951002
INQXXX10.1177/0046958020951002INQUIRY: The Journal of Health Care Organization, Provision, and FinancingRiediger et al
research-article2020
Original Research
An Evaluation of an Experiential
Learning Program in Global and
Indigenous Health: The University
of Manitoba’s Queen Elizabeth II
Diamond Jubilee Scholarship Program
INQUIRY: The Journal of Health Care
Organization, Provision, and Financing
Volume 57: 1–10
© The Author(s) 2020
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https://doi.org/10.1177/0046958020951002
DOI: 10.1177/0046958020951002
journals.sagepub.com/home/inq
Natalie D. Riediger, PhD1,2,3 , Monica Cyr, RD, MSc1,3,
and Javier Mignone, PhD2
Abstract
We conducted a mixed-methods outcome evaluation to examine student experiences and learning in the University of
Manitoba’s Queen Elizabeth II Diamond Jubilee Scholarship Program in Global and Indigenous Health. Our scholarship
program is a bi-directional, 3-month international experiential learning program, including both undergraduate and graduate
students, with associated online course focused on community engagement. Students completed a semi-structured
narrative report at the conclusion of their funding related to their experience and learning. The Likert questions were
analyzed descriptively and student responses to the open-ended questions were utilized for thematic analysis. Also included
in this paper is a summary of our lessons learned through program administration. A total of 38 students completed the
program between 2016 and 2018, with 95% reporting that they either met or exceeded their goals in the program. Three
overarching and inter-related themes emerged in our thematic-analysis of students’ narrative reports, including success
through relationships and new perspectives, challenges of the unfamiliar, and personal growth through strong emotions. Many
students reported personal growth as their greatest success and linked this with new perspectives and awareness of how
different contexts shaped their understanding of health issues. Overcoming challenges in their placements contributed
to students’ confidence in their ability to problem-solve. Overall, students reported value in their experiential learning,
which further supports the growing trend to incorporate both experiential learning and formal education in community
engagement in public health pedagogy. However, international experiential learning requires considerable financial and
human resource commitments to ensure its success.
Keywords
experiential learning, public health education, global health, Indigenous health, community engagement
What do we already know about this topic?
Experiential learning in global and Indigenous health research is a potentially valuable pedagogical approach for
community engagement.
How does your research contribute to the field?
This report provides confirmatory evidence of the value of experiential learning in global health settings as a pedagogical approach for community engagement. Of particular importance is the value of peer mentorship and community
relationships in providing a rich learning environment.
What are your research’s implications toward theory, practice, or policy?
The findings from the study can inform ongoing pedagogical advances in public health education to further the
development of interdisciplinary, engaged public health leaders who can address emerging public health challenges
in new ways.
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2
Introduction
Health equity and social justice are viewed as central themes
in Canadian public health education, which was catalyzed
by the Ottawa Charter for Health Promotion.1 This focus
informs our research approaches, particularly in global and
Indigenous health, in order to address global and domestic
health disparities.2,3 (Indigenous in this paper refers to
Indigenous to their own lands. More specifically in the context of our program, Indigenous health in settler colonial
countries within the Commonwealth.) Increasingly factors
influencing public health both globally and domestically are
not contained by, nor independent of, national borders. This
is currently evidenced by the 2020 global COVID-19 pandemic.4 As such, public health professionals and researchers
will be progressively required to understand and work in
cross-cultural settings. At the same time, given that health
issues are multi-causal, addressing complex and systemic
global health issues requires ongoing advancements in public health education to facilitate new skills for trainees, particularly in community engagement, interdisciplinary and
systems thinking, inter-professional collaboration, and leadership. As public health education evolves and responds to
this changing context and workforce need, there is a growing interest in implementing experiential learning opportunities and course content in community engagement. We
report here on the evaluation of the experiences and learning
of students that took part in an experiential learning program
in Indigenous and/or global health settings that included a
course in community engagement.
Background
Public Health Pedagogy
Public health education is interdisciplinary in nature, including a focus on the traditionally core disciplines of epidemiology and biostatistics, and more recently health promotion and
critical social sciences. Though theoretical components of
public health education will always remain important, the
application of theory to public health practice has not received
the same level of attention in public health “classrooms.” Both
Indigenous and global health research have colonial histories
that have shaped past and present public health practice.5
Given these power asymmetries, community engagement is
widely understood to be of critical importance to both fields to
contribute to relevant and prioritized research questions,
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enhance uptake of research findings, and ensure ethical conduct, among other reasons. Despite this acknowledged importance, a recent review of 76 graduate-level public health
programs in Canada revealed only 16% required a course in
community engagement.6 With Canadian graduate programs
offering 6 times more quantitative methods courses compared
to qualitative, Yassi et al6 further state that, “an appreciation of
historical, socioeconomic, and cultural context cannot be captured in quantitative methods alone, nor could the political
forces that determine the social processes driving the health
inequities manifesting at the individual unit of analysis” (p. 6).
The need for new paradigms combined with limited research
on improving the training of public health workforce,7,8 suggests further educational research in the area of communityengaged public health practice is urgently needed. This is
especially pertinent given the documented challenges of ethical engagement and its complexities.9
Experiential Learning
Learning by doing, or “experiential learning,” is, in its foundation, interdisciplinary and constructivist.10 Experiential
learning is most effective when coupled with critical reflection of new experiences, which can spur new ways of thinking and new attitudes. Chapman et al11 describe core,
inter-related, attributes of experiential learning, as a balance
between content and theory; safe space(s) to critically selfreflect and discuss learning; personally relevant and meaningful; big picture or systems thinking; presence of meaningful
relationships; and getting outside one’s comfort zone.11
In the context of public health, the Harvard T. H. Chan
School of Public Health is advocating for experiential learning to be a core component of public health moving forward,
as well as complementary online learning.12 We must
acknowledge that real-world challenges cannot be duplicated
in the classroom, nor can complex research questions be
answered through datasets alone. Through experiential learning students develop practical skills in reflective learning
that can be applied later in their professional lives, despite
changing contexts and health issues.
Description of Our Program
Goals and objectives. The University of Manitoba’s Queen
Elizabeth II Diamond Jubilee Scholarship (QES) Program:
Promoting community-university partnerships in global and
1
Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Canada
Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
3
Ongomiizwin Research, Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
2
Received 4 October 2019; revised 24 June 2020; revised manuscript accepted 23 July 2020
Corresponding Author:
Natalie D. Riediger, Department of Food and Human Nutritional Sciences, University of Manitoba, 209 Human Ecology Building, Winnipeg, MB R3T 2N2,
Canada.
Email: Natalie.riediger@umanitoba.ca
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Riediger et al
Table 1. Categories and Description of Student Eligibility.
Internationala
Canadian/permanent resident
Graduate
Degree-seekingb
Undergraduate
Visiting
Community-engaged
experience
Funding
Research or
practicum
$6000
Research or practicum
Research
Research
$6000
$3600-$3750
Travel requirements
90 day minimumc in
a commonwealth
country
Community
organization (n = 7)
90 day minimumc in a
commonwealth country
No specific requirement as
student traveled to the
UManitoba for degree
Internationally (n = 1);
a local community
organization (n = 3); or
another organization in
Canada (n = 1)
Flight + $1200-$1250
monthly stipendd
90 day minimum in
Winnipeg, Manitoba
Placement settings
University (n = 9);
community organization
(n = 2); or healthcare
facility (n = 1)
At the University of
Manitoba (n = 11);
government laboratory
(n = 1); or local community
organization (n = 1)
a
Must be a citizen of a commonwealth country.
Completing graduate degree at the University of Manitoba.
c
Travel could be split in 2 trips to meet the 90-day requirement.
d
Allowable monthly stipend by the funder increased mid-way through the program.
b
Indigenous health accepted its first students in 2016. The
national QES program, and its affiliated university-specific
programs, are jointly funded through an initiative of the
Rideau Hall Foundation, Community Foundations of Canada and Universities Canada.13 The goal of the national QES
program is to develop global citizens, activate a new generation of global leaders, enhance collaborative capacity and
relationship building, and amplify community development
across the Commonwealth. Our specific university QES
program sought to: (1) provide 3-month, international community-based participatory research experiences to local
and international students in Indigenous and global health;
(2) sustain and strengthen relationships between the University of Manitoba and our partner organizations; and (3)
increase local capacity with respect to research skills and
mentor Indigenous leaders and leaders from lower income
countries.
Program design. The conceptual framework for the program
was based on a model, similar to that developed by Gough
et al.14 In this model a number of core components of the
partnership-based approach were applied, including codevelopment and co-implementation of the program, ongoing critical and ethical engagement and reflexive learning,
and ethical partner relationships. The network of program
partners was facilitated through a number of units and individuals at the University of Manitoba engaged in research
relationships in our partner countries: Australia, Belize,
Kenya, India, and New Zealand. We sought to ensure reciprocal value to the host organizations, where possible, by
providing students from our partner institutions abroad
research opportunities at our institution within the program.
In this way, further networks were nurtured between institutions, faculty, and students.
Student eligibility criteria was purposively broad to capture multiple disciplines and programs, beyond public
health, including at the undergraduate and graduate level
(Table 1). Eligibility criteria, established by Universities
Canada, also greatly shaped our program structure, which,
most notably, resulted in the exclusion of trainees >35 years
old. Later concessions were made for some students on the
age requirement by the funder. Initially, we noted that the
age restriction was particularly challenging for recruiting
Indigenous graduate students. Nevertheless, our broad
wcriteria resulted in a diverse cadre of inter-disciplinary (eg,
public health, medical microbiology, literature, science,
nutrition, environment), and inter-professional (eg, medicine, occupational therapy, dietetics, pharmacy) trainees.
The timelines for student planning, application, travel,
course, and report submission is illustrated in Figure 1.
The pedagogical aspect of the program was informed by
an experiential learning model.10 All students were required
to complete a 6-week online course in Community Engagement
and Program Science, summarized in Table 2. This course
was developed together with faculty conducting both global
and Indigenous health research as well as with input from
our Indigenous and global health partners. Keeping with the
experiential learning pedagogical approach, we included
weekly online discussion of course readings with application
to the students ongoing research and fieldwork abroad. In this
way, reflexivity was woven throughout the course.
Our purpose was to evaluate student learning and experiences in our program. Specifically, we sought to assess students’ self-reported development of leadership, networking,
and communication skills; establishment of networks;
awareness of challenges faced by local or global communities; and achievement of their program-specific or project
goals. Additional evaluation questions included:
4
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Figure 1. Flow diagram of student timeline.
Table 2. “Community Engagement and Program Science” Online Course Structure, Learning Objectives, and Assessments.
Course content (units)
Learning objectives
1. Course overview
2. Program Science
• Student introductions
• To orient students to the concept of Program Science.
• To explore the strengths and limitations of program
science.
3. Strategies for engagement
• To explore the rationale for stakeholder engagement in
research or program planning.
• To critically explore who are key research stakeholders
and what their role is in the research process.
• To discuss specific approaches and models of engagement,
and their applicability to student’s own plans.
• To orient students to ethical issues related to research
involving individuals and communities.
• To explore methods for negotiating individual and
community informed consent.
• To discuss the relationship between applied research,
ethics and empowerment.
• To discuss how what we learned might impact our
understanding of program science.
4.
Ethics
5. Putting the pieces
together: program
science, community
empowerment, and ethics
6. Communicating research
• To practice the communication of research plans to peer.
• To provide feedback and support presenters in improving
their research plans.
• To practice positive and supportive criticism skills.
Assessmentsa
N/A
Formative: Peer discussion online,
facilitated by instructor
Summative: One-page response to
broad question on required readings
Formative: Peer discussion online,
facilitated by instructor
Summative: One-page response to
broad question on required readings
Formative: Peer discussion online,
facilitated by instructor
Summative: One-page response to
broad question on required readings
Formative: Peer discussion online,
facilitated by instructor
Summative: One-page response to
broad question on required readings
Formative: Student feedback to peers
on presentation
Summative: Student presentations and
final paper/proposal
a
Midway through our program, we waived the requirement for students completing summative assessments, due to curricular limitations in completing
the course for credit; though all students were required to receive credit in some way.
i. How did students describe their experiences as they
relate to the acquisition of the previously listed skills?
ii. How did Canadian and international students differ
in their descriptions?
iii. How did undergraduate and graduate students differ
in their descriptions?
Methods
Our evaluation of the program utilized a mixed-methods
approach and the qualitative analysis was informed by theories of experiential learning, as previously described.10-12
Each student was required by Universities Canada to complete a structured narrative report, which included a combination of open- and closed-ended questions. The narrative
report was developed by Universities Canada and completed
through an online portal directly by the students within
2 weeks of the students’ placement end date. Individual institutional programs did not have input into the structure of the
report, but it was approved for our use in this evaluation by
Universities Canada. Notably, students did not provide their
individual informed consent for our institutional analysis, as
such we elected not to utilize direct quotes in our analysis.
This study was approved by our institutional Joint Faculty
Research Ethics Board.
First, we conducted a descriptive analysis of the likertscale, closed-ended questions using Microsoft Excel.
Students could select strongly disagree, disagree, neutral,
agree, or strongly agree for the following statements: my
QES experience has strengthened my knowledge and skills,
5
Riediger et al
Figure 2. Descriptive analysis of students’ experience and learning outcomes.
increased my leadership skills, improved my communication
skills, improved my networking skills, enhanced my personal/professional networks, and has allowed me to increase
my awareness of the challenges faced by local/global communities. As a follow-up to each likert-scale questions, students were able to comment and explain their selection.
Students were also asked to list their goals at pre-departure
and then reflect as to whether they did not meet their goals,
met their goals, or exceeded their goals. Again, there was
additional space for students to comment further on meeting
or not meeting their goals.
Second, we completed a qualitative, thematic analysis of
all the open-ended questions on the students’ narrative
reports. Beyond what was asked as follow-up to the likertscale questions, students were asked to reflect on the most
important lessons learned, as well as share a success story
and explain why it is a success story. Initially, the data were
grouped according to the categories community engagement,
success, challenges, and project description, which reflected
to some extent the categories of questions. From these initial
groupings, the first and second author, and a student research
assistant examined the data and developed a code list with
corresponding description of each code. Student narrative
reports were then uploaded to NVivo version 12 and analyzed with the corresponding code list using a thematic content analysis.15 The first author completed the remaining data
analysis with frequent communication and verification
regarding the collapsing of categories and emerging themes
with the second author. Further analysis to compare answers
between Canadian and international students, as well as
undergraduate and graduate students was also completed.
Throughout the analysis, the first and second author were
reflective of their roles as faculty lead and instructor, and
coordinator of the program. The third author joined the program advisory group in 2018 and being more of an outsider
to the program had the role of providing external evaluation
supervisory support for this evaluation, given experience in
educational program evaluation.
Results
A total of 38 students were funded by the program between
January 2016 and September 2018. This included 7 Canadian
graduate students, 13 Canadian undergraduate students, 13
visiting international graduate students, and 5 international
graduate degree-seeking students enrolled at the University
of Manitoba. Two Indigenous students were funded and 9
(24%) of the placements were Indigenous health-focused.
The majority of students reported that they met their goals
(53%) or exceeded their goals (42%). The results from the
likert scale questions are summarized in Figure 2. Results for
all skills were particularly positive for undergraduate students in the program such that 62% reported that they
exceeded their goals, as compared to 42% for the whole
cohort. Similarly, scores for all skills were typically more
positive for visiting international students as compared to
either Canadian graduate or degree-seeking international
graduate students.
Three overarching and inter-related themes emerged in
our qualitative, thematic-analysis of students’ narrative
reports, including success through relationships and new
perspectives, challenges of the unfamiliar, and personal
6
growth through strong emotions. All themes were more
prominent for undergraduate and visiting international students, partly mirroring the richer reflection the same groups
put into their narrative report.
Success Through Relationships and New
Perspectives
While some students were placed in academic institutions
with related partnerships with community organizations,
others were placed directly with community organizations.
However, students discussed learning from community irrespective of their primary placement, either at a university or
community organization. Learning from outside the academy contributed to students’ confidence, particularly with
respect to communication, networking, and leadership skills,
summarized in Figure 2. The majority of students identified
community engagement as a positive experience through
which they had gained new perspectives.
In discussing their own successes, new “relationships,”
“friendships,” “teams,” and “networks” in their placements
and with other students in the program were at the fore-front.
Many students reported relationships as their greatest success and linked this with new perspectives and awareness of
how different contexts shape their understanding of health
issues. This led many students to embrace skills in patience,
flexibility, and adaptation. The volume of learning was an
overwhelming success for some, indicating a strong intrinsic
motivation to learn, while a minority of students cited more
tangible outcomes of success, such as a publication or news
article about the research.
Given the known challenges of international work, the
program coordinator and academic lead purposely designed
several undergraduate placements and visiting international
student placement in pairs, or in 1 case as a group of 3. This
was strongly reflected in these students’ narrative reports,
and as a resounding success from their perspective. Having
another student whom they were familiar with and in some
cases, working on a related project, allowed students to
engage in reciprocal reflection, peer mentorship, and psychosocial support. This likely contributed to the more positive learning outcomes reported by the undergraduate and
visiting international students overall, as well as to buffer the
challenges described in the next theme.
Challenges of the Unfamiliar
Most students experienced some challenges and for a
minority the challenges overtook their experience. For
example, some students were working in low resource settings and/or rural areas, which contributed to frustration,
loneliness, and isolation. Many students initially experienced an “adjustment period,” which for some was strongly
linked with travel-related fatigue. Cultural differences in
working environments were a barrier for some Canadian
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students. While these challenges were noted, students’ ability to overcome them contributed to the feelings of success
previously described. The ability to overcome challenges
was seemingly tied to students’ opportunity and/or ability
to network and develop relationships in their placements, as
well as having an easygoing, open-minded attitude and
growth mindset with respect to some challenges. The lack
of mentorship and/or relationships was mentioned as a
challenge and seemed to be related to the most negative
learning experiences. In this way, there was variation in
terms of how challenges were perceived by students, as
some challenges were considered positive (even if initially
considered negative) and others wholly negative.
Personal Growth Through Strong Emotions
Tied to the strong emotions felt during challenges, including
workplace challenges, was an overwhelming description of
positive emotions and personal growth. Many students, particularly visiting international students and undergraduate
students, were incredibly grateful for the experience. They
reported increased confidence from the program selection,
mentorship support, the development of networks and relationships, and the opportunity to travel somewhere they have
never been. Many students, both Canadian and international,
described the program as “life-changing.” The program
motivated several students to pursue graduate studies in the
area of global health, which was partially the result of exposure to graduate students in the online course. The personal
growth described also motivated students to pursue additional experiential learning opportunities abroad (including 2
international visiting students who returned for a second
placement), and/or support QES students in subsequent iterations of the program; this linked the themes personal growth
to success through new relationships.
Lessons Learned
We have documented the focus and evaluated student experiences and learning outcomes of an experiential learning program centered on community engagement in global and
Indigenous health research settings. Many of our findings
align with previous evaluations and support the global movement toward increasing experiential learning opportunities in
public health training,8,16-21 formal education in community
engagement,6,16,20,22 interprofessional learning in public
health,19,23 and in international education experiences, generally.17,24 Throughout the discussion reflections of directing,
teaching in, and coordinating the program have been integrated in making meaning of the students’ experiences, further documenting the lessons learned, and finally, providing
recommendations for other global and Indigenous health
experiential learning programs (Table 3).
A major strength of the program was its flexibility,
including different eligible countries, disciplines, research
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Riediger et al
Table 3. Lessons Learned and/or Recommendations for Experiential Learning in International Settings.
A. Administration
1. Institutional
• Faculty interest in student supervision was limited. Institutional commitment to incentivize mentorship for experiential learning is
needed to maximize program success.
• Institutional requirements for visiting students, particularly for English language requirements for visiting students, was a barrier to
reciprocal exchange for partner institutions. We recommend waiving the English testing requirements for visiting students, as we
did for our program, provided students had a working knowledge of English.
2. Program
• We experienced student recruitment challenges initially for Canadian students. We recommend program promotion through
student alumni experiences by engaging with the institutional communications office.
• Student supervision by community partners and host institutions, particularly in the Global South could be burdensome. It is
important to negotiate the student supervision carefully, with consideration to the hosts’ capacity to supervisor.
• In order to maximize partner benefit, we offered reciprocal exchange for students of partner institutions with great success.
3. Funder
• The funding structure was inflexible such that funding was mostly limited to student scholarships, which limited funding for
administration and any funding for partner host institutions. This contributed to asymmetrical power relations between
institutions, community partners, and partner institutions (particularly in the Global South). More flexibility in how specific
institutional programs can administer funding would allow for more equitable partnerships.
• Scholarship amounts were fixed such that students received identical amounts regardless of the host country costs of living.
This was particularly challenging for students interested in Indigenous health placements in Australia or New Zealand and was a
barrier to equitable program access. Some students were successful in receiving additional scholarship funds; program support for
obtaining additional funding is recommended.
• Funder requirements dictated the need for student to receive formal credit for their participation. This requirement, combined
with limited curricular space, stringent course requirements in many program, and course timelines, created challenges for many
students’ participation. Again, greater flexibility on the part of the funder would allow for more students to “fit” an international,
community-based experience in their program.
B. Curriculum
• Given the unpredictability of community-based work and the need to work with partner timelines, the program requires
flexibility in scheduling of travel and course offering, within reason. Ideally, the online course offering would coincide with student
travel to maximize reflexive practice; however, on a few occasions this alignment did not occur due to inflexibility of curriculum
and also partner availability.
C. Pedagogy
• The broad disciplinary background of the students is a considerable pedagogical strength. Given the research foci of the
instructors and departmental units, course readings disproportionately focused on infectious disease. Students requested more
diverse readings to engage a greater number of students in content relevant to their individual interests.
• Course discussion is optimal with approximately 5 to 9 students to allow for sufficient dialogue, space for critique, and feedback.
Fewer students resulted in less exposure to different research/program topics and perspectives. Too many students results in
the development of more parallel discussion threads, thereby minimizing exposure to topics outside students’ direct interest but
allowing for exposure to more diverse perspectives.
methods, graduate and undergraduate students, Canadian
and international visiting students as well as degree-seeking international students. This flexibility allowed students to work in settings/projects of interest to them, and
learn from each other, in addition to their own respective
placements and research, which was further facilitated
through the online course. In turn, the diversity in the virtual classroom further supported inclusion and safe spaces
for students to reflect on their learning, which is a key
component of experiential learning models.11 The role of
graduate students in mentoring undergraduate students in
the online course was noted as beneficial by the undergraduate students, though interestingly not by the graduate students. It is possible graduate students, many of
whom were travelling for thesis-related research, were
experiencing academic fatigue. Little attention has been
paid to the value of peer mentorship in public health education despite its documented success in other disciplines.25 Indeed, peer mentorship was integral to many
students’ success and the program’s success through
recruitment via word-of-mouth, and support for students
in subsequent cohorts. We recommend that public health
education programs, in general, facilitate greater opportunities for peer mentorship.
Another key finding in our evaluation was the importance
of an open-minded and inclusive attitude to a successful student learning experience as much as technical knowledge
and skills. Similarly, Frenk et al8 list “common attitudes, values and behaviors” as priorities in their list of 10 major educational reforms required to train the next generation of
health professionals. We acknowledge that students who
self-selected into our program were more likely to possess
8
these attitudes and values prior to their experience. However,
we did find that personal transformation was also a key finding. We attribute this personal transformation to the experiential learning aspect of the program, as also reported by
Sabo et al,26 but also the psychosocial support students
received through mentorship and relationships to overcome challenges. More educational research is needed to
disentangle these relationships to examine the value of
experiential learning among students with a more narrowminded attitude initially and explore how to effectively
teach “attitudes.”
Every student dealt with challenges, though their
responses to challenges varied, which was partially dependent on the attitudes previously discussed. While cultural differences were sometimes viewed as an opportunity to reflect
on ones’ own cultural assumptions, other students experienced frustration at differences, for example, in differential
cultural understandings of time. Challenges coping with different cultural contexts in experiential learning settings have
been previously documented.27 There are ethical considerations to consider in this regard, as outlined by Gough et al14;
for example, student privilege and entitlement, shallow or
superficial student reflections, as well as students perpetuating stereotypes on-site. The course instructor (first author)
attempted to normalize challenges as part of the learning
process as that can be an indication of values being challenged. This helped some students remain positive despite
also feeling frustrated, thus building confidence in students’
own ability to solve problems and cope. However, some
challenges did require intervention from a programmatic
standpoint and it is important to be able to differentiate what
can be a fine line between student learning and creating a
negative experience.
While student experiences and learning were generally a
positive outcome of the program, we recognize that an institutions’ ability to offer such programs may be limited as
these programs are extremely resource-intensive. It was clear
that success, as perceived by students, was directly dependent on mentorship support and supervision, which is labor
intensive. During this time period, our program received
nearly $300,000 in funding and we documented over
$500,000 in university cash and in kind contributions, mostly
attributed to coordinator salary, and faculty and community
member workloads for student supervision. The recommendations listed in Table 3 also correspond to, mostly, faculty
member workloads. Engaging faculty as mentors was a challenge for the program and in some cases, contributed to negative experiences for students. Limited faculty buy-in for
experiential learning has been noted by others,28 and may be
particularly difficult at research intensive institutions,12 such
as in our case. As Frenk et al12 noted in their description of
updating the public health curriculum at Harvard, we must
“forge the identity of research-teacher. . .into a single role.”
As is, the current academic climate in Canada does not support this. In our institution the majority of Indigenous and
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global health researchers are practicing physicians or salary
award holders. We need to consider the way the current
career reward structure frames research and teaching as
mutually exclusive. Just as institutional culture and systems
changes were, and still are, required to integrate community
engagement into valued academic pursuits,9,29 so too is institutional change required to fully value experiential learning
opportunities in community-engaged research and practice.
As highlighted in the recent Lancet special issue on
Women’s Health, increasing the number of women in leadership roles in global health is of paramount importance.30,31
While our high numbers of women trained is positive,
we acknowledge that our numbers do not tell the whole
story. A barrier for several women trainees, particularly
Indigenous trainees and including those who were not able
to participate, was the challenge of delegating care-taking
responsibilities during a 3-month placement. This was
compounded by the comparatively low level of funding for
students who sought Indigenous-focused placements in
Australia or New Zealand, given the higher cost of travel
and living. As also noted in the Lancet special issue, sexual
harassment and assault is rampant in the global health
field,32 with 55% of women in a recent survey reporting
sexual harassment and/or assault during their training.33
While more needs to be done to address this in academic
institutions globally, including our own, it is crucial for any
international experiential learning program to be prepared
to receive disclosures of sexual harassment and assault.
There are a number of limitations to this evaluation. First,
only informal feedback from host institutions of student
placements was received. A formal evaluation was thought to
be a burden on host institutions. Nonetheless, the first author
was successful in receiving additional funding for the QES
Program in 2018 based on the continued support of most
international partners. Second, this evaluation was based on
a structured narrative report. A formal open-ended, in person
evaluation may have resulted in a greater depth of inquiry
into student learning. Given the nature of open-ended survey
questions, responses varied considerably in their length and
depth. While the themes described in this paper reflect the
data collected, data saturation was not reached, and in particular there was a divide in terms of how students perceived
different challenges in relation to learning. However, it was
felt that the existing application, orientation, and reporting
structure already placed a heavy respondent burden on students given the funding amount. Furthermore, the faculty
lead and coordinator were in regular contact with most students such that a great deal of informal feedback was received
throughout the program. Third, the narrative reports were
mandatory and not anonymous. Students may not have felt
comfortable relaying negative feedback regarding the program to either the funder or program management. Moreover,
the reports were completed in most cases prior to the conclusion of the students’ respective placements, usually within
the last week. It is possible that students’ perceptions of their
9
Riediger et al
learning may have changed, either positively or negatively,
as a result of a period of reflection following the conclusion
of the placement.
In conclusion, experiential learning in global and Indigenous health research is a valuable pedagogical approach
in community engagement, particularly for undergraduate
students. However, international experiential learning
requires considerable financial and human resource commitments to ensure its success, as well as mitigate equity
issues. This evaluation can inform ongoing pedagogical
advances in public health education to further the development of interdisciplinary, engaged public health leaders who
can address emerging public health challenges in new ways.
Furthermore, greater consideration for community-based
and peer learning in public health pedagogy should be considered, regardless of the international context. Further evaluation is needed to examine how global experiential learning
opportunities prepare trainees as they enter, or reenter, the
public health workforce.
Acknowledgments
NR is a recipient of a CIHR Early Career Investigator Award (20182022; grant #155435). We gratefully acknowledge funding for the
Queen Elizabeth II Diamond Jubilee Scholarship program from
Universities Canada, Rideau Hall Foundations, and Community
Foundations Canada (2015-2019; 2018-2021). The online course
was funded through a Teaching and Learning Enhancement Fund to
NR from the University of Manitoba. The authors would like to
thank Ms. Tyiesha Wright for her assistance in the qualitative analysis of the narrative reports. Ms. Wright was partially funded by the
University of Manitoba’s Indigenous Summer Student Program.
Finally, we thank the program’s advisory committee, our international program partners, the staff and our colleagues at Ongomiizwin
Research—Indigenous Institute of Health and Healing in the Rady
Faculty of Health Sciences, the Centre for Global Public Health, the
Department of Community Health Sciences, the Department of
Medical Microbiology, and the International Office, all of the
University of Manitoba for their support of this program.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support
for the research, authorship, and/or publication of this article:
Start-up funding to NR from the University of Manitoba contributed to the evaluation and publication of this article.
Ethics
This evaluation was approved by the University of Manitoba JointFaculty Research Ethics Board.
ORCID iD
Natalie D. Riediger
https://orcid.org/0000-0002-8736-9446
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