Elsevier

Nurse Education Today

Volume 39, April 2016, Pages 63-71
Nurse Education Today

Should I stay or should I go? A systematic review of factors that influence healthcare students' decisions around study abroad programmes

https://doi.org/10.1016/j.nedt.2015.12.024Get rights and content

Summary

Background

Study abroad programmes have been shown to have significant benefits for participating healthcare students such as promoting cultural awareness and understanding of different healthcare settings, policies and practices. Healthcare students are encouraged to undertake elective or Erasmus placements overseas to enhance personal and professional development and to broaden horizons through lived cultural experience. However, there is a relatively low uptake of such opportunities amongst this student group.

Objectives

This systematic review aimed to explore factors that influence healthcare students' decision making around study abroad opportunities within undergraduate training programmes.

Review design methods

A systematic review was undertaken utilising a narrative synthesis approach.

Data sources

A comprehensive literature search was conducted on MEDLINE, CINAHL, EMBASE, PsycINFO, ASSIA, and ERIC databases. Key institutions were contacted for grey literature. Studies that reported on factors that influence healthcare students' decisions regarding study abroad programmes were included in the review.

Results

Ten studies were identified for inclusion (5 qualitative studies, 5 surveys), indicating a paucity of research in this area. Data synthesis indicates that factors that influence healthcare students' decisions to participate in study abroad programmes are similar across different geographic locations and different professional groups. Factors that support decisions to study overseas include having sufficient information about study abroad programmes, especially early in an academic programme, having an interest in other cultures/countries and having academic staff and family as positive role models who motivate them to study abroad. Key barriers are cost and language issues. Language remains a significant barrier even when generous bursaries are available, as with the Erasmus scheme, when students are not proficient with the language spoken in host countries. Students tend to prefer destinations where language is not a problem or where countries have cultural or historical connections, such as being part of the Commonwealth countries.

Conclusions

Promotion of study abroad opportunities needs to start early in an academic programme. It should include detailed information and provision of language support. Faculty have an important part to play as enthusiastic role models.

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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