A Pilot Study of the Long-term Impact of a Taiwan-China Medical Clerkship Exchange Program

10.6145/jme201508

Cho-Yi Huang；Katherine Gosselin；Ming-Jung Ho

international exchange ； framework analysis ； healthcare systems

Journal of Medical Education

19卷2期（2015 / 06 / 01）

79 - 87

英文

Purpose: International exchange programs are a popular topic of medical education research, but much of the existing literature has focused on the short-term impacts of exchanges between Western medical schools and their international counterparts. This study investigates the longer-term impacts on students of an exchange program between two Eastern medical schools. Method: The authors conducted interviews with 19 Taiwanese medical students who participated in the initial four cohorts of an exchange program with a Chinese medical school from 2010-2013. Using a grounded theory approach, qualitative framework analysis was applied to identify and categorize recurring themes in the interview transcripts. Results: Six themes emerged from the interviews: medical knowledge, personal development, career development, interpersonal relationships, systems-based practice and cultural sensitivity. Students reported improved awareness of the possibility for changes in their own healthcare system and also expressed the program's impact on their longer-term career development. Most students, however, reported no long-term retention of clinical knowledge or skills. Conclusion: Future exchange program-planning should take into account the findings of this study. For example, student's retention of clinical knowledge and skills could be improved through the introduction of topics not well-covered in the existing curriculum. Given the career development and systems-based practice were considered more significant long-term impacts of the program by students, future program-planning could consider how to enhance support to these non-curricular areas. In the future, additional cohorts could be studied so as to identify continued or new impacts of the exchange program.

1. Balandin, S,Lincoln, M,Sen, R(2007).Twelve tips for effective international clinical placements.Med Teach,29,872-7.
2. Bozinoff, N,Dorman, K,Kerr, D(2014).Toward reciprocity: host supervisor perspectives on international medical electives.Med Educ,48,397-404.
3. Bryman, A(ed.),Burgess, R(ed.)(1994).Analyzing Qualitative Data.London:Sage.
4. Callister, LC,Cox, AH(2006).Opening our hearts and minds: the meaning of international clinical nursing electives in the personal and professional lives of nurses.Nurs Health Sci,8,95-102.
5. Coupeta, S,Del Valle, J(2013).A case for an international health elective training program during residency: a four-points call for action.Teach Learn Med,25,266-71.
6. Dacso, M,Chandra, A,Friedman, H(2013).Adopting an ethical approach to global health training: the evolution of the Botswana-University of Pennsylvania partnership.Acad Med,88,1646-50.
7. Damon, W(1984).Peer education: the untapped potential.J Appl Dev Psychol,5,331-43.
8. Dharamsi, S,Osei-Twum, J-A,Whiteman, M(2011).Socially responsible approaches to international electives and global health outreach.Med Educ,45,508-35.
9. Dowell, J,Merrylees, N(2009).Electives: isn't it time for a change?.Med Educ,43,121-6.
10. Drain, PK,Holmes, KK,Skeff, KM(2009).Global health training and international clinical rotations during residency: current status, needs and opportunities.Acad Med,84,320-5.
11. Dyne, PL,Strauss, RW,Rinnert, S(2002).Systemsbased practice: the sixth core competency.Acad Emerg Med,9,1270-7.
12. Grudzen, C,Legome, E(2007).Loss of international medical experiences: knowledge, attitudes and skills at risk.BMC Med Educ,7,47.
13. Izadnegahdar, R,Correia, S,Ohata, B(2008).Global health in Canadian medical education: current practices and opportunities.Acad Med,83,192-8.
14. Jacobs, F,Stegmann, K,Siebeck, M(2014).Promoting medical competencies through international exchange programs: benefits on communication and effective doctor-patient relationships.BMC Med Educ,14,43.
15. Jeffrey, J,Dumont, RA,Kim, GY(2011).Effects of international health electives on medical student learning and career choice: results of a systematic literature review.Fam Med,43,21-8.
16. Kassam, F,Damji, K,Kiage, D(2009).The Sandwich fellowship: a subspecialty training model for the developing world.Acad Med,84,1152-60.
17. Lancet, Editorial(1993).The overseas elective: purpose or picnic?.The Lancet,342,753-4.
18. Lawson, A,Serwadda, D,Sewankambo, N(2012).Partnering for medical education in Sub-Saharan Africa: seeking the evidence for effective collaborations.Acad Med,87,216-20.
19. McAllister, L,Whiteford, G,Hill, B(2006).Reflection in intercultural learning: examining the international experience through a critical incident approach.Reflective Practice,7,367-81.
20. Miranda, JJ,Yudkin, JS,Willott, C(2005).International health electives: four years of experience.Travel Med Infect Dis,3,133-41.
21. Mueller, P,McConahey, L,Orvidas, L(2010).Visiting medical student elective and clerkship programs: a survey of US and Puerto Rico allopathic medical schools.BMC Med Educ,10,41.
22. Mutchnick, IS,Moyer, CA,Stern, DT(2003).Expanding the boundaries of medical education: evidence for cross-cultural exchanges.Acad Med,78,S1-5.
23. Nishigori, H,Takahashi, O,Sugimoto, N(2012).A national survey of international electives for medical students in Japan: 2009-2010.Med Teach,34,71-3.
24. O'Donnell, P,McAuliffe, E,O'Donovan, D(2014).Unchallenged good intentions: a qualitative study of the experiences of medical students on international health electives to developing countries.Hum Resour Health,12,49-56.
25. Ouma, BD,Dimaras, H(2013).Views from the global south: exploring how student volunteers from the global north can achieve sustainable impact in global health.Global Health,9,32-7.
26. Pan, H,Norris, J,Liang, Y(2013).Building a professionalism framework for healthcare providers in China: a nominal group technique study.Med Teach,35,e1531-6.
27. Sawatsky, AP,Rosenman, DJ,Merry, SP(2010).Eight years of the Mayo international health program: what an international elective adds to resident educaiton.Mayo Clinic Proc,85,734-41.
28. Thompson, MJ,Huntington, MK,Hunt, DD(2003).Educational effects of international health electives on U.S. and Canadian medical students and residents: a literature review.Acad Med,78,342-7.
29. Vygotsky, L(1978).Mind in Society: The Development of Higher Psychological Processes.Cambridge:Harvard University Press.