionals require intercultural competency to promote and provide improved health outcomes. Results from this study indicate the need for structure when conducting a VE, addressing the need to increase the number of direct interactions and thereby promoting more intercultural exchanges. Likewise, the interviews demonstrated that changes in course instruction need to be implemented gradually to allow for students to adjust to unfamiliar teaching methods.

Transforming Perspectives Through Virtual Exchange: A US-Egypt Partnership Part 2

Collaborative online international learning programs, such as virtual exchange, that utilize telecollaborative activities have been integrated into more classrooms within the higher education setting. These programs provide students exposure to international cultures, perspectives, and ideas is no longer considered "value added", but a prerequisite to entering many workforces. These programmatic objectives compliment Mezirow's Transformative Learning Theory, that substantiates two major elements of transformative learning are critical reflection and dialectical discourse. This study presents the second half of a qualitative inquiry into the prominent themes that arose during a virtual exchange that was conducted in March 2021 between students in the United States (US) enrolled in a global public health course and Egyptian microbiology students. This study sought to expand upon the Transformative Learning Theory through inductive analysis procedures to offer a modernized adaptation of the theoretical framework within international learning environments. Student responses enrolled in an undergraduate global public health course were collected and analyzed by two coders using inductive/open coding to identify salient codes. These codes were then summarized into categories and subsequently defined. Resulting themes include Connectedness, Openness, Acquisition of Knowledge and Skills, Communication, Cultural Identity, Anticipation of Options for New Roles, Relationships, and Actions, and Absence of Change. Several themes have corresponding categories and subcategories. Adult learning environments such as the modern college classroom have changed with the introduction and reliance upon online learning domains, as well as the diversification of higher education student demographics, accentuating the need to inductively analyze student learning processes and outcomes. In doing so, our findings provide a modernized adaptation of the Transformative Learning Theory that allows for adult learning theorists, researchers, and scholars to integrate tenets of transformative learning more appropriately. As such, this provides an opportunity for educators to coalesce the identified mechanisms (e.g., openness, cultural background, anticipation of roles and relationships) to bolster student's willingness and ability to engage in transformative critical reflections. By capitalizing on students' innate characteristics, such as open-mindedness predispositions and cultural background, educators are able to augment transformative learning strategies through tailored assignments and course activities.

Transforming Perspectives Through Virtual Exchange: A US-Egypt Partnership Part 1

With more classrooms within higher education mobilizing strategies for internationalization, collaborative online international learning (COIL), also referred to as virtual exchange, is an effective approach at offering intercultural competence through experiential learning. This strategy provides students who face barriers to international travel the opportunity to engage with students from other countries in meaningful ways, while enhancing and reinforcing course content. Grounded in the transformative learning theory, this study evaluates the effectiveness of a virtual exchange that was implemented within an undergraduate global public health course. The virtual exchange connected students from the University of Florida (within the US) with medical students in a microbiology course at Ain Shams University in Cairo, Egypt. Using adapted reflection prompts, we assessed the students' knowledge and learning before, during, and after the virtual exchange. This was coupled with a final paper to capture how personal backgrounds and experiences may contribute to their perception of the virtual exchange, as well as if they felt their global perspective had changed or shifted during the experience. Using directed content analysis for each of the measurements, two researchers coded the data independently to then present agreed upon salient themes to the larger group. Of the 28 randomly sampled students who participated in the virtual exchange, seven major themes emerged from the data: Connectedness; Openness; Acquisition of Knowledge and Skills; Communication; Cultural Identity; Anticipation of Options for New Roles, Relationships, and Actions; and Absence of Change. Through this evaluation it was clear there was a variance of different perspectives with many sampled students having diverse lived experiences that influenced their worldview prior to the virtual exchange. Despite course-related barriers, students acknowledged several facilitating factors that improved their intercultural competence and knowledge of course content. The integration of a virtual exchange within the classroom, with careful design and implementation, can provide a unique experience for students and an inclusive approach to learning.

Examining Cross-Age Experiences in a Distance-Based Intergenerational Music Project: Comfort and Expectations in Collaborating With Opposite Generation Through "Virtual" Exchanges

There has been an increase in the number of music-based intergenerational programs conducted by music therapists as part of wellness and intergenerational music therapy programs. Research has shown that intergenerational music therapy programs have improved cross-age attitudes, interactions, and older adults' psychosocial well-being. Anecdotal evidence indicates that one of the challenges for creating music-based intergenerational programs is finding agencies that serve younger and older generations within close proximity to one another. We sought to remedy this problem with the integration of "virtual" technology. The purpose of this study was to examine changes in cross-age comfort, expectations after experiencing "virtual" exchanges, and preconceived notions of older and younger persons enrolled in a distance-based intergenerational project. A secondary purpose was to determine what intergenerational project factors were most enjoyable for older and younger participants. Eighteen older adults (61 through 79 years old) from an intact music-therapy choir along and 14 younger children from an intact community choir (9 through 14 years old) served as participants for the current study. All participants experienced the 4-week distance-based intergenerational program that consisted of: (a) two group "virtual" exchanges, (b) two reflective journals related to the "virtual" exchanges, (c) an in-person half-day music-therapy intergenerational workshop, and (d) a joint performance. Cross-age comfort, preconceived notions, expectations, and preference factors were examined through pre-test and post-test measurements. Results indicated an increase in older adults' comfort level collaborating with children after participation in the intergenerational music project. The majority of younger (64%) and older (69%) participants indicated that their preconceived notions about the other generation were different and positive from what they initially thought prior to the project. Both generations indicated an improvement in cross-age attitudes and interactions due to the collaboration process ("virtual" exchange, workshop, and joint-performance) and the cross-age interactions during the project. These findings suggest that music therapists can foster cross-age interactions and relationships between generations that are not within close proximity of one another by using a combination of "virtual" and "live" interactions as an intervention for enhancing the overall quality of life among older adults.