This paper describes the design, implementation and evaluation of a course in international service learning and community engagement for pharmacy undergraduate students. The course offered students opportunities to cultivate cultural competency in an international setting foreign to their own—Sub-Saharan Africa. The experience consisted of pre-departure preparation seminars followed by subsequent community immersion to experience, explore and confront personal attitudes and perceptions. A key feature of this course was its emphasis on a continuing cycle of learning, community engagement and reflection. Three students participated, a near-maximum cohort. Their daily self-reflections were qualitatively analyzed to document the impact of their cultural learning and experiences and revealed meaningful learning in the domains of self-assessment and awareness of their personal and professional culture, exposure to a participatory health delivery model involving the patient, the community and a multidisciplinary team and opportunities to engage in patient care in a different cultural setting. This proof-of-concept course provided students with experiences that were life-changing on both personal and professional levels and confirmed the viability and relevance of international service learning for the pharmacy field within its university-wide mandate.
References
[1]
Anderson, L.M.; Scrimshaw, S.C.; Fullilove, M.T.; Fielding, J.E.; Normand, J. Culturally competent healthcare systems: A systematic review. Am. J. Prev. Med. 2003, 24, 68–79, doi:10.1016/S0749-3797(02)00657-8.
[2]
Betancourt, J.R.; Green, A.R.; Carrillo, J.E.; Ananeh-Firempong, O. Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and healthcare. Public. Health. Rep. 2003, 118, 293–302.
[3]
O’Connell, M.B.; Korner, E.J.; Rickles, N.M.; Sias, J.J. Cultural competence in healthcare and its implications for pharmacy part 1. Pharmacotherapy. 2007, 27, 1062–1079, doi:10.1592/phco.27.7.1062.
[4]
Assemi, M.; Cullander, C.; Hudmon, K.S. Implementation and evaluation of cultural competency training for pharmacy students. Ann. Pharmacother. 2004, 38, 781–786, doi:10.1345/aph.1D402.
[5]
Brach, C.; Fraser, I. Can cultural competency reduce racial and ethnic disparities? A review and conceptual model. Med. Care. Res. Rev. 2000, 57, 181–217.
[6]
Coulter, A.; Ellins, J. Effectiveness of strategies for informing, educating, and involving patients. BMJ. 2007, 335, 24–27, doi:10.1136/bmj.39246.581169.80.
[7]
Bentley, R.; Ellison, K.J. Increasing cultural competence in nursing through international service-learning experiences. Nurse. Educ. 2007, 32, 207–211, doi:10.1097/01.NNE.0000289385.14007.b4.
[8]
Dharamsi, S.; Richards, M.; Louie, D.; Murray, D.; Berland, A.; Whitfield, M.; Scott, I. Enhancing medical students’ conceptions of the CanMEDS health advocate role through international service-learning and critical reflection: A phenomenological study. Med. Teach. 2010, 32, 977–982, doi:10.3109/01421590903394579.
[9]
Hunt, R. Service-learning: An eye-opening experience that provokes emotion and challenges stereotypes. J. Nurs. Educ. 2007, 46, 277–281.
[10]
Amerson, R. The impact of service-learning on cultural competence. Nurs. Educ. Perspect. 2010, 31, 18–22.
[11]
Kirkham, R.; Vanhofwegen, L.; Pankratz, D. Keeping the Vision: Sustaining Social Consciousness with nursing students following international learning experiences. Int. J. Nurs. Educ. Scholarsh. 2009, 6. Available online: http://www.degruyter.com/view/j/ijnes.2009.6.1/ijnes.2009.6.1.1635/ijnes.2009.6.1.1635.xml;jsessionid=24B9D8F836146C53CDE7F33D00108F77/ (accessed 5 August 2013).
[12]
Larson, K.L.; Ott, M.; Miles, J.M. International cultural immersion: En vivo reflections in cultural competence. J. Cult. Divers. 2010, 17, 44–50.
[13]
Levine, M.A.; Perpetua, E.M. International immersion programs in baccalaureate nursing education: Professor and student perspectives. J. Cult. Divers. 2006, 13, 20–26.
[14]
Schuessler, J.B.; Wilder, B.; Byrd, L.W. Reflective journaling and development of cultural humility in students. Nurs. Educ. Perspect. 2012, 33, 96–99, doi:10.5480/1536-5026-33.2.96.
[15]
Smit, E.M.; Tremethick, M.J. Development of an international interdisciplinary course: A strategy to promote cultural competence and collaboration. Nurse. Educ. Pract. 2013, 13, 132–6, doi:10.1016/j.nepr.2012.08.006.
[16]
Jungnickel, P.W.; Kelley, K.W.; Hammer, D.P.; Haines, S.T.; Marlowe, K.F. AACP Curricular change summit supplement: addressing competencies for the future in the professional curriculum. Am. J. Pharm. Educ. 2009, 73. Article 156. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828317/pdf/ajpe156.pdf (accessed on 8 July 2013).
[17]
Evans, E. An elective course in cultural competence for healthcare professionals. Am. J. Pharm. Educ. 2006, 70. Article 55. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1636952/pdf/ajpe55.pdf (accessed on 8 July 2013).
[18]
Accreditation Council for Pharmacy Education. Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree; Accreditation Council for Pharmacy Education: Chicago, IL, USA, 2011. Available online: https://www.acpe-accredit.org/standards/default.asp/ (accessed on 16 February 2013).
[19]
American Pharmacists Association. Code of Ethics; American Pharmacists Association: Washington DC, USA, 1994. Available online: http://www.pharmacist.com/code-ethics/ (accessed on 11 November 2012).
[20]
American society of health-system pharmacists. Report of the ASHP ad hoc committee on ethnic diversity and cultural competence. Am. J. Health-Syst. Pharm. 2005, 62, 1924–1930, doi:10.2146/ajhp050100.
[21]
Obtaining CCAPP Accreditation for Pharmacy Programs; Canadian Council for Accreditation of Pharmacy Programs: Toronto, Canada, 2013. Available online: http://www.ccapp-accredit.ca/obtaining_accreditation/ (accessed on 9 November 2012).
[22]
Toope, S.J. Promoting Intercultural Understanding: A Discussion Paper Draft 2; University of British Columbia: Vancouver, Canada, 2009. Available online: http://diversityatubc.sites.olt.ubc.ca/files/2010/11/Promoting-Intercultural-Understanding_August-20099.pdf (accessed on 2 November 2012).
[23]
International Service Learning: Current Programs; UBC Go Global: Vancouver, Canada, 2011. Available online: http://www.students.ubc.ca/global/learning-abroad/international-service-learning/current-programs/ (accessed on 9 November 2012).
[24]
Audus, K.L.; Moreton, J.E.; Normann, S.A. Going global: The report of the 2009–2010 Research and Graduate Affairs Committee. Am. J. Pharm. Educ. 2010, 74. Article S8. Available online: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058427/ (accessed on 5 July 2013).
[25]
Wertenbroch, A.; Nabeth, T.; the Centre for Advanced Learning Technologies Team. Advanced Learning Approaches & Technologies: The CALT Perspective; The center for advanced learning technologies: Fontainebleau, France, 2000. Available online: http://www.insead.fr/CALT/Publication/CALTReport/calt-perspective.pdf (accessed on 2 November 2012).
[26]
Dewey, J. How We Think: A Restatement of the Relation of Reflective Thinking to the Educative Process; D.C. Heath: Boston, MA, USA, 1985.
[27]
Chesney, C.E. Outreach and engagement at Tennessee State University. J. High. Educ. Outreach. Engagem. 2009, 13, 67–88.
[28]
Furco, A. Service Learning: A balanced approach to experiential education. In Expanding Boundaries: Serving and Learning; Taylor, B., Ed.; Corporation for national service: Washington, WA, USA, 1996.
[29]
Connors, K.; Seifer, S. A Guide for Developing Community-Responsive Models in Health Professions Education; UCSF Center for the Health Professions: San Francisco, CA, USA, 1997.
[30]
Eyler, J.S.; Giles, D.E.; Stenson, C.M.; Gray, C.J. At a Glance: What We Know about the Effects of Service-Learning on College Students, Faculty, Institutions and Communities, 1993–2000; Vanderbilt University: Nashville, TN, USA, 2003. Available online: http://www.compact.org/resource/ aag.pdf (accessed on 20 November 2012).
[31]
Seifer, S.D. Service-learning: community-campus partnerships for health professions education. Acad. Med. 1998, 73, 273–277, doi:10.1097/00001888-199803000-00015.
[32]
Nickman, N.A. (Re-) Learning to care: Use of service-learning as an early professionalization experience. Am. J. Pharm. Educ. 1998, 62, 380–387.
[33]
Crabtree, R.D. Theoretical foundations for international service-learning. Michigan J. Community Serv. Learn. 2008, 15, 18–36.
[34]
The AIDS Support Organization Website. Available online: http://www.tasouganda.org/ (accessed on 8 November 2012).
[35]
Fadiman, A. Spirit Catches You and You Fall Down; Farrar, Straus and Giroux: New York, NY, USA, 1997.
[36]
Easterly, W. The White Man's Burden: Why the West's Efforts to Aid the Rest Have Done so Much Ill and so Little Good; The Penguin Press: New York, NY, USA, 2006.
[37]
Kissoon, N. Out of Africa—A mother’s journey. Pediatr. Crit. Care. Med. 2011, 12, 73–79, doi:10.1097/PCC.0b013e3181ce74ef.
[38]
Chickering, A.W.; Gamson, Z.F. Applying the Seven Principles for Good Practice in Undergraduate Education. New Directions for Teaching and Learning; Jossey-Bass Inc: San Francisco, CA, USA, 1991.
[39]
Angelo, T.; Cross, K.P. Classroom Assessment Techniques; Jossey-Bass, Inc.: San Francisco, CA, USA, 1993.
[40]
Ramsden, P. Learning to Teach in Higher Education; Routledge: New York, USA, 1992.
[41]
Pashler, H.; Bain, P.M.; Bottge, B.A.; Graesser, A.; Koedinger, K.; McDaniel, M.; Metcalfe, J. Organizing Instruction and Study to Improve Student Learning: IES Practice Guide; National Center for Education Research, Institute of Education Sciences, US Department of Education: Washington DC, USA, 2007. Available online: http://ies.ed.gov/ncee/wwc/pdf/practice_guides/20072004.pdf (accessed on 6 June 2013).
[42]
O’Connell, M.B.; Rickles, N.M.; Sias, J.J.; Korner, E.J. Cultural competence in healthcare and its implications for pharmacy. Part 2: Emphasis on pharmacy systems and practice. Pharmacotherapy. 2009, 29, 14e–34e.
[43]
Hurtado, S.; Milem, J.; Clayton-Pederson, A.; Allen, W. Enacting Diverse Learning Environments: Improving the Climate for Racial/Ethnic Diversity in Higher Education. Washington, DC; The George Washington University, Graduate School of Education and Human Development: Washington, DC, USA, 1999. ERIC Document Reproduction Service ED 430514. Available online: http://www.eric.ed.gov/PDFS/ED430514.pdf (accessed on 5 November 2012).
[44]
Self-Management Support for Canadians with Chronic Health Conditions: A Focus Primary Healthcare; Health Council of Canada: Toronto, Canada, 2012. Available online: http://healthcouncilcanada.ca/tree/HCC_SelfManagementReport_FA.pdf (accessed on 11 November 2012).
[45]
Naughton, S. Youth and Communities Helping Each Other: COMMUNITY Based Organizations Using Service-Learning as a Strategy During out of School-Time; National Service Website, New York: Corporation for national service: Washington, DC, USA, 2000. Available online: http://www.nationalserviceresources.org/files/r1803-youth-and-communities-helping-each-other.pdf (accessed on 5 November 2012).
[46]
Urraca, B.; Ledoux, M.; Harris, J.T. Beyond the comfort zone: Lessons of intercultural service. Clearing House 2009, 82, 281–289, doi:10.3200/TCHS.82.6.281-289.
[47]
Drain, P.K.; Primack, A.; Hunt, D.D.; Fawzi, W.W.; Holmes, K.K.; Gardner, P. Global health in medical education: A call for more training and opportunities. Acad. Med. 2007, 82, 226–230, doi:10.1097/ACM.0b013e3180305cf9.
