Evaluation of Student Learning Using a Framework to Guide Reflective Journaling Across Study Abroad Courses

There is increasing interest in the world of academia for college universities and professors to encourage students to participate in study abroad experiences. Within the last decade, students in the United States have taken an increasing interest in study abroad activities. According to the Institute of International Education (2018), approximately 332,727 students studied abroad during the years 2016-2017 which was more than double the number of students recorded over the past 17 years. With the world becoming more culturally diverse, nursing professionals frequently encounter cultural differences and language barriers (Goodman, 2016). According to Martins de Oliveira and Tuohy (2015) there is evidence to support the fact that nursing students would be better prepared to provide culturally sensitive health care to diverse populations if they were able to participate in study abroad experiences.

This ongoing project examines faculty-led study abroad opportunities for nursing students in the following countries: Thailand, December 2017; United Kingdom, May 2018; and an upcoming course to Austria in spring 2019. The purpose of these study abroad courses is to promote awareness and understanding of global health issues and to foster cultural competence in the profession. To ensure quality across study abroad courses a common framework is being used to guide student evaluation through reflective journaling.

Reflective journaling is a commonly used method to encourage students to critically think about their cross-cultural experiences and how these experiences will impact their professional careers According to Taliaferro (2016) reflective journaling is a method for students to examine feelings regarding cultural experiences. Nguyen (2017) found that, across 8 different short-term study abroad programs (n=57 students), “well-defined” activities contributed to the development of self-perceived Intercultural Competence before, immediately after and 3 months after the activity. One of these activities was journaling. Walters, Charles and Bingham (2017) studied the impact of student critical reflection on transformational learning in six different study abroad programs (n= 27). They found that journaling was one of factors that led to the highest critical reflection scores, particularly “journal writing that is tailored to facilitate transformational learning” (Walters et. al., 2017, p. 117).

The Intercultural Global Health Assessment and Reflection (IGHAR) framework is being used to guide student reflections on global health experiences and learning about global health. The framework, based on Leininger’s Sunrise Model and the Social Determinants of Health, was first used with an interprofessional (nursing and social work) group of students involved in a three-week immersion course in China (Riner et. al., 2015). It helps focus student reflections on the influence of care expression, patterns and practices in the following dimensions: educational, technical, religious and philosophical, kinship and social, cultural values and beliefs, political and legal, economic. Students are instructed to choose four of these dimensions for reflective journaling, to be completed at specific intervals throughout their trip. These dimensions served as a framework for student learning in previous study abroad courses to the United Kingdom (May 2018) and Thailand (December 2016) and again, will be used this spring in a study abroad course to Austria (May 2019).

To evaluate student learning, reflective journals for students, studying in Thailand (n=11) and United Kingdom (n=10), were reviewed to find common themes within the dimensions of the IGHAR framework. Students from both groups discussed the differences in healthcare and nursing education between the United States and the traveled countries. They all reflected on the differences and similarities between nursing education in the U.S. and in the host country. The students in Thailand compared healthcare in the U.S. with the Thai system that includes traditional medicine. The students in London seemed to be more interested in the historic aspect of the country, healthcare and nursing. The students visiting Thailand wrote about Thai traditional cultural values and beliefs whereas the students visiting London reflected on the culture of nursing. The majority of reflections across groups focused on education and cultural values and beliefs. While the education dimension is easily distinguished from the other dimensions, cultural values and beliefs were significant to all of the dimensions and seem to be more of an overarching theme in the framework.

There were inconsistencies in the focus and quality of student journals, particularly in the attention to the details of each dimension. A wide variation in critical refection was noted within and between groups. There are numerous ways to improve this process. The first is more rigorous preparation of the students prior to the trip. This would include a thorough introduction to reflective journaling, providing journal examples and completing a pre-trip reflection assignment. Time for journaling can be scheduled within the daily activities in the host country. These activities will better ensure that students understand the significance of the assignment as a part of the overall experience.

Global health issues are important to healthcare professionals, and teaching students about these concerns should be an integral part of faculty responsibilities. Study abroad provides students and faculty a wonderful and transformational encounter for learning. Providing a structured process for reflecting by using a framework like the IGHAR will ensure that students are thinking critically about their study abroad experiences.