METHODS: We conducted a multicentre instrumental case study across three international medical programmes, all of which were characterised by an international student intake, an internationalised curriculum and international partnerships, and all of which used English as the medium of instruction. We conducted 24 semi-structured interviews with purposively sampled curriculum directors and teaching staff. Participants shared their personal experiences and responded to ethical concerns expressed in the literature. Our multidisciplinary team performed a template analysis of the data based on theoretical frameworks of ethics and social responsibility.
RESULTS: Participants primarily experienced the internationalisation of their institutions and programmes as having a positive impact on students, the university and the future global society. However, they did face several ethical dilemmas. The first of these involved the possibility that marketisation through international recruitment and the application of substantial tuition fees might widen access to medical education, but might allow weaker students to enter medical schools. The second concern referred to the homogenisation of education methods and content, which offers opportunities to expose students to best practices, but may also pose a risk to education quality. The third issue referred to the experience that although student diversity helped to promote intercultural learning, it also jeopardised student well-being.
CONCLUSIONS: In the eyes of teaching staff in international medical education, internationalisation can benefit education quality and society, but poses ethical dilemmas through the forces of marketisation, homogenisation and diversification. The findings reflect a tension between the views of scholars and those of practitioners. The critical perspective found in academic debates is largely missing in practice, and theoretical frameworks on ethics possibly overlook the benefits of international education. To facilitate ethical decision making, we propose that scholars and practitioners globally try to learn from each other.
METHODS: A mixed-method study was conducted with pre-clinical medical students at Newcastle University Medical School, UK, and Newcastle University Medicine Malaysia. A total of 266 students participated in an online survey questionnaire, with 25 students participating in focus group discussions (FGD). Quantitative data were analysed using descriptive analysis and qualitative data was analysed with thematic analysis.
RESULTS: The majority of students (94.7%) recognised that active learning is important for their learning, but had a narrow definition of what active learning constituted, and familiarity with active learning techniques was lacking. Many students' independent learning techniques were centred around methods of 'active recall', with factors affecting the utilisation of active learning techniques mainly focused on time availability, group dynamics in active teaching sessions and teaching styles of educators.
CONCLUSION: Students acknowledged the importance of active learning but are generally unfamiliar with ways to effectively utilise a broad range of active learning strategies. This study demonstrated that it is important for educators to understand firstly how students define active learning as well as how students interact with active learning taught sessions, to ensure that they create an environment where students feel confident to engage in active learning techniques.
DISCUSSION: Creating an inclusive assessment culture is important for equitable education, even if priorities for inclusion might differ between contexts. We recognise challenges in the enactment of inclusive assessment, namely, the notion of lowering standards, harming reliability and robustness of assessment design and inclusion as a poorly defined and catchall term. Importantly, the lack of awareness that inclusion means recognising intersectionality is a barrier for well-designed inclusive assessments. This is why we offer considerations for HPE practitioners that can guide towards a unified direction of travel for inclusive assessments. This article highlights the importance of contextual prioritisation and initiatives to be considered at the global level to national, institutional, programme and the individual level. Utilising experience and literature from undergraduate, higher education contexts, we offer considerations with applicability across the assessment continuum.
CONTEXT: In this state of science paper, we were set the challenge of providing cross-cultural viewpoints on inclusive assessment. In this discursive article, we focus on inclusive assessment within undergraduate health professions education whilst looking to the wider higher education literature, since institutional policies and procedures frequently drive assessment decisions and influence the environment in which they occur. We explore our experiences of working in inclusive assessment, with the aim of bridging and enhancing practices of inclusive assessments for HPE. Unlike other articles that juxtapose views, we all come from the perspective of supporting inclusive assessment. We begin with a discussion on what inclusive assessment is and then describe our contexts as a basis for understanding differences and broadening conversations. We work in the United Kingdom, Australia and Malaysia, having undertaken research, facilitated workshops and seminars on inclusive assessment nationally and internationally. We recognise our perspectives will differ as a consequence of our global context, institutional culture, individual characteristics and educational experiences. (Note that individual characteristics are also known as protected characteristics in some countries). Then, we outline challenges and opportunities associated with inclusive assessment, drawing on evidence within our contexts, acknowledging that our understanding of inclusive assessment research is limited to publications in English and currently tilted to publications from the Global North. In the final section, we then offer recommendations for championing inclusion, focussing firstly on assessment designs, and then broader considerations to organise collective action. Our article is unapologetically practical; the deliberate divergence from a theoretical piece is with the intent that anyone who reads this paper might enact even one small change progressing towards more inclusive assessment practices within their context.
AIM: What types of Transnational Medical Education programmes can be identified from the international literature? What are the strengths and weaknesses of these programmes and do they prepare students for international practice?
METHODS: This review was based on the PRISMA-Guidelines for systematic reviews. We searched five electronic databases: MEDLINE, EMBASE, CINAHL, WEB of Science and ERIC. No date or language restrictions were placed on the inclusion criteria. Data extraction was completed by two independent reviewers. Quality appraisal was carried out using the Mixed Methods Appraisal Tool (MMAT), and a narrative synthesis of the included papers was conducted.
RESULTS: Our literature search identified 12 studies. From the included studies we were able to identify three types of Transnational Medical Education Programme, and a number of strengths and weaknesses of these programmes. Strengths were: increasing medical workforce capacity, enhancing the quality of education locally, promoting intercultural competence and increasing exposure to new ways of working (enhanced communication skills, shared decision-making, experience of multidisciplinary teamwork and patient-centeredness). Weaknesses were: potential curriculum misalignment within the context of clinical practice, language barriers and encountering differences in hierarchical systems, shared decision making and patient-centredness all of which impact preparation for practice.
CONCLUSION: Transnational medical education programmes address shortages within the medical workforce by creating additional training opportunities. They can also drive up the quality of medical education locally. There is, however, a potential mismatch between the curriculum and the place of practice which can impact upon graduates' preparation for professional practice.