Should I stay or should I go? A systematic review of factors that influence healthcare students' decisions around study abroad programmes
Section snippets
Background
Several benefits have been associated with the provision of study abroad programmes for healthcare students, including enhancing cultural awareness and providing a means of exchanging ideas and values that promote understanding of different healthcare settings, policies and practices (Lachat and Zerbe, 1992). In this way, students are able to learn about and appreciate cultural differences, compare healthcare systems, and enhance their personal and professional development (Button et al., 2005
Research Aim
The aim of this review was to identify and synthesise evidence that explores factors that influence healthcare students' decisions regarding participation in study abroad programmes.
Methodology and Methods
A systematic review was undertaken based on a narrative synthesis approach, defined by Popay et al. (2006:5) as “an approach to the systematic review and synthesis of findings from multiple studies that relies primarily on the use of words and text to summarise and explain the findings of the synthesis”. Popay et al. (2006) describe four elements in their framework for narrative synthesis:
- 1.
Describing a theory of how the intervention works, why and for whom
- 2.
Developing a preliminary synthesis of
Inclusion Criteria
For the purposes of this study, ‘healthcare students’ are defined as dentistry, medical, nursing, midwifery, physiotherapy, physician assistant, pharmacology and pharmacy students. Articles were included in the review if they included data on healthcare students' prospective or retrospective accounts of factors that influenced their decision making to participate (or not) in a study abroad or elective programme in the course of their training. Papers from any regional or healthcare context were
Search Strategy
A four-step search strategy sought to identify both published and unpublished studies but was limited to articles in the English language. No date restrictions were applied. MEDLINE, CINAHL and Google Scholar were searched as a first step and keywords in the titles and abstracts as well as the index terms used to describe identified articles were noted. Secondly, the keywords and index terms were used in a comprehensive search across all included databases. Table 1 shows the list of databases
Critical Appraisal of Studies
Included studies were critically appraised using the Critical Appraisal Skills Programme (2013) checklist for qualitative studies and the Centre for Evidence-Based Management (2014) checklist for surveys. All papers assessed for quality were included in the review. The role of critical appraisal, particularly in qualitative evidence synthesis, is contested and there is a lack of agreement over the appropriateness of excluding studies, the potential impact (or not) of excluding eligible papers
Data Extraction
A specific data extraction tool was developed to extract data such as year of publication, students' home country, students' healthcare discipline, preferred host country (if stated), number of students involved in the study, study methods, and findings. These are presented in Table 2. Findings that were extracted included students' interests in studying abroad and prospective or retrospective accounts of factors that influenced their decision making to participate in a study abroad programme
Data Synthesis
This narrative synthesis did not employ the first step of Popay et al.'s (2006) 4 step process (outlined above) as this review was not evaluating an intervention. The remaining 3 elements of the framework were used in an iterative manner (Pope et al., 2007). A preliminary synthesis was carried out by organising studies according to their design, participants and findings in a table. This enabled the reviewers to identify and compare key findings across the various studies. Reviewers then read
Results
The results have been organised into three major subheadings — positive factors, negative factors and choice of destination. Positive factors are those that motivate students to study abroad, negative factors are those that deter them from studying abroad and ‘choice of destination’ describes factors that influence students' decisions on where to have their elective placement.
Discussion
The benefits of participating in study abroad programmes or overseas elective placements for healthcare students are well-known and efforts have been directed at increasing the number of students that participate in them (Button et al., 2005, Casey and Murphy, 2008, Milne and Cowie, 2013). However, this systematic review has identified that little research has been undertaken to explore factors that healthcare students consider as important when making decisions about their involvement in study
Limitations of the Review
The findings of this review should be interpreted in light of inherent limitations associated with included studies. The ten studies that were included in this review were either qualitative studies or surveys and had several limitations that might have affected their findings. Non-response bias could have affected the results of some of the surveys (Mashburn and Brown, 2000, Owen et al., 2013). Moreover, none of the surveys had validity and reliability of their tools established (Mashburn and
Conclusion and Recommendations
This review has identified a paucity of data that explores factors that influence healthcare students' decision making processes regarding participation in study abroad programmes. It has identified that healthcare students are motivated by their desire to travel abroad, experience other cultures and healthcare settings. However, other factors such as expenses involved in participating in study abroad programmes, limited foreign language skills and reluctance to leave family/friends may prevent
Authors' Contributions
MB coordinated the review, the final draft of paper and is the lead editor. EAB undertook the literature search and undertook first drafts of the paper. CE conceptualised the study and provided overall guidance.
Competing Interests
The authors declare that there are no competing interests.
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