|ORIGINAL RESEARCH PAPER
|Year : 2012 | Volume
| Issue : 2 | Page : 111-115
A Student's Analysis of the Moi University-Linköping University Exchange Programme
Consolata Hospital, Kenya
|Date of Submission||15-Feb-2009|
|Date of Decision||26-Jun-2012|
|Date of Acceptance||12-Jul-2012|
|Date of Web Publication||14-Nov-2012|
A S Mwenda
Consolata Hospital, P.O Box 25-10100, Nyeri
Source of Support: None, Conflict of Interest: None
Introduction : Moi University College of Health Sciences was established in 1989. It is comprised of the schools of medicine, nursing, public health and dentistry. Since its inception, the college has been in collaboration with Linköping University in Sweden. This collaboration has taken the form of student and staff exchanges, as well as infrastructure and library improvements. This study was carried out to analyse the exchange programme and highlight some of the strengths that the exchange programme brings to the students' academic experience. Methods : A qualitative cross-sectional survey was conducted among the students who participated in the elective/exchange programme in the years 2009, 2010 and 2011. Self-administered questionnaires were completed by the participants. Additional data were obtained from the recommendations and conclusions from the reports that the students wrote after their participation in the exchange programme. Focus group discussions and key informant interviews were also carried out. Results : A total of 46 students participated in the exchange programme: 27 from Moi University and 19 from Linköping University. The disciplines of students reflected the undergraduate courses offered by these universities. The exchange programme's strengths were exposing students to new cultural settings, different healthcare system organisation and influencing future academic and personal lives, as well as making education global. The main challenge facing the exchange programme was language. Discussion : This study shows the exchange programme as a strong pillar of the medical education curriculum, enabling students to get a global perspective on their education, while exposing them to significant cultural and healthcare organisation diversity. There is a need to expand the collaboration so that more students have the opportunity to experience the overseas exchange programme.
Keywords: Community-Based Education and Service, electives, exchange programme, innovative medical education, international collaboration, student analysis
|How to cite this article:|
Mwenda A S. A Student's Analysis of the Moi University-Linköping University Exchange Programme. Educ Health 2012;25:111-5
| Introduction|| |
Moi University College of Health Sciences (Moi), located in Eldoret, Kenya, was established in 1989. Since its inception, Moi has been participating in collaborations with several overseas universities through a caucus called 'Friends of Moi'. Among these collaborating universities is Linköping University (Linköping) in Sweden. The Moi-Linköping exchange has taken the form of staff/student exchange, development of joint library facilities and curricula development. , The funding for this collaboration has been primarily provided by the Swedish International Development Agency (SIDA).
The student exchange programme is 2-fold. A group of students participate in a six-week elective experience during which they rotate in various departments at the host university. Another group of students is involved in a 12-week exchange programme in which they are placed in pre-selected departments at Linköping during which period they sit in exams and earn marks which are transferable to Moi to be included in final exams. Moi students going for exchange to Linköping have focused on clinical and pre-clinical medical rotations, while Linköping students on exchange to Moi have mainly focused on Community-Based Education and Service (COBES). In both scenarios, the objective has been to offer the students an experience that is unique to the institution of exchange.  Such experiences are important for players in the healthcare sector given that hitherto isolated medical threats have now become worldwide concerns as the world becomes a global village courtesy of information technology and travel advancements. 
Enhancing student mobility through international exchanges is the most common approach to globalising medical curricula.  By interviewing undergraduate students, Niemantsverdriet et al. were able to identify the main learning outcomes from student electives. Fabian et al. have also been able to demonstrate the impact of an exchange programme on one's professional/medical practice.  When students from developed countries go for electives in the developing world, they are able to better understand the differences in the healthcare system, and this can enhance their global outlook to health  and in the end, their future career choices. ,
Past work has extensively covered the aspects of student exchange and inter-university collaboration. Weel et al. described exchange programmes among medical students in Europe.  Vora et al. established a student-initiated and student-facilitated elective programme that provides a course for students intending to pursue international electives and further assigns the students to supervisors and set objectives. 
However, literature on this topic with regard to Moi has been from the administration (provider) perspective. To date, students have only contributed through recommendations in the reports they write after their participation in the exchange programmes [unpublished data]. It is important, therefore, to get the students' (consumer) perspective on such collaboration and include these perspectives in future planning, acknowledging the strength that comes with active student involvement  in the organisation of such programmes.
To this end, the present study is a student's analysis of the Moi-Linköping exchange. It is not intended to analyse the outcomes or learning methods of the exchange programme; this has been done by other researchers. , Overall, the main objective of this study is to analyse the organisation of the Moi-Linköping exchange programme and describe the strengths and advantages this programme brings to students involved in this educational offering.
| Methods|| |
This was a cross-sectional qualitative descriptive study covering the 2009-2011 student exchange period. A total of 46 students (19 from Linköping and 27 from Moi) took part in the programme. Self-administered questionnaires were completed by the participants. The questionnaire for the years 2010 and 2011 contained additional questions and modifications from that of 2009, after taking into consideration recommendations from a reviewer. Four interviews with student team leaders (either face-to-face or through the Facebook TM chat) and two group discussions were also conducted. Additional data were obtained from the recommendations and conclusions from the reports that students wrote after their exchange/elective programme. This study was approved by the ethics committees of the two universities.
| Results|| |
A total of 46 students from different disciplines took part in the exchange programme [Table 1]. Nearly 59% (n=27) of the students taking part in the exchange programme were from Moi, whereas 41% (n=19) were from Linköping.
|Table 1: Number of Students from Respective Disciplines in the 2009– 2011 Exchange Programmes|
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A total of 20 questionnaires were returned from the 46 students (response rate=43.5%). The responses were from medicine (11), nursing (4) occupational health, environmental health and physiotherapy (1 each). Student leaders interviewed were from medicine (2), nursing and occupational therapy (1 each). Eight students participated in the first group discussion (4 from Moi and 4 from Linköping), whereas the second group discussion had 7 participants (4 from Moi and 3 from Linköping).
Six-week exchange programme for moi students
For the medical students in the six-week elective programme, the departments of attachment included colorectal surgery, radiology, burns unit, orthopaedics and palliative care. After the period of attachment, the supervisor in the department completed log forms for the students addressing: (1) student's willingness to learn; (2) professional respect; (3) punctuality in the department; and (4) relationship with the staff. The log forms were returned to the exchange programme coordinator, who later compiled them to produce a summary report that was used in Moi as part of the final score for the course Basic Medical Sciences (MSB) 500 (electives), and added to the score accrued from the written elective report.
The nursing students usually rotated in the departments of cardiothoracic surgery and community health centres and similar log forms were completed, with the same process of scoring as with medical students. The environmental health students were attached to the department of public health in the university and set out objectives to meet in the laboratory and other appropriate departments according to the assigned supervisors. Their assessment was the same as for the other students.
Six-week exchange programme for linköping students
The Linköping students arrived at Moi at the beginning of the COBES 1, which is a six-week programme in the Moi curriculum, to take part in the programme. The first two weeks are dedicated to teaching research methodology and community entry. This is followed by three weeks of attachment to health centres in rural Kenya and a final week of presentation of the field attachment research findings. Sometimes, Linköping students opted to spend the first two weeks rotating in relevant departments of the Moi Teaching and Referral Hospital (the teaching hospital for Moi) to gain experience in clinical practice. Among the reasons Linköping students gave for opting to rotate in the hospital were : The basic research methods being taught during the first two weeks had already been covered in Sweden and the desire to experience how medicine relating to their disciplines of study was practiced in Kenya. Once back in Linköping, the students gave a report on their experience in Kenya.
Twelve-week exchange programme for moi students
Only Moi medical students took part in the 12-week exchange programme (three in 2010 and three in 2011). They spent four weeks each in the departments of ophthalmology, orthopaedics and anaesthesiology. At the end of each attachment, the students took a continuous assessment test (CAT), the results were sent back to Moi for inclusion in their final CAT score. The rest of the assessment done for the six-week Moi exchange group also applied to this group.
Making health/medical education global
A major strength of the programme was that it made health sciences education global. Students were impressed that they could easily blend into the new curriculum. One Moi student who rotated in anaesthesiology was impressed at the level of knowledge she had mastered at home: 'I mean when we sit down to discuss anaesthesia I realize I am on top' (student 5).
The universality of education and a career in health sciences was a constant observation by the students: 'But also broaden my own learning-platform by seeing how my future profession is practiced throughout the world. I believe that a part of learning is by doing, so the chance to actually do something both in the occupational therapy department and out in the field, gave me a chance to learn so much' (Student 2).
The environmental and socio-cultural experience
'There is an aspect of cultural shock', reported one Moi student when asked what was the first experience in Sweden. The cultural difference was in both the hospital/university setting and at the society level (students' residence, shopping malls and the transport sector). New experiences in the Linköping hospital included the degree of automation and use of technology in patient management compared with the Linköping students' impression at the dependence on clinical acumen and examination thoroughness in planning patient management, especially in the level 1-3 health facilities in Kenya. Beyond the hospital setting, Moi students were impressed by the advanced infrastructure, while the Linköping students were more amazed by the African wildlife and the communal life in Kenya.
Student-lecturer interaction was free and informal in the Linköping setting, whereas in Moi it was very formal and hierarchical: 'I long for a time when African medics will treat each other as colleagues only separated by bridges and not huge gaps. Kenyan consultants and senior medics are so full of themselves and may not be as interested in making better doctors out of their juniors as they claim to do' (Student 6).
A unique experience in the setting of a different healthcare organisation
Moi students found out that much of the healthcare in Sweden is funded by the government. In Kenya at the time of the study, such a comprehensive coverage for all was not in place. This was an opportunity for Swedish students to appreciate the healthcare in their country: 'It changed my way of looking at our health system and our problems and diseases in my country, both in good ways and in bad. We have a lot to be thankful for' (Student 1).
Influence of the experience on students' future academic and professional lives
Several Moi students felt that the exchange programme changed their general approach to academics: 'It helped me change the way I look at academics' (student 10); 'I became more interested in what I study' (student 12). Students also indicated that the elective experience widened their scope of health sciences education: 'It was a definite eye-opener to the diversity of healthcare and expanded my thinking… due to immense exposure to advanced and innovative methods in…I only read in books' (student 7). For the Linköping students it was their exposure to tropical medicine that was notable and some thought they had started developing some early interest in tropical and international health.
Language barrier was identified as a challenge as students had to depend on lecturers and peer students. This made direct communication with patients and the community hard: '…The Swedish classes helped a little but inability to speak Swedish affected interaction with patients and other people' (student 9). Lack of sufficient resources, such as limited access to internet services, was the main problem for the Linköping students.
| Discussion|| |
The distribution of the students taking part in the exchange programme was varied. There were no students taking occupational therapy, physiotherapy or speech and language pathology from the Moi group as these courses are not offered at Moi University. The same applies for environmental health, which is only offered at the postgraduate level in Linköping. The annual variation in the number (and course) of Linköping students in the programme was random and depended on how many students (and from which courses) chose to have their exchange in Kenya. The higher number of medical students in the Moi group reflects the higher population of students taking the course compared with others. There were no students from the School of Dentistry as this school started recently and its premier students were yet to reach the year during which the programme is undertaken.
The model of attaching students to a tutor for a particular duration of time and having student log forms ensures adherence to set goals and achievement of set objectives for the department of attachment.  This exchange programme brings several strengths to the medical education system. It is an opportunity that offers students' experience outside their local environment, not only in learning but also in life. Through the programme, the students were able to experience the organization and delivery of healthcare in the country of exchange. This is consistent with Weel et al. who observe that an exchange programme adds value to students' education through the influence of a different healthcare system and working in a foreign academic environment. While the Moi students experienced healthcare as it is practised in a first world country, Linköping students had the opportunity to experience healthcare in a developing world. Such vital experience improves the students' understanding of global health while sharpening their clinical acumen as there is less dependence on technology for diagnostics. ,
There is a positive influence on one's academic and general life and increased variety of health/medical conditions that students experience during this programme. The exchange programme brings richness to the health/medical curricula and provides a break from the routine learning in the local institution to a new environment, while maintaining the value of the home university's curriculum.  In addition, teaching innovations exchanged by the institutions come as an additional advantage of the programme. For the Moi students, the programme means exposure to more advanced teaching methods such as a better equipped library and more specialties in the various academic programmes. For the Linköping students the programme brings an experience of tropical medicine and COBES.  The students had a unique experience and wished the duration of electives could have been longer. Given the chance to contribute more, for instance, through initiating an orientation programme for the future beneficiaries of the programme, students should be able to provide workable solutions to some of the challenges that face this programme. 
It does not come as a surprise that language barrier is a major challenge facing the programme. This problem was pointed out previously. , 'For clinical attachment, communication to patients is essential and students should be able to speak the language of the host university'.  It was not possible for the students to learn the local language and be able to effectively communicate with patients.
The Linköping students had difficulties in access to internet services. Moi University has internet services in the library, student computer laboratory and the students' residence halls. However, the university does not have a well-developed online library to meet the Linköping students' expectations. Thus, it may have been uncomfortable for them reading hard copies of journals and books when they were used to electronic literature. Although the situation is not always as dire as published elsewhere  ('The electrical supply is unstable, Internet connections can be erratic, water pipes run dry, roads that are passable one day are washed out the next, and posted timetables tend to be vague indications at best'), it is in the same array of challenges and learning experiences that visiting European medical students may face in Africa. Few expect overwhelmingly positive reviews of African healthcare by medical personnel from the developed world. ,
This study portrays the exchange programme as a strong pillar of a medical education, enabling students to get a global feel about their education, while exposing them to significant cultural and healthcare diversities. There is a need for more research to look at any differences that exist between the curricula of the two universities and determine other strengths that can improve teaching in the undergraduate health sciences. There is also a need to expand the collaboration so that more students have the opportunity to experience an overseas exchange programme.
Overall, students were unanimous in their recommendation for increased funding and involvement of more students in the exchange programme in addition to involvement of peer students from the clinical departments of attachment to facilitate orientation.
| Acknowledgements|| |
Robbert Duvivier recommended changes in the initial methodology as well as guided the appropriate literature search for this study. He reviewed this paper prior to submission. Jedidah Njoroge and Joseph Macharia collected data for the year 2010 and 2011. The author thanks all the students who participated in the exchange programme and in this study.
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