Short-Term Study Abroad: The Students' Perspective on London 2019

KEY POINTS

• Study abroad programs have many potential benefits for future health care providers, including personal growth, intellectual stimulation, gaining a different perspective on one's own culture, increased cultural awareness, better prepared preparation to work with the changing demographics in our society, and understanding of the globalization of athletic training and therapy.

• To date, there has been no investigation of the student's perspective on participating in an international educational experience in athletic training.

• More opportunities need to be developed for athletic training students to attend short-term study abroad programs.

INTRODUCTION

Study abroad is not a new concept to higher education. These experiences can vary in location, duration, objective, and cost. Study abroad allows students to explore another country or region's culture, language, cuisine, art, architecture, sports, and history, and hopefully increase the student's cultural awareness. Although increasing students' cultural awareness can be accomplished in many different ways, international educational experiences allow for students to be fully immersed in another culture.

Because of the prescriptive nature of professional entry-level athletic training programs, many study abroad opportunities have the potential to cause delay or disrupt the normal progression for the traditional athletic training student, especially yearlong or semester-long experiences.^1–3 One way for athletic training students to travel internationally and experience other cultures is through short-term study abroad programs. These programs are increasing in popularity and prevalence across athletic training, allowing students to experience different cultures while maintaining their progression within their athletic training curriculum.

Currently there are resources available for educators interested in developing a short-term study abroad program for athletic training students, including Guyer¹ and Jutte,² who outline their personal experiences planning and executing international educational experiences with step-by-step advice. Information about embedding study abroad into athletic training curriculum can be found in Abe-Hiraishi et al.³ Although this information provides the “how to” for short-term study abroad programs, what is missing in the literature is the student's perspective on participating in an international educational experience. The purpose of this article is to

1. Discuss a recent short-term study abroad program offered to athletic training students;

2. Report the students' perspective of a short-term study abroad program; and

3. Summarize the students' experience and perceived benefits for students attending a short-term study abroad program.

BACKGROUND ON THE INTERNATIONAL EDUCATIONAL EXPERIENCE

In October of 2018, King's College, Wilkes-Barre, Pennsylvania, in conjunction with the Professional Baseball Athletic Trainers Society; the National Athletic Trainers' Association; St Mary's University College in Twickenham, London, England; and the British Association of Sport Rehabilitators and Trainers, announced the opportunity for athletic training students to attend a short-term, noncredit study abroad program in London, England, from January 14 to January 20, 2019. Four first-year master of science in athletic training students from Moravian College (Bethlehem, PA) elected to attend. This international educational experience included active participation at the inaugural International Sports Science Medical Conference: Diagnosis, Management and Rehabilitation of Injuries in Elite Upper Extremity Athletes; networking opportunities with professional athletic trainers and sport therapists from other countries; and the chance to gain professional and international academic perspective on techniques and topics in athletic training and sports rehabilitation from leading professionals from both the United States and the United Kingdom. The experience also included both structured and nonstructured cultural activities throughout London. Faculty members from King's College's professional athletic training program traveled with the students and attended the structured activities with the group. The international educational experience did not include activities such as attending St Mary's University College classes or any clinical experiences while abroad.

THE STUDENTS' PERSPECTIVE

Before leaving, the 4 students were asked to journal about their experiences and reflect on each day's activities while in London. After their return, the students met with me (E.K.P.) to debrief about their international educational experience. This informal session allowed the students to reflect and share their experiences while abroad. This session began with discussing the day-to-day agenda and logistics. The students also reflected on cultural differences and similarities, attending their first professional conference, and whom they interacted with on the international educational experience. This session helped me (E.K.P.) create the specific questions, based on our informal discussion, which were then sent to each student. The students then had 72 hours to independently reflect on their international educational experience and answer the questions presented to them to allow for a timely return. Below are the questions and a summary of the students' answers.

• 1.

  Prior to your international educational experience to London, what experience(s) had you had with international travel or study abroad?

Three of the 4 student (H.C., A.D., and M.H.) had never traveled outside the United States before this international educational experience, but all expressed an interest in international travel. To illustrate this, H.C. (22 years old) wrote,

Prior to this trip to London, I had never traveled abroad. I received my undergraduate degree in upstate New York, by the Canadian border, which exposed me to some cultural differences, but I never traveled into Canada to really experience it.

M.H. (22 years old) also wrote, “I have never had the opportunity to travel internationally before, but have always wanted to.”

In contrast, S.D. (23 years old) had extensive experience traveling abroad with her family. She reflected:

While this was my first opportunity to do a formal study abroad trip, I have had many opportunities to travel throughout Europe and experience many of the different cultures the continent has to offer. My first experience in Europe was when I first visited London 4 years ago, which was not as quite of a culture shock as some of the other places I have since traveled. I have visited Ireland, Spain, Scotland, Croatia, Montenegro, Bosnia and Herzegovina, Hungary, Poland, and the Czech Republic in Europe and all had their own unique cultures. The most diverse culture experience I had was in Bosnia and Herzegovina; it was still very much rebuilding from its civil war that ended in 1995, which was shocking to see coming from America.

• 2.

  Why were you interested in this international educational experience? What sparked your interest? Why did you decide to go on this international educational experience?

All 4 students expressed an interest in this study abroad experience because of their interest in going to London for its historical aspects. They also discussed and wrote about an interest in attending the associated conference, specifically because of the shoulder content, and the potential networking opportunities from attending this international educational experience. For example, H.C. wrote:

I was interested in this trip right away, because I have always wanted to travel abroad, and London sounds awesome at first glance. London has an amazing historical background and has a bit of influence over our culture in the United States. Aside from that, the athletic training conference was a big interest for me because I'm interested in the shoulder and its biomechanics and this conference was all about that. I was a bit nervous to go but with a gracious nudge from my mom, I filled the paperwork out and got the appropriate documents rolling.

A.D. (22 years old) also illustrated her reasons for wanting to go to London when she wrote:

I have always wanted to travel out of the United States and always had an interest in other cultures than my own. London was always on my top list for places I wanted to travel. I also enjoy the history aspect of older places, and what better place for history than London. I thought this would be the best way to travel on my own, but within a group. I did not have to worry about a language barrier, which allowed me to appreciate my surroundings even more.

• 3.

  Were there any barriers (real or perceived) to you going on this international educational experience? How did you overcome them?

For the 3 students who had never traveled abroad (H.C., A.D., and M.H.), the barriers they had to overcome were different than those for S.D., who had extensive experience traveling abroad and who had previously been to London. H.C., A.D., and M.H. expressed initial concerns about obtaining passports, navigating public transportation, food differences, and other uncertainties of leaving the United States. These 3 students discussed that many of the things that they perceived to be barriers before travel were actually not. The anxiety they felt preparing to leave the United States and while in London was partially mitigated because they were going through this with their friends. One common consideration for international travel that the students did not have to contend with when going to London was the language difference. H.C. illustrated many of these points when she reflected:

Luckily, a language barrier wasn't a problem and there weren't many actual barriers with traveling to London, but I made a few for myself by overthinking the whole trip. I'm a picky eater to put it lightly, so I was nervous about the change in food that they have there. Public transportation has never been a part of my life because I come from a tiny town in upstate New York, making trains and subways a stressful time for me. I was also concerned with the currency change and if my debit/credit cards were going to work or if it was an all cash all the time kind of agenda. I'm not sure I completely overcame them because I found myself anxious in those moments, but I was surrounded by people that were feeling the same way, so it made me feel better and more comfortable in the situation.

A.D. had concerns about the cost of traveling abroad and wrote:

When I first received the e-mail about the trip, I actually deleted it because deep down I knew I wouldn't be able to afford it. After talking to my 2 friends, I decided to take the leap…. My parents talked me into taking the chance, mostly because I would regret it if I did not go. This was a once in a lifetime chance, and I could not pass it up. I just needed a little nudge in the right direction.

She was able to overcome this possible barrier to attending this international educational experience with help from her parents.

• 4.

  How did this study abroad trip change your perspective about other cultures? Think about what you thought prior to the trip and what you think now, what changed?

After traveling abroad to London, the students all commented on both the similarities and differences in the United States and the United Kingdom. As discussed before, the fact that English is spoken in the United Kingdom was definitely a cultural similarity the students appreciated. The students also enjoyed learning more about the history of London and the United Kingdom during their visits to museums and other cultural and historical sites. Many of the things the students were concerned about being different before getting to London (eg, the food) proved not to be very different once the students actually arrived. The biggest difference the students discussed was the fact that vehicles are driven on the opposite side of the road as compared with the United States. The students noted that they actually had to pay attention when crossing the street. Although the cultures are not drastically different between the United States and the United Kingdom, this international educational experience seemed to make the students more receptive to future international travel. H.C. summarized this when she reflected, “After this trip, I'm not as nervous to travel abroad and experience other cultures, which will be beneficial in my future in this profession.”

• 5.

  How did this study abroad experience change your perspective about athletic training?

This international educational experience exposed the students to many different aspects of athletic training. This included both international and domestic athletic training opportunities, especially related to professional sports and research. H.C. realized the vast possibilities after graduation and reflected:

It made me realize how big of a profession it [athletic training] actually is, while sitting in class they tell you about how big and broad the opportunities are, but you never really realize it. I got to see the professional aspect of it and their stories on how they got there, and it really opened my eyes to all the opportunities after I graduate with my master's.

Although A.D. made it clear that there are currently not a lot of opportunities for international internships, the students were still encouraged by the possibility. M.H. wrote, “It was also nice to hear from the physiotherapists and how they encourage American students to come to Europe for internship opportunities and jobs.” S.D. also reflected on her changed views after learning more about athletic training in the United Kingdom. She reflected:

This study abroad trip was able to change my perspective on what I thought about athletic trainers in the United Kingdom. I did not think there was much available as far as education and job opportunities because it is not talked about much, but after attending this trip it was nice to see how international athletic training is as a profession.

Because this was the first athletic training conference the 4 students had ever attended, the experience also opened their eyes to how research is disseminated and the variety of research being conducted related to athletic training. S.D. discussed her new appreciation for research after attending the conference and wrote, “The amount of different research that was presented at the conference in London made me think about all the possibilities of research that are still left to be explored.” The students also appreciated the interactions they had with the professional baseball athletic trainers in attendance at the conference. All 4 returned home discussing their perspective on injuries, or more specifically injury prevention. Simply, A.D. said they learned that for baseball “it is about being proactive rather than reactive to injuries.”

• 6.

  How do you think this experience will change your educational path? Your career path?

All 4 students returned with an interest in working in baseball that they did not have before the trip. Simply, H.C. wrote, “I never expected myself to work in baseball because I never had a passion for the sport, but now I will be more open to the opportunity to work in baseball.” A.D. went on to expand on this idea and wrote:

Before attending the conference, I had no interest in working professional baseball. The conference made me aware of all the possible jobs available within each organization. I never thought of the need for athletic trainers in the developing farm systems like the Dominican Republic and Florida. It made me realize that there are many more opportunities available than I thought. I did not know you had to go through the organization like the players do to be at the top. I honestly thought it was about who you knew. With all this new information, I have an interest in working with Major League Baseball.

The international educational experience and attendance at the associated conference also helped students in how they viewed themselves as future professionals and to be more confident in themselves. For example, H.C. summarized this when she reflected:

I'm also not as nervous to broaden my horizons and study abroad and attend conferences abroad to learn from professionals. If the opportunity to internship abroad arises, I may be more apt to entertain the opportunity, more than before. I also find myself more comfortable talking to other professionals in the field because after attending this conference, I feel more of a professional than I did before going.

M.H. discussed the networking opportunity and reflected:

This experience definitely allowed me to meet new students and professionals not only from various spots in the United States, but also from various universities in England. It was really cool to see the group of 50 American students ranging from Seattle to Houston to the East Coast come together all for the same common goal of learning and networking.

• 7.

  What recommendations do you have for other students considering going on a study abroad experience in the future?

The students, without reservation, would recommend a short-term study aboard experience to other athletic training students. S.D. may have said it best:

I think any opportunity anyone can get to study abroad, whether it is for a week or a semester, they should take. Being able to immerse yourself into a different culture gives you an unforgettable experience to expand your knowledge of the world we live in. However, being able to attend a conference that is geared toward a person's career path so closely as the Sports Science Medical Conference did, it really made the opportunity even more special than just any study abroad trip. In addition, I believe that having cultural awareness as an athletic trainer may be able to help international athletes when working in a more traditional setting.

H.C. continued with the same sentiment:

Take the jump and go for it, no matter where it is. You will feel scared and anxious about it, but there will be people there that are either feeling the same thing or willing to help you through it. It will open your eyes to people and things that you would have never been able to experience in your life. Don't allow yourself the possible regret of not going, you will be humbled by the experience and realization that the world is so much bigger than where you're from.

Lastly, M.H. discussed the conference and connections she made and wrote:

Hopefully there are more international conferences for athletic trainers and physiotherapists to continue educating each other on current issues in those prospective countries, and to allow prospective students to have an opportunity to step out of their comfort zones and make really important connections.

SUMMARY

As the role of the athletic trainer in health care continues to evolve, so does the diversity of the patients athletic trainers treat. Athletic trainers care for a variety of patients of different ages and socioeconomic statuses, and many who participate in nonsport activities. Athletic training also continues to expand internationally. With the globalization of athletic training to countries such as Ireland, Japan, and Spain, there are more and more opportunities for athletic trainers to travel abroad and interact with populations outside of the United States. No matter the setting or geographic location athletic trainers are practicing in, they must take cultural differences into account when interacting with patients. One way for athletic training educators to help prepare their students to work with a diverse population of patients in their future roles in health care is through international educational experiences and short-term study abroad opportunities.^1–6

International travel can be stressful, even to the seasoned traveler. This short-term study abroad program allowed the students to experience international travel as part of a group. A common theme in both their written reflections and our debriefing session was hesitation about traveling internationally from the 3 students who had not done so before. These 3 had to navigate obtaining a passport, packing, public transportation, cuisine differences, and other unknown cultural differences. Some of this stress was mitigated by going through the process with their friends and a group of other students having a similar experience.

The students also noted that they did not have to adapt to language differences during this international educational experience. This helped alleviate some of the stress that international travel can have and made this a smoother experience for the students. The students also reflected on other similarities between the 2 countries that they had not anticipated before traveling to London. For example, yes, they served beans with breakfast, but the students could also find most of the foods they were used to eating while in London. These cultural similarities and differences allowed the students opportunities for reflection and increased cultural awareness.

On this international educational experience, the students gained an understanding of how athletic training is practiced in other countries, especially related to research and caring for professional athletic teams. Beside the sport therapists from the United Kingdom in attendance, there was also a representative from the Japanese Athletic Training Society. There were networking opportunities for the students to interact with these professionals, along with the athletic trainers in attendance from Major League Baseball (MLB). The students especially appreciated hearing their stories of how the MLB athletic trainers got to where they are in their careers and how easy it was to interact with them during the conference. From their interactions with the MLB athletic trainers, these students had an increased interest in baseball and the associated injuries.

What was prominent to me (E.K.P.) from both the debriefing session and written reflections was the students' perceived barriers to attending this international educational experience and how all 4 students would now highly recommend a short-term study abroad experience to other athletic training students. For these students it was more than just learning about athletic training; this experience was about seeing the world differently and expanding their horizons. This international educational experience increased their cultural awareness, and when they practice as athletic trainers, this experience will have an impact on their providing culturally competent patient care. Hopefully this international educational experience will be just one of many experiences in the lifelong process of becoming culturally competent practitioners.

RECOMMENDATIONS

Although the reflections of these 4 students on their international educational experience bring to light their perspective about short-term study abroad experience, they also open the door to additional research. More research needs to be done to objectively assess how these types of international educational experiences influence athletic training students' cultural awareness and cultural competency upon return. The use of validated cultural assessment instruments, such as the Inventory for Assessing the Process of Cultural Competency among Healthcare Professionals (IAPCC)–Student Version, is recommended. Various versions of the IAPCC has been used in nursing and athletic training.^7–10 There is also an area for interprofessional education opportunities for both cultural competency and health care in a larger perspective to be explored.^4,6 Lastly, it is recommended to continue the development of best practices when it comes to short-term study abroad programs for athletic training students, especially as athletic training programs transition to the entry-level master's.

CONCLUSIONS

Short-term study abroad programs are one way for students to increase cultural awareness while staying on track with their athletic training curriculum. The students who attended the international educational experience in London in the winter of 2019 reflected on the perceived barriers and benefits of international travel with a group. From the students' perspective, the experience was positive, and they would recommend it to other athletic training students.