Short-Term, Faculty-Led Study Abroad Program in Japan

Agreement with Host Universities

Because the university did not have an agreement with any Japanese universities offering athletic training, sports medicine, or exercise science programs, it was important to establish relationships with academic programs related to sports medicine, athletic training, or exercise science. The executive board members of the JATO (all certified athletic trainers who work as faculty or athletic trainers at Japanese universities) were contacted, and the idea of a study abroad program was discussed using the program overview and learning objectives. Upon agreement on the general idea, a visit to each university was planned.

Securing Funds

It was crucial to secure funding for developing the study abroad program. A planning grant was received from the university and allowed the program leader to visit 7 universities in 5 different cities in Japan in May 2015. This visit was essential before an actual trip with students in order to (1) meet faculty and staff members at potential host universities, (2) obtain necessary documents for an agreement, (3) discuss and develop specific activities at each university, (4) visit facilities that the students would potentially visit, (5) estimate realistic expenses of the trip, and (6) become familiar with local transportation. All information gathered during this visit was helpful to assess overall safety, to discuss potential culture shock with students, and to build a realistic itinerary and budget. Based on the May 2015 visit, the proposal for funding was revised. In September 2015, an additional revised proposal was submitted to the university to request funds for conducting the short-term study abroad program in Japan, and the program was funded in November 2015.

Student Recruitment

An official announcement was made to students in the ATP in November 2015. This announcement initiated the application cycle for the program. Required application materials are summarized in Table 3. After the application materials were reviewed in December 2015, 5 students (1 man and 4 women; age = 24.0 ± 3.81 years) were invited to participate in the study abroad program and instructed to enroll in an elective course for the spring 2016 semester. Such an elective course is loosely structured, and generally called independent study, in which students study selected topics under the supervision of faculty. This independent study course was designated for the study abroad program, instead of creating a new course for the program, in order to avoid additional processes of curriculum approval. Another possible option would be to add the study abroad component to an existing course if a relevant course is available.

Table 3 Application Materials

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To assist in preparing and conducting the study abroad program, a graduate student served as an assistant to the study abroad program. Thus, the group traveling to Japan was composed of 5 undergraduate students, 1 graduate student as the program coleader, and 1 faculty member as the program leader, resulting in the student to leader ratio of 2.5:1.

Pretravel Requirements

Throughout the spring 2016 semester, the students were required to prepare for the international travel by completing the course pretravel requirements, including (1) attending weekly class meetings, (2) attending a predeparture safety orientation hosted by the Global Education Office at the university, and (3) developing presentations that would be given in Japan. The weekly meetings were used to assist the students in completing mandatory travel requirements such as a travel health consultation and in obtaining passports and international health insurance. The presentation topics and slides that would be given in Japan were discussed and developed. At each meeting, the students showed their updated presentation slides and received feedback from the graduate assistant and program leader. Furthermore, the travel itinerary was built based on the information gathered from the program leader's previous planning trip. Once the itinerary was formed, the students were responsible for searching for accommodations, flight, and cultural activities at each city in Japan. Several activities, described in the following section, were used to facilitate this search.

Pre-exposure

As an outcome of the program leader's visit in May 2015, a group of students from the Japanese university the program leader had been collaboratively working with visited our university in March 2016. Our students planning to travel to Japan provided tours of campus and athletic facilities at the university and had lunch and dinner with the group. The visiting group gave a presentation on the history, structure, and curriculum of their university. Our students used the opportunity to ask about affordable options for accommodations, food, and cultural activities in order to build their travel itineraries. The discussion extended to what differences the visit group noticed in the United States. The group pointed out that most gyms in Japan require taking shoes off to avoid getting the floor dirty, whereas the gyms in the United States do not, and that people in the United States blow their nose loudly, which is not normal in Japan. These points were eye-openers for our students. After the visit of the Japanese group, all of our students mentioned that it was difficult to communicate with the language barrier, yet this opportunity was beneficial so that they could learn all the information from the visiting group before the trip.

Predeparture Orientations and Workshops

In April 2016, the Global Education Office at our university provided predeparture safety orientations in order for the students to learn the best tips for traveling abroad safely, such as the processes of immigration and customs at the airport. Furthermore, a guest lecture was presented by a graduate student who had previously traveled to Japan. He shared his experiences in Japan in terms of culture, history, public transportation, challenges, and general recommendations on cultural sites and activities. The guest lecture influenced students' decisions on accommodations, foods, and cultural activities that they wanted to be exposed to in Japan. Additionally, a session on the use of chopsticks was also helpful for students to learn what is considered rude in Japanese culture. Such a work session is very simple, yet can lead to enhancement of students' cultural awareness and sensitivity. In sum, the orientations and interaction with Japanese people helped the students feel more confident and comfortable in traveling to Japan.

Beyond the pretravel requirements described above, the students were encouraged to apply for a scholarship specifically for the study abroad program available at the university. In order to secure additional funds, the students participated in fundraisers. Through these activities, the students successfully secured additional travel funds ranging from $300 to $900 each.

Visiting Multiple Sites

It is recommended that a study abroad program include visits to multiple institutions, because in other countries education is often institution specific. Each institution that we visited in Japan has a unique education system. For example, students at one institution study for a minor in athletic training while taking Eastern medicine courses as the major degree. This university offers an impressive educational degree integrating contemporary and traditional medicine in Japan. On the other hand, some Japanese institutions incorporate the US athletic training education program model into their educational degree plan. Another affordance of visiting multiple institutions is that students have opportunities to visit multiple cities, exposing them to distinct regional and local cultures. To enhance the cultural exposure in each city, a study abroad program should allocate an entire day or at least half a day for students to explore the city independently without being guided by the program. Although direct guidance or supervision of the students was not required on those days, the program leader was available in case of emergency. Thus, the program leader must be familiar with the local transportation and have a general idea of where the students would go.

Transportation

Transportation is an important factor to consider when traveling from one city to another while minimizing cost and time lost. Around and within the greater Tokyo area, public transportation is well developed and was the best option for our study abroad program to avoid heavy traffic and minimize cost. Public intercity transportation, such as between Tokyo and Kyoto, located approximately 200 miles apart, is quick and affordable. One disadvantage of using public transportation is that the students needed to carry their heavy luggage throughout the trip, from city to city. Thus, it is strongly recommended that students make their luggage compact and as light as possible. To alleviate this luggage issue, organizers of a study abroad program may decide to use a rental car, which is also a common method of transportation in Japan. However, a rental car may be the least desirable transportation option because of increased unforeseen risks such as heavy traffic, unfamiliar roads and car models, and the requirement of possessing an international driver's license.

Balance Between Academic and Cultural Activities

Another factor to consider when developing an efficient travel itinerary is the amount and timing of academic activities in relation to cultural activities as they provide students the opportunity to enhance their multicultural education. Although an adequate balance between academic and cultural activities in a study abroad program is still unclear, the students indicated “long day,” “tired,” and “run out of energy” in their daily reflection on the second day of full academic activities. The students also mentioned in the reflection that they were getting tired quickly more than usual in Japan. This might be due to multiple factors including the unfamiliar environment, jet lag, being in a foreign country, the different language, and diets to which they were unaccustomed.^16,17 Based on the reflections and experience from our study abroad program, more than 2 consecutive days of full academic activities reduced the students' ability to engage in activities. To minimize this, it is recommended that social events be included in an academic day. In addition, the first day in Japan should not be an academic day as students recover from the long international flight.

Program Events

The study abroad program provided 3 program dinners to students. These dinners were included in the itinerary not only to provide traditional Japanese meals to students, but also for the program leader to recognize students' physical and mental health status via casual conversations. Each student felt increased stress to some degree because of the exposure to unfamiliar environments in a foreign country. The program leader was able to recognize any changes and provide necessary accommodations to students as needed. Another benefit from informal and casual conversations at the program dinners was that students asked questions and brought up their concerns without hesitation. Thus, the program dinner should be considered when developing a study abroad program.

Budget

An accurate estimation of travel expenses played an essential role in developing the itinerary, obtaining funds, and recruiting students. The program leader's previous visit to each host university was very helpful in estimating the travel expense per student, which ranged from $2300 to $2800. The students, the assistant, and the program leader successfully kept the travel expenses below budget (Table 5) using 2 main strategies. The first was that the students started to search for flights once the travel itinerary was formally solidified, which was approximately 3 months before the trip. The second was to search for affordable types of accommodations. The students stayed in campus housing at host universities and also used capsule hotels, which is a unique type of accommodation developed in Japan and significantly cheaper than a hotel. The students noted in their reflection about the capsule hotels: “Interesting because still experiencing the Japanese culture,” and “It was a pod or tiny room that could basically only fit a bed and a shelf. It was surprisingly comfortable and I kind of enjoyed it.” In addition, the duration of a study abroad program must be taken in consideration. The longer the duration, the more expensive the stay in Japan. Lastly, gifts for each host university should be included in the budget. The gifts can be anything with the guest university's name and logo, for example, a towel, notepad, flag, cap, T-shirt, or sticker. Selection and the amount spent on these gifts are highly dependent on how many people the study abroad program gives the gifts to. It is customary for visitors to show appreciation for hosting the study abroad program.

Table 5 Travel Expense of a Representative Student

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Local Facilitator

Someone who understands both English and Japanese should be available to facilitate communication between students as necessary. Whether such a facilitator is available at an institution must be taken into consideration when the itinerary is developed. Accordingly, before the trip Japanese certified athletic trainers affiliated with the host universities were contacted to ensure their willingness and availability to facilitate students' communication. It was most appropriate to include Japanese certified athletic trainers at each host institution because they had received their athletic training education in the United States and were familiar with their host university. A study abroad program may also want to request the facilitator to serve as a translator during some academic activities such as the host university's presentation if it is provided in a language other than English. Furthermore, the facilitator provided tours of campus and a variety of facilities at the host university. Therefore, the facilitator at each host university was an essential asset for the study abroad program in Japan and enhanced the students' experience.

Safety

To keep the trip safe, it was important for everyone involved in the study abroad program to recognize potential risks within a foreign country. Although Japan is thought to be a safe country for international travelers, the potential risks include, but are not limited to, (1) limited communication tools because of lack of international cell phone plans; (2) potential exposure to an emergency medical situation; (3) accidents, illnesses, and other unforeseen conditions; and (4) unprofessional conduct and/or behavior. To minimize and prepare for these risks, the students were prepared in safety and precautionary travel practices throughout the pretravel sessions and orientations provided by the Global Education Office at the university. A general health consultation by the Student Health and Counseling office at the university was provided to each student. As part of the consultation, it was ensured that students were able to travel to Japan with proper vaccinations. The students were also informed of the professional conduct that is expected for international travel in Japan during the pretravel sessions. The study abroad program rented several mobile Wi-Fi routers in order to give students access to the Internet. The students made and received calls through the Internet.

Daily Reflection

As part of the 15-day study abroad program requirements, students completed daily reflections, performed presentations at each institution, and attended all program activities. Daily reflections emphasized addressing the daily questions, including, but not limited to, “What did you observe and learn?” “What was your impression?” and “How would you use today's experiences in your professional and personal life, if applicable?” Students were also asked to comment on challenges and any positive and negative aspects of the study abroad program. Students' reflections were carefully reviewed and significantly valued for overall improvements in the study abroad program. It is highly recommended that time be allocated for students to write the daily reflection each day.

Presentations by Host Universities

All program activities and the itinerary were discussed with faculty members at each host university before the trip in order to enhance students' experiences. Specifically, the students attended presentations given in English by students of host universities on structure, curriculum, and features of the university as well as local traditions, festivals, and foods. Tours of laboratories and athletic facilities, including athletic training facilities, were also provided to our students by faculty and students of host universities. The presentations and tours helped our students understand education and the profession of athletic training in Japan as well as local cultures. Specifically, students' reflections highlighted several points of the presentation at host universities, including Japanese traditional sports (eg, judo and kendo), Eastern medicines (eg, acupuncture and moxibustion), and the profession of athletic training in Japan. A student mentioned in a reflection:

It's so crazy the differences in athletic trainers between Japan and the US. I didn't expect there to be such a huge difference. I wonder how hard it is for the Japanese certified athletic trainers who received an education in the US to come back to Japan. When in some jobs they cannot do all the things and skills they were trained to do while in school in the US.

Additionally, a student's reflection indicated that the presentation on the Japanese traditional sports and Eastern medicine before the actual observation and experience of the sports was very beneficial.

Cultural Exchange with Japanese Students

In addition to the academic activities, social activities were also included in the itinerary in order to enhance the interaction between hosts and our students. For example, lunch and dinner with Japanese students between and after academic activities were great opportunities for both Japanese students and our students to share their academic, professional, and personal experiences in a casual social situation while enjoying Japanese meals. In fact, our students highlighted this casual social event: “The Japanese students were shy at first, but we had great conversations at lunch about American and Japanese pop culture, their lives in Japan, and sports.” Moreover, as described above, such informal social activities within an academic day were helpful to prevent overloading of academic activities on students.

Independent Exploration

The independent exploration without being guided by the program was challenging for students because of the complex public transportation system and language barrier in Japan, yet it helped them build autonomy in a foreign country. As indicated in the students' reflections, because of the independent exploration in the study abroad program the students gained confidence to travel to Japan or even other foreign counties. The students also indicated that “those days without the program guidance were some of the most enjoyable and memorable experiences in Japan.” This student's response is in accordance with the previous report that 92% of students in a study abroad program liked free time to explore the city on their own.¹⁸ As described earlier (see “Visiting Multiple Sites”), the program leader should be available in case of emergency for students' safety.

Communication

Although there was a language barrier, Japanese students were willing to communicate with our students in English, particularly at informal social activities. Throughout the interaction with Japanese people, it was clearly observed that our students adjusted their communication with Japanese students by using body language, speaking slowly, and using different words. The changes in communication were supported by the students' reflections: “It was a challenge to communicate with the [Japanese] students because I had to slow down my own speaking so that they were able to follow and understand on what I was saying,” and “Language is just a tool of communication. We could know each other without verbal communication.” Additionally, our students highly valued their personal interactions with Japanese people and enjoyed sharing their personal and academic experiences with the Japanese students. Communication with people with a language barrier was one of the significant features in the study abroad program: that Japanese students and our students tried to break the language barrier and to interact with each other with respect based on an understanding of cultural differences and background. Such enhanced intercultural communication skills due to exposure to various cultures have also been documented when collegiate students participated in 3-month or 1-semester study abroad program.^19,20 As the diversity of the population increases, athletic trainers are more likely to face such language barriers in the work environment. Thus, the experience of overcoming language barriers should be viewed as a very positive educational feature for students from the perspective of cultural competencies.

Awareness of Japanese People and Culture

It has been documented that exposure to foreign people and cultures through a study abroad program enhances students' cultural awareness,^20–22 which was also found in our students' reflections. For example, the students described Japanese people: “respectful,” “helpful,” “humble,” “courteous,” “hospitable,” and “polite.” This was likely because all Japanese students, faculty, and staff members at each host university welcomed our students well. The students said:

When we have foreign exchange students at the university be sure to print out something that says, “We Welcom[e] XX University.” All universities had a banner or display welcoming us. Something so simple made me feel really special,

and “Japanese people are treating everyone how you want to be treated.” Moreover, our students were impressed by not only people at the host universities but also those on the street. Some students received great help from people on the street figuring out how to buy a train ticket and how to get to a destination.

In their reflection, some students pointed out a lack of ethnic diversity in Japan: “In talking to (Japanese) students, I realized that there are a lot of things that the people here aren't exposed to, such as religion and race.” Another example that might indicate a lack of diversity is that the student mentioned, “Caught a few eyes everywhere.” The student did not feel surprised or uncomfortable because the pretravel presentation by a graduate student introduced that staring at foreigners is normal in Japan. Accordingly, the students recognized that Japanese people are not accustomed to diverse cultures or people, which might be the reason for shyness and hesitation at first.

The students became very respectful of and sensitive to Japanese tradition. Overall, students' impression was that “people follow the traditions that have been used for centuries,” “following the traditions is important to maintain their identity and culture,” and “people are proud of their traditions.” To show respect for Japanese tradition, the students often asked Japanese students and faculty whether they needed to take their shoes off when entering a room, which is a very difficult practice in Japan as it is difficult for visitors to know when they need to take their shoes off. From a public-health perspective, the students learned that, because of this tradition, health care providers should take extra care with foot hygiene when traveling with athletes to Japan.

The students also noticed differences between Japanese and American diets, which health care providers should be aware of. The students described the Japanese diet: “An American diet consists of a lot of meat, poultry, and processed foods that are high in salt and sugars, compared with a Japanese diet,” “The serving size and portions in America are a lot larger than the normal serving size in Japan,” and “Japanese food consists of a lot of fish, rice, noodles and vegetables.” Furthermore, the student discussed: “This disparity in diet must be considered when I have a Japanese athlete in a team, as he/she may not be able to accept an American diet.” As our students experienced difficulty getting accustomed to Japanese diets throughout the study abroad program in Japan, they now recognize how difficult it is for athletes to compete abroad.

After returning to the United States, the students described “reverse culture shock”¹⁷ in their reflection to indicate the cultural and ethnic diversity in the United States and appreciation of their home culture. Taken together, in accordance with the previous studies,^20–22 the exposure to Japanese people and culture throughout the study abroad program enhanced students' cultural awareness and sensitivity.

Health Care Profession in Japan

Our study abroad program visited multiple clinical facilities and universities to observe health care professions in Japan with the purpose of not only exposing students to local culture but also learning the characteristics of health care professions at each facility. We visited one university that offers Eastern medicine and athletic training courses as the major and minor degree, respectively. The students were given the opportunities to learn, observe, and experience Eastern medicine, including judo therapy and acupuncture. At an acupuncture clinic of the university, certified clinicians performed a needle stick on some students. The students also attended a judo therapy class to practice wrapping and immobilizing the shoulder (ie, shoulder spica) using a nonelastic cotton bandage that is typically used by judo therapists. As it is rare to be exposed to Eastern medicine in the United States, these experiences were valuable and interesting for the students. The students described the experiences in their reflections: “It was really fun and great learning experience,” “The nonelastic bandaging is very interesting,” and “It was a little weird working with the cotton wrap rather than elastic wrap.” A student also noticed, “The judo therapy clinic is very much like an athletic training room in the United States.” The visit to this exemplary university made the students realize an influential factor of Eastern medicine in health care professions for the integration of contemporary and traditional medicine in Japan, which Japanese athletes are accustomed to.

We also visited a rehabilitation center of an orthopaedic hospital where more than 10 athletic trainers and 50 physical therapists work. The students noticed that athletic trainers at this hospital did not perform any therapy or treatment that involves direct contact with the patients. The athletic trainers only instructed how to perform exercises, whereas physical therapists performed many manual therapies, similar to chiropractors in the United States. Additionally, the students learned that the process to become a physical therapist is very different from the one in the United States. Thus, roles and responsibilities of each health care profession in Japan, at least at this hospital, differed from those in the United States. Nevertheless, as the students also mentioned, all health care professions in Japan are dedicated to providing patients with the optimum health care in a given situation.

Multiple visits to the athletic training facilities of host universities allowed the students to compare and contrast them with those in the United States and to understand the profession of athletic training in Japan. In terms of the size and equipment of athletic training facility, our students mentioned: “Similar size to high school athletic training room, but athletic trainers accommodate with the limited space and equipment,” “The athletic training room is very equipped, for example, SwimEx,” and “The size and equipment actually varied across universities in Japan.” Regarding how athletic trainers provide services to patients, some students noticed and mentioned: “The athletes work on their own exercise programs instead of the athletic trainer having to do that for them,” “Only allowed to supervise patients on exercises and modalities such as cryotherapy and thermotherapy instead of applying them to patients,” and “Surprised that there are athletic trainers around the practice to provide services because no athletic trainers in other universities even during practice of intensive sports like judo.” Thus, the students learned that how athletic trainers provide services is also dependent on universities in Japan, which may indicate that there are no clear standards for how athletic trainers should provide services in Japan. The exposure to a variety of health care facilities helped the students to recognize similarities and differences among them as well as between Japanese and US facilities.^23,24 Consequently, the students appreciated how well the standards of athletic training profession and education have been developed in the United States. This enhanced awareness of one's own learning and living environment is another feature of the study abroad program and valued as a significant benefit through the program.²⁵ In sum, the students recognized ordinary things in the United States that may not be found everywhere.