Cultural humility is the interpersonal approach that builds on cultural competence (Lekas et al., 2020. It constitutes increasing self-awareness, promoting self-reflection, being a lifelong learner and comprehending diverse cultures (Greene-Moton & Minkler, 2019). Cultural humility recognizes that no healthcare practitioners can be fully aware or competent in every culture, but it encourages healthcare practitioners to adopt an open, humble attitude through being consistently actively aware of one's own biases and thoughts (Greene-Moton & Minkler, 2019). It is an essential building block to enhancing relational practice, which is the basis of how to interact professionally and with meaning in healthcare settings (Doane & Varcoe, 2021). Cultural humility calls for the construction of empathetic and therapeutic relationships with patients (Doane & Varcoe, 2021) as it increases healthcare practitioners’ appreciation of different beliefs, values, and cultures within the patient-healthcare practitioners’ relationship (Ulvund et al., 2023). Through this, cultural humility can lead the patient to feel more understood and appreciated, as it is one of the components of the patient-centered approach (Button et al., 2005). While healthcare practitioners can acquire cultural humility through multiple means such as classroom education and local clinical practice, engaging in international placements has been shown to be the gold standard for development of cultural humility (Adamson et al., 2018). It is important for Canadian healthcare practitioners to collaborate with healthcare practitioners in different regional contexts and cultures, as it offers a chance for cultivating cultural humility to inform healthcare practitioners’ relational practice (Jansen et al., 2021). International collaboration not only enriches healthcare practitioners’ comprehension of diverse cultures, but also underscores the significance of tailoring their communication and care to make it readily comprehensible to a specific target population (Schwind et al., 2013). Such adaptability is especially pivotal in nations characterized by diverse ethnic compositions, including the United States, Canada, Colombia, and others (Browne et al., 2015).
Healthcare practitioners provide care for patients in environments that are often short-staffed and have high patient turnover and levels of acuity (Park et al., 2012). The high standards of delivering quality care, tailoring treatment to individuals, and demonstrating cultural humility can lead to healthcare practitioners experiencing burnout and a decrease in the quality of care provided (Poghosyan et al., 2010). Educators are currently encountering a conundrum of how to equip students and future healthcare practitioners with the necessary skills they need to provide quality and equitable care (Park et al., 2012). International placements can contribute to building these skills, and they are an encouraged way to improve curriculum content for developing better care (Adamson, 2018). International placements can be a gateway to cultivating knowledge and developing as professional healthcare practitioners who can appreciate diverse cultures and values (Adamson, 2018). Time spent overseas in a culture different from practitioners’ own, is associated with an increase in the attributes of cultural humility within the healthcare practitioners, such as developing the need for constant reflection and experiencing personal and professional growth (Adamson, 2018). Despite the duration of international placements, immersion in diverse cultures is the most effective way to gain cultural humility and enhance the professional and personal growth of participating healthcare practitioners (Jansen et al., 2021; Peel et al., 2021). International placements can help acquire attributes that enhance cultural humility. One of these attributes is enhancing cross-cultural awareness in different healthcare settings (Peel et al., 2021).
Several studies reviewed have highly underscored the importance of cultural humility development in novice healthcare practitioners or pre-licensure students through international placements (Adamson et al., 2018; Jansen et al., 2021; O'Donnell et al., 2022; Peel et al., 2021). As an example, Adamson et al. (2018) conducted a descriptive qualitative study aimed at assessing the emotional impact of 10 nursing students after they underwent international placements in Australia and Scotland (Adamson et al., 2018). Even though the two countries the students visited had similar healthcare environments, the study found that cultural humility is a major skill acquired by the student nurse participants after their return from the placement opportunity, which was more prominent than the emotional aspects the study originally aimed to assess (Adamson et al., 2018). Similarly, O'Donnell et al. (2022) focused on the impacts of an international placement in Ireland on 19 nursing students enrolled in US universities, by using a qualitative descriptive approach. The authors found that the difference between the healthcare environments in the two countries prompted the students to engage in a continuous self-reflection process while practicing person-centered approaches to care for the entire 15-week duration of the experience. All participants noted that they had never engaged in this level of reflection during their clinical practice experiences in the United States. Immersion in a different culture makes healthcare practitioners aware of the difficulty of acclimatizing to a new country and navigating new ways of learning as a foundation for practicing person-centered approaches in a new world. This study emphasized the importance of fostering more international collaborations with international healthcare practitioners to cultivate knowledge and improve healthcare practitioners' own relational practice, making them global citizens (O'Donnell et al., 2022). The knowledge gained through international placements strongly contributes to increasing aspects of cultural humility like self-reflection, which makes international placements necessary to be integrated into all healthcare programs (Jansen et al., 2021; O'Donnell et al., 2022; Peel et al., 2021).
International placements also have a greater impact on developing cultural humility attributes if the host country is vastly different from healthcare practitioners’ own. Peel et al. (2021) conducted a qualitative descriptive study focused on reflections of 62 Australian nursing students on how impactful it was for them not to speak the language of the host country like Nepal and to adequately express oneself in a different context. The researchers found that this experience, with limited duration, significantly contributed to the participants' understanding of cross-cultural awareness in the context of providing care. Furthermore, Jansen et al. (2021) conducted a qualitative, phenomenological study to compare the outcomes of international placements of 23 nursing students from universities in Ireland, England, and Denmark. Nineteen students went to countries with a different native language than their own, including Thailand, Cyprus, Turkey, and Tanzania. Four of the 23 students stayed in Europe, particularly in Finland, UK, and Norway. The authors found that active listening, empathy, and compassion—all aspects of cultural humility—are more significant when students are placed in a country where they do not know the language. Adding to that, Jansen et al. (2021) noted that placement outcomes are different when they are in low-, middle-, or high-income countries. For instance, placements in Turkey, a middle-income country, prompted participants to gain a deeper understanding of cultural humility compared to participants who underwent placements in high-income countries, like Norway (Jansen et al., 2021). Furthermore Jansen et al. (2021) suggested that the lower a country’s income level and having a language different from the healthcare practitioners undergoing placement, encourages deeper understanding of cultural humility.
Despite the positive impacts, international opportunities are limited in all health fields, particularly for students in North America to engage in such international opportunities (O'Donnell et al., 2022). More international opportunities should exist for future healthcare practitioners to ensure they evolve their relational practice in their home country and collaborate with international healthcare systems (O'Donnell et al., 2022). Browne and Fetherston (2018) conducted a quantitative study to find out what learning outcomes 18 institutions in Australia focused on in their international placement offerings to 100 undergraduate nursing students in Asian regions by doing a systematic thematic synthesis. Among the shared learning outcomes across institutions, one key outcome was becoming more culturally aware through immersion. The study found that while there is a substantial body of literature describing the outcomes of international placements, cultural humility is not always the identified learning outcome even when it is the intended goal for the placement. This is because there is no definitive way of predicting what international placements will teach or provide to students (O'Donnell et al., 2022). Therefore, it is essential to establish more placements globally to contribute to the existing body of knowledge, particularly in cultural humility development in healthcare practitioners through international placement experiences. Experiences that fulfill this outcome are crucial to include in the existing literature, as they contribute to educating healthcare practitioners in Canada and around the world about aspects that influence care and enhance care quality and satisfaction, such as cultural humility.
This study focuses on the exploration of one nutrition student researcher’s (participant) story of experience with an international placement opportunity in one clinic in Africa. Current literature primarily has focused on nursing students’ international experiences (Adamson et al., 2018; Bagnasco et al., 2020; Gower et al., 2017; Jansen et al., 2021; Kent-Wilkinson et al., 2015; O'Donnell et al., 2022; Peel et al., 2021). Other studies have also focused on medical students' international placement experiences (Bauer, 2017; Malau-Aduli et al., 2022; Weurlander et al., 2018). In addition, such literature seldomly explored students’ international placement experiences in the North African context, primarily detailing placements in Europe (Peel et al., 2021), Asia (O'Donnell et al., 2022) and South Africa (Cooper et al., 2020), with no placements in North Africa. Particularly, very few studies explore experiences of allied healthcare practitioner students engaging in international placements (Farias et al., 2021; Henley et al., 2020; Lough et al., 2012; Ross et al., 2019; Simonelis et al., 2011; Tyler et al., 2019). Therefore, this paper aims to contribute to the body of knowledge on international placement experiences for allied healthcare practitioner pre-licensure students in Canada, such as students in nutrition, and their development of cultural humility because of such an international experience.