From Classroom to Boardroom and Ward

Case 1: International human resource management

Many international business courses, especially management and human resource management courses, focus on the development of analytical skills and understanding the application of theoretical concepts (Woods, Barker, & Daly, 2004; see also Lane, Maznevksi, Di Stefano, & Dietz, 2009). In contrast, EXCELL focuses on developing practical skills in intercultural communication. The objective of the teaching innovation was to assess whether integrating intercultural skills development in the analysis of international human resource management case studies would (a) improve students’ skills in identifying cross-cultural interaction problems in business situations, (b) improve students’ skills in identifying appropriate strategies to overcome problems in cross-cultural business interactions, and (c) increase students’ self-confidence and self-efficacy in cross-cultural situations.

EXCELL skills development was embedded in four, 2-hr workshops. Traditionally, students examined case studies such as one involving an expatriate manager working in an Asia-Pacific subsidiary who needs to give feedback to Head Office in New York about an employment contract. In the teaching redesign described here, instead of only a case discussion students enacted the case, taking on the role of the manager giving feedback. A pretest posttest design found that students were able to demonstrate improvements in some of the specific intercultural competences required in business as well as reporting increased self-confidence and self-efficacy in cross-cultural situations. Additionally, participants demonstrated improved identification and articulation of cross-cultural business problems and formulation of appropriate intervention strategies. Learning journals enabled students to reflect on their learning and develop action plans for how to further develop their competencies in intercultural management. Integration of the case study method with elements of EXCELL was supported, however, because students are more accustomed to courses that emphasize theories and conceptual analysis, the rationale for including a skills component within the course must be explained from the outset. Also, participation needs to be linked to course assessment, and facilitators need to be appropriately trained in the method.

Case 2: Communication course

This study used a quasi-experimental design to investigate whether adding a skills-based sociocultural training module (EXCELL) to a university course on communication would improve students’ (a) social interaction skills, (b) cross-ethnic social self-efficacy, and (c) amounts of cross-ethnic friendships (see Mak & Buckingham, 2007). A subsample (N = 26) of enrolled students (total N = 142) volunteered to complete 2-hr EXCELL workshops over a period of 6 weeks, as an additional module in their curriculum. The remaining students who studied only the knowledge-based general communication course served as a comparison group.

The study found that incorporating the EXCELL program in a group of local and international students represents an effective approach to fostering positive intergroup contact and developing self-efficacy in interacting with others. In line with Harrison’s (1992) research, combining both behavior modeling and cultural knowledge learning in cross-cultural management was more effective in facilitating changes in attitudes and behaviors, than was either method individually. The research could be enhanced through a follow-up design to explore whether improved intercultural social skills and confidence and cross-ethnic friendships are maintained over time.

Case 3: Pharmacy course for Saudi Arabian students

EXCELL was embedded in the “Introduction to Pharmacy and Practice” bridging course within the second year of the Bachelor of Clinical Pharmacy for a cohort of 12 newly arrived Saudi Arabian students (Maganlal, Blauberg, & Barker, 2011). Students examined how each of the six generic competencies was performed in their culture, compared with in Australia, and the cultural values underpinning the behaviors. Scenarios drawn from Pharmacy practice (e.g., giving feedback to a hospital pharmacist) were role-played by students.

Evidence suggests the EXCELL program helped the Saudi students improve their social interactions skills in their new cultural context. Students commented that the most useful parts of the EXCELL program were an increase in understanding of the Australian culture, being able to practice their communication skills, and learning about the competency of how to refuse a request. To achieve wider applicability for Health students across the higher education sector, vignettes of practice scenarios involving multiple health practitioners need to be developed and filmed for use in the classroom.

Case 4: First year Pharmacy course

Further to the intervention described in Case 3, EXCELL was integrated into the first seven weeks of a first-year pharmacy course to enhance intercultural competence and improve pharmacy students’ confidence and self-efficacy in the university and wider social setting (see Maganlal et al., 2012). The program aimed to teach social competencies relevant to the Australian context for all pharmacy students, both domestic and international. Pre- and postsurveys were conducted to evaluate the impact of the EXCELL course on students’ intercultural and interpersonal skills as well as students’ perceptions about the course. The course was also evaluated by the faculty who facilitated the workshops.

Postprogram tests showed that students improved in each of the six generic competencies. While international students rated the course as significantly more valuable than domestic students, the faculty found the course very useful for enhancing interactions between domestic and international students. Embedding the EXCELL in a first year Pharmacy course appears to be a promising strategy to improve students’ intercultural competence and social interaction skills. Students were reluctant to engage in homework related to skills practice because of the “not-for-credit” status of the course. Future development needs to consider more pharmacy-specific and more interpersonally challenging scenarios to fully engage domestic students.

Reflections on the Case Studies

The four case studies presented here provide a context for analyzing the strengths and limitations of embedding skills development in different disciplines. Each case demonstrated particular ways of integrating a behavioral component in courses that had traditionally focused more on development of cognitive and analytical skills. Each application resulted in enhanced self-reported intercultural communication skills and improved self-efficacy of students. There were no major differences between different disciplinary contexts in what is involved in the integration of skills development. Each application required real commitment on the part of faculty, including the capability development of workshop facilitators. The challenges experienced in each of the four cases studies included (a) ensuring that discipline-specific critical incident scenarios were used, (b) assessing students’ baseline skills levels, and (c) evaluating outcomes separately for international and domestic students. Also, it would be useful to consistently assess any change in intercultural attitudes and cross-ethnic friendships and the use of comparison groups, as in the Mak and Buckingham (2007) study.

Taken together, the curricular innovations suggest there is merit in embedding the EXCELL framework to develop students’ generic social competencies. It is argued that intercultural competencies (e.g., expressing disagreement to a peer who is from a culturally and linguistically different background) require more refined skills, than does the execution of generic social competencies (e.g., expressing disagreement to a peer from the same culture), because of the complexity of cultural differences. If intercultural competencies constitute a graduate attribute, then faculty need to help students to achieve mastery of generic social competencies as a foundation to building intercultural competencies.

To date, much of the emphasis in IoC has been on the inclusion of international and global dimensions in course content and assessment (Rizvi & Lingard, 2010; Shiel, 2007). IoC must also address behavioral and affective development of students as emerging global graduates. The need to ground intercultural competency development in the substrata of specific disciplines is the primary pathway to engage faculty, clinical preceptors, industry practitioners, and most importantly, students of the discipline.

Common Critical Incident Social Scenarios in Business, Nursing, and Pharmacy Classrooms

Table 2 lists some of the most common critical incident social scenarios in the classroom identified by stakeholders. Each scenario has been linked to one of the six EXCELL key competencies. As discussed earlier, more than one competency may be involved in any interpersonal interaction. Interestingly, most of the scenarios reported by stakeholders were not discipline-specific, nor were they necessarily highly intercultural in nature. For example, take the example given by Business and Health faculty about students’ difficulties in seeking help or information. From time to time, domestic (home) and international students need to seek an extension from a faculty member to complete an assessment piece (e.g., a delay due to ill health). The interaction may prove more challenging for shy students, those unfamiliar with the norms of interacting with university faculty, and particularly some international students who are not experienced communicators in the new cultural context.

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Table 2.

Common Critical Incident Social Scenarios in Business, Nursing, and Pharmacy Classrooms.

Relevant social competency	Common scenarios across Business, Nursing, and Pharmacy classrooms
1. Seeking help or information	• Students seeking an extension of time for an essay from a faculty member.
	• International students not seeking clarification of what the teacher says even when they cannot understand the teacher because of her accent.
2. Making social contact	• Student unsure how to engage with culturally different fellow students during a class break.
	• A home student who is learning Chinese feels isolated in a class where the majority of students are from a Chinese background because they only talk to fellow Chinese students.
3. Participation in a group	• International students having difficulties delegating work in a group project.
	• Students reluctant to participate in a seminar for fear of inadequate English.
4. Expressing disagreement	• Students wanting to disagree with the tutor about marks deducted from their assignment.
	• Students feels it is rude to say no, so they say something else instead of no, but it means no.
5. Refusing a request	• Student refuses invitation to move to the campus bar to continue the project meeting.
	• A student did not contribute to the group project but asks to borrow another student’s notes.
6. Giving feedback	• International student feels uncertain about how to give peer feedback that other students are not participating actively in the group research project.
	• Student wants to give feedback to a lab assistant about his racist jokes

The intercultural scenarios offered by faculty stakeholders highlight several generic issues in the classroom. Interestingly, irrespective of discipline, there was a high level of similarity in the types of challenging classroom scenarios identified. Multicultural group work, in particular, was a frequently occurring situation where intercultural communication competencies were tested in the classroom. Productive group work not only requires what EXCELL defines as access competencies (i.e., active participation, making social contact, and seeking help or information) but group projects also provide a context in which students frequently need to express disagreement, refuse a request, and give feedback to other group members (i.e., negotiation competencies). In particular, faculty noted issues around students not being able to delegate work in a group project; not being able to chat with other group members; and refusing a request by a group member to borrow another student’s notes.

Faculty from the three disciplines also noted three scenarios in relation to “giving feedback” and “refusing a request” that they found challenging. These included refusing “thank you” gifts from students so as to uphold their institution’s policy in this area as well as their uneasiness about the motivation behind the gift-giving. Interestingly, faculty from each discipline also identified the challenges in giving feedback to students who insisted their marks be increased or to students about to become more actively engaged in class activities.

Common Critical Incident Social Scenarios in Business, Nursing, and Pharmacy practice

Table 3 presents examples of common critical incident reported by practitioners from diverse disciplines. The scenarios refer to practice in business organizations, hospitals, health care settings, and pharmacies mapped against the six competencies.

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Table 3.

Common Critical Incident Social Scenarios in Business, Nursing, and Pharamcy Practice.

Relevant social competency	Common scenarios across Business, Nursing, and Pharmacy practice
1. Seeking help or information	• Colleagues not understanding Australian colloquialisms
	• Interns reluctant to seek help from supervisors about difficulties encountered on a project/task
2. Making social contact	• Discomfort with shaking hands and making small talk with a client/colleague.
	• Lack of confidence to interact with colleagues from other ethnic groups during workplace social activities (e.g., lunch, business)
3. Participation in a group	• Lacking confidence to speak up in meetings or ward rounds
	• Uncertain about culturally appropriate ways to interact with team members at a staff meeting
4. Expressing disagreement	• Raising an issue with or challenging a supervisor/clinical preceptor
	• Disagreeing with a client or patient about how to deal with his or her issue or concern
5. Refusing a request	• Politely refusing alcohol/food at company functions and work gatherings
	• Refusing a request to work overtime, as saying “no” may indicate uncooperativeness
6. Giving feedback	• Giving feedback to manager about inability to attend workgroup lunch due to religious reasons (fasting during Ramadan)
	• Advising a supervisor her expectations about the time frame for completing an assigned task is unrealistic

The highly multicultural nature of Australian society is a theme that underpins the scenarios identified by industry stakeholders. Similar to the scenarios described in the classroom, discipline representatives commented that cultural diversity refers not just to international students but also to students, staff, patients, clients, and community members from CALD backgrounds. Related to multiculturalism, several scenarios focused particularly on religious practices. The competency of giving feedback was required when an intern had to inform her supervisor about not being able to attend a workgroup lunch owing to her religious practices (i.e., fasting during Ramadan). A related scenario involved a student who did not drink alcohol or eat pork for religious reasons and who had been advised that alcohol and pork dishes would be served at a staff social function.

Many of the other scenarios common across the disciplines involved lack of confidence and lack of assertiveness in workplace interactions. Sometimes these situations were exacerbated by cultural differences, but gender and power differences between student interns and senior staff members/supervisors/clinical preceptors were evident. Clearly, the interplay between adjusting to the culture of the workplace, societal cultural factors, and power differentials were intertwined in many scenarios, depending on the characteristics of the interactants. For example, stakeholders reported numerous incidents of interns being reluctant to seek help from supervisors about difficulties encountered on a project or task, or challenging the supervisor about an issue (e.g., providing feedback to a clinical preceptor that her expectations about the time frame for completing an assigned task is unrealistic). These types of scenarios were explained by stakeholders as the problem of “losing face.” Other examples included expressing disagreement with a supervisor about a course of action and refusing a request to work overtime because saying “no” may indicate uncooperativeness on the part of the intern or staff member. Analysis of the common scenarios across stakeholders indicated the robustness of the six generic social competencies underpinning them. In the next section, we examine whether the framework continues to hold when discipline-specific critical incidents are examined.

Discipline-Specific Critical Incident Social Scenarios in Professional Practice

Compared with classroom scenarios, which did not seem to differ significantly between disciplines, many discipline-specific critical incident scenarios were discussed by stakeholders. Table 4 presents six scenarios from stakeholder practice, mapped against the six general social competencies.

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Table 4.

Discipline-Specific Critical Incident Social Scenarios in Professional Practice.

Relevant social competency	Nursing scenarios	Pharmacy scenarios	Business scenarios
1. Seeking help or information	Nurse tries to dispense medication to an elderly Japanese patient who cannot speak English and whose family has gone home for the night. Patient does not seem to understand the nurse’s instructions and refuses to take medicine.	Pharmacists from particular ethnic backgrounds do not appear to seek help about whether to supply particular medication (e.g., Pseudoephedrine) to pharmacy clients.	International business intern feels disadvantaged because in team discussions/projects only Australian/European examples are used. Intern is frustrated and does not know how to discuss this with the supervisor.
2. Making social contact	Male nurse needs to examine a female Middle-Eastern patient. Patient requests nurse to leave the room.	Arabic customers address pharmacy interns as “Doctor”—because in their home countries, pharmacists have medical degrees. Interns have to explain the differences without offending customers.	New Muslim employee shocks and distracts Australian staff in the office by taking out his handkerchief, kneeling by his desk, and praying.
3. Participation in a group	Vietnamese nursing students rarely speak up in a ward round or to patients unless asked a question directly.	Couple of Middle Eastern background came to pharmacy because the woman (wearing a scarf but not a veil) was suffering from a common medical condition that was sensitive in nature. She would not speak directly to the female pharmacist and her husband acted as a mediator.	A manager supervising a business student intern is concerned that the student does not participate actively in the meetings with clients even though the student is highly competent technically.
4. Expressing disagreement	Taiwanese intern upset about the inappropriate behavior toward her (e.g., patting her bottom) by Australian elderly male patients.	Pharmacists from Asian cultures may be more reluctant to challenge customers if they seem scary. They seem to prefer to avoid conflict and try to get customers out of shop as quickly as possible.	Australian clients go to China with Chinese trade assistant to visit suppliers. Trade assistant calls head office, offended that clients do not respect her. They bought bottles of water (AUD 30 cents) for themselves but did not buy her a bottle even though they could afford it.
5. Refusing a request	Patient needing to be treated for severe pain (rheumatoid arthritis) but refusing medication and wanting only natural remedies.	Pharmacist refusing entry to Chinese tourists who try to walk into the dispensary section of pharmacy.	Manager finds it difficult to refuse a request by an employee to take time off to care for sick relative even though employee seems to lack strong work ethic.
6. Giving feedback	Female Muslim intern having to treat an elderly Australian male patient who was very religious and did not want the nurse wearing a head scarf to care for him.	Ethnic Cambodian pharmacist, who trained in New Zealand, reports Asian clients often assumed she spoke their language. A father and son entered pharmacy, spoke Chinese to her, then wrote note in Chinese. Customers were irate that pharmacist could not understand them, so they stormed out of the pharmacy.	Resolving conflict between an Asian intern and her Chinese manager due to differences in their communication styles (manager was perceived as “rude” and “aggressive.” Intern felt too shy to ask for clarification of instructions.

Analysis of the critical incident social scenarios underlined the importance of skilled communication in health care settings, particularly where cultural differences were present. As discussed earlier, in a multicultural society intercultural communication challenges occur frequently between health professionals and patients/clients, between supervisors and students, and between workgroup peers. While the Business practice examples underlined important issues (such as the need to provide worksite privacy to allow a Muslim employee to pray in private without disrupting the workgroup), asking for help or giving feedback seemed to be particularly crucial in Health settings where patients’ health and safety were at stake. Take, for example, the situation of the Vietnamese intern who did not speak to patients unless requested, or the pharmacist who had to speak indirectly about a female patient’s health needs through her husband acting as interpreter. Scenarios such as these highlight the importance of generic social competencies that underpin intercultural communication. Furthermore, the scenarios point to the crucial role played by industry supervisors and clinical preceptors in providing on-the-job skills development and constructive feedback to interns. Industry stakeholders shared many challenges they experience as they try to manage their own heavy workloads, while trying to provide the appropriate level of guidance to “professionals-in-training.” Their need for professional development resources and support was evident as they discussed how intercultural factors made practice more complex, regardless of whether this stemmed from the needs of clients/patients, colleagues, students, or the interplay between them. The workplace is indeed where “the rubber meets the road.” A test of an effective internationalized curriculum, therefore, is whether graduates can demonstrate the capacities to interact effectively with clients, peers, and supervisors from CALD backgrounds.

Each critical incident provided by stakeholders constitutes rich case material for students preparing for internships. It gives them a preview of the types of incidents they may encounter in pharmacies, hospital wards, and business organizations. Similarly, the cases can be used in professional development workshops for faculty and practitioners who supervise students on their internships as well as provide resources for course assessment. If IoC is to be grounded in practice, then it is most instructive to use stakeholder-generated intercultural critical incidents as curricula resources. In particular, the scenarios illustrate how and why intercultural knowledge, awareness, and skills are needed by professionals. Taken a step further, the scenarios can provide the basis for employing EXCELL techniques such as mapping the stages of interactions and the values underpinning each stage. For example, Pharmacy students could practice refusing a client’s request to purchase a banned substance. If needed, the student can be coached to ensure their behavior would be perceived as culturally and professionally appropriate by colleagues and supervisors.