1. Lindy McAllister PhD Di Eley PhD Fiona Hawthorne PhD Presentation at SOM T&L Conference November 2010 Maximising learning outcomes for students undertaking international health electives.

2. Overview Make a case for why learning outcomes of International Health Electives (IHEs) need to be ‘examined’ Offer some ways forward on how we might improve the outcomes of IHEs for all stakeholders

3. International health electives For the purposes of this talk I focus on placements which students elect to undertake outside the normal educational context IHEs in non-English speaking environments Often in emerging economies For our context:  4 week placements in year 1  8 week placements later in the program

4. Traditionally, internationalisation of the medical curriculum relied on student mobility IHEs are enjoyed by students – so much so that IHEs are sometimes referred to as medical tourism Dowell, J., & Merrylees, N. (2009). Medical Education, 43, 121-126. Students report IHEs contribute to their knowledge and skill BUT……

5.  Are the outcomes of this learning (knowledge and skills) greater than could have been achieved ‘at home’?  What other ‘value-adding’ has been achieved from the IHE?  Does the benefit To student Host site Staff at host site Patients at host site “The profession”  Outweigh the costs? To student Organising site e.g., admin time Host site and staff

6. There is insufficient evidence of benefits and effectiveness of IHEs Edwards et al., 2004, Medical Education, 38(7), 688 – 690. Learning outcomes are variable because of  lack of structure and preparation Izadnegahadar, R., et al. (2008). Academic Medicine, 83, 2, 192-197.  lack of learning support during IHE  lack of opportunities for reflection and consolidation of learning on return home Eckhert, N. L. (2006). Annals of Family Medicine, 4, Supp 1, S38-39.  Moral and ethical considerations Dowell, J., & Merrylees, N. (2009). Medical Education, 43, 121-126. Benefits to host sites being questioned Miranda, J., et al. (2005). Travel Medicine and Infectious Diseases, 3, 133-141. Risks are unexplored, perhaps unrecognised, often unmanaged Petrosoniak, A., et al. (2010). Medical Education, 44, 683-690.

7.  So, in a climate of financial belt-tightening and risk management, we need to be able to make a better argument for the unique and strong learning outcomes for IHEs  We need to maximise the learning opportunities of IHEs Through better preparation Learning support during placement On return  And utilise the untapped possibilities for learning Global health Intercultural communication Interprofessional education Higher order cognitive skills Higher order personal and interpersonal skills

8. Some strategies for maximising LOs in IHEs Preparation  Global health content UNMDG  Research the health system, health issues, education & welfare systems, literacy levels etc of host country  Module on intercultural competence/communication Principles of culture general vs culture specific  Prior contact with hosts Learning plan with measureable goals In country learning support  Virtual input from staff and peers eg., via online forums, skype  Self-directed learning that links experience to goals of Lg plan  Reflective activities eg., inter- cultural communication failures Return home  Debriefing  Write up of Lg plan outcomes  Critical incident report on significant learning experience  Assignment e.g., resource for host site, webpage etc  Presentations