Experiences within a cross-cultural academic exchange programme and impacts on personal and professional development

Abstract

Introduction

As society becomes increasingly internationalised, it is important to consider international perspectives on occupational therapy education. There is little research on the experiences and impacts of international learning opportunities such as through academic exchange programmes. The aim of this study was to explore the impacts of an international academic exchange programme among occupational therapy students.

Methods

This study was conducted as a qualitative research study. Data were collected by in-depth semi-structured interviews with nine participants (three men and six women) who participated in an exchange programme at Thomas Jefferson University in the United States and graduated from Kitasato University in Japan. A grounded theory approach was used to analyse the qualitative data.

Findings

Educational outcomes were sorted into four categories: experience, reaction, learning and behaviour. Knowledge and experience gained from the international exchange programme had a positive impact on the personal and professional development of the participants. Participants reported that the programme helped them in acceptance of diversity, collaborating beyond boundaries and gaining confidence from challenges. These impacts persisted even after they graduated.

Conclusions

In an increasingly globalised world, internationalisation of occupational therapy education is significant to build a global community of occupational therapists who seek to improve their practice.

Keywords

Occupational therapy education internationalisation qualitative research academic exchange occupational therapy students

Introduction

As society becomes increasingly internationalised, it is important to build and sustain mutual relationships between countries. As Knight (2008) has mentioned, internationalisation is occurring rapidly in the field of education. More specifically, Horton (2009) stated that internationalisation is an important tool that occupational therapy education programmes can use to prepare students for the new opportunities presented by the widening scope of occupational therapy practice. The World Federation of Occupational Therapists (2016) asserted that the world trend towards internationalisation is widespread; therefore, an international perspective on occupational therapy education is warranted. Some academic occupational therapy programmes have started to provide international learning experiences, which offer students the opportunity to participate in international practice placements (Barker et al., 2010; Davies et al., 2017; Haro et al., 2014; Kinsella et al., 2008; Lalor et al., 2019; Mu et al., 2016; Shields et al., 2016). Carey et al. (2019) suggested that international experiences can foster an appreciation of cultural similarities and respect for cultural differences, which can enhance occupational therapy delivery. However, as far as we know, little research is available on the experiences and impacts of international academic exchange programmes in entry-level occupational therapy education. As Andrich (2020) discussed, educators who plan international programmes must be explicit about learning objectives and expected educational outcomes. Because there is a need to assess learning outcomes for education abroad, our research was conducted to answer the following question: How did experiences in international academic exchange programmes for entry-level occupational therapy education impact personal and professional development as an occupational therapist?

Literature review

Van Damme (2001) suggested that we have come to the point where issues of quality and quality assurance are no longer avoidable in the development of internationalisation in higher education. In medical education, it has been said that international activities will increasingly affect the core of medical educational programmes (Harden, 2006). In the same way, Shimmell et al. (2016) describe the importance of internationalisation in the field of occupational therapy. Occupational therapy students must therefore be provided with opportunities for entry-level professional education in a global setting. Previous studies (Barker et al., 2010; Davies et al., 2017) have reported that international fieldwork placements foster the personal and professional development of occupational therapy students. Previous qualitative research by Humbert et al. (2012) explored the perspectives of occupational therapy students not only in educational fieldwork but also in service experiences, and reported the usefulness of these entry-level educational opportunities. As described by Gray et al. (2002), studying in another country – even for a short period of time – contributes to a student’s personal growth, increases their awareness and challenges their fundamental opinions. These findings suggest that both short-term international exchange programmes and long-term clinical placements are beneficial both to produce more sophisticated occupational therapists and to widen the scope of their occupational therapy practice. In previous studies of the other health professions, it has been found that participation in international exchange programmes promotes several competencies, including effective clinical communication among medical students (Jacobs et al., 2014) and better understanding of core concepts among nursing students (Myhre, 2011).

However, there have been few reports on the impact of such programmes on personal and professional development in occupational therapy education. For example, Barker et al. (2010) proposed categories of learning in international practice placement education; however, no one has addressed how the categories interact with respect to personal and professional development. Some international academic activities in the occupational therapy field have been introduced, including an international-based education programme between universities in the United States (US) and the Philippines that focuses on the home teaching method (Cabatan and Grajo, 2017) and a partnership between schools in the US and a Cuban community-based clinic (Tupe et al., 2015). Thus, there is a need to discover and develop more international partnerships. With respect to other fields of study, Shieh (2004) stated for example that an important consequence of an international exchange programme in nursing is the internal transformation that occurs, which leads to personal and professional growth. Barker et al. (2010) regarded personal and professional development as a single core category of learning in international education. Therefore, in this study, we also adopted personal and professional development as a single core process to explore the impact of an international academic exchange programme in entry-level occupational therapy education on personal and professional development.

Methods

Research design

This study was conducted as a qualitative research study. Data were collected via face-to-face interview. Diers (1979) argued that the adoption of a qualitative design is appropriate when the phenomenon that occurs cannot be categorised clearly into quantitative variables. We considered a qualitative research design to be appropriate for this study because very few empirical data are available from the participants. The COREQ checklist (Tong et al., 2007) was used to ensure that the methods, results and discussion were reported appropriately. Ethical approval was obtained from the institutional review board at Kitasato University School of Allied Health Sciences in 2016.

Participants

All participants were occupational therapists who graduated from Kitasato University in Japan and who participated in an exchange programme at Thomas Jefferson University in the US during the period from 2005 to 2015. Qualitative analysis focused on their experiences in the international exchange programme, an entry-level education programme for occupational therapy students.

About the international exchange programme

The international exchange programme described in this research was coordinated between Kitasato University in Japan and Thomas Jefferson University in the US as part of the allied health sciences professional education programme. The purpose of this programme was to provide talented students with an international perspective so that they would be able to apply their knowledge to a broad international community. Two volunteers were selected from each course and sent to the partner university every other year. All participants were enrolled in the following courses: physical therapy, occupational therapy and radiological technology. Participation in this programme was voluntary. Participants were selected from an application process based on their grades and personal statement; English language skills were not considered as part of the application criteria. The duration of each exchange visit was 1 week. This duration was determined by the host university. Participants were granted tuition, accommodation and food expenses by the host university. During the programme, participants engaged in several cross-cultural experiences, including attendance at lectures, site visits to occupational therapy services, presentation and discussion about occupational therapy practices in both the host and home country and dinner with local students.

Sampling and recruitment

Purposive sampling was conducted to recruit participants to this study. The last author introduced the first author to 11 potential participants. The first author sent an e-mail directly to each potential participant and asked if they would like to participate in this research. The first author knew two of the potential participants but had no prior relationship with the remaining nine potential participants. Two of the potential participants refused to participate; one did not participate because they were not currently working as an occupational therapist and the other did not participate due to scheduling conflicts. The demographics of the remaining nine participants are reported in Table 1

Table 1.

Participant demographics.

Participant	Sex	Year of exchange programme	Time since graduation	Position at time of interview
A	Female	2011	6 Years	Studying abroad
B	Male	2005	12 Years	Working at a hospital
C	Female	2013	4 Years	Working at a hospital
D	Male	2015	2 Years	Working at a hospital
E	Male	2007	10 Years	Working at a hospital
F	Female	2009	8 Years	Working at a company
G	Female	2005	11 Years	Working in home visit care
H	Female	2009	7 Years	Working at a hospital
I	Female	2013	3 Years	Working at a hospital

Data collection

Prior to data collection, the first author summarised the purpose of the research and obtained written informed consent from each participant. The first author conducted an in-depth face-to-face semi-structured interview with the nine participants using an interview guide. Each interview was conducted in a location chosen by the participant. The interview guide was developed specifically for this study (see Table 2

Table 2.

Interview guide.

1. Questions about participation in the international exchange programme

・ Why did you decide to join the programme?

・ What kind of things did you feel when you went to the US?

・ Do you have any impressive experiences from the programme?

・ How did your behaviour change compared to before the programme?

・ What did you learn from your experiences during the programme?

2. Questions about the participant’s current situation

・ What do you do for a living?

・ How did the experience within the programme impact your personal and professional development?

3. Questions about the participant’s future direction

・ What do you think about your future career?

・ Give me any feedback for improvement of the programme if you have any

), but the conversation was primarily participant led using open-ended and probing questions. Each face-to-face interview was recorded on an integrated chip recorder, and field notes were taken by the first author with the permission of the participant. Interviews ranged in duration from 33 minutes to 63 minutes (average 47 minutes). The recordings were transcribed verbatim by the first author; however, the transcripts were not forwarded to each participant for verification.

Prior to conducting the interviews, the first male author travelled to the US to experience the same exchange programme as the participants. Moreover, the first author attended seminars about qualitative research and was trained by specialists with significant experience in the field of health science. These individuals were asked to provide supervision on a regular basis to ensure the reliability and validity of this study.

Data analysis

The constant comparative method inspired by grounded theory (Glaser et al., 1968) was used to improve the understanding of the processes that the interviewees experienced. The first author performed open coding of the data. The selected units included those that mentioned experiences and impacts of the international exchange programme. These were labelled and sorted into subcategories according to themes with similar labels. These themes then were sorted into larger groups. Axial coding was performed to examine each category relative to the other categories. The first author investigated the concordance of the sorting process with the second author, who had no experience with the international exchange programme. The first, fourth, and last authors performed selective coding to conclude the analysis, and the third author managed the entire data analysis process. The authors reached consensus on the findings via extensive discussion of the categories, which emerged from the analysis process. Rigor was achieved via triangulation and member checking. The data analysis steps focused on each participant’s experience within the international exchange programme and the impacts of the programme on their personal and professional development after graduation.

A previously published model for analysing and evaluating the results of training and educational programmes consisted of four criteria: reaction, learning, behaviour and results (Kirkpatrick, 1975). This model evaluates how experiences within a programme impact participants and organisations after the programme ends. We partly referred to this theory as we categorised our educational outcomes, as has been done in previous studies (Steinert et al., 2016).

Results and discussion

The results are presented in four categories consisting of 24 sub-categories that emerged from this study. An overview of the results is provided in Figure 1

Figure 1.

Overview of the results.

. Findings are summarised in Table 3

Table 3.

Quotes as examples of data.

Category	Sub-category	Definition	Quote
Experiences	Being challenged in a new environment	To experience a new learning environment for occupational therapy education	I thought that I would learn new things when I go abroad and the opportunity didn’t seem to be usual and a bit tough. That is the reason why I decided to join the programme. (Participant 7)
	Participating in a professional education setting	To experience the process of teaching and learning at a US-based university	I was jealous when I found the professional education system in the US is higher. Compared with it, I was told that Japanese occupational therapists start learning after one’s graduation. (Participant 1)
	Observing in a clinical setting	To experience a visit to a clinical setting with local students	In my memory, it was impressive that occupational therapists in the US did activities of daily living (ADL) training without using any instruments during the sessions in contrast to occupational therapists in Japan using some instruments. (Participant 2)
	Engaging in student-centred learning	To experience classes at an American university, where active participation is expected	Lectures in the US progressed by students’ questions and they started discussing or the teacher explained on the topic. Classes in the US had many parts which are driven and pushed by students. (Participant 6)
	Surveying American students working in a clinical setting	To attend practical training with local students in a clinical setting to understand how to act correctly and make independent decisions	In the practice placement, mainly students talked to the patient rather than therapists did. After that, students do their intervention by themselves. (Participant 3)
	Reflecting on the high motivation of American students	To think carefully about American students’ desire for learning	I found that there are a lot of students with great passion to become occupational therapists in the world. For instance, in the US, they asked questions as soon as they wanted to know during the lecture. (Participant 4)
	Interacting with American students	To experience the opportunity to communicate with students from different backgrounds	It was impressive that I stayed at student housing with local students. (Participant 2)
Reaction	Considering different cultural backgrounds	To care about or respect cultural differences, such as the type of experience, education, etc.	As previously being stated, I’ve already known about the problems such as the disparities or price in medicine in the US. I was wondering what is going on in the US. That was one of the reasons why I wanted to participate in the exchange programme. (Participant 1)
	Hypothesising differences between Japan and the US	To think about something that is unusual for people from different countries	Well, I think that occupational therapy in each country has its own customs due to the cultural differences. (Participant 3)
	Discovering similarities	To recognise similar practices of occupational therapists in different countries	The process of the occupational therapy intervention in the US is almost the same as it is in Japan. The things American therapists asked patients are also in common with what Japanese therapists do. (Participant 9)
	Realising the importance of active learning	To understand the importance of the active learning process	I feel I should have learned many things actively by myself such as preparations or reviews of what I study at university. (Participant 6)
	Understanding various specialities within occupational therapy	To learn about different areas of occupational therapy in clinical settings	As for the things I learned during the exchange programme, I learned that the function I serve as an occupational therapist cannot be decided for me. That’s a good way to think. I might have had a narrow way of thinking about occupational therapy. (Participant 7)
	Being interested in specialising	To cultivate an interest in a speciality within occupational therapy	Therapists are needed to be an expert by focusing on a specific field. I am concerned about securing the quality of human resources at a medical field in Japan. If occupational therapists don’t have any speciality, it might come true. (Participant 6)
	Being motivated	To gain motivation for learning by observing American students who are willing to learn	I was very slack at university. Don’t you think American students are amazing, because they are passionate about studying? (Participant 9)
	Reflecting on one’s own role as a professional	To think carefully about one’s experiences within the programme and current situations	I wonder why occupational therapists in Japan have no chance to work at institutions such as nursery schools, although I found it is very important through the experiences in the US. (Participant 4)
Learning	Broadening one’s perspectives	To cultivate a deeper understanding through interactions with things and persons from different cultures	My perspectives toward Americans or occupational therapy in the US have been broadened due to the exchange programme. If I didn’t go to the US, it would not have been changed. (Participant 3)
	Focusing on developing one’s expertise	To keep in mind the importance of having one’s own speciality in addition to gaining fundamental competency as an occupational therapist	Although I still haven’t decided my path for the future as an occupational therapist till I graduated, I started thinking to become a proficient therapist in the specific field. (Participant 6)
	Establishing mutual understanding	To realise the importance of communicating with colleagues or individuals from other professions with the intent to understand each other	American students tried communicating with us even though I cannot speak in English well. It makes me motivated to communicate so hard. Although I was wondering how much I can communicate with them in the beginning, the exchange programme gave me opportunities to understand the importance of establishing mutual understandings. (Participant 8)
	Comprehending the importance of professional dialogue	To understand the importance of professional discussions and to observe American students’ attitudes during a discussion	I found that American students have many opportunities to discuss in the lectures at the university. I thought it was amazing even though I wonder if I can do like that as a student. Thinking back now, it is very important not to criticise but to discuss. (Participant 7)
	Gaining confidence through accomplishments	To believe in one’s ability via completion of the programme’s tasks	A sense of accomplishment still remains in my heart even now. (Participant 5)
Behaviour	Interacting with other professionals	To think about how to become involved with colleagues in a work environment	Working at the hospital for four years and a half, after all, I’m an occupational therapist. What I can do at the work place is based on learnings at the university. I realised I have a different perspective from what physical therapists have. (Participant 1)
	Trying new things	To attempt new challenges even after graduation with confidence gained from the programme	I might have thought that I passed to do anything new, so that I have no confidence. After attending the exchange programme, I can try it with great confidence. (Participant 4)
	Internalising distinct values	To perceive various opportunities and possibilities in occupational therapy	Through these experiences, I understand that occupational therapists can work in various fields and serve in many different ways. (Participant 7)
	Stating one’s opinion confidently	To state one’s opinions in the belief that it is important to do so	Although I don’t have the words to explain, I had many good experiences during the exchange programme. Making use of my experience in the US, I’m getting to pass my opinions initiatively talking with various people. (Participant 8)

by defining each category and presenting a related quote from one of the participants. Overall, participants reported that their experience in the international exchange programme had a positive impact on their personal and professional development.

Participants recognised that attendance in the programme resulted in ‘being challenged in a new environment’ and that ‘participating in a professional education setting’ was one of the most meaningful learning experiences within the programme. Participants considered ‘reflecting on the high motivation of American students’ and ‘interacting with American students’ as important experiences within the programme.

Participants gave examples such as ‘considering different cultural background’, ‘being motivated’ and ‘reflecting on one’s own role as a professional’ as learning reactions to their experiences in the US. Through ‘interacting with American students’, participants were ‘discovering similarities’ and ‘hypothesising differences between Japan and the US’. Participants reported that they were ‘realising the importance of active learning’, ‘understanding various specialities within occupational therapy’ and ‘being interested in specialising’. Through the programme, participants were able to explore their role as an occupational therapist in a cultural context, thereby gaining an understanding of the importance of diversity and expertise in occupational therapy.

Participants reported that their participation in the exchange programme resulted in ‘broadening one’s perspectives’, ‘focusing on developing one’s expertise’, ‘establishing mutual understanding’, ‘comprehending the importance of professional dialogue’ and ‘gaining confidence through accomplishments’. These reactions are based on what they experienced in the programme and what they learned in the US. In addition, the attitude of the American students towards studying hard was motivating and widened the perspective of the Japanese participants. Participants reported ‘gaining confidence through accomplishments’ after they came back home.

In the clinical setting, participants learned about ‘interacting with other professionals’. Through the exchange programme, participants also learned about ‘trying new things’, such as presenting at conferences and having meaningful collaborations with other professionals. Participants made use of their knowledge gained from the programme in ‘stating one’s opinion confidently’. These behavioural changes came about by ‘internalising distinct values’ and ‘broadening one’s perspectives’. Participants realised the importance of acting like a professional in accepting the differences and values of clients and individuals in other professions.

These findings were further organised into four categories to measure the effectiveness and impact of learning programmes: experience, reaction, learning and behaviour.

Experience

The category ‘experience’, which included seven sub-categories, summarises the impressions that the educational experience had on participants in the programme. The international exchange programme was a challenge for Japanese participants. As participant 7 described (see Table 3), it was unusual and tough to learn new things abroad. During their experience in a professional educational setting in the US, Japanese participants found that local students are expected to be independent and student centred to learn at both the university and in a clinical setting. Japanese participants reported that American students in this environment were more independent and motivated to study. Thus, interacting with highly motivated students in an American educational setting left a positive impression on Japanese participants.

Reaction

The category ‘reaction’, which included eight sub-categories, measures how participants feel about the various aspects of the exchange programme, including the topics, speakers, schedules and so forth. Thus, reaction can be considered a measure of customer satisfaction (Kirkpatrick, 1975). Through their experience in a US academic programme and interaction with American students, Japanese participants realised that studying hard is important to be a better occupational therapist. Japanese participants also noted both cultural similarities and differences. For example, participants noticed differences in work styles and social behaviours within occupational therapy, which were related to differences in the culture and public system. However, participants also noticed similarities in the evaluation and intervention of patients as an occupational therapist. Participants were also able to observe the expertise and diversity of occupational therapy in a clinical setting. As participant 7 described (see Table 3), the experience allowed them to consider possible advances in occupational therapy in Japan. They also learned that it was necessary for each therapist to enhance their expertise. In addition, throughout the programme, interaction with local students motivated participants to study harder and to become more competent in occupational therapy practice.

Learning

The category ‘learning’, which included five sub-categories, is a measure of the knowledge acquired, skill improved, or attitudes changed due to training (Kirkpatrick, 1975). Participants reported that they initially learned to focus on developing their own expertise. For example, participant 6 (see Table 3) and participant 9 noticed that each occupational therapist in the US has a speciality within the field. Participants realised the importance of having a speciality and have had a conscious awareness of this fact throughout their career development. Such experiences in the exchange programme broadened their perspectives. As a result, participant 3 reflected that what occupational therapists in the US do is not unrelated to occupational therapy in Japan (see Table 3). Hence, participants realised that they should have a speciality as an occupational therapist and also understood the importance of mutual understandings with the other professionals at the same time. Participant 8 (see Table 3) realised that it is important to communicate one’s intention but faced a challenge in speaking with local students due to a lack of English language proficiency. This experience was transformed into comprehending the importance of communicating with other professionals using professional dialogue. Participant 7 noted that communication is important for mutual understanding (see Table 3). In the end, participants gained confidence by accomplishing their challenges in the programme. Similarly, participant 5 reported that they still have the confidence that they gained in the programme (see Table 3).

Behaviour

The category ‘behaviour’, which included four sub-categories, measures the extent to which participants change their on-the-job behaviour due to training (Kirkpatrick, 1975). All participants who participated in the interview were actively working within an organistion with colleagues from various backgrounds at the time of the interview. As participant 1 noted, this experience allows them to develop professionally while working as an occupational therapist (see Table 3).

Participant 4 indicated that the exchange programme was effective in helping the participant gain confidence to face new challenges and interests (see Table 3). Participants felt that the educational effect of the international experience contributed to their confidence. In addition, participants thought that the programme positively impacted on their behaviour, particularly in accepting their values and stating their opinion confidently. Participants modelled their ability to put their thoughts into words and express their viewpoints on the behaviour of American students. Participant 8 affirmed that being able to speak with confidence was one behavioural change from the programme that continued after graduation (see Table 3). Thus, tolerance towards differences was brought about by this international experience. These results are summarised in Figure 2

Figure 2.

Chart of the results.

. As Kirkpatrick mentioned, each level of learning has an impact on the next level (Kirkpatrick and Kirkpatrick, 2006), which is demonstrated by these results.

Analysis of the educational impact of the international programme

The aim of this study was to explore the experience and educational impact of an international academic exchange programme on personal and professional development among occupational therapists. This qualitative research showed that an international exchange programme had a positive impact on occupational therapy education. This study not only highlights the complexity of the personal and professional development process suggested by Barker et al. (2010) but also confirms the impact of this programme on the behaviour of the participants throughout their professional career. This research is consistent with several previous studies (Barker et al., 2010; Sim and Mackenzie, 2016; Witchger Hansen, 2015) that have observed the impact of occupational therapy education in international settings. The following discussion explores the possible impacts of an international experience on entry-level occupational therapy education from three aspects: accepting diversity, collaborating beyond boundaries and gaining confidence from challenges.

Accepting diversity

Participants experienced occupational therapy practice and education in the US, and thus interacted with local students and practitioners who come from a different cultural background. These experiences motivated participants and broadened their perspectives. They became tolerant of differences in values and lifestyles. This study therefore reports a significant impact of the international exchange programme, which is consistent with previous research on intercultural education (McAllister et al., 2006). Learning outcomes discovered by the stury of Barker et al. (2010), including ‘adaptability’ and ‘thinking outside the box’, were mentioned as positive impacts on personal and professional development. Another study by Davies et al. (2017) reported ‘becoming respectful of difference’ as an impact of overseas activities. Participants in this study learned about diversity and differences in attitudes in occupational therapy, which improved their awareness about having a speciality within their practice as well as broadened their perspectives about the field. Although participants only participated in a 1-week international exchange programme, this study shows that the experience provided an important educational opportunity to learn and accept cultural differences. The findings in this study are consistent with prior qualitative research (Humbert et al., 2012), in which the duration of cross-cultural fieldwork ranged from 1 week to 2 years. Similarly, Sim and Mackenzie (2016) reported that culture was a significant factor in cross-cultural fieldwork in a developing country. For the reasons outlined above, the experience of learning about occupational therapy in a cross-cultural environment gave students the opportunity to think outside the box. Together, these studies support the idea that international learning opportunities are useful to participants.

Collaborating beyond boundaries

As shown in Figure 1, participants learned the importance of having discussions with individuals from different cultural backgrounds in ‘establishing mutual understanding’. Based on this knowledge, participants adapted their behaviour to discuss issues with other professionals in a clinical setting. As participant 4 noted, experience in the programme facilitated their communication with fellow therapists as well as other professionals in a professional setting.

This study found that the programme provided meaningful interprofessional education (IPE) in communication and discussion. IPE ‘occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care’ (The UK Centre for the Advancement of Interprofessional Education: CAIPE, 2002). Accordingly, occupational therapists need to receive IPE as part of an entry-level education programme to learn how to collaborate with other healthcare professionals as well as administrators and other professional personnel. A recent systematic review of the healthcare field (Reeves et al., 2013) indicated that IPE has several positive effects on team approaches to care, including better clinical outcomes (Strasser et al., 2008). Moreover, a previous study among entry-level professionals suggested that IPE enhances attitudes and perceptions towards interprofessional collaboration (Lapkin et al., 2013). In this study, participants reported that they were ‘stating one’s opinion confidently’ in various situations, including during meetings and at professional conferences.

Gaining confidence from challenges

Participants in this study reported ‘trying new things’ during their post-professional activity, noting a positive effect of the confidence gained during the exchange programme. As noted by participant 5, confidence acquired through the programme was perceived long after graduation. As noted in another study, students encounter difficulties when they are exposed to an international environment, and their immersion in these experiences allows them to gain confidence (Sim and Mackenzie, 2016), which they then apply to their professional experiences after graduation in their own environment. Findings from this study suggest that learning experiences in international environments are significant components of professional education in terms of providing students with an opportunity for learning, which is consistent with previous studies in which participants were challenged with experiences outside their personal comfort zones (Haro et al., 2014; Mu et al., 2016; Sim and Mackenzie, 2016). Thus, together these findings indicate that learning in an international environment facilitates confidence.

Implications for the occupational therapy profession

This research specifically highlighted the experience of occupational therapy students during an international exchange programme. To the best of our knowledge, this is the first report from a Japanese perspective, and therefore provides insight more broadly for other international exchange programmes. This study showed that the experience during the programme had a long-term influence on the behaviours of participants once they started their careers as occupational therapists. These findings therefore suggest that such programmes can contribute to the continuing professional development of occupational therapists, as emphasised in the minimum standards for the education of occupational therapists (World Federation of Occupational Therapists, 2016). Thus, this research highlights the need for a greater emphasis on the internationalisation of occupational therapy education and the importance of forming a global community of occupational therapists.

Limitations and strengths

This study provides findings only from Japanese participants who spoke English as their second language and attended an international exchange programme in the US. There are two main limitations with this study. First, the language barrier may have limited the amount that participants could learn over a 1-week programme. Second, it is possible that these findings are not representative of occupational therapy students in other countries and that participants with different cultural backgrounds may have different perspectives (Witchger Hansen, 2015). However, these findings are supported by previous research on the topic of internationalisation of occupational therapy education. This research thus provides both students and faculty with broader perspectives on international practice.

Recommendations for future research

One recommendation that emerges from this study is to carry out international exchange programmes globally with occupational therapists from various cultural backgrounds, which would enable an examination of the cross-cultural similarities and differences in occupational therapy delivery. In addition, future research should evaluate which educational factors associated with international exchange programmes have the greatest impact on subsequent attitudes and professional behaviours in occupational therapy practice.

Conclusion

Findings from this research indicate that participation in an entry-level international academic exchange programme in occupational therapy had a positive impact on personal and professional development. One important outcome from this study is that participants noted a change in their attitudes as a result of their experience in this international programme. Participants reported that these attitudes persisted long after graduation and influenced their professional behaviour as they became occupational therapists. In an increasingly globalised world, the internationalisation of occupational therapy education is needed to build a global community of occupational therapists who seek to improve their practice.

Key findings

Internationalisation of occupational therapy education enhances students’ acceptance of diversity.

Experiences within a cross-cultural academic programme resulted in collaboration with other professionals.

Occupational therapy students gained confidence from experiences in international settings.

What the study has added

This study highlights the importance of internationalisation of education and adds to knowledge about the effectiveness of an international academic exchange programme even a short period.

Footnotes

Acknowledgements

The author(s) thank the participants for sharing their experiences and all who helped with this study.

Research ethics

This research was approved by the institutional review board of the School of Allied Health Sciences, Kitasato University in 2016 (reference number: 2016-024).

Consent

All participants provided written informed consent for the study.

Declaration of conflicting interests

The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Contributorship

Yuki Mashizume and Kayoko Takahashi contributed to the conceptualization and design of the research, interpretation of the data, drafting the manuscript and revising it critically. Makoto Watanabe contributed to data collection, interpretation of the data and drafting the manuscript. Yuko Fukase was involved in interpretation of the data and drafting the manuscript. Yosuke Zenba contributed to interpretation of the data and revising the manuscript. All authors approved the final manuscript to be published before it was submitted for review.

ORCID iD

Yuki Mashizume

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