Critical moments in student learning on international advanced pharmacy practice experiences

Abstract

Introduction

The purpose of this study was to evaluate self-perceived critical moments that were transformative to learning in students who participated in an international advanced pharmacy practice experience (APPE).

Methods

Twenty-two pharmacy students from Purdue University College of Pharmacy, the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and the University of North Carolina Eshelman School of Pharmacy who went on an international APPE participated in a one-hour focus group evaluating self-perceived critical moments that impacted their learning. Focus groups were coded using a conventional content analysis approach and went through a two-cycle open coding process to identify major themes according to country income classification.

Results

Twenty-two students participated in the focus groups with 18% going to a high-income country (HIC) and 82% going to a low-to-middle income country (LMIC) location. Major themes identified within HIC locations included witnessing an innovative patient care technique and experiencing interprofessional healthcare team dynamics. Major themes identified within LMIC locations included engaging in a sensitive patient interaction, experiencing healthcare system barriers, going out of their comfort zone, and making a difference.

Conclusions

International APPEs in both HIC and LMICs provided students with disorienting experiences that facilitated transformative learning and led to changes in their perspectives on patient care and pharmacy practice. While critical moments were different across country income locations, both provided valuable experiences that could be translated into local context.

Introduction

International experiences are abundant with opportunities to transform students' personal and professional perspectives. They are a component of many curricula, with approximately 7% of student pharmacists and 24% of medical students participating in an international rotation before graduation.^1,2 These experiences provide unique opportunities for students to further develop their communication skills, empathy, self-efficacy, and cultural awareness,^3,4 as well as influence their attitudes regarding cultural sensitivity and professional outlook.⁴ As institutions continue to grow their international offerings, it becomes imperative to understand the process of learning in order to inform the development of effective international learning experiences.

International experiences are influential to students' personal and professional development, but it is unclear what events within the experience precipitate that transformative process. Transformative learning is a process of provoking change in an individual's perceptions.⁵ These perceptions are influenced by past experiences and guide behavior and future actions until faced with opposing information. Mezirow's Transformative Learning Theory suggests students need to face a “disorienting dilemma” that challenges them to reconsider their beliefs and construct new learning and perspectives that result in behavioral changes.⁶ This theory has been used to explain the process of learning and professional identity transformation in medical trainees who participated in international rotations.⁷

International experiences challenge students' existing beliefs by placing them in an unfamiliar environment and practice setting; however, it is unknown what aspects of these experiences contribute to this “disorienting dilemma” that stimulates transformative learning in pharmacy students. Knowing the facilitator for this process can help institutions develop or re-contextualize international experiences to be more impactful on student learning. With the current coronavirus pandemic, this information may also be beneficial for institutions looking to recreate disorienting global experiences in their local settings. The purpose of this study was to evaluate self-perceived critical moments that were transformative to learning in students who participated in an international advanced pharmacy practice experience (APPE).