Optimising student learning on international placements in low income settings

Ackers, HL; Ackers-Johnson, J; Ahmed, A; Tate, NJ

Abstract

This paper challenges the assumption that student visits to low resource settings inevitably promote the acquisition of cultural competence. Much of the literature and marketing rhetoric advocating the expansion of such ‘exposures’ lists numerous positive outcomes with an emphasis on ‘cultural learning’. With important exceptions, the concept of cultural learning remains uncontested, nestling in the fluffy haze of an inherently benevolent multi-culturalism. The emphasis in current research is on ‘learning’ or ‘competency’ at the expense of definitional clarity around the concept of culture itself. This results in a tendency to overemphasise (and essentialise) difference rather than commonality and conflates cultural learning with narrow (stereotypical) concepts of race, ethnicity and religion.
The paper discusses the experiences of students undertaking placements in Uganda through Knowledge For Change, a UK charity hosting the Ethical Educational Placements project, to identify and critique this dimension of ‘learning’. Using an action-research approach combining observational research with qualitative interviews and surveys the paper uncovers the nuance of cultural learning. In important respects the behaviour that students are witnessing and attributing to culture is connected more to the specific organisational contexts that they are placed in and the patient groups they ‘serve’ than any connection to an homogenous ‘national’ culture. Poverty and gender inequality, amongst many other forms of structural inequality, result in ‘othering’ behaviour on the part of health workers towards patients that is a fundamental characteristic of public health organisations in residualised welfare systems. In this complex environment, cultural learning is not so much about celebrating difference. It is more about understanding social context and accepting that you don’t and can’t possibly know a person’s situation; and with that in mind you should treat everyone with the same degree of humility and respect. Adopting and practising ‘epistemic humility’ (Hanson et al 2011; Ahmed, Ackers-Johnson & Ackers 2017) is crucial to meaningful learning in any context. Further, a lack of understanding of the broader structural processes perpetuates inequalities between the Global North and South (Husih, 2012; Ahmed, Ackers-Johnson & Ackers, 2017) and impedes knowledge acquisition, particularly cultural learning. Moreover, hubris – or Western students’ assumptions of superiority over host health care workers (Bauer, 2017; Elit et al, 2011, Ahmed, Ackers-Johnson & Ackers, 2017) – may act as a further obstacle to cultural learning. Cultural learning is as much about learning about ourselves and what it feels like to be ‘othered’ as it is learning about others. International placements in LMICs create critical opportunities for relevant student learning. But achieving this and guarding against the risks of ‘mis-learning’ requires the level of cultural brokerage provided by ‘More Knowledgeable Others’ that we take for granted with clinical learning.

Citation

Ackers, H., Ackers-Johnson, J., Ahmed, A., & Tate, N. (2019). Optimising student learning on international placements in low income settings. Open Journal of Social Sciences, 7(3), 311-327. https://doi.org/10.4236/jss.2019.73026

• Journal Article Type: Article
• Acceptance Date: Dec 7, 2018
• Online Publication Date: Mar 21, 2019
• Publication Date: Mar 21, 2019
• Deposit Date: Feb 13, 2019
• Publicly Available Date: Apr 16, 2019
• Journal: Open Journal of Social Sciences
• Print ISSN: 2327-5952
• Electronic ISSN: 2327-5960
• Publisher: Scientific Research Publishing
• Volume: 7
• Issue: 3
• Pages: 311-327
• DOI: https://doi.org/10.4236/jss.2019.73026
• Publisher URL: https://doi.org/10.4236/jss.2019.73026
• Related Public URLs: https://www.scirp.org/journal/jss/