AN INTEGRATED ORGANIZATIONAL VIEW OF THE DEVELOPMENT OF INTERNATIONAL EXPERIENCES IN GRADUATE PROFESSIONAL EDUCATION: CASES OF DENTISTRY, LAW, AND MEDICINE AT A RESEARCH UNIVERSITY By Julie Sinclair A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of Higher, Adult, and Lifelong Education – Doctor of Philosophy 2014 ABSTRACT AN INTEGRATED ORGANIZATIONAL VIEW OF THE DEVELOPMENT OF INTERNATIONAL EXPERIENCES IN GRADUATE PROFESSIONAL EDUCATION: CASES OF DENTISTRY, LAW, AND MEDICINE AT A RESEARCH UNIVERSITY By Julie Sinclair Internationalization of U.S. postsecondary institutions is a prominent topic in the current higher education environment. As part of internationalization efforts, universities and colleges are increasing study abroad or different types of international experiences that give students academic opportunities outside of the United States. The discussion of the importance of such experiences has been particularly prominent in undergraduate programs. However, literature indicates that providing international experiences to graduate students is of growing concern in the current global environment. Data indicate that majority of international experiences occur within graduate professional programs, including law, business, and the health professions. Additionally, literature on internationalization of U.S. higher education indicates that organizational factors within individual academic institutions matter in how international activities and strategies developed historically and are carried out in different ways. However, little is understood about how international experiences developed within graduate professional programs. Additionally, few research studies have used an organizational lens to understand development of such experiences. The focus of the current study was to understand the factors involved in developing and implementing international experiences within graduate professional programs through an integrated organizational approach. This research project included three academic programs, dentistry, medicine, and law, at a doctoral-level research university that is part of a multi-campus system. Faculty and administrators in the three academic schools, as well as campus-level administrators, provided their views on how international experiences began and were sustained over time. Key factors identified included faculty work and roles, various types of support, the role of curriculum, and connecting the international experiences in increasing ways across a variety of organizational levels. Additionally, the research data provided for a discussion of sustainability of international experiences in the three graduate professional programs. Future directions for research, policy, and practice are considered. Copyright by JULIE SINCLAIR 2014 I dedicate this dissertation to my parents, Jan and Ken Sinclair, and to my sister, Peggy SinclairMorris. Their support was crucial in my pursuit and completion of PhD program and this dissertation. v ACKNOWLEDGEMENTS There are many people who provided incredible support throughout my PhD and dissertation journey. First, I wish to thank my doctoral advisor and dissertation committee chair, Dr. Marilyn Amey, who provided support of every type from before I enrolled in the program to the conclusion of this dissertation. I consider Marilyn one of the most important mentors I have had during my life and appreciate her guidance tremendously. I also want to thank Dr. John Dirkx, who had many roles during my PhD program, including dissertation committee member, professor, and supervisor for my graduate assistantship. I consider Dr. Dirkx a mentor of the most transformative kind. Additionally, I would like to thank Dr. Roger Baldwin and Dr. Dawn Pysarchik for serving on my dissertation committee and providing guidance and suggestions throughout the PhD. I also want to thank my HALE cohort and other HALE friends for their support. This journey was only completed with the encouragement of many friends along the way. Additionally, I wish to acknowledge my supervisor, Dr. Patricia Croom, and my colleagues in the Office of Admissions at Michigan State University. Their encouragement and humorous emails meant a great deal. I also appreciate the support of many friends around the world and former colleagues at Oklahoma City University, who encouraged me to both start and finish this journey. In addition, I wish to thank many professional colleagues in NAFSA: Association of International Educators and friends from around the U.S. and the world and friends from Mount Hope Church in Lansing, MI. There were so many people who cheered me on throughout this process. vi I also want to give thanks to God for the opportunity to move to Michigan for the PhD program. My life was greatly enriched, and I found a place that became home. I am truly grateful. vii TABLE OF CONTENTS LIST OF TABLES ......................................................................................................................... xi Chapter 1: Introduction ................................................................................................................... 1 Problem Statement ...................................................................................................................... 7 Research Questions ..................................................................................................................... 8 Significance of the Study ............................................................................................................ 9 Chapter 2: Literature Review ........................................................................................................ 10 Definitions ................................................................................................................................. 10 Internationalization of Postsecondary Education ...................................................................... 12 An historical view. ................................................................................................................. 13 Motivations and Rationales for Internationalization ................................................................. 16 Internationalization of Graduate Education .............................................................................. 19 The Role of Academic Discipline ............................................................................................. 20 The professional disciplines and internationalization. .......................................................... 22 Types of international experiences. ....................................................................................... 27 Organizational Factors in Internationalization .......................................................................... 29 Research universities as organizations. ................................................................................. 29 Organizational Frameworks ...................................................................................................... 31 Studies of organizational factors in internationalization. ...................................................... 33 Conceptual Framework: An Integrated View ........................................................................... 35 Chapter 3: Methods ....................................................................................................................... 39 Research Design ........................................................................................................................ 39 Qualitative approach. ............................................................................................................. 39 Case study. ............................................................................................................................. 39 Site Selection and Sampling ...................................................................................................... 40 Data Collection .......................................................................................................................... 43 Analytical Strategy .................................................................................................................... 44 Limitations ................................................................................................................................ 46 Role of the Researcher .............................................................................................................. 48 Description of Research Site ..................................................................................................... 49 Chapter 4: The Case of Dentistry.................................................................................................. 52 Development from the Ground Up: Faculty Grassroots Initiatives and Work ........................ 53 The Role of Support: Is it Really all about Time and Money? ................................................. 58 Connecting International Experiences to the Curriculum ......................................................... 63 Connecting to Existing Systems: Being Part of the Three-Ring Circus ................................... 65 Chapter 5: The Case of Law ......................................................................................................... 70 A Broad Portfolio: Faculty Initiatives and Work ...................................................................... 71 Rationale: International Experiences as Part of Legal Education ............................................. 73 viii Multiple Layers in the External Environment ........................................................................... 75 The Institutional Environment .................................................................................................. 80 A Broad View of International Experiences for Students ......................................................... 83 Coordinating the Ad Hoc: A Changing Approach .................................................................... 85 Chapter 6: The Case of Medicine ................................................................................................. 88 Grassroots Development: Faculty Work and Initiatives ........................................................... 90 Paradigm of Partnership ............................................................................................................ 96 Curriculum Connection: Credit, Non-Credit, and Competencies ............................................. 99 Layers of Support .................................................................................................................... 107 From Silos to Broader Connections in Global Health............................................................. 112 Chapter 7: Campus Administrator Views ................................................................................... 115 International Efforts and Graduate Professional Education at LUMC ................................... 115 Chapter 8: Cross-Case Analysis.................................................................................................. 121 Faculty Background, Motivation, and Work........................................................................... 121 Realities of the workload. .................................................................................................... 123 Grassroots efforts. ................................................................................................................ 126 Serendipity. .......................................................................................................................... 127 Support Factor ......................................................................................................................... 127 Resources. ............................................................................................................................ 127 Leadership and culture of support. ...................................................................................... 129 Campus and university support. .......................................................................................... 131 Host country partners........................................................................................................... 132 Curriculum Factor ................................................................................................................... 132 Rationale. ............................................................................................................................. 133 Formalization. ...................................................................................................................... 135 Accreditation. ...................................................................................................................... 137 Connecting Factor ................................................................................................................... 138 Chapter 9: Discussion ................................................................................................................. 143 Getting International Experience off the Ground .................................................................... 143 Maintaining International Experiences ................................................................................... 144 Sustainability ........................................................................................................................... 149 The Academic Discipline ........................................................................................................ 155 The Integrated Organizational Framework ............................................................................. 159 The Importance of Organizational Layers .............................................................................. 166 Implications for Future Research, Policy, and Practice .......................................................... 168 Implications for future research. .......................................................................................... 168 Implications for policy and practice. ................................................................................... 174 Conclusion............................................................................................................................... 178 APPENDICES ............................................................................................................................ 180 APPENDIX A: Participant List............................................................................................... 181 APPENDIX B: Interview Protocol ......................................................................................... 183 ix APPENDIX C: Participant Email Invitation ........................................................................... 185 REFERENCES ........................................................................................................................... 187 x LIST OF TABLES Table 1: Organizational Frames……………………………………………………………….161 Table 2: Participant List……………………………………………………………………….181 xi Chapter 1: Introduction Postsecondary institutions in the U.S. have faced many different contexts of change over time, one of which is internationalization. Substantial literature documents that internationalization is not a passing fad (Altbach & Knight, 2007; DeWit, 2002; Hudzik, 2010; Merkx, 2003; NASULGC, 2004). As the terms globalization and internationalization are often confused, I define them as follows. Globalization is “the flow of technology, economy, knowledge, values, people, [and] ideas…across borders” (Knight & DeWit, 1997, p 6). Globalization is the environment that frames postsecondary institutions’ efforts to internationalize higher education. Although there are a number of different terms for the internationalization of postsecondary education, including campus internationalization and comprehensive internationalization, for the sake of consistency, I use the term “internationalization” throughout this study. Additionally, internationalization is the term most commonly used in the literature. I utilize Knight’s (2003) definition of internationalization as “the process of integrating an international, intercultural or global dimension into the purpose, functions, or delivery of postsecondary education” (p. 2). Although internationalization is a complex term and may mean a variety of things in different institutional contexts, some of the components generally identified as part of internationalization within postsecondary education include study abroad, enrollment of international students, incorporating international and intercultural dimensions into the curriculum, international research opportunities for students and faculty, and also different types of exchange agreements and cross-border partnerships with higher education institutions outside of the United States. The call to internationalize is a challenge for most institutions and not easily realized. Institutions often define their adoption of internationalization efforts through 1 measureable demographic and structural changes, e.g., adding a new office or staff position, increasing percentages of students on study abroad, increasing international student enrollment, or adding language related to internationalization to the mission statement of the institution (Green, Luu, & Burris, 2008). Mapping internationalization at U.S. colleges and universities shows that there are still many challenges and barriers to incorporating and sustaining a high level of commitment to international work (Green, Luu, & Burris, 2008). One primary component of internationalization is study abroad experiences for students. According to the American Council on Education (ACE) survey (Green et al.), most institutions recognize the importance of study abroad and are making efforts to increase the numbers of students participating in study abroad experiences. However, although numbers of students participating in study abroad are increasing, some populations of students are underrepresented in these numbers (Green et al). One such population is older adult students whose life experiences make it more challenging to go abroad for any extended period of time (Ladika, 2009; Shallenberger, 2009). Literature and research about internationalization of the student experience, including study abroad opportunities, typically focus on undergraduate students. A literature search of internationalization and graduate education resulted mostly in discussions about international student enrollment in graduate programs. However, recent literature indicates that internationalization of the graduate student experience is a growing concern within a number of academic disciplines (Dirkx et al., 2014; Hulstrand, 2007; Leggett, 2008, 2009; Tobenkin, 2009). A 2004 NASULGC task force highlighted both the need for adding international experiences to graduate education as well as some of the challenges in doing so: "Unfortunately, a welldeveloped international mindset is rare among new Ph.D. graduates and many faculty because 2 the interdisciplinary, intercultural, and diverse experiential aspects do not fit the focused disciplinary nature of typical Ph.D. programs” (Allen, 2004 a, p. 24). Additionally, graduate education plays a key role in the nation’s ability to remain innovative and competitive in the global arena (Council of Graduate Schools, 2007). Current literature indicates an increasing focus by graduate programs to incorporate various types of international opportunities. International experiences for students in graduate programs include individual travel for conferences, internships and research, short-term facultyled study abroad trips, service learning projects, and dual and joint degree programs (Gearon, 2011; Hulstrand, 2007; Leggett, 2009; Redd, 2008). Because I consider a broad range of international activities in the current study, I use the term international experiences when referring to graduate students. International experience is an umbrella term used to signify a variety of different types of opportunities, including language study, work, study, or travel abroad, and interaction with international students in the U.S. (American Council on Education, 2000). In this study, however, I do not consider interactions with international students in the U.S. Additionally, I define graduate education as post-baccalaureate. In health professions, such as medicine and dentistry, institutions may refer to MD or DDS students as undergraduates, but I define them as graduate professional students for the purpose of this study. In recent years researchers undertook a number of studies to look at short-term study abroad experiences, generally defined as one to eight weeks (Spencer & Tuma, 2002) or two to eight weeks in duration (IIE, 2010). Such experiences are the primary area of growth within study abroad not only for undergraduate students, but also increasingly for graduate students (IIE, 2010; Gearon, 2011). According to the Open Doors Report published by the Institute of International Education, in the 2008-2009 academic year over 480,000 international students 3 were enrolled in U.S. graduate programs, while only approximately 31,000 U.S. students spent any portion of their graduate experience outside the U.S. However, the trend for U.S. graduate students to participate in international experiences is on the rise (Gearon, 2011). In a U.S. News & World Report Online article, Erich Dietrich, assistant dean for academic and global programs at New York University's Steinhardt School of Culture, Education, and Human Development, noted that “five years ago 280 master's-level students studied abroad under the NYU programs; this year 600 will participate” (Gearon, 2011). Although research on the outcomes of short-term study abroad programs is limited and primarily focused on undergraduate student populations, scholars are documenting benefits for students through short-term study abroad programs (Chieffo & Griffiths, 2003; Dwyer, 2004). Currently there are only a few studies related specifically to outcomes of short-term international experiences for graduate students, such as that by Dirkx et al. (2009), which looked at how shortterm international experiences fostered transformative learning for adult learners. Another more recent study, titled Graduate Learning Experiences and Outcomes (GLEO), provided a view of the landscape of short-term faculty-led international experiences for graduate students at a group of research universities (Dirkx et al., 2014). Additionally, graduate education has an important role to play in an increasingly global world. A seminar held at UC Berkeley’s Center for Studies in Higher Education highlighted the role of graduate education in the current global environment. Due to globalization, graduate education today has to fulfill a dual mission: that of building a nation’s infrastructure of professionals and scholars, and of educating domestic and international graduate students for participation in a global economy and an international scholarly community. This dual mission is often experienced as a tension. (CSHE, 2009) While some evidence of internationalization is found in most academic disciplines (Redd, 2008), international experiences that focus on student learning or professional development 4 outcomes appear to exist primarily within the professional disciplines, which emphasize applying knowledge to practice, and are increasing their emphasis on professional practice in international settings (Bremer, 2008; Hulstrand, 2007; Leggett, 2008, 2009; Redd, 2008; Tobenkin, 2009). Although little research exists to document the influence of academic discipline on international experiences, available conceptual writing hints at the possible impact that discipline has on the nature and types of international experiences for graduate students. Academic disciplines have different cultures, traditions, beliefs, and values, which impact how knowledge is understood and applied (Becher & Trowler, 2001). Such differences are likely to play out in the rationale for and design of graduate international experiences. Although literature indicates that graduate programs are increasing their offerings of international experiences, little research has focused on understanding the organizational factors that play a role in a university’s or academic department’s ability to develop and implement international experiences for students. Many universities and colleges have study abroad or other international offices to assist in coordinating international experiences for students (Green, Luu, & Burris, 2008), but it is unclear how much of a role these offices play in developing or supporting international experiences for graduate students. Therefore, examining the academic program level is crucial to understanding the factors involved in developing and implementing international experiences for graduate students, as curriculum decisions typically happen at the academic school, department, or program level (Stark & Lattuca, 1997). It is also critical to understand institutional and external influences on the work of graduate programs. Internationalization developed differently from one institution to another, so institutional influences are important (Merkx, 2003). Literature also shows that other 5 influences, such as academic disciplines and professional associations, shape graduate programs (Leggett, 2008; Redd, 2008; Tobenkin, 2009). Organizational literature indicates that such factors as policies, people and roles, funding, environments, planning, decision making, and beliefs and values contribute to how and whether new initiatives are implemented and supported (Bolman & Deal, 2003; Morgan, 2006; Scott & Davis, 2007). While some research on study abroad alludes to the importance of organizational factors, such as leadership and resources, in expanding study abroad opportunities (Stroud, 2010), these factors have rarely been the focus of empirical study. For example, international partnerships in academic departments, which may include short-term international experiences for graduate students, are often implemented due to an initial faculty champion (Amey, 2010). However, most research neglects understanding the role of the academic department or the department chair (Amey). Scholars documented the primary themes related to internationalization of postsecondary education. According to Kehm and Teichler (2007), the primary foci of internationalization research are mobility, issues of teaching and learning, and strategies or ways of internationalizing. Broader, organizational pictures of internationalization are limited. When one examines the history of internationalization within U.S. higher education, institutional factors emerge as crucial in shaping the development of international activities and initiatives. Therefore, the lack of research about organizational views of internationalization within institutions and academic programs is surprising. Merkx (2003) documented the historical development of internationalization in U.S postsecondary education through two primary waves. The first wave, following World War II, saw the establishment of offices to support the needs of incoming, degree-seeking international 6 students and outgoing American students on study abroad (Merkx). The primary influence on how internationalization developed was the individual institution. For example, liberal arts colleges often emphasized internationalization as study abroad for students, while land grant universities became involved in international development projects (Merkx). This time period highlights the reasons why internationalization developed differently from one college or university to another and why understanding the type, structure, and culture of an institution is so crucial. The 1980s ushered in the second wave of internationalization, which highlighted increasing external influences on internationalization. The end of the Cold War, new technologies, and an increasingly globalized world economy all began to influence the development of internationalization to make it increasingly varied and complex (Merkx, 2003; Altbach & Knight, 2007). However, I argue that institutional factors still remain at the heart of understanding both the form and meaning of internationalization. Knight (2004) described the importance of the national and sector levels in understanding internationalization but stated that it was the institutional level “where the real process of internationalization is taking place” (p. 6). Therefore, organizational studies are important to truly understand the full picture of internationalization in U.S. colleges and universities. Developing and implementing international experiences within graduate programs is an emerging component of internationalization, providing a valuable context within which to conduct an organizational study. Problem Statement Internationalization of higher education is a prominent topic among U.S. postsecondary institutions. As part of this trend, universities and colleges throughout the U.S. are placing 7 increasing importance on internationalizing the student experience in order to prepare students to live and work in a global environment. Until recently, this discussion focused primarily on internationalizing the undergraduate student experience. Currently there is growing recognition that international experiences are also important for graduate students (Dirkx et al., 2014; NASULGC, 2004). However, little empirical research exists related to international experiences for graduate students. Additionally, the organizational factors that are part of the development and implementation of international experiences are not well understood. Research Questions The purpose of this study was to understand how and why graduate professional programs developed international experiences for students by considering the following research questions:  What are the organizational factors involved in the development and implementation of international experiences for students within graduate professional programs?  If the organizational factors vary, how do they vary?  If the organizational factors vary, why do they vary? In developing the current study, I recognized that factors both internal and external to the organization might be involved. As my goal was to understand how these factors impacted the work of graduate programs within an academic institution, I use the broad label “organizational factors.” I conducted a multi-site case study of three graduate programs within one doctoral level research university that developed and implemented a variety of international experiences for graduate students. My goal in this study was not only to identify the organizational factors that 8 were important for graduate programs to develop and implement international experiences, but also to understand how and why these factors were important. Significance of the Study The history of internationalization in U.S. postsecondary education showed that institutional factors are critical in shaping how internationalization is defined and what it looks like within each college or university (Merkx, 2003). However, little research on internationalization to date has been conducted at the academic program level (Amey, 2010) or using an organizational framework. Additionally, most research on internationalization has focused on undergraduate education. Available statistics indicate that internationalization of the student experience is growing at the graduate level (Gearon, 2011; Open Doors, 2013); however, few empirical studies exist in this area. The current study helped address this gap in the literature by providing understanding of the organizational factors that were important for academic programs to develop and implement graduate international experiences. In the following chapters, I review literature related to internationalization of postsecondary education in the U.S., focusing on graduate education and the organizational context. I then discuss the research methods and design used in this multi-site case study. I present findings of each of the cases in dentistry, law, and medicine, followed by summarized findings from campus administrators. Next I provide a cross-case analysis highlighting similarities and differences in the findings across and within the three cases. Finally, I offer a discussion of the findings in relation to existing literature and consider recommendations for future research, policy, and practice. 9 Chapter 2: Literature Review In the literature review, I first provide definitions of terms used in this study. Next, I discuss the broader context of internationalization within postsecondary education, including the historical picture of internationalization in the U.S. and the rationales and motivations for internationalization within U.S. colleges and universities. I then consider the emerging conversation in the literature related to internationalization of graduate education by first providing a discussion of graduate education and the role of academic discipline, and then examining the literature related to international experiences for students within graduate education. Finally, I review literature on higher education institutions as organizations and on organizational frameworks. In this section, I examine empirical research studies that highlight organizational factors within internationalization. Definitions In the current study, I use the following definition of internationalization: “the process of integrating an international, intercultural or global dimension into the purpose, functions, or delivery of postsecondary education” (Knight, 2003, p. 2). The word “process” is important in that it signifies the ongoing, changing nature of internationalization and implies both inputs and outcomes as part of internationalization (Knight, 2004). “International” refers to relationships among nations and cultures; the term “intercultural” recognizes cultural diversity within a nation, while “global” indicates a “world-wide scope” (Knight, p. 11). Knight’s term “integrate” is also significant, as it indicates that internationalization needs to be more than just a peripheral or marginal part of the work of universities and colleges or the domain of only specified offices or leaders (Hudzik, 2010; NASULGC, 2004). Altbach and Knight (2007) distinguish traditional internationalization as those activities that promote international or intercultural learning for 10 students, such as study abroad and exchange programs, enrollment of international students, and changes to the curricula. While the traditional mission continues, there are also many new approaches to internationalization, including new types of international partnerships (Altbach & Knight; Croom, 2010), some of which have implications for international experiences in graduate education. I discuss terms related to international partnerships and types of graduate international experiences later in the literature review. Internationalization in the 21st century context of higher education is, then, the response of postsecondary institutions through policies and practices to the forces of globalization, a response which involves numerous choices (Altbach & Knight, 2007). Altbach and Knight define globalization as the “economic, political, and societal forces pushing 21st century higher education towards greater international involvement” (p. 290). Internationalization may be defined from two perspectives: internationalization at home, which includes internationalization activities that happen on the home campus, and internationalization abroad, also referred to as cross-border education (Knight, 2004). Internationalization at home highlights efforts undertaken on the home campus, including internationalizing the teaching and learning processes and extracurricular activities, as well as emphasizing interactions with cultural and ethnic groups in the community (Knight). Crossborder education is defined as “collaborations among colleges and universities in different countries around both instructional and non-instructional activities” (Sakamoto & Chapman, 2011, p. 3). The emphasis is on the mobility of students, scholars, and faculty across borders. Although the scope of my study focused on the U.S. context of developing and implementing international experiences, the literature on cross-border partnerships provided insight into the rationales and types of available international experiences for graduate students. 11 Internationalization of Postsecondary Education Internationalization has become a key theme of U.S. higher education (Childress, 2009, Fall). Leaders in higher education and government comment increasingly on the need for academic institutions to better prepare students, staff, and faculty to engage in a globalized world. Former University of Michigan President James Duderstadt called for postsecondary institutions to reconsider how international components were incorporated into educational missions (Duderstadt, 2000). Former Harvard University President Derek Bok wrote about his concerns that American college students still lack knowledge of world affairs, stressing the importance of the responsibility of colleges to prepare students for a future that will increasingly involve work beyond the borders of the United States (Bok, 2006). For reasons such as these, postsecondary institutions in the United States are increasingly working towards the goal of internationalization. Such efforts include developing opportunities for American students to study abroad, focusing more efforts to recruit international students and scholars, establishing international research collaboration and partnerships, as well as considering how to add international components to undergraduate curriculum (Olson, Green, & Hill, 2008) and increasingly to graduate education as well (Gearon, 2011). Numerous organizations currently emphasize the importance of the internationalization of higher education. Professional associations and organizations, including NAFSA: Association of International Educators (NAFSA), call for universities and colleges to move towards the goal of comprehensive internationalization, meaning inclusion of “international and comparative perspectives throughout the teaching, research, and service missions of higher education” (Hudzik, 2010, p. 6). In recent years the American Council on Education (ACE) produced a number of publications, including Internationalizing the Campus: A User’s Guide (Green & 12 Olson, 2008), designed to help postsecondary leaders work towards comprehensive internationalization strategies at their institutions. Carrying out the work of internationalization is a complex task that takes place within individual institutional contexts (Knight, 2004). Mapping internationalization efforts on U.S. campuses shows that although internationalization activities are increasing, there are still many gaps, and internationalization often remains more rhetoric than reality (Green, Luu, & Burris, 2008). Data and literature indicate that internationalization is still not a part of the majority of institutions’ strategic planning and remains difficult to measure, making it challenging to know how well such efforts are implemented from one campus to another or what the true benefits are (Green, Luu, & Burris). Adding to the challenge is the historical lack of a common definition of internationalization from one college or university to another, as well as differences in how internationalization developed within various postsecondary institutions (Merkx, 2003). An historical view. Although many scholars consider the beginnings of internationalization to date all the way back to the earliest years of postsecondary development in Europe (deWit, 2002), the current movement towards internationalization of U.S. higher education starts primarily following World War II (Merkx, 2003). As the U.S. moved away from a period of isolationism prior to the war, international students began to enroll in U.S. colleges and universities to gain degrees in a system often considered to have advantages compared to postsecondary education in their home counties (de Wit, 2002). In response to this trend, universities and colleges needed to implement campus services for these primarily degreeseeking international students, which in part led to the establishment of international offices and development of administrative staff to handle such work (Merkx). 13 The post WWII period also saw the early days of study abroad for American students who, along with the influx of international students to the U.S., were part of that first wave of internationalization in the 1950s and 1960s (Merkx, 2003). Professional associations, such as the National Association for Foreign Student Affairs, later known as NAFSA: Association of International Educators, evolved to provide services to inward and outward bound college students. The years following WWII also saw the introduction of international studies as an academic subject (Merkx, 2003). This first wave of internationalization highlights the importance of considering the institution type and culture in how internationalization developed differently from one U.S. campus to another, both from the perspective of structure and outcomes. To this day, what an institution considers most important within internationalization often goes back to differences in organizational response to internationalization at individual universities and colleges (Merkx). In short, “no single type of internationalization or organizational strategy emerged as dominant in American higher education” (Merkx, 2003, p. 9). For example, a demand for overseas study opportunities often drove many liberal arts colleges to place greater value on study abroad programs. Internationalization at many research universities developed a focus on enrollment of degree-seeking international students, resulting in offices to manage international student support and visa services, with the chief international officer role located within an international services support office (Merkx). Other research universities were influenced by the 1958 National Education Defense Act, encouraging faculty to undertake research in international settings and resulting in chief international officers who were often faculty members within international or area studies (Merkx). Land-grant universities began to focus on international development projects designed to address problems of world hunger during the 1950s and 1960s 14 with the passage of such acts as the Foreign Assistance Act of 1961 (Merkx). The head of the international development project then became the chief international officer at many land grant universities. Although many universities and colleges now incorporate multiple aspects of internationalization, different functions may have developed separately, leaving a history of internal competition in the institution between internationalization activities (Merkx). The second wave of internationalization in the U.S., beginning in the 1980s, came with a greater amount of drivers external to postsecondary education, including globalization of world economies, development of the internet, and the end of the Cold War (DeWit, 2002; Merkx, 2003). An increase in the “volume, scope, and complexity” (Altbach & Knight, 2007, p. 290) of international activities is especially evident during the past two decades. From an institutional perspective, the second wave of internationalization highlighted several elements. The first was an increased focus on tying internationalization to broad, often vague, institutional missions and goals. The second feature was growing involvement from stakeholders within the organization not historically associated with international activities, such as governing boards and professional schools (Merkx). Additionally, many new models of international partnerships, including branch campuses and collaborative degrees, emerged during this wave and continue to increase in the current decade. Traditional components of internationalization within higher education also remain, including study abroad (Merkx). In spite of the prevalence of similar external forces in recent years, the total picture of internationalization still differs greatly from one institution to another and among different institution types. However, large doctoral-level universities appear to have the biggest scope and range of international activities (Merkx, 2003; Green, Luu, & Burris, 2008). Mapping internationalization on U.S. campuses indicates that doctoral universities are the most likely to 15 have written commitments to internationalization included in their mission statements and that 97% of doctoral institutions have one or more offices dedicated to internationalization efforts (Green, et. al., 2008). Doctoral institutions have also increased their support and commitment in recent years for faculty to be involved in international work: “The proportion of doctorategranting institutions providing funding to send faculty abroad increased substantially between 2001 and 2006, suggesting that doctorate-granting universities view helping their faculty acquire international knowledge and experiences as a key internationalization strategy” (Green, et al., 2008, p. 32). Interestingly, however, such international work is still generally not a factor for hiring or promotion at doctoral institutions (Green, et al., 2008). It seems there is a tension between stated commitments and growing support for international activities in some ways, yet lack of change in crucial areas at the same time. I believe this tension in doctoral or research universities provides a rich context for studying the development and implementation of international experiences as an evolving part of the work of graduate programs. Motivations and Rationales for Internationalization Motivations and rationales for internationalization refer to the various factors that influence postsecondary institutions’ decisions to internationalize (Knight, 2004). As discussed in the previous section, there are external forces that postsecondary institutions face due to globalization that impact their decisions to internationalize. At the same time, there are also numerous institutional drivers that affect the picture of what internationalization looks like at a particular university or college. Both external forces and internal institutional drivers play an important role in shaping how and why postsecondary institutions internationalize. A number of scholars studied and categorized rationales for internationalization of postsecondary education. One of the most well-known is De Wit (2002), who described 16 rationales and motivations within four primary categories: academic, economic, political, and socio-cultural. Academic rationales include adding international components and dimensions to teaching and research in order to expand the worldview of students and faculty. Academic rationales also include increasing academic profile and status. Economic drivers relate to finances and competitiveness. Political motivations span the policy arena from the institutional to the regional and national levels and involve technical assistance and diplomacy. Sociocultural rationales consider issues of cultural identity and intercultural understanding, as well as citizen and community development. Because of the changing factors impacting internationalization of U.S. postsecondary institutions, Knight (2004) recognized that a new conceptual framework was needed to understand the rationales and motivations for internationalization. Knight highlighted the impact of national or sector level influences, including policy, regulatory frameworks, funding, and programs. However, Knight also acknowledged that the actual work of internationalization is carried out at the institutional level and that institutional level rationales, though not always easy to separate from external drivers, are critical. Institution type also affects how motivations to internationalize drive decisions. An increasingly important institutional rationale for internationalization is institutional prestige (OECD, 2004), which Knight (2004) referred to as academic standards. Institutional prestige highlights the reputation, ranking, and branding in the global postsecondary arena (Knight, 2004; OECD, 2004; Sakamoto & Chapman, 2011). For example, desire for international prestige is a key driver behind decisions such as opening a branch campus (Croom, 2010), which is primarily an internationalization strategy undertaken by larger research universities. Financial rationales or generation of income is also an increasingly important 17 institutional rationale for internationalization (Knight, 2004; OECD, 2004; Sakamoto & Chapman, 2011). Competition for the world’s increasingly mobile student population brings not only economic benefits but also institutional prestige (Knight, 2004). Student and staff development is another institutional motivation in the push to internationalize. Knight described this rationale as something that has existed for a long time but is receiving a renewed emphasis for a variety of reasons including an increasingly global labor market and numerous cultural conflicts around the world. There is also an emphasis on graduating globally competent students, staff, and faculty. Sakamoto and Chapman (2011) provided a model of four categories of factors that impact a higher education institution’s willingness to participate in cross-border education: organizational, financial, individual, and broader contextual factors, such as national policy and legal issues. Organizational factors include centrality to institutional mission, sufficient comparative advantage, faculty workload, existing institutional relationships, anticipated prestige, and organizational depth of interest, meaning the number of faculty who want to participate in the international initiative (p. 7). Additionally, Sakamoto and Chapman’s (2011) model highlighted motivations of individual members of an institution and how those motivations influence organizational decision making related to internationalization. These include faculty interest, experience, incentives, and international contacts. As Sakamoto and Chapman (2011) emphasized, motivations and rationales that influence the development and implementation of international activities are varied and complex. 18 Internationalization of Graduate Education One of the major components of internationalization within higher education, both historically and in recent years, is the inclusion of international experiences for students. International experience is a key component of the growing push towards student development of international or global competencies, seen as increasingly necessary in the environment of the 21st century (Deardorff, 2005). Both short and long-term study abroad opportunities, and the offices to administer such programs, are found in many postsecondary institutions. For the most part, however, the conversation about developing and implementing international experiences for students has focused on undergraduate education. For example, the Lincoln Commission passed an act in U.S. Congress to support participation of one million undergraduate students in study abroad in the next decade (Lincoln Commission, 2005). Discussions about internationalizing the undergraduate general education curriculum are also prominent. Leaders on many U.S. campuses set institutional priorities for increasing international components of undergraduate education, including increased study abroad and changes to the curriculum. A NAFSA task force on strengthening study abroad stresses the critical role of study abroad within the undergraduate experience (NAFSA, 2008). Former Harvard President Derek Bok remarked that study abroad experiences “can benefit undergraduates in multiple ways,” including increased foreign language study, greater interest in world affairs, and gains in life skills and attitudes, such as self-confidence (Bok, 2006, p. 236). However, the conversation about the importance of internationalization does not happen as frequently at the institutional level in graduate education for a number of reasons. Graduate programs, in contrast, are more highly discipline-based and lack a common curriculum. Decisions about graduate curriculum are usually under the purview of departments and colleges 19 or schools and are also influenced by academic, discipline-based accrediting organizations and professional associations (Stark & Lattuca, 1997). Graduate education is also a process of students’ socialization into the nature of the academic discipline, as well as into the profession(s) associated with the discipline. University and professional association leaders cited the importance of having doctoral students with international mindsets who understand the international dimensions of their disciplines (NASULGC, 2004). In 2003, Eva J. Pell, Vice President for Research and Dean of the Graduate School at Penn State University, delivered a message addressing the role that study abroad opportunities play for both undergraduate and graduate students, indicating that international experiences for American graduate students are not as common but still highly important. At the undergraduate level, there is increased emphasis on programs that enhance students' cultural experiences. Study abroad is strongly encouraged of our undergraduate students. These experiences allow students to live overseas with all the relevant benefits. At the graduate level, international opportunities are increasing but are still the exception. That said, the benefits are as great or greater than for undergraduate students. Literature shows that in recent years not only is graduate student participation in international experiences on the rise but that it is increasingly seen as an important component of graduate education. The Role of Academic Discipline Academic discipline is a key piece of understanding graduate education. Disciplines have different cultures, structures, beliefs, and ways of understanding and using knowledge that impact work within academic units, such as departments, at universities and colleges (Becher & Trowler, 2001). Several frameworks or classification systems of disciplines exist that are helpful in the current study. Biglan, (1973a, 1973b) developed a well-known classification of disciplines 20 based on analysis of responses from over two hundred academic scholars in order to understand how they viewed their subject matter. Results led to development of three dimensions within academic subject areas: “existence of a paradigm, concern with application, and concern with life systems (p. 195).” Biglan discovered that some disciplines have particular paradigms that inform theory, such as many sciences, while other disciplines do not. Biglan labeled this first dimension as hard or soft with many sciences at one end classified as hard, social sciences in the middle, and humanities at the opposite or soft end. A second dimension of disciplines highlighted whether or not the focus was on practical application of knowledge, which Biglan labeled as pure or applied. Subjects such as accounting and education are at the extreme positive end of this scale, while physical sciences and philosophy fall at the negative end. The third classification concerned whether or not a discipline works with living subject matter. In a follow up study, Biglan (1973b) examined social structure and research output in different subject matter areas. He identified four key areas of difference among scholars in the study: “(a) the degree to which they were socially connected to others, (b) their commitment to teaching, research, and service, (c) the number of journal articles, monographs, and technical reports they published, and (d) the number of dissertations they sponsored” (p. 204). Biglan’s results showed that the hard disciplines, or those that have a particular paradigm, tended to have more social connectedness as they have a common framework upon which to build. Scholars in applied areas showed more inclination towards service functions than those in pure subject matters. All of these differences potentially have implications for the type and nature of international experiences in graduate education. Kolb (1981) carried Biglan’s (1973b) framework further to understand the impact of disciplinary differences on learning styles. Using an experiential learning framework, Kolb 21 classified learning styles as abstract-concrete and active-reflective. The abstract-concrete dimension involved learning that “represents the concrete experiencing of events, at one end, and abstract conceptualization at the other” (Kolb, p. 236). The second dimension “has active experimentation at one extreme and reflective observation at the other” (Kolb p. 236). Kolb used this framework to study the undergraduate education of 800 subjects and found that the participants’ learning styles paralleled Biglan’s domains. Concrete learning styles match the soft disciplines, while abstract learning styles fit the hard disciplines (Kolb, 1981). Pure disciplines involve more reflective learning while applied disciplines show greater active learning. Although my study does not involve researching student learning styles, Kolb’s work is important in showing another dimension of disciplinary differences that may impact the nature of international experiences in graduate education as it highlights how disciplines approach both learning and the learner differently. Becher (1981) emphasized that disciplines are also cultural with different beliefs, values, and language. Becher sought to understand similarities and differences among six disciplines, including physics, history, biology, law, and mechanical engineering. His participants made the important point that disciplines are certainly not homogenous entities, even if there are distinguishing characteristics, and that those characteristics can change over time. For example, Becher found that sociology is a fragmented discipline with scholars who are part of prestigious institutions and avoid professional association involvement and scholars in less prestigious institutions who look to professional associations as a source of identity and recognition. His findings indicate that institutional and local academic program factors also impact disciplines. The professional disciplines and internationalization. In this section I turn to a discussion of professional education, as my research cases came from within the professional 22 disciplines. The goal of professional education is to prepare students to practice in a particular profession (Houle, Cypert, & Boggs, 1997). Structurally, professional disciplines often exist as independent schools that are part of larger institutions, such as research universities (Houle et al., 1997; Rhodes, 2001). As described above, the professional or applied disciplines focus on practical application of knowledge, although epistemological beliefs and disciplinary cultures vary within the professions. Research is still limited on how disciplinary differences within the professions impact development and implementation of international experiences for graduate students. Literature on internationalization of graduate education indicates that the development of international experiences for students is more prominent in the professional disciplines. Part of the reason for this may be that the vast majority of master’s programs fall within the professional disciplines (Gumport, 1993), which literature indicates have the greatest amount and breadth of international experiences. Second, the applied nature of professional disciplines plays an important role. In recent years NAFSA: Association of International Educators published a series of articles on the internationalization of a variety of graduate disciplines, all in professional areas: business, social work, urban planning, nursing, law, medicine, and dentistry. Although these articles are not empirical studies, they provide important understanding of the rationale for and types of international experiences for graduate students. In looking at the themes that emerge, first of all, the NAFSA articles indicate that professional programs are sensitive to environmental factors that impact their practice. For example, globalization impacts the nature of the problems that professional disciplines address, such as global health issues, challenges of urban planning in developing nations, or the global competitiveness of the American business enterprise as well as American business education 23 (Bremer, 2008; Ladika, 2008; Leggett, 2008, 2009). Second, professional associations and accrediting agencies increasingly emphasize internationalization within their own mission statements and practices, which in turn influences graduate programs (Leggett, 2008; Tobenkin, 2009). Third, student interest in international specializations and overseas experiences at the graduate level is on the rise (Bremer, 2008; Hulstrand, 2007). It should be noted that graduate students are diverse in terms of age and life experience, and the impact of their backgrounds on participation in international experiences is not yet well-studied. However, the NAFSA article series indicates that the majority of international experiences within graduate programs are shortterm, although there are some examples of longer experiences, and that they typically reflect the nature of the discipline. What does not emerge clearly through these articles is whether or how graduate programs’ internationalization efforts are situated within broader institutional internationalization contexts. MBA programs and the discipline of business in general represent a relatively long history of having a global outlook. In 1988, Congress provided funding for U.S. institutions to create Centers for International Business Education (CBIEs) to foster the United States’ economic competitiveness (Hulstrand, 2007). Traditionally, American MBA programs had the largest market share of students worldwide, but that is changing as these programs experience increasing global competition due in part to growing economies of other nations (Hulstrand, 2007). Interest of U.S. students in gaining international experiences within their MBA programs is also increasing. Many MBA programs are expanding offerings through working with international partners to provide students with a variety of international experiences, including research projects, internships, and dual degrees (Hulstrand, 2007). 24 There is also limited empirical research about MBA programs that examines organizational factors that impact a graduate program’s ability to develop and implement international experiences for students. Alon and McAllaster (2009) examined the global footprint of MBA programs, which refers to a label for measuring an institution’s internationalization efforts across a variety of dimensions, including curricula, faculty, and students (Alon & McAllaster, 2009). Although their study is not limited to U.S. institutions, it is significant for a number of reasons. First, the study emphasized the role of discipline in internationalization of graduate education. Second, the footprint model the authors used brings out the importance of factors such as structure, revenue, and partnerships in internationalizing MBA programs (Alon & McAllaster, 2009). Third, the authors name and describe different types of international experiences within MBA programs, including international internships, international consulting, international study trips, and international residency programs. Additionally, the authors find that larger institutions tend to have more international experiences available for students (Alon & McAllaster, 2009). Law is an example of a discipline where the development of internationalization has happened in quite similar ways across law programs, especially over the last decade (Tobenkin, 2009). According to a 2007 Bar Association survey, 110 schools of the 159 that participated encouraged students to take part in study abroad programs through their own or other schools; 95 of the institutions surveyed indicated that they have a summer abroad program (Tobenkin, 2009). International and comparative law courses are being added to American law school curricula as well (Tobenkin, 2009). As in the case of most graduate disciplines, benefits of international experiences for law students are mostly anecdotal and include professional development and personal growth. 25 Social work is another discipline emphasizing internationalization. According to the Educational Policy and Accreditations Standards of the Council on Social Work Education (CSWE), educational programs are required to “prepare social workers to recognize the global context of social work practice” (Leggett, 2008, p. 42). While the preceding statement applies to both undergraduate and graduate programs, anecdotal evidence supports the fact that master’s programs in social work increasingly emphasize international opportunities for students. For example, Monmouth University, Loyola University Chicago, and Tulane University all have study tours or short-term overseas programs for students in their master’s programs (Leggett, 2008). Ron Marks, Dean of Tulane’s School of Social Work, took groups of graduate students to India and believed such trips had value for a number of reasons. “Students see something outside their paradigm, something that doesn’t make sense in their worldview and they begin to struggle with those issues” (Leggett, 2008, p. 46). Graduate education in social work is also one area where adding internationally-focused content to the curriculum is part of the current discussion (Leggett, 2008). To that end, the CSWE established a new institute in 2004 to integrate international content into the core of social work education (Leggett, 2008). Within graduate programs in urban planning, students increasingly choose international specializations in their programs, often due to interest in global issues about the environment, energy resources, community development, and tourism (Bremer, 2008), leading graduate programs to offer more international experiences for students in response. The increasing commitment to internationalization is also reflected in the initiatives of the Association of Collegiate Schools of Planning (ACSP), the primary U.S. professional association for urban planning. Urban planning is considered a collaborative discipline, and partnerships abroad play a key role (Bremer, 2008). One example of longer-term international experiences for graduate 26 students in urban planning is Florida State University’s joint program with the Peace Corps, begun in the 1980s, called the Master’s International Program (Bremer, 2008). Students spend one year at FSU, two years with the Peace Corps, and then a final year at FSU. The health professions are also increasing their emphasis on internationalization. The need for students to understand global health issues is part of the reason for expanding an international focus in nursing programs, including at the graduate level (Ladika, 2008). Shortterm faculty-led international experiences make up a great part of the available international opportunities (Ladika, 2008) for graduate nursing and medical students. Another version of international offerings includes service learning opportunities (Ladika, 2008; Leggett, 2009), such as the Master’s International Program, where graduate nursing students spend two years in the Peace Corps as part of the program. The effort to internationalize curricula within nursing is proving to be a slow process, however (Ladika, 2008). Medical schools have experienced substantial change due to the increasing international focus of medical education (Leggett, 2009). According to Association of Medical Colleges (AAMC) statistics, only six percent of students in U.S. medical programs participated in international clinical experiences in 1984, while that number increased to 39% in 2002 (Leggett, 2009). The growth of global health education and growing student interest appeared to be primary factors behind the increase (Leggett, 2009). Student participation in international experiences generally occurs in summers between academic years or during clinical periods and is often supported by partnerships with medical schools in other countries (Leggett, 2009). Types of international experiences. Currently there is no existing typology of international experiences for graduate students. However, available magazine articles, conceptual literature and a limited number of research studies provide some indication of the 27 different types of international experiences for graduate students. Additionally, available literature on study abroad and cross-border education provide definitions for some types of international experiences. Short-term international experiences are on the rise and appear to constitute a predominate type of international experiences in which graduate students engage (Gearon, 2011; Open Doors, 2013). This trend may be due in part to the fact that adult students often have family, work, or financial responsibilities that impact their ability to participate in some types of international experiences (Ladika, 2009). Graduate students, as is the case with non-traditional adult students, frequently have lives that do not allow for extended time overseas (Gearon, 2011; Schallenberger, 2009). Another type of international experience is collaborative degrees, often labeled as either dual or joint degrees, which involve partners in different countries that issue either a combined or joint degree or issue separate or dual degrees (Knight, 2011). Collaborative degrees are also referred to as “twinning” programs and involve coursework taught both at the home campus and international campus and lead to degrees granted by one or both institutions (Thomas, 2008). Although twinning programs are more commonly found in undergraduate degrees, they are also on the rise in graduate education (Thomas, 2008). The Council of Graduate Schools survey (Redd, 2008) indicated that collaborative degrees are most common in engineering, with 25% of responding engineering graduate programs indicating they offer such collaborative degrees. The Council of Graduate Schools (CGS) surveyed member institutions about their international student admissions efforts and practices (Redd, 2008). Member institutions were asked to provide information about types of initiatives used in their programs to attract international students. The survey shows that engineering programs are the most likely to offer 28 some type of collaborative degree or certificate compared to programs in other disciplines (Redd, 2008). A U.S. News and World Report Online article cited the CGS study and indicated that U.S. students also participate in collaborative degree programs at the graduate level (Gearon, 2011). An American student interviewed in the article explained that having two degrees made him more competitive (Gearon, 2011). It is important to note that I did not consider branch campuses as part of my study. Literature indicates that the primary focus of branch campuses is not to create international experiences for U.S. based students but is rather to enroll students from the branch campus host country or region and to increase an institution’s prestige, ranking, and visibility in the global higher education arena (Croom, 2010; Sakamoto & Chapman, 2011). Available literature indicates that discipline has an impact on the nature of international experiences within graduate education. Additionally, the literature indicates that the role of the institution is crucial in understanding what internationalization looks like at higher education institutions, as that is where the actual work of internationalization happens (Knight, 2004). Organizational Factors in Internationalization In this section of the literature review I examine the role of the institution in the work of internationalization. First I discuss higher education institutions as organizations with a focus on research universities, as they have the largest number and variety of graduate programs. I then review literature on organizational frames as ways to understand what happens in organizations, followed by a discussion of empirical studies that shed light on how organizational factors impact internationalization. Finally, I consider the importance of understanding internationalization through the lens of an integrated organizational frame. Research universities as organizations. Postsecondary institutions are highly complex, often bureaucratic, organizations or loosely-coupled systems (Weick, 1976), meaning that 29 linkages within the organization are often loosely connected to each other. Larger research universities, in particular, are generally decentralized with high degrees of autonomy within academic units. However, decentralized structures do not necessarily mean lack of bureaucracy. Mintzberg (1979) outlined characteristics of a professional bureaucracy, which included a large, highly trained operating core with specialized skills and local control, and he indicated that administrative coordination across units is typically a major challenge. The idea of a professional bureaucracy also plays out in relation to internationalization, especially at research universities (Green, Luu, &Burris, 2008). The majority of research universities have one or more specialized offices to support different functions within internationalization, such as study abroad and international student services offices (Green, et al., 2008). The history of internationalization at research universities highlights how different functions within internationalization have developed separately and have left a legacy of competition and disconnect between various internationalization activities within the institution (Merkx, 2003). Graduate education exists at many universities across the U.S., but the primary location for graduate programs, including the largest number of professional schools, is the research university. Although graduate programs are certainly connected to the larger institution, they also reflect strong local organization (Gumport, 1993). Research universities are highly decentralized and also increasingly fragmented as one tendency is for sub-specialties in academic departments to become their own departments (Atkinson, 2007). Rhodes (2001) provided a good description of the problems that decentralization in large research universities can lead to, such as “intellectual isolation, disciplinary fragmentation, and multiplicity of aims (p. 22).” Faculty workload is also an important facet of research universities where faculty face increasing pressure to not only fulfill the traditional functions of teaching, research, and service 30 but also to bring in outside funding and to become involved in additional numbers of projects (Rhodes, 2001). Increasingly, this includes international research and other international activities, such as leading groups of students abroad (Green, Luu, & Burris, 2008). However, faculty may see international activities as just added pressure to an already large workload (Childress, 2010) and are also still not frequently promoted or rewarded based on their international work (Green, et al., 2008). Organizational Frameworks In spite of the fact that the individual postsecondary institution has a central role in determining the meaning and strategies involved in internationalization, there are surprisingly few studies that use a broad organizational framework as a way of studying internationalization. Although a number of scholars discuss organizational frames, for the sake of consistency I use Bolman & Deal’s (2003) terminology throughout the current study. Bolman and Deal (2003) defined an organizational frame as “a coherent set of ideas that enable you to see and understand more clearly what goes on day to day” (p. 41). Each frame provides a different way of seeing and interpreting the events and activities in the workplace. The four frames are structural, human resources, political, and symbolic (Bolman & Deal, 2003). Heyl (2007) described Bolman and Deal’s frameworks as being “of particular value in understanding large and complex organizations – as many universities and other institutions of higher education tend to be” (p. 5). A structural approach to organizations focuses on beliefs of rationality and efficiency, attention to minimizing problems, achieving clearly outlined goals, and well defined roles and relationships (Bolman & Deal, 2003). The human resource frame highlights “how characteristics of organizations and people shape what they do for one another” (Bolman & Deal, 2003, p. 111). 31 When problems arise, it usually indicates a poor match in the fit of people to the organization. Organizations are there to meet people’s needs (Bolman & Deal, 2003). The political frame emphasizes scarcity of resources and divergent interests within organizations, which result in conflict (Bolman & Deal, 2003). People in organizations gain power over these scarce resources through negotiation and building coalitions. The final frame is symbolic, which “seeks to interpret and illuminate basic issues of meaning and belief that make symbols so powerful” (Bolman & Deal, 2003, p. 242). Symbols include rituals, stories, heroes, myths, and artifacts that are part of an organization’s culture. Shared beliefs and values of members of the organization are important. Members of the organization interpret events in different ways, and it is those meanings of events that are more important than the events themselves (Bolman & Deal, 2003). One way of illustrating the differences between frames is to examine an organizational process such as decision making through each lens (Bolman & Deal, 2003). In a structural frame, decision making is a rational process with the goal of reaching the correct decision, while the goal in a human resource frame is commitment. Decision making within the political frame is about gaining or using power. From a symbolic view decision making may have the goal of confirming beliefs and values or being part of a ritual of how things work in a particular organization. Each frame has value for interpreting what is happening within the strategies and work of internationalization. Heyl (2007) introduced the idea of understanding the role of senior international officers (SIOs) as change agents by viewing their work through the four organizational frames. SIOs are administrators with primary leadership responsibility over an institution’s internationalization efforts. Heyl advocated for SIOs to understand different 32 organizational frames in order to best identify paths for change that are appropriate within a particular institution. Studies of organizational factors in internationalization. Although there are many external influences on internationalization processes at universities and colleges that are important to understand, the core work of internationalization happens within individual institutions (Knight, 2004; Merkx, 2003). In their article The Internationalization of Higher Education: Motives and Realties (2007), authors Altbach and Knight made the statement, “Globalization may be unalterable, but internationalization involves many choices” (p. 291). Thus, institutional studies that examine organizational processes and factors are important in understanding how and why certain choices are made surrounding internationalization. Research that considers an organizational picture of how internationalization happens at the institutional level or within academic programs in postsecondary institutions, particularly within graduate programs, is still greatly limited. Additionally, while a few studies emphasize the important role of faculty in internationalization (Childress, 2010), much of the available research on internationalization in postsecondary education neglects an understanding of the crucial role of key administrators, such as department chairs, in the incorporation of international activities into academic work (Amey, 2010). A few recent empirical studies addressed organizational factors and processes that impacted development and implementation of internationalization within institutions. Such studies included strategic decision making (Croom, 2010), organizational strategies to engage faculty in the work of internationalization (Childress, 2010), and organizational culture’s impact on universities’ response to internationalization (Burnett & Huisman, 2010). Croom (2010) conducted a case study of a public land-grant institution in order to understand strategic decision 33 making processes related to internationalization. Croom found that decision making processes for developing a branch campus happened in a different way than for other internationalization activities. While many of the internationalization strategies at the institution followed a bottomup, consensus building approach, the decision to add a branch campus in Dubai came from a topdown approach, driven by the institution’s president and outside stakeholders (Croom, 2010). Croom’s study is important in highlighting the fact that organizational approaches and motivations differ around various forms of internationalization. Another recent study of faculty engagement in internationalization showed that although individual faculty motivations are important, organizational strategies are also critical in engaging faculty in international work (Childress, 2010). Childress’ study at two universities, University of Richmond and Duke University, resulted in a model of five organizational strategies the institutions used to engage faculty in campus internationalization activities, which included intentionality, investments, infrastructure, institutional networks, and individual support (Childress, 2010). Her study made a significant contribution in understanding the institution’s role in operationalizing internationalization strategies as part of the work of the organization. Burnett and Huisman (2010) used a multisite case study approach to examine how four Canadian universities’ cultures influenced their responses to globalization. Burnett and Huisman used McNay’s (1995) four categories of culture in higher education institutions: enterprising, corporate, collegiate, and bureaucratic. Each showed different levels of looseness or tightness in policy and operational control. Burnett and Huisman (2010) found that all of the universities had collegial cultures, meaning that they had decentralized structures, loose policy and operational controls, and an emphasis on individual freedom. Two of the institutions also had enterprising cultures, which emphasize external opportunities and relationships with stakeholders and have 34 tight policy controls but loose operational controls. Burnett and Huisman analyzed the impact of organizational culture on the strategy of international student recruitment and retention. They found that the institution with the most enterprising culture had the strongest institutional support for internationalization at all levels and the greatest variety of strategies in place. Conceptual Framework: An Integrated View The role of the institution is central not only in the historical development of internationalization in U.S. postsecondary institutions, but also in the way international activities and strategies are carried out in the work that institutions do. In spite of the importance of organizational factors to the development and implementation of international efforts at U.S. institutions, few research studies have used an organizational lens. I believe there is need to conduct more research from an organizational perspective and that an integrated organizational framework, as put forward by Bolman and Deal (2003), was an appropriate lens to use in my study. Their framework provided me with multiple organizational perspectives simultaneously to understand how and why graduate professional programs created international experiences. Reading about motivations and rationales of internationalization, I noticed a striking parallel between the four traditional rationales for internationalization: academic, economic, political, and socio-cultural (DeWit, 2002) and the four organizational frameworks (Bolman & Deal, 2003). At times it is easy to identify what process is at work, whether it is a rational decision in a university context or a clearly identified economic motive within the rationales to internationalize. Much of the time, however, there are multiple rationales and motivations occurring at the same time based on perspectives of members of the organization, which impact universities’ decisions to develop and implement internationalization strategies. By the same token, organizational processes are not always easily separated into neat categories. Multiple 35 organizational frames are needed to understand what is going on in an organization (Bolman & Deal; Heyl, 2007). The available literature on graduate education hints at the idea that numerous motivations and organizational factors are at work in developing and implementing international experiences for graduate students. Therefore, a research lens that provided multiple ways of understanding and analyzing those factors was critical in exploring this topic. I now move to a discussion of my conceptual framework, an integrated organizational approach. The history of internationalization at U.S. colleges and universities shows that institutional factors impact the meaning of internationalization, which international activities are viewed as most important, and how those international activities are structured and carried out within the organization (Knight, 2004; Merkx, 2003). In essence, there are multiple organizational realities or multiple ways of interpreting organizational factors related to internationalization from one institution to the next, as well as from one member of an organization to the next. Individuals may understand events that happen within their organization in different ways (Bolman & Deal, 2003). For example, one individual may see implementing international experiences as a result of a rational decision making process, while another may see this as a more symbolic act. To illustrate this point I provide a brief, hypothetical example of the decision of a law program to implement a new international experience as part of a graduate law course. From a structural perspective, the decision to implement a new international experience in the course might simply be that the course is on common law and it makes sense for students to spend two weeks studying the topic in the UK where common law is practiced. A human resources view is that spending two weeks in the UK as part of the law course provides personal and professional development for graduate students and faculty leaders. A political frame might 36 best explain what is happening if the university is prioritizing international activities by providing funding to departments that add international components to some of their courses. Finally, from a symbolic viewpoint the course might confirm the long-standing value that the law program faculty place on international work. Perhaps multiple perspectives are at work at the same time, and members of the law program may also see this new international experience through different lenses. As Bolman and Deal noted, “Organizational life is full of events that can be interpreted in a number of ways. Multiple realties produce confusion and conflict as individuals view the same event through their own lenses” (p. 305). Additionally, certain frames may be more prominent than others during different situations and events (Bolman & Deal, 2003). For example, Bolman and Deal suggested that the human resource and symbolic lenses may be prominent “whenever issues of individual commitment, energy, and skill are key to effective implementation” (p. 309). Clear goals for organizational activities may imply a structural or human resource approach, while higher levels of ambiguity may indicate that the symbolic and political frames are especially present (Bolman & Deal). Greater complexity in organizational events also emphasizes the symbolic lens, which highlights “symbols as a way of finding meaning and “truth” (p. 311) in highly complex situations. I theorized that all four organizational frames – structural, political, human resource, and symbolic – were important in understanding how those involved in a graduate academic program developed and implemented short-term international experiences for students. Using an integrated organizational framework allowed me to understand that members of an organization interpreted the same processes and events in multiple ways. Additionally, Bolman and Deal (2003) titled their chapter on integrated frames as “Integrating Frames for Effective Practice” (p. 37 303). Therefore, I anticipated that an integrated organizational approach to this study not only provided a useful conceptual lens but would also potentially have implications for practice in the higher education context. I felt that the recent, growing emphasis on adding international experiences in graduate professional programs presented an excellent opportunity to use an integrated organizational framework to understand the development of graduate student international experiences at a research university. I now move to a discussion of the research methods I used in the current study. 38 Chapter 3: Methods In this section, I outline the approach and research design used in this study. First I discuss my choice of using a qualitative approach and the research design of a multi-site case study. I then review site selection and sampling, data collection, and the methods I used for analysis of the data. I also consider my own role as the researcher. Finally, I provide a description of the institution where I conducted the research for the current study. Research Design I used a qualitative approach with a multi-site case study design, as I felt this was an appropriate approach to address the research questions, which were the following:  What are the organizational factors involved in the development and implementation of international experiences for students within graduate programs?  If the organizational factors vary, how do they vary?  If the organizational factors vary, why do they vary? Qualitative approach. My goals in the current study were not only to identify organizational factors involved in internationalizing student experiences in graduate professional education but also to understand how and why those factors varied. Therefore, a qualitative research approach was appropriate for this study (Glesne, 2006). Qualitative methods are valuable when variables are likely to be “complex, interwoven, and difficult to measure” (Glesne, 2006, p. 5). Additionally, my goal was to understand the perspectives and meanings that participants in the study ascribed to internationalizing the graduate student experience, which also indicated that a qualitative approach was suitable. Case study. I used a multi-site case study as my research design. Merriam (2009) described a case study as “an in-depth description and analysis of a bounded system” (p. 40). 39 Patton (2002) described the purpose of case study analysis as gathering “comprehensive, systematic, in-depth information about each case of interest.” In the current study there are three bounded systems, or cases of interest, which are three academic programs within a single, doctoral level university. The history of internationalization in the U.S. shows that institutional factors are important in shaping what internationalization looks like within a particular university or college. Therefore, situating the study within one institution allowed for understanding the institutional context and how it shaped international experiences for graduate students. I chose multiple academic programs within one institution as case-study sites so that I had variation in academic areas and types of international experiences. Discipline is an important influence on graduate education in general, and literature indicates that the types of international experiences have similarities and differences in various academic areas. Additionally, my case study design has both a particularistic and heuristic focus (Merriam, 2009) meaning that I was interested in a particular phenomenon, the organizational factors involved in internationalizing the graduate student experience. Site Selection and Sampling For this multi-site case study, I selected three graduate professional programs within a single doctoral level, research university. To select the research site, I employed purposeful sampling, meaning that I intentionally selected a university with multiple graduate professional programs involved in developing and implementing a variety of international experiences for students. Within the many types of purposeful sampling, I describe my approach as intensity sampling, which seeks cases that are information rich and exhibit the phenomenon of interest in strong ways (Patton, 2002). 40 I utilized a number of criteria to select the institutional site and individual programs for the case study. First, I used an expert nomination process to select a doctoral level, research university (Glesne, 2006). I believed a research university was the best option for my study, as literature indicated that research universities typically have the largest number of professional programs (Redd, 2008). My process for contacting experts was to include knowledgeable leaders in international and graduate education from universities, including senior international officers and study abroad directors, as well as senior representatives from professional associations in international education and graduate education, including NAFSA: Association of International Education (NAFSA), the Association of International Education (AIEA), and the Council of Graduate Schools (CGS). At the time of the current study, there was no directory, ranking system, or other listing related to graduate programs with international experiences. The purpose of contacting a number of experts in selecting my research site was to see if there was consensus among multiple experts about research universities that had a variety of graduate professional programs involved in international experiences for students. I conducted telephone interviews with thirteen experts in the fields of international and graduate education. Additionally, I asked experts in the disciplines of business and law, with whom I conducted pilot interviews, to recommend other strong examples of institutions offering these academic fields. I asked these experts to recommend other experts with whom I should speak and useful resources, including literature, reports, and websites that I then reviewed. Additionally, I made adjustments to my interview protocol after the pilot interviews. Following conversations with the thirteen experts, I reviewed websites of the recommended universities. Two universities, one private and one public university system, received the most nominations. I eliminated the private university, as some experts suggested it 41 was a unique case that might not be representative of the majority of research universities. I found that university and graduate program websites did not always provide detailed information on international experiences for graduate students. Therefore, I arranged telephone conversations with the study abroad directors at two of the campuses in the top recommended public university system. I selected the campus with the larger number of professional schools, which included several health professions, a JD program in law, and an MBA. My next step was to select three or four graduate programs that had already developed and implemented international experiences or were in the process of considering development and implementation of a variety of international experiences. I intended to select MBA and law programs, as literature indicated these fields had a long history of providing international experiences for graduate students, as well as several different types of international experiences (Alon & McAllaster, 2009; Hulstrand, 2007; Redd, 2008; Tobenkin, 2009). I had telephone conversations with a faculty member in the MBA program at my site, but eliminated that program from the study based on the faculty member’s comments. I then selected law and two other graduate professional programs, dentistry and medicine, based on recommendations from the study abroad director at that campus. Additionally, a number of the 13 experts I interviewed for site selection felt it was important to include a health profession in the study, as programs in health professions were becoming more involved in internationalization efforts. In order to select an initial group of participants, I contacted the study abroad director, who recommended faculty and administrators to interview in each of the three graduate programs. I contacted those individuals for interviews and then used snowball sampling (Merriam 2009), asking each of them who else I should meet. Additionally, I interviewed the dean or assistant dean in each of the three professional schools, based on who was available. I 42 interviewed staff and former staff in study abroad and the international programs office, as well as the former provost, former assistant provost, and service learning director, based on recommendations from staff in international programs. I interviewed a total of 30 participants: 3 faculty and an assistant dean in dentistry; 3 faculty, an administrative assistant, and an assistant dean in law; 7 faculty, 3 administrators, and the dean in medicine; 7 staff in the international programs office, including 2 in study abroad and the former senior international officer; 2 former academic staff members from academic affairs; and the service learning director. I gave each participant a pseudonym to provide anonymity; a full list of participants with pseudonyms, work roles, and description of international involvement is located in the Appendix A. I obtained signed permission from each participant prior to the start of the interview. The consent forms included an explanation of my project and my contact information. A sample consent form and participant invitation email are included in the appendices. Additionally, I did not name the countries where international experiences took place. For masking purposes, I identified regions only. Data Collection My main method of data collection was in-person interviews, a primary data collection method used in qualitative research (Merriam, 2009). I conducted a few interviews on Skype and by phone, as some participants were only available that way, and completed a few follow up telephone interviews with some of the individuals. Additionally, I analyzed institutional and program websites, as well as discipline-based professional association and accrediting body websites, as literature indicated that such associations may impact the decisions of graduate programs to internationalize (Leggett, 2008; Tobenkin, 2009). I searched university and academic school websites and asked participants to provide me with documents not available on 43 websites that gave insight into the development and implementation of international experiences. Such documents included strategic plans, internationalization plans, promotional or other descriptive materials for any international experiences. I used document analysis to review them for themes related to my questions of interest. I used a semi-structured interview protocol with both targeted and open-ended questions. Examples of targeted questions included asking participants to describe the international experiences they offered or were considering for graduate students in their programs. Openended questions included asking participants why they viewed international experiences for graduate students as important. Interviewees were asked how and why international experiences were developed and implemented and the benefits and challenges of each. I listened for prompts in participants’ responses that required clarification or follow-up. I attempted not to assume that I understood what a participant meant by a phrase or term and followed up by asking that individual to describe what she meant. The full interview protocol is located in the appendices. I tested my interview protocol through a pilot study, during which I interviewed three individuals at a local research university that offered a variety of international experiences for graduate students. I interviewed a law faculty, an MBA faculty, and a graduate school dean. Based on the pilot interviews, I adjusted my interview protocol in order to ensure that I obtained data that answered my research questions. Analytical Strategy My overall goal in this research was to illuminate the key organizational factors involved in developing and implementing international experiences for graduate professional students. My second goal was to conduct a comparative analysis of the similarities and differences of factors among graduate professional programs and types of international experiences. A third 44 objective was to provide a discussion of how and why the organizational factors varied, if they did. I also intended to discuss and analyze how and why international experiences became part of the work of graduate professional programs. Finally, my goal was to show how an integrated organizational framework helped illuminate the multiple ways of understanding what the organizational factors meant within the graduate professional programs. For the analytical process, I initially used open coding to read one transcript from each of the three academic programs. Open coding meant that I did not have any initial set of themes or categories going into the analysis and looked at the interview transcripts, as well as my field notes, to develop an initial set of categories within which the data appeared to fall. I made notes in the margins of the interview transcripts and underlined key points that seemed to reoccur and also related to my research questions. I invited 3 peer coders to read and code one of these interview transcripts, then compared my notes with each of the peer coders and created an initial group of themes based on comparison of my initial analysis with those of the three peer coders. From that point, I continued my analysis using thematic coding or category construction (Merriam, 2009). During this part of the analytic process, I made multiple passes through my interview data, field notes, and documents I collected with the goal of refining my list of themes to four or five that best captured the data and related to my research questions. After each reading of the interviews and my notes, I adjusted the groups of themes and gradually reduced them to the four that I felt best captured the data. I then built an excel table with the themes and excerpts or quotes from the data related to each category. In the findings section of this study, I discuss key themes that emerged in each academic program separately. In order to minimize my own bias as a researcher, I asked a peer reviewer to read my initial draft of the findings and also review my data table. This meant that I selected 45 someone who was able to critique my findings and identify alternative ways of seeing my data that I did not consider and that could lead me to different conclusions. Based on my peer reviewer’s feedback, I reviewed my interpretations of the data and made revisions to the findings. I also used triangulation across various sources to reinforce the validity of my findings (Glesne, 2006; Merriam, 2009), meaning that I looked for themes among interviews as well as compared interview data with websites and other documents that I reviewed. Following these revisions, I completed a comparative or cross-case analysis of factors across the three programs. Limitations A case study design provided a number of strengths for the current study. It allowed me to answer research questions that involved interactions of multiple, complex variables (Merriam, 2009). At the same time, there are limitations to case study design. A primary limitation is that I focused on three programs in a single institution, which makes it is difficult to generalize beyond my case. However, as Merriam comments, “It is the reader, not the researcher who determines what can apply to his or her context” (2009, p. 51). One limitation of this study is that I did not interview leaders in all organizational levels. In analyzing my data, I realized that faculty involvement with international experiences depended a great deal on the nature of the departments within which they worked. This was especially true in the health professions, where some faculty had primarily clinical work roles. Support from division and department leaders for faculty to engage in international experiences was often more difficult in departments involving primarily clinical work. I chose not to add interviews with department and division chairs due to time constraints and the amount of data I already collected. However, I indicate in the findings and discussion that the departments mattered to the outcomes of my study. 46 Another limitation arose from the difference in my intended selection of academic programs compared to those that actually became part of the study and resulting lack of diversity. At the outset of this research project, my goal was to have four graduate professional programs. I intended to include MBA and law, as I knew based on the literature and my professional work in the field of international education that these academic programs have offered international experiences for students for a long time. Therefore, I thought MBA and law would provide examples of a longer history of international work. I then planned to choose two other disciplines based on recommendations of the study abroad director or other administrators at the site I chose. As I went through the expert nomination process, a number of experts recommended including a health profession, as they felt the discussion of international experiences in health programs was timely. I therefore also sought a university site that would offer law, MBA, and a health profession, with a remaining academic program to be chosen based on what the institution offered. The goal was to offer strong diversity among professional programs. One of the challenges I encountered in carrying out this study was that experts I interviewed to nominate sites had extensive knowledge about internationalization at a variety of institutions but not always specifically within graduate professional programs at those institutions. I had to get to the level of interviewing people on individual campuses in order to learn this type of information, which meant I was limited by time in covering as many institutions as may have been helpful in order to choose the best site. My selected site offered all programs I sought. However, once the study was already underway, it became clear that the MBA program did not provide the right context for my study. Additionally, I ended up with two health professions, as both offered rich contexts for my research questions. I attempted to add 47 additional diversity to the study by interviewing several faculty in the master’s in social work program. However, I still needed several more participants in that program, and time limitations were pressing. Due to the large amount of data I already obtained from the programs in law, medicine, and dentistry, my dissertation committee chair and I chose to complete the study with the three programs only. I recognize that this limits the findings of this study due to the lack of diversity in academic fields. At the same time, I should note that through carrying out my research, I learned that health professions are certainly more diverse that I understood at the outset and had long histories of international work. Role of the Researcher In any research, it is important to acknowledge the role of the researcher, including her connection to the topic being studied. As a researcher, I come from a social constructivist perspective, which means that an individual’s understanding of the world is constructed through his or her interpretations of it (Glesne, 2006). Social constructivists believe that the researcher and the research participants share in constructing meanings of the world and are co-creators of a story. Therefore, I saw my own voice as an important part of this research project. I have been involved in international education for nearly 20 years, much of that time within my career in an international office, and more recently as a scholar and doctoral student. Additionally, I participated in two international study tours for graduate students as a doctoral student and conducted research for the past four years on graduate international study experiences. There was the potential for ethical issues involved in studying a topic so close to my own experience; however, as a researcher I believed the combination of my administrative, student and research experiences positively contributed to the understanding of international experiences within graduate professional education. I arrived at this dissertation topic through 48 critically questioning the literature and examining both the gaps and opportunities for further research within internationalization and organizational studies. Additionally, I endeavored to employ rigorous methods of data collection and analysis. Description of Research Site My research site was a doctoral level university that is part of a multi-campus university system. I use the pseudonym Lexmark University (LU) for the larger university system and Lexmark University Metro City (LUMC) for the specific campus where I conducted my research. LUMC is a public, urban research university with a number of professional schools that enrolls a large number of commuter and older students in both undergraduate and graduate programs. All degrees are awarded by LU not the campus of LUMC. Therefore, the academic schools are titled “LU School of Dentistry,” for example. LUMC developed institutional priorities in a number of areas during the past 20 years. These efforts included an emphasis on community involvement and service learning, as well as expanding international opportunities and outreach in a more strategic way. A number of campus administrators and faculty at LUMC mentioned the importance of connecting to growing immigrant communities in the area. The current senior international officer (SIO) at LUMC, who had the primary leadership role for campus internationalization, described the institution’s commitment to community engagement and meeting the needs of the older, urban student population and immigrant communities as “part of our driving mission.” The service learning director echoed this sentiment, explaining that, “There’s a very deep history around what’s our relationship to our community and communities.” LUMC has a large number of professional schools, three of which were part of this study: the LU School of Dentistry, the LU School of Law, and the LU School of Medicine. Medicine 49 was the largest of the professional schools and was often referred to by participants as the “800 pound gorilla.” One campus administrator stated, “As the School of Medicine goes, so goes the campus.” The three sites in this case study were the following academic programs: the Doctor of Dental Surgery (DDS), Juris Doctorate (JD), and the Doctor of Medicine (MD). Faculty in the schools of dentistry and medicine referred to students in the DDS and MD programs as undergraduates, although I refer to them as graduate professional students, meaning postbaccalaureate. All three of the academic programs offered international experiences for students for a number of years, in some cases more than twenty years. A former academic administrator noted that there was a connection between the professional schools and priorities of the LUMC campus: LUMC, as it was trying to create an identity, recognized that what really sets it apart – well, I shouldn’t say that – what really gives it its cohesion, its common core, its common values is community engagement. And that really grows out of professional schools because every professional school depends on the community as a basis for its education. You just can’t prepare teachers or doctors without being engaged with the actual community where those people are going to ultimately practice. So community involvement has been something that we were able to make as a unifying, cohering value that really sets us apart. Current and former campus administrators referred to the culture at LUMC as collaborative, nimble, progressive, and ready to try new things. They also talked about the strong focus on professional education at LUMC. A former administrator remarked, We (LUMC) were from the get go more interested in professional and pre-professional education and in community engagement than in highly theoretical work, not that research has been neglected. And another characteristic of LUMC, because of its particular history, is that it’s incredibly entrepreneurial and innovative, and it’s had the freedom to do that. And the institution as a whole has this very entrepreneurial, innovative spirit. 50 A senior administrator in international programs commented that the campus had an “interdisciplinary” focus, which might not be a common thing on a campus with a large number of professional schools that often view themselves as separate entities. I think despite those natural tendencies of the professional schools, at the same time the campus is much more interdisciplinary and collaborative in focus just in the way it was formed. We have groups of faculty that meet and talk to each other in ways that are not found in the other campuses. A current senior administrator added that this collaborative emphasis was “part and parcel” of the institution’s history. In addition to a focus on community engagement and service learning, LUMC undertook a number of efforts over the past several decades to internationalize, which included building international partnerships, a number of which developed first in the School of Medicine. LUMC also built a study abroad office, which was part of the broader international programs office. For some time, LUMC has sent a substantial number of graduate students abroad on experiences developed in the academic schools. As I learned from interviews with participants, LUMC was not new to working with international opportunities for their graduate professional students. In the following findings chapters, I provide a history of the development and implementation of international experiences for dentistry, law, and medical students. I also discuss the ongoing challenges of maintaining these experiences. Additionally, I identify the key factors that emerged from my data that answered my research questions. 51 Chapter 4: The Case of Dentistry The LU School of Dentistry located on the Metro City Campus has a long, established history and enrolls students in a variety of dental programs, including the DDS degree. The School of Dentistry’s primary mission focuses on teaching, research, and community service. The DDS program has a large number of students, of whom approximately 50% participated in an international experience abroad during their degree program at the time of the current study, normally during their third or fourth year. The international experiences for students began as service opportunities in several countries and developed over time into a formal service learning model. At the time of the current study, there were nearly a dozen trips offered each year mainly during summer in developing nations across the globe, including Latin America, the Caribbean, Africa, and Asia. Each trip was led by a faculty member from the School of Dentistry with established partners in each host country, including universities, community, and nonprofit organizations. All students who participated in these experiences were required to take a semester-long preparation course. At LUMC, a core group of three faculty members started the international experiences for students over ten years ago and continued to work together to develop not only the semester-long preparation course for students but also to assess outcomes of the international experiences. The three core faculty members involved included Dr. Evans, Dr. Garcia, and Dr. Johnson. Dr. Evans was a faculty member in Department B doing primarily teaching and clinical work, as well as supervising a clinic for students. Additionally, he was involved in a variety of community service efforts. Dr. Garcia, a faculty member in Department A, was involved in teaching and service as well as laboratory and clinical research. Dr. Johnson directed a newly 52 created office focused on community outreach. Assistant Dean James also provided perspective from the School of Dentistry dean’s office on the development of international experiences. A number of key factors brought the international experiences for students to the place where they were at the time of the current study, including faculty initiatives and work, various forms of institutional and school level support, building the curriculum, and connecting to a variety of institutional systems. Development from the Ground Up: Faculty Grassroots Initiatives and Work I think it’s fair to say that our program here would not have developed were it not for a few key individuals who had a personal interest in that country. There was not administration that came in and said, we need to develop this program in 12 countries. Nobody ever said that. Matter of fact, the individual faculty members had to campaign to be allowed to take students out of the country. We had to develop it from the ground up. We had to ask permission and fight to get the permission for this thing. And only after we started it, did the university see that it was a valuable tool and actually encouraged us to do it some more. But, it was not an administrative initiative at all. It was our own grassroots initiative that the administration now sees as valuable. Faculty Member, School of Dentistry The first key factor in the development and implementation of international experiences for LU DDS students is the involvement of faculty. Faculty members were instrumental in building the international experiences for students from the ground up. At the time of the current study, the international experiences involved nearly a dozen faculty leading experiences in a variety of developing countries. Associate Dean James commented that the initial spark that got the international experiences for students going was “the passion and the interest of individual faculty.” Each of the three core faculty members had international backgrounds or prior experience living abroad. Dr. Garcia is originally from Latin America and worked as a dentist there. Both Dr. Evans and Dr. Johnson spent several years or more living abroad in developing nations doing work that involved healthcare. They described their experiences abroad as critical in their own lives and 53 impacting their future goals and careers, as well as motivation for fostering international experiences for their dental students. Dr. Johnson described her time abroad working with a relief organization as pivotal. So that was absolutely pivotal in our lives. And it’s impacted my whole career in the doors that it’s opened for me. So you know, five years in a lifetime is not that much, but relative to the time, the impact that it’s had on our lives to me just affirms an incredible value for stepping outside of your comfort zone, stepping outside of your own culture, and being open to learning. Dr. Evans’ time living and working abroad with a community organization impacted not only his desire to involve students in international work but also shaped the goals of those experiences. For me, I spent 2 years out of the country in [a developing nation], and ever since I had that experience, it truly has changed my worldview. It changed my outlook on life. It changed my appreciation for life and for the values that we hold dear in the United States. It changed my outlook on service to community, and so it is important to me to be able to share that potential opportunity with other students. At the time Dr. Evans and Dr. Garcia were working towards getting the first two international experiences for students off the ground, Dr. Johnson began her career at LU. Also interested in having international opportunities for dental students, Dr. Johnson arranged to meet with the associate dean at that time. Dr. Evans learned about this meeting and arranged to be there as well so that he could find out, in Dr. Johnson’s words, “who this was who was going to come in and make this thing happen.” Dr. Johnson commented that she was initially concerned that having this additional faculty member in the meeting might mean “trouble” but soon discovered that Dr. Evans was actually a kindred spirit and that they were in fact “on the same side.” Although the three core faculty members each spent considerable time on the international experiences for students, this involvement was in addition to their regular faculty workloads, necessitating finding support for the work wherever they could, especially at the 54 beginning. Dr. Garcia described the early days of their efforts: “We started by…each faculty member their own dime, their own time, pretty much working with administrative assistants from each one of their departments, begging and pleading, and ‘Please, please, please, help me out here!’” Dr. Evans described the work of coordinating international experiences as a “volunteer” effort. "I mean, we're all essentially volunteers, and we volunteer to take students to individual countries." The faculty members also developed a service learning model that formed the framework of each of the international experiences in the School of Dentistry. Dr. Garcia and Dr. Evans became the directors of the international service learning work and collaborated to oversee the semester-long pre-trip preparation course for students. Although coordinating international experiences remained primarily extra work above and beyond their regular jobs, Dr. Garcia and Dr. Johnson explained that they were able to integrate involvement with the international experiences into their regular workloads to a certain degree. Dr. Garcia described the international experiences as a natural fit within the mission of her department. This fit of the department mission to her work gave her the opportunity to integrate international involvement into all areas of her work – teaching, research, and service. But I’m very lucky in the sense that I work for the [Department A of Dentistry], and all the international work we do is community oriented. So it’s a natural fit for me. I know there are other faculty members who are not as lucky as I have been. And I have a chairman that has always been supportive of these kinds of endeavors. Because it’s in the mission of our department. Because Dr. Garcia did research as part of her regular role and received grants to support her research, she was also able to include research as part of her involvement abroad, in addition to working with the international experiences for students. Additionally, she earned tenure in part based on her involvement in the international service learning experiences. 55 Dr. Johnson explained that her involvement in the international service learning experiences also helped her application for tenure at LU. She discussed how her involvement with international experiences gave her great personal satisfaction and that she was not discouraged from doing it. “It’s very rewarding as a faculty member. I just have had a very interesting job being allowed to do this and not being discouraged from doing it. I could clearly do my job without this component, but it’s something I wanted to do, and nobody’s ever discouraged me from doing it. And that has really contributed to my job satisfaction.” Dr. Evans had primarily a clinical role. Although considered one of the directors of international service learning experiences, it was more challenging to integrate this work into his regular roles than it was for his colleagues. “There’s a fair amount of time that I spend, but they have not reduced my other expectations, you know, so I’m still supposed to run my day job plus do this.” He has, however, received recognition for his involvement in the international service learning experiences from LU and the School of Dentistry, which he described primarily as a pat on the back. The benefit to the faculty is largely individual to satisfy our own desires for service and teaching and influencing dental students in this regard. There is a small added benefit of being recognized by the university, and we do get, I think many of the people who have been involved in this program have gotten some sort of citation in terms of getting an award for service learning or getting an award for service. I’ve received a faculty member of the year award and teacher of the year award. I got meritorious service from the American Dental Association, so we get recognized. It doesn’t give us any money typically, but it’s recognition. In addition to receiving varying degrees of recognition for their work, all three of the core faculty members described the growth of the international service learning experiences as an opportunity for professional development. Over the years, they pursued numerous opportunities inside and outside the university to educate themselves in ways that might impact the ongoing development of these experiences for students. For example, as service learning became a 56 greater priority at LUMC, the faculty took courses on service learning offered on campus that helped them move the international experiences into a service learning model. Dr. Garcia shared, “So we developed ourselves. Got more familiar with anything that had to do with international and/or service learning.” Dr. Garcia and Dr. Evans also invested time attending workshops in another state. Dr. Garcia described the rationale for doing this: This is my second hat, so I can use all the help I can get actually. This is not what I do full-time. That’s why [Dr. Evans] and I realized we needed to educate ourselves and to learn more. We’re always looking for opportunities to learn more, and I am by no means an expert. I’m a humble dentist. During an off-campus professional development opportunity, the two wrote the syllabus and learning objectives for the international service learning course. The faculty members took time to educate themselves and to invest in their own learning, in part because they realized they needed additional knowledge to support involvement with the international experiences. Over time this allowed them to not only develop their own knowledge but also to adjust and sometimes reduce their initial expectations about how quickly and in what ways the international experiences developed, for example in the expectations regarding what their international partners in the host countries might be able to do. Another piece of faculty work was initiating partnerships in the host countries where the international experiences took place. The majority of international experiences were initiated by individual faculty members in the School of Dentistry via contacts they established through their own experiences in other countries. Host country partners included universities, community organizations, and other nonprofit organizations. The faculty in the School of Dentistry built academic partnerships wherever they could. Dr. Garcia explained that part of the reason for this was to build partnerships that developed beyond the initial interest of any individual faculty 57 member. She described an example of building a university partnership in a Latin American country: We felt we needed that academic connection, because the interest and the personality of the faculty member who runs the program always permeate. And so we were researchers who wanted that academic connection. And literally we looked on the yellow pages, and said, “Let’s get an appointment.” And we knocked on the doors, “Hello, you want to play with us?” All three faculty emphasized that an important goal was to build partnerships that were sustained over time and to work with the same partners year after year. The Role of Support: Is it Really all about Time and Money? The balancing act is not letting it become such a main focus of what you’re doing that you’re not able to do all the other multifaceted jobs of academic or working in an academic institution that you’ve got to do. ...It’s fun work, but it’s a lot of work. Associate Dean, School of Dentistry I think when we resolved the fact that it’s not going to cost the school anything and that we would do it on our own time basically, that that resolved it. Faculty Member, School of Dentistry The second major factor involved in the development and implementation of international experiences for students in the School of Dentistry is various levels of support, though not necessarily primarily time or money. Although there were numerous challenges along the way, there was also support, even if it meant simply “not being discouraged” from moving forward with international experiences. In order to get the first international experiences off the ground, the Dean of the School of Dentistry at the time loaned the faculty $30,000, which Dr. Johnson described as “a bit of a leap of faith on his part, to give us that kind of support.” Other than that initial investment, however, there was not much financial support on the part of the School of Dentistry, and the faculty also did not ask for that. 58 Well, he (the Dean) does not provide financial support, but we haven’t asked him for that. I have kind of, one of my strategies is not to ask for money because it’s a….I have never been told I can’t do anything at the dental school, and it’s partly because I don’t ask for money to fund it. I go out and find the money...it’s just a way to avoid being told you can’t do something. (Faculty member) Each of the three core faculty had varying levels of financial support within their own departments and divisions. At the time of the current study Dr. Evans continued to personally fund his own participation in the international experiences while Dr. Garcia and Dr. Johnson were able to cover their travel costs through departmental support. The dental faculty got release time to lead international experiences, although it did not start out that way. “But then after doing this for a couple of years, we talked to the dean and said, ‘Don’t you think we ought to be able to do this on company time?’ And he agreed, you know, that it’s clearly an educational effort. So at least we are given release time.” Associate Dean James admitted there were still concerns about the time away that faculty spent conducting international experiences: But then there’s some more mundane things to think about, like if we have a faculty member that wants to take a week off...to do a service learning trip. Well, what were their job duties and responsibilities back here on campus that they’re not going to be able to do because they’re off doing this trip? We are a healthcare facility. We count on our clinical income to maintain ourselves operationally on an annual basis, and if you have a few key or strategic faculty members gone 2 or 3 weeks out of the year – even for that matter, one week – it can affect your budget on an annual basis. So we worry about those types of things. As a clinical faculty member, Dr. Evans felt particularly challenged by taking time away, as someone else had to cover his responsibilities. The dental faculty also saw supporting student funding as part of their role. They supported students in fundraising efforts to help offset the cost of the international experiences. The faculty members did fundraising in a variety of ways, including taking speaking engagements and contacting alumni. 59 An additional challenge was finding staff support. For most of the history of the international experiences, faculty managed all travel arrangements and much of the other logistical work by themselves. As Dr. Johnson explained, they had to find help from department administrative staff wherever they could, which sometimes led to resentment and tensions among the staff. Eventually, that led to the dean’s office providing a half-time dedicated administrative assistant for international work. It really became a problem, because we had no systematic way of doing, for instance, the flight reservations. It had to be made through the university travel bureau. And so consequently, the secretaries or the administrative assistants in the department of whoever was leading that particular program did these connections, made these connections, and it was a mess. Everybody was angry. You know, the secretaries said, “It’s not my job. I don’t know how to do this. It’s not my job.” So now we finally have a dedicated person. Dr. Garcia explained that lobbying for staff support, though it took a long time, was one of the goals of supporting the international experiences. “It only took 10 years to get there (laughter), but we’re there.” In addition to this new logistical support from a half-time staff member, the School of Dentistry received various types of support from each host country partner, including arranging in-country transportation and housing. In some cases partners helped arrange clinical activities and assisted with in-country licensing issues. The LU faculty also involved some partners in teaching the pre-trip semester course through video conferencing. The three core School of Dentistry faculty all emphasized that host country partners played a crucial role. Partners included universities, community organizations, and other nonprofit organizations. The LU faculty acknowledged that international experiences could be burdensome to host country partners, and one of the goals was ensuring that partners also benefited from the relationship with LU. Dr. Johnson explained, 60 So we do have a couple different formats. But the fact that it’s a partnership, and the people who are there and working there are - we’re there to support them, to work with them, to learn and not to impose our will and our practices. And that’s not always easy. Although host country partners were crucial in providing logistical support, faculty and administrators explained that the partners were far more than support for the international experiences. Dr. Garcia emphasized that part of their philosophy was establishing long-term partnerships and returning to the same sites on a regular basis, underscoring that the LU School of Dentistry international experiences were not “hit and run,” nor were they “medical tourism.” Associate Dean James echoed this same sentiment, “We’re not over there as missionaries to save them from disaster. We’re there to partner to help where we can and to learn and benefit from them as they can do for us.” The core faculty also felt that they received support from LU’s Study Abroad Office. Faculty explained that LU central administration added procedures in recent years related to international experiences for students, which meant more steps in approving and maintaining the experiences. However, the three dental faculty felt they received helpful support from the LUMC Study Abroad Office, which included reviewing and approving online student applications, verifying travel safety, making sure health insurance was covered, and providing professional development for faculty. Dr. Johnson explained that in addition to helping with the application process, the Study Abroad office also offered “a lot of kind of continuing education in a way, a lot of support. They’re very helpful.” The School of Dentistry recently helped the Study Abroad Office pilot a new online study abroad application system. Faculty participants in the current study explained there was also criticism concerning the international experiences within the School of Dentistry. One criticism from some of the faculty, as well as the administration, was that the goals of the international experiences could be met by 61 doing service learning opportunities in the local community, where there were still challenges with access to healthcare for some populations. Dr. Johnson explained that this was an understandable criticism and that dental students could learn about different cultures right in Metro City. However, she also described the value of gaining cultural experience outside of the U.S. We have a lot of things going here also that we value highly. But we don’t want to be provincial. We would really like for students to have a broader understanding of people from other cultures. And that is one of the primary reasons for this program – and not just try to understand them by meeting them in Metro City, but to see where they come from. There was also some concern raised that the experiences abroad might take resources away from needs in the immediate geographical area. Dr. Evans did not “dispute” that, but explained that he actually spent more time on service initiatives to the underserved in the local community. So I think the best way that I can come up with to counter any criticism that we’re taking resources away from the U.S. is to say that, well, I donate as much time in the U.S. as I do overseas, and frankly, it’s all my time and money anyway. It should not be a big issue. So I think that those are ways that we can help to promote the program without being seen as a burden to the university. The three core faculty said that for the most part they were not “discouraged” from doing international experiences and that faculty colleagues and the administration of the School of Dentistry were generally supportive of this work. Dr. Evans shared that “most people almost entirely are supportive in concept even if they don’t physically give any money or give any time to it. They believe it’s valuable.” The three core dental faculty also worked closely with other faculty in the School of Dentistry to develop international experiences. A number of years ago, the three faculty members created a faculty committee where the international experiences could be addressed. Dr. Garcia explained that the committee not only helped create standard operating procedures for 62 the international experiences but also provided other support. “So we started putting things in writing and, quite honestly, just having a faculty community where you can vent a lot of times, it gives you the support you need.” Connecting International Experiences to the Curriculum Another key step in the development of international experiences was the faculty members early connection of these experiences to the DDS curriculum. The core group of faculty sought early on to build an academic experience through offering an elective course that students were able to count to meet degree requirements. This included developing a semester long preparation course that all student participants in the international experiences were required to take. Over time the faculty continued to formally connect the international experiences to the curriculum: And we started by doing it the easiest, the simplest way and the one way we had accessible at the time, which was creating electives. And now we moved into creating a, we created a new class that’s going to have different sections. Some of them aren’t going to be electives, some of them are going to be mandatory. So we’ve evolved again throughout the years. From the onset, the three core faculty members developed academic goals for students involved in the international experiences. Part of the main component of DDS curriculum at LU was developing student competencies, including cultural competency. Dr. Evans explained the goal of gaining cultural competence through international experience: Over the past years, as we have developed this intramural course, our goals have changed to more in line with what I told you recently about the desire for cultural competence and the desire to change their outlook on life toward serving the underserved, especially in the Hispanic culture in the U.S. The net goal is that the students will be more willing to see patients from different cultural backgrounds when they get into private practice, and that they will be able to have a heart for serving the underserved when they get into a private practice. 63 Cultural competence was built not only through students’ participation in experiences abroad but also through the semester-long pre-trip preparation course. The overall goal of increased cultural competence was then, according to Dr. Garcia, to “bring those lessons home to treat the various patient pools. So that has been the driver in the dental school.” Another component of the curriculum involving the international experiences was to develop a formal service learning model. This, in part, was due to the university’s focus on service learning and how the core faculty connected to that approach. Additionally, the faculty worked to align the service learning approach to the international experiences to the guidelines and requirements of the various dental accrediting and professional agencies. Dr. Garcia explained that “we have from day one tried to link our service and learning outcomes to ADA, which is American Dental Association’s, established competence parameters, CODA, which is the Commission of Dental Accreditation standards, and [LU] competencies – so our School of Dentistry’s competencies.” Using a formal service learning model allowed the international experiences to develop consistently. Dr. Johnson explained that developing a uniform approach was challenging. “So we do kind of struggle a little bit with faculty who want to call their program service learning when it isn’t. So adopting the framework really helped us to be able to say, ‘this is what it needs to have.’” Connecting international experiences to the curriculum also involved engaging the broader faculty. The three core faculty discussed how the faculty committee they created provided a vehicle to not only build support for the international experiences but also to discuss pedagogical issues and opportunities for faculty development. Dr. Garcia explained some of the future goals: What we have right now is a committee. Well we do support, but we do logistical things. We’re gonna create purely a faculty committee where we’re gonna do pedagogical 64 support for faculty… We’re applying for a grant, and hopefully, knock wood, we’ll get it – again. And we’ll be able to bring external speakers, and we’ll able to have some readings and develop, probably meet a couple times a month or once a month and have some [guided] readings. And we’ll probably develop a syllabi together. Yeah. So that’s our next, just keep growing, try to improve the teaching of international experiences. Finally, another piece of incorporating international experiences into the curriculum was tackling the administrative aspects of offering a formal course. As dental curriculum is very “lock step,” the international experiences only fit during the elective components of students’ third and fourth years. Enabling international experiences to fit in a narrow window involved lining up all the administrative pieces, such as the school calendar, in order not to conflict with exam schedules and other key events. Dr. Garcia explained that “we have been lucky to be able to create a system that allows them [the students] to do this without disrupting their classes.” Connecting to Existing Systems: Being Part of the Three-Ring Circus In creating a system that allowed for the international service learning courses to be a formal part of the broader curriculum, the faculty found it necessary to connect to multiple academic school and institutional level systems. Dr. Garcia described this as “always utilizing the university mechanism.” These connections represent a fourth crucial factor in the development and implementation of international experiences for students in the LU School of Dentistry. From the view of the three core dental faculty, part of connecting to the broader systems was ensuring that the international experiences went through the normal administrative channels in the School of Dentistry, particularly the Academic Affairs Office. Dr. Garcia emphasized that every time the faculty added a new date for an international experience, they had a conversation with the Academic Affairs Office staff to make sure the date was on the calendar early and that 65 the experiences were in the course schedule. To Dr. Garcia, such administrative connections helped ensure that “you are part of the circus.” One key piece to be able to do both things, to be able to be part of the three-ring circus and part of the calendar, and to be able to utilize the university mechanisms for funding and scholarship, is to create these international experiences as an academic experience. So create a class, a course number that goes with it, so you’re in the schedule, you’re in the transcript. And that that gives you the chance to be – it makes it easier for administrators to say, “Okay, we’re going to plug in this class at this time.” Not making it a separate experience. Dr. Johnson also noted that especially at the beginning of developing international experiences she knew that there would be barriers and that establishing connections to administrative structures and systems within the School was important “to circumvent or get around barriers that would exist since there weren’t any such programs.” Connecting also meant working with university offices and systems outside of the School of Dentistry. For example, the Study Abroad Office was responsible for reviewing student applications, insurance coverage, and issues related to student and faculty safety. Although the dental faculty said that these administrative processes added to their work, they saw the Study Abroad Office as an important partner in their work. Dr. Garcia elaborated, We have learned to partner and utilize all the resources that are there (in the International Affairs Office). We became international affairs junkies. So we started partnering with them. So we do that with them, and then had a faculty member become a member of their Committee on Study Abroad. So we had a seat at the table. In addition to connecting the international experiences in dentistry to institutional partners, the three dental faculty described an important connection to institutional values and priorities. Over the years, LUMC developed a focus on and reputation around service learning and placed increasing importance on international work and activities. One of the faculty members explained that “international service and experiential learning” were “highly valued” 66 by the university. The faculty went on to say that this was a major reason why the School of Dentistry built its international experiences for DDS students on a service learning model. As soon as it (service learning) became valuable to LUMC, then LU Dental let us start. I had asked to take students for 20 years and was not allowed…It had to be an accepted practice on a larger scale before we could do it…As soon as you get known for something where you’re good at it and you’re ranked because of it, then everybody else thinks it’s okay. And you can jump on the bandwagon. But until then it was just seen as a distraction from what we’re currently doing- unnecessary. Yeah, risk. Nobody wanted to support it until the university supported it. Although the three faculty connected the international experiences to broader institutional priorities, making the connection to the mission of the School of Dentistry was a bit less certain. Dr. Johnson and Dr. Garcia described the natural fit of international experiences to their work and their department’s focus on community outreach; however, the administrative view of the international experiences was still mixed. Associate Dean James explained the clear benefits related to the development of international experiences for students: Well, from I guess an associate dean’s perspective, I try and look at it from the advantage of how do we as a school take advantage of it in advancing our mission, and our mission states not only trying to educate students but enhancing education within the state and around the world, in addition to providing services and healthcare for folks locally but also internationally. So it blends in perfectly well with that. Associate Dean James said that the School of Dentistry was proud of the international work of the faculty and publicized their international involvement. He personally had extremely meaningful connections through interaction with international colleagues. However, although there were benefits, the Associate Dean had concerns about the international work as well. One of the things that internationalization does is take away resources from other activities – time, focus, energy. If you’ve got a strategic plan that you’re trying to operationalize and you allow yourself to get too distracted by doing certain types of activities that don’t really blend in well with your strategic plan that can be problematic. Now, we do have international activities as at least a small part of our strategic plan, and certainly it’s a part of our mission statement…So what we’ve tried to operationalize or strategize on is how can we make sure this is a win-win for everybody... And as always, 67 it (participation in the global community) can be very exciting and fun, but in some ways it can be a drain and a distraction. The Associate Dean and the three faculty all agreed that the School “leveraged” the international experiences for students to promote the School of Dentistry. Dr. Johnson explained, “Oh, everybody loves it when it’s over (laughs)! It’s great PR for the school. The students just come back energized and excited about it, and the school’s really proud of having done it.” She also described that the international experiences appealed to alumni, which “resonated” with the dental school since “happy alumni” were important. The School of Dentistry’s work with international experiences also had an impact at the larger LU system level. Dr. Evans explained how these experiences in dentistry brought more visibility to the Metro Campus within the LU system: Yeah, we are an LU school, so when we get a dental degree, it’s from LU university, but politically, we are affiliated with LUMC, and so anything we do at LU Dental reflects hopefully positively for LUMC in terms of making this campus be recognizable as an important institution. The faculty members felt that over the years the international experiences really “caught fire” in unexpected ways. Dr. Garcia agreed that faculty working with international experiences were initially “kind of flying under the radar. It wasn’t such a big deal. Then six or seven years ago, we exploded.” She elaborated that faculty initially had no idea that the international experiences would result in “spin-offs of our work,” some of which included international research opportunities, receiving grants for some of the research, and fund raising efforts. “We’ve gotten, we do fundraising. We send letters to alumni, and they come back. So we didn’t know this was going to have a life of its own.” Another spin-off was additional involvement with some international partners, for example, establishing a bi-lateral exchange with a Latin American partner and receiving international residents from that partner. Dr. Garcia explained 68 that these spin-offs were not necessarily initial goals of having international experiences for students, but that “10 years will do that to you.” She also mentioned that although the goals of the international experiences for dental students had not necessarily changed over time, the faculty themselves became, “Older, and I hope, wiser (laughs). And so we are less ambitious in certain things and more ambitious for others.” The case of dentistry highlighted how a team of faculty members connected early in the development of international experiences for their students and continued to work together over a number of years. During this time the faculty worked to formalize the experiences and connect them more fully to the systems and structures in the dental school and within the university. Next I move to a review of the findings in the LU School of Law on the Metro City campus. 69 Chapter 5: The Case of Law The well-established Lexmark University School of Law on the Metro City campus enrolls a large number of students in Juris Doctor (JD), Master of Laws (LLM), and Doctor of Judicial Science (SJD) degree programs. Many of the students are commuters and a substantial number are enrolled in the part-time JD program. LU’s location in a metropolitan area provides a variety of opportunities for internships and connections to law firms. Additionally, the LU School of Law has a strong international focus as part of its mission and is involved with numerous international efforts including study abroad experiences, international internships, international and comparative law centers on campus, and student associations focused around international themes. The Law School also hosts a number of international students on campus and runs LLM programs abroad. The LU School of Law on the Metro City campus offered international experiences for its JD students for more than 20 years at the time of the current study. These experiences began with a summer program in partnership with a law school in an Asian country. The program was for credit and offered two and four week options. During the experience abroad, students attended lectures and participated in site visits that exposed them to Asian law. Recently, the director of the Asia summer program added an internship option following the academic portion of the course for those students who wanted the extra experience. For many years LU sent only its own JD students on this program. However, a few years ago, LU extended the program to several other universities and sent approximately 40 students in summer, half from LU and half from several partner universities. At the time of the current study, the Asia summer program was the only study abroad program offered by LU School of Law. Additionally, LU offered international law internships for JD students. I do not cover the internship experiences in this 70 study in depth because I was not able to interview the faculty member in charge of the international internships. In past years the LU School of Law offered a number of other study abroad programs for JD students, several in Western and Eastern Europe, as well as in Latin America. These study abroad programs were no longer offered at the time of the current study for reasons that impacted student enrollment, including the downturn in the economy, higher currency exchange rates, issues with partner institutions, competition among law schools offering study abroad programs, and changes in tuition pricing which increased the program costs for students. In spite of a reduced number of study abroad options offered to law students, the LU School of Law faculty and administration at LUMC maintained a strong commitment to providing international experiences for students, looking for other ways to do so. The development of international experiences in the School of Law connected to a variety of important factors, including faculty initiatives and work, rationale of including international experiences in the curriculum, the institutional environment, the external environment, an “ad hoc” approach to international work and activities, and a broad view of what it meant to offer international experiences for students. A Broad Portfolio: Faculty Initiatives and Work I kind of became one of the people the law school identified with a reasonable amount of international activity, so it just kind of grew out of nothing and then developed over time. I’m still not an internationalist full-time. Most of my research and most of my teaching focuses on domestic U.S. law. But like a lot of our faculty, I’ve developed a portfolio in international activities. Dr. Randolph, School of Law According to Dr. Randolph, Assistant Dean of Academic Programs at the LU School of Law, over 40% of the faculty in the School were involved in some type of international work. 71 Dr. Baker, responsible for directing the Asian summer study abroad program for students, talked about having an “international plate” that included multiple types of international work. In addition to summer program oversight, he directed an Asian law center at LU, was involved with the LLM, and coordinated visits for scholars and faculty from an LU partner university in Asia. In explaining the large percentage of LU law faculty with international work portfolios, Dr. Baker stated it was “partly a conscious decision [of the law school] to pursue that as a niche and partly luck that the people we hire tend to take on, by force of personality, some aspect of international law or experiences.” Dr. Baker described how he came to the point in his work where so much of his involvement in the law school included an international focus. His international journey began with a summer study abroad opportunity in Germany, which he described as a life-changing experience. When he began his career as a faculty member at another institution, Dr. Baker had the opportunity to teach in Eastern Europe, which then led to connections in other parts of Europe and more international work. Another faculty member, who began the LU Asian summer law program and was preparing to retire, suggested that Dr. Baker take on the role of directing the Asia program. Dr. Baker elaborated, “And then when I was awarded tenure, I was promoted to direct the Asia program too, and the rest of it has just built and built and built because of connections and opportunities.” Dr. Baker believed that faculty motivation to be involved in international work, and particularly with the international experiences for students, was “all personal driven” and “voluntary.” As far as faculty involvement, it’s strictly voluntary. There is no centralized management. We have a degree of - if somebody wants to start a new program, all it takes is that person’s energy and interest. We do have some degree of strategic decisionmaking about, if we were going to start a new summer program, where should it be? Not 72 just that somebody has an interest in doing Scotland, for example. We’ll be strategic about going to Scotland. And so there is no comp time on course teaching, no comp on committee work. The Asian summer law program got off the ground because of a particular LU faculty member’s interest and connections to a faculty member in Asia. Dr. Baker related the following story of the Asia summer law program’s beginnings: And how Professor Maxwell got the connections, how he got into Asia in the late 1980s, I don’t know. An apocryphal story, and if it’s not true, it’s still a great story, is that there was a young professor at Asia University named Dr. Lee, who Dr. Maxwell came to know. And fast forward 10 years, Dr. Lee is now a prestigious professor at Asia University, and we move our program from [City A to City B]. And fast forward another 10 years, and Dr. Lee is Dean. So it’s been a long relationship with him and many other people at Asia University. Dr. Baker elaborated that it was the “long, loyal ties” with Dr. Lee and Asia University that helped the LU School of Law make “an easy leap” to the word spreading about the LU School of Law spreading to other countries. The motivation of individual faculty as well as their energy and time continue to be crucial factors in supporting international experiences for the school’s JD students. Rationale: International Experiences as Part of Legal Education Faculty and the Assistant Dean in the law school spoke about their motivations for having law students gain international experience during their studies. One faculty commented that part of the goal and strategic plan of the School of Law was to provide a breadth of international experiences for law students, including study abroad courses, internships, and other experiences such as international moot courts. Faculty felt it was critical that students become familiar with different aspects of international law, even if they intended to work in the U.S. Dr. Baker explained that there was first of all a “doctrinal” level rationale for international experiences: 73 I tell the students that there is no county in this state rural enough that you can’t encounter international law. If you have a garage, and you make a widget, and you have a computer and you advertise it on the internet, and somebody from another country that’s a signatory to the CISG buys it, you’re subject to that law. And every law firm of any size has an international department nowadays. Because there’s so much investment of our investors in foreign countries and then foreign countries investing here. So it’s a, you would be at best a partially equipped lawyer graduating from law school these days and not having some knowledge of the law, internationally. A second part of the rationale explained by faculty was the following: The other level I guess that it serves is horizon broadening. Lots of people travel nowadays far more than 20 years ago or 30 years ago, but it’s still possible, especially for young people – the students – who’ve gone from high school to college to law school and been on tight budgets all the time, that they haven’t much travel experience. And so getting the chance to experience another culture is, as it was for me, life changing. You can’t, once you’ve broken bread with somebody in another country, you can’t think in the same stereotypes that you can without doing that. So that’s a major component. Dr. Baker also spoke about the career preparation and networking that international experiences provided, in part through an optional internship following the Asia summer program. He also mentioned the “unintentional learning” that happens: “Lots of stuff, if you have your eyes and ears open, you can pick up about the legal profession (in another country) and then reflect on our own legal profession.” According to the Assistant Dean, international exposure for law students was part of the school’s formal strategic plan and was one part of offering “a strong legal education.” He felt it would be “negligent” not to provide international experiences. The general focus of the strategic plan from the international side was to get our students more experience in the international environment. And it has several components. One is boosting the curriculum, the international law curriculum, here at the law school. So they can learn about different legal systems in the process of solving legal problems. And we’ve done a pretty good job of that through some hiring over the last several years, and through expansion of the teaching portfolios of some of the faculty we had here already. He, along with faculty, commented that international involvement and activities enhanced the reputation of the Law School: 74 From my perspective for the law school it enhances the law school’s reputation, it makes - our footprint then is global versus state-based or regionally-based or nationally-based. But that we would have alumni in other countries. And whatever enhancements may come from having that bigger reputation. Multiple Layers in the External Environment The LU School of Law discontinued some international experiences for students, often related to factors in the School of Law’s external environment. For example, faculty cited economic issues as the first crucial environmental factor that contributed to the School of Law’s decision to end some of the international experiences. At one time the LU School of Law had a variety of summer programs abroad for students, which they referred to as study abroad programs. In addition to the long standing program in Asia, the law school offered summer study abroad programs in Western Europe, Eastern Europe, and Latin America. Although the program in Asia continued at the time of the current study, the number of students enrolling in it declined from the peak period five or six years ago. Assistant Dean Randolph discussed how economic issues led to the decline of some of the law school’s international offerings. “The primary program we have is the study abroad mechanism, so that they’re able to spend a summer doing classes in Asia at this point. We had other programs, which have basically died on the vine because of economic issues.” Dr. George, who was formerly involved with the School of Law’s summer study abroad opportunities in Europe, described the decline of LU’s programs as a “reverse trend” in the field of law. It’s a reduced involvement of our students in international programs. And these are mainly triggered by financial reasons. I think the students would be very keen to go, but they are much more concerned about the cost now than they used to be 5 or 10 years ago. We ran a total of 4 summer study abroad programs a while ago, sending over 100 of our students into these programs every year. And now we’re down to one. 75 The increasing financial debt loads of law students combined with the national economic downturn had a sharp impact on LU School of Law’s summer study abroad programs, which made 2008 and 2009 particularly bad years for student enrollment in the school’s international experiences. Although the Asia summer study abroad program was not cut, student participation decreased from the peak level prior to 2008. According to Dr. George, the reduction of study abroad programs was a nationwide issue among law schools and symbolic of a larger trend of declining growth in the field of law due in great part to the economy. He described several dimensions to the decline: The one [dimension] is the summer study abroad programs. They were hit first by the recession. So we would have a little over 200 ABA accredited law schools in this country now. I think about 120 programs were run abroad a while ago. That’s dropped down to about a little more than half nationwide. Uh huh. So schools have shut down programs and merged programs and so on. There’s a lot fewer U.S. JD students going abroad nowadays. Some programs have just reduced in size. Like ours used to be 5 weeks. Now we experimented with giving 2 week options back to back so somebody could do the whole 4 weeks but somebody who wanted to go but didn’t have the money or also needed to work or so could only go for 2 weeks. Dr. George then discussed the second dimension to the decline in law as a 26% reduction in students taking the LSAT in recent years, due in great part to increased difficulty gaining employment in the field of law. He described this trend not as a temporary market change in job prospects but rather as a “structural change in the market for lawyers.” Assistant Dean Randolph echoed these same sentiments about the changes in the job market for lawyers. There had been a big expansion during the boom years of the 80s, 90s, right, to respond to the market. Now that law firms themselves are as well experiencing competition from outside, the whole kit and caboodle is being rethought. It used to be, a student coming out of let’s say the top law schools, you had a choice regarding which law firms were you gonna go to – an embarrassment of choices. And now it’s much more difficult. These economic issues contributed to law schools’ challenges to run study abroad programs nationally and at LU. LU, therefore, needed to change the structure of the one 76 remaining summer study abroad experience in Asia. Dr. Baker, the director of the Asia summer law program, addressed the changes, which included offering a two-week option for students who worked full-time or could not afford to stay longer and inviting a number of other law schools to participate in this program. In peak enrollment years, LU sent over 30 of its own students on the Asian law summer program. In contrast, in the summer of 2012 approximately half of the nearly 40 law students who participated in the program came from several partner universities. Dr. Baker acknowledged that both the economy and the particular student population at the LU School of Law combined to make it difficult to sustain enrollment without involving other U.S. law schools. We have a lot of students here who are mid-career, mid-management, who have jobs, and they weren’t going to do anything to jeopardize those jobs by going away for 4 weeks in a bad economy. And so those (2008-2009) were a tough couple years. We held programs each year. They were respectable. I think maybe we had instead of 30 to 35, we had 20. So it was a big drop, but lots of schools cancelled outright in those years. Dr. Baker explained that the partner schools also were unable to sustain high enough enrollment to run their own programs, so the affiliation with LU’s Asia program helped the other institutions “fulfill the needs of their students” while simultaneously helping LU’s program grow. Partnering with other law schools to run study abroad programs was not only due to a difficult economy, however. Growth in study abroad programs nationwide among law schools resulted in increased competition among programs. Dr. Baker described the trend: The other factor that affects enrollment levels is competition. Twenty-five years ago we were one of a couple U.S. law schools over there – a very small number. Now it seems half the law schools in the country have a program - somewhere. And of that ½, half have one in [Asia], so there’s a lot more competition. Assistant Dean Randolph echoed that the same dynamic was true in Europe and that although he felt the now-discontinued program in Europe was an interesting experience for students, there was simply too much competition among summer law programs in Western Europe. The 77 challenging economy, high currency exchange rates in Europe with fixed costs of running the program, and competition among law school programs in Europe all contributed to the decision of the LU School of Law to discontinue its program. Another contributing factor to the decline of some international programs and the redesign of the Asia summer program revolved around challenges with partners in host countries. The School of Law ran a summer program in Eastern Europe, which was popular with students. However, Dr. Randolph expressed that changes in the institutional environment of the partner university in Eastern Europe made it difficult for LU to continue working with that particular university partner. The faculty, therefore, decided to discontinue the program, at least for the time being. The problem there, though, was the university we were working with in [Eastern Europe] went through some administrative changes, and it became difficult for our people to work with them. And, while there was interest, student interest in going, I think in numbers that might have sustained it, we kind of lost some faculty interest in moving it forward because it became difficult, more and more difficult, to work with them. In the case of the Asia summer law program, LU retained a strong relationship with the original host country university partner. According to Dr. George, some of the reasons for the strength of the partnership in Asia included the fact that “There we have the good luck of having a local partner that is giving us a very good deal on a package with instructors and residence halls and stuff like that.” He further explained that the “long and loyal” ties with LU’s Asian partner helped maintain the summer law program for students over its many years of existence. At the same time, however, some of the partnership dynamics with Asia University changed due to the increase of law school partnerships outside the U.S. Dr. George explained, And of course Asia University, when we started partnering with them, there wasn’t really any ranking done [there]. Well, they knew of, at least claimed that they were amongst the top schools, nobody really knew what that meant. In the meantime, they know very well. And all their newer partners are the level of Harvard and Oxford and Stanford and places 78 like that. But since there’s been a longstanding relationship, and there’s a feeling of mutual loyalty and appreciation on both sides, we’re still in the mix. We’re not the exclusive partner anymore. In addition to partnership dynamics, two other law faculty discussed the challenge of regional or geographic issues. The School of Law offered a summer study abroad program in South America for a time. However, several faculty explained that the program never had strong enrollment in part due to the location in the southern hemisphere with opposite seasons so that students were there during winter, which did not appeal to students. Assistant Dean Randolph mentioned that the School of Law was interested in potentially having a Latin American study abroad opportunity in the future, perhaps in Mexico, but that they had not yet located the right partner. Finally, one additional challenge of the external environment was the difference in the structure of legal education in the U.S. compared to that in most other countries. Dr. Baker explained that although the School of Law was potentially interested in expanding the types of international opportunities offered, most of their international experiences for students were structured as a summer study abroad model, set up as a free-standing program that did not involve enrollment at the overseas institution. Dr. Baker explained that U.S. legal education was at the graduate level, while most legal education abroad was at the undergraduate level. And then moving apart from the type of program from summer study abroad, it would be good to have student exchange programs, to have semester or year abroad programs, which we don’t have. And the major problem with that historically is that, well, forever we were the only country where law was a graduate program. Dr. Baker added that there are recent changes to legal education in a few countries, including Korea and Japan, where graduate law degrees were now part of the landscape. He felt that may offer potential for a greater variety of international experiences for law students in the future. 79 The Institutional Environment In addition to external factors, the institutional environment at LU played an important role in the development of international experiences for students in the School of Law. Institutional dynamics created an environment that was at the same time challenging to, yet also supportive of, international offerings for law students. In terms of challenges, funding of international experiences was a key issue. As Dr. George commented, fixed costs to run international programs remained regardless of other factors and that there was a financial “bottom line” that must be considered. We have to ideally at least break even on these programs. That’s always our goal, because a program that needs to be subsidized not just the first or second year when you launch it, but long term, will be very carefully scrutinized for the value it adds to our school. Before we can sink in, you know, a loan every year into a program, we have to look at it and say, “Is that really worth it?” You know, because this is money that comes from somewhere obviously. External economic pressures necessitated changes to internal funding structures, specifically related to how student tuition for international experiences was covered. Historically, the LU School of Law provided a full tuition subsidy for LU law students participating in their summer study abroad programs. However, the current dean decided to decrease the amount of the tuition subsidy to 50%. Assistant Dean Randolph explained the rationale for this change. [The current dean] took a different view than previous deans had taken toward them. The previous deans had taken the view that so long as the students’ tuition and fees that they were paying for the study abroad programs – so long as they covered the costs of sending a faculty member over there and teaching it for the summer, and so long as they covered at least some of their kind of normal tuition fees. Previous deans did not see it as a net loss of income to the law school, but when [the current dean] took a look at it, and he was right about this, he realized that because we charge by the credit hour here that if they were taking credits, say 6 credits abroad, that means that they weren’t taking six credits here. So in order for the program to actually be breaking even, they needed to be paying essentially full tuition for the six credits abroad plus whatever additional costs were incurred in sending faculty members over there and doing all the extra work. 80 Dr. Randolph then explained that it might be a different story if the School of Law had a system of block tuition rather than charging per credit hour, but could not really do so due to the substantial number of part-time law students enrolled at LU. Dr. George emphasized that the reduced tuition subsidy was recognition that the law school could not afford to subsidize tuition for international experiences at the same level any longer. He explained the decision was “understandable but unfortunate” and that decreased financial support for students did not mean a lack of overall support for study abroad programs. “We’re still charging only 50%, so the school is still supporting these programs.” He added that the combination of the reduced tuition subsidy, law students’ increasing aversion to a high debt load, plus the various external economic challenges made it difficult to continue some study abroad programs. Although a small number of institutional study abroad scholarships existed for graduate students, law school faculty agreed finding support for students to fund international experiences was important. Dr. Randolph acknowledged that solutions to the challenge of student funding remained a concern. Law school has become a lot more expensive than it used to be, even for in-state students, and we need to be more creative in how we can help students do things internationally that are not going to bankrupt them. And that’s a bit of a problem. Dr. Baker also commented that one consideration was how many study abroad programs were feasible to support financially and in terms of student enrollment. “But when you have two or three or four summer programs, at least internally, you cannibalize each other because there’s a limited set of students who want to go, can afford to go.” In addition to funding issues, faculty members cited administrative challenges within the larger institution, as well as in the broader Lexmark University system, as hindrances to the development of international experiences. Procedures had increased in areas such as study abroad office approvals related to safety and health insurance. Law faculty felt that the role of 81 the study abroad office was primarily to support undergraduate study abroad programs rather than the graduate professional programs. Faculty members explained that a second administrative challenge was a new university system process to approve a study abroad course. All new study abroad programs, including those at the graduate level, required approval by a committee made up of faculty and administrators from across the LU system. Several law faculty commented that the time needed for the approval process discouraged them from considering new programs. All approvals also needed to go through the lead administrator in the international office on a different campus within the LU system. Dr. Baker felt this was in part “because there is the whole branding issue of the LU brand. That would be a process…I would not want to start a new program given the bureaucratic hurdles at the campus level, the university level, and then at the ABA.” Dr. Baker also added that in spite of the School of Law’s identification with the broader LU system, they were used to a certain degree of autonomy both within the LU system and on the Metro City campus. “And the law school here has a fairly autonomous existence. We’re on one extreme corner edge of campus. We have our own parking, we have our own cafeteria.” Dr. George explained that existing international partnerships within the various academic schools at LU were treated as exceptions to current administrative policies. You know there is a thing that many schools in the LU network have traditional partnerships – before these ideas of organizing it more centrally and then having these strategic partnerships was even created. And so, and LU was smart enough not to tell the schools that they have to drop their well-established partnerships. So we were basically grandfathered into the system. The LUMC campus built a number of university-wide partnerships in recent years, and faculty in the law school explained that they were encouraged to focus on connecting to those campus-level partnerships. Dr. George elaborated on the dynamics of whether or not to do so. 82 But nowadays, if I wanted to start a partnership with another school in Asia, that would be a headache. That would have to be going all the way to the President in [another campus] for approval. And they would basically say, “Why don’t you do this with [University A in Asia] because they want to” and whatever. Nowadays it’s easier to use established networks, where you already have MOU’s in place and so on. A Broad View of International Experiences for Students Another important factor that emerged was the law school’s focus on a broadening understanding of what it meant to provide international experiences for law students. In spite of external and institutional challenges and the decline of some summer study abroad programs, the law faculty all expressed that providing international opportunities continued to be an important part of the School of Law’s mission. Faculty mentioned the direct ties of multiple types of international experiences, including those that take law students out of the U.S, as one important piece of the School’s strategic plan. Assistant Dean Randolph highlighted that international efforts “have been a priority. It’s part of our strategic plan to enhance the international experience for our students both here and to try to get them abroad in some fashion.” Dr. Randolph clarified that the remaining study abroad experience in Asia, as well as the available international internships, were just one part of the broader international programmatic offerings in the LU School of Law. He reinforced the fact that a large percentage of the faculty were involved in some aspect of international work in teaching, research, or programming and that LU School of Law had a stronger international component than most law schools in the region. Dr. Randolph added that the international focus was part of a “long-term vision of the school and faculty” and not something that was no longer important for the law school or LU law students. And that’s not something that we are cutting back on. Quite to the contrary. And it’s also the feedback from the employers in town, the bigger law firms and medium-sized, larger corporations. We asked them, “What should we do better for the students? How do you 83 want them to be qualified that they are more useful for you than they are now?” And the answer that you will get very, very regularly is “more international competence.” All of the LU law faculty interviewed emphasized that the goal was not to decrease international exposure for the School’s law students but to be more strategic and to think about how international experience might happen in a variety of ways. Part of looking at international experiences in a broad way meant that all students had the opportunity to benefit, even if they were not able to travel anywhere. Dr. George explained another facet of looking at international experiences broadly allowed the opportunity to streamline the international offerings. It’s not about more; it’s about doing the right things with less money. Not necessarily reducing the number of activities, but that may also be part of it, but certainly fine tuning them to make them more efficient. We have to be better with less, and that’s a big job to accomplish. The faculty members agreed that a core part of having international experiences for students in the law school involved the presence of international students, scholars, and visitors on campus from outside the United States. Assistant Dean Randolph mentioned that having international students and visitors on campus was not only more “cost-effective” but also of benefit to U.S. students. Dr. George agreed, One thing is that with our policy of growing the incoming foreign student population, that’s also an experience in a way. Because in the classroom an American student’s going to sit next to somebody from abroad more and more. And they will, in the discussions, they will say, “Well, in my country we do this differently.” So they will be exposed to those kinds of issues. Along with the importance of having international students at the law school, faculty member Dr. Morris mentioned that student organizations with international themes were another important component of internationalizing the student experience. 84 Coordinating the Ad Hoc: A Changing Approach Although the international experiences for students evolved primarily due to the personal motivation and energy of various individual faculty members, the LU School of Law began an initiative to coordinate the international work and activities of the school. Faculty member Dr. Morris was appointed to a new role of Assistant Dean of Internationalization. Dr. Morris explained that it was not only a goal of the School of Law to consider international experiences for students in a broader way but to connect all of the various forms of international activity in the School in greater ways. She described part of the goal of the new position: To try to enhance and to make it more purposeful, because there’s very rich international activities going on. What I’m interested in is how can others get to play in that field as well, right? You know, what follow-on effects can we have from students going there or students coming here? I want our students to interact with those students. If they would like to give talks, I’d like them to give talks whether to us or to the faculty, because they know things that we don’t, and to me it helps spark thoughts, ideas that will be of interest, I think. Dr. Morris added that another goal was to coordinate the various international programs and initiatives in order to achieve greater “information dissemination within the law school and also with our outside constituencies” as historically there was not much coordination of the many international activities. Dr. Morris elaborated, So basically, we have a lot of international initiatives and programs going on. Often times they are the outgrowth of interests of various faculty members, and while those faculty members and their assistants and the dean may know about it, sometimes others have no idea that this is going on. So, in order to harness the potential, right, the ability of others to participate, I’m attempting to coordinate information gathering and then dissemination about those activities. Dr. Morris’ hope for the new role was to facilitate “more information sharing, that there will be more coordination and cross-pollination, whether it is research interests, whatever the case may be” and that the main task was “to help coordinate how others can take advantage of it, how we can see it as a whole, versus here are these individual pieces.” 85 Assistant Dean Randolph discussed how most of the international work developed through “individual faculty efforts, ad hoc” and acknowledged that there had not been an administrative staff person overseeing and coordinating the various international efforts. Dr. Randolph cited what he felt were the positive and negative aspects of having an individual faculty-driven approach to the school’s international work. And then when their priorities change or they [faculty] feel like that it’s becoming too difficult given the other things they want to do with their careers, then you’ve got to find somebody else to pick it up. And because we don’t have anybody, never had anybody, in charge of all of that, they became unsustainable. So that’s, I think ad hoc, which is essentially what we have. We have an ad hoc approach to international program development, and we’ve developed quite a few things, but all through individual faculty initiative. And the good thing about that is that it’s organic and people do things that they’re really interested in, but the bad thing is when they’re no longer really interested then you don’t have anybody there to keep it going. Dr. Morris explained, however, that coordination did not mean management or the inhibition of faculty initiative and freedom. So, coordination, not in the sense of managerial coordination. That is, as a faculty member, each faculty member has the power and ability to go off and, with respect to academic freedom, to pursue the interests that they would like to. I’m not directional; my role is not a directional one. It’s merely to find out what’s going on, help to get others involved if they’d like to, and help facilitate international law and international programming interests. And as I said, it’s sort of a fine line between trying to find out information and disseminate it, and… I don’t know if you’re familiar with academia. Everyone wants to go their own way, so it’s very, it can be very difficult for even the institution to know what’s going on with respect to its programs. So I think there was a perception that we were not being strategic enough or focused enough with respect to our international activities, and so that there needed to be a little bit more harnessing. Dr. Morris added that greater coordination and collaboration were not only needed at the individual law school level in regards to international work and programming but across law schools so that rather than each school building individual programs in the same cities and countries, there would be greater collaborative efforts. 86 Faculty and administrators in the School of Law highlighted the history of their study abroad experiences, including the need and reduce the number offered for a variety of reasons. Nevertheless, they remained committed to offering international experiences in other ways. In the next chapter, I discuss findings from the case of medicine. 87 Chapter 6: The Case of Medicine The Lexmark University School of Medicine is the largest of the professional schools on the LUMC campus and has a long history. While the main campus of the School is in Metro City, there are also a number of other sites across the state. Dean Stevens succinctly described the LU School of Medicine as “old and big” with a major focus on clinical care. Many faculty and staff on the LUMC campus, including those in the School of Medicine, referred to it as the “800 pound gorilla” on campus. At the time of the current study, the LU School of Medicine had many years of involvement in international work, including providing a variety of for-credit and non-credit international opportunities for students in its MD program. The earliest of the LU international experiences was an independent clinical rotation elective that existed over 35 years, selected by approximately ten to 20 students per year. MD students spent one to two months abroad during their fourth year for this experience and made their own arrangements for placements, working through a faculty coordinator. About half of the students worked in mission hospitals. Most international experiences in the School of Medicine were developed by faculty in various academic departments. Several faculty in Department A developed a partnership with an African university over 20 years ago that became a hallmark of the school’s international work, involving research, faculty development, and international opportunities for MD students and medical residents. Approximately 30 to 40 MD students annually participated in a two month clinical rotation at different times throughout the year. Additionally, some students spent several months in Africa during the summer following their first year of the MD program. The Africa partnership was managed by several LU staff members, including a program administrator who worked with the partnership full-time and a faculty director who divided his time between the 88 partnership and clinical faculty work. The relationship with the African university developed into an LUMC campus and LU university system-wide partnership over time, and numerous other academic schools and programs became involved. Faculty in several departments created international experiences in two Latin American countries that included students: a one week, non-credit spring break experience for first and second year MD students, and a clinical rotation opportunity for fourth year MD students. The international work in one of the Latin American countries, which was developed by Department B, also expanded into a campus-wide partnership involving multiple academic schools, although not to as large a degree as the international efforts in Africa. Unfortunately due to safety concerns, activities for MD students in this country were discontinued. Faculty and medical residents were allowed to continue their work in this Latin American country, however. The School of Medicine also offered international experiences for MD students in a second Latin American country. A faculty member and program administrator in Department C developed these experiences as part of a broader Hispanic curriculum track. Most of the experiences required Spanish language skills. Opportunities included a non-credit spring break run jointly through the Medical Service Learning Office and a for-credit medical elective primarily for fourth year MD students. The newest international experiences in the School of Medicine were in an Asian country and involved a new university partner in the host country, which also became a broader campus and university partner. The main international experiences for MD students were fourth year clinical rotations. The fourth year clinical elective began recently and involved a small number of MD students spending one to two months at the Asian university hospital at the partner site as part of an exchange agreement with this university. A clinical medicine faculty member in 89 Department B coordinated the rotation for LU medical students and also oversaw arrangements for incoming Asian exchange students. The development of international experiences for MD students in the LU School of Medicine highlighted a number of key factors including the grassroots efforts of faculty and staff, a paradigm of partnership, a strong connection to curriculum goals, support at a variety of levels, navigating the school, campus and university-system structures, and a growing focus on connecting the School of Medicine’s international work in broader ways. Grassroots Development: Faculty Work and Initiatives The first important factor in the development of international experiences for students in the School of Medicine was the interest and initiatives of a number of faculty members and staff in several departments. In most cases, faculty and staff members became interested in international work through their own prior international involvement or because they were originally from outside the U.S. Faculty and staff spoke frequently about their passion for remaining involved in international work and how including MD students in international experiences not only benefited the students but kept faculty and staff connected to work they were passionate about. Faculty spoke a great deal about how they developed international experiences from the “ground up.” Jordan, staff member in Department C and program coordinator for some of the international experiences in Latin America, spent several years in that country prior to working at LU. She met the current faculty coordinator of the Latin American experiences years ago and then reconnected with that individual at LU. She explained, “So that’s how the (Latin American) work got started, which was both just our passion, and looking at global health and student 90 education. So, it keeps me connected in a professional and a personal way to a place that I have just a huge love for.” Dr. Sanders, a faculty member of Latina heritage in Department B, became a key faculty coordinator for some of the student and resident experiences in a Latin America country. She spent part of her childhood in Latin America and then lived in areas of the U.S. with substantial Hispanic populations. Those childhood experiences fostered an early interest in incorporating international work into her medical career, and she became involved in developing some of LU’s international efforts in Latin America. At the time of this study, student experiences in the particular country were not running because of safety concerns. Dr. Nelson, a clinical faculty member and director of the LU program in Africa, developed an interest in global medicine due in part to time spent living and working in a developing country. He partnered with several other LU School of Medicine faculty members, who also previously spent time in developing countries, to create the school’s international work in Africa, in partnership with an African university. Dr. Nelson discussed that his and other core faculty members’ motivations were focused first on engaging other faculty in international work, “so that particularly our faculty members could have an opportunity to engage or to scratch that global itch that they have. We recognized of course that if we could engage faculty members in global health that students and residents would quickly follow.” Dr. Bates, a clinical faculty member in global health, became involved in LU’s Africa partnership due to her interests in global health, fostered by several international experiences during her undergraduate studies and prior experience in Africa as a medical student at LU. Of time in Africa during her medical studies, Dr. Bates commented, “I was very excited because it was the first time to kind of engage my love of cross-cultural communication and international 91 work with medicine. So it’s been about 14 years since I first went, and it was career changing, life changing.” When Dr. Bates first began employment at LU, she was offered the opportunity to spend two years as the faculty supervisor for LU medical students and residents doing rotations with the partner institution in Africa. Dr. Li, a research faculty member in the School of Medicine, helped initiate a partnership with a university partner in Asia, of which he is an alumnus. When LUMC began efforts to develop a key partnership in Asia, Dr. Li suggested a particular university partner there, which also had a well-known medical school and then facilitated contact between the deans of both medical schools. Dr. Li believed his involvement made sense because his status as an alumnus of the potential partner university let him talk directly with both institutions and understand both systems. “That’s why I think I have a role to play to talk to both sides, because they all trust me. I know both sides. Because I know American system, I know (Asian) system.” As part of the work with the Asian university partner, Dr. Li coordinated summer language and culture programs in Asia. This partnership expanded beyond the School of Medicine to become the newest LUMC university-wide partner. Dr. Meier, a clinical faculty member in Department B, also became involved in the new Asia partnership. In addition to his regular clinical faculty work, he directed the Asia exchange program for the School of Medicine, which included a clinical rotation option in Asia for LU medical students and hosting a number of medical exchange students from the partner university. Although Dr. Meier described inheriting the Asian exchange program “somewhat by default” four or five years ago, he commented that he “loved being involved” as it was an opportunity to keep his adopted children connected to their birth country, as well as supporting his own enjoyment of cultural interaction. 92 The dean of the LU School of Medicine, Dr. Stevens, also spent time abroad in Asia prior to joining the staff of LU, describing his time outside the U.S. as pivotal in his life. During his career at LU, Dean Stevens saw the development not only of the international partnership in Africa, which began while he was chair of Department A, but of the other international work. He described the role of the faculty involved in developing the various international efforts: So one of our medicine faculty is originally from (Latin America, Country B) and created a small program there with our blessing. And we get – well rotating and having experiences there. Similarly, a faculty member of (Latina) heritage [in another department] has created a small program in [another country] where our students have the opportunity to go. And then lastly, most recently we created an exchange program with [an Asian] university, and again, catalyzed by a faculty member who was a graduate of that institution. Additionally, Dean Stevens remarked on the incredible passion these faculty had for international work. Some medical faculty did not have prior international experience but became involved through their work in the School of Medicine. Dr. Jones, whose former position at LU involved working with LU’s medical education curriculum, described the impact of her international involvement LU: The opportunity to work internationally I do think is a true privilege. I think it opens your eyes literally to the world and to different cultures. And for the same reasons that I think that our students should go I think personally happened to me in terms of just getting back to the roots of what is important about the profession of medicine. So it just starts feeling like you’re doing meaningful work again, where you can get lost in the day to day shuffle of your academic enterprise back in your home country, I think. Regardless of how they became involved in international work, faculty and administrators spoke enthusiastically about the larger benefits to their departments and also to the School of Medicine. Jordan, program coordinator for the Latin American experiences run out of Department C, commented: 93 One of the great things is it expands your world, and I think it’s good for our department. So we kind of, because we can get real focused in just our little piece of things. And so then there’s the (Latin America) project or the (Asia) project that allows people to get excited about something and feel that they’re working for something a little bit larger than themselves. Sometimes when you’re too busy looking…you miss the forest for the trees a lot of times… This is something that keeps people happy. It keeps people engaged. It feels like you’re contributing to the larger good, which you do on a daily basis but sometimes you lose that. In spite of the passion and interest of medical faculty and staff in international work, they did not always intentionally become involved in helping organize international experiences for medical students. In some cases faculty became involved through what they referred to as serendipity or the encouragement of others in the institution. Dr. Brown, coordinator of the elective international clinical rotations, commented that opportunities to spend time abroad with the LU Africa partnership fostered his interest in continued international engagement. He discussed being approached by the previous elective coordinator about taking over the role: “And as he neared retirement he needed somebody to turn it over to, and he just asked me if I wanted to do it. So, you know, it was kind of serendipity, really.” Faculty and administrators explained that for the most part, they gladly took on international work in addition to their regular clinical, teaching, administrative, or research responsibilities. In general, faculty and staff expressed willingness to engage in international efforts and to develop opportunities for student participation even though they described their involvement often as volunteer and shared that they faced challenges finding time to do the extra work. Dr. Li discussed how his role became larger than anticipated when asked to become director of the new exchange program in Asia, in addition to his other medical work and research. He related the conversation with university administrators encouraging him to take on this new role: 94 “You be the director.” “I don’t think I’m in that area. Just helping you do something.” But they say, “You are the director. You love (Asia). Just organize.” (laughs). So I said, “Okay.” So then I thought okay, so I’m the one who knows both sides. I have advantage to this. Although Dr. Li noted time was a primary challenge and that he sometimes felt he had two fulltime jobs, he also commented that it was worth it to facilitate the exchange work in Asia because “you can see the impact, you can see the students learn something from all these programs.” When asked about his primary challenge in coordinating international experiences, Dr. Meier remarked “Besides doing it on the side?” He explained that there was a staff member in the medical school whose role was to provide support services for incoming international students and scholars, which was a great help. However, he did not have other staff or time allocated to supporting outbound international experiences. Like Dr. Li, Dr. Meier emphasized that it was still worth it to him to support international experiences for students. Dr. Nelson, director of the Africa partnership, echoed the substantial amount of extra time required to be involved in international initiatives. Although a percentage of his time was allocated to working with the Africa partnership, it was still a challenge to accomplish the international work in addition to his clinical and faculty roles. He also recently added a leadership role in developing a new university-wide global health center to his workload. Dr. Meier explained that the work of an academic physician is already somewhat “schizophrenic” by nature, involving both clinical and academic roles and that clinical activities were often what funded faculty salaries, unless faculty had grants. International initiatives or other local community projects were generally on top of other faculty work, “And I think that’s a general thing where physicians are always kind of caught in the middle between, you know, providing the services here that create your salary.” (Dr. Meier) 95 In general, however, medical faculty and administrators in the current study felt that the benefits of participating in the development of international initiatives, including experiences for students, kept them involved in spite of time challenges. Jordan described how international work was just one of her many roles, yet she was willing to put in extra time to support these international initiatives: It gets me a lot of really good interaction with students that I don’t normally have. I get to create curriculum that I wouldn’t normally get to create, you know, around global health issues and things like that, which is fun and challenging…But when I’m there, I get to watch. I get to teach. I get to watch the light bulbs go on. I get to have part of the conversation. So that piece of medical school education that I get to be a part of there, which is the really hands on piece Dr. Jones spoke about her involvement in international efforts as “volunteer,” explaining that she got no reimbursement for her time. She went on to say, “And I do it with gladness.” Paradigm of Partnership The second important factor that shaped the creation of international experiences in the LU School of Medicine was a paradigm of partnership. Medical faculty and administrators continually reinforced the important role of host country partners in the creation and sustainability of international experiences for students, as well as in other international efforts. Faculty and program administrators explained that they could not have developed international experiences without the support of highly valued partners in host countries. The majority of host country partners were academic institutions, but other partners included hospitals, community, and nonprofit groups. Dr. Nelson described the focus on partnership in the Africa program as a “paradigm” that fostered mutual benefits for host country partners. I think the paradigm that we have that we instituted is a little bit different than – it’s not little bit, it’s very much different than what historically has happened. I think there’s much greater recognition now of the importance of this sort of relationship that emboldens, empowers, enables hosts – the host country institutions and host country individuals. 96 Another faculty member noted that an important goal of international experiences was to ensure a reciprocal relationship with the overseas partner, stating, “The one thing we thought was very important is that we not make this an experience for United States students and not reciprocate.” To that end, for example, the School of Medicine made a point to host international students from partner universities. Participants explained that they worked to communicate the importance of partnership to MD students and to build international experiences in ways that the value of reciprocity was supported. And there’s no doubt that we better educate our medical students and residents by having them go over, but I just never want us to lose sight of the fact that we originally created the partnership as a mutually beneficial partnership for both sides. (Dr. Bates) Dr. Jones summed up the School’s philosophy about partnership: Everything we do is partnership. We are not there to go in as PIs, get big grants, find some findings that benefit the individual for promotion and tenure and then leave. That is the antithetical model to what we do. So the former of the dual partnership in all missions – clinical care, research, and education – is part of our mission, vision mantra. A focus on partnership and reciprocity also meant being sensitive to overtaxing the host partner. Therefore, the School of Medicine limited the numbers of students who participated in nearly all of the international experiences. Dr. Bates explained that managing numbers was a primary concern and sometimes a challenge due to high interest among students in international opportunities. It’s hard to tell people “no” because you know it’s a very positive experience, but also knowing that there is an upper level, an upper limit to the numbers that a site can tolerate without it becoming a burden on the host site. Jordan echoed a similar thought about spring break trips, I think we limit it to 15 because one of the things that we find out kind of organizationally is we would love to be able to do more, but our partners and our communities can only accommodate so many. 97 In general, faculty and program administrators were cognizant of the potential negative impact of a large number of students visiting a host country and worked to ensure the experiences were manageable for host country partners. Faculty explained that the focus on reciprocity and partnership was a major reason for the sustainability of operating international experiences for students. Additionally, they worked over time to establish long-term partners. “Fourteen years of sustained relationship with one place has been really, really good. For us, just those long-term relationships I think are the overall most positive part of it (Dr. Sanders).” This sentiment was reflected in Dean Stevens’ comments on the importance of “staying power” of partnerships and connection of partnership to the School of Medicine’s success in international efforts. I would say one of the things that we’ve tried to do that distinguishes our programs is to try to make sure they are truly collaborative with our international partner. And I say that because some of our observations over the years have been that, well, a school might develop a relationship with some international partner, and the driving force is that they’re really trying to do some major research project, and that once that’s done, it’s like, “Okay, see you later.” And so you don’t develop these really long-standing true relationships that are the glue that holds things together for a long period of time. So we’ve been very careful about how we go into these things and make sure that they are, that everybody is involved for the right reason and that, similar to what I’ve mentioned in terms of our own culture, you know, these are relationships of mutual respect, of collaboration and teamwork, and that there’s no sense that one side is trying to extract something from the other side. And I think that’s had a lot to do with our staying power and what we’ve been able to accomplish. Although faculty focused on sustainable partnerships, sometimes factors in host countries caused student experiences to be cancelled. During a follow up interview, Jordan shared that the Latin American experiences run through Department C had to be cancelled for that year. However, she and a faculty colleague were trying to develop another experience in a nearby country. Jordan commented, “How things change! Rather than talking about our international 98 experiences, I have been busy preparing presentations on how to cancel international/global health programs.” Curriculum Connection: Credit, Non-Credit, and Competencies The LU School of Medicine provided international experiences for its MD students for many years. Dr. Brown explained that individually located medical rotations abroad were a common type of international experience at many medical schools and one of the earliest types, which was the case at LU. Over time the number of international offerings for MD students at LU grew markedly, in part as a result of the close connection of international experiences to LU’s medical curriculum. LU faculty and administrators engaged in a thoughtful process of connecting international experiences to the general structure of medical education, outlining a variety of different intended rationales for the experiences, and beginning to incorporate additional global health aspects into the broader curriculum. Additionally, faculty discussed how new curriculum initiatives at LU and in the discipline of medicine could impact the future development of international experiences for students. The first and second years of an MD program were primarily about basic sciences and then the third and fourth years focused on clinical care. The majority of international experiences fell within or right after students’ first year studies or during their fourth year of medical school. First year international experiences took place during spring break or in the summer between the first and second year, and most were non-credit. So that’s the last time at LU’s system that they have the summer off. Once they start the 2nd year of medical school, they go year round until they hit the end. But they’ve got this summer off, so about 8 or 9 weeks where they can do anything. (Jordan) Dr. Nelson echoed this comment stating that, “We have selected opportunities for a few students between their freshmen and sophomore year to go abroad for the summer, but you know that’s 99 the only time in the first 3 years where there’s any flexibility because of the nature of medical school.” The curriculum during the second and third years was highly structured and did not generally allow time for students to go abroad. International experiences offered in the fourth year were primarily elective clinical rotations. Medical rotations were a required part of LU’s curriculum, although students were not required to complete them abroad. The 4th year students, on the other hand, it’s just treated as any other elective. They’re 4th year medical students so they take, you know, their 4th year in medical school is generally a series of 4 week electives. They couple together two blocks so they’ll go for 8 weeks. (Dr. Nelson) One faculty member explained that students generally interview for residencies in the fall of their fourth year and then may choose to do an international elective in the second semester of that year after interviews were completed. The LU School of Medicine implemented a competency-based curriculum over 10 years ago, requiring students to obtain a certain number of competencies at different levels in order to graduate. Faculty tied the international experiences they developed to particular competencies so that students were able to fulfill competency requirements. These competencies are really what we felt would supplement what most medical schools are (or aren’t?) teaching in terms of knowledge content and procedural skills. And they include things like communication, professionalism, ethics, self-awareness – the kinds of things that are tougher to teach but critical for practicing physicians. (Dr. Jones) Although students generally met competency requirements when participating in credit-based international experiences, they could potentially fulfill competencies through non-credit experiences as well. Dr. Jones elaborated, Well, a lot of the spring break things would be considered extracurricular. They aren’t necessarily tied into the competencies. Now somebody may opt to go work with the competency director and use any of these experiences as a special elective. And if it gets 100 approved prior to the travel and the experience with goals, objectives, and outcome measures, that they can be used toward the competencies. Faculty also described how some of the international experiences, typically those that are forcredit, were more formally tied to the structure of LU’s curriculum. So like the elective in Africa and other countries, that is on the books as an already approved elective, and it already adopts one or two of the competencies within that elective. And so that would be an established way for a student to accrue their requirements toward a particular competency. That doesn’t in any way prohibit students from doing elective work in any area. (Dr. Jones) Dr. Jones explained the importance of honing “the goals, objectives, and the evaluation process – for the sake of a formal curriculum making it so that it can really fit into the grid of activities, especially the competencies, for example.” She also noted that although “the big push in professional education, or in medical education, is based on competencies,” at LU, “we’ve taken it farther in terms of actually institutionalizing it and making it systemic to our organization.” In addition to the connection to competencies, study participants cited a variety of reasons for offering both credit and non-credit international experiences to medical students, including professional and personal development, gaining greater cultural awareness that would translate to medical work at home, learning patient care in a more “hands on” environment, and fostering inter-professional learning. Another part of the rationale was to help students strengthen their connection to core values within the discipline of medicine, such as altruism and serving the underserved, whether abroad or in students’ local communities. Finally, faculty and administrators hoped to support students’ development of a broader “global health” perspective. In the area of professional development, one faculty described that the international experiences at their core were meant to develop the competencies of “ethics, self-awareness, and professionalism.” Other faculty and administrators spoke about how important it was for students to gain personal and professional perspectives that they could best develop through an 101 international experience. “But you go there, you can see the face, the people actually just like us. So I just want them to keep a sense. I think that’s one part. For their professional, that’s another part” (Dr. Li). Dr. Bates explained, I think probably the biggest goal there would be to broaden the horizon and broaden the perspective of our medical students and our medical residents. If we fail to internationalize and if we fail to create partnerships abroad, I think we fail to give them a perspective that only – I don’t know if it’s only – but that experiences outside of the country can offer that may not be able to get if they just stay home their entire training. Dr. Nelson explained that personal development was also a key reason for sending students abroad during their medical education. Oh, students gain enormously from this. I think – you know, in many ways, the biggest benefit is – you know, medicine’s just the medium. What this accomplishes and what this program is about transcends medicine. And so to – for a student – to give students a worldview, that of course then is simply a mirror into their own soul. It is – that’s the greatest value to this program. But I think this gives – this program, this partnership with (the university abroad), these elective experiences are enriching for our medical students, both from the perspective of their personal careers as well as from the perspective of who they are as individuals and as citizens of our local community and citizens of our world. Cultural awareness and sensitivity were other primary outcomes that faculty and administrators hoped medical students would achieve. Dr. Meier defined cultural awareness as “seeing beyond your way of doing things,” realizing that there are “different ways of doing things” instead of “this is our way, and it’s the right way.” Another part of cultural awareness was encouraging students to experience the host country and culture as fully as possible. Dr. Jones emphasized that faculty wanted students to go abroad with an open mind and therefore provide students the space to engage with the local culture. We didn’t want to over-script it, because we thought we would really lose some of the unique opportunities of being in the host country and just experiencing it. But we felt that was really part of learning the culture and increasing cultural sensitivity was going with an open mind and just being, just being a guest, a good guest. 102 This intent was reflected in how faculty described a primary goal of the Africa rotations for MD students as “understanding the life of an (African) medical student.” Other faculty members and program administrators echoed this sentiment, explaining that medical students were likely to encounter increasingly diverse populations in many parts of the U.S., and providing international experiences was an important way of preparing students for their future practice and relating to patients from a variety of backgrounds. When asked by other faculty and staff at LU why students needed to go abroad to gain such perspectives, faculty members emphasized the fact that students bring back what they have learned abroad to the local environment. I would say the initial reason that motivated me 14 years ago to do this was because I thought it was, it’s always a positive experience to push students and residents out of their comfort zone, out of what they’re familiar with so they can have a much better understanding of immigrants, of immigrant families and patients – not only the language, a little bit of the culture, but really just, you know, if you don’t know where somebody comes from you can never truly understand how to explain where we are here. And so I felt like that even if it was just a week – obviously a month or two months is a much better experience - but I just felt like it gave you a much better perspective to interact with patients and families once you were back here in the States. (Dr. Sanders) Another important motivation was allowing students to gain medical skills in “limited resource environments” with the goal of learning a more “hands-on” approach to patient care. Dr. Nelson described the guiding philosophy behind the international experiences as “leading with care.” Faculty frequently discussed the value of medical students gaining experience in evaluating patients and developing physical exam skills without the technology, medicines, treatment options, or other resources they were used to finding at home. Everything you’ve seen written about moving from a high technology to a low technology environment where you have to count on your communication and your observation and your clinical decision making, also really bring to the fore the things we try to teach in medical school but often get lost when you’re on the ward in a crazy high technology environment where someone’s just getting a CT followed by an MRI followed by an ultrasound for diagnostics and then patient being rushed around instead of 103 having a conversation about what they’re feeling and experiencing and actually laying on hands to do a good physical diagnostic examination. (Dr. Jones) Additionally, through participation in international experiences, students encountered diagnoses they might never see in their future practices. Inter-professional learning was another part of the rationale. In developing international experiences, medical faculty and administrators often worked with colleagues not only in a variety of disciplines within medicine but also more broadly across healthcare fields, and in some cases with entirely different academic programs and schools. For example, the Africa program involved faculty, staff, and students from several academic areas across the LUMC campus and university system. Faculty and administrators in dentistry and nursing often worked jointly with colleagues in the School of Medicine. The inter-professional work was then reflected in the intended outcomes of international experiences for students. Dr. Sanders described the evolution of this goal: What we found is when we looked at dental and nursing, there were very similar competencies and so we really tried to emphasize again that kind of inter-professional learning. We looked at the competencies that crossed these different professions and tried to focus on reflecting on some of those things like team building, understanding health systems, professionalism, and obviously, you know, kind of the cultural competency issues. So again it evolved from just having an understanding of patients from different backgrounds to having an understanding of the complexity of healthcare, how to work with different disciplines, how to compare different systems and see the benefits and the drawbacks of a system (in a different country). In addition to inter-professional learning, a primary goal was connecting student international experiences to the core values of medicine, including empathy, altruism, and caring for the underserved. Faculty elaborated that due to the structure of curriculum in medical education, students spent the majority of the first few years studying basic science with little opportunity to interact with patients. Faculty talked about how international experiences helped students “reconnect” with reasons they entered the field of medicine, “almost a kind of a re104 inoculation of things that matter in our profession” (Dr. Jones). Dean Stevens underscored the importance of connecting students to the core values of medicine through involvement in international opportunities. So I think it helps us in terms of our culture broadly by having people with the right kind of mindset, that they do have a sense of altruism. And that they – ideally we would like every person at this place to be here because they believe that medicine is a calling instead of medicine being a business. The impetus for starting it (the Africa program) in the first place was the notion that giving learners an opportunity to spend time in the developing world would reinforce the altruistic spirit of medicine. So that’s really what it was. That was really the driving force, was from the beginning, and in my mind has continued to be the driving force and rationale for all of this. Faculty and administrators spoke about how their goals for student participation in international experiences changed and developed over time. One key factor affecting the rationale was connecting students more fully to global health issues, which faculty described as gaining an understanding of “a global view of healthcare systems,” so that students “developed perspective of different countries, different cultures, and different healthcare systems.” Casey, program manager for the Africa program, explained that a global health perspective included a greater appreciation of the idea that “every person regardless of where they are is entitled to quality healthcare.” Dr. Brown emphasized that students also gained “a much broader awareness of what’s going on in medicine beyond our own institution and seeing us as part of a bigger medical system than just what’s going on here.” Faculty felt strongly that this was a perspective students could gain from experiences in developing countries in particular. Dr. Sanders elaborated on this point: I think our community and our training here have also changed tremendously. I mean, there’s cultural and linguistic competency integrated throughout so that that is not so much the need. I mean we talk about those things all the time and across different rotations and learning experiences. So that doesn’t necessarily have to be a goal anymore but definitely to professional care, learning about different health systems is huge because our own health system is changing so dramatically. So understanding the amazing array of different ways that places and people deliver healthcare across the 105 world is, I think, another goal that we’ve come to. Understanding disparities and, you know, how do you make decisions in resource-scare communities. Those are kind of more of the goals than the basic one that I was driven by just in terms of helping the students understand people from different backgrounds. Dr. Bates also discussed how the discipline of medicine was developing structures to provide greater connections to global health curriculum. So there’s global health education consortium that now has a new name – Consortium of Universities for Global Health, but they have actually come together to come up with sample curriculum and sample competencies and goals and objectives, learning goals and objectives for global health. A final piece of the connection of curriculum to the development of international experiences was curriculum reform underway at the LU School of Medicine and more broadly in the discipline of medicine. Faculty described one priority for curricular changes as weaving clinical experiences throughout the four years of medical education. Harper, a School of Medicine administrator, explained that “the primary change that will take place, which I think is the model that is required by the accrediting body, is to have a better integration of the clinical and the basic sciences aspects of medical school” and that traditionally medical students did not “interface” with patients until the third year of their studies. He described that the new curricular model under discussion allowed clinical care experiences from “almost the first week.” Though it was still too early to know how development of international experiences might be impacted, faculty and administrators anticipated that changes might allow for more involvement in international opportunities throughout students’ four years of medical education. Faculty expressed frustration at not having a global health curriculum or track integrated through the four years of medical school at LU. A global health track for LU medical residents was created but was not part of the curricular reform efforts underway for MD students at LU because of resistance within some areas of administration in the medical school. Although 106 developing a global health curriculum for medical students was a goal for some faculty, they struggled finding the time to move that goal forward. One faculty member explained that “It takes the political will of those who are doing the curricular reform to say, yes, this is something that we want all of our medical students to experience.” Layers of Support Although participants in the current study experienced frustrations in creating a stronger curriculum in global health, most discussed the School of Medicine environment as generally supportive of international involvement. Faculty spoke of challenges navigating some of the administrative procedures required to approve and maintain international experiences for students, as well as concern about university system level support. Other major challenges were finding funding for faculty and student participation, and faculty time and workload. However, support was evident in various ways, including assistance from the Study Abroad Office on the LUMC campus and from host country partners. Additionally, faculty discussed the support of colleagues and the dean as primary reasons why they were able to stay involved in international experiences for students. One of the challenges mentioned was navigating the administrative procedures required by the LU system and by the School of Medicine to develop and maintain international experiences. The application to approve an international experience, whether curricular or cocurricular, was a fairly rigorous and lengthy process. The policy came from the President’s Office at the university-system level, so all campuses were required to follow it. While faculty in the School of Medicine generally felt an approval process was necessary, the length of time needed to get an international experience off the ground increased substantially over prior years. 107 There was also some frustration that the system-level approval procedure and School of Medicine administrative approval processes were not always in sync. One of the main areas of discussion in terms of support was resources, which meant funding, time, workload, and staff support. Of these resource considerations, faculty explained that funding for students and for faculty involvement was often the biggest challenge. The majority of the cost to run international experiences was covered by the students in terms of tuition, fees, and travel expenses. The Africa program, which involved a large amount of research, received external grant funding that also helped cover costs of faculty and program staff onsite who provided support for the student experience. However, grants did not cover the costs for student participation. Faculty commented that, in general, it was difficult to find funding for “educative” portions of international experiences. What I’m finding is a lot of people want you to write grants and get grant funding for this that or the other. But there are certain areas that are easier to get either philanthropic funding or grant funding, and usually grant funding falls under clinical contribution and research contribution, but education – you might know this well I guess as a researcher in this area – that program development and educational programs are not - it’s harder to find good funding support for those things because it’s harder to sell a twice monthly educational program for residents to a philanthropist and it’s also just harder to find funders in the grant world that really see that area as one of the more important areas for them. (Dr. Bates) Several faculty spoke about early efforts to help students raise funds to participate in international experiences, which became “too stressful” to do on a long-term basis. Time and other workload expectations made it difficult to sustain fundraising. There were program development grants available for international projects through a competitive process within the LUMC campus and several medical faculty received these internal grants, which not only protected a portion of their work time but also helped them gain visibility for international work 108 within their divisions and departments. One faculty commented about the impact of receiving an institutional grant: So I had a tiny little amount. I think it was 6% of my time or something. But again, it did justify what I was doing, and you know, I think my department liked it that I was part of it. It was a big deal to get a signature center grant. Everybody wanted one. And so the fact that we had gotten one and were able to renew it, that was looked upon positively. Participants in the current study cited funding as the main resource challenge both historically and currently. In the early years of developing international experiences, one faculty discussed how the initial feedback from School of Medicine leadership was simply “Who pays?” The current Dean stated, “The vast majority of the challenges can be summed up in one word – and that’s dollars. So, you know, they have real cost in terms of people’s time and just other costs. So you’ve got to figure out a way to pay those bills. That’s the hardest part.” Faculty shared that they generally preferred not to approach administration in the School to ask for money. Dean Stevens confirmed that School of Medicine leadership support for international experiences consisted primarily of being a “cheerleader.” Several faculty said that verbal support “from the top” was crucial and without support from leadership at the school and institutional level, “you cannot work well.” However, faculty also explained that they did not necessarily seek financial support from leadership because of the importance they saw of keeping a “grassroots” approach to their international initiatives. Faculty felt challenged in terms of not only funding but also allocating time for their involvement. Although most faculty received financial support at the department level at least to cover costs of travel abroad, they seldom had time allocated to do the administrative work of running international experiences for students. The two program managers and the faculty director of the Africa program had a portion of their time allocated to support international work. 109 However, the majority of the faculty, including the director of the Africa program, had clinical responsibilities. Dr. Meier elaborated, I have no protected time. I do it out of, I’m a mostly clinical person, so again, the School of Medicine has the financial support but not manpower support. I have really no secretarial support. And we are short in our division as well secretarial wise, so that’s probably the biggest part which has been difficult to run a program like that. Other faculty echoed these comments, sharing that they rarely had secretarial or any type of administrative support to help manage international experiences. One laughed when discussing how she “creatively carved out time” to work with the student experiences abroad. Faculty and staff were appreciative of any type of time that their departments could provide. And so the department says, “Yeah, we support this,” meaning “We’re gonna let you have some time for it. We’ll cover some of your travel.” But that’s about all there is. So there’s not any, which I think is incredibly generous. It’s not that it’s a complaint at all. It’s incredibly generous of them, because if we didn’t have that, we couldn’t do it. But it’s done, I wouldn’t say catch as catch can. But it’s done in addition to…everybody’s plate is full, and this is kind of on top of it. But because we love working with students, and we really feel we do good work and this is a good project, we’ll stay until 6:00 or 7:00 at night and work on stuff. And we’ll come in on Saturdays and do orientations, and we’ll do these things just because we believe in what we’re doing. But it’s, the people that are involved in it are very dedicated. (Jordan) Other participants echoed that in spite of the limitations of funding, staffing, and allocated time, they valued their involvement in supporting international experiences. They generally described a supportive environment from colleagues and leadership within their departments, from the leadership of the School of Medicine, and from the broader LUMC campus. Dr. Meier described having support from all of these levels – division, department, School of Medicine, and campus – in spite of international work being a “ pretty impressive time sink.” He explained that a key part of this support was that the faculty within his department valued involvement in outside activities that were important to each of them. One person might be interested in doing a service 110 project in the local area, while another was interested in supporting a student experience abroad. In Dr. Meier’s department, faculty covered each other’s work so that such involvement was possible. He stated, “I have really had no problems from my colleagues, for example. I think that’s what it comes down to.” Harper explained that many faculty volunteer their time to support both domestic and international service learning projects and that it was generally not difficult to find faculty willing to give extra time to support all types of student experiences. Dr. Meier felt the campus had a “mindset” of support for international work and issues related to global health. There clearly is an LU mindset, like LU School of Medicine mindset which is very supportive of global health. And I think that’s something which is critical for me, for example, since I don’t really have any protected time for that. I don’t have any salary support, or I don’t have any real financial support to do those things. And as you know, they’re quite – on paper it doesn’t look like it takes much time… I can’t see patients when I’m gone. There’s a certain revenue loss that I’m risking. And to some degree it’s my responsibility, but the fact that I’m being allowed to go without having to go through huge hoops. And support overall. So with [Africa] being the most known one, but people do many things. I mean there’s people going all over the place. You know, like they do in general. Many physicians do some mission trips, like going to Haiti if something’s happening. But I think here it’s a lot more organized basis – formally supported basis, so it’s a very common thing. I think that’s something which is hard to find. It is also important to note that faculty and administrators commented on the importance of the support given by the Study Abroad Office. Although a few faculty members felt the reporting process used by the Study Abroad Office did not always fit the types of international experiences offered in the School of Medicine, they generally expressed positive comments about the help the office provided, especially navigating the university approval process. Participants in the current study universally discussed the crucial role of support they received from host country partners, including help with travel logistics, arranging local accommodations, assisting in supporting clinical activities abroad, and navigating the local systems in general. Additionally, faculty and administrators emphasized the value of 111 establishing long-term relationships with host country partners not only to provide support for student experiences in those countries but also to provide benefits to partners. Participants felt strongly that part of the goal of any international initiative was to develop a sense of reciprocity and mutual benefit for everyone involved. From Silos to Broader Connections in Global Health Historically, international experiences for students developed through grassroots efforts of faculty and administrators in specific departments within the School of Medicine, and then continued to be run out of the departments where those individuals worked. There was no central office for managing international experiences involving sending students overseas or for broader international work in the School. Recently, however, the LU School of Medicine developed a global health center. As a result, a number of the participants in the current study talked about the possibility of connecting international activities more broadly in the future. Dr. Nelson had primary responsibility for getting the new center off the ground. He explained that there were many goals in establishing such a center. He shared that the role of the new center was not to be directive but to provide a forum for connecting international involvement within the School of Medicine and across other professional schools at the LUMC campus, as well as across other campuses in the LU system. Dr. Nelson spoke of the potential role of the new center in getting LU out of its “medical silos” and also in connecting to larger global health discussions around the U.S. Jordan described her hopes for the new Global Health Center: I think that would be something that would be very good, that would be a unifying piece for things to fit under and give people commonality for people to talk about that, what’s going on. I think understanding global health issues. There’s a basic level whether you’re in (this country or that) that you understand. Then depending on your specific experience you’re gonna have different outcomes based on that. But I think you could have some of the global things that unify, and then people can have their program meet 112 certain specific things underneath that. I’m excited with the new global health center. I’m really excited about the opportunities that are gonna come from that and how that’s gonna change what we’ve done. I like change. Change isn’t anything that I…I’m sure they’ll be some glitches, and I’m sure there’ll be some things, “That doesn’t really make a lot of sense.” But at least we’re opening the dialogue and talking about some new things. So I’m pretty excited just to see what other people have thought about. Jordan agreed that the new global health center might provide a forum for greater collaboration and connections in supporting not only international experiences for students but also the larger picture of international work in the School of Medicine. Dean Stevens explained how this vision of connection related to the culture within the School. We’re a place that hasn’t taken culture for granted. We’ve actually been at a constant effort the last 10 plus years to discuss and mold our culture, and we say that that’s a culture of collaboration, teamwork, selfless leadership, service to the underserved, mutual respect. And so this Africa program, well the international programs in general, are all just sort of a piece of that overall puzzle as far as I – I mean from my own perspective. Dr. Nelson spoke about of having the School of Medicine’s international work connecting to all levels of the university’s mission: So that at the end of the day, all 3 missions – service, training, and research – are on equal footing. No one mission more important than the other, but it’s an acknowledgement that if you do research without attentiveness to training and to service, the product of your research is going nowhere. Or if you do education or training without attention to the other two, you’re not gonna achieve what you want to achieve. As with the other two graduate programs in law and dentistry, faculty work and initiatives was a prominent driver that facilitated development of international experiences. Support from leadership, though generally not financial, also mattered, as well as support of colleagues. Additionally, the support provided by overseas partners was a crucial factor, and everyone interviewed in medicine emphasized the importance of having reciprocal partnerships. Additionally, connecting the international experiences to medical curriculum was an important piece of their development. Finally, faculty and administrators in medicine were looking at 113 connecting their work around international initiatives in broader ways. Next, I consider the views of campus level administrators in the development of international experiences in the three graduate professional programs. 114 Chapter 7: Campus Administrator Views In addition to interviewing participants in the three schools, I also met with 10 LU administrators in academic affairs, international programs, and service learning. Seven of these administrators were in the international programs office and included the study abroad director (Kathy), study abroad advisor (John), senior international officer (Dr. Arthur), senior director of international programs (Marion), academic director of international programs (Dr. Milton), outreach director (Dr. Greene), and the former senior international officer (Dr. Smith). Senior international officer (SIO) indicates an individual with primary leadership over the international office at LUMC. I also interviewed three other academic administrators: the former provost (Dr. Avery), the former associate provost (Dr. Hughes), and the service learning director (Jane). All of these participants offered perspectives about the development of international efforts at LUMC that helped frame the current study. In particular, the former provost and former SIO provided background across a number of years of tenure at LUMC that were pivotal in the development of LUMC’s international work. Additionally, administrators’ comments gave context for the role of international experiences in graduate professional education at LUMC. The discussion in this section focuses on campus administrators’ perspectives on the following areas: the rationale for including international experiences in graduate professional education, institutional support for the academic programs running international experiences, how being part of a multi-campus university system impacted international efforts, and their views of how the professional schools contributed to the broader international work at LUMC. International Efforts and Graduate Professional Education at LUMC As the study abroad director noted, LUMC had a large number of professional schools with graduate programs that offered international experiences. This meant that for some time 115 there were substantial numbers of graduate students going abroad. Dr. Arthur commented, “I would say that there is an advance in approach to graduate level international curiosity if not actual programs as there is anywhere in the United States for a campus like this.” Administrators shared their views on how international experiences fit into graduate professional education. They agreed with faculty in the Schools of Dentistry and Medicine that part of the rationale was for students to support the care of local immigrant populations in their future healthcare work. “Through these international experiences, they (students) will have a different perspective on healthcare, how to interact with patients, and so on. So trying to give healthcare workers – nurses, dentists, doctors, social workers – those kinds of experiences clearly makes them better professionals” (Dr. Avery). Marion offered additional comments: The usual effects, I think, that we expect study abroad to have on people, but more targeted application to their profession, because unlike undergrads where they finish their undergrad and then kind of may or may not go into a line of work that’s directly related to their undergrad study, pretty much with the professions you have students that are going to go directly into that field of work. Several administrators cited “the changing nature, the globalization of those professions in and of themselves” as a major reason that graduate students needed to have international experiences and were doing so in increasing numbers. Dr. Smith remarked, “It does mean every profession understanding that profession in an international context and it means doing this through partnership with international colleagues as the key driver.” Additionally, administrators cited the need for graduate students to gain global competency skills related to their professions, echoing what many of the faculty in the three academic schools shared. Dr. Avery provided the following example, More particularly, we think that we need to prepare globally conscious professional graduates. And that means that whether you’re in a field like nursing or medicine, where your ability to practice depends on your understanding not only of how diseases do not respect borders, HIV for example or the bird flu or whatever it may be – swine flu, but 116 also how you interact with patients whose language may not be spoken by anyone who’s on the medical team. How you deal with communities where values are very different than those of the majority community and so on. So, the point here is to really prepare people who can practice in an environment where it reflects the way in which the world is moving, increasingly more highly mobile. And at the same time to understand that their research, the things that will continue to make things better, whether it’s in medicine or transportation or energy, will advance much more quickly if they can be done by drawing on resources that are global. Dr. Smith contrasted the goals of global competency in the health professions with law, Law and business are different from medicine and dentistry in this regard. You can’t really be a lawyer or a business person these days without getting into international law or international business. In terms of medicine and dentistry, the difference is this – that the patient that our dentist and doctors are going to be seeing are, you know, with immigration they come from a very wide background, and our dentists and doctors need to be prepared for that, even if they’re practicing only in the U.S. Now add to all of it that research in all the four fields is now international. Dr. Smith also elaborated on how the three professional programs prepared their students to go abroad, in particular, the School of Dentistry’s formal semester-long preparation course: “And it prepares them for the cross-cultural aspects of it, for the healthcare aspects. It’s really great. So they don’t just go down and are sort of shocked and, you know, start drilling. They really get the students ready to do this work.” Jane, director of the Service Learning Office, discussed the semester-long preparation course in dentistry that prepared students for their service learning experiences abroad. She explained that the course became a formal part of dentistry’s “umbrella” program, meaning that dentistry offered experiences in multiple countries, but each experience has a service learning design. She commented, “I would say when you speak with dentistry, the international experiences are really, really important to their school’s identity right now.” She also noted that the experiences in dentistry were all curricular, which is part of LUMC’s formal definition of service learning. 117 Another area that administrators discussed was the types of support that the institution, particularly the International Programs Office and Study Abroad Office, provided to the professional schools. One International Office administrator discussed some of the challenges connecting with the professional schools: And I think there’s a tendency for professional programs to operate in silos and to feel that they’re unique, and so the law school or the MBA program or the MD program. “Well, we have to do things our own way because that’s how our profession works.” And they might have particular accreditation issues – the American Bar Association or whatever that they have to attend to. So sometimes there’s less of a willingness or, and this is gonna vary considerably, but sometimes there’s a little bit more of a tendency for them to want to be independent and just do things on their own rather than looking to a central campus office to support them. Administrators noted that interaction between the Study Abroad Office and the professional programs varied. Part of the role of the Study Abroad Office was to oversee university systemwide administrative requirements for all programs. Additionally, the International Programs Office provided professional development opportunities in a variety of ways. In the case of dentistry, dental faculty helped pilot a new study abroad online system and participated in many of the professional development opportunities. Those in International Programs felt they probably connected least with the School of Law. Support consisted mostly of monitoring where students were abroad, as well as assisting with international study course approval processes. One administrator from the International Programs Office explained: The law school had a history of having several ABA accredited programs where they were actually – that sort of pre-dated our study abroad office – where they were enrolling students from law schools from all over the U.S. or even international, so they already kind of had an infrastructure built up. So they’re probably the most reluctant campers on the campus in terms of just utilizing the support of the office or seeing what they do as being distinctive. Marion suggested that there was a need for central administration, including the international programs office, to approach the professional schools in more individual ways: 118 So I think the challenge is to try to understand that culture of that school and how do you reach out and build bridges with that particular culture in order to support the faculty in a way that’s going to be meaningful to them. Administrators acknowledged that faculty in the three professional schools faced many challenges in the competing demands on their time and finding time to do the work needed to support international experiences. Additionally, the value academic departments placed on faculty involvement in such experiences varied. I think the leadership and the culture of the unit are key factors in how international work of any kind is valued. And I often think that you have to have some key groundbreakers, people who have made service respectable or illustrated to their units the importance of and the impact of working internationally. Because I think no university today can say that we’re not in a global environment. (Dr. Hughes) A number of the administrators expressed that there were numerous challenges in being part of a university system and not the “flagship” campus. A senior administrator explained, And then as I hear the folklore here, and I don’t think it’s just folklore, but how did this campus, to put it rhetorically, manage to create its own identity in light of having a powerful flagship campus, as it’s called. And apparently the leadership of LUMC from early on decided it was going to create a national identity for itself and not always think about where it fit into the system here. One administrator in the international office explained that LUMC’s international work had developed substantially over the years: I guess I’ve been here (a number of) years. This campus has just bloomed in terms of its international connections. When I came here it was seen as, (the main campus) was seen as the international one and this was the locally focused. But even then it had a lot of international work going on, but that’s just blossomed incredibly. We dwarf (the main campus) in terms of our international work. As the faculty also shared, administrators from the International Programs Office explained that in recent years the main campus implemented more procedures related to international activities. In the past we (LUMC campus) had much more autonomy. You could do, you could sign whatever agreement you wanted. But in the past probably 2-3 years, there’s been a 119 tightening of the ability to sort of just go out and offer agreements, and so the university – Lexmark University – has a much tighter rein on what agreements can be signed. Administrators acknowledged the crucial role the professional schools played in building international programs campus-wide international partnerships. What was happening was a recognition that global collaboration really depended increasingly on the exchange of expertise so that professional schools became critically important for building partnerships. It was no longer history, language, culture that was the basis for collaboration. Instead it was professional education – engineering, medicine, nursing, law, and so on. And those are the programs that really are based here at LUMC. (Dr. Smith) In particular, administrators mentioned the role of the School of Medicine. It was clear the campus “gets” international and knows what it is. And I think that’s - we couldn’t say that if the professional schools were not engaged in this kind of international activity for their students. It wouldn’t be enough to just have the undergrad schools and those programs being involved. Each of our major partnerships have actually started with the School of Medicine, which is our - every institution has its most influential school – and for us it’s the school of medicine, which is huge. (Marion) Administrators’ comments confirmed much of what faculty and deans in dentistry, law, and medicine shared about the development of international experiences. They also provided a broader perspective of the campus and university system that was not from the lens of an academic unit. Additionally, campus administrators offered understanding of the larger context of international work at LUMC over time and how that connected with what was happening in the professional schools. In the next chapter, I provide a cross-case analysis, highlighting similarities and differences of the development of international experiences in the three cases of dentistry, law, and medicine. 120 Chapter 8: Cross-Case Analysis From the accounts of the LUMC programs discussed in the findings chapter, four core organizational factors emerged as key influences on the development and implementation of international experiences across all three academic programs: dentistry, law, and medicine. These four factors were faculty motivations, background, and work; organizational support; the role of curriculum; and making connections in a number of different ways across the individual programs and schools as well as across the institution and university system. While there were many commonalities in how each of these factors emerged, there were also differences in how the factors played out within each program. Faculty Background, Motivation, and Work The first core factor influencing the development of international experiences was faculty background, motivation, and work. As participants across dentistry, law, and medicine shared, their own personal and professional backgrounds impacted their rationale and motivation for involving graduate professional students in international opportunities. Additionally, how faculty members and administrators incorporated the international activities into their workloads highlighted similarities and some differences across and within the three academic programs. Faculty and administrators in the three LU professional schools discussed how personal and professional backgrounds and life experiences impacted their own interest and involvement in international work. A majority of participants in the current study had some type of international experience prior to their current roles, including as students. A few began their international involvement during their careers at LU, which then fostered a continued interest in international work. Other participants were originally from different countries and had interests and connections in those home countries or regions. As highlighted in the findings chapter, 121 faculty and administrators shared how their own international experiences impacted them in a profound way, fostering continued commitment to international involvement in their work and providing international opportunities for students. Two dental faculty spent time living and working in developing countries prior to beginning their current roles at LU, which they described as “absolutely pivotal” in their lives and “impacting” their careers. One of the faculty in law echoed those comments, describing how a summer study abroad experience impacted him in a “life changing” way. Opportunities to teach abroad while in a position at another law school furthered his international interests. Faculty members and program administrators in medicine also emphasized the impact their international experiences had for them. Several participants in medicine spent a significant amount of time working and living in regions or countries in which they were currently involved. Faculty in medicine commented how their time abroad helped them develop an interest in global health that remained a core interest in their current work. One faculty member who supervised the elective international clinical rotations began his international involvement after joining LU. He commented that his interest in global health and international involvement grew and become a part of his work at LU over the years. In each of the three academic programs, some faculty were originally from countries other than the U.S. or had heritage from other countries and lived at least a part of their lives in those countries. These participants shared how their backgrounds fostered interest in international work, and discussed how connections in their home countries or regions connected to their current international involvement. Faculty administrators’ “pivotal” life experiences led to a desire to stay connected to international work and then translated into helping students have international experiences as well. 122 Additionally, participants spoke about the role of serendipity in becoming engaged in international work and developing opportunities for students. Some faculty became involved internationally unexpectedly, or in the case of dentistry, like-minded faculty connected early on in ways they referred to as “serendipity.” Those connections were then crucial in how they built international experiences. Whether by chance or by design, connection to international work was something participants valued as part of their careers. The assistant dean in dentistry summed up what faculty across the three schools shared: it was the “passion and interest of individual faculty” that got the international experiences for students off the ground. Faculty members in all three programs discussed the desire to stay involved in international work, for which they had developed a passion – a word they used frequently during interviews. One administrator described international involvement as a way to stay “happy and engaged” in the overall work environment. Work satisfaction was, therefore, a primary motivator for faculty to stay involved in international activities. Faculty became involved in international experiences for students in part due to their personal desires to stay connected to international work. The director of the Africa program commented that the work in Africa started primarily to allow faculty to “scratch their global itch.” The purpose was not to involve students at the start, though he and other faculty recognized that involving medical students and residents was a natural next step. In contrast, the three faculty in dentistry worked to develop international experiences for students from the beginning. Realities of the workload. In addition to connections of their backgrounds to international work and passion for being involved, participants spoke a great deal about how they managed to fit the work required to support international experiences for students into their 123 responsibilities. Some faculty, particularly in law, had what they referred to as an “international portfolio” as a formal part of their job responsibilities, while others worked on international experiences strictly as “volunteers,” doing what they needed to on top of other work. Nearly all participants spoke about the extra time required to support international experiences. Most discussed the role of international experiences in work satisfaction and recognition, whether involvement was voluntary or more formally a part of their roles. Additionally, faculty and administrators commented about the different organizational structures they worked in, from the division/department, school, campus, and university-system levels that affected involvement with international experiences. Finally, participants in the three academic programs talked about how involvement impacted them as professionals, with dental faculty especially seeing involvement as opportunity for professional development. Participants universally commented on the significant amount of time required to support international experiences for students in their programs. Clinical faculty in the two health professions in particular considered what they did to support international experiences as voluntary, since they generally did not get release time. As one dental faculty member commented, regular work expectations were “not reduced.” One administrator in medicine explained that for the most part, clinical work generated revenue and salaries for these faculty members, which made it more difficult for faculty to allocate time towards international activities. One of the law faculty members also commented that supporting the international experiences must be a different situation for clinical faculty than it was for him. Some faculty in the health professions found it easier to incorporate international involvement into their regular work. Dentistry faculty whose roles focused mostly on outreach or research expressed greater 124 ease including international activities in their work, indicating that international involvement was a good “fit” to the missions of their departments. However, regardless of primary work responsibilities, participants said that the commitment involved in working with international experiences for students often became larger than originally anticipated. The faculty directors of the Africa and China programs in medicine had part of their time dedicated to international work, yet both echoed that they had more than one full-time job. The faculty director in charge of the School of Law’s Asia program shared similar comments, explaining that although he had a partial “international portfolio,” the time and work required to support the summer study abroad experience were significant. One area that highlighted differences in law compared to the other two schools was greater formalization of international involvement as part of faculty work. As one law faculty member commented, many his law colleagues had an “international plate” as a portion of their work. He commented that some faculty, himself included, did not start out with the plan of becoming an “internationalist” but that this developed over time as they became involved with international opportunities. The assistant dean explained that the LU School of Law also deliberately recruited faculty with an international portfolio. In contrast to the law school, few faculty in the School of Medicine had a formalized international portfolio. In Dentistry, two faculty talked about their international work as more of a fit within their regular roles, although it was not formalized in the same way as law. Regardless of the lack of time within their formal roles to support international experiences, faculty and program administrators commented frequently on how international involvement added to their job satisfaction. This sentiment was repeated by nearly every participant in this study who, whether through intentional or unintentional involvement at the 125 beginning, expressed the fulfillment experienced from being part of international experiences that engaged their students. For some, it brought them back to the nature of what their profession was about and also allowed them to see the impact on students in that profession. In addition to personal satisfaction, faculty in the three schools, especially in dentistry and medicine, talked about formal recognition. Recognition sometimes included a pat on the back from leadership, a formal citation, and in a few cases impacted the faculty member’s service category, which in turn supported efforts towards promotion and tenure. This was particularly true for faculty who were able to integrate research as part of their international work. The School of Dentistry stood out as different in several ways with regard to faculty work. The first is how the three faculty spoke about their involvement with the international experiences as an opportunity for professional development. Two faculty in particular engaged in campus-based and off-campus opportunities to build their knowledge and work on developing the service learning model of international experiences. Another difference was the way the three faculty connected early on and continued to work together developing international experiences. Their efforts resulted in one umbrella program model with a number of other faculty leading student experiences each year to different parts of the globe. Grassroots efforts. Regardless of whether international experiences developed due to efforts of a team or a single faculty member, participants explained that these programs were “grassroots” efforts. In all three academic programs, faculty and administrators talked about how these experiences were built from the ground up and not due to directives of the academic school or university. As participants commented, the international experiences for graduate 126 professional students at LU developed the way they did due primarily to faculty members’ interests and connections. Serendipity. Another word that a number of faculty used to describe their involvement in developing international opportunities was “serendipity.” Not all participants lived or worked abroad prior to their current university roles; however, they related part of their personal involvement to serendipity: being asked for some reason to take over a course or program that involved sending students abroad. Some participants had what they referred to as chance encounters with other faculty in their school or other schools at LUMC that led to development of programs. Support Factor The second primary factor that emerged from the cross-case analysis was the role of organizational support, which fell into four primary categories. The first was resources, which included time, funding, and staffing to support faculty involvement. The second was a culture of support. This meant that leadership and colleagues in departments and schools valued the international experiences in some way. The third category was campus and university support, including the role of the Study Abroad Office and a perceived lack of support from the main campus. Finally, another key piece of support was the role of the host country partners. Resources. As a faculty member in the School of Dentistry explained, most faculty started international experiences “with their own time, their own dime.” Support in the forms of time, funds, and staffing were cited as primary challenges across all three academic programs in maintaining international experiences. However, faculty got the international experiences off the ground in spite of these challenges. 127 Participants in all of the academic programs spoke about funding as a major challenge, both in terms of funding for their own involvement as well as for students. Funding for faculty involvement varied. While some still funded their own travel, faculty whose international work tied well to their department missions found it easier to receive financial support. In the law school, student fees also supported faculty costs. Additionally, faculty in any program at LUMC could apply for small competitive program development grants through the institution, which provided some financial support and covered a small amount of work time. Several faculty in medicine commented about the challenges of locating grant money to support “educative” experiences focusing on student opportunities. Some faculty in medicine and dentistry had external grant funding that helped with costs, but the grants were connected to research. Finding financial support to assist students with costs was a challenge in all three academic schools. For the most part, students covered their own costs for participation in international experiences. Faculty in dentistry initially borrowed money from the dean to get early experiences started and assisted with fundraising events to help defray program costs for students. Several faculty in medicine mentioned that they used to help with fundraising efforts but no longer did so due to the time involved. The School of Law used a form of tuition subsidy to fund some of students’ costs. At one time it was 100% but was 50% at the time of the current study. As a senior administrator in law noted, several study abroad experiences had to be eliminated so that they would not “cannibalize” each other and the School had to re-consider the tuition subsidies they could provide. Although finding funding was a major challenge, a number of the faculty participants expressed that they did not want to ask leadership in their schools for money to support student international experiences. Faculty did not want to be told they could not be involved. 128 Another primary resource challenge across all three academic programs was clerical staff support. Dental faculty shared that their goal for a long time was to have clerical staff support. For many years they asked for help from various administrative assistants, which caused resentment among those individuals, as they did not see the work as part of their jobs. Only recently did they receive a half-time assistant to help with travel and other logistics. Faculty in medicine laughed when talking about how the lack of clerical support caused them to think of creative ways “to carve out time” for these experiences. Leadership and culture of support. Support at various organizational levels from departments to the dean’s office emerged as the next key factor. Support from colleagues was also important so that faculty could be involved with international experiences. Additionally, participants discussed the importance of a culture of support in their departments and schools, even if financial and staff resources were not readily available. As a former LUMC senior administrator noted, “the leadership and culture of a unit are key factors in how international work of any kind is valued.” Comments of faculty and administrators particularly in dentistry and medicine affirmed this statement. As faculty in dentistry explained, department level support mattered a great deal in terms of getting release time and funds for travel. Leadership at the level of the dean’s office was also important in all three schools. While support from the dean did not necessarily mean funding or providing clerical staff, some type of verbal support for international involvement from the dean mattered. As a dental faculty member described, that could mean simply they were “not being discouraged” by the dean from international involvement. The dean in the School of Medicine described himself primarily as a cheerleader, while the assistant dean in Law explained that, although there had been a reduction 129 in tuition subsidies to help with costs, international experiences for students were still valued. All three of the deans and assistant deans felt there were challenges offering international experiences from funding to the work sometimes being a “drain and distraction” from other priorities. Participants mentioned that most people in the academic schools were supportive “in concept” and saw value in the international experiences even if it did not mean allocating time, money, or staff. However, as one dental faculty pointed out, sometimes getting the support “in concept” did not happen at the beginning. This faculty member described fighting for permission to start international experiences. However, in time administration at the school level began to see the experiences as a “valuable tool.” For many participants, starting international activities meant finding support wherever or however they could. Several medical faculty talked about support from colleagues in their departments, which meant they could take time away to be involved in international experiences. In return, participants in this study covered the colleague’s work, so that they could also engage in opportunities they were passionate about. An administrator in the School of Medicine explained that there was a strong culture of volunteering among faculty in that school. This was true in dentistry as well, although faculty said they dealt with criticism from colleagues about international activities potentially taking away resources from the immediate geographical area. Dental faculty established a faculty committee as a vehicle to discuss and approve international experiences that created standard operating procedures and became a place to vent about challenges of working with international experiences. A dental faculty member explained that having this faculty committee helped build support for the experiences. 130 Campus and university support. Participants discussed support at the campus and university system levels, often in terms of not feeling supported by the main campus. They also felt administrative procedures for study abroad experiences put into place in recent years became burdensome. Faculty and administrators also talked about their view of the role of the Study Abroad Office in terms of supporting international experiences. Faculty in all three academic schools expressed concern about the level of support from the main campus in the LU university system, including what they felt was a lack of senior leadership support for international work at the LUMC campus. Although some of the international work at LUMC grew to involve the entire university system, faculty felt that leadership at the main campus still did not value the international work of the LUMC campus. Faculty also discussed how changes in administrative policies and procedures set by the main campus made developing international experiences more challenging. Approval processes for curricular and co-curricular international experiences became lengthier, discouraging faculty from wanting to start new experiences. Participants shared views about support from the Study Abroad Office. Law faculty expressed the least connection with the Study Abroad Office, viewing it primarily as working on safety issues and being more involved with undergraduate international experiences. Law faculty also explained that their school was used to a great deal of autonomy in most of their affairs. Faculty and program administrators in the School of Medicine expressed some frustration with paperwork required by the Study Abroad Office but generally thought the office provided helpful support in a number of ways, including navigating the university approval process for international experiences. Dental faculty expressed the strongest connection with the Study Abroad Office, believing it provided not only administrative support, but also 131 opportunities for their own continuing education and professional development. They even volunteered to help the Study Abroad Office pilot a new online system. Host country partners. In the cases of dentistry, law, and medicine, faculty, program administrators, and central campus administrators all echoed the importance of host country partners in developing and sustaining international experiences. Host country partners were primarily universities but also included community and nonprofit organizations for some of the experiences offered in medicine and dentistry. These partners provided logistical support for housing, setting up site visits, travel arrangements within country, and in the case of the health professions, sometimes assisting with licensing issues. It is important to note that participants viewed host country partners as far more than just providing logistical support. In all three cases it was clear that faculty and administrators at LUMC placed great value on these relationships. Making sure host country partners benefited from the relationships was a primary concern. As a dental faculty member stated, they were not in the host country to “impose their will and practices,” though that was at times challenging. The dean in the School of Medicine cited the “staying power” of long-term partner relationships abroad as a key factor in the success of maintaining international efforts. This point was echoed by the faculty director in law about the Asia program. A longstanding relationship with an Asian university resulted in loyal ties that helped sustain the partnership between the two even while other US institution law schools got involved in international work in that region. Curriculum Factor Another important component of the development of international experiences in each program was the connection to curriculum and curriculum structure. Connecting international experiences to the curriculum included the following: rationale for offering the experiences, the 132 different ways that the experiences became a formal part of the curriculum, and the role of external accrediting and professional bodies. Rationale. A number of common themes emerged in the data regarding the rationale for having international experiences as part of the curriculum in the three programs. Some themes were professional development or competency in the profession, including career preparation, cultural development or “horizon broadening,” and personal growth, including connecting more fully to the values of the discipline. Faculty and administrators in the three schools all discussed professional development or competencies within their specific discipline as an important rationale for bringing international experiences into the curriculum. One aspect of this was preparation for careers in the U.S., which looked slightly different when comparing the two health professions and law. For dentistry and medicine, doing clinical work in an international setting was important, meaning the opportunity for students to learn patient diagnoses and treatment planning in a low technology, low resource or more “hands on” environment. Another goal was to prepare students to work with growing immigrant populations in the U.S. Gaining communication skills was also part of professional development in dentistry. In law, professional development involved becoming knowledgeable about various aspects of international law. As a faculty member explained, no state in the U.S. was “rural enough” that practicing lawyers were not impacted by the laws of other countries. Additionally, many law firms had a section dealing with international law and valued the competence students gained in an international setting. Faculty considered knowledge of international law a necessity for students in order to prepare for future careers. 133 Personal development was also a common rationale. Faculty in all programs talked about the importance of students learning to see beyond their own ways of doing things. Participants in the two health professions spoke about students developing a deeper attitude of care for patients through participation in international experiences. The dean of medicine talked about these experiences as opportunities for students to reconnect with the values of the field – altruism and serving the underserved. He believed spending time in developing countries was one of the best ways to connect with these core values. A third rationale common across the three programs was cultural competence or knowledge related to the discipline, which was closely tied to both professional and personal development. Faculty in the three programs said they felt students could best gain cultural competence related to the discipline through experiences abroad. As faculty in dentistry stated, a formal goal for students was cultural competence, which they felt fostered the desire to work with diverse immigrant populations at home. General cultural awareness or “horizon broadening” was part of the rationale expressed across the three programs as well. Faculty spoke about students becoming better world citizens, gaining a different worldview, and developing a greater appreciation for life at home. As one law faculty noted, not all students had the opportunity to go abroad as undergraduates. Faculty in medicine and law also discussed the comparative understanding of different medical and legal systems that came from time spent abroad. One of the law faculty described a goal of professional development as “unintentional learning” or understanding the subtleties of international law that students gained from observing law practice in another country. Medical faculty indicated that the rationale for international experiences evolved over time from understanding different patient populations to developing a global health perspective. This 134 meant understanding the variety of ways healthcare happened across the world, which helped students understand the U.S. system better. One medical faculty highlighted a different goal for international experiences in the curriculum: inter-professional learning. The faculty member defined this as looking at competencies that cross disciplines within medicine, other healthcare areas, and other academic disciplines and reflecting on the common competencies, such as professionalism and team building. Formalization. The second key area was the ways in which international experiences became a formalized part of the curriculum. This happened differently in each of the three cases. In dentistry, formalization included written outcomes and assessments for student experiences and ensuring experiences were part of formal systems in the dental school, such as the academic calendar. In both healthcare professions, formalization involved connecting international experiences to competency-based curriculum, although faculty and administrators also noted the challenges of offering international experiences due to the structure of curriculum in those disciplines. Rigid or “lock-step” curriculum meant that there were issues related to timing of including international experiences. Faculty in medicine discussed the current separation of the basic science portions of the curriculum and the portion focusing on clinical work, which happened later in the MD program and was the main time available for international opportunities. One difference to note is that Medicine offered both for-credit and non-credit international experiences. The non-credit experiences were primarily offered in spring break of the first year or between the first and second year of the program. Although not formally part of the curriculum structure, faculty and program managers considered these experiences an important part of the school’s offerings. This may be tied to what an administrator described as a 135 culture of service in the School of Medicine, which also included many local service opportunities. The School of Medicine did not define service learning as credit bearing. In contrast, dentistry adopted the LUMC definition of service learning as “for credit,” because from the beginning, their goal was to make the international experiences an “academic experience.” Over time, faculty formalized this goal in focused ways, starting by offering international experiences as an elective and then adding a semester-long preparation course. In the future, faculty thought some portions of the preparation course would become mandatory. Additionally, while students in medicine also completed reflective assignments for their international experiences, the School of Dentistry was the only program with a formalized assessment of student outcomes. Dental faculty also mentioned that the service learning model provided a common structure for international experiences and helped them decide what components to include. Both health professions also had a competency based curriculum, and faculty and administrators tied the international experiences closely to the school competencies, such as cultural skills, and also to the competencies set by accrediting bodies. Faculty in medicine discussed the broader structure of medical education and the trend towards competency-based curriculum. At LU, however, competencies were integrated even more fully into the curriculum structure so that a focus on competencies was “systemic” and “institutionalized” beyond what was required in medical education. MD students were not required to meet competencies through international experiences, but for-credit international options were always tied closely to appropriate competencies. Faculty in medicine and dentistry tied the international experiences to administrative structures in the academic schools, including being part of the course schedule, on the calendar 136 or “on the books” so that there were not conflicts with other offerings. In the JD program in the School of Law, formalization of the curriculum took a different form. The school’s strategic plan included enhancing international experiences for students and making sure these experiences were part of the “breadth of offerings.” However, due to the elimination of some summer study abroad programs, the law school needed to look more broadly at how they could give students “international competence.” Participants in law emphasized that although part of their goal was to get students “abroad in some fashion,” other ways to “boost the international curriculum,” included international law content in campus-based courses and involving international students and scholars in classroom discussions, lectures, and other events. Accreditation. Another piece of connecting to curriculum was the role of accrediting bodies in the three academic disciplines, although this did not emerge as a strong factor related to development of international experiences. Of the three academic programs, law had more influence from its accrediting organization compared to the two health professions. Competencies were part of the normal curriculum in dental and medical education; however, accrediting organizations did not require students to meet competencies through international experiences. One dental faculty commented she had never seen a session on any international topic at an American Dental Association (ADA) conference. As in dentistry, faculty in medicine connected international experiences to curriculum requirements of accrediting bodies rather than the reverse. Faculty commented about potential changes to the structure of medical school curriculum in the broader field of medicine. One aspect under consideration was increased integration of basic science curriculum and clinical experiences, which could allow for more diverse options of international experiences in the future. Additionally, faculty mentioned a 137 consortium of global health that was trying to develop sample curriculum. At the time of this study, LU offered a global health track for residents but not yet for MD students. Law had the strongest link between its accrediting body, the American Bar Association, and its international experiences. The ABA did not necessarily drive the original creation of international experiences, but did play a role in regulating and setting guidelines for study abroad programs. Law schools also increasingly competed with each other to enroll students in international programs. Faculty commented that the field was undergoing structural changes, including fewer students taking the LSAT and graduates competing for fewer jobs. Law schools, not only LU, shut down some international experiences or merged them with other law schools’ study abroad programs. Connecting Factor The fourth crucial factor that emerged across sites was connecting. This included connection to systems, priorities, values, and missions at the department, academic school, and campus levels. Connecting is particularly difficult to discuss as a discrete factor, as it draws upon the other factors already mentioned. As one of the dental faculty explained with regard to implementing international experiences, “You have to be part of the three-ring circus” and “utilize the university mechanisms.” Connecting the international experiences meant first connecting them to institutional systems, particularly at the school level. As discussed in the curriculum factor, part of the process of formalizing curriculum for the two health professions meant getting the international experiences integrated into formal systems, such as the calendar, course schedule, and even on the list of activities offered in the school. It was important to be connected to the regular administrative processes and systems and not have the international opportunities 138 become “separate experiences.” Connecting to existing administrative systems helped “circumvent barriers that would exist,” especially when international experiences were new. Connecting also meant tying international experiences to campus and university level systems. One example was connecting to the study abroad office, particularly related to administrative processes, including student safety and liability, reports, and also the university system-level approval process for offering international experiences. As discussed in the section on support, faculty in dentistry most closely aligned themselves with the Study Abroad Office, while the law school aligned the least closely. Dental faculty saw the study abroad office as not only providing a variety of support and professional development opportunities but also as a way to further their goals in offering international experiences. Their involvement with the Study Abroad Office gave them a “seat at the table” Faculty and administrators across all three schools expressed less of a connection with the main campus and some of the university system-level processes. Several mentioned that system-level administrative processes for creating and approving international experiences became more burdensome over the years, and they found it more difficult to get a new experience going than in the past. There was also concern that LUMC did not always receive the level of visibility from the main campus for their international work that participants thought should be the case. Another key aspect of connecting was integrating international experiences into the missions and strategic plans of the three schools. Participants in all programs indicated that part of each school’s mission was to provide international opportunities for students, and that some aspect of internationalization was incorporated into their strategic plan. Sometimes, this was a formal approach as in Law, which included offering study abroad opportunities, international law 139 courses, co-curricular experiences on campus, and hiring faculty with international portfolios. In Dentistry, international service learning was part of a broader program goal of increased intercultural competence and building community service. Although I did not locate a recent formal strategic plan for the School of Medicine, medical faculty closely connected international experiences to academic systems in the school, integrating them into the competency based curriculum structure. In the previous section on curriculum, the importance of connecting international experiences to the values within the academic disciplines was one of the primary reasons faculty shared for starting the experiences. Connecting experiences to institutional values, particularly at the academic school and campus levels, was also important. This emerged most clearly in dentistry. Several faculty wanted to offer international experiences for students for a long time, however, they could not get support from senior administration. This changed once the faculty developed a plan to offer the international experiences in a format that connected to broader institutional, campus level priorities, specifically service learning. As one member stated, faculty were able to get the experiences going once they connected with broader campus goals that were “highly valued,” which got the experiences on the radar of school level leadership. What the dental faculty did not expect was the way the international service learning experiences became an umbrella model that also created “spin-offs” or connections to research work, alumni fund raising, and other opportunities. An important point about connecting to values and priorities is that connections run in both directions – from academic school to broader institution as well as the reverse. At LUMC, the institution connected to the international work started by the School of Medicine in particular; each of the primary institutional-level international partnerships started with 140 Medicine, LUMC’s most “influential” school. In recent years, several campus and system-level international efforts built on the partnerships started by Medicine. One challenge in connecting international experiences at the school level was lack of a central person or office to coordinate international activities. As noted by a law faculty, this often caused international activities to develop in an “ad hoc” fashion around the interests of individual faculty, which was “organic but not sustainable.” Law faculty commented about the fact that many other law schools had a lead international person or office, but the LU School of Law did not, which they felt hindered coordination of international efforts. A new international center on global health in the School of Medicine represented efforts to connect international work to all three university missions – service, training, and research. Another goal was to provide more connection of international activities across departments within medicine, as well as across healthcare disciplines and other academic schools on the LUMC campus and in the LU system. Part of the new center’s goal was to provide opportunities for information sharing and potentially help faculty and administrators “get out of medical silos.” The center was also intended to give the medical school more opportunity to be part of conversations on global health across schools of medicine. Finally, in the law school, a faculty member took on a new role to coordinate international work and activities in hopes of providing more opportunities to connect. The new role was one of information dissemination and idea sharing across the law school and to external constituencies that did not exist in the past, so that there were opportunities for others to be aware of the international activities going on in the school and to become involved. The role also was intended to help avoid duplication of international efforts and programs. A common 141 aspect of the coordination efforts underway in medicine and law at LU was that the new roles and offices were not established to provide managerial control of international activities or to control the work of faculty members. Another important point to note is some of the common values that emerged across the three programs and that provided a glimpse into the broader campus culture at LUMC. For example, faculty, program administrators, deans, and campus administrators all expressed valuing of host country partners which meant ensuring there was reciprocity in relationships abroad. That sentiment was also reflected in the way that international partnerships developed more broadly on the LUMC campus in recent years. In the next chapter, I move to a discussion of the key findings related to available literature and provide recommendations for future research, policy, and practice. 142 Chapter 9: Discussion The findings chapters bring to light key organizational factors related to the development of international experiences in three graduate professional programs. The cross-case analysis highlights how these factors compared within and across the three academic programs. In the discussion, I first briefly review the core factors identified as important in developing international experiences in the three graduate professional programs. I then discuss how the results answer not only the question of getting the international experiences off the ground but also the factors and challenges involved in maintaining the experiences over time. Additionally, I provide a discussion and definition of sustainability based on results of this study. Next, I consider the importance of academic discipline in shaping how the international experiences at LUMC developed, the value of using an integrated organizational approach as a conceptual framework, and the importance of understanding the impact of various organizational layers. Finally, I discuss implications of the current study for research, policy, and practice. Getting International Experiences off the Ground Analysis of the data showed that four organizational factors were crucial in developing and implementing international experiences. In particular, faculty “grassroots” initiatives and some level of support from leadership in the academic schools stood out as two key factors. Faculty’s own life experiences, motivations, and passion for international involvement, plus some level of verbal support from leadership, got the experiences off the ground. In some cases, leadership support simply meant not preventing faculty from becoming involved with international experiences for students, even if department or school leaders did not strongly support faculty with funding or release time. Leadership support also meant “cheerleading,” as in the case of medicine. 143 Additionally, cultural support emerged as important at various levels of the organization. Some clinical faculty were able to become involved in international work due to the support of colleagues and a department culture of support that allowed faculty to be away to engage their particular passions. Support in terms of funding, work time, and staffing was rare, particularly at the beginning, regardless of the type of international experience being developed. Faculty talked about starting the experiences “on their own dime, their own time.” In some cases travel costs for faculty were covered by their department but in other cases they were not. As the current study showed, support meant far more than resources. Individual faculty interest and motivation played perhaps the greatest role in developing and implementing international experiences for students. In the cases of dentistry and some of the international experiences in medicine, a small group of faculty connected early on to develop the experiences. Faculty built the experiences from the ground up, not due to any type of topdown initiative mandated by university administration. As Croom (2010) documented, international activities, such as experiences for students, tend to get built “bottom-up” through the efforts primarily of faculty members. The current study showed that faculty and administrators became involved with international work to provide experiences for students and to remain involved in work they cared about. As a faculty member in medicine commented, international experiences developed in part so that faculty could “scratch their own global itch.” Maintaining International Experiences Although participants in the current study described themselves as willing “volunteers,” there were certainly many challenges they faced in trying to keep the international experiences going. The research questions in this study focused on developing and implementing international experiences or getting these experiences off the ground. At the time I proposed this 144 topic, I expected that graduate professional programs would not have offered student international experiences for a long period of time. Available data from sources such as Open Doors indicated that there was significant recent growth in graduate students participating in study abroad (IIE, 2013). For that reason the research questions did not include the idea of maintaining or sustaining international experiences over time. In analyzing the findings I realized that participants in the study spoke not only about getting international experiences started but also a great deal about the challenges of maintaining them, as the experiences existed for a number of years in most cases. Becoming part of the “three-ring circus,” a metaphor used frequently by a faculty member in dentistry, captured a core part of what maintaining the international experiences meant. Participants talked about the importance and challenges of being part of the circus at a variety of organizational levels, especially within departments and the academic school. Connecting international experiences to institutional structures, systems, priorities, values and strategic plans did not necessarily happen right at the beginning but was critical to developing and maintaining the international experiences over time. The more the experiences became part of the structures, systems, and values of the academic school, the more they continued in spite of many challenges. Becoming part of the system and structures included integration into course systems, calendars, and the curriculum of each of the three schools. Increased integration, or “being part of the circus” of systems and structures brought its own challenges, however. As faculty explained, continued integration into systems and structures in their academic schools sometimes took more “political will” than they could muster. Although faculty got many international experiences started without time, staff, or money allocated to support the experiences, these resources became some of the main challenges of 145 keeping the international activities going. Faculty work time was a common challenge among participants, especially for clinical faculty in the two health professions. Even in law, where faculty had a more formal international portfolio, extra time was often required to support the international experiences for students. Lack of clerical staff support was a frequent challenge, especially in dentistry and medicine. For example, faculty in dentistry lobbied many years for support staff and only recently received a half-time assistant to provide logistical support. That was also after much begging for time from other administrative staff that did not see supporting international experiences as part of their job descriptions. Funding for faculty participation depended primarily on departmental support, although LUMC did offer a limited number of small “start-up” grants for international work, which a few faculty in the current study obtained. Funding for international experiences varied some by type of international work of which they were a part. International activity that focused solely on student involvement was funded primarily by the students themselves with faculty assisting them in fundraising opportunities at times, especially in dentistry. Faculty in medicine also assisted students with fundraising for a time but found they could not continue such efforts due to the amount of work and time involved. Funding for faculty participation varied by department and was most difficult for some of the clinical faculty, particularly if department leadership did not support time away from core work activities. The Africa program in the School of Medicine was perhaps different than other international work in the current study. As the director of the program explained, the work in Africa was started with a focus on faculty involvement; student participation came later. Health related research was also a core component of the Africa program, which was therefore able to obtain external grant funding. However, faculty involved in the Africa program expressed that it was still challenging to gain external funding for “educative experiences” for students. 146 One key point was the tension between positive outcomes of international experiences versus having them become too large a part of the ongoing work of an academic school. Over time, the international experiences became part of formal strategic plans, at least nominally. However, as faculty explained, having all leaders at the department and academic school levels value the international experiences was not the same as getting support for them. Participants described that most people in their academic schools supported international experiences at least “in concept.” However, the challenges of integrating them into the structures, systems, and values of an academic school were ongoing. Valuing something “in concept” was a long way from having it as a core part of the academic schools. Loving an activity “when it’s over” did not indicate that the activity was necessarily a central part of the work of that unit. Senior leadership appreciated the positive impact international experiences had from the view of alumni groups and the visibility the experiences brought to their school. However, continued commitment to support the experiences, particularly with faculty work time and funding, was challenging. As a senior administrator in dentistry explained, international activities were “fun work” but also “a drain and distraction” if they became too much a part of the school’s activities. The tensions that played out between the benefits of the international experiences and the challenges of maintaining them were expressed particularly by school-level academic leadership. I interviewed a dean or assistant dean from each of the three schools and it became clear that this was a crucial level of leadership in giving not only moral support to start the experiences but also ongoing support to continue them. The deans and assistant deans in the current study discussed faculty work time and revenue as major challenges in maintaining international experiences. As the assistant dean in law mentioned, having students away on international experiences meant 147 that they were not enrolling at home, which impacted revenue at the school level. Therefore, the dean made the decision to decrease tuition subsidies for students participating in the experiences. An additional challenge came from integrating international experiences into the curriculum. As dentistry and medical faculty noted, part of integration came from making sure the international experiences were part of the calendar or “on the books.” Other challenges resulted from fitting the experiences into the curriculum structures of each program. Medicine had a competency-based curriculum, which was in part a reflection of curriculum in the field but developed to an even greater degree at LU. Faculty ensured that the international experiences connected to particular competencies. Law faculty and administrators felt having a variety of offerings in the curriculum with an international focus was essential. This meant not only offering opportunities for students to get outside of the U.S. but also offering courses on international and comparative law and opportunities to interact with international students and scholars on campus. There were challenges, however, in the continued integration of international experiences into the curriculum. Faculty in medicine and dentistry discussed the problem of a rigid, “lockstep” curriculum structure, which did not allow for students to engage in international experiences during large portions of their education. Medical faculty also discussed bringing global health curriculum to MD students as a challenge. LUMC offered a global health track for residents; however, participants in this study commented that there was not support among all areas of upper administration to develop global health curriculum for MD students. Buy-in from faculty colleagues was also a challenge. Dental faculty discussed how they developed a faculty committee over time to address such challenges. The committee gave other faculty, including the “naysayers,” opportunities to have a voice in the ongoing development of 148 the international service-learning experiences. At the institutional level, LU senior administrators also worked over time to develop a more strategic institutional focus to the international work, creating faculty learning and discussion groups as part of that process and opportunities for others in the institution to become involved. The Former LUMC provost described the importance of connecting international experiences to mission in order to help build sustainability: It’s there in our mission statement. And I think that endures beyond any change in leadership. So I think being able to get enough of an institution’s buy-in to that as a value, as a part of mission is really critically important. It’s not easy to do, but it’s something you have to build. Although there was an LUMC campus priority on building sustainability of international efforts, participants in the current study frequently expressed that they did not feel buy-in from LU system level senior leadership. Faculty also commented that some of the newer administrative processes related to international experiences implemented at the system level were burdensome. Some faculty stated these new processes would keep them from wanting to start new international experiences. Sustainability The results of the current study highlighted not only the challenges of developing and maintaining international experiences but also factors that led to sustainability. The research questions of this study did not focus on sustainability; however, the three cases of law, medicine, and dentistry provided some understanding of how international experiences became institutionalized. Sustainability appeared as something deeper than whether a particular international experience continued permanently or not. In this section, I highlight several aspects of sustainability that emerged from my data. The first was the importance not only of support for international experiences but also of valuing 149 them. The second aspect of sustainability came from looking at how international experiences continued in spite of huge challenges within faculty work. Finally, increasing connections of international experiences within academic schools and across academic disciplines and subdisciplines was an important piece of sustainability. The data in this study highlight the idea that sustainability was more than just keeping a particular international experience going. An example is School of Law, which had to eliminate several summer international experiences for students for various reasons, as discussed in the findings section. However, faculty and academic leadership expressed that providing international experiences for students was still a part of the strategic plan and the education portfolio they wished to offer students. Value for the international experiences remained, but faculty had to look at other ways of carrying out the goals of the experiences. The case of law showed that there were times when it was necessary to eliminate an experience, yet the value that experience represented still remained part of the law school’s mission, allowing faculty to consider different ways of accomplishing goals. Some international experiences in dentistry and medicine were also eliminated at different times due to conditions in the developing countries where the international experiences took place. Faculty and administrators worked to find alternate locations when possible. The desire to include international experiences for students did not diminish on the part of nearly all those interviewed for the current study because there was strong value attached to them. Additionally, even without much resource support, international experiences still became a sustainable part of the work of the academic programs in various ways. The DDS program in dentistry represented an interesting example of developing international experiences around a growing institutional priority, service learning, and connecting the experiences to an institutional 150 value early on. Faculty also helped build value for the international experiences by making them academic. Most international experiences in the three programs were for credit. Medicine also offered non-credit international experiences. Non-credit volunteer experiences were a strong part of the culture of the School of Medicine in general. Faculty in law expressed the value of international experiences by looking at ways to incorporate other types of international activity on campus. Attaching international experiences to valued priorities within schools and in the broader institution helped build sustainability. The continued challenge of financial and staff resources, however, did show that building commitment for the international experiences was still ongoing. Another key point in understanding sustainability of international experiences at LU was faculty work. Although most of the faculty and program managers said time in their workload was one of the biggest challenges of being involved with international experiences, somehow these same individuals stayed involved for a number of years. They also described lack of funding and clerical staff support as major challenges to sustainability. Other literature confirms funding as a key challenge for faculty engagement in internationalization. For example, Green and Olson (2008) described funding as one of the major institutional challenges for faculty involvement. However, at LUMC international experiences started and continued through such challenges due to a number of faculty and administrative champions and their passion for international engagement. Numerous authors cite faculty as a key driver of internationalization (Childress, 2010; Green & Olson, 2008; Helms & Asfaw, 2013; Hudzik, 2010). At the same time, literature on internationalization shows faculty champions as a challenge in sustaining international efforts (Amey, 2010). Faculty champions may leave or discontinue their involvement with no one to 151 continue work (Amey). Although LU was not immune to this issue, there were pockets of sustainability that emerged and grew larger than a single faculty member. One example is the School of Dentistry where three faculty members connected early on and approached the development of international experiences as a team. Two of them worked in departments where international work tied in well with the department mission. The third faculty in a primarily clinical role had more difficulty connecting international experiences to the work of his department. However, as a team, the faculty supported each other’s efforts to build the experiences and also to find opportunities to develop themselves professionally. A senior administrator in international programs confirmed how this team approach in dentistry helped build sustainability of the dental school’s international experiences. I think once you get they buy-in of the faculty and enough people participating so you build a knowledge base within the school, I think there’s a real – it can sustain and perpetuate itself. If one faculty member has to do all the heavy lifting, they can get burned out and the experience can easily fizzle out, whereas in the School of Dentistry, there’s been a couple of key faculty who have been leaders in developing and working with each other to develop the programs. Over time, dental faculty developed a formal model of running all international experiences for students under a service learning umbrella. Their team efforts allowed them to build and refine a framework, resulting in increasing integration into the dental curriculum. The “spin-offs” of other faculty becoming involved in the service learning model were not intended at the beginning but added to the sustainability of international experiences. In the School of Medicine, the largest of LU’s professional schools, international experiences became situated in departments with the faculty that started them. The program in Africa started with faculty work in mind and involved students later. The Africa program involved multiple types of international work much broader than just student experiences and over time included other academic departments and schools within LU and across the LU 152 system. In fact, LUMC built a larger university partnership in Africa from the program developed by the School of Medicine. Both the Schools of Law and Medicine were involved in recent efforts to build forums allowing for greater involvement of others and increased sustainability of international efforts. In medicine, faculty created a new global health center; in law, a faculty member became the new coordinator of international activities, not in a managerial capacity but in a communication role to allow others “to play in the same field.” Those recent efforts within law and medicine illustrated a third crucial aspect of sustainability: connecting. In medicine, the faculty director of the new global health office described plans to help those interested in global health issues connect across disciplines within medicine, with other disciplines in the health professions, as well as to connect with other LU professional schools, the LUMC campus, and the broader university system. In law, a faculty member received a new appointment to facilitate coordination of international efforts. The goals for this new role were to those of the new office in medicine. The focus was especially to increase communication about the variety of international activities happening in the law school and providing a forum for others to become involved. The law and medicine faculty involved in these new coordination efforts expressed similar sentiments that international experiences may not remain sustainable if resting on the backs of one faculty champion or even one department. They also discussed benefits that could potentially happen through increased connection, including greater interprofessional collaboration. In her case study research on engaging faculty in internationalization, Childress (2010) referred to this type of connecting as the principle of coordination. Childress found that Duke University’s support system for “planning, policy development, and information 153 sharing” (p. 70) among faculty impacted the development of internationalization efforts positively. Also noteworthy in sustaining international experiences was how participants in all three programs focused on building long-lasting partnerships abroad. Faculty, staff, and administrators in each of the three schools, as well as in the broader campus, sought to develop long-term and multi-dimensional relationships with international partners. Faculty in the health professions commented often that they did not use a medical tourism approach, flying in to one place one year and a different place another year. They worked to build partnerships that continued, and all three schools had partnerships lasting over a number of years. LUMC campus administrators built on the international partnerships that started in the professional schools, particularly those developed in medicine. A current theme in the literature related to internationalization echoes the importance of sustainable international partnerships (Sutton, 2010). The data from this study indicated that the heart of sustainability is a combination of factors that took the international experiences beyond one faculty champion. International experiences became part of the work of the three academic programs in different ways, even though many challenges remained in keeping the experiences going. Although some of the international experiences were discontinued, faculty and administrators showed that they still valued what the experiences represented by looking for other ways to accomplish them. The development of international experiences at LUMC in dentistry, medicine, and law provided a potential definition of sustainability through metaphors that participants themselves used. The experiences would not have existed without passionate faculty and administrators who developed them through “grassroots” efforts. International experiences grew in many cases 154 beyond initial faculty champions, although many of those individuals remained involved for a long time. The first metaphor that captured sustainability in the current study was “being part of the three-ring circus” or the importance of connecting to institutional systems, structures, processes, and values. The second metaphor was allowing others to “play in the same field” or providing opportunities for connection of people and ideas across people, departments, disciplines, sub-disciplines, the campus, and the broader university system. Finally, the data from the current study indicated that serendipity played a role in sustainability, making room for and incorporating those unexpected connections and outcomes that participants did not anticipate at the beginning. The Academic Discipline In addition to the factors involved in developing, maintaining, and sustaining international experiences, the data from the current study showed that the academic discipline played a key shaping role. The academic disciplinary environment included culture and values of the discipline, as well as connection to and role of accrediting and professional associations in the discipline. The professional disciplines of dentistry, medicine, and law shaped the development of international experiences in each of the academic programs. Data from this study indicated that academic disciplines connected to the inception, continuation, and longer-term sustainability of the experiences. Faculty and administrators spoke about international experiences as a way to not only connect students with disciplinary values but to re-connect with those values themselves. Becher (1981) noted that disciplines have different beliefs, values, and language, which certainly emerged in the current study. Discipline-based connections also happened in faculty members’ goals to build skills and knowledge for students in an international setting. 155 This played out in slightly different ways in the two health professions compared to law. Faculty in dentistry and medicine spoke about having students gain skills practicing health care in low resource settings and then being able to interact with immigrant populations they might treat in their future practices in the U.S. Law faculty commented about how international law affected nearly every area of law practice in the U.S. Such results of the current study are in line with several concept articles written as part of the NAFSA: Association of International Educators’ series on internationalizing graduate education that reinforce disciplinary connections noted above (Fernandez, 2014; Leggett, 2009; Tobenkin, 2009). For example, Fernandez described the importance of dental students gaining “hands-on experience not offered in traditional clinical rotations to a commitment to do good with one’s career (p. 36)” and to work with immigrant populations back home. Another point of discipline-based connection to international experiences was accrediting agencies and professional associations. In the current study, I found that accrediting and professional associations were not key drivers of why international experiences got off the ground in the law, medicine, or dentistry programs at LUMC. In law, the accrediting body played a strong shaping role in how international experiences were carried out. In the two health professions, faculty connected the international experiences to accrediting and professional association goals. For instance, according to participants in this study, medicine and dentistry had in part a competency-based curriculum. LUMC showed how they met these competencies through international experiences, although associations did not require competencies to be met in this way. Faculty in medicine commented that the professional associations did not dictate offering international experiences. Accrediting bodies played more of a role in regulating such things as ensuring medical students were supervised by board approved or board eligible 156 physicians at all times, which included overseas experiences. However, associations such as the Consortium of Universities for Global Health provided a vehicle to support and connect medical programs working on global health issues. Dentistry faculty expressed probably the weakest connection between professional and accrediting associations and development of international experiences. The Commission on Dental Accreditation (CODA) did not dictate that dental programs should offer international experiences. However, literature indicates that dental programs have a long history of including experiential education, such as service learning, in the curriculum (Yoder, 2006). The international experiences offered in dentistry at LUMC were framed as a service learning model. It is important to note that service learning, however, does not necessarily mean exactly the same thing across dental programs (Yoder). Law had the strongest connection to its accrediting organization, the American Bar Association (ABA). Faculty in the LU School of Law at LUMC discussed the strong shaping role of the ABA in the development of international or study abroad opportunities. Ferguson (2010) explained that “law school study abroad programs are distinctive in that they evolved and are required to function within a tight framework of rules developed by the ABA’s Section on Legal Education and Admissions to the Bar” (p. 5). For example, ABA representatives must visit each international site in order for the study abroad program to be offered (Ferguson), which was the case for LU. Additionally, the ABA has regulatory criteria for summer and semester study abroad programs, as well as for earning credits at foreign institutions (Ferguson). There was also much more awareness across law schools of what other schools offered, as well as consortium building among law schools in running international programs Although the ABA played a strong shaping role for LU’s study abroad program, the association was still not a 157 primary reason why the international experiences began in the first place. Faculty interest was still the primary driver. It is worth noting that accrediting bodies did not play as strong a role in the development of international experiences as I expected at the outset of the study. I may have found differences in this regard if there had been some other academic disciplines, such as social work or business, as part of my research. There are academic disciplines in which the accrediting and professional associations do indicate that there should be an international focus within the curriculum. However, this does not necessarily mean that some type of international content has to be carried out through offering experiences outside of the U.S., which was the focus of the current study. As I learned in the case of law, international experiences can also happen on campus, and the LU Law School was actively considering ways to provide such experiences, especially in light of having to cut back on study abroad options. It is also important to mention that my findings are based on the perspectives of the participants I interviewed. A different study focused primarily on university leaders might have given other views of the role of accrediting and professional bodies. This is not to say there was no role of such associations in this study; I just found that accrediting and professional organizations in the academic disciplines I included did not dictate that these three academic programs create international experiences for their students. Additionally, there was a longer history of the international activities in each of the three programs than I expected, particularly in medicine and dentistry. Perhaps accrediting bodies may have a greater role in the current environment or in the future than what I saw. Finally, I note again that based on the results of my study, a shaping role, where an accrediting body has influence on the development of international experiences, is different than being a true driver, or a key factor that instigated the development of the experience in the beginning. 158 An additional difference in the discipline of law was the overall climate of the field. As faculty participants in the current study explained, in recent years the law employment market declined, resulting in law schools experiencing drops in enrollment. Decreased enrollments in turn impacted the ability of law schools to offer as many international experiences as they once did. The downturn of the U.S. economy following 2008 also impacted law students’ interest in participating in LU’s study abroad programs. The law school at LUMC had an older student population due to its urban location and history. The student demographics, when combined with the economic downturn and challenges faced more broadly by law schools, led to LU’s decision to cut a number of international experiences. Dentistry and medicine did not face the same impact from external factors to their international experiences. In fact, enrollment in the dental experiences grew to include 50% of DDS students. A number of authors commented not only on how academic discipline shapes the development of international experiences but also cite discipline as a potential barrier or challenge to internationalization. Green and Olson (2008) listed disciplinary divisions and priorities as one of three key institutional barriers. This is in part due to faculty being more focused on disciplinary priorities and issues, as well as politics within academic departments (Childress, 2010; Green & Olson). However, in the current study, I found that faculty also paid attention to institutional priorities, which then partly shaped the development of the international experiences, for example, the service-learning umbrella for international experiences in dentistry, that grew in part from an institutional priority. The Integrated Organizational Framework One of the primary tools that illuminated the factors involved in the development of graduate student international experiences was the integrated organizational framework (Bolman 159 & Deal, 2003). The integrated framework ties together four organizational frames: structural, human resource, political, and symbolic (Bolman & Deal, 2003). As described in chapter one, organizational factors include policies, people and roles, funding, environments, planning, decision making, and beliefs and values, and these factors contribute to how and whether new initiatives are implemented and supported (Bolman & Deal, 2003; Morgan, 2006; Scott & Davis, 2007). Rather than conducting a study of each of these factors in a discrete way, the integrated organizational framework allowed me to see which factors bubbled to the surface at different times, or simultaneously, and brought out the meanings ascribed to organizational factors by participants in the study. Additionally, the integrated framework allowed me as the researcher to see that there are multiple perspectives with which to view the work going on in an institution. As Bolman and Deal (2003) noted, participants in an organization may view the same event through different lenses. Additionally, the current study showed that multiple frames were often present at the same time, depending on the viewpoint of the participant, and that certain frames also appeared more prominently within different factors. Rarely was a single organizational frame at work. The table below provides a view of the different frames as a researcher I saw at work in the findings that emerged in this study. Using an integrated organizational framework meant that I did not pre-define various terms and that I was able to see the multiple perspectives of participants that emerged. For example, the term “support” meant different things to participants in this study. Faculty discussed support in terms of resources as an ongoing challenge. In this context, support represented a political frame or competition for scarce resources (Bolman & Deal, 2003). From the dean of medicine’s perspective, support did not mean providing funding, but instead meant 160 Table 1: Organizational Frames Factor/Finding Dominant Organizational Frame(s) Faculty background and motivation Structural, human resource, symbolic Faculty work and roles Structural, political, human resource Faculty grassroots efforts Political, symbolic Serendipity Symbolic Support: resources (funding, support staff) Political, symbolic Support: leadership Human resource, political, symbolic Support: faculty colleagues Human resource, symbolic Support: campus/university system Structural, political, human resource Support: host country partners Structural, human resource, symbolic Curriculum: rationale Structural, human resource, symbolic Curriculum: formalization Structural, political, human resource Curriculum: accrediting organizations Structural, political, human resource Connecting to administrative systems Structural, political Connecting to missions, strategic plans Structural, political, human resource, symbolic Connecting across people, departments, schools, disciplines Sustainability Structural, political, human resource, symbolic Structural, political, human resource, symbolic cheerleading or providing moral support, which indicated a human resource frame (Bolman & Deal, 2003). One of the clinical faculty in medicine provided another example of a human resource view of support. The faculty member discussed how he was able to leave for a week to go abroad because colleagues covered his work; in turn, he covered the colleague’s work so that 161 person could participate in an outside activity he valued. This faculty’s example also connected to the symbolic frame, as participation in activities outside of the workplace was a shared value in his department (Bolman & Deal). An important distinction brought to light by the integrated frame was the difference between support of an activity and value of it; support was not necessarily equal to value. Participants described that even though they got at least verbal support from leadership to start an international experience, it did not mean the experience was valued at the beginning. On the other hand, pulling back support for various reasons did not mean that people in the organization valued international experiences less, as discussed in the case of law. The law school was no longer able to provide the same level of support for some international experiences that were no longer economically viable. Instead, faculty and administrators expressed their continued value of international experiences by incorporating them in other ways. Another example is faculty work and roles. From a structural view, there were different types of faculty roles present in the three academic programs, some of which allowed for easier involvement in the international experiences. A political frame was also present in that some departmental priorities incorporated faculty involvement better than others. A human resource frame emerged in faculty work within the Law School, as hiring practices involved finding faculty with an international portfolio. Faculty grassroots efforts, developing the international experiences from the ground up, highlight both the political lens in terms of faculty control of the experiences and the symbolic frame, emphasizing the important value faculty place on academic freedom. As Bolman and Deal (2003) noted, certain frames tend to emerge when there is greater complexity surrounding organizational events, particularly the human resource and symbolic 162 frames. I found this to be true with a number of the factors that emerged in my study. I expected to see the political frame related to support, which appeared in my study when participants discussed the challenges of time, support staff, and funding. I also surmised from the literature that a structural view could in part explain why faculty wanted to start international experiences, meaning they were essential for students practicing within various disciplines in an increasingly global environment. I was not expecting the strong human resource view, which appeared as a type of support in cheerleading from leadership and the support of colleagues in some departments for involved faculty to carry out what was mostly extra, volunteer work. The symbolic frame was present in many areas, in addition to support, such as rationale for having the international experiences in connecting to the values of the discipline, as well as keeping faculty connected to work they cared about, and doing it in a way that upheld the value of academic freedom or a “grassroots” approach. All organizational frames were present in the idea of sustainability. As I learned through this research project, sustainability was far more than just keeping the international experiences going. There was the symbolic faculty champion present in starting each of the international experiences. Literature also cites the challenges of relying on a single faculty champion in terms of human resources, in that it is a problem when that faculty champion leaves or is no longer interested in coordinating international activities (Amey, 2010). The current study showed, however, that there is much more to consider in the sustainability of international experiences in graduate programs. I found the human resource and symbolic frames particularly important in understanding the data I obtained in this study. A structural view, while helpful in understanding why faculty started international experiences, does not necessarily provide the best explanation of why faculty continued to maintain these experiences often for many years in spite of 163 incredible challenges related to work time, funding, and support. Somehow, faculty remained involved anyway. The human resource lens showed participants in the study connected personally and professionally to being involved with international experiences – or to “scratch their global itch” as one faculty member explained. Remaining involved in activities they cared about was important. The symbolic frame was also highly important in understanding sustainability of international experiences, as they connected to values of the discipline and of faculty work, including academic freedom attached to grassroots efforts. The political frame was strongly present as well, not just in the idea of having to compete for resources to keep international experiences going but also in becoming “part of the circus” or ensuring international experiences were connected to university systems and priorities. Sustainability of organizational activities is highly complex and requires the view of all four organizational frames. The current study showed that a single organizational frame would not have been enough to understand the complexity of organizational life that surrounded development and sustainability of international experiences in the graduate professional programs. Heyl (2007) proposed Bolman and Deal’s (2003) four organizational frames as a way for senior international officers (SIOs) charged with leading international efforts to understand their colleges and universities, which are often large, complex organizations. Heyl suggested the four frames as a way to equip SIOs to better “initiate and sustain change” (2007, p.7) related to campus internationalization. He explained that “all four of these frames are likely to be relevant at one time or another and in one domain of the university or another, sometimes simultaneously” (p. 6). In the current study, the integrated organizational framework showed that Heyl’s suppositions were the case - not only that all four frames were relevant but also that participants 164 viewed events in the workplace in different ways. The integrated lens also brought out understanding of factors that could be missed through a study of discrete pieces of organizational work or through the use of one organizational lens. Integrating frames does not give a prescription for how organizational events happen or why, but does highlight the different meanings members of an organization ascribe to events and activities in the workplace. Some other research approaches related to campus internationalization use a lens of a planning process. While I do not mean to say there was no planning involved in developing international experiences in the three graduate professional programs at LUMC, I did not want to assume there was a particular planning process at work or some kind of linear, rational approach. There were certainly participants in the current study with goals and motivations for getting international experiences off the ground, but I believe my understanding would have been limited by such an approach, and I may have missed parts of the puzzle that were important in not only developing but also sustaining international experiences in the three graduate professional programs. Keeping the international experiences going in the midst of major resource challenges was not necessarily based on rational planning and measurement. There was much more going on, which the integrated frames approach helped me understand. Perhaps the limitation of an integrated view of organizational frames is that it does not go far enough in untangling the complexity of organizational life in a way that might provide more specific guidance for leaders and managers. A potential additional lens that may prove useful is systems theory. Systems theory recognizes that individuals have a particular view that impacts how they approach life in their organizations (Anderson et al., 2006). It also recognizes that there are political and symbolic processes involved in organizational life, and that system 165 structures are socially constructed and have impacts on policy and practice (Anderson et al.). Systems theory has potential in taking the broader understanding gained in this study through the use of Bolman and Deal’s (2003) integrated organizational approach and building a model that may offer managers and leaders a way to more effectively work with graduate programs that are both establishing and trying to sustain international experiences for their students. The Importance of Organizational Layers One area that takes on great importance in using the integrated organizational framework is the role of organizational layers in shaping the work of developing and maintaining international experiences. Organizational dynamics are particularly complex in research universities. Koehn, Deardorff and Bolognese (2010) showed that internal institutional dynamics played a greater role than external factors in engagement of some types of international initiatives at doctoral and large universities. SIOs at doctoral level institutions and institutions of over 15,000 students cited institutional dynamics as the primary obstacle in getting international research, development, and capacity building opportunities off the ground (Koehn et al., 2010). The current study considered development of a different type of international activity than did the study by Koehn et al. However, findings from the current study supported the idea that internal organizational dynamics at all levels also played a large role in how student international experiences developed. Additionally, different organizational layers within LUMC impacted the development of international experiences. As scholars noted, the middle organizational layers, particularly academic departments, played a major role in what and how various initiatives got implemented and supported (Bolman & Deal, 2003; Heyl, 2007). Although I did not interview department leaders, faculty participants in the current study made it clear that department priorities mattered 166 in their ability to become and remain involved in working with international experiences for students. For example, in dentistry two of the faculty were located in a department with a focus tied to community engagement. The connection to department mission helped these faculty more easily incorporate working with international experiences into their regular work. In contrast, the third faculty member was in a department with a primarily clinical mission. This individual had more difficulty tying the international experiences to his regular work and did not have the same level of support from departmental leadership. Another crucial organizational layer highlighted at LUMC was the academic school. Leadership support and concerns about the international experiences impacted how they developed and continued. Support of the dean in each of the three schools was crucial in getting international experiences off the ground, even if support meant simply giving the okay for faculty to move forward with implementation. Deans were the ones who needed to consider how much of the school’s mission should center on international experiences, especially when it came to faculty work. Integrating international experiences at the academic school level also meant integrating them into systems such as the calendar and the curriculum priorities. Other organizational layers that were important included the campus and broader university system. An example of connecting to campus priorities occurred in dentistry, where faculty linked international experiences early on to a growing service-learning priority at LUMC. The system-level organizational layer of LU also shaped the development of international experiences at LUMC. LUMC was not considered the “main” campus, and participants in this study sometimes felt frustrated with system-level policies implemented in recent years related to offering international experiences. Participants in the current study expressed a lack of support for their international involvement from leadership at the main campus. 167 The integrated organizational framework allowed a holistic view of how the work place and the organizational layers within that work place shaped development of international experiences in dentistry, medicine, and law at LUMC. The integrated frame also showed that key organizational factors had a variety of meanings to different participants. Implications for Future Research, Policy, and Practice The points raised in the discussion have numerous implications for future research, policy, and practice. First, I consider additional research related to faculty work in developing and sustaining international experiences within the various organizational layers at a research university. Second, I discuss the need for further research on curriculum and internationalization of graduate education. Finally, I consider the implications of sustainability of international experiences within graduate professional education raised in the current study, particularly related to the metrics institutions often use to measure internationalization efforts. Implications for future research. Authors frequently cite the role of the faculty as a key driver to successful internationalization at the institutional level (Childress, 2010; Green & Olson, 2008; Hudzik, 2010). However, there needs to be additional research on faculty involvement in internationalization from the perspective of middle layers of the organization and within graduate programs. As the current study showed, faculty work and the ability to become involved with international experiences at LUMC was different across academic schools and disciplines. Additionally, faculty involvement varied within departments, as a result of a number of local organizational issues. The departmental focus and mission, and how well these connected into international work, mattered as well. Faculty work at LUMC was also impacted by the values, beliefs and priorities of colleagues and leaders within their work units. 168 Bolman and Deal (2003) noted the important role of the academic department and department chair in decision-making in a university setting. However, there is a gap in current internationalization research about the role of department chairs in the development and sustainability of international engagement (Amey, 2010). Therefore, my first recommendation for future research is to look at the development of international initiatives from the perspective of academic departments and department chairs. Such research will help illuminate the factors that hinder and support faculty involvement in internationalization beyond what I found in this study. Literature also documented the challenges of sustaining international initiatives that rest entirely with faculty champions (Amey, 2010). At the same time, literature about internationalization emphasized the need for greater faculty engagement in these efforts (Childess, 2010; Green & Olson, 2008). In the course of the current study, these two emphases in the literature raised a paradox for me. On one hand, the higher education community calls for greater engagement of faculty in campus internationalization. On the other hand, authors cite the challenges of sustaining international efforts that rest primarily on faculty champions. The paradox, then, is that the higher education enterprise is critical about faculty involvement on two fronts – more engagement but not too much. Involve the faculty but not too much. The second recommendation for future research, therefore, focuses on understanding where the balance is between these two parts of the faculty paradox. How do higher education institutions engage faculty in international efforts more deeply and, at the same time, minimize concerns about what happens to the international activity when the faculty member leaves or is no longer interested? Again, I believe that research about organizational issues at the department, division, and school levels within an institution will contribute to understanding the faculty engagement paradox. 169 Such research also needs to consider different institution types, as well as compare across similar institution types. Literature on the history of internationalization in U.S. higher education emphasized the importance of institutional factors and institution type in determining how internationalization plays out and continues to develop (Koehn, Deardorff, & Bolognese, 2010; Merkx, 2003). Another area of future research related to faculty work and internationalization is to more fully consider faculty roles and the changing nature of faculty work. Faculty in this study were primarily in tenure track and/or clinical positions. Literature indicated that the fastest growing faculty category is contingent faculty, meaning non-tenure track (Baldwin & Wawrzynski, 2011). In this case, will such faculty be involved in the international efforts of higher education institutions, and if so, how? Additionally, faculty work varies with the type of appointment they have, such as fixed-term (non-tenure track), tenure track, clinical, and so on. While the current study offered insight into faculty work as a driver of developing and maintaining international experiences in graduate professional programs, further research on faculty role and attributes is needed. For example, at what point in their careers do faculty typically become involved in international work and how does that differ with various faculty roles, in different disciplines, and within the range of higher education institution types? Further understanding of faculty attributes may help provide more insight into the question of sustainability of international experiences. A fourth area of recommended research is to consider faculty work within different types of international initiatives. The current study focused on the development of international experiences involving students in graduate professional education. Results of this study showed that faculty had challenges including involvement in student international experiences in their 170 workload, especially for those in clinical roles within health professions. Prior research showed that the factors related to different types of international efforts may not be the same. For example, Croom (2010) discussed how traditional types of international activities, such as study abroad, typically developed from the ground up through faculty grassroots efforts. However, other types of international activity, such as establishing a branch campus abroad, were driven primarily by senior institutional leadership with a top down approach (Croom). An additional area of recommended research is examining the role of international experiences within graduate programs. In order to do so, it is important to acknowledge that graduate education is not a homogeneous entity. Becher (1981) noted that the disciplines are not homogenous, and results of this study indicated that was the case, even within professional disciplines. At research universities such as LUMC in the current study, professional schools operated as separate unites within the larger institution (House et al., 1997; Rhodes, 2001). As graduate programs have strong local organization (Gumport, 1993), further research will also help understand how disciplinary differences play out in graduate education. Data from the current study showed that faculty and administrators in the three graduate professional programs were thinking about how to connect international experiences for students and other international work in broader ways, both within and across professional schools and also across the university. In this study, I examined graduate professional programs in the three disciplines of dentistry, medicine, and law. Including other professional disciplines in a similar research study is important in order to understand whether the findings that emerge are similar to or different than the factors I identified. It is important to note that all three academic programs in the current study, by definition, are only graduate level, meaning degrees are post baccalaureate. U.S. higher education does not offer undergraduate programs in these three academic areas. 171 Including professional disciplines that also offer undergraduate degrees, such as social work or business, would aid in understanding where differences may lie between undergraduate and graduate level international experiences. As noted in literature (Dirkx et al., 2014; Open Doors, 2013), international experiences in graduate education are on the rise, especially in the professional disciplines. Additionally, research studies are needed that include graduate programs in other disciplines in addition to the professions. Rationale for offering international experiences may be different, and the forms that international experiences take may also vary. Another recommendation for future research relates to internationalization of the curriculum. Most research in this area to date focuses on undergraduate education. For example, an American Council on Education mapping study looked at higher education institutions’ efforts to internationalize general education and other aspects of undergraduate curriculum (ACE, 2012). Unlike undergraduate education, graduate programs do not have a core liberal arts curriculum that provides a common framework for conversation across disciplines and programs. One potential angle for such research based on results of the current study is to consider interprofessional education as a framework, meaning considering goals and competencies common across different professions. Medical faculty in the current study cited inter-professional education as a goal of offering student international experiences. A series of conceptual pieces published by NAFSA: Association of International Educators provided some background for the rationale of including international experiences in graduate professional education. Articles included the three academic fields in the current study: law, medicine, and dentistry. Similar to results of the current study, authors described connecting to the profession and gaining skills and competencies in an international setting as important goals (Fernandez, 2014; Leggett, 2009; Tobenkin, 2009) However, little empirical 172 research exists on the role of international experiences in graduate professional curriculum. Comparative research on disciplines outside of professional education is also valuable in order to understand similarities and differences of internationalizing the curriculum, as prior research indicates that goals and orientations of disciplines are different (Becher & Trowler, 2001; Biglan, 1973a). A final recommendation for research is the need to look beyond metrics that focus on statistics alone when measuring internationalization. Numerous reports and articles offer comparative statistics related to internationalization of higher education in order to provide an understanding of the internationalization landscape. For example, the American Council on Education mapped internationalization at universities and colleges in the U.S., with the latest effort in 2011 (ACE, 2012). Some areas mapped at higher education institutions included articulated institutional commitment to internationalization, faculty policies and practices, and student mobility (ACE). The ACE study used several metrics to measure professional development and funding opportunities for faculty, including “funding for faculty leading students on study abroad programs” (p. 15). Data showed that such funding grew slightly. Hill and Green (2008) discussed how chief academic officers needed multiple ways of measuring the results of internationalization. They commented that while statistical measures, which they referred to as “inputs of internationalization” (2008, p. 37) are useful, such measures do not provide any information about outcomes. An overreliance on statistical data is problematic, as it may not take into account organizational factors that impact both inputs and outcomes. Organizational studies provide a deeper and more holistic understanding of factors that impact internationalization, which may be difficult to gain from surveys. 173 Implications for policy and practice. A number of implications for policy and practice emerged from results of this study and relate to future research suggestions. The first is the need for academic and administrative leaders to move beyond a primary focus on measuring internationalization through statistical data. Much of the current focus on measuring internationalization efforts resembles the tip of an iceberg, or a limited statistical view of the landscape. A great deal of the story of internationalization happens in the workplace of higher education institutions, which represents the larger part of the iceberg under the water. Much of what institutions report related to internationalization includes metrics, such as how many students went abroad, how many study abroad programs there were, how one academic program or school compared to another, or how many faculty were involved in leading programs abroad. Such data tell only a partial story, especially when compared across academic programs and schools. Statistics do not incorporate the role of academic discipline and the work and values involved at a variety of organizational levels within academic units. Statistics also do not reveal the motivations, beliefs, and values of the individuals in academic programs who are catalysts for international experiences. Based on the results of my research, I believe that there are other types of data that are crucial in understanding how to work with and support graduate professional programs that are initiating and trying to sustain international experiences for their students. The first type of data is historical. In other words, what is the history within a graduate program of international involvement generally and of international experiences for students more specifically. Questions used in the protocol of the current study helped me understand how international experiences developed and revealed that they had been there much longer than I expected going into this study. The historical analysis was crucial, and my supposition is that campus administrators may 174 not always know the historical pieces of specific programs. A second type of data is an understanding of an academic program’s or department’s current priorities and challenges. For instance, what are the constraints that impact faculty work in a particular unit? What are the current priorities of the unit? What is it that the people within a unit value? Answering these questions, through the view of the four organizational frames, provides data that is deeper than statistics can convey and that aid in establishing policy. The current study emphasized that international experiences at LUMC were developed through grassroots efforts of the faculty and administrators within the academic programs, and described those efforts in ways that help one understand how values, efforts, ideas, timing, relationships, and resources coalesce to move initiatives forward and how sometimes, even with the best intentions, initiatives are put aside. Statistics do not take into account the history of such grassroots work, and how international initiatives emerged in similar and different ways across academic programs. The integrated organizational framework used in the current study brought out the important factors that impacted the work of faculty and administrators in academic programs. Statistics that institutions often collect and use to make decisions do not necessarily take into account the factors identified in the current study and how those factors play out in different types of faculty work and organizational levels. Current literature calls for the need for institutions to be more strategic in their efforts to internationalize (Hudzik, 2010). Further organizational studies will provide deeper understanding of the dynamics involved in internationalization of graduate programs, which will then aid campus leaders in understanding how to build more sustainable strategies. 175 A key campus leader that may have the opportunity to impact strategy is the senior international officer (SIO), charged with leading campus internationalization efforts. As Heyl (2007) stated, “The point is that the SIO must understand her or his own institution, how key stakeholders see how the institution “works,” and what frames of understanding can best guide the SIO to identify levers for change (p. 7).” Based on the results of the current study, I would add to this that it is important for an SIO to understand her own perspectives and organizational lenses she tends to use to understand organizational events. SIO positions may vary greatly in terms of specific title, reporting structure, institution type, etc., which in turn impacts how an SIO works to manage change. I believe findings from the current study hint at the idea that supporting efforts of graduate programs to internationalize may be even more complex than at the undergraduate level because there is no common academic framework and often less connection to centralized administrative units, such as the study abroad office. SIOs may need to engage differently with deans, department chairs, and faculty across graduate programs. The results of the current study indicate the need to look at policies and practices at not only the institutional level, but also in schools and departments. Policies set at various organizational levels impact the ability of faculty to be involved in international efforts (Childress, 2010). Ways of measuring and assessing international engagement may also vary across different disciplines and organizational units. Connecting was one factor that emerged in this study, providing important considerations for institutions trying to build international experiences in graduate professional education: connecting goes in two directions, not just from the institutional priorities and strategies to the academic programs and school but the other way, as well. It is important to note that many of the international experiences in the three professional programs existed for a number of years. 176 At LUMC, campus internationalization strategy in recent years included developing some of the international partnerships started by the School of Medicine into campus-wide partnerships. Therefore, it is crucial for campus leaders including senior international officers, to understand the history of international work in academic units and to connect back to that work in building institutional international strategy. The current study also has implications for administrators in study abroad and international offices, as institutions look more strategically at the role of international experiences within graduate education. Participants in the three academic programs in this study had different connections with the study abroad office that ranged from close interactions to limited and bureaucratic ties. Faculty in dentistry saw their involvement with the study abroad office not only as professional development but as a way to further their goals in developing international experiences for students. Law faculty expressed the least connection with the study abroad office, seeing it more as a part of undergraduate education and an office primarily related to visa issues. Although most participants in medicine appreciated support of the study abroad office in navigating university procedures, others felt some of the processes just did not fit the nature of international experiences in medicine. Study abroad administrators may need to think differently about processes for working with graduate professional programs, e.g., terms such as “study abroad” may not be the best fit. As law faculty in this study commented, they associated the term study abroad with undergraduate education. Finally, an implication for practice addresses current calls in higher education and from international education associations for comprehensive internationalization. Hudzik (2010) defined comprehensive internationalization as inclusion of “international and comparative perspectives throughout the teaching, research, and service missions of higher education” 177 (Hudzik, 2010, p. 6). Comprehensive internationalization stresses the importance of a strategic, institutional approach. Therefore, I believe there is a need for professional associations to support conceptual writing, research studies, and resources for practitioners that use organizational frameworks in order to provide a deeper, more holistic understanding of the context in which the work of internationalization takes place. By this I also mean not only studies and resources at the institutional level but also from the perspectives of academic schools, departments, and programs, which are the building blocks of universities and colleges. As an administrator within international programs, the results of this study shifted my own paradigm on how to approach my work. I realized that for many years I did not have a deep enough understanding of the organizational factors that occur in academic units. Instead, I often focused on statistical measurements of internationalization. I did not understand enough about the work happening below the surface of the water, which constitutes the largest part of the iceberg. Conclusion In the current qualitative study, I used an integrated organizational framework to explore the factors involved in getting international experiences for graduate professional students off the ground in three academic programs at a research university. Although the goal of this study was not to generalize across institutions, the findings highlight important considerations in understanding the organizational work happening in graduate professional programs. Using a broad lens to understand the development and implementation of international experiences in the three LU programs illuminated key factors of faculty roles and work, support, curriculum, and connecting as crucial. These factors were not only important in getting the experiences off the ground, but also in sustaining them through challenges over time. Additionally, the current study 178 brought out the different meanings of each of the factors that allowed understanding beyond one organizational lens. Support was far more than work time, staff, and funding, for instance. The current study highlighted the need for further organizational research to understand the changing landscape of faculty work structures and how they impact the ability to develop and sustain international experiences within graduate programs. In addition, there is a need to look deeper than the current focus on institution-level conversations of internationalization. Current literature indicates that in order to promote greater sustainability of international work and priorities, institutions needs to be more strategic in connecting such work to missions and also move beyond relying on single faculty champions to carry the initiatives. However, there are many organizational levels in between the individual faculty and the institution: academic programs, divisions, departments, and colleges and schools, which are particularly important at the graduate level. Each organizational level has shared values, beliefs, policies, goals, missions, and practices that impact engagement in internationalization. Graduate education is a key part of the U.S. higher education landscape, and indicators show that efforts to internationalize graduate education are on the rise. Further organizational research on the internationalization of graduate education will aid campus leaders in understanding and supporting comprehensive internationalization not only in graduate education but throughout the institution. 179 APPENDICES 180 APPENDIX A Table 2: Participant List Participant Pseudonym School/Department/ Office Work Role Dr. Evans Dentistry, Dept. B Clinical faculty Dr. Garcia Dentistry, Dept. A Faculty Dr. Johnson Dentistry, Dept. A Faculty Dr. James Assistant Dean Dr. Baker Dentistry, Dean’s Office Law Dr. George Law John Law Dr. Morris Law Dr. Randolph Jordan Law, Dean’s Office Medicine, Dept. C Casey Medicine, Africa program Faculty, works with LLM abroad Program assistant to Dr. Baker Faculty, new coordinator of international activities Assistant Dean Program administrator, variety of roles, Dept. C Program administrator Dr. Brown Medicine, Dept. B Faculty Clinical faculty 181 Connected to following international experiences for students Coordinates and leads dental service learning programs Coordinates and leads dental service learning programs Leads dental service learning program Director of Asia study abroad program Assists with Asia study abroad program Supports several Latin American experiences Works with medical student rotations in Africa Oversees independent, international medical rotations Table 2 (cont’d) Participant Pseudonym School/Department/ Work Role Office Dr. Meier Medicine, Dept. B Clinical Faculty Dr. Li Medicine, Dept. D Faculty researcher Dr. Nelson Medicine, Dept. A Dr. Sanders Medicine, Dept. B Clinical faculty, director of Africa program Clinical Faculty Harper Medicine Service learning director Dr. Jones Medicine, academic Faculty research, and research office administrative role in global health Medicine, Dept. B Faculty, global health program for residents Dean’s office Dean Academic affairs Former provost Academic affairs, Former associate provost faculty Service learning Director Study abroad Director International Senior international programs officer International Academic director programs Study abroad Advisor International Senior director programs International Former senior programs international officer International Outreach director programs Dr. Bates Dr. Stevens Dr. Avery Dr. Hughes Jane Kathy Dr. Arthur Dr. Greene John Marion Dr. Smith Dr. Milton 182 Connected to following international experiences Coordinates Asia rotations Oversees Asia Partnership Oversees Africa partnership Worked with former student rotations in Latin America Works with non-credit medical service learning experiences APPENDIX B Interview Protocol 1) Describe this graduate program briefly. 2) Describe the student profile in this program. 3) Describe your key roles and responsibilities within this institution/program?  To what extent does your role include responsibility for international experiences? 4) In your opinion, what does internationalization mean in this program? 5) Describe some of the international experiences you offer for graduate students. 6) What is your role in these international experiences?  How did you become involved? Why? 7) Briefly describe for me the history of the international experiences in this program? 8) What were the original goals of these international experiences?  Have these goals changed over time?  How have they changed? Why have they changed? 9) Describe what you consider to be the key outcomes of these experiences. 10) How do you support these international experiences organizationally? 11) Does this international work in your program connect in any way to the graduate school? To the study abroad or international office? If so, how? 12) What are the benefits and challenges for you of offering these experiences? What about for this graduate program? 13) Is there anything else you would like to add that I haven’t asked about already? Additional questions for senior administrators 14) Describe for me what this institution is doing in terms of offering international experiences for graduate students. 183 15) What role does your office have, if any, in these international experiences? What types of support or resources do you provide?  Has this changed over time? 16) What do you hope are the outcomes of your involvement with these international experiences? Why have these international experiences as a part of graduate education? 17) What are the benefits and challenges in offering these international experiences? 18) Is there anything else you would like to add that I haven’t asked about already? 184 APPENDIX C Participant Email Invitation Email Header: Qualitative Study: International Experiences in Graduate (Post-Baccalaureate) Professional Education Email Body: CALL FOR PARTICIPANTS Dear Dr. X, I am writing to you to request your consideration to participate in a research study that focuses on developing a better understanding of the factors that are contributing to the growth of international experiences within graduate (post-baccalaureate) professional education. Lexmark University and the Metro City campus (LUMC) provide an excellent context for this research study, due to the long history of international work in professional programs. As head of the X program (for example, law program), your participation in this research is important to help develop a deeper understanding of the growth and development of international experiences for students in graduate (post-baccalaureate) professional programs at LUMC. This research is part of a dissertation for fulfillment of my doctoral degree in higher, adult, and lifelong education at Michigan State University. It represents my continuing interest in international education and it also aligns well with the research interests of a number of faculty members within my program at Michigan State University. Prior to returning to graduate school, I worked for over 16 years in international education within a postsecondary context, and I am excited to be able to pursue this interest as part of my doctoral studies. If you are willing to participate, please contact me via email at sincla53@msu.edu or by telephone (XXX) XXX-XXXX, to schedule an in-person interview, which will require 60 to 90 minutes. I greatly appreciate your consideration of participation in my research study. Sincerely, 185 Julie Sinclair, Doctoral Candidate Michigan State University Higher Adult & Lifelong Education Program sincla53@msu.edu 186 REFERENCES 187 REFERENCES ACE (2012). Mapping internationalization on U.S. Campuses: 2012 edition. Washington, D. C.: American Council on Education. Retrieved from http://www.acenet.edu/newsroom/Pages/Mapping-Full-Report.aspx. Allen, G. (2004 a). NASULGC Task Force report on internationalizing the campus. Retrieved from http://www.nasulgc.org/comm_intprogs.htm Alon, I., & McAllaster, C. M. (2009). Measuring the global footprint on an MBA. Journal of Studies in International Education, 13(4), 522-540. Altbach, P. G., & Knight, J. (2007). The internationalization of higher education: Motivations and realities. Journal of Studies in International Education, 11, 290-305. American Council on Education (2000). Student poll, 4(3), Baltimore, MD: Arts & Science Group. Amey, M. J. (2010). Administrative perspectives on international partnerships. In P. Eddy (Ed.), International collaborations, opportunities, strategies, challenges (New Directions for Higher Education, No. 150, pp. 57-68). San Francisco, CA: Jossey-Bass. Andersen, D. F., Bryson, J., Richardson, G. P., Ackermann, F., Eden, C., & Finn, C. B. (2006). Integrating modes of systems thinking into strategic planning education and practice: the thinking person's institute approach. Journal of Public Affairs Education, 12(3), 265-293. Atkinson, R. C., & Blanpied, W. A. (2007). Research Universities: Core of the U.S. Science and Technology System, from http://repositories.edlib.org/cshe/CSHE5-07. Baldwin, R. G., & Wawrzynski, M. R. (2011). Contingent faculty as teachers: What we know; what we need to know. American Behavioral Scientist, 55, 1485-1509. DOI: 10.1177/0002764211409194. Becher, T. (1981). Towards a definition of disciplinary cultures. Studies in higher education, 6, 109-122. Becher, T., & Trowler, P. R. (2001). Academic tribes and territories, 2nd edition. Buckingham, UK: SRHE and Open University Press. Biglan, A (1973a). The characteristics of subject matter in different academic areas. Journal of Applied Psychology, 57(3), 195-203. Biglan, A (1973b). Relationships between subject matter characteristics and the structure and outputs of university departments. Journal of Applied Psychology, 57(3), 204-213. 188 Bok, D. (2006). Our underachieving colleges: A candid look at how much students learn and why they should be learning more. Princeton: Princeton University Press. Bolman, L. G., & Deal, T. E. (2003). Reframing Organizations: Artistry, Choice, and Leadership. (2nd ed.). San Francisco: Jossey-Bass. Bremer, D. (2008). Planning tomorrow's urban world. International Educator, 17(4), 32-39. Burnett, S., & Huisman, J. (2010). Universities' responses to globalisation: The influence of organisational culture. Journal of Studies in International Education, 14(2), 117-142. Center for Studies in Higher Education (CSHE) (2009). The globalization and internationalization of higher education: A macro and micro view. Berkeley, CA: University of California. Retrieved on August 13, 2009 from http://cshe.berkeley.edu/events/index.php?id=273 Chieffo, L., & Griffiths, L. (2003). What’s a month worth? Student perceptions of what they learned abroad. International Educator, 12(4), 26-31. Childress, L. K. (2010). The twenty-first century university: Developing faculty engagement in internationalization. New York: Peter Lang Publishing, Inc. Commission on the Abraham Lincoln Study Abroad Fellowship Program (November 2005). Global Competence & National Needs: One Million Americans Studying Abroad. Washington, D. C. Council of Graduate Schools (2007). Graduate education: The backbone of American competitiveness and innovation. Washington, D.C. Retrieved from http://www.cgsnet.org/portals/0/pdf/Gr_GradEdAmComp_0407.pdf. Croom, P. W. (2010). Institutional strategy in a global context: The land-grant university experience (Doctoral dissertation). ProQuest Dissertations and Theses, Retrieved from http://ezproxy.msu.edu/login?url=http://search.proquest.com/docview/816191987?accoun tid=12598 de Wit, H. (2002). Internationalization of higher education in the United States of America and Europe: A historical, comparative, and conceptual analysis. Westport, CT: Greenwood Press. Deardorff, D. K. (2005), A matter of logic? International Educator, 14(3), 26-31. Dirkx, J. M., Janka Millar, K., Berquist, B., Clason, N., Sinclair, J., & Vizvary (2014). The landscape of graduate international experiences: 2014 research report. Unpublished manuscript. Retrieved from http://education.msu.edu/ead/outreach/gleo/documents/GLEOResearchReport2014.pdf. 189 Dirkx, J. M., Jessup Anger, J. E., Brender, J. R., Gwekwerere, B., & Smith, R. O. (2007). Emotion and cross-cultural experience: The messy business of self-formation in adult learning. In L. Servage & T. Fenwick (Eds), Learning in community: Proceedings of the Adult Education Research Conference and the Canadian Association for the Study of Adult Education (pp.163-168). Halifax, Nova Scotia: Mount St. Vincent University. Duderstadt, J. J. (2000). A University for the 21st Century. Ann, Arbor, MI: The University of Michigan Press. Dwyer, M. M. (Fall 2004). More is better: The impact of study abroad duration. Frontiers: TheInterdisciplinary Journal of Study Abroad, 10, 151-163. Fernandez, K. (2014). All smiles. International Educator, 23(4), 35-44. Gearon, C. J. (2011). More graduate students consider study abroad. U.S. News & World Report Online, retrieved March 29, 2011, from http://www.usnews.com/education/best-graduateschools/articles/2011/03/16/more-graduate-students-consider-study-abroad. Glesne, C. (2006). Becoming a qualitative researcher: An introduction (3rd ed.). Boston, MA: Pearson Education Inc. Green, M. F., Luu, D., & Burris, B. (2008). Mapping internationalization on U.S. Campuses: 2008 edition. Washington, D. C.: American Council on Education. Green, M. F., & Olson, C. (2008). Internationalizing the campus: A user's guide. Washington, D. C.: American Council on Education. Gumport, P. J. (1993). Graduate education and organized research in the United States. In B. R. Clark (Ed.) The research foundations of graduate education: Germany, Britain, France, United States, Japan (pp. 225-260). Berkeley and Los Angeles: University of California Press. Heyl, J. D. (2007). The senior international officer (SIO) as change agent. Washington, D. C.: Association of International Education Administrators. Hill, B. A., & Green, M. (2008). A guide to internationalization for chief academic officers. Washington, D.C.: American Council on Education. Houle, C. R., Cyphert, F., & Bogg, D. (1987). Education for the professions. Theory into Practice, 26(2), 87-93. Hudzik, J. K. (2010). Comprehensive internationalization: From call to action. A report of the NAFSA: Association of International Educators Task Force on Internationalization. Washington, D.C. Retrieved from www.nafsa.org/internationalization. 190 Hulstrand, J. (May/June 2006). Education abroad on the fast track. International Educator, 15(3), 46-55. Institute of International Education, (2010). Profile of U.S. Study Abroad Students, 1999/002008/09." Open Doors Report on International Educational Exchange. Retrieved from http://www.iie.org/opendoors. Institute of International Education, (2013). Open Doors Report on International Educational Exchange. Retrieved from http://www.iie.org/opendoors. Kehm, B. M., & Teichler, U. (2007). Research on internationalisation in higher education. Journal of Studies in International Education, 11(3/4), 260-273. Knight, J. (2003). Updated internationalization definition. International Higher Education, 33, 23. Knight, J. (2004). Internationalization remodeled: Definition, approaches, and rationales. Journal of Studies in International Education, 8(1), 5-31. Knight, J. (2011). Higher education crossing borders: A framework and overview of new developments and issues. In R. Sakamoto & D. W. Chapman (Eds.) Cross-border partnerships in higher education (pp. 16-44). New York: Routledge. Knight, J., & deWit, H. (Eds.). (1997). Internationalization of higher education in Asia Pacific countries. Amsterdam: European Association for International Education. Kolb, D. A. (1981). Learning styles and disciplinary differences. In A. Chickering and Associates (Ed.) The Modern American College. San Francisco, CA: Jossey-Bass. Ladika, S. (2008). Nursing goes global. International Educator, 17(6), 27-33. Leggett, K. (March/April 2008). Making a world of difference. International Educator, 17(2), 42-49. Leggett, K. (May/June 2009). Teaching medicine without borders. International Educator, 18(3), 34-42. Matross Helms, R., & Asfaw, A. (2013, April). Engaging faculty in internationalization, part 1. Internationalization in Action. American Council on Education. Retrieved from http://www.acenet.edu/news-room/Pages/Intlz-in-Action-2013-April.aspx. McNay, I. (1995). From the collegial academy to corporate enterprise: The changing cultures of universities. In Schuller, E. (Ed.), The changing university (pp. 105-115). Buckingham, UK: Open University Press. 191 Merkx, G. W. (2003, Winter). The two waves of internationalization in U.S. higher education. International Educator, XII(3), 6-12. Merriam, S. B. (2009). Qualitative research. San Francisco, CA: John Wiley & Sons, Inc. Mintzberg, H. (1979). The professional bureaucracy. In M. C. Brown II (Ed.), Organization & governance in higher education (5th ed., pp. 50-70). Boston: Pearson Custom Publishing. Morgan, G. (2006). Images of Organizations. (2nd ed.). Beverly Hills: Sage Publications. NAFSA: Association of International Educators. (2008). Strengthening study abroad: Recommendations for effective institutional management for presidents, senior administrators, and study abroad professionals. Washington, D.C. NASULGC (2004). A Call to leadership: The role of the president in internationalizing the university. A report of the NASULGC Task Force on Internationalization. Retrieved on from http://www.aplu.org/NetCommunity/Document.Doc?id=340. Olson, C. L., Green, M. F., & Hill, B. A. (2008). Building a strategic framework for comprehensive internationalization. Washington, D. C. Organisation for Economic Co-operation and Development: Center for Educational Research and Innovation. (2004). Internationalisation and trade in higher education: Opportunities and challenges. Paris: Organisation for Economic Co-operation and Development. Patton, M. Q. (2002). Qualitative research & evaluation methods. Thousand Oaks, CA: Sage Publishing. Pell, E. J. (2003). Internationalization and diversification of graduate education: A message from the Vice President for Research and Dean of the Graduate School. College Station, PA: The Graduate School, Pennsylvania State University. Retrieved on August 13, 2009 from http://www.gradsch.psu.edu/current/internationalization.html. Redd, K. E. (2008). Findings from the 2008 CGS international graduate admissions survey: Phase II: Final applications and initial offers of admission. Council of Graduate Schools, Washington, D. C. Rhodes, F. H. T. (2001). The American Research University Today. In F. H. T. Rhodes (Ed.), The Creation of the The Future: The Role of the American University. Ithaca, NY: Cornell University Press. Sakamoto, R., & Chapman, D. W. (2011). Expanding across borders: The growth of cross border partnerships in higher education. In R. Sakamoto & D. W. Chapman (Eds.) Cross-border partnerships in higher education (pp. 3-15). New York: Routledge. 192 Scott, W. R., & Davis, G. F. (2007). Organizations and Organizing: Rational, Natural, and Open Systems Perspectives. Upper Saddle River, NJ: Prentice Hall. Shallenberger, D. (January/February 2009). Education abroad for adult students. International Educator, 18(1), 50-53. Spencer, S. E., & Tuma, K. (Eds.) (2002). The guide to successful short-term programs abroad. Washington, D.C.: NAFSA: Association of International Educators. Stark, J. S., & Lattuca, L. R. (1997). Shaping the college curriculum: Academic plans in action. Boston: Allyn and Bacon. Sutton, S. B. (2010). Transforming international education through partnerships. International Educator, 19(1), 60-63. Thomas, J. (2008). International students getting more graduate program offers. Retrieved October 1, 2011 from http://www.america.gov/st/educenglish/2008/August/200808211426381CJsamohT0.6500 666.html. Tobenkin, D. (Jan/Feb 2009). Legal minds: Internationalization is expanding rapidly at law schools. International Educator, 18(1), 28-37. Weick, K. E. (1976). Educational Organizations as Loosely Coupled Systems. Administrative Science Quarterly, 21(1), 1-19. Yoder, K. (2006). A framework for service-learning in dental education. Journal of Dental Education, 70 (2), 115-123. 193