GRADUATE STUDENT EXPERIENCE OF SHORT-TERM, FACULTY-DIRECTED EDUCATION ABROAD By Jacob D. Lemon 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 2021 ABSTRACT GRADUATE STUDENT EXPERIENCE OF SHORT-TERM, FACULTY-DIRECTED EDUCATION ABROAD By Jacob D. Lemon As graduate and professional programs internationalize to provide students with global competencies and skills, more graduate students are participating in education abroad programs. Graduate students represent a growing portion of the total population participating in education abroad, with short-term, faculty-directed (STFD) programs expanding as an internationalization strategy at the graduate level. Scholarship has only recently emerged to understand the characteristics of STFD graduate education abroad programs and the students who participate in them. The literature on graduate education abroad provides a useful foundation for recognizing that graduate students are unique in terms of personal, professional, and scholarly contexts. However, there is still little known about how graduate students experience education abroad and how these contexts matter to their experiences. The purpose of this dissertation was to explore graduate students’ experiences of a STFD education abroad program relative to three contexts and their corresponding intersections: adult learning, professional socialization, and curriculum and pedagogy. This dissertation utilized an instrumental case study design to examine a STFD education abroad program in the graduate field of medicine at a large research university. Through the collection and analysis data including document analysis, observation of pre-departure meetings, and semi-structured interviews with 11 graduate students and the faculty-director—findings provided insight about how four contexts and their corresponding intersections influenced graduate student experiences of a STFD education abroad program: adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. These findings situate STFD education abroad programs as a graduate-level experience and provide valuable insight on how education abroad programs can be designed and facilitated to better fit the goals, needs, and characteristics of graduate students. As contexts were mutually important to graduate student experiences of STFD education abroad, understanding their intersections illuminated a holistic perspective regarding student engagement and development in these programs. The analysis of these findings led to the creation of a model for understanding graduate student experiences of STFD education abroad, which highlights the complexity and holistic nature of students personal, professional, scholarly, and interpersonal needs in these programs. Implications underscore the design and facilitation of STFD education abroad programs at the graduate level, guiding faculty to support graduate students in ways addressing their goals, needs, and experiences within contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. Copyright by JACOB D LEMON 2021 ACKNOWLEDGEMENTS Through the dissertation process, I learned a lot about myself as a person and scholar, as my patience and resilience were constantly tested. I feel incredibly fortunate to have an amazing support system of family, friends, and mentors who gave me the strength, motivation, and confidence to complete this academic journey. To Lida, your patience, love, and unwavering support was so important to my success. Your wisdom and strength kept me going during the most difficult of times. To my family (Pat, Dave, Katie, Massoud, and Shahla), your care and encouragement gave me the confidence to believe in myself and to trust the process. To my dissertation committee (Dr. Matt Wawrzynski, Dr. Inge Steglitz, Dr. Marilyn Amey, and Dr. John Dirkx), thank you for believing in me, inspiring me, and guiding me to reach my goals. Your feedback, ideas, encouragement, and willingness to listen to my many questions and concerns provided the foundation I needed to succeed. You played a critical role in developing me into the scholar I am today. Finally, to my HALE friends, thank you for checking-in, listening, reviewing many drafts, and making me feel like I wasn’t alone during the writing process. I feel so lucky to have made lifelong friends during my PhD journey, which made my experience truly meaningful and enjoyable. v TABLE OF CONTENTS LIST OF TABLES…………………………………………………………………………….…xii LIST OF FIGURES……………………………………………………………………………..xiii CHAPTER 1: INTRODUCTION.................................................................................................... 1 Background to the Study ..................................................................................................... 3 Short-term, Faculty-directed Education Abroad Programs ..................................... 4 Education Abroad Programs at the Graduate Level ................................................ 5 Graduate Student Contexts Influencing Their Education Abroad Experiences ...... 6 The Context of Adult Learning ................................................................... 7 The Context of Professional Socialization .................................................. 8 The Context of Curriculum and Pedagogy .................................................. 8 Intersections Between the Contexts............................................................. 9 Problem Statement and Research Question ......................................................................... 9 Significance of the Study................................................................................................... 10 Administrators ....................................................................................................... 11 Faculty-directors .................................................................................................... 12 Overview of Dissertation ................................................................................................... 13 CHAPTER 2: LITERATURE REVIEW....................................................................................... 14 The Internationalization of Graduate Education ............................................................... 14 Internationalization Through Education Abroad ............................................................... 15 Definition of Education Abroad ............................................................................ 16 History and Purpose of Education Abroad ............................................................ 17 Trends in Education Abroad .................................................................................. 18 Types of Education Abroad ................................................................................... 19 Short-term, Faculty-Directed Education Abroad Programs .................................. 20 Education Abroad Expanding at the Graduate Level ........................................................ 21 The Demographic Landscape of Graduate Education Abroad .............................. 22 The Developmental Influence of Graduate Education Abroad ............................. 23 Experiential Learning in Graduate Education Abroad .............................. 23 Transformative Learning in Graduate Education Abroad ......................... 25 Professional Competencies and Outcomes of Graduate Education Abroad.......... 27 The Field of Medicine ............................................................................... 27 The Field of Student Affairs ...................................................................... 28 The Field of Business ................................................................................ 30 Faculty Experiences and Approaches for Graduate Education Abroad ................ 31 Organizational Implementation of Graduate International Experiences ... 31 Faculty Pedagogical Approaches for Graduate Education Abroad ........... 32 Contexts of Graduate Students Influencing Their Experiences of Education Abroad ...... 34 The Context of Adult Learning ............................................................................. 34 Experiential Learning ................................................................................ 36 vi Transformative Learning ........................................................................... 37 The Context of Professional Socialization ............................................................ 38 Professional Identity .................................................................................. 39 The Context of Curriculum and Pedagogy ............................................................ 40 Context: Social and Cultural Forces Informing Graduate Education Abroad ....................................................................................................... 41 Content: Learning Outcomes Guiding Graduate Education Abroad ......... 43 Form: Pedagogical Practices of Graduate Education Abroad ................... 44 Intersections Between the Contexts of Graduate Students .................................... 46 Conceptual Framework ..................................................................................................... 46 Adult Learning....................................................................................................... 48 The Experiential Learning Cycle............................................................... 48 Transformative Learning ........................................................................... 49 Professional Socialization ..................................................................................... 51 Graduate and Professional Student Socialization ...................................... 51 Graduate Curriculum and Pedagogy ..................................................................... 54 Matrix of Curricular Design ...................................................................... 54 A Model for Understanding Graduate Student Experience of Education Abroad 56 Conclusion ......................................................................................................................... 59 CHAPTER 3: METHODS ............................................................................................................ 60 Methodological Orientation............................................................................................... 60 A Case Study Research Design ......................................................................................... 61 Units of Analysis Informing the Case ................................................................... 62 A Single Case Selection ........................................................................................ 62 The Use of Theory in Guiding the Case Study...................................................... 63 Case Study Boundaries .......................................................................................... 63 Site and Participant Selection ............................................................................................ 64 Case Selection ....................................................................................................... 65 Participant Selection .............................................................................................. 66 Data Collection .................................................................................................................. 67 Interviews .............................................................................................................. 67 Faculty-director Interviews ....................................................................... 68 Student Interviews ..................................................................................... 68 Document Analysis ............................................................................................... 69 Direct Observations ............................................................................................... 70 Data Analysis..................................................................................................................... 71 Trustworthiness ................................................................................................................. 72 Credibility .............................................................................................................. 73 Triangulation ............................................................................................. 73 Member Checking ..................................................................................... 73 Peer Debriefer ............................................................................................ 74 Transferability ....................................................................................................... 74 Reflexivity ............................................................................................................. 75 Ethical Considerations ........................................................................................... 76 Delimitations ..................................................................................................................... 76 vii Limitations ......................................................................................................................... 77 Conclusion ......................................................................................................................... 77 CHAPTER 4: CASE STUDY BACKGROUND INFORMATION ............................................. 79 Graduate Education Abroad Program ............................................................................... 79 Partnerships with Costa Rican Healthcare Organizations ..................................... 80 Student Selection into the Program ....................................................................... 81 Program Duration and Itinerary............................................................................. 82 Program Evaluation ............................................................................................... 84 Overview of Student Participants .......................................................................... 84 Student Participant Profiles ....................................................................... 85 Overview of Faculty-director Participant .............................................................. 91 Directing the Costa Rica Program ............................................................. 92 College of Medicine .......................................................................................................... 93 Curriculum and Pedagogy ..................................................................................... 94 Graduate Certificate Programs .............................................................................. 95 Service-Learning ................................................................................................... 95 Conclusion ......................................................................................................................... 96 CHAPTER 5: FINDINGS – CONTEXTS INFLUENCING GRADUATE STUDENT EXPERIENCES OF EDUCATION ABROAD ............................................................................ 97 The Context of Adult Learning Influencing Graduate Student Experiences..................... 97 Experiential Learning ............................................................................................ 97 Prior Experience Traveling Abroad........................................................... 98 Prior Work Experiences .......................................................................... 101 Reflecting on Prior Experiences During the Education Abroad Program ................................................................................................................. 104 Applying Experiences in Costa Rica to Inform Learning and Development ................................................................................................................. 105 Elements of Transformative Learning ................................................................. 106 Self-reflection and Reexamination of Values.......................................... 107 Beginning to Reexamine and Reframe Perspectives ............................... 108 Considering New Approaches ................................................................. 110 Pragmatic Learning ............................................................................................. 111 Preparing for an International or Global Career ...................................... 112 Gaining Knowledge of International Policies and Practices ................... 113 Building Cultural Competence for Serving Patients ............................... 115 The Context of Professional Socialization Influencing Graduate Student Experiences.......................................................................................................... 116 Formal Requirements and Competencies ............................................................ 116 Meeting Program Requirements .............................................................. 117 Seeing Alignment Between Medical Program Goals and Education Abroad Outcomes .................................................................................... 118 Social and Cultural Influences............................................................................. 120 Peer Influence to Participate .................................................................... 120 Social and Cultural Norms for Studying ................................................. 121 viii Developing Peer Support Systems .......................................................... 123 Professional Development ................................................................................... 124 Focusing on Professional Development .................................................. 124 Career and Program Advancement .......................................................... 126 The Context of Curriculum and Pedagogy Influencing Graduate Student Experiences . 129 Curriculum and Pedagogy Influencing Learning and Development ................... 129 Experiencing the Costa Rica Program Through the College of Medicine Curriculum ............................................................................................... 130 Hands-on Learning Complimenting Curriculum and Pedagogy. 131 Solidifying Confidence in the Curriculum. ................................. 133 Education Abroad Curriculum and Pedagogy Influencing Student Experiences.............................................................................................. 135 Pre-departure Meetings. .............................................................. 135 Course Objectives ........................................................................ 136 Activities Organized into the Program Itinerary ......................... 138 Service Projects ........................................................................... 141 Leadership and Guidance ............................................................ 144 The Context of Interpersonal Development Influencing Student Experiences ............... 146 Relationships Between Students.......................................................................... 146 Teambuilding in the Education Abroad Program .................................... 147 Student Relationships Developing in Costa Rica .................................... 148 Gaining Different Perspectives and Viewpoints in Group Activities ..... 149 Language Learning and Immersion ..................................................................... 150 Cultural Immersion .............................................................................................. 153 Culturally Immersive Interactions with Host Families ........................... 153 Understanding Culture in Relation to Healthcare and Medicine............. 154 Conclusion ....................................................................................................................... 156 CHAPTER 6: FINDINGS – THE INTERSECTION OF GRADUATE STUDENT CONTEXTS INFLUENCING EXPERIENCES OF EDUCATION ABROAD .............................................. 158 Overarching Themes for Experiences of the Costa Rica Program .................................. 161 Fred: Gaining Experience in Global Health ........................................................ 161 Monica: Improving Professional Practice Through New Perspectives ............... 162 Tammy: Building Cultural Competence and Working with Underserved Communities........................................................................................................ 162 Jay: Reinforcing the Importance of Patient-Centered Practices .......................... 163 Intersections with the Context of Adult Learning ........................................................... 164 Fred ...................................................................................................................... 164 Monica ................................................................................................................. 166 Tammy ................................................................................................................. 168 Jay ........................................................................................................................ 169 Intersections with the Context of Professional Socialization .......................................... 169 Fred ...................................................................................................................... 170 Monica ................................................................................................................. 171 Tammy ................................................................................................................. 171 Jay ........................................................................................................................ 173 ix Intersections with the Context of Curriculum and Pedagogy .......................................... 174 Fred ...................................................................................................................... 174 Monica ................................................................................................................. 175 Tammy ................................................................................................................. 176 Jay ........................................................................................................................ 177 Intersections with the Context of Interpersonal Development ........................................ 178 Fred ...................................................................................................................... 179 Monica ................................................................................................................. 180 Tammy ................................................................................................................. 181 Jay ........................................................................................................................ 182 Participant Summaries of Intersections Between the Contexts ....................................... 184 Fred: Summary of Intersections Between the Contexts ...................................... 184 Monica: Summary of Intersections Between the Contexts ................................. 185 Tammy: Summary of Intersections Between the Contexts ................................. 185 Jay: Summary of Intersections Between the Contexts ........................................ 186 Conclusion ....................................................................................................................... 186 CHAPTER 7: DISCUSSION AND IMPLICATIONS ............................................................... 188 Contexts Influencing Graduate Student Experience of STFD Education Abroad .......... 189 The Context of Adult Learning ........................................................................... 190 Experiential Learning .............................................................................. 191 Elements of Transformative Learning ..................................................... 193 Pragmatic Learning ................................................................................. 195 The Context of Professional Socialization .......................................................... 196 Formal Requirements and Competencies ................................................ 196 Social and Cultural Influences................................................................. 197 Professional Identity Formation .............................................................. 198 Career and Professional Advancement .................................................... 198 The Context of Curriculum and Pedagogy .......................................................... 199 Context: Social and Cultural Influences on the Curriculum ................... 200 Content: Competencies and Structure of the Curriculum........................ 201 Form: Pedagogical Decisions and Strategies .......................................... 203 The Context of Interpersonal Development ........................................................ 205 A Definition of Interpersonal Development ............................................ 205 Interpersonal Development and Education Abroad................................. 206 Relationships Developing Between Students. ............................. 206 Language Learning and Immersion. ............................................ 207 Cultural Immersion ...................................................................... 208 Intersections Between Contexts Influencing Graduate Student Experiences of STFD Education Abroad ............................................................................................................ 210 Intersections Between Contexts of Adult Learning and Professional Socialization ............................................................................................................................. 211 Pragmatic Learning Intersecting with Professional Socialization ........... 212 Experiential Learning Intersecting with Professional Socialization........ 213 Intersections Between Professional Socialization and Curriculum and Pedagogy ............................................................................................................................. 214 x Intersections Between Curriculum and Pedagogy and Adult Learning .............. 215 Curriculum and Pedagogy Intersecting with Pragmatic Learning........... 216 Curriculum and Pedagogy Intersecting with Experiential and Transformative Learning ......................................................................... 217 Intersections Between Interpersonal Development and Curriculum and Pedagogy ............................................................................................................................. 219 A Holistic Perspective of Graduate Student Experiences of STFD Education Abroad .. 222 A Revised Model for Understanding Graduate Student Experiences of STFD Education Abroad ................................................................................................ 222 Implications for Policy and Practice................................................................................ 226 The Context of Adult Learning ........................................................................... 227 The Context of Professional Socialization .......................................................... 230 The Context of Curriculum and Pedagogy .......................................................... 232 The Context of Interpersonal Development ........................................................ 234 Intersections Between the Contexts..................................................................... 235 Implications for Future Research .................................................................................... 236 Conclusion ....................................................................................................................... 238 APPENDICES ............................................................................................................................. 240 APPENDIX A: INTERVIEW PROTOCOL ............................................................................... 241 APPENDIX B: RESEARCH INFORMATION AND CONSENT FORM ................................ 246 APPENDIX C: PROGRAM RECRUITMENT LETTER .......................................................... 248 REFERENCES ............................................................................................................................ 250 xi LIST OF TABLES Table 1: Overview of Participant Themes and Intersecting Contexts……………………....….159 Table 2: Overview of prevalent intersections between contexts influencing graduate students’ experiences……………………………………………………………………………………...211 xii LIST OF FIGURES Figure 1: A Model for Understanding Graduate Student Experiences of STFD Education Abroad.…………………………………………………………………………………………...57 Figure 2: A Revised Model for Understanding Graduate Student Experiences of STFD Education Abroad……………………………………………………………………………….……….....224 xiii CHAPTER 1: INTRODUCTION With globalization advancing social, economic, and educational objectives, many colleges and universities in the United States have embraced internationalization as a priority (Altbach, 2004; Knight, 2004). The term globalization can be defined as “the context of economic and academic trends that are part of the reality of the 21st century” (Altbach & Knight, 2007, p. 290). Moreover, in the field of higher education, the concept of internationalization represents “the process of integrating an international, intercultural, or global dimension into the purpose, functions or delivery of postsecondary education (Knight, 2003; p. 2). Thus, in response to globalization, many higher education institutions (HEI) in the US engage in internationalization strategies to help students develop global perspectives (Altbach & Knight, 2007; Knight, 2004). At the graduate level, scholars and organizations called for the preparation of the next generation of globally aware professionals through the implementation of programs, policies, and practices (Nerad, 2010; Council of Graduate Schools and Educational Testing Service [CGS], 2010). Industry, businesses, universities, and research entities now striving to be more globally accountable, graduate students are motivated to develop translational skills (i.e., cross- cultural communication, innovation, mobility, intercultural competence) to be successful professionals on the international stage (Nerad, 2012). For graduate students, the professional advancement involves gaining global perspectives and skills (CGS, 2010; Council of Graduate Schools [CGS], 2013). With education abroad programs ranking as a top priority for campus internationalization (Helms et al., 2017), they represent a strategy for at the graduate level for students to build academic and professional skills (Dirkx et al., 2014a; Dirkx et al., 2016; Sanger & Mason, 2019). 1 Graduate students represent a growing share of the total population of US students participating in education abroad programs. During the 2000-01 academic year, graduate students represented about 8% of the total US population studying abroad, which has since grown to 12% in 2018-19 (Institute of International Education, 2020a). This estimate may be low; however, as Sanger and Mason (2019) suggested national data on education abroad at the graduate level is usually underreported. In their efforts to develop a stronger demographic profile, they found 3.4% of all US graduate students participated in overseas learning activities during the 2016-17 academic year, which commonly included education abroad programs at 11,582 students (Sanger & Mason, 2019). Although education abroad enrollments have increased over time at the graduate level (Dirkx et al., 2014b; Sanger & Mason, 2019), only a limited amount of scholarship focuses on graduate student experiences in these programs (Dirkx et al., 2016). This research suggests graduate students “perceive, understand, and make sense of their study abroad experiences in ways that reflect their status as adult learners and practicing professionals” (Dirkx et al., 2016, p. 515). Additionally, some studies spread across different professional disciplines highlight developmental and professional outcomes for graduate students in education abroad programs (DuVivier & Patitu, 2017; Gilin & Young, 2009; Litzelman et al., 2017; Witkowsky & Mendez, 2018). Despite these advancements in scholarship, much of what is known about education abroad comes from research on undergraduate students and programs. The purpose of this qualitative study was to better understand graduate student experiences in education abroad programs. As Dirkx, et al. (2014b) inquired, “What makes study abroad a graduate-level experience?” (p. 15), more research is needed to understand the experiences of graduate students in these programs relative to their unique contexts situated 2 within the graduate learning environment. In this chapter, I highlight background information to present a need for the current study and state the research question that guided this inquiry. Background to the Study Although growing at the graduate level, education abroad programs represent an internationalization strategy traditionally employed by college and university campuses for undergraduate students (Mullens & Cuper, 2012; Twombly, et al., 2012). Most notably, the congressionally appointed Commission on the Abraham Lincoln Study Abroad Fellowship Program (Lincoln Commission, 2005) reported on the cross-cultural, economic, and societal benefits of education abroad, calling for a large increase in the number of undergraduate students participating in these programs. Since the Lincoln Commission, many colleges and universities have created education abroad programs for an ever-widening range of academic disciplines (Dolby, 2007; Mullens & Cuper, 2012; Twombly et al., 2012). Several scholars have documented education abroad learning outcomes to include intercultural competence (Anderson et al., 2006; Mullens & Cuper, 2012), global citizenship (Donnelly-Smith, 2009; Tarrant, et al., 2013), identity development (Dolby, 2004; Gaia, 2015), transformative learning (Brewer & Cunningham, 2009; Perry, et al., 2012), and the development of professional skills (Long et al., 2010). Some of these same scholars have also advanced best practices for undergraduate education abroad, taking into account components of student preparation, engagement, reflection, and reentry (Donnelley-Smith, 2009; Hovey & Weinberg, 2009; Mills et al., 2010). Education abroad generally exists as an umbrella term accounting for “education that occurs outside of a participant’s home country,” which can include “international experience as work, volunteering, non-credit internships, and directed travel, as long as these programs are 3 driven to a significant degree by learning goals” (Forum on Education Abroad, 2011 p. 10). The term describes many programs from culturally immersive student exchanges, study tours, to short-term education abroad experiences built into coursework (Engle & Engle, 2003; Twombly et al., 2012). Due to its broad distinction, the higher education community continues to promote the expansion of education abroad to meet goals of internationalization through many avenues to enhance students’ global engagement, language learning, foreign diplomacy, and cross-cultural awareness. In the next sections, I briefly describe how education abroad programs have expanded to the graduate level. Short-term, Faculty-directed Education Abroad Programs During the 2018-19 academic year, short-term programs were the most popular form of education abroad, accounting for 55% of all programs (IIE, 2020). Short-term education abroad programs typically last eight weeks or less and are directed by a faculty member who provides intentional oversight, often building international experiences directly into the design and facilitation of coursework (Chieffo & Griffiths, 2009). These types programs are commonly arranged into a course setting that consists of faculty directed meetings and activities taking place before, during, and after students’ experiences abroad (Mills et al., 2010). Several scholars have noted short-term programs accommodate students desiring flexibility in their life, work and academic schedules (Chieffo & Griffiths, 2009; Hulstrand, 2006; Mullens & Cuper, 2012). Since many of these programs are organized and guided by faculty (Hulstrand, 2006), I use the terminology short-term, faculty directed (STFD) to describe them. At the graduate level, education abroad is primarily expanding with the implementation of STFD programs (Loebick, 2017). 4 Education Abroad Programs at the Graduate Level Several graduate and professional fields offer variations of STFD education abroad programs for students, including business (Peppas, 2005; Tang & Rose, 2014), education (Dirkx et al., 2016), law (Tobenkin, 2009), nursing (Gilliland et al., 2016), medicine (Litzelman et al., 2017; Melby et al., 2016; Ventres et al., 2020), student affairs (DuVivier & Patitu, 2017; Slantcheva-Durst & Danowski, 2018; Witkowsky & Mendez, 2018), and social work (Gilin & Young, 2009; Roholt & Fisher, 2013). Much of the literature on graduate education abroad is comprised of research within these professional disciplines. Only a few larger studies exist, primarily in the form of exploratory research projects and academic dissertations, which provide insight regarding the demographic landscape (Dirkx et al., 2014a; Sanger & Mason, 2019) and faculty experiences of graduate education abroad programs (Loebick, 2017; Sinclair, 2014) Within this body of literature, demographic characteristics of graduate students participating in education abroad suggest they are older in terms of age and enroll primarily in short-term programs (Dirkx et al., 2014a; Sanger & Mason, 2019). Additionally, scholars across several professional disciplines recognize developmental outcomes for graduate students participating in education abroad programs, including opportunities for experiential learning (Gilin & Young, 2009; Tang & Rose, 2014) and transformative learning (Dirkx et al., 2016; Litzelman et al., 2017; Roholt & Fisher, 2013). Gilin and Young (2009) found graduate students in the field of social work reflected on their professional identities and practices as the result of their education abroad experiences. Litzelman et al. (2017) argued international medical rotation experiences offered opportunities for students to reframe their perspectives about healthcare, resources, and patient care. Another study concluded graduate students experienced education abroad programs with a professional mindset, focusing more on strengthening their academic 5 skills as researchers and practitioners (Dirkx et al., 2016). Also, a number of scholars linked goals of graduate education abroad programs with professional competencies and accreditation standards (DuVivier & Patitu, 2017; Peppas, 2005; Slantcheva-Durst & Danowski, 2018). Within the field of medicine, Ventres and Wilson (2020) highlighted medical students were socialized to seeing opportunities for international programs as a pathway to career success and advancement. Scholars in the field of student affairs found graduate students advanced their career skills and goals as the result of their STFD education abroad experiences (DuVivier & Patitu, 2017; Witkowsky & Mendez, 2018). Finally, some scholarship focused on faculty goals, perceptions and approaches to designing and facilitating graduate international experiences and education abroad programs. Sinclair (2014) found faculty decisions to organize graduate international experiences were shaped by the culture, values, and competencies within their professional disciplines. Faculty recognized international experiences were a way to connect students with disciplinary values, knowledge, and skills. Also, Loebick (2017) showed how faculty decisions to lead short-term graduate education abroad programs were influenced by a desire to accommodate students’ disciplinary learning within a global context. Faculty leaders recognized the value education abroad programs brought to networking, experiential learning, disciplinary knowledge, and career preparation for graduate students in their professional programs. Loebick (2017) argued learning objectives and goals of education abroad at the graduate level were unique and differentiated from undergraduate programs. Graduate Student Contexts Influencing Their Education Abroad Experiences Together, these studies provide a useful foundation for thinking about STFD graduate education abroad programs engaging students within the knowledge, goals, and values of 6 graduate education. Graduate students are a unique population participating in education abroad programs because they tend to be older and more experienced (Dirkx et al., 2014a; Dirkx et al., 2014b; Sanger & Mason, 2019; Tang & Rose, 2014), recognize opportunities for academic, professional, and career advancement (Dirkx et al., 2016; Gilin & Young, 2009; Ventres & Wilson, 2020), and engage in curriculum and pedagogy designed towards their knowledge and skill development within a specific discipline (Loebick, 2017; Sinclair, 2014). Clearly, graduate students hold unique contexts relative to their experiences, maturity, knowledge acquisition, and socialization, which may influence how they experience education abroad programs. For the purpose of this paper, I assign the term context to represent a lens used to frame graduate student experiences. Graduate student contexts of adult learning, professional socialization, and curriculum and pedagogy likely shape their experiences in STFD education abroad programs. The Context of Adult Learning Graduate programs typically recruit from an older population of adult learners (Hegarty, 2011), who bring professional goals, extensive life-experiences, and self-awareness into their learning process (Kerka, 2002; MacKeracher, 2004; Merriam & Bierema, 2014). There are many perspectives of adult learning in the literature, such as experiential learning, transformative learning, self-directed learning, and andragogy (Boucouvalas & Lawrence, 2010), making a universal definition elusive (Brookfield, 1995). As such, adult learners can engage in a range of learning perspectives that foster change in their ways of knowing, incorporate their knowledge and experiences, and motivate personal or professional fulfillment. The context of adult learning highlights these perspectives and accounts for the experience, maturity, and self-awareness graduate students may bring with them into an STFD education abroad program. 7 The Context of Professional Socialization Graduate education is grounded in the process of professional socialization, where students learn knowledge, norms, values, and skills preparing them for their future social and occupational roles (Gardner & Mendoza, 2010; Golde & Walker, 2006; Weidman et al., 2001; Weidman & Stein, 2003). According to Austin (2002), “The graduate experience is a crucial point in time to determine whether students are exposed to the types of skills and expectations likely to confront them on the job” (p. 96). Formal and informal dimensions of professional socialization guide the way graduate students conduct research, engage in networking, interact with colleagues, and participate in programs (Weidman et al., 2001; Weidman & Stein, 2003). The context of professional socialization represents the knowledge, skills, and values graduate students likely seek to develop and affirm in an STFD education abroad program. The Context of Curriculum and Pedagogy Generally, curriculum and pedagogy represent the intentional design and facilitation for student learning negotiated by faculty (Toombs & Tierney, 1993). At the graduate level, curriculum goes beyond general skill-building to engage students in complex training, research, and development within a specific discipline (Council of Graduate Schools [CGS], 2011). Through apprenticeships, graduate students are taught to integrate their knowledge and training to succeed as researchers and practitioners (Golde, 2008; Sullivan, 2005). Consequently, curriculum and pedagogy at the graduate level represents the design and facilitation of an STFD graduate education abroad program fitting within the specialized knowledge and social expectations of graduate education. 8 Intersections Between the Contexts If graduate students’ experiences of STFD education abroad programs are influenced by adult learning, professional socialization, and curriculum and pedagogy, they likely occur through intersections between these contexts. For the purpose of this paper, I define intersection as a point of commonality at which contexts overlap. A few examples of intersections might include curriculum that engages graduate students in training and knowledge development within a specific discipline (Sullivan, 2005) overlapping with elements of the socialization process focused on their professional preparation (Weidman & Stein, 2003). Additionally, pedagogical practices revolving around a learner’s knowledge and values (Kerka, 2002), might influence adults who arrive to a learning experience with maturity and established worldviews (Merriam & Bierema, 2014). Intersections between the contexts situate the graduate student at the center of the experience. Problem Statement and Research Question Increasingly, graduate and professional programs are internationalizing policies and practices to provide students with global competencies, perspectives, and skills (Nerad, 2010; 2012; CGS, 2010). As a result, more graduate students are participating in education abroad (Dirkx et al., 2014b; Gearon, 2011). Yet, scholarship has only recently emerged on the demographic, developmental, professional, and pedagogical characteristics of education abroad at the graduate level (Dirkx et al. 2014a; Dirkx et al., 2014b; Dirkx, et al., 2016; Gilin & Young, 2009; Loebick, 2017; Sanger & Mason, 2019; Sinclair, 2014; Slantcheva-Durst & Danowski, 2018; Witkowsky & Mendez, 2018). A few of these studies suggest graduate students are unique in terms of their professional goals and status as adult learners (Dirkx et al., 2014; Dirkx et al., 2016), and they engage in STFD education abroad programs designed to fit their development 9 within a specific discipline (Loebick, 2017). Beyond these studies, there is a lack of research aiming to understand the experiences of graduate students who participate in STFD education abroad, and how programs reflect their unique contexts as adult learners, emerging professionals, and engaged scholars. For STFD education abroad programs to succeed as an internationalization strategy for graduate education, they must account for the students who are participating in them, or else they risk becoming ineffective means of fulfilling global competencies and initiatives. Gaining a better understanding of graduate student experiences of education abroad will improve program design and facilitation and build awareness for best practices. More empirical research in this area will help to ensure graduate education abroad programs are supporting the goals, needs, and experiences of the graduate students they serve. With this imperative, the purpose of this qualitative study was to explore contexts of graduate students and their intersections, as they related to their experiences of an STFD education abroad program. The current study explored the following research question: • How do contexts of adult learning, professional socialization, and curriculum and pedagogy intersect to influence graduate students’ experiences of a short-term, faculty- directed education abroad program? Significance of the Study This study adds to a growing body of literature on graduate education abroad. Recent scholarship indicated graduate students experience education abroad in ways reflecting their age, professional goals, and academic responsibilities (Dirkx et al., 2014b; Dirkx et al., 2016). Additionally, scholars showed faculty design graduate education abroad programs to connect students with specific competencies, values, and skills in their respective disciplines (Loebick, 10 2017; Sinclair, 2014). The current study builds upon this research by exploring how contexts of adult learning, professional socialization, and curriculum and pedagogy intersect to influence graduate students’ experiences of education abroad programs. These contexts are likely complex and multifaceted, so examining their intersections allows for a better understanding of the graduate student to account for their goals, needs, and experiences in education abroad programs. Additionally, there may be other contexts influencing graduate students’ experiences beyond adult learning, professional socialization, and curriculum and pedagogy—which this study can explore and examine further. As a result, this research is beneficial to two main stakeholders regarding the design and facilitation of graduate education abroad programs: administrators and faculty-directors. Administrators As internationalization has become a prominent trend in higher education (Altbach & Knight, 2007; Knight, 2004), graduate students are expected to develop personal and professional competencies to compete in a global economy (CGS, 2010; Nerad, 2010). With education abroad serving as an internationalization strategy (Helms et al., 2017), graduate students represent a growing share of the total US population studying abroad (IIE, 2020). However, a lack of knowledge and follow-through representing graduate students as individuals, professionals, and scholars may hinder education abroad programs from meeting their goals, values, and expectations. According to Selby (2008), the benefits of education abroad often conflict between what administrators view as strategic global outcomes and what students cite as meaningful experiences. At the heart of this dilemma, administrators are likely making critical decisions about funding, resources, and international partnerships without redefining and validating how graduate students experience education abroad. Thus, in learning about the 11 contexts influencing graduate students experiences of STFD education abroad, administrators will better understand how students perceive these programs enhancing their professional development within an academic discipline. As a result, administrators can make more informed, logistical decisions about STFD graduate education abroad programs, concluding whether or not these programs are effective at fulfilling espoused goals and global competencies. Faculty-directors Through upholding rigorous disciplinary requirements, managing international partnerships, and accommodating cross-cultural pedagogical strategies, faculty directors influence many aspects of students’ experiences of STFD education abroad (Chieffo & Griffiths, 2009; Goode, 2008; Loebick, 2017; Mullens & Cuper, 2012). However, aside from a few studies providing an account of faculty leaders’ approach to designing and facilitating graduate education abroad (Loebick, 2017; Sinclair, 2014), there is a dearth of knowledge about how curricular and pedagogical decisions influence what graduate students gain cognitively, professionally, and academically from studying abroad. According to Twombly et al. (2012), there is much to learn about how education abroad should be designed, implemented, and assessed, given the many types of programs emerging for an increasingly diverse set of student participants, so data is more valuable than ever to move the field forward. Thus, more research is needed for faculty directors to consider the perspectives and experiences of graduate students when designing and implementing education abroad programs. With more research focusing on graduate student experiences, faculty directors can be more intentional about how they approach, design, and facilitate graduate STFD education abroad programs. 12 Overview of Dissertation In this chapter, I outlined the need for this study along with the research question and significance of this work. In Chapter 2, I explore the literature showing how education abroad has evolved at the graduate level, and I contextualize graduate students’ experiences by highlighting three contexts: adult learning, professional socialization, and curriculum and pedagogy. The literature review also includes a conceptual framework discussing how these contexts might intersect with one another to influence graduate students’ experiences of a STFD education abroad program. Following the literature review, Chapter 3 outlines my methodology and research design for the study. Chapter 4 provides background information about the case study to set a context for the following chapters, including an introduction of participants and overview of the STFD education abroad program that served as the case. Chapter 5 presents the findings on contexts influencing participants’ experiences of a STFD education abroad program, and Chapter 6 highlights how these contexts intersect. Finally, Chapter 7 discusses results and implications of the current study. 13 CHAPTER 2: LITERATURE REVIEW In this chapter, I review a body of literature to better understand the personal, professional, and scholarly contexts of graduate students that influence their experiences during STFD education abroad programs. As discussed in the previous chapter, there is a dearth of research covering how graduate students make sense of their educational experiences, especially regarding international opportunities such as education abroad. Four sections are included to provide insight for this study. The first section situates graduate education abroad into the broader landscape underpinning internationalization goals and strategies of higher education. Within this section, a brief history, classifications, and current trends of education abroad are discussed, providing context about how these programs have evolved at the graduate level. The second section highlights literature dedicated to graduate education abroad, covering the demographic landscape, developmental influence, professional competencies, outcomes, and faculty approaches for these programs. The third section focuses on three contexts that frame the experiences of graduate students participating in education abroad programs: adult learning, professional socialization, and curriculum and pedagogy. Each context is explored and linked to literature on graduate education abroad programs. Intersections between contexts are also briefly addressed. The chapter concludes with the conceptual framework highlighting theoretical concepts that inform the contexts of adult learning, professional socialization, and curriculum and pedagogy. An integrated model is included to provide a guiding framework for the study. The Internationalization of Graduate Education Graduate education has traditionally been linked to a process of socialization where students learn specialized knowledge and skills for advanced academic and professional careers (Austin, 2002; Gardner & Mendoza, 2010; Weidman et al., 2001). Within this process of 14 socialization, graduate students develop broad competencies related to scholarship, critical thinking, and practical skills that greatly influence their future academic, social, and occupational livelihood. These broad competencies do not exist in a vacuum but are often influenced by internal and external forces shaping graduate education, such as workforce demands, institutional accreditation standards, and institutional pressure for innovation (Denecke et al., 2017; CGS, 2010). One such force is globalization. Trends of globalization have influenced graduate and professional programs. Over the last several decades, governments around the world began engaging in internationalization to compete in a new knowledge economy by investing in research, creating innovation policies, and sponsoring professional students to study overseas (Nerad, 2010; 2012). As a result, graduate education, and specifically doctoral programs, repositioned themselves to make students more internationally mobile, professionally transferrable, and interculturally nimble. Demonstrating this paradigm shift, the Council of Graduate Schools (2010) acknowledged the importance of preparing US graduate students to succeed in an increasingly global economy. One of the recommendations to prepare graduate students was through engagement in international experiences such as education abroad programs. Today, education abroad programs exist at the graduate level to meet the needs of doctoral and professional programs (Dirkx et al., 2014a; 2014b; Sanger & Mason, 2019). Yet, education abroad programs encompasses some of the oldest means for internationalization at the undergraduate level (Hoffa & DePaul, 2010; Lewin, 2009; Twombly et al., 2012). Internationalization Through Education Abroad Education abroad represents an internationalization strategy utilized by HEIs to engage students in the development of skills for a globally oriented world (Dolby, 2007; Lewin, 2009; 15 Mullens & Cuper, 2012; Twombly, et al., 2012). Recently, Helms et al. (2017) ranked education abroad as the top priority among campus internationalization strategies. According to Lewin (2009), “Those at the top of the higher education ladder are encouraging students to study abroad as never before, with many central administrators even setting ambitious percentage goals in the name of ‘internationalization of higher education’” (p. xii). Indeed, education abroad serves as a means for internationalizing a campus. Although education abroad has greatly strengthened and expanded over the past few decades, new developments with students, programs, and outcomes have encouraged scholars to continue exploring this topic. However, much of what is known about education abroad exists exclusively within the realm of undergraduate education. In the following sections, I overview the history, purpose, trends, and types of education abroad, showing how this internationalization strategy has evolved to the graduate level. Definition of Education Abroad Education abroad is an umbrella term that covers many types of student programs, opportunities, and experiences within the context of international education (Forum on Education Abroad, 2011). Some programs falling under education abroad include study abroad, international research opportunities, internships, and service learning. Most recently, organizations such as the American Council on Education’s Center for Internationalization and Global Engagement (CIGE) acknowledged changes to adopt the terminology of “education abroad” rather than “study abroad” (Helms et al., 2017). This distinction is important because it recognizes standards that reflect the intentionality of these international experiences in contributing to students’ learning and development. The CIGE report closely aligned with the model put forth by the Forum on Education Abroad, which is an association of international 16 educators dedicated to preparing education abroad professionals with resources, training, and standards for practice. The Forum on Education Abroad acts as a primary resource for information and research on education abroad. Therefore, I utilize the definition of education abroad utilized by the Forum on Education Abroad (2011), which establishes the term as “Education that occurs outside the participant’s home country. Besides study abroad, examples include such international experience as work, volunteering, non-credit internships, and directed travel, as long as these programs are driven to a significant degree by learning goals” (p. 10). History and Purpose of Education Abroad Historically, education abroad is one of the oldest forms of internationalization within higher education, as it is associated with a long tradition of students traveling overseas for learning and development (Twombly et al., 2012). Hoffa and DePaul (2010) show how education abroad has employed four overlapping goals including curricular engagement, cross-cultural connections, career enhancement, and personal development. However, some scholars also recognize global citizenship being the foundational aim of education abroad (Lewin, 2009; Mullens & Cuper, 2012). Starting as a form of cultural exploration for elite males, education abroad in the US eventually evolved to include a wider array of students and later became a method of internationalization infused into the curriculum at many HEIs (Hoffa, 2007). At a national level, education abroad was viewed as a way to enhance foreign policy and diplomatic interests but later became a way to develop globally educated citizen leaders (Bu, 1999; Hoffa & DePaul, 2010; Twombly et al., 2012). There are many outcomes cited in conjunction with education abroad, including identity development and self-awareness (Dolby, 2004, 2007; Gaia, 2015), intellectual development (McKeown, 2009), global mindedness (Chieffo & Griffiths, 2004), and professionalism (Long et 17 al., 2010). However, intercultural competence, defined as “the ability to communicate effectively and appropriately in intercultural situations based on one’s intercultural knowledge, skills, and abilities” (Deardorff, 2004, p. 194), is the outcome measure most often associated with education abroad (Anderson et al., 2006; Hoffa & DePaul, 2010; Lincoln Commission, 2005; Twombly et al., 2012). Overarching approaches to education abroad by many HEIs are increasingly learner- centered, helping students adapt to and apply skills they learn within an international setting (Vande Berg et al., 2009). Consequently, education abroad was recognized as a high impact practice (HIP), which describes meaningfully rich curricular and cocurricular college experiences where students become invested in their learning and development (Kuh, 2008). This HIP concept was further explored by Wawrzynski and Baldwin (2014), who suggested activities like education abroad provided students with opportunities meaningfully reflect on their background through the lens of internationalization. In recent decades, the higher education community has continued the call to increase education abroad in order to meet the goals of internationalization and globalization. In 2005, the Commission on the Abraham Lincoln Study Abroad Fellowship Program (Lincoln Commission) was created by the United States Congress to leverage new global demands placed upon HEIs and advocate for one million students to study abroad annually by the 2016-17 academic school year. By 2006, upwards of 90 percent of HEIs provided education abroad as an option for students (Hoffa & DePaul, 2010; Twombly et al., 2012). Trends in Education Abroad While many initiatives such as the Lincoln Commission advocated for the expansion of education abroad, the numbers of students studying abroad has continued to grow. The total population of US students studying abroad has consistently increased, from 70,727 during the 18 1989-1990 academic year to 347,099 in 2018-2019 (Institute of International Education [IIE], 2020). Most forms of education abroad are credit-bearing experiences, with only 9% of students participating in non-credit work, study, or research abroad. Of the college population participating in education abroad, over 38,000 were graduate students, supporting literature asserting graduate level programs are on the rise (Dirkx et al., 2014b; Gearon, 2011). Types of Education Abroad Under the umbrella of education abroad, many different types of international options exist for students, including study abroad, study tours, semester abroad, short or long-term cultural immersion programs, international internships, research, and service-learning. One of the earliest typologies associated with education abroad was developed by Engle and Engle (2003), who outlined five different types of programs taking into account components such as the length of experience, inclusion of language competencies, and the scope of cultural immersion. Five classifications were specified to include (a) study tours, (b) short-term study, (c) cross-cultural contact programs, (d) cross-cultural encounter programs, and (e) cross-cultural immersion programs (Engle & Engle, 2003). Some of what differentiated the types of programs were duration, coursework, cross-cultural objectives, and student or faculty expectations— making them susceptible to change based on the parameters of an HEI or academic program (Twombly et al., 2012). For study tours and short-term study, these programs required little to no language proficiency, lasted 8 weeks or less, and were typically coordinated by faculty either from the home institution or a partner institution (Engle & Engle, 2003). At the opposite end of the continuum were cross-cultural programs that progressively relied on cultural interaction, language proficiency, and longer duration of stay. Within this typology, short-term programs 19 witnessed the largest expansion is student participation over recent decades (Chieffo & Griffiths, 2009; Hulstrand, 2006; Mullens & Cuper, 2012). Short-term, Faculty-Directed Education Abroad Programs Over the past several decades, short-term programs have served as the most common form of education abroad (Hulstrand, 2006; Twombly et al., 2012), and they accounted for about 55% of all programs in 2018-19 (IIE, 2020). Short-term education abroad programs typically last less than a typical academic semester (i.e., eight weeks or less) that include a faculty member who travels with a group of students to provide curriculum, oversight, and guidance (Chieffo & Griffiths, 2009; Long et al., 2010; Mills et al., 2010). Many scholars linked short-term education abroad programs with significant opportunities for undergraduate students to increase their self- awareness, global citizenship, intellectual development, and intercultural competence (Anderson et al., 2006; Chieffo & Griffiths, 2009; Donnelly-Smith, 2009; Gaia, 2015; Lewin, 2009; Long et al., 2010; Mills et al., 2010; Mullens & Cuper, 2012). Due to their compact structure, short-term education abroad programs provide additional options for students who are unable to commit to extended time abroad due to career, financial, or family responsibilities (Donnelly-Smith, 2009; Hulstrand, 2006; Mills et al., 2010). According to Mullens and Cuper (2012), these programs have “created greater and oftentimes more accessible and feasible opportunities for students to travel and study internationally and are proving to be particularly helpful when attempting to attract students who have not elected to study abroad in the past” (p. 9). Typically directed by faculty, short-term programs are more attentive to intentional design of curriculum and pedagogy along with students’ unique international experiences (Chieffo & Griffiths, 2009; Donnelly-Smith, 2009; Mullens & Cuper, 2012). As a result, these programs offer greater flexibility to fulfill diverse requirements and 20 learning styles that exist for many academic disciplines including business, education, engineering, nursing, and social work (Hulstrand, 2006). Education Abroad Expanding at the Graduate Level With short-term, faculty-directed (STFD) programs providing greater flexibility to enhance professional development opportunities without disrupting education requirements (Chieffo & Griffiths, 2009; Hulstrand, 2006), graduate students are a growing proportion of the total population participating in education abroad (Dirkx, et al., 2014a; 2014b; Gearon, 2011; Hulstrand, 2006; Sanger & Mason, 2019). However, relatively little is known about graduate education abroad, and the existing literature is scattered over different academic and professional disciplines. Within this body of literature, programs are classified with diverse terminology. For example, the field of business labels education abroad as international study visits and medicine categorizes them as short-term global health experiences. For continuity in the remaining chapter, I use the term graduate education abroad when referring to these programs. The literature on graduate education abroad programs comes from several professional fields including business (Peppas, 2005; Tang & Rose, 2014), education (Dirkx et al., 2016), law (Harmon & Kaufman, 2008, Tobenkin, 2009), nursing (Gilliland et al., 2016), medicine (Litzelman et al., 2017; Melby et al., 2016; Ventres & Wilson, 2020), student affairs (DuVivier & Patitu, 2017; Slantcheva-Durst & Danowski, 2018; Witkowsky & Mendez, 2018), and social work (Gilin & Young, 2009; Roholt & Fisher, 2013). A few larger, interdisciplinary studies were conducted to highlight the demographic landscape (Dirkx et al., 2014a; Dirkx et al., 2014b; Sanger & Mason, 2019) and faculty experiences, perspectives and goals (Loebick, 2017) of graduate education abroad programs. Additionally, Sinclair (2014) focused her dissertation on faculty experiences with organizing and implementing graduate international experiences. These 21 larger studies consist of either exploratory research projects or academic dissertations, which suggest this topic is still relatively unexplored. In the following sections, I review existing literature on graduate education abroad programs to highlight: (a) student demographics, (b) developmental influence, (c) professional competencies and outcomes, and (d) faculty experiences and approaches. Although limited, this body of literature provides a window to understanding graduate student experiences in education abroad programs. The Demographic Landscape of Graduate Education Abroad The demographic landscape of graduate education abroad was explored in two separate studies conducted five years apart—the Graduate Learning Experiences and Outcomes (GLEO) project in 2014 (Dirkx et al., 2014a) and the Graduate Learning Overseas (GLO) project in 2019 (Sanger & Mason, 2019). The GLEO project conducted a multi-institutional survey of 172 graduate education abroad programs at 15 research universities and also interviewed several doctoral students about their international experiences (Dirkx et al., 2014a). The findings from this study indicated graduate education abroad was diverse in terms of the academic discipline represented and the types of activities students experienced, which included academic field trips, research, service, community engagement, and volunteer work (Dirkx et al., 2014a). Additionally, participants interviewed in the second part of the GLEO project were older in age (e.g., 23-45) than traditional undergraduate students. The GLO project was implemented in partnership with the Institute of International Education and surveyed over 700,000 graduate students from 205 colleges and universities about their educational activities overseas (Sanger & Mason, 2019). Based on the GLO project’s findings, a key estimate was 3.4% of all enrolled graduate students participated in some type of overseas learning activity during the 2016-17 academic year, which most predominately included 22 education abroad. Also, the GLO project revealed a majority of graduate education abroad programs were conducted with traditional methods of coursework instruction and guided primarily by students’ career interests rather than degree requirements (Sanger & Mason, 2019). Both the GLEO and GLO projects found a vast majority of education abroad programs were short-term, and the largest category of student participants were at the master’s rather than doctoral level (Dirkx et al., 2014a; 2014b; Sanger & Mason, 2019). Also, both studies found academic disciplines with the highest number of programs and rates of student participation included business, health professions, and education. Finally, a majority of surveyed education abroad programs in both projects were academic credit bearing. While the GLEO project represented one of the earliest accounts exploring the landscape of graduate education abroad, the GLO project showed a growing interest by the US Department of Education and higher education organizations to understand the scale and scope of these programs. The Developmental Influence of Graduate Education Abroad Some of the literature on graduate education abroad focuses on the developmental influence of these programs on students’ experiential and transformative learning. Scholars across several professional disciplines highlight how graduate students apply experiences in education abroad programs to expand on existing knowledge. Other studies focused on graduate students processing their education abroad experiences in critically reflective ways. These developmental approaches influenced how graduate students experienced education abroad programs, and they are representative of adult learning, which is discussed later in this chapter. Experiential Learning in Graduate Education Abroad There are a few examples in the literature showing the importance of experiential learning for graduate students in education abroad programs. Gilin and Young (2009) discussed 23 the experiential learning of students who participated in a short-term education abroad for a Master of Social Work (MSW) program. They identified several areas where students’ education abroad experiences enhanced their learning and development. First, students gained an awareness of international policies and practices they could apply to serving clients back home (Gilin & Young, 2009). Also, students gained empathy for non-English speaking clients after they experienced difficulties adapting to language barriers. Finally, students reflected on their professional identities as the result of their experiences, seeing themselves as members of an international coalition of social workers. Gilin and Young (2009) concluded that students’ participation in the education abroad program extended their knowledge beyond what they attained in the MSW program. Roholt & Fisher (2013) also emphasized experiential learning as an important pedagogical method for MSW students in an education abroad program. They pointed out that learning in education abroad could happen everywhere and was a product of daily experiences. Instructors were encouraged to anticipate opportunities to engage students in reflection when situations or critical incidents occurred. Roholt and Fisher (2013) described critical incidents as “moments in practice that create ‘disorienting dilemmas’ in which our old ways of knowing do not work to make sense of our experience” (p. 55). Structured time for reflection was also discussed as a helpful method for students to debrief their daily experiences. Finally, these scholars suggested host-country facilitators were valuable to guiding structured reflections and discussions because they could engage students in learning about local policies and practices (Roholt & Fisher, 2013). Experiential learning was highlighted by scholars in the field of business management as an effective model for education abroad in the form of international study visits (Tang & Rose, 24 2014). While this study featured programs in Australia and the United Kingdom, they still provided insight for student experiences in graduate education abroad programs. Tang and Rose (2014) noted executive MBA students were often mature and held prior knowledge related to business management. Consequently, these students benefitted from out-of-class experiences to meet with international business executives and policymakers because they could apply knowledge directly to their professional development. Experiential activities purposefully structured into the program, such as pre-visit preparation assignments, on-the-ground learning activities, and post-visit opportunities to apply lessons learned, were found to prompt a deeper level of learning and engagement for students (Tang & Rose, 2014). Transformative Learning in Graduate Education Abroad A few scholars recognized opportunities for transformative learning during graduate education abroad programs when students processed their experiences in critically reflective ways. Roholt and Fisher (2013) found critical incidents influenced MSW students to reframe their perspectives about privilege and citizenship during an education abroad program. Moreover, they emphasized an instructor’s role to capitalize on critical incidents by helping students process their assumptions and supporting them in reflection to make sense of their experiences. Scholars in the field of medicine highlighted the transformative potential of international rotation experiences when medical students confronted frame-shifting situations—interacting with patients facing disability and encountering healthcare vastly different from the United States (Litzelman et al., 2017). Medical students described their international rotation experiences as “…life changing and as the most important and influential experience in their medical training” (Litzelman et al., 2017, p. 601). Some students reinforced their commitment for working with 25 underserved communities and pursuing a career in global health after their international rotations. These experiences were accompanied by on-site, faculty-led reflections and discussions, which provided opportunities for students to process their emotions, thoughts, and perspectives. Litzelman et al. (2017) concluded that global partnerships with host organizations were important to integrate into a medical school curriculum to foster culturally conscious professionals and practitioners. Additionally, doctoral students interviewed in the GLEO project were reflective about challenging situations they encountered abroad and motivated to reframe their personal and professional values within the larger context of global citizenship (Dirkx et al., 2014a). In a follow-up to the GLEO project, Dirkx et al. (2016) utilized transformative learning as a conceptual framework to examine doctoral students’ critical reflection and sensemaking during education abroad. Regarding the sensemaking of graduate education abroad, findings pointed to three overarching ways that students talked about their experiences: academic travel, relational travel, and deep travel (Dirkx et al., 2016). First, academic travel was the most common narrative expressed by students and represented a shallower emotional connection to a cross-cultural experience. Instead, students focused analytically on the integration of internationalization into their scholarly work and professional development. Second, the dimension of relational travel encompassed opportunities for students to develop personal relationships with peers and process their experiences within a group setting (Dirkx et al., 2016). Finally, deep travel occurred when graduate students began to reevaluate ways to see themselves as scholars and practitioners as the result of an education abroad experience. While these instances were rarer, they happened when cross-cultural experiences would push graduate students beyond their comfort levels (Dirkx et al., 2016). 26 In discussing the findings, Dirkx et al. (2016) noted, “…the stories described by these doctoral students reveal more focus on the academic and professional development dimensions of these international experiences, evoking the deeper and richer occupational backgrounds they bring to these programs” (p. 529). These scholars concluded that doctoral students began to engage in the transformative learning process through the development of a deeper professional self-understanding, but they fell short of fully changing their ways of being and knowing. This study furthered the call to explore graduate student characteristics and disciplinary aims guiding the development of graduate education abroad programs. Professional Competencies and Outcomes of Graduate Education Abroad Another area in the literature highlighted the connection between professional competencies for graduate students and the outcomes of education abroad programs. Recognizing challenges and opportunities of globalization, the Council of Graduate Schools called for graduate programs to prepare students for entering a dynamic and cross-cultural workforce (CGS, 2010; 2013). Across several professional fields, scholars recognize similar aims and heed accrediting organizations calling on them to prepare graduate students to meet the demands of an increasingly global society. Education abroad programs are often recognized as a way to help graduate students develop professional knowledge and skills to fulfill these goals. The alignment between competencies, outcomes, and professionalization also relates to the concept of professional socialization, which is discussed in more detail later in this chapter. The Field of Medicine In the field of medicine, short-term global health programs are growing because they offer valuable training and networking opportunities for students preparing to become globally competent physicians and practitioners (Melby et al., 2016). Ventres and Wilson (2020) pointed 27 out there is a “…trend towards seeing international work as a path to professional success” (p. 34). Medical students are often driven by socialization to focus on opportunities for technical training and skill development in education abroad rather than attending to humanitarian and community purposes of service-learning (Ventres & Wilson, 2020). However, scholars are calling for social, cross-cultural, and humanistic goals for education abroad programs to promote critically engaged, service-oriented, and community conscious practitioners for an increasingly global medical profession (Melby et al., 2016; Ventres & Wilson, 2020). With over two-thirds of students expected to participate in education abroad during their time in medical school (Melby et al., 2016), these programs represent a larger awareness of international healthcare issues and a rise in global health degree programs (Jogerst et al., 2015). The Field of Student Affairs Professional competencies in the field of student affairs also drive graduate programs to implement education abroad in preparing practitioners to build multicultural competence for serving increasingly diverse and international student populations (DuVivier & Patitu, 2017; Slantcheva-Durst & Danowski, 2018). DuVivier & Patitu (2017) explored self-perceptions of graduate students who participated in a three-week international internship, finding they reported gains in communication, human relations, and professional skills as the result of their experiences. Additionally, graduate students increased confidence in their professional self- worth and developed career skills related to their development as future practitioners. The scholars concluded, “…global dispositions, knowledge and skills of graduate students relative to the articulated professional competencies in Student Affairs in Higher Education can be enhanced through participating in a short-term study experience abroad” (DuVivier & Patitu, 2017, p. 26). 28 Slantcheva-Durst and Danowski (2018) also highlighted competencies in the field calling for the training of new student affairs professionals to support multicultural initiatives and communities, and they recognized the potential of education abroad in accomplishing these goals. Using semantic network analysis, these scholars reviewed journal entries of graduate students in short-term international study trips to explore their gains in multicultural competence, which they divided into awareness, knowledge, and skills. Notable findings of this study demonstrated students engaged in self-awareness and reflection when confronted with cultural differences and unfamiliar experiences (Slantcheva-Durst & Danowski, 2018). Also, students reported their abilities to form relationships with peers and navigate group dynamics as the result of the program. Finally, students highlighted specialized knowledge they gained about systems of higher education outside of the United States, showing the programs contributed to their professional development. Witkowsky and Mendez (2018) recognized education abroad as a pedagogical method for preparing emerging professionals in the field of student affairs to develop intercultural competence. These scholars found graduate students enhanced their understanding of cultural differences, which translated into meaningful skills for working with international student populations on campus. Additionally, some students altered their career goals after gaining an appreciation for international programs, students, and higher education systems they encountered during education abroad. Moreover, Witkowski and Mendez (2018) contended that short-term education abroad programs offered beneficial experiences for graduate students’ professional development. 29 The Field of Business Finally, education abroad was recognized as a strategy to satisfy accreditation standards and prepare new professionals to gain global perspectives, values, and experiences in the field of business (Alon & McAllaster, 2009; Peppas, 2005). Alon and McAllaster (2009) surveyed 67 different MBA programs from 19 countries regarding their global footprint, which included dimensions of curriculum, faculty and student global experiences. They argued most schools were aware of globalization as a driving force behind MBA program goals and approaches to educating business leaders. Within the student dimension, the study explored international experiences, including short-term study trips, consulting projects, residency, and internship experiences. While a majority of schools offered short-term study trips for business students, few were required by MBA programs, prompting recommendations for increases in international opportunities for students (Alon & McAllaster, 2009). Additionally, Peppas (2005) suggested short-term education abroad programs were a method to meet accrediting standards pushing for business schools to provide students with global perspectives. Moreover, Peppas (2005) focused on the experiences of non-traditional, adult, business students in a short-term education abroad program. More specifically, the study retroactively surveyed graduate and upper-level undergraduate students who had participated in a two-week study tour in the eight-year period when the course was offered. A majority of respondents believed their work performance and career development were positively influenced by their participation in the study tour. Furthermore, respondents noted positive gains related to cultural awareness and the development of intercultural skills. Some other advantages were discussed, including the ability for students to see business practices outside of the United States and understand practical applications of coursework. Peppas (2005) argued “The results of this 30 study indicate that, for the non-traditional student, this type of program provides substantial benefits with regard to business education, cultural awareness and sensitivity, and work-related gains” (p. 162). Faculty Experiences and Approaches for Graduate Education Abroad Two scholars, Sinclair (2014) and Loebick (2017), focused on faculty goals, experiences, perceptions, and approaches with designing, organizing, and facilitating graduate international experiences, such as education abroad programs. Both of these studies were academic dissertations tracking faculty experiences across several graduate and professional disciplines. Moreover, these studies highlighted the role faculty took in developing international experiences, incorporating them into their curriculums, and guiding graduate student learning and engagement. By examining faculty goals, experiences, and approaches, these studies offer a window into understanding how graduate education abroad programs are influenced by curriculum and pedagogy. Organizational Implementation of Graduate International Experiences Seeking to understand the organizational factors involved with developing graduate international experiences in Dentistry, Law, and Medicine, Sinclair (2014) examined the roles of faculty in building and supporting initiatives such as education abroad within their departments. Moreover, faculty assumed critical roles in developing partnerships with host institutions and implementing grassroots efforts to develop, maintain, and sustain education abroad experiences in their departmental curriculums (Sinclair, 2014). Aligning international experiences with the curriculum often required faculty to rationalize the value of programs to colleagues by highlighting the hands-on, cross-cultural, and internationally comparative experiences they provided to students. Additionally, faculty had a hand in how international experiences were 31 formalized into the curriculum, through the incorporation of written outcomes and assessments, credit-bearing options for students, and aligning them with professional competencies set by accrediting bodies in their field. Faculty were also instrumental in blending international experiences into the priorities and missions of their departments by aligning these programs with broader internationalization efforts within their institutions. Another important finding of the study was faculty were shaped by the culture and values within their academic disciplines when developing international experiences (Sinclair, 2014). Faculty from each academic discipline (Dentistry, Medicine, Law) were distinct in their espoused goals and outcomes for creating graduate international experiences to fit within competencies in their professions. In many cases, these international initiatives served to bolster knowledge and skills within an intercultural setting, with faculty intent on connecting students with disciplinary knowledge, training, and practices. Faculty Pedagogical Approaches for Graduate Education Abroad In her dissertation study, Loebick (2017) explored faculty leaders’ goals, perceptions, and pedagogical approaches of short-term graduate education abroad programs. This study found graduate education abroad programs were highly influenced by decisions regarding intended outcomes, curricular requirements, international partnerships, and travel logistics. For the organization of programs, Loebick (2017) identified two models encompassing the design of graduate education abroad programs: subject-based and project-based. For subject-based models, faculty relied on a preexisting curricular structure to guide education abroad programs with a specific disciplinary goal. Conversely, project-based models were organized by faculty around a selected theme to guide students’ education abroad experiences. Dimensions of each model influenced how faculty guided student learning and experiences in education abroad programs. 32 Faculty leaders in this study cited students’ ability to apply disciplinary learning to an international context was the primary purpose of short-term graduate education abroad programs (Loebick, 2017). Faculty also acknowledged other purposes, including opportunities to implement experiential learning, networking outside of the classroom, engage in comparative analysis related to policies and practices, and develop global competencies. Along with the perceived goals of these programs, faculty leaders shared four espoused student learning outcomes for graduate students: (a) interdisciplinary connections, (b) changed perspectives, (c) personal growth, and (d) learning from and with peers (Loebick, 2017). First, faculty expected graduate students to be more intuitive while studying abroad and spoke of opportunities for them to apply international experiences to academic or interdisciplinary contexts. Second, faculty mentioned how graduate students changed their perspectives and assumptions regarding work or life as the result of an experience abroad (Loebick, 2017). Third, many faculty leaders intended for education abroad to enhance students’ personal growth by shifting their intercultural awareness to reflect broader ways of thinking. Finally, peer-to-peer learning was recognized by faculty as a crucial transformational aspect of education abroad because graduate students learned from one another and collaboratively processed their experiences. Overall, this study documented the vital role faculty play in guiding graduate student experiences with short-term graduate education abroad programs. Additionally, the study showed how graduate short-term education abroad programs were discipline-specific and designed for graduate student development in a particular profession. Speaking to this distinction, Loebick (2017) asserted, “The results of this study suggest that graduate-level, short-term education abroad experiences are just that, inherently graduate level” (p. 191). She continued, “…the very nature of graduate education abroad, from graduate learners to program curriculum, 33 differentiates graduate-level, short-term education abroad” (Loebick, 2017, p. 191). Consequently, Loebick’s (2017) claims illuminate the distinctiveness of graduate students in education abroad programs and suggest they are influenced by elements of curriculum and pedagogy at the graduate level. Contexts of Graduate Students Influencing Their Experiences of Education Abroad Together, the literature on graduate education abroad highlights the graduate student experience in terms of contexts surrounding their sensemaking as adult learners, professional socialization, and engagement in curriculum and pedagogy designed towards knowledge and skill development within a specific discipline. As mentioned in chapter one, I use the term context to describe the lens used to frame graduate student experiences. Graduate students represent unique contexts relative to their personal, professional, and scholarly development. First, graduate students are adult learners (Dirkx et al., 2016; Hegarty, 2011), who likely process cognitive, professional, and social aspects of their life with more maturity and self-awareness. Additionally, the process of socialization shapes graduate students in their approach to professional development and preparation for their future careers (Weidman et al., 2001). Finally, graduate students experience curriculum and pedagogy during education abroad that is discipline-specific, faculty-driven, and competency-oriented (Loebick, 2017; Sinclair, 2014). In the following sections, I highlight how three contexts likely influence graduate students’ experiences in education abroad programs: (1) adult learning, (2) professional socialization, and (3) curriculum and pedagogy. The Context of Adult Learning Although some undergraduate students are adults, graduate students are considered adult learners (Dirkx et al., 2016; Hegarty, 2011), who bring self-directed, experiential, and reflective 34 characteristics into their educational experience. An agreed-upon definition of adult learning is difficult to find in the literature (Brookfield, 1995). Hansman and Mott (2010) suggested the definition of adult was based on social and cultural distinctions such as age, maturity, and psychosocial development. Merriam and Bierema (2014) asserted, “…adults participate in learning for a number of reasons, all of which link back to their position in the life cycle as adults” (p. 12). Unfortunately, there is a dearth of knowledge reflecting graduate students as adult learners. Some of the only scholarship comes from Hegarty (2011), who conceptualized graduate students as self-motivated adult learners looking to advance their academic learning and professional careers. There is some scholarship, however, linking education abroad with adult learning (Coryell, 2011; Dirkx et al., 2016; Peppas, 2005; Shallenberger, 2009; Slantcheva-Durst & Danowski, 2018). Many of these scholars recognize graduate students participating in education abroad are adult learners who process their experiences with an attention to self-awareness and reflection, collaborative engagement, and professional growth. Graduate students bring professional goals and make deep academic and occupational connections to their education abroad experiences (Dirkx et al., 2016). Also, adult learners are influenced by meaningful interactions and relationships that develop between peers, faculty, and hosts during education abroad programs (Coryell, 2011). Adult learning theories assume several categories representing behavioral, cognitive, social, and humanistic perspectives (Boucouvalas & Lawrence, 2010; Merriam & Bierema, 2014). Some of the main theories of adult learning include andragogy, self-directed learning, experiential learning, and transformative learning. Andragogy represents the fundamental underpinnings of adult learning grounded in a problem-solving orientation where students 35 prioritize applying knowledge and acquiring new skills (Knowles, 1980; Merriam & Bierema, 2014). Self-directed learning is a theory where adult learners take responsibility for their learning, being self-motivated by individual goals, values, and experiences (Brookfield, 1995; Merriam & Bierema, 2014; MacKeracher, 2004). For this study, I focus on two theoretical concepts of adult learning that are more heavily embedded within the literature on graduate education abroad: experiential and transformative learning. Later in this chapter, I incorporate elements of these theories into my conceptual framework to demonstrate how the context of adult learning might influence the experiences of graduate students during an education abroad program. Experiential Learning Experiential learning is a holistic perspective of adult learning where experiences are used as resources for building new knowledge (Conlan, et al., 2003). The prior personal and professional experiences of adult learners are often what allows them to consider, adjust, and utilize new knowledge (Brookfield, 1995). Dewey (1963) first recognized the importance of a learner’s ability to make meaning of experiences to fit new situations. Later, Kolb (1984) introduced the experiential learning cycle, which identified learning as a process where learners encounter a new experience, reflect on the experience, conceptualize ways to act on their experience, and take action to engage in future experiences using newfound knowledge. For graduate students, applying their prior knowledge and experiences helps them recognize important differences between ideas or practices at home and abroad (Gilin & Young, 2009). Despite ideas or practices being completely foreign, adult learners “…can be very open to new ways of seeing the world; in fact, they may have joined a travel study course because they are seeking that” (Shallenberger, 2009, p. 51). The opportunity to encounter challenges and new 36 experiences in an education abroad program is part of an experiential learning process that also must coincide with opportunities for reflection (Lutterman-Aguilar & Gingerich, 2002; Roholt & Fisher, 2013). Consequently, processes of reflecting, adapting, and relearning are promising tools for graduate students who may arrive to an education abroad program with a variety of personal and professional experiences. Transformative Learning Transformative learning stems from the work of Mezirow (1991, 1997), who conceptualized meaning making as a change in one’s frames of reference (i.e., assumptions and perspectives) through a process of reflection. A learner is prompted to engage in reflection as the result of a disorienting dilemma, or an uncomfortable or unfamiliar experience. Reflection is a key part of this process and “…becomes transformative whenever assumptions or premises are found to be disorienting, inauthentic, or otherwise invalid” (Mezirow, 1991, p. 6). Additional components of transformative learning involve testing perspectives through dialogue with others and taking action based on newfound understanding (Mezirow & Associates, 2000). One way a person can transform their perspectives is through experiencing another culture and critically reflecting on their misunderstandings of other people, groups, or systems (Mezirow, 1997). The literature on graduate education abroad relates to transformative learning through critical incidents or disruptive events encouraging students to reflect on their assumptions and perspectives (Litzelman et al., 2017; Roholt & Fisher, 2013). When an international experience shifts graduate students outside of their comfort zones, they have an opportunity to broaden their personal and professional viewpoints as adult learners. However, Dirkx et al. (2016) noticed varying levels of engagement in reflection from graduate students when faced with disruptive events, which suggested transformative learning may be difficult to fully achieve in education 37 abroad programs. These scholars suggest dedicated time for reflection helps to ensure graduate students are making sense of their experiences in a way that moves them closer to a transformative experience. Relatedly, some graduate programs require students to complete reflective assignments, such as keeping personal journals and engaging in post-trip discussions, to think critically about their international experiences while abroad (Roholt & Fisher, 2013; Slantcheva-Durst & Danowski, 2018). The Context of Professional Socialization The role of professional socialization is also valuable for understanding how graduate students make sense of their experiences. Several scholars advance the concept of professional socialization as the process graduate students take in adopting values, norms, behaviors, knowledge, and skills to successfully assimilate into a chosen profession or discipline (Austin, 2002; Gardner & Mendoza, 2010; Golde & Walker, 2006; Weidman et al., 2001; Weidman & Stein, 2003). After conducting an extensive review of the literature on professional socialization, Weidman, et al. (2001) situated the concept into a developmental model showing how students advance into a professional career through stages involving role adoption, observation, internalization, and identity formation. Later in this chapter, I incorporate core elements of Weidman et al.’s (2001) model into my conceptual framework to inform my understanding of how the context of professional socialization might influence the experiences of graduate students during an education abroad program. Other valuable literature to this study highlights the important role disciplinary communities, faculty, and academic departments take in forging the socialization of graduate students by setting policies, practices, mission statements, and curriculum (Gardner & Mendoza, 2010; Golde & Walker, 2006; Weidman & Stein, 2003). Centered within this literature are 38 formal and informal dimensions of socialization shaping graduate students’ experiences as scholars, professionals, and members of a disciplinary community. Formal dimensions of professional socialization include explicit training and instruction that students receive from faculty through course requirements, examinations, and other aspects of the curriculum (Weidman & Stein, 2003). Informal dimensions of professional socialization encompass conversations, relationships, or other interpersonal interactions with faculty, peers, and colleagues. Since socialization is shaped by interaction, training, and instruction—education abroad programs are a part the graduate student experience likely perpetuating this process. Increasingly, short-term graduate education abroad programs encompass a type of field experience adopted by academic disciplines to meet espoused programmatical goals and outcomes (Loebick, 2017; Sinclair, 2014). Some goals and outcomes of graduate education abroad relating to professional socialization include career preparation (Loebick, 2017; Peppas, 2005; Tang & Rose, 2014; Witkowsky & Mendez, 2018) and professional identity development (Gilin & Young, 2009). Specifically, in the field of medicine, socialization was cited as a reason that students pursued academic and technical benefits from education abroad over more cross- cultural or community-focused outcomes (Ventres & Wilson, 2020). Professional Identity Although a majority of research on socialization specifically focuses on the doctoral process of joining the professoriate, some scholars have connected the socialization process with and the development of professional identity in fields such as social work (Levy et al., 2014), student affairs (Liddell et al., 2014), and medicine (Cruess et al., 2014; Cruess et al., 2015). The development of professional identity is considered a major goal of the professional socialization process (Cruess et al., 2014; Cruess et al., 2015; Levy et al., 2014; Liddell et al., 2014). 39 Professional identity is the internalization of knowledge, norms, and values affecting an individual’s behavior, competence, judgement, and responsibility within a specific profession. Multiple factors contribute to the development of professional identity, such as maturity through adulthood, group and individual experiences, interpersonal experiences with role models and mentors, and formal instruction through the curriculum (Cruess et al., 2015). Some of the factors influencing professional identity development connect with goals and outcomes of graduate education abroad programs. For instance, education abroad is a hands-on experience shaping medical knowledge and clinical skills for students in the field of medicine (Litzelman et al., 2017), career preparation in the field business (Peppas, 2005; Tang & Rose, 2014), and self-awareness and social responsibility in the field of student affairs (DuVivier & Patitu, 2017; Slantcheva-Durst & Danowski, 2018). Another factor involving the formal teaching and training in a graduate curriculum can include education abroad, which shapes the development of professional identity. For example, Gilin and Young (2009) found education abroad built helped MSW students construct their professional identities within an international community of social workers. Consequently, professional identity development represents another, more nuanced, lens to connect education abroad programs to the professional socialization process of graduate students. The Context of Curriculum and Pedagogy The curricular and pedagogical strategies of faculty shape student learning (Lattuca & Stark, 2009; Tagg, 2003). Moreover, faculty are often deliberate in their curricular decisions to engage student learning and development while also paying attention to competencies in their academic fields of study and broader institutional goals (Lattuca & Stark, 2009). In the literature on graduate education abroad, faculty were responsible for developing and formalizing programs 40 into their curriculums and facilitating what students learned during these international experiences (Loebick, 2017; Sinclair, 2014). Graduate education abroad programs were shaped by faculty decisions about written outcomes and assessments, departmental requirements, and international partnerships. As a result, curriculum and pedagogy is likely a context influencing graduate students’ experiences during education abroad programs. However, the literature describing the unique characteristics and components of graduate curriculum and pedagogy is scant. In order to better understand graduate curriculum and pedagogy, I adapt a matrix from Toombs and Tierney (1993) to highlight how components of context, content, and form guide faculty decisions about curriculum design. For the purpose of this study, the matrix provides a conceptual mechanism to examine the assumptions, knowledge, structures, and strategies faculty consider when making curricular and pedagogical decisions, which I apply to the graduate level. Later in this chapter, I incorporate Toombs and Tierney’s (1993) matrix into my conceptual framework to inform my understanding of how the context of curriculum and pedagogy might influences the experiences of graduate students in an education abroad program. Context: Social and Cultural Forces Informing Graduate Education Abroad When faculty engage graduate students in professional coursework, social and cultural forces shape curricular and pedagogical decisions. The component of context refers to social or cultural forces that influence the nature of professionalism and what is considered valuable knowledge for the workforce (Toombs & Tierney, 1993). Much of how context influences a graduate student experience is grounded in a community of practice (CoP). Moreover, CoP covers the legitimate knowledge, expertise, and training needed for a professional career (Wenger, 2006). For many graduate students, the labor market determines elements of human 41 capital (i.e., expertise and technical proficiency) shaping their specialized training within their chosen profession (Sullivan, 2005). Thus, faculty employ different pedagogical methods (e.g., apprenticeships, field experiences, clinicals, practicum, internships) to model the specific norms and behaviors deemed integral to a specific profession (Golde, 2008; Sullivan, 2005). In professional education, a pillar of curriculum and pedagogy is the apprenticeship, which involves members of a disciplinary community organizing, sharing, and transmitting knowledge to new members (Golde, 2008; Sullivan, 2005). Most professional schools are chartered to teach and train students with the expertise, ethical standards, competencies, and social roles to succeed in a professional context (Sullivan, 2005). Thus, the professional apprenticeship is a pedagogy of modeling that engages students to integrate knowledge, skills, and practices for serving clients and the larger society. At different times, the apprenticeship prepares students with intellectual content development, skill building for complex tasks, and identity development around the social roles, responsibilities, and values shared by a professional community (Sullivan, 2005). An activity adhering to the idea of professional apprenticeship might be an education abroad program. Graduate education abroad is increasingly supported by standards and competencies in many professional fields (DuVivier & Patitu, 2017; Gilin & Young, 2009; Peppas, 2005; Slantcheva-Durst & Danowski, 2018), leading programs to become intertwined or embedded into the curriculum and pedagogy of graduate schools (Loebick, 2017; Sinclair, 2014). Additionally, faculty emphasize the professional components of education abroad programs that complement their graduate curriculums, such as hands-on activities, cross-cultural networking, or comparative international research for students (Loebick, 2017). In some fields, context may determine the location of an education abroad program based upon the types of training or skills 42 required by a field. For other fields, context may shape goals of education abroad programs that reflect values for practitioners. For instance, scholars in the field of medicine recently called for short-term global health programs to prioritize critical engagement and nurture global humility for students engaged in service-learning and sustainable community practices (Melby et al., 2016; Ventres & Wilson, 2020). Thus, the way an education abroad is designed and facilitated guides activities or initiatives catering to the culture of a professional discipline. Content: Learning Outcomes Guiding Graduate Education Abroad Traditionally, faculty play a significant role in planning and facilitating course content, influencing what students learn (Lattuca & Stark, 2009). The component of content addresses how knowledge is organized and the principles of inquiry guiding learning outcomes (Toombs & Tierney, 1993). Building upon the undergraduate curriculum, graduate learning outcomes encompass more advanced and specialized modes of inquiry, research, and professional practice (Golde, 2008; Sullivan, 2005). For example, a report by the Council of Graduate Schools (2011) addressed two areas where graduate learning outcomes are different from the undergraduate level. First, core learning extends beyond developing written or communication skills to reflect higher-order competencies such as research methodology, epistemological orientation, and professional ethics. Second, rather than exposing students to a wide range of disciplines, graduate learning outcomes include content with application to a specific field of study. Following faculty content decisions, graduate education abroad is informed by the intended outcomes deemed appropriate to reinforce disciplinary learning (Loebick, 2017). In her study, Loebick (2017) recognized several purposes and outcomes that faculty leaders had for graduate students participating in education abroad, such as “…experiential learning within graduate appropriate contexts, scholarly growth, opportunities to develop cultural and global 43 competencies and perspectives, application of disciplinary knowledge in diverse contexts, and professional development opportunities” (p. 179). Goals and outcomes for graduate education abroad programs recognized by other scholars included, gaining experience with international marketing (Tang & Rose, 2014), work cross-nationally and cross-culturally (Gilin & Young, 2009), and building multicultural competence to support international students (Slantcheva-Durst & Danowski, 2018). Many of these outcomes embodied the advanced, specialized roles of graduate students. As a whole, graduate education abroad programs likely represent several content-related decisions surrounding students’ outcomes specific to their professional development, networking, research, and practice. Form: Pedagogical Practices of Graduate Education Abroad The process of teaching is vital to what students can learn, understand, and experience in an academic environment (Lattuca & Stark, 2009). The component of form represents the resources, decisions, and instructional strategies faculty implement in the curriculum (Toombs & Tierney, 1993). Although Toombs & Tierney (1993) do not define pedagogy, they mention it as a key element of a curriculum shaping the presentation and structure of learning. Because the component of form represents instructional strategies and the integration of learning activities (Toombs & Tierney, 1993), I use the term to represent faculty pedagogical decisions shaping the facilitation of programs. In one of the few studies on the pedagogy of graduate education abroad, Loebick (2017) found faculty leaders often tied the structure of their programs with goals and outcomes of their disciplines, which varied based on the needs of their students. Many faculty leaders noted factors that were important to their design and facilitation of programs, such as ensuring disciplinary application for graduate learners, making sure the international setting provided experiences 44 related to their professions, and preparing students to engage in the cultural context of the host country (Loebick, 2017). In many cases, faculty leaders recognized themselves as solely responsible for many facets of education abroad programs, including “…curricular development, logistical planning, student preparation, oversight, and leadership…” (Loebick, 2017, p. 173). Overall, this account showed how faculty pedagogical approaches centered around students’ professional development and disciplinary learning, which were unique at the graduate level. Additionally, Loebick (2017) showed how many faculty leaders prioritized practices for supporting student experiences in education abroad programs, which fit into three critical components: pre-departure, during the experience, and post-travel. Within these components, faculty leaders set logistics and itinerary, conducted orientations, facilitated experiential learning, shared knowledge with students, conducted site visits, and led reflective debriefings. Many of the pedagogical decisions related with the larger body of literature on education abroad accounting for ‘best practices’ (Donnelly-Smith, 2009; Hovey & Weinberg, 2009; Lutterman-Aguilar & Gingerich, 2002; Mills, et al., 2010). Loebick’s (2017) account of best practices also resonated with some other scholars documenting education abroad at the graduate level. For example, researchers in the field of business concluded that a purposefully designed education abroad program, with structured activities during pre-and-post-departure periods, guided faculty in providing a richer learning environment for MBA students (Tang & Rose, 2014). In the field of medicine, best practices included creating a robust curriculum with pre-departure training, ethical and cross-cultural education, in-country orientation sessions, and post-departure assessment methods (Melby et al., 2016). Overall, these examples highlight how faculty pedagogical decisions likely shape the 45 types of interactions, learning, and training graduate students experience during an education abroad program. Intersections Between the Contexts of Graduate Students Looking across the literature, there are intersections that occur likely influencing graduate students’ experiences of education abroad programs. The components embodying the contexts (i.e., learner characteristics, professional competencies, developmental outcomes, pedagogical practices) exist as a result of one another, rather than being isolated on their own. For instance, the design and facilitation of curriculum is informed by the characteristics, needs, and goals of learners (Toombs & Tierney, 1993), which include maturity, career advancement, and reflective engagement at the graduate level (Dirkx et al., 2016; Hegarty, 2011). Additionally, professional competencies and training at the heart of formal socialization (Weidman & Stein, 2003; Weidman et al., 2001) overlap with graduate learning goals in the curriculum (CGS, 2011) and instruction geared towards professional preparation (Golde, 2008; Sullivan, 2005). Graduate students who engage in education abroad programs have the potential to reframe their perspectives (Dirkx et al., 2014a; Roholt & Fisher, 2013), satisfy professional competencies (Gilin & Young, 2009; Melby et al., 2016; Peppas, 2005), and gain valuable experiences for the global job-market (CGS, 2010). These graduate student experiences might be built upon the intersection contexts—i.e., adult learning, professional socialization, curriculum and pedagogy. I further illustrate the intersection of graduate student contexts in the conceptual framework for this study. Conceptual Framework To provide a conceptual framework for this study, I demonstrate how theoretical concepts frame my understanding of graduate student contexts of adult learning, professional 46 socialization, and curriculum and pedagogy. I show how each theoretical concept informs graduate student contexts. Next, I explain how the theoretical concepts help inform my understanding of graduate students’ experiences of an STFD education abroad program. Finally, I provide a model to highlight intersections between graduate student contexts guiding my understanding of how they might influence graduate students’ experiences of an STFD education abroad program. The conceptual framework is divided into several subsections. First, I overview the following theoretical concepts that underpin my understanding for the context of adult learning: Mezirow’s (1991) transformative learning theory and Kolb’s (1984) experiential learning cycle. Second, I highlight core elements of Weidman, et al.’s (2001) theory of graduate and professional socialization to provide support for my understanding around the context of professional socialization. Third, I summarize Toombs and Tierney’s (1993) matrix of curricular design, which informs my understanding of curriculum and pedagogy at the graduate level. Finally, I propose an integrated model illustrating how contexts of adult learning, professional socialization, and curriculum and pedagogy intersect with one another. This model engages the theoretical concepts at the core of graduate student contexts to conceptualize how the intersection of personal, professional, and scholarly characteristics might influence graduate students’ experience of an STFD education abroad program. Additionally, the model is fluid, to account for contexts outside of adult learning, professional socialization, and curriculum and pedagogy that may influence graduate student experiences of an STFD education abroad program. As a result, this conceptual framework acts as a tool, grounded in the literature on graduate education abroad, to guide my understanding and analysis of this complex topic. 47 Adult Learning As previously mentioned in the literature review, graduate students are often adults who process their learning in ways consistent with their maturity, self-awareness, prior-experience, and professional motivations. The scholarship on graduate education abroad suggests students engaged in programs through opportunities for deep reflection the application of personal and professional experiences (Gilin & Young, 2009; Litzelman et al., 2017; Roholt & Fisher, 2013; Shallenberger, 2009). Therefore, two theoretical concepts provide a framework for understanding how the context of adult learning influences graduate students’ experiences of an STFD education abroad program: Kolb’s (1984) experiential learning cycle and Mezirow’s (1991) theory of transformative learning. The Experiential Learning Cycle The theory of experiential learning distinguishes learning as a continual process of forming and reforming knowledge through the adaption of experience (Kolb & Kolb, 2005). Experiential learning is most commonly “portrayed as an idealized learning cycle or spiral where the learner ‘touches all the bases’—experiencing, reflecting, thinking, and acting—in a recursive process that is responsive to the learning situation and what is being learned” (Kolb & Kolb, 2005, p. 194). More specifically, the experiential learning cycle includes four stages: concrete experience (CE): encountering or recalling an experience or situation, reflective observation (RO): meaning making from reflecting and observing the experience, abstract conceptualization (AC): thinking deeply about the experience to integrate them into new ideas or concepts, and active experimentation (AE): taking action to apply new ideas to future situations or experiences (Kolb, 1984). The learner can enter the experiential learning cycle at any of these stages but must engage in each stage of the model for effective learning to take place (Merriam & Bierema, 48 2014). Kolb’s (1984) experiential learning cycle is a model of adult development because it emphasizes a learner adapting and applying experiences to serve as a resource for future learning. Additionally, experiential learning engages adult learners in analyzing real-life experiences through reflecting on their existing knowledge and applying it to inform new ideas, concepts, and skills. Thus, key components of experiential learning are an adult learner’s knowledge and experiences. Kolb’s (1984) experiential learning cycle is useful to this study because graduate students are adult learners who connect and adapt their past experiences, opportunities, knowledge, and values to hands-on experiences, such as education abroad programs. For adult learners, the experiential learning cycle happens through active engagement and critical reflection to make meaning from experiences (Kerka, 2002; Merriam & Bierema 2014). During an STFD education abroad program, some graduate students may encounter new cross-cultural experiences and opportunities for reflection that engage them in new ways of thinking about their personal or professional goals. Also, graduate students might be motivated to apply their existing knowledge and prior learning experiences to professional situations they encounter during an STFD education abroad program. Consequently, the experiential learning cycle is a valuable concept for understanding how adult learning may influence graduate students’ experiences of an STFD education abroad program. Transformative Learning Transformative learning is a widely used philosophy of adult education and it has been adapted to feature several different interpretations, frameworks, and theories (Merriam & Bierema, 2014). However, I draw from the work of Mezirow (1991), who originally conceptualized transformative learning as a multi-phase process, beginning with a disorienting 49 dilemma, moving to reflection, the shifting of perspectives, and eventually culminating in new roles, relationships, and actions. Later, Mezirow and Associates (2000) revised some of the terminology around transformative learning. For the purpose of this study, I focus on four core elements from Mezirow’s (1991) work: (1) disorienting dilemma, (2) critical reflection, (3) reflective discourse, and (4) perspective transformation. Transformative learning (or perspective transformation) often occurs with a disorienting dilemma that is prompted by an experience bringing about feelings of discomfort or challenge (Mezirow, 1991). These feelings encourage a learner to engage in critical reflection on their frames of reference (i.e., assumptions, perspectives, values, worldviews) and how they were formed. Moreover, critical reflection is a key part of transformative learning because it results in change to a learner’s frames of reference. According to Mezirow (1991) reflection becomes transformative when assumptions and perspectives are understood as “distorting, inauthentic, or otherwise invalid” (p. 6). Transformative learning is also a social process and reflective discourse prompts learners to critique their assumptions, perspectives, and worldviews by sharing them with others who have negotiated a similar disorienting dilemma. Through reflective discourse, learners explore options for new roles, relationships, and actions through the shared experiences, values, and beliefs of others. Finally, perspective transformation happens when a learner decides to act on reframing their assumptions, perspectives, and worldviews. Transformative learning culminates with a paradigm shift for the learner. Transformative learning is a concept that relates well with the goals of this study because education abroad is a type of experience where disorienting dilemmas and perspective shifting can occur for adult learners such as graduate students. Some of the literature on graduate education abroad focuses on the potential of these programs to transform students’ frames of 50 reference, perspectives, and worldviews (Litzelman et al., 2017; Roholt & Fisher, 2013). As a result of participating in an STFD education abroad program, graduate students may explore new career pathways or build confidence for engaging in practices outside the norms of their professional training. When program is service-based or community-focused, graduate students might change their perspectives about social, historical, or political aspects of a host country. These experiences may also encourage graduate students to reframe their assumptions about social or political systems in their home country. Ultimately, transformative learning is a useful concept for understanding how adult learning might influence graduate students’ experiences of an STFD education abroad program. Professional Socialization Most graduate students engage in a process of professional socialization where they adopt norms, values, behaviors, knowledge, and skills to gain membership into a discipline or profession (Gardner & Mendoza, 2010; Golde & Walker, 2006; Weidman & Stein, 2003; Weidman et al., 2001). Professional norms, values, and practices are socialized by faculty, through policies, mission statements, and curricular decisions. Some of these decisions might encompass out-of-class experiences that fulfill global competencies, such as education abroad programs. Thus, exploring the processes underpinning professional socialization is likely important to understanding the experiences of graduate students who participate in an STFD education abroad program. Graduate and Professional Student Socialization Weidman et al. (2001) conducted a wide review on the concept of graduate and professional socialization in higher education. They produced a comprehensive nonlinear model accounting for components of socialization, including professional degree program and 51 institutional culture, student backgrounds and characteristics, and stages and core elements of the socialization process. For the purpose of this paper, I focus on Weidman et al.’s (2001) four stages and core elements of the professional socialization, which they adapted from a framework of role identity that was developed from the work of Thorton and Nardi (1975). According to Weidman et al. (2001), “This conceptualization is particularly appropriate for addressing socialization in graduate programs because it recognizes explicitly the developmental nature of the socialization process” (p. 24). The four stages of socialization highlighted by Weidman et al. (2001), include: (a) anticipatory, (b) formal, (c) informal, and (d) personal. These stages were conceptualized as overlapping and nonlinear. First, the anticipatory stage involves students familiarizing themselves with the expectations and norms of a professional field before enrolling into a graduate program. Through media outlets (e.g., websites, publications) graduate students seek information about the terminology and accepted scholarly behaviors within a discipline. The overarching goal of this learning process is to help students gain the confidence to enroll into a professional academic program. Second, the formal stage occurs when graduate students adhere to professional standards and academic requirements. Moreover, students draw conclusions about whether they fit the norms and expectations of their chosen graduate program (Weidman et al., 2001). Third, the informal stage consists of graduate students exploring the social and cultural aspects of an academic departments to build support structures and acknowledge acceptable behaviors as an emerging professional. According to Weidman et al. (2001), “In some graduate programs, close-knit cohort groupings of student peers facilitate communication and support” (p. 27). Finally, the personal stage encompasses the professional identity graduate students assume as they utilize values and knowledge to succeed in their careers. During this 52 stage, graduate students are more self-reliant and self-motivated in their research interests and professional endeavors. Graduate and professional students move through the four stages to adopt the culture and community of their academic department or discipline. Additionally, Weidman et al. (2001) adapted three core elements of socialization that represented students’ capacity building and commitment into their professional role: knowledge acquisition, investment, and involvement. These core elements overlap with each of the four stages of socialization. First, knowledge acquisition encompasses the cognitive and affective knowledge students are expected to gain in order to successfully assimilate into a professional role. “During socialization, knowledge shifts from being general to being specialized and complex” (Weidman et al., 2001, p. 29). Moreover, knowledge acquisition leads to the development of a professional identity and the capacity to meet the needs of a professional role. Second, investment relates to a student’s commitment to a graduate program, disciplinary learning, and goals for becoming a professional. Finally, the core element of involvement comprises the extent to which a student immerses themselves into their professional program, interacts with their peers, and works with faculty mentors (Weidman et al., 2001). The model of graduate and professional student socialization is helpful to this study because graduate students likely establish professional values, knowledge, and skills through participation in an education abroad programs (Dirkx et al., 2016; Gilin & Young, 2009; Peppas, 2005). Additionally, faculty develop education abroad programs to align with competencies, outcomes, and training in their professional fields (Loebick, 2017; Sinclair, 2014). As a result, some graduate students may be influenced by recruitment materials, peer conversations, or faculty guidance when deciding to participate in education abroad programs. Other students might view globalization being intertwined with the culture of their academic department or 53 profession, which motivates them to participate in education abroad to satisfy norms around credentials, training, and career readiness. Ultimately, core elements of Weideman et al.’s (2001) model are valuable to understanding how graduate students may experience an STFD education abroad program through the process of professional socialization. Graduate Curriculum and Pedagogy Student learning, engagement, and experiences often depend upon faculty decisions about curriculum and pedagogy (Lattuca & Stark, 2009; Tagg; 2003). Within the literature on graduate education abroad, faculty were instrumental in establishing the curriculum of these international programs and fitting them into the larger scope of departmental goals, missions, and competencies (Loebick, 2017; Sinclair, 2014). Moreover, these curricular and pedagogical decisions shaped how graduate students were expected to engage in education abroad programs. However, very little is known about how curriculum and pedagogy operate at the graduate level. In highlighting components of curriculum design, Toombs and Tierney’s (1993) matrix of curricular design (MCD) provides a framework to understand how the context of curriculum and pedagogy might apply to graduate students’ experiences of an STFD education abroad program. Matrix of Curricular Design In conceptualizing a way to practically apply the concept of curriculum to academic program design, Toombs and Tierney (1993) created a matrix highlighting three primary components: context, content, and form. Toombs and Tierney (1993) defined curriculum as “an intentional design for learning negotiated by faculty in light of their specialized knowledge and in the context of social expectations and social needs” (p. 183). The three components in the matrix describe the social, structural, and logistical aspects that faculty imply and apply when designing a curriculum. First, the component of context describes social demands, organizational 54 influences, and environmental factors shaping expectations for what students learn (Toombs & Tierney, 1993). Context prompts faculty to account for the culture within their academic departments, while also cultivating practitioners to fit needs of the labor market in their professional fields. Second, the component of content highlights the methods and structure of knowledge construction that guide faculty in setting learning outcomes. Moreover, content underscores competencies, epistemologies, theories, and bodies of information that shape expertise in a particular field of study. Finally, the component of form accounts for the logistics, instructional strategies, and assessment methods faculty use to engage students in the learning process (Toombs & Tierney, 1993). Furthermore, the component of form essentially describes pedagogy, or the practice of teaching that shapes how faculty deliver and convey information to students. The literature on graduate education abroad suggests programs are influenced by faculty decisions regarding curriculum and pedagogy (Loebick, 2017; Sinclair, 2014). Thus, MCD provides a useful bridge to understanding the social, structural, and logistical influence curriculum and pedagogy have on graduate student experiences. Within the component of context, graduate students might be influenced by the international location of an STFD education abroad program or the types of training organized for them to engage in during an international experience. Additionally, the component of content may account for academic or professional expectations for graduate students that influence their experiences during an STFD education abroad program. Finally, the component of form may influence graduate student experiences with pre-departure and post-departure meetings, academic coursework, and assignments in an STFD education abroad program. Ultimately, faculty pedagogical approaches likely contribute to graduate student experiences. As a result, the three components of MCD are 55 valuable to understanding how curriculum and pedagogy might influence graduate students’ experiences of an STFD education abroad program. A Model for Understanding Graduate Student Experience of Education Abroad Using the theoretical concepts from in this section to support the contexts of adult learning, professional socialization, and curricular and pedagogical practices, I provide an integrated model (see figure 1) to inform my understanding of graduate student experiences of an STFD education abroad program. By integrating the theoretical concepts together and illustrating intersections between graduate student contexts, this model frames my research question: “How do contexts of adult learning, professional socialization, and curricular and pedagogical practices intersect to influence graduate students’ experiences of a short-term, faculty-directed education abroad program.” Finally, I use the integrated model to show how my preunderstanding is based in the literature on graduate education abroad. 56 Figure 1: A Model for Understanding Graduate Student Experiences of STFD Education Abroad 57 The integrated model has several layers of contexts that merge at the central point to represent graduate students’ experiences of an STFD education abroad program. I use the word context to describe a lens used to frame graduate student experiences. First, the outside circle surrounding the model encompasses any possible context influencing graduate student experiences. The purpose of this broader circle is to represent factors outside the contexts of adult learning, professional socialization, and curriculum and pedagogy that my also influence graduate students’ experiences of an STFD education abroad program. As a result, this integrated model is intended to be fluid and guiding. Within the larger circle, there are three overlapping circles to represent the contexts of adult learning, professional socialization, and curriculum and pedagogy. Each context is supported by the theoretical concepts highlighted throughout the conceptual framework and supported by the literature on graduate education abroad programs. The circles intersect at three points to illustrate commonality between the three contexts where goals, outcomes, and practices are shared. For example, the contexts of adult learning and professional socialization intersect when graduate students apply and reflect on their experiences to inform their professional knowledge and skills. The context of curriculum and pedagogy intersects with adult learning when instructional strategies target the needs of mature, reflective, and experienced students. The contexts of professional socialization and curriculum and pedagogy intersect when professional competencies inform coursework and training in a graduate program. At the center of the model and layered inside three overlapping circles is the graduate student, to illustrate how the intersection of contexts—i.e., adult learning, professional socialization, and curriculum and pedagogy—might influence their experiences of an STFD education abroad program. The resulting model provides a guiding framework for the current study. 58 Conclusion In this chapter, I reviewed literature situating education abroad within the broader scope of the internationalization of higher education, showing how these programs evolved at the graduate level. Then I examined literature dedicated to the characteristics, goals, and outcomes of graduate education abroad programs. Stemming from this body of literature, I highlighted three graduate student contexts framing their experiences of education abroad: adult learning, professional socialization, and curriculum and pedagogy. Finally, I described the theoretical concepts grounding these contexts and included an integrated model that provided a guiding framework for this study. 59 CHAPTER 3: METHODS The purpose of this qualitative study was to explore whether personal, professional, and scholarly contexts of graduate students intersect to influence their experiences of an STFD education abroad program. My research question specifically posed “How do contexts of adult learning, professional socialization, and curriculum and pedagogy intersect to influence graduate students’ experiences of a short-term, faculty-directed education abroad program?” In this chapter, I outline the methodological approach and single case study research design used to conduct this study. First, I overview my methodological orientation as a researcher and discuss my choice to use a case-study research design. Next, I review boundaries and design of my case study in order to establish criteria for the selection of research site and participants. Following, I overview the methods of data collection and analysis. Finally, I consider measures to ensure trustworthiness for the study. Methodological Orientation At its core, my study aimed to gather an in-depth understanding of the lived experiences of graduate students and the contexts surrounding their engagement in an STFD education abroad program. Thus, my epistemological orientation is grounded in the constructivist paradigm, where knowledge subsumes the personal, social, organizational, and cultural contexts influencing the way people construct their reality (Glesne, 2016). According to Merriam (1998), “The key philosophical assumption upon which all types of qualitative research are based is the view that reality is constructed by individuals interacting with their social worlds” (p. 6). Interpretation on the part of the researcher is central to constructivist inquiry. Using a constructivist approach, I sought to understand participants’ experiences through their contexts of adult learning, professional socialization, and curriculum and pedagogy. Knowledge was co- 60 constructed on a more individual level to show the perspectives of participants and the specific contextual conditions influencing their experiences of an STFD education abroad program. My work was also situated within a relativist ontology to understand reality is a multilayered and complex human interpretation of real-life experience that changes from person to person (Denzin & Lincoln, 2017). Research should concentrate on the perspectives of participants in order to do justice to these real-world situations or experiences that unfold (Cohen et al., 2011). I sought to understand students’ experiences, thoughts, and feelings in a way that developed resonance to unique characteristics of time, place, and perspective within an education abroad program. A Case Study Research Design The research design for the current study was a case study. A case study is an empirical method examining a particular entity or system (i.e., a case), typically bounded by a set of contextual characteristics (i.e., its context) to develop an in-depth understanding of a broader phenomenon (Merriam, 1998; Stake, 2005; Yin, 2018). Case studies are helpful in understanding a complex phenomenon (Yin, 2018), and they are particularly useful for research focusing on bounded units such as programs (Merriam, 1998). According to Cohen et al. (2011), “A case study provides a unique example of real people in real situations, enabling readers to understand ideas more clearly than simply by presenting them with abstract theories or principles” (p. 289). Additionally, case studies recognize the boundaries are blurred between a phenomenon and its context (Yin, 2018). As such, a researcher must examine the context of a case in order to understand the broader phenomenon. An instrumental case was chosen for the current study to allow for reflective interpretation and analysis of a broader phenomenon situated within a case. An instrumental case 61 identifies the case as secondary to understanding a broader issue or phenomenon (Stake, 2005). In the current study, an STFD graduate education abroad program set within a single academic discipline represented my bounded case. I utilized the STFD education abroad program to better understand graduate student experiences. Thus, the broader phenomenon included understanding how contexts of adult learning, professional socialization, and curriculum and pedagogy intersected to influence graduate students’ experiences of an STFD education abroad program. Units of Analysis Informing the Case The units of analysis in a case study specify to define what is being analyzed (Yin, 2018). There are two types of case studies: (a) holistic, which treat a case as a global unit, allowing research to be conducted at a single, abstract level; or (b) embedded, which include subunits of analysis at more than one level (Yin, 2018). The current study took an embedded approach by including an individual subunit to focus on graduate student experiences, motivations, and goals. This subunit of analysis was useful because data was collected with the primary purpose of understanding graduate student experiences. The larger unit of analysis (i.e., the STFD education abroad program) was also examined in order to provide context for graduate student experiences. A Single Case Selection When choosing a methodological design such as a case study, researchers must decide on the number of cases needed to gather an accurate understanding of a phenomenon along with balancing time and resources available for data collection (Stake, 2005). Yin (2018) recommends incorporating a single-case study design when the subject matter represents common conditions that connect to broader and related phenomenon. A goal of the current study was to identify a case relevant in scope to the current landscape of graduate education abroad programs. The boundaries established for this study aimed at making the case representative of short-term 62 programs that are common at the graduate level (Sanger & Mason, 2019). As graduate student characteristics and education abroad program structures can be applied across discipline to some extent (Dirkx et al., 2014a), an in-depth analysis of a single case was warranted. The Use of Theory in Guiding the Case Study The use of a theoretical framework is a necessary component in developing a case study. The use of a framework helps to define the research problem and narrow the focus of data collection (Merriam, 1998; Yin, 2018). A guideline that Yin (2018) suggests is the prior development of theoretical propositions, which are often shaped from the literature and guide initial perceptions of a phenomenon into the logic used to connect data with findings (Yin, 2018). Additionally, Merriam (1998) laid out guidelines for a researcher to review literature and develop a clear theoretical framework before defining the research problem and conducting a case study. In the current study, I integrated theories into a conceptual model guiding my inquiry into the intersection of contexts influencing graduate students’ experiences of an STFD education abroad program: (a) adult learning, (b) professional socialization, and (c) curriculum and pedagogy. These contexts were grounded in the literature on graduate education abroad and served to narrow the scope of the current study, while also framing the research question. Also, the contexts helped address my assumptions as I approached, collected, and analyzed the data. Case Study Boundaries In a case study, contextual characteristics provide boundaries that highlight important criteria for selecting a case, and they help readers think about the relevant units behind a broader phenomenon (Cohen et al., 2011; Yin, 2018). Moreover, case boundaries help to narrow a particular system to analyze based on an issue, process, or concern (Merriam, 2009). In the current study, boundaries were important for setting parameters around the social, organizational, 63 educational, and institutional aspects of a graduate education abroad program. First, I included boundaries establishing my case as both a credit-bearing and intentionally designed graduate education abroad program. The intentionally designed boundary ensured my case consisted of only graduate students who participated in an education abroad program with intended goals or outcomes linked to a specific professional discipline. Second, the for-credit boundary narrowed my case to only include an education abroad program aligning with curricular components of graduate coursework, rather than one solely focused as an interdisciplinary study tour or cultural immersion. Additionally, I utilized a boundary to situate my case within the broader framework of education abroad at the graduate or professional level, which occur primarily with short-term, faculty-directed initiatives (Dirkx et al., 2016; Gearon, 2011; Sanger & Mason, 2019). Thus, I included boundaries setting my case as a short-term, faculty-directed education abroad program. My case criteria included a graduate, short-term, curricular-embedded design with faculty oversight that incorporated learning objectives and activities. These boundaries guided me in selecting a graduate discipline where education abroad was integrated into the academic curriculum, culture, and norms associated with a degree program. Site and Participant Selection Using the boundaries of my case, I employed two stages of sampling. In the first stage, I selected the case. Following, I selected a sample of participants for interviews. Stake (2005) argued the most valuable criteria for selecting a case is the opportunity for learning to take place. Consequently, much of the sampling and selection process was purposeful to allow for opportunities to learn about graduate students’ experiences of an STFD education abroad program. 64 Case Selection In selecting the case, I narrowed down my search to a large research university, given these types of institutions typically encompass a large number of graduate and professional programs. Additionally, I was interested in a university with many graduate and professional programs that organized education abroad for students. In order to evaluate this criterion, the university needed to include a centralized education abroad office that maintained a directory of education abroad programs, helping me to identify potential cases. As a result, a large research university, Northern State University (NSU) (pseudonym) was selected, which had a centralized education abroad office that tracked and coordinated a variety of education abroad programs at the graduate and undergraduate levels. Following institutional selection, I used purposeful sampling to select an education abroad program that fulfilled the boundaries of being short-term, faculty-directed, credit-bearing, and intentionally designed for graduate students. Purposeful sampling is a process of identifying a site that matches a researcher’s criteria and provides the greatest opportunity to gain insight and learn about a particular phenomenon (Merriam, 1998). The process of selecting the case was completed by holding conversations with administrators in the central education abroad office and researching an education abroad database to identify a number of graduate programs fitting the boundaries of my study. Following the recommendations of education abroad administrators, I identified a short-term, faculty-directed program in the College of Medicine, called Exploring Healthcare in Costa Rica (pseudonym) (shortened to the Costa Rica Program). I took into account the goals, structure, and intentionality behind the graduate education abroad program to distinguish whether the professional discipline of medicine matched the goals of my study. In September of 2019, I contacted the faculty-director of the Costa Rica program and arranged a 65 meeting to inquire about the possibility of using it as a research site for my case study. In October of 2019, I gained approval from the College of Medicine to utilize the Costa Rica program as the research site for my case study. My chosen research site aligned with the boundaries I established for my case study. The Costa Rica program was a 1-credit elective course in the College of Medicine also satisfying a requirement of 40-service hours for medical students. The program was intentionally designed by the faculty-director to accomplish specific objectives related to medical student preparation in the College of Medicine. In designing the program, the faculty-director developed partnerships with two healthcare organizations that facilitated a majority of educational activities and projects in Costa Rica. In partnership with these organizations, the faculty-director provided oversight for the program and accompanied students to Costa Rica. Finally, the Costa Rica program was short- term, as students participated in three pre-departure meetings followed by an overseas portion occurring during the week of Spring Break for the university. Additional background information about the case is included in Chapter 4. Participant Selection The second stage of sampling was participant selection. First, I engaged in a process of recruiting students to participate in interviews for the study. Again, purposeful sampling was used because students represented key unit of analysis constituting the scope of the study. All 18 of the students who enrolled in the Costa Rica program were invited to participate in interviews for the study. The purpose of this sampling method was to maximize information, since each student likely represented different perspectives, goals, and experiences of the Costa Rica program. As purposeful sampling “is based on the assumption that the investigator wants to discover, understand, and gain insight” (Merriam, 1998, p. 61), each student added depth to the 66 study. A total of 11 students consented to participate in interviews for the study. Additionally, the faculty-director for the program consented to participate in interviews for the study. A detailed overview of participants is provided in Chapter 4. Data Collection Case studies are very diverse in the kinds of data utilized (Cohen et al., 2011). Moreover, Yin (2018) discussed six sources of evidence for a case study including documentation, archival records, interviews, direct observations, participant-observations, and physical artifacts. My study relied on three main sources of data collection: interviews, document analysis, and direct observations. In the following sections, I describe and detail each method of data collection. Interviews For the current study, interviews served as the primary method of data collection. I conducted semi-structured interviews, lasting approximately 60-90 minutes with both the faculty-director and participating graduate students in the Costa Rica program. Semi-structured interviews include questions that are both structured and open-ended, with flexibility by the researcher to respond to new ideas and topics that emerge from responses of the participant (Merriam, 1998). Each interview consisted of approximately 10-15 semi-structured questions with room for additional follow-up questions and open-ended conversation. The full interview protocol is located in the appendices. For each participant, I conducted two interviews. The first series of interviews took place prior to the overseas portion of the Costa Rica program, and they were conducted in-person at a location where participants felt comfortable meeting. The second interviews were conducted after participants returned from Costa Rica. These interviews were conducted using a Zoom video format due to meeting restrictions put in place for the COVID-19 pandemic. All interviews 67 were recorded using either a digital voice recorder or the recording option in Zoom video. In addition, I took handwritten notes while conducting interviews. Each interview was saved as an audio file and transcribed verbatim using Trint software. During the transcription process, I removed all personal identifying information and assigned participant-selected pseudonyms to references and citations in the transcript. Finally, the transcripts were reviewed and edited to remove verbal fillers and pauses in the recordings. Faculty-director Interviews I conducted two semi-structured interviews with the faculty director about her goals, perceptions, and experiences of the education abroad program. These interviews took place before and after she traveled to Costa Rica. In the pre-departure interview, questions included her experience of becoming involved with leading the Costa Rica program. Also, I asked the faculty director questions about the curricular and professional intentions that went into planning and facilitating the Costa Rica program. These questions explored the faculty director’s goals, expectations, and outcomes for the education abroad program. Upon return from the overseas portion of the education abroad program, a second interview was conducted with the faculty director with questions focused on: (a) her overall impressions of the experience, (b) the goals and outcomes she believed students achieved, and (c) her experience of collaborating with host partners in Costa Rica. I also posed questions regarding the course itinerary. These questions targeted the faculty director belief about what was valuable to the learning and development of graduate students in the Costa Rica program. Student Interviews I also conducted semi-structured interviews with student participants both before and after they departed for Costa Rica. The basis of the interviews consisted of guided conversations 68 that pursued a fluid line of inquiry surrounding participants’ goals, interests, interpretations, and experiences of the Costa Rica program. First, pre-departure interviews with student participants began with structured questions to familiarize myself with the background of each respondent and establish a baseline for the interview. These questions focused on personal, educational, and professional categories, where participants were asked about their family upbringing, educational history, and career trajectory. Also, student participants were asked more open-ended questions about their goals, interests, and experiences associated with enrolling in the Costa Rica program. Finally, interview questions inquired about students’ perception of coursework (i.e., conversations, activities, assignments) that prepared them to participate in the Costa Rica program. The post-departure interviews with student participants asked open-ended questions their about general impressions of the Costa Rica program and what they found personally meaningful about the experience. More targeted questions asked participants to reflect on interests, goals, and expectations they felt were realized as a result of their participation in the Costa Rica program. Additionally, I asked questions focused on participants’ experiences of the Costa Rica program that influenced their personal and professional development. Finally, interview questions focused on components of the course (e.g., itinerary, conversations, activities, assignments) that contributed to their learning and development. Document Analysis The second method of data collection for the current study was document analysis. The process of document analysis includes studying documents to interpret meaning or understanding for a particular context (Bowen, 2009; Merriam, 1998). A strength of documents is they are not created as the result of the research process, which aids their ability to corroborate other sources 69 of data such as interviews (Yin, 2018). In the current study, some documents were used to interpret students’ experiences of the Costa Rica program. First, an analysis of application essays provided background information of students and an overview of their goals and interests in participating in the Costa Rica program. Second, students were required to complete a feedback summary at the conclusion of the program, which provided an additional source of reflections about their experiences of the Costa Rica program. Other documents were utilized to interpret how the Costa Rica program fit into the broader structure, culture, and curriculum of the College of Medicine. Online documents such as guidebooks and webpages were reviewed to provide information about the College of Medicine curriculum, competencies, and certificate programs. Finally, the syllabus and program itinerary for the education abroad program were analyzed for information about objectives and purpose of the course, as well as activities and projects that students participated in while on-the-ground in Costa Rica. Direct Observations A final method of data collection was direct observation, which is a type of fieldwork where a researcher views a first-hand account of a particular phenomenon (Merriam, 1998; Yin, 2018). For the current study, I coordinated with the faculty-director to observe pre-departure meetings for the Costa Rica program. I assumed the role of an observer as participant (Merriam, 1998), where my activities of data collection were known to students, but I was only a spectator of the meetings. While observing the meetings, I recorded descriptive, hand-written notes regarding activities, assignments, conversations, and interactions between the faculty-director and students. Observations were useful to gain insight into pedagogical methods that faculty- director incorporated beyond what was interpreted from interviews and documents. 70 Data Analysis According to Merriam (1998), “Data analysis is a complex process that involves moving back and forth between concrete bits of data and abstract concepts, between inductive and deductive reasoning, between description and interpretation” (p. 178). My process of data analysis involved an intuitive balance of inductive and deductive reasoning, where I constantly sought to refine my preunderstandings about contexts influencing graduate students’ experiences of an STFD education abroad program. Thus, making sense of the data involved inductively interpreting participant-indicated experiences, while also accounting for a specific set of contexts and their intersections. For my analysis, I initially reviewed interview transcripts, documents, and observation notes to highlight points that stood out, make comments, and develop overall impressions of the data. Some of the course documents such as the syllabus and program itinerary were analyzed earlier in the data collection process to gain insight into the Costa Rica program. Next, I used a spreadsheet to open code the data, constructing an initial set of categories in which the data appeared to settle. I aimed to first acknowledge what participants’ experiences were in the program and then interpret whether they connected with contexts in my research question. Once this step was completed, I invited a peer to review my categories and discuss themes that could be constructed based on my initial analysis. This individual served as a peer debriefer who helped to ensure my data analysis was consistent and unbiased. As a result of this process, categories related and unrelated to my research question were confirmed. Following, I engaged in a process of refining categories into themes that both captured the data and reflected my research question. I reduced down to four themes, which became the contexts addressed in the initial findings chapter of the current study. After a draft of my findings was completed, I invited 71 a peer to review two separate transcripts, look through categories and themes in my excel spreadsheet, and read through the chapter to ensure my analysis was consistent. In order to identify intersections between the four contexts, I conducted a separate analysis of the findings presented in Chapter 5. First, I revisited my findings chapter, highlighting quotes and excerpts, as well as taking note of participants’ experiences that cut across the four contexts. Next, I created a series of data display tables that reorganized the findings by participant to show their quotes and excerpts for each of the four contexts. Also, I made additional passes through categories and themes to add data points in the display tables for participants that reflected intersections between the contexts. Following these steps, a majority of my analysis consisted of examining participant quotes and excerpts within a primary context to interpret how they overlapped with secondary, tertiary, and quaternary contexts. I aimed to interpret how participants’ experiences were influenced by more than a single context, as I could not assume that the contexts were mutually exclusive since participants’ experiences were multi- layered and complex. To add credibility, I encouraged a peer to review and critique drafts of my findings, which further confirmed my analysis. Trustworthiness In order to produce trustworthy findings, the current study took measures to implement a careful and thoughtful research design throughout conceptualization, data collection, analysis, and interpretation. A major factor of trustworthy research means research produced is realistic, authentic, ethical, and rigorous (Merriam, 2009). Several strategies were considered in applying standards of trustworthiness to the current study including credibility, transferability, reflexivity, and ethical considerations. 72 Credibility Credibility ensures findings are plausible and representative of the phenomena being interpreted by a researcher (Creswell & Creswell, 2020). As the interpretation of data is a subjective process, analysis must carefully account for the cultural, social, individual perspectives of those being researched (Merriam, 2009). Thus, the current study employed three methods to ensure the credibility of the research: triangulating data from multiple sources, member-checking with participants, and using peers debriefers to review my findings and analysis process. Triangulation Triangulation is “a process of using multiple perceptions to clarify meaning, verifying the repeatability of an observation or interpretation” (Stake, 2005, p. 454). I utilized multiple sources of data including document analysis, observations, and interviews from students and the faculty- director, which made my interpretation more balanced, coherent, and reliable (Creswell & Creswell, 2020; Tracy, 2010). As I was able to corroborate findings through different methods of data collection, triangulation added credibility to the study. Additionally, participants were each interviewed twice, allowing me to address issues and ask follow-up questions, which ultimately provided a more clear and consistent interpretation of data. Member Checking The process of member checking can include sharing interview transcripts, reflections, interpretations, or findings with participants to ensure accuracy of data they provided (Glense, 2016). After interviews were transcribed and edited for clarity, I emailed each participant a copy of their transcripts to complete a member check. Participants were asked to review the transcripts and reflect on the dialogue of the interview. Additionally, participants were given two weeks to 73 provide feedback about the interview process, make edits, or clarify points in their transcripts. One participant made minor edits to their transcripts, three participants responded back with no revisions, and eight participants did not respond at all. This process was completed prior to the analysis phase to help ensure the accuracy of interview data. Peer Debriefer At several stages of the current study, peer debriefers were used to review my data analysis process and provide feedback regarding my role in conducting the study. A peer debriefer is a “person who reviews and asks questions about the qualitative study so that the account will resonate with people other than the researcher” (Creswell & Creswell, 2020, p. 223). Directly after I open coded the data, a peer debriefer was able to review my categories and talk through my development of themes. Additionally, a separate peer debriefer reviewed my initial findings chapter, transcripts, and coding structure to provide feedback about my interpretation of the data. This strategy helped to ensure I was making sense of the data with an open mind. Transferability The current study aimed to provide a rich description of the case in order for readers to transfer the research to meet their own situations, actions, or interpretations. Transferability helps research adapt to have general applicability to a broader set of individuals, settings, and situations (Merriam, 2009; Tracy, 2010). By incorporating a thorough description of the Costa Rica program and the College of Medicine, I aimed to help readers connect the case study to similar-type situations within the broader landscape of graduate education abroad. Additionally, I sought to provide detailed description of events that I observed, such as pre-departure meetings, to help the reader better connect the case to their own understanding of education abroad. 74 Reflexivity In maintaining authenticity of this work, I held a level of self-reflexivity regarding my goals, biases, and experiences surrounding the current study. Reflexivity engages a researcher to “reflect about how their role in the study and their personal background, culture, and experiences hold potential for shaping their interpretations, such as the themes they advance and the meaning they ascribe to the data” (Creswell & Creswell, 2020, p. 258). My positionality played a role in the development of this research, as I participated in education abroad for the first time as a doctoral student. While participating in education abroad, I was heavily influenced by readings, projects, and activities embedded in the course curriculum. Upon completing the program, I felt more knowledgeable about professional practices within an international context based on my experiences and interactions. Thus, my own personal and professional experiences inspired me to approach this research topic. In addition, my research of the literature on graduate education abroad shaped pre- understandings about the nature of the graduate student experience. To some degree, the research question for the current study was informed by literature and theory suggesting personal, professional, and scholarly contexts of graduate students were important to consider in an education abroad program. While my research question guided inquiry for the study, I also strove to acknowledge my assumptions and interpret the data with an open mind. Reflexive thinking helped me to set aside pre-understandings and focus on what participants were telling me about their experiences before making interpretations. I felt confident in my ability to both answer my research question while also considering alternative explanations in the data. Ultimately, this process led me to uncover an additional context outside the scope of my research question. 75 Ethical Considerations Following the IRB approval process, I ensured my study qualified under all ethical policies and protocols for human subjects’ research. Ethical considerations for my study were communicated to participants in a consent form. In the form, I addressed participant questions, rights, and responsibilities regarding interviews. Students were asked to create a personal pseudonym to provide confidentiality in the study. Participants could choose to withdraw at any point in the study. I obtained permission from student participants to utilize materials from course documents such as application essays and feedback summaries. As students submitted these documents as part of the course, their real names and identifying information were connected to them. As a result, I chose to mask quotes from the application essays and feedback summaries in my findings, labeling them universally with participant instead of using their pseudonyms. Thus, material taken directly from these documents was purposefully non-identifiable, which helped to safeguard participant anonymity. Delimitations There are a few delimitations associated with this single case study design. First, the nature of a case study being interpretive, open-ended, and idiographic weakens its generalizability (Yin, 2018). Since my case is bounded within a single university system and academic discipline, establishing a broad understanding beyond a particular institution and professional program becomes difficult. In this sense, case study evidence is subjective and unique, rather than applicable or valid across different settings of higher education. Second, the case study offered rich data relevant to understanding the nature of graduate education abroad; however, following the purpose of my study, I focused particularly on contexts influencing 76 student experiences in these programs. While I provide a rich description of the Costa Rica program, the case served as a vehicle to understanding graduate students’ experiences of an STFD education abroad program. Limitations There are also a few limitations of the current study. First, although originally anticipated, I was unable to travel to Costa Rica with the education abroad program due to limited capacity with lodging and resources. Consequently, I was unable to observe aspects of students’ experiences occurring in Costa Rica, such as activities, conversations, events, and reflective discussions. Therefore, I relied on the program itinerary and interviews to provide context for the parts of the Costa Rica program that influenced student experiences. Second, only a single second-year medical student volunteered to participate in interviews for the current study. Although there were only a small number of second-year students enrolled in the Costa Rica program, having only a single participant with this status limited my findings for students in their second-year of medical studies. Finally, I did not interview leaders from GMI and PLAC as part of the study even though they played a role in the planning and facilitation of the Costa Rica program. These interviews were not pursued due to concerns around language barriers and a lack of access to these individuals. Conclusion In this chapter, I discussed my constructivist methodological approach to implementing a single, instrumental case study design that explored how contexts intersect to influence graduate student experiences of an STFD education abroad program. Boundaries guiding selection of the case site and participant sample were discussed. Also, I described methods of data collection and the process for analyzing data. Following, I included measures of trustworthiness guiding the 77 research process. Finally, I provide delimitations and limitations of the current study. In Chapter 4, I provide background information for the STFD education abroad program that served as the case and a detailed description of participants in the study. 78 CHAPTER 4: CASE STUDY BACKGROUND INFORMATION The purpose of this chapter is to set a foundation for understanding the case study before presenting findings in Chapter 5. In order to provide important context for the case, this chapter includes two main sections. First, an overview of the graduate education abroad program that served as my case study is provided with details about its goals, setting, partnerships, duration, itinerary, and requirements. Within this section, participant roles and characteristics are also highlighted. Second, information about the College of Medicine is provided with details about the curriculum, pedagogy, certificate programs, and service-learning requirements. Graduate Education Abroad Program The first section of this chapter provides an overview of the STFD graduate education abroad program, Exploring Healthcare in Costa Rica (pseudonym) (shortened to the Costa Rica Program), which served as my case for the current study. The Costa Rica program was a 1-credit elective course provided to first and second-year medical students in the College of Medicine with the goal of introducing them to universal healthcare policies and practices in Costa Rica through the format of education abroad. Moreover, the education abroad program existed for many years as a longstanding partnership between the College of Medicine and a medical institute in Costa Rica, called Global Medical Institute (GMI) (pseudonym). The program was established to fulfill a comparative healthcare component in the College of Medicine curriculum. For many years, the program was student-led, meaning a few students were trained to oversee components of behavior, safety, and security for their cohort during the overseas portion of the experience. A faculty member still held pre-departure meetings to highlight expectations and learning opportunities but did not accompany medical students abroad. Once medical students arrived in Costa Rica, GMI handled all logistics and academic components for the program. 79 The student-led education abroad program lasted until 2017, when a safety and security issue prompted GMI administrators to request postponement until a faculty member could accompany students in Costa Rica. As a result, the Costa Rica program was canceled in 2018 and overhauled to be offered again to medical students in 2020. Since the Costa Rica program struggled to compete with other programs offering students opportunities to complete service- learning requirements, a service project was added along with a faculty-director. In addition to earning an elective credit, medical students participating in the 2020 Costa Rica program completed 40 hours of service through a project with a non-governmental (NGO) organization affiliated with GMI called the Patient Legal Assistance Collective (PLAC) (pseudonym). These 40 hours fulfilled the minimum service requirement for students within the College of Medicine. Also, the Costa Rica program was directed by a faculty member within the College of Medicine, who helped organize the service-learning project and approve the additional partnership with PLAC. In the syllabus, written objectives for the course were for students to learn about tropical diseases, clinics, and universal healthcare in Costa Rica, compare public and private healthcare systems, speak to patients about their experiences, and provide service to a local healthcare organization. Partnerships with Costa Rican Healthcare Organizations The graduate education abroad program was facilitated through partnerships with two healthcare organizations in Costa Rica. First, the College of Medicine facilitated the education abroad program through a longstanding partnership with GMI, a healthcare institute that facilitated a majority of on-the-ground educational content and logistics in Costa Rica. GMI was an academic healthcare institute that strived to foster the global exchange of medical knowledge, practices, research, and development for communities of Central America and the Caribbean. A 80 central mission of GMI was to foster opportunities for international exchange for medical education curriculums in order to serve and educate medical students. GMI was led by a group of doctors who were experts in the Costa Rican healthcare system and had connections to policymakers, administrators, and other NGOs in the country. As a result, GMI developed the itinerary for the overseas portion of the program and provided medical students with activities and experiences around universal healthcare systems in Costa Rica. Additionally, GMI was instrumental in connecting the faculty-director from the College of Medicine with PLAC for the service-learning component of the program. GMI and PLAC were closely affiliated organizations, so the service project for the education abroad program was built out of connections formed prior to 2020. Second, PLAC partnered with the College of Medicine for the service-learning component of the education abroad program. PLAC was an NGO in Costa Rica that legally advocated for patients of critical and chronic diseases in the process of navigating legal, bureaucratic, and administrative barriers within the Costa Rican healthcare system. A major goal of PLAC was to advocate for patients to receive the medical care they needed from the Costa Rican healthcare system. Advising and defending the interests of patients in Costa Rica, PLAC filed complaints to governmental agencies and made medical treatment referrals. During the Costa Rica program, medical students collaborated on a series of service projects supporting PLAC in their work advocating for patients. Student Selection into the Program After the Costa Rica program was approved by the campus Education Abroad Office on September 4, 2019, applications were advertised to students in the College of Medicine until November 15, 2019. First and second-year medical students in good academic standing were 81 selected into the Costa Rica program through review of this application. Moreover, the application asked students to answer four questions in an essay format: (1) “Why are you interested in this program to Costa Rica?”, (2) “What do you hope to gain from this experience?”, (3) “Have you ever traveled abroad? If so, describe the program and experience.”, and (4) What is your level of Spanish?”. A review of applications was beneficial to this study by providing additional data regarding students’ interests, goals, and experiences prior to completing the education abroad program. During the review of applications, a preference was first given to students with bilingual skills because a majority of the program was conducted in Spanish. Students were also evaluated based on their intent for participating in the program and how their goals for participation aligned with their professional development and the service-learning component of the course. Due to lodging and travel capacity, a maximum of 18 spaces were available for the program, which were completely filled by students. Although a few students were waitlisted, others declined to enroll due to the personal costs associated with the program. Consequently, all medical students who applied and confirmed their interest in participating were admitted into the program. Program Duration and Itinerary The duration of the education abroad program lasted approximately four months from December 2019 until March 2020. The first three months consisted of a pre-departure period for program preparation with the overseas portion in Costa Rica lasting nine days. During the initial three-months of the program, medical students attended three conference-style pre-departure meetings where they learned about details, expectations, and requirements associated with the overseas portion of the program. Additionally, pre-departure meetings gave medical students an 82 opportunity to connect through teambuilding activities and introduced them to representatives from GMI and PLAC they would be working with in Costa Rica. Outside of the pre-departure meetings, medical students were expected to learn about Costa Rica and practice Spanish to be able to interact with doctors, administrators, and patients abroad. Finally, medical students were encouraged to collaborate on service projects with PLAC prior to their arrival in Costa Rica. Students were equally divided into groups for three projects: fundraising, social media, and patient stories. The fundraising project involved medical students raising money to purchase materials for PLAC, including a computer and printer to provide them the capacity to improve outreach with patients. The social media project engaged students in creating instructional manuals for PLAC and teaching administrators about best practices for using platforms such as Instagram, Facebook, and Twitter to advertise and publicize their organization. The patient stories project encompassed students developing questions and instructions for interviewing PLAC clients and retelling their stories about healthcare experiences. During pre-departure meetings, students were given time to work on their assigned service projects. In the final pre- departure meeting, students met virtually with administrators from PLAC to discuss their progress and finalize details for their projects. These conversations were held in Spanish and helped students gain a better sense of the objectives of the on-the-ground portion of the program. Additionally, students were able to lean about the history behind PLAC and understand the meaning behind the service projects they were providing to this NGO. The overseas portion of the education abroad program took place during spring break in the academic calendar, which provided medical students the availability to participate, as no regular classes, exams, or clinicals were scheduled during that week. In addition to a few culturally focused activities, a majority of the program itinerary in Costa Rica was dedicated to 83 students experiencing the healthcare system in a professional capacity. Students engaged in meetings, keynote lectures, seminars, panel discussions with doctors and policymakers, and toured hospitals and clinics. During many of these activities, students were encouraged to dress in professional attire and wear their medical white coats. A secondary piece of students’ experience in Costa Rica was completing their service projects with PLAC. Some students engaged in discussions with PLAC to advise them about using social media platforms to reach out to patients and clients. Additionally, all students had the opportunity to interview patients for the stories project. Program Evaluation Once students returned from Costa Rica, they were required to complete a feedback summary of their education abroad experience and to satisfy their service requirement for the medical school program. This assignment included reflection questions about their experiences and asked students to provide feedback about program preparations, academic content, on-site logistics, health and safety, cultural immersion, and service projects. Additionally, the assignment asked students to provide a personal reflection about how they prepared for the education abroad program and what they learned professionally, academically, and cross- culturally from the experience. These reflections were beneficial to this study by including an additional source of data covering students’ experiences in Costa Rica and therefore, adding credibility to the findings. Overview of Student Participants There was a total of 18 medical students who enrolled and were admitted into the Costa Rica program. Eleven of the 18 students consented to participate in this study. Although there were more second-year students who enrolled in the education abroad program, all but one of the 84 participants were in their first year of medical school. Participants were evenly split between in- state and out-of-state status, with some enrolling in the College of Medicine after completing a post-baccalaureate (post-bacc) or master’s program and others coming from professional work experiences. Additionally, the medical students were split between two separate campus locations at the university, influencing where they received instruction and clinical experiences. A majority of participants were from the [Campus 1], while two participants were students at the [Campus 2]. Although students received the same level of training through the medical school curriculum at both campuses, their cohorts and social circles were separate from one another. The pre-departure meetings were the first time medical students from the two campuses interacted with one another, which created unique interpersonal dynamics for the Costa Rica program. Student Participant Profiles In this section, I provide a brief profile for each of the student participants in this study. The purpose of the participant profiles is to add context and background to the case study. Each of the student participants chose a pseudonym for themselves, which I used to protect their identities. Fred (pseudonym) was a first-year medical student at Campus 1. He was born in the US but spent a majority of his youth overseas in [Southeast Asia] as an expatriate, which gave him opportunities to travel and develop an appreciation for different cultures. Fred was an out-of- state student who completed a master’s degree in global medicine and worked for a year as an HIV clinical researcher before enrolling in the College of Medicine. While completing his master’s degree, Fred served on medical missions to Uganda and Panama, and he worked on an individual project in Bali with a small mental health NGO. These experiences inspired Fred to 85 think about policies and practices of healthcare systems outside the US and solidified his interests for practicing medicine tied to global health. Fred was a novice Spanish speaker but wanted to improve bilingual skills for interacting with patients of different backgrounds and experiences. Fred’s goals for education abroad centered around improving his cultural competence, comparing experiences between Panama and Costa Rica, and learning about healthcare advocacy. Moreover, Fred felt that experiences during the Costa Rica program would reinforce his interests and capacity for working in the field of global health. Natasha (pseudonym) was a first-year medical student at Campus 1. She was an in-state student and completed her undergraduate degree at NSU in physiology with a minor in Spanish. Consequently, Natasha was an advanced Spanish speaker who was interested in practicing her Spanish language skills in Costa Rica. The Costa Rica program was the first time Natasha traveled outside of the US, which made her both nervous and excited for the international experience. Overall, Natasha’s goals for education abroad revolved around interacting with patients in a different culture, experiencing a different healthcare system in Costa Rica, and volunteering with organizations to advocate for patient rights. Kay (pseudonym) was a first-year medical student at Campus 1. She was motivated to practice medicine outside of the United States after graduating. A large portion of Kay’s family lived in [Southeast Asia], and her experiences visiting that region shaped interests in rural medicine and goals for gaining exposure to a universal healthcare system. Kay was an in-state student who completed her undergraduate degree in psychology but also finished a post-bacc program and volunteered at a local hospital prior to enrolling the College of Medicine. Kay credited the post-bacc program with helping her recognize the value of practical-based learning and applying information to her future medical career. She was a beginner Spanish speaker, but 86 she was interested in advancing her language skills to work with diverse patient populations. Kay’s goals for education abroad were to gain exposure to universal healthcare, provide service to PLAC, and develop transferrable skills for practicing medicine in [Southeast Asia]. Mary (pseudonym) was a first-year medical student at Campus 1. She was interested the education abroad program to incorporate intercultural competence into her work serving rural populations as a future physician. Mary was an in-state student, and she completed her undergraduate degree in biology while also minoring in Spanish. Consequently, Mary considered herself an intermediate Spanish speaker. During her undergraduate degree, Mary went on a mission trip to the Dominican Republic as part of a Spanish medical professions course, which inspired her to participate in the Costa Rica program. Overall, Mary’s goals for education abroad were to compare healthcare systems, understand diverse medical policies and practices, and serve patients outside of the US. Jay (pseudonym) was a first-year medical student at Campus 2. He was an out-of-state student who completed his undergraduate degree in biology and then worked as a certified Emergency Medical Technician for a few years before getting his master’s degree in medical science. Afterwards, Jay worked for a medical device company and a medical technology startup prior to enrolling in the College of Medicine. During an international business trip for the medical device company, Jay recognized the value of hands-on, cross-cultural experiences to his personal and professional development. Jay’s Spanish speaking skills were novice. He was interested in becoming a family physician and opening a free health clinic to connect comprehensive healthcare resources to underserved families. Jay’s goals for education abroad were to learn about different healthcare systems and resources, so he could apply this knowledge to working with underserved patients and families in his home community. 87 Nala (pseudonym) was a first-year medical student at Campus 1. She was an in-state student and completed her undergraduate degree at NSU in human development and family studies. Coming from a social science background, Nala was reflective about patient and community care, seeing the Costa Rica program as an opportunity to improve her cultural competency. Nala considered herself an intermediate Spanish speaker because she took some language courses during her undergraduate degree. Additionally, she participated in a short-term education abroad program to China, which influenced her to think about the importance of experiencing different cultures and learning in new environments. Nala’s goals for education abroad were to compare Costa Rican healthcare to the United States system, study tropical diseases, and build cross-cultural skills for working with diverse patient populations. Monica (pseudonym) was a first-year medical student at Campus 1. She was interested in the Costa Rica program to improve her professional knowledge and skills by interacting with doctors and learning about different healthcare structures. Monica was an in-state student who completed her undergraduate degree in microbiology. Monica also took a few undergraduate courses in Spanish and considered her language skills to be intermediate. As an undergraduate student, Monica visited Costa Rica twice on short-term service trips for an honor society program where she served local communities and educated primary students about disease prevention. These experiences kept Monica motivated to improve her cultural competence and pursue additional international opportunities for learning. She was also focused on utilizing the education abroad program to gain a professional perspective of healthcare policies and practices in Costa Rica. Monica’s goals for education abroad included gaining knowledge about universal healthcare, learning about tropical diseases, and understanding how cultural differences shaped patient care. 88 Angeline (pseudonym) was a first-year medical student at Campus 1 with interests in working internationally as a future physician. She completed her undergraduate degree in microbiology at an in-state university and then worked professionally for a few years out-of-state before enrolling in the College of Medicine. Angeline was interested in linguistics and studied Spanish, so she was an intermediate Spanish speaker. A formative international experience for Angeline was a four-week undergraduate education abroad program in Ghana where she worked on a maternal morality project at rural clinics. Consequently, Angeline was inspired to pursue education abroad in medical school. Angeline’s goals for education abroad were to learn about universal healthcare, compare Ghanaian and Costa Rican experiences, and support PLAC in serving patient needs. Yondu (pseudonym) was a first-year medical student at Campus 1 who had traveled abroad before to Costa Rica to volunteer for disaster relief. He was an out-of-state student who was fluent in Spanish. Yondu was interested in diverse approaches to healthcare, and he was motivated to practice medicine abroad in a program such as Doctors Without Borders. Before enrolling in the College of Medicine, Yondu completed his undergraduate degree in psychology and worked for several years in different careers, which led him to pursue the field of medicine. Yondu was also interested in pursuing public health and believed the Costa Rica program offered a great opportunity to learn about a different healthcare system. Ultimately, Yondu’s goals for education abroad included learning more about the Costa Rican medical system, diversifying his healthcare perspectives, and connect with patients from different backgrounds. Tammy (pseudonym) was a first-year medical student at Campus 1. She was interested in practicing medicine for underserved areas and helping patients navigate socioeconomic challenges in getting the care they needed through public healthcare policy. Tammy was an out- 89 of-state student who completed her undergraduate degree in sociology and finished a post-bacc program while working as a communications assistant and clinical researcher before enrolling in the College of Medicine. During her post-bacc experience, Tammy was able to take on leadership positions focused on community health awareness, which shaped her interests in working with underserved communities. Tammy was in a certificate program in the College of Medicine that focused public healthcare policy. As an undergraduate student, she participated in a short-term education abroad program to Spain during her undergraduate degree, and she considered her Spanish speaking skills to be intermediate. Tammy’s goals for education abroad centered on understanding the healthcare system in Costa Rica and adapting the experience to advocate for healthcare equity in underserved communities. Jane (pseudonym) was a second-year medical student at Campus 2. She was interested in the Costa Rica program for the opportunity to work with diverse patients, learn about a different healthcare system, and help underserved communities. Jane grew up in the [Oceana Region] and experienced adjusting to a new culture at the age of 18 when she moved to the United States, so she recognized the importance of advocating for patients with different backgrounds. She was an out-of-state student who completed a post-bacc program while also working professionally as a lab technician and a grant writer before enrolling in the College of Medicine. Also, prior to medical school, Jane participated in a medical mission trip to the Dominican Republic to serve rural community clinics. Jane’s Spanish speaking skills were novice. As a second-year student, Jane was preparing to take certifying exams shortly after returning from Costa Rica, which caused some anxiety about managing her study time concurrently with the education abroad program. Jane was in a certificate program in the College of Medicine focused on working with 90 underserved patients, and she tied her goals closely to professional opportunities for supporting and advancing healthcare for vulnerable communities. Overview of Faculty-director Participant As part of the case study, I also interviewed the faculty-director for the Costa Rica program. Joan (pseudonym) served as the Director for Graduate Curriculum and Global Experiences. In her role, Joan oversaw the short-term education abroad programs and facilitated international rotations for medical students in their third and fourth year in the College of Medicine. Joan designed and facilitated the Costa Rica program as well as other programs in the College of Medicine. Another responsibility for Joan was approving curriculum development and tracking service-learning requirements for medical students in the College of Medicine. Under the umbrella of curriculum development, Joan managed the application and evaluation process for graduate certificate programs. Additionally, Joan evaluated whether service-learning activities completed by medical students met graduation requirements and engaged them in meaningful learning. Starting in her position in 2016, she overhauled the service-learning process for the college by redesigning student outcomes for service-related activities. These experiences eventually informed Joan’s decision to add service-learning to the Costa Rica program. Prior to working in the College of Medicine, Joan served as the director of academic affairs and advising for a residential college at NSU focused on supporting STEM and pre- medicine undergraduate students. Joan credited her professional background in the approach she took to balance student needs while also holding them accountable to program goals and outcomes. As a result, Joan was constantly thinking about student engagement, learning, and development. 91 Directing the Costa Rica Program Serving as the faculty-director for education abroad since 2016, Joan managed the curricular, logistical, and leadership aspects of the Cuba and Costa Rica programs for the College of Medicine. Moreover, Joan inherited these longstanding programs when she joined the College of Medicine. Since both programs coincided with one another, Joan accompanied students to Cuba during her first several years in the role. Although she managed pre-departure trainings, Joan did not accompany students to Costa Rica until after there was a safety issue in 2017, prompting GMI to encourage a faculty member direct students on-the-ground as part of programs moving forward. In efforts to overhaul the Costa Rica program, Joan canceled the trip in 2018 and began working with GMI in 2019 to find a second partner for adding a service-learning component to the curriculum. In collaboration with GMI, Joan incorporated PLAC into the Costa Rica program and built the service projects into the design of the course. In 2019, Joan traveled to Costa Rica to meet with members of PLAC and ensure the service project was on a scale that students could accomplish during the education abroad program. During the spring of 2020, Joan accompanied medical students in Costa Rica as the faculty-director. While GMI handled much of the academic content and logistics for the program, Joan’s responsibility in Costa Rica was to help students stay organized with the itinerary, engage the group in reflection about cultural immersion, and manage safety and security issues. Joan’s efforts to build service-learning into the education abroad curriculum and forge a new partnership with PLAC embodied a large portion of her responsibility for organizing and directing the Costa Rica program. Talking about adding service-learning, Joan said, “…that drove a lot of how I designed the Costa Rica program.” Also, the service-learning project, 92 student engagement, and relationships established with GMI and PLAC represented Joan’s development in the faculty-director role over time. She said, I've been able to develop or be more intentional about how I engage and prepare the students. That keeps changing each year because I learn things based on thinking about how students approach these experiences and what they think is happening on these experiences and being able to try and shape that a little bit better. Especially, because we're doing service and community engagement. Ultimately, the service-learning projects helped students make meaning of their experiences in Costa Rica and shaped opportunities for hands-on learning that carried over to career and professional development. As a result, Joan played a substantial role influencing what students learned and experienced in Costa Rica. College of Medicine The second section of this chapter provides an overview of the College of Medicine. The mission of the College of Medicine involved educating physicians to provide knowledge and services for communities both in the United States and abroad. The College of Medicine educated first and second-year medical students across two campuses and organized training programs spanning across many clinics and hospitals throughout the state. Central pillars of the medical program were diversity, inclusion, and taking a patient-centered approach to providing care to underserved communities. Additionally, the College of Medicine prided itself on offering medical students several opportunities to gain international clinical and health-related experiences through education abroad programs. Evident in interviews with participants, these goals and competencies of the College of Medicine influenced students’ perspectives about 93 learning and professional development. Moreover, these pillars were also represented by aspects of the program’s curriculum and pedagogy. Curriculum and Pedagogy The College of Medicine focused on student-centered, hands-on, and collaborative learning through the use of early clinical experiences built into the curriculum. Students were introduced to clinical work in their first and second year of the medical program, which was a unique curricular practice among medical schools. This practical and experiential approach to educating medical students was cited by the program’s website as a useful tool connecting theoretical knowledge with professional and patient-centered competencies. Moreover, the blending of clinical and theoretical learning was central to the student-centered approach of curriculum and pedagogy within the College of Medicine. Medical students expected a level of practical and experiential learning to be incorporated into their medical education. As a result, this orientation towards learning influenced some participants’ goals for their education abroad experiences. Another component of the curriculum was teaching medical students to approach theoretical content from patient perspectives of illness and care. In other words, medical students were encouraged to simplify medical issues from high-level disciplinary systems down to the patient symptoms and experiences. As a result, several participants in the study mentioned the importance of being patient-centered in their approach to medical practice and highlighted the Costa Rica program as a means to improve these skillsets. Finally, medical education in the College of Medicine was based on six core competencies sourced from the Accreditation Council for Graduate Medical Education and further adapted to fit the college’s mission. Curriculum, training, and expectations were guided 94 by six competencies: service, care of patients, rationality, integration, professionalism, and transformation. These competencies served as a foundation for course offerings in the curriculum and guided ongoing progress assessments for medical students in the program. As part of these assessments, medical students were encouraged to reflect on their learning process, strengths, and weaknesses. Consequently, participants in the study were reflective about professional knowledge and skills they were developing as a result of the education abroad program. Graduate Certificate Programs The College of Medicine offered three graduate certificate programs medical students could elect to complete within the curriculum to gain expertise in a professional area of their interest. The certificate programs included options for working with underserved communities and rural communities as well as working in public health. Moreover, these certificate programs required students to enroll into elective courses and pursue specific clinical training sites aligning with these areas of interest. Additionally, some of the certificate programs encouraged students to participate in education abroad as part of their training. Several participants in the study were engaged in these certificate programs and mentioned how education abroad aligned with their goals and desired skillsets. Service-Learning As one of the College of Medicine competencies was service, students were expected to engage in service-learning to demonstrate commitment, preparation, and planning for supporting community needs. Medical students were required to complete 40 hours of structured service- learning with a community organization by the time they graduated. A key part of fulfilling the service-learning requirement was the completion of a reflection essay focused on students’ understanding of social issues and consciousness of the responsibility to respond to community 95 needs. Consequently, service-learning was embedded into the structure and culture of the College of Medicine, and students understood the connection between service, their academic coursework, and clinical training. Medical students were unable to count required courses and activities towards fulfilling their service-learning requirements. However, service-learning experiences during education abroad and certificate programs qualified to satisfy service hour requirements. As a result, the Costa Rica program satisfied all 40 service-learning hours in a single commitment. The ability to complete service hours through education abroad motivated some participants to participate in the Costa Rica program. Conclusion In this chapter, I provided background information for the case study, including an overview of the Costa Rica program and details regarding participants. Additionally, I highlighted information about the College of Medicine that housed the education abroad program to detail components about curriculum and requirements that influenced the experiences of participants. The purpose of this chapter was to add context and setting to this case study prior to the presentation of findings in Chapter 5. 96 CHAPTER 5: FINDINGS – CONTEXTS INFLUENCING GRADUATE STUDENT EXPERIENCES OF EDUCATION ABROAD The following chapter explores contexts influencing graduate students’ experiences of the Costa Rica program. Specifically, my research question was: “How do contexts of adult learning, professional socialization, and curriculum and pedagogy intersect to influence graduate students’ experiences of a short-term, faculty-directed education abroad program?” In order to examine intersections, I first needed to identify contexts influencing graduate students’ experiences of the Costa Rica program. Thus, this chapter represents the first step in addressing my research question. The findings were organized around four main themes constructed from the data regarding contexts influencing participants’ experiences of the Costa Rica program: (1) adult learning, (2) professional socialization, (3) curriculum and pedagogy, and (4) interpersonal development. In Chapter 6, I explore and analyze intersections between these contexts. The Context of Adult Learning Influencing Graduate Student Experiences The first major theme constructed from participant reflections and responses about their education abroad experience was the context of adult learning. Participants demonstrated three perspectives of adult learning when describing their goals, outcomes, and experiences of the Costa Rica program. This section includes three sub-themes, which are described in detail throughout this section: (a) experiential learning, (b) transformative learning, and (c) pragmatic learning. Experiential Learning A sub-theme within the context of adult learning was experiential learning, as many participants drew on prior experiences to inform their goals and expectations for the Costa Rica program. Past cross-cultural experiences associated with traveling internationally, such as 97 personal travel, education abroad programs, medical service trips, or occupational work informed students’ decisions to enroll in the Costa Rica program. Also, some participants discussed prior work experiences leading them to participate in the education abroad program. While in Costa Rica, some participants reflected on prior experiences to build knowledge, consider new perspectives, and set additional goals for learning. Finally, new experiences working with doctors and patients in Costa Rica led participants to ways of thinking about healthcare and practicing medicine. Prior Experience Traveling Abroad Many participants in the study previously traveled outside of the United States in some capacity, which influenced their experience of setting goals for the Costa Rica program. For example, Kay visited her family in Southeast Asia every other year, which allowed her to experience and reflect on a different medical system. When asked about how her family factored into her decision to participate in education abroad, Kay explained: My husband lives in [Southeast Asia]. So, definitely because I think being able to see how medicine is delivered in other countries [provides] a better understanding of where I want to take my career and the things that would be possible in the future…Being connected [and] having roots that travel all over the globe definitely led me to the conclusion that here's the thing I should do. Additionally, Yondu traveled outside of the United States several times and twice to volunteer prior to the Costa Rica program. He said: I think my most memorable experiences abroad have both been volunteering…one was Ecuador, and the other was St. John's in the Virgin Islands. I think those were the most memorable because I got to really know the people that I was helping…it was 98 volunteering for disaster relief, so seeing their good spirits in a time that most people would probably be crushed I think made a big impact on me and made me want to do more of the work I was doing. Yondu believed his prior experiences traveling abroad and volunteering provided motivation for him to participate in the Costa Rica program. When asked why he thought medical students participated in education abroad programs, Yondu replied: I think one big part of that is a lot of the medical students are probably younger than I am, not by much. But they haven't been abroad too much. So that might be one thing to do early-on, before their career really gets in motion. And then, the other case would be people that have been abroad already, [which is a] similar experience to mine. They like new cultures, and they like volunteering. While Yondu believed some of his peers were less traveled, in fact, a number of participants took part in education abroad prior to the Costa Rica program. Some of these participants indicated how their prior education abroad experiences were formative to developing an awareness of other cultures and approaching international perspectives with an open mind. For other participants, prior education abroad experiences inspired them to participate in the Costa Rica program. Nala participated in an undergraduate education abroad program in China, which brought moments of culture shock as she adapted to different traditions and learned about non-Western ways of life. She said: Going to China, I feel like it made it easier for me to reach out to other people who weren't necessarily in my culture…I feel like I became more open than I already was because I got to meet so many different people from different cultures... 99 Additionally, Mary participated in a medical service trip to the Dominican Republic with a pre- medicine club prior to entering medical school. During the trip, Mary was able to work with patients and observe doctors in medical settings, most of which occurred in Spanish. This experience shaped how Mary viewed herself fitting into a global community. She explained: I was always very judgmental of people who studied abroad and then came back and said ‘oh, my gosh, it changed my life.’ But then, I was that person. And it changes how you see the world and how you see other people when you go and experience people living in such different ways than you do. Mary believed the experience in the Dominican Republic was valuable to the realization international travel was important to her personal and professional development. She continued: Experiencing the culture of the Dominican and seeing and learning all these things about those people and then about myself. And then, the opportunity came up to go to Costa Rica, and I was like ‘sure, why not, [I’ll] do it again.’ Similarly, Jane went on a medical mission trip to the Dominican Republic where students were paired with physicians to observe their medical practice at rural area clinics. When asked about how she saw this experience influencing her decision to enroll in the Costa Rica program, Jane stated: I felt like the Dominican Republic trip was a very structured experience, and I felt that it was really nice to be able to experience something like that with another group of students…with similar backgrounds in terms of education…it's nice to have classmates go as well. So, it's not just me exploring one country by myself. Based on her prior experiences, Jane believed a structured program with opportunities for peer engagement was central to her learning in Costa Rica. 100 As an undergraduate student, Angeline participated in an education abroad program in Ghana working on a biomedical engineering project, which allowed her to see different medical care disparities between urban and rural areas of the country. This experience inspired Angeline to participate in the Costa Rica program as a medical student. She explained, “…it actually influenced me in wanting to be more involved in working with underserved communities and internationally. And so, I was just like, ‘as soon as I get another opportunity to do that, that's what I want to do.’” Finally, Fred participated in two medical service-trips during his master’s program and believed these past experiences would influence how he approached the Costa Rica program. He said: Because of the previous experiences, I think I may be coming in with...I don't want to say [I have] less bias, but I understand that if you haven't really traveled and done healthcare, even just been a patient abroad, it's hard to see outside the US healthcare system…I guess, the last few trips I went on, there's that whole phrase ‘think globally, act locally’ kind of thing, where ultimately going abroad will frame myself or just allow me to observe and listen more...and allow me to go in seeing how even though some problems may seem similar compared to the US and Costa Rica, understanding that solutions can be very different and what works in one place also may not work somewhere else. Based on past service-trip experiences, Fred was going into the Costa Rica program with an awareness about the importance of immersing himself in the culture and seeing solutions outside of the United States healthcare system. Prior Work Experiences Some participants worked professionally part-time or full-time prior to enrolling in medical school, which prompted them to reflect upon the value of an international experience 101 through employment. For others, work experiences led to an awareness about flaws in the United States healthcare system that motivated an interest in gaining outside perspectives and practices. Three examples show how some participants used prior work experience to inform their goals for the Costa Rica program. First, Tammy worked for five years prior to medical school while also completing her post bachelorette degree coursework. One of her jobs was being a communications assistant where she interviewed nursing students about their experiences traveling to Ghana for a medical mission trip. The experiences the students described inspired Tammy to apply to the Costa Rica program. She explained, …part of my job, I directed and edited our annual campaign video. I got to interview the nursing students, and they talked about…why the funds were important for their medical missions…They just explained the impact that they were able to have on that community and also how much they learned from that community. I got to see footage of their trip and it really just looked amazing... outside of even the medical things they did when they got there, they were immersed in the culture… So, that really increased my desire to go abroad and do those types of things. Also, when asked about experiences that motivated him to participate in the education abroad program, Jay recalled an international business trip to Berlin where he learned the importance of cultural differences. He explained: One of things I used to do as a project manager was [understanding] the requirements it took to produce a medical device. I became very familiar [with] what it [took] to bring a medical device from an idea to something you could put on the market…And my company realized we had a huge market potential in Germany. I had to [conduct] research about their regulations [and] understand their requirements. It was one thing to 102 read it online, but I realized that if I really wanted to understand the need and how eventually, if we [did] plan [for] marketing in Germany, [we were] going to actually do it with the customers there. So, we reached out to their regulatory body in Germany and had [a] conference [in Berlin]. It was essentially an educational conference where we got to teach them about the device, and they taught us what the requirements were to market the device in Germany. They were teaching us, and we were teaching them about the device. And the more I got to understand, I realized there [were] those cultural differences, but there was a different experience when you actually got to meet someone from a different culture. And whether it be coming from a business sense or personal stance, it was very humbling because it made me realize how much I didn't know about the device... During the conference, Jay learned how Germans were using the medical device in a completely different way than doctors in the United States. After learning about these differences, Jay modified the device to fit their specifications. In discussing how the conference was important to his work, Jay stated, “I wouldn't have known that if I didn't get to actually be there, meet them, understand them, and see what their version or their interpretation was like on the same device.” Overall, this international business experience seemed to influence Jay’s viewpoints about the link between cultural competence and professional development, which inspired him to participate in the Costa Rica program. Finally, Natasha spoke about her part-time job working in a pharmacy and realizing medicine was too expensive for some patients to afford. Natasha’s experiences with customers’ financial hardships in the pharmacy contributed to her interest in seeing how other countries handled the distribution and affordability of medicine. Natasha said, “…working in the 103 pharmacy, you see it. People can't afford the co-pays on their medication...So I don't know how it is in other countries, which is why I'm interested to see how Costa Rica does it.” Reflecting on Prior Experiences During the Education Abroad Program Some participants discussed how their experiences of the Costa Rica program engaged them to reflect on their past personal and professional experiences. For Jane, staying with her host family and working through language barriers in Costa Rica brought up past experiences of having to interact non-verbally with patients in a clinical setting. Jane said about her experience: I've never really had a host mother before, but I've felt like this isn't my first time trying really hard to connect with somebody [through] language barriers. So, it does kind of remind me of other experiences I've had with other individuals, like whether it's within a clinic…It's something that I want to continue to address, so I can find other non-verbal ways to communicate with other people, too. And be respectful of how they interpret non-verbal language. As Jane reflected on her experiences working with patients across language barriers, she was encouraged to continue improving non-verbal ways to communicate with others. Additionally, by comparing his travel experience in Berlin and Costa Rica, Jay gained a new perspective about adapting to a language outside of his comfort zone. He explained: My past experiences going to Berlin, I felt that there was a good [number] of English speakers. So, going there, I didn't really have an issue with the language gaps. But then, going to Costa Rica, I was forced to practice my Spanish. And if anything, it made me realize that English isn't the number one language in the world…it made me realize traveling to a country like Germany [is] one thing, but it's also accommodating for English speakers as well. But, going to Costa Rica, when you're in the rural areas, you 104 [have] got to be willing to adapt; willing to learn; willing to learn the customs; the different phrases to get by. Finally, Monica was a participant who previously traveled to Costa Rica twice for short-term service trips prior to the education abroad program. When asked about how she reflected on her past experiences, she said: I did reflect on my previous experience a lot. I don't know if I can say I was really surprised with very much. When I went the first couple of times, they even brought up the healthcare system just because you can tell they're so proud of it. Especially, talking to people coming from the United States where we have so many issues. I guess the only thing that really surprised me was getting to talk to physicians and patients and the different types of people involved in the healthcare system. It seems like the consensus all around was they were all very happy with it…even despite talking about the downsides to it. Monica’s experiences talking with doctors and patients, coupled with her prior travel experiences, allowed her to develop a deeper perspective about the Costa Rican healthcare system. Applying Experiences in Costa Rica to Inform Learning and Development Finally, some participants shared the experiences that contributed to their learning and development in Costa Rica. Moreover, these experiences allowed participants to develop new ways of thinking about healthcare and envision a future in the field of medicine. Angeline said, “In terms of learning a lot about the healthcare system, I actually thought [it] was really important to not just see what was done, but how it was being done.” One hands-on experience highlighted by several participants was shadowing a doctor who demonstrated a physical examination technique used to assess patients without imaging technology. Since doctors in 105 Costa Rica had limited access to expensive imaging machines, they needed to understand anatomy more closely when diagnosing patients. The experience of learning from doctors about using this technique was surprising to participants and inspired them to change their practices with physical examinations for their clinical work back in the United States. Nala mentioned how observing the doctor overcome a lack of resources inspired her to pay greater attention to the physical examination as a medical student in the future. She said: ...they heavily rely on actually knowing the anatomy and physiology...So that was very meaningful to me and really motivated me to learn. I was learning the material, but to actually sit down and absorb it all. Because it is very true. You'll have cases where you won't have time to rely on imaging [technology]. Jay said, “…when I do start practicing as a physician, I'm not just going to rely on ‘oh, the best imaging technique.’ But rather, I have the needed tools so I can take care of patients if imaging [goes] down.” Echoing this idea, Monica said, “...seeing the importance of the physical exam in other places. I hope to keep that in mind when I'm learning about the physical exam and really taking that seriously.” Participants’ plans to apply the physical examination to their future training and development after shadowing the doctor was an example of experiential learning in the education abroad program. Elements of Transformative Learning A second sub-theme within the context of adult learning was participants’ demonstrating elements of transformative learning. Transformative learning occurs when a disorienting dilemma causes an individual to question and reframe their perspectives and explore new ways of thinking (Mezirow, 1991). Some participants demonstrated elements of transformative learning by reflecting on their abilities and values, acknowledging a change in perspectives about 106 healthcare and medical training, and considering ways to incorporate new roles and responsibilities into their training and development. While transformative learning is complex and spans over the course of an individual’s experiences and ability to reframe their perspectives (Mezirow, 1997), the participants in this study only demonstrated elements consistent with the start of this process. Thus, experiences in the Costa Rica program seemed to serve as building blocks for participants’ readiness to engage in transformative learning process. The following section is grouped into three areas where participants demonstrated components consistent with transformative learning: (a) self-reflection and reexamination of values, (b) reframing perspectives, and (c) considering new approaches. Self-reflection and Reexamination of Values Presented with new situations in Costa Rica, a few participants were reflective about their values. Fred’s experiences working with PLAC led him to reflect on personal barriers while advocating for resources. He stated: I was raised to be extremely appreciative of all the opportunities that [are] given. I am, while trying to find this space and understanding that I can [feel] like it's not complaining [but] advocating and fighting for the rights of some people and learning how to navigate that. I think that was an interesting perspective I got from Costa Rica because of the stories that the patients and PLAC had shared about how, within those structures they fought for their treatments and for essentially the right to live. I'm not sure how much of myself has changed, but that was definitely an aspect of something I had thought about for myself that was brought up again. As Fred was influenced by PLAC’s work to defend patient rights, he began to reexamine values around politeness and being appreciative when inadequate systems called for advocacy to reach 107 necessary change. Although Fred was not certain if he changed because of this experience, the experience learning about PLAC’s advocation of patient rights was disorienting enough to prompt inflection and contributed to elements of the transformative learning through his engagement in reframing his perspectives. Additionally, Jay reflected on personal values for serving patients in his local community after listening to a physician talk about working with underserved populations in Costa Rica. Jay said: …one thing that definitely drew me in was the reason why they do it. And…it was actually talking to the OBGYN physician who said, ‘One thing is for sure is that being a physician in Costa Rica, it's not the most lucrative or popular job.’ But he does it because he knows he would have the skillset and a means to help his community. I have always thought I had the motivation of really focusing on coming back to the community to serve, but he really emphasized that for me. This conversation seemed to prompt Jay to reexamine his purpose for becoming a physician and thinking deeply about his desire to help his own community. Beginning to Reexamine and Reframe Perspectives Other elements of transformative learning displayed by participants was the tension between prior assumptions and different experiences in Costa Rica, causing some to begin acknowledging new perspectives about healthcare policies and practices. Participants spoke about being influenced by conversations with Costa Rican doctors and administrators focusing on ethical dilemmas with the lack of access to healthcare in the United States versus Costa Rica. Also, new perspectives took shape for participants about the United States healthcare system after seeing alternative approaches in Costa Rica that prioritized patient care and coverage. Kay 108 talked about a process of questioning her assumptions about patient responsibility for health after seeing a different healthcare system in Costa Rica. She said: I guess the monotony of it all can start seeming like there are people out there who don't want to take care of themselves. It's all subconscious and it happens very slowly, but you do get to a point where you might find yourself thinking that like ‘oh, this person doesn't care about their health. They don't deserve these medications or whatever.’ And then, when you remove yourself from that circumstance, and you go to a place that does everything so differently...you see the difference that it makes in like everyone's livelihood. I guess it puts back into perspective that it's not just like one person's choice to not take care of themselves. It's a whole myriad of factors at work causing a person to be in a situation that feels a little more hopeless than others. By questioning her previous assumptions, Kay began to reexamine her personal feelings around patient care and the systemic factors responsible for health disparities. Also, Monica had a similar experience after speaking with doctors who challenged her perspectives about the United States healthcare system. Monica explained: A big thing that we talked about there was they just couldn't believe that a country as advanced as a United States could be so unfair with their healthcare...And the way that they talk about their healthcare system. How pretty much everybody gets everything that they need at no cost to them. The burden is not on them. It was just almost kind of hard to walk away from that and then come back here and realize how divided our system is. It definitely changed my perspective on how I look and think about a lot of things in healthcare here. 109 The conversations with doctors comparing healthcare systems engaged Monica in critical assessment to begin reframing her opinions about the challenges to the United States healthcare system. Additionally, the emotions of embarrassment Monica felt about lack of coverage for patients in the United States seemed to be a disorienting event prompting her to begin reframing her perspectives about universal healthcare. Finally, Tammy began to reframe her perceptions about the quality of international medical preparation after talking and working with Costa Rican doctors who surprised her with their medical knowledge and skills. Tammy explained: I [learned] that I had my own preconceived notions. I think I also had this assumption that medical education abroad wasn't as strong as it is in the US. I think that assumption comes from knowing that students [who] come from abroad have such a difficult time matching into residencies here... But I spent a lot of time with young doctors that blew me away [with] how much they knew and taught us. I was just so impressed and intimidated by how intelligent they were. So yeah, I think that's something that I learned about myself. As Tammy was impressed by the knowledge and expertise of Costa Rican doctors, she reflected on her preconceived notions and began to reframe her worldviews about medical preparation outside of the United States. Considering New Approaches After experiencing the universal healthcare systems in Costa Rica, some participants considered the possibility of advocating for policy reform in the United States. For example, Jane said, “I’m hoping that with my understanding of the universal healthcare system, I could be a better advocate for this kind of structure in terms of making sure that our elderly, our pregnant 110 patients are covered effectively...” Additionally, Fred talked about using his awareness to educate other medical professionals about the real benefits and challenges of universal healthcare, stating, “…[it] gives a few more focused points on what I can look at when I maybe need to retort, argue, or discuss similar points with someone about that.” Two excerpts from participant feedback summaries supported these interview responses. One participant wrote, “This provided so much insight because although, we do not have universal healthcare, it prompted me to write down ideas on what I can do to possibly help patients in the US who do not have insurance.” Another participant summarized, “Learning about their system has made me want to advocate for policies that provide healthcare for all.” By considering new professional responsibilities to advocate for the healthcare structures participants learned about in Costa Rica, they demonstrated a readiness to engage in the transformative learning process. While these participants’ accounts were not indicative of a total transformation, elements of the transformative learning process were demonstrated by disorienting experiences shaping their willingness to reexamine and reframe their perspectives and consider new approaches around healthcare, medicine, and medical education. Given short length of the Costa Rica program, participants’ accounts of their new professional perspectives provide support for their readiness to engage in transformative learning as the result of their engagement in graduate education abroad. Pragmatic Learning A final sub-theme was pragmatic learning. Wlodkowski and Ginsberg (2017) describe adult learners as highly pragmatic because they are motivated to build competence related to their life and career responsibilities. Additionally, adult learners want to be successful in their learning and take activities seriously when they meaningfully align with interests, values, and 111 goals. In the Costa Rica program, participants were motivated to learn knowledge and skills they believed were meaningful to their professional and career development. Some of the goals highlighted by participants included (a) preparing for an international or global career, (b) gaining knowledge of international policies and practices, and (c) building cultural competence for serving patients. Preparing for an International or Global Career Some participants indicated they were motivated to participate in education abroad to prepare them for an international medical career. Since Kay was interested in practicing medicine outside of the United States, she noted observations and interactions with patients in the healthcare system was something that influenced her to enroll in the Costa Rica program. Kay explained: The fact this program specifically dealt with healthcare and chronic illnesses. I think the outlook I've seen in my personal community in [Southeast Asia] is you really only seek it when you have life threatening emergencies. And there are chronic illnesses people deal with but don't necessarily have the medical education to handle well or aren't like being given that information by providers…But I just wanted to see those interactions and what kind of support those patients are getting. Yeah, definitely a lot of this is for my own personal understanding of serving medicine outside the states. After returning from Costa Rica, Kay spoke about how seeing complexities in the healthcare system between patients and providers was important to her exposure to medical care beyond the model in the United States. These types of experiences left Kay with a broadened perspective about universal healthcare that she expected to carry with her into a future career abroad. She said: 112 …it wasn't until we talked to the patients that we were exposed to the people who might slip through the cracks or the different loopholes for why you're not covered or why the healthcare system might turn you away in situations where you're battling a chronic illness. One participant wrote in their feedback summary, “Part of my future career will include working internationally as often as possible, going where physicians are most needed. Understanding various countries’ healthcare systems will be crucial to these plans.” Finally, Fred’s interests in pursuing a career in global health motivated him to participate in the education abroad program. He said, “I do want to work in global health. So, I want to be able to do service trips in my professional degree because I want to show that I am committed.” Additionally, when asked about how education abroad influenced his goals and responsibilities as a medical student, he said, “I think this would further reinforce my desire to work in a global health capacity to further any global health skills…I would still need to be as culturally competent [and] culture sensitive as I can.” After returning from the Costa Rica, Fred said about the program, “…it definitely reinforced a lot of the passions I had for global health.” Gaining Knowledge of International Policies and Practices Some participants were motivated to learn about international policies and practices in Costa Rica to improve their professional knowledge and skills. Tammy was motivated to learn about healthcare policies and practices in the Costa Rican healthcare system that both challenged and benefitted underserved communities. Before leaving for Costa Rica, Tammy said, “My goal is to walk away with a greater understanding of how communities are affected by the health system there. To have a better understanding of what challenges they're having in terms of gaining access to healthcare.” Tammy was enrolled in a certificate program focused on public 113 healthcare policy and underserved communities. When asked where she saw herself in the future as a professional, Tammy said, “I think whatever I do; whatever community I end up servicing, I definitely want to serve underserved communities. But I think that also have a strong desire to be involved at the community-level.” Thus, Tammy’s goals to learn about the Costa Rican healthcare system at the community-level seemed to coincide with her professional interests and development within the College of Medicine. Additionally, Monica held goals of improving professional practice by shadowing physicians in Costa Rica. Monica looked forward to working with doctors to model and reflect on differences in medical practices between the United States and Costa Rica. Specifically, she was interested to see how doctors in Costa Rica treated their patients; seeing these social dynamics was important to her development as a well-rounded physician. Monica stated, “One of the biggest things I like about shadowing doctors is seeing how they interact with patients…I'm really excited to do that in Costa Rica, just to see if the dynamic is different there or if it's similar.” As Monica spoke with doctors in Costa Rica, she learned about the importance of using the physical exam in situations when imaging technology in unavailable. She stated, When the doctors were telling us about the physical exams that they do, it was amazing to hear about how in depth they go…I walked away realizing how important and how informative that physical exam could be, which I hope to carry with me when I become a physician.” Ultimately, some of the outcomes Monica took away from the Costa Rica program reflected her initial goals to learn about differences in patient practices outside of the United States. 114 Building Cultural Competence for Serving Patients Finally, several participants held goals for improving their cultural competence in order to serve patients with different backgrounds and language skills. Jane saw a benefit of the Costa Rica program was helping her connect with patients back home who represented culturally or geographically diverse backgrounds. Jane explained, “I feel like cultural barriers is such a significant issue in providing medicine for a diverse community. I think that being able to understand different cultures is going to help me become a better physician.” Additionally, Monica said, “I hope to open my mind to a new culture and new people [to] see how different cultures view health [and] disease so much differently…I think as a physician, it's just important to be aware of these things, be aware of the cultural impacts just to provide the best care you can to your patients.” Similarly, Jay stated, “I really want to be the type of physician who…not saying 100% understands other cultures, but who’s open-minded and who understands the small things that are in common. So, I can identify ways to connect my patients.” Nala expected the Costa Rica program to provide her with more confidence to support English as a Second Language (ESL) patients in her clinical training. She explained: Personally, I want to be more comfortable working with other patients from different races…I'm going into a different country and now I have to work with their patients. So, it's about me growing and my cultural competency [and] growing in my communication skills. Because we do have a lot of patients who come in who are immigrants and who sometimes have trouble articulating what they want to say, or they're scared to tell us that their English is not the greatest. Finally, Tammy believed the chance to improve her cultural competence was a key outcome of the Costa Rica program. She said: 115 Professionally, I think this will help improve my cultural competence, which is something that is definitely needed within our medical system here. Just because we're not in another country doesn't mean we don't see patients from other countries. As participants linked cultural competence with the ability to support and interact with patients in their professional roles, they demonstrated motivations for learning that meaningfully benefitted their success as future physicians. The Context of Professional Socialization Influencing Graduate Student Experiences A second theme constructed from the findings was the context of professional socialization. Through professional socialization, students learn and adopt knowledge, skills, norms, and values within a professional discipline (Austin, 2002; Gardner & Mendoza, 2010; Weidman et al., 2001). Participants linked their experiences of the Costa Rica program with programmatic competencies, professional development, and career advancement within the field of medicine. Additionally, participants’ social and cultural interactions with faculty and peers in the medical program shaped their experiences of the Costa Rica program. Finally, participants described aspects of the Costa Rica program that catered to their professional and career aspirations. This section includes three sub-themes showing how professional socialization influenced participants’ experiences of the Costa Rica program: (a) formal requirements and competencies, (b) social and cultural influences, and (c) professional development. Formal Requirements and Competencies Aspects of formal requirements and competencies in the medical program influenced students’ decision to participate in education abroad and their beliefs about the value of knowledge gained in Costa Rica. Some participants were influenced by the service hours built into the education abroad program allowing them to satisfy requirements in the College of 116 Medicine. Additionally, participants mentioned applicable outcomes of education abroad that aligned with expectations and competencies in their medical program. Meeting Program Requirements For participating students, the Costa Rica program awarded 1-elective credit and 40 service hours towards their degree. Although there was no meaningful utility for the 1-credit, since the medical program’s curriculum was highly structured and seldomly required electives, students were motivated to participate in education abroad for the 40 service hours. During a pre- departure interview, the faculty-director mentioned how she had to incorporate service hours into the Costa Rica program to stay competitive with other education abroad programs within the medical school. Joan explained: The service part was intentionally added in order to have students still also think about going on the program because we offer service in the Cuba program. Students started to kind of hold out for that because it has a service requirement…So, that was why the service part was started to be built in. Otherwise, it was still a struggle to kind of keep offering the program. Many participants mentioned the 40-service hours contributed to their decision to enroll in the Costa Rica program. For example, Angeline said, “We're required to do 40-hours of volunteer work, and it makes it kind of easy to get all of that done right away, in one setting.” Similarly, Jane said, “I think it's appealing to know that you can finish your service-learning requirements right now from just one trip.” The service hours were an added benefit for Jay, as he stated, “…this actually helps us fill our service requirement, which I believe is a great thing.” Finally, Mary spoke about the service hours in the Costa Rica program helping her build towards 117 accumulating 100 total service-learning hours for requirements in her certificate program. She said, “…seeing this as a way to kind of chunk hours together was a very appealing idea for me.” Seeing Alignment Between Medical Program Goals and Education Abroad Outcomes When asked about how they saw their outcomes aligning with the College of Medicine’s goals for the education abroad program, many participants believed there was a connection. Acknowledging program expectations and embedded within the education abroad curriculum, participants talked about working with underserved communities, developing teamwork skills, honing patient-centered practices, and experiencing different healthcare systems. Some participants decided to enroll in the medical program because they wanted to work with underserved communities, which they believed to fit directly with the goals of the Costa Rica program. Jay said: ...originally, I came to [College of Medicine] because it really focused on the human aspect of [medicine]. The patient-centered care and also working with communities that are essentially underserved or don't have many medical resources. Going to Costa Rica, it was actually a really great way for me to really connect the whole patient-centered aspect of it. He continued: …one thing they really did emphasize in Costa Rica was talking to the patient…actually understanding what’s going on. Understanding not only the healthcare aspect of it…like the current condition…but also understanding how is this going to impact their life? How is going to impact their ability to work? [Going] beyond the clinical diagnosis and treatment. 118 In a similar way, Nala believed there were connections between the College of Medicine’s focus on underserved communities and seeing the effect of universal healthcare on the Costa Rican patient population. She said, I think the goals somewhat do align in regard to exploring the Costa Rican health system, what it offers, and how that differs from the US system. And then I think the bigger part that they share is the service aspect. Because I think [College of Medicine] [values] service, or underserved, or vulnerable populations. I think that the study abroad, by working with PLAC, and even in general, by visiting the hospitals and learning about the healthcare system, [we] did come away with... Well, one, we were able to serve that population. But we also came away with an impression of what kind of things can [we] translate from Costa Rica and the type of service [we] did there back to the population of patients that [we] will see here. Mary also acknowledged links between program values and the outcomes of the Costa Rica program. She stated, “I can’t imagine that [College of Medicine] would have written better goals...But [College of Medicine] is very into teamwork and service and helping underserved populations and getting a thorough and well-rounded education.” Additionally, Tammy said, “I think learning about a different healthcare model and the challenges that exist within that model, and also comparing it to the US model... was one of the goals they had for us. I think that was achieved.” Overall, participant abilities to interpret the goals and outcomes of education abroad relative to competencies and culture in the College of Medicine demonstrated formal aspects of professional socialization. 119 Social and Cultural Influences Social and cultural dimensions within the medical program influenced participants’ interests and experiences in the education abroad program. Participants spoke about relying on peer advice to determine whether or not to enroll in the Costa Rica program. Also, some participants noted a culture within the College of Medicine that prioritized studying and exam preparation ahead of education abroad. Finally, participants described the development of supportive relationships and networking opportunities with other students during the Costa Rica program. Peer Influence to Participate Some participants relied on their peers for support and guidance before enrolling in the education abroad program. Peer insight was helpful in determining if the Costa Rica program was a worthwhile added commitment. According to Tammy: I didn't think that I was going to have time to apply. So only in the sense that my friends pressured me to make the time to fill out the application…There are some students who studied abroad previously at College of Medicine and said they had a great experience, and they would recommend it. And then, also a student that is doing the trip as well encouraged me to apply. Additionally, Angeline said, “I was trying to gauge who was applying…I asked second years what their experience was…I really just wanted to do it on my own, but I was interested to see who else was applying.” For other participants, camaraderie and fellowship of current students in their cohort helped to further the decision to participate. Fred said, “I was kind of on [the] edge initially but knowing that some people I knew [were going], who I was familiar with already, I think did help 120 me decide to eventually go as well.” Finally, conversations with another student who previously traveled abroad to Costa Rica played a part in persuading Kay to enroll in the program. She said, “There's another student in the group, and she talked about [Costa Rica] a lot…she's been there twice. And so, when I found out that's where we were going this year, I was a little bit more inclined [because of] the way that she talked about it in the past.” Social and Cultural Norms for Studying Faculty in the College of Medicine seemed to normalize studying as a way for students to determine commitment and success. Placing importance on the amount of time dedicated towards studying and preparation, some participants saw the Costa Rica program conflicting with these academic norms— adding pressure and stress. During pre-departure orientation meetings, I observed some students alluding to the challenges of participating in education abroad because it added extra obligations and commitments to their schedules. Before the start of meetings, students talked with one another about progress on class assignments and seemed very conscious of their study time. Although participants identified the benefits of the Costa Rica program outweighed the challenges, study time was consistently brought up when they were asked about disadvantages of participating in an education abroad program. For example, Jane spoke about negotiating the challenges of participating in education abroad as a second-year medical student. She said: You would see less second-years because once spring break is over, everyone is going to go into hardcore study mode. But I think for me, since I'm kind of interested in family medicine, I think that pressure is a little less…And my other friend, who is also a second year that's going to be in Costa Rica. She's just a very relaxed personality anyways. So 121 then, we're not too high-strung about the curriculum itself. But other classmates have advised me to not go to Costa Rica because it was so close to Step 1. Step 1 is taken at the end of the second year of medical school, as the first of a series of exams through the United States Medical Licensing Examination (USMLE). These exams determine whether graduates are qualified to practice medicine in the United States. Even though Jane decided to participate in the Costa Rica program, she recalled how studying for the exam held her back from fully immersing into some aspects of the experience. She explained: I felt like I had a stressor in the background because I have my Step 1 exam planned for June. So, part of me felt a little stress I need to probably not go out with the group at the end of the day, so I can have some relaxation time and maybe look over some notes or do some practice questions…So, I felt like I had to take myself away from certain extra leisure activities that were planned. Additionally, Natasha viewed Step 1 exam preparation as a potential deterrent to participating in a short-term education abroad program as a second-year student: Let's just say hypothetically, next year for the Cuba program, if I was feeling like I wasn't at all prepared for Step 1, or that I really couldn't lose those days of studying, then I wouldn't participate. Because that would be like sacrificing my career overall just to do a trip...So, I think that would play a big factor for some people. And I think it's true because that's why some people didn't want to do the Costa Rican trip... Other participants indicated that studying was socialized into the culture of their medical program by both faculty and students. For example, Jay explained: …a lot of medical students have been sold that time is such a resource. I remember right before we went on our winter break, the faculty encouraged us to review and study…a lot 122 of medical students have been grown to realize that time is such a huge resource, especially when it comes to studying for Step 1. In a similar way, Yondu said, “I think as medical students, we always feel unproductive if we don't study...I think that will be in our heads either before we leave or when we come back [from Costa Rica].” Developing Peer Support Systems The Costa Rica program was also an opportunity for participants in the medical program to interact with one another to develop support for their progress as students and professionals. Once in Costa Rica, some participants recognized the relationships developed with other students in their cohort were supportive to their social and emotional development—leaving a positive impression on their ability to persist through the medical program. This was Angeline’s experience, who explained: I think that also it was good to realize everyone is in the same boat in terms of medical school. You’re not alone. If you feel isolated, we all feel isolated, or if you’re feeling like you don’t understand, we all feel like we don’t understand. It’s like none of the feelings I was having, I was having alone. Also, Jane talked about a lasting friendship she developed in Costa Rica that motivated goals for future clinical work in her certificate program. She stated: …there’s at least one other individual that I feel like I’m going to have a long-term friendship with…I do want to maintain this friendship over the next few years…I think once [we] have [to do] clinical sites in third and fourth year, we might come back together again. 123 Jane’s ability to develop a support system for future levels of the medical program demonstrated the types of relationships developed in the socialization process. Finally, the Costa Rica program allowed for first and second-year cohorts to interact with each other. As a first-year student, Monica mentioned how developing relationships with second year students was valuable to networking and navigating the medical program. She said: There was also some second years, which was really cool because you can see how they’ve grown over the past year. They are very open to giving advice, whether it was stuff we were doing in Costa Rica or even just in general—being a medical student. I had a couple of them show me their schedules they did during intercessions and giving me an idea of how to set that up. So, that was really helpful. By providing opportunities for first- and second-year students to forge new relationships and network with each other, the Costa Rica program seemingly contributed to the development of peer support systems. Professional Development When asked about professional or career-related outcomes they gained from the education abroad experience, participants shared a variety of views relating to their advancement in the field of medicine. Participants spoke about the Costa Rica program as meaningful to strengthening their knowledge about healthcare, medicine, international service, and public policy. Additionally, participants believed their experiences in Costa Rica benefitted their advancement in residency interviews, certificate programs, and career pathways. Focusing on Professional Development Some participants noted professional differences between the education abroad program and service trips they completed in the past. Participants wanted to focus on medicine, 124 healthcare, and other professional topics that advanced their knowledge and skills. For example, Fred said, “In the past, I had only done service trips. And so, I was glad actually that I had this opportunity to also look at more about a healthcare system and not necessarily all service.” Two other participants who previously visited Costa Rica prior to the education abroad program recognized they were more focused on their professional practice in this experience. For example, Monica said: It was very much a different experience than I had [in] the previous two times that I'd gone [to Costa Rica]...The people were different. But then, we also obviously focused a lot on medicine while we were there. So, we did get to talk to doctors…we got their view on their healthcare system and how they interact with patients. We also got to interview patients themselves. Additionally, Yondu spoke about wanting to focus more on healthcare and medicine. He said: I liked my previous volunteer experiences, but something I noticed was missing was a health aspect to it…I wanted to do something health-related abroad…I think a big part of why I did this was because it was [College of Medicine]-related, and it had a health aspect to it. Following his education abroad experience, Yondu recalled the differences in professionalism when interacting with doctors, feeling legitimate as part of a larger network of physicians. He said: For the regular service trips, I was just kind of there to provide a service. But for this trip, the role was more of a future medical professional. And I feel like the people that we interacted with embodied us as one of their future own. I think it was just a different type of feeling... 125 Based on Yondu’s account, interactions with other professionals in the Costa Rica program seemed to influence his professional identity development. Other participants’ responses suggested they were aware of opportunities for professional development during the education abroad program. Natasha said of her approach to education abroad, “I was more motivated to do the professional activities because at the end of the day, that's kind of why we signed up. We signed up to go to Costa Rica to learn about the healthcare system.” Altogether, these participants viewed the education abroad program as an extension of their professional development in medicine and healthcare. These responses were further corroborated by excerpts from two participant feedback summaries highlighting professional benefits of the education abroad program. One participant wrote: As somebody who…hopes to continue doing work internationally as a physician, this trip was eye-opening because it was an opportunity to learn about a healthcare system as well as the overall legal and social security system of Costa Rica while also being able to provide some sustainable service to the community... Also, another participant reflected, “Without this program having been medically oriented, I likely would never have experienced these amazing aspects to Costa Rican culture, nor would I have this kind of understanding of universal healthcare in a different society with varying priorities.” Ultimately, goals and outcomes for graduate students during the Costa Rica program revolved around the chance to improve knowledge, skills, and competence as future medical professionals. Career and Program Advancement Another meaningful aspect described by participants was the opportunity to apply experiences in Costa Rica towards advancement in residency, certificate programs, and future 126 careers. Natasha highlighted the appeal of the Costa Rica program was making her a more competitive candidate for residency: “Professionally, it's a great opportunity to learn about another healthcare system [and] to make international connections. And then, if we're being realistic, for residency interviews, it's a really cool thing to put on your CV.” She continued, “…with me being interested in anesthesia, it's a competitive field so you want your CV to...[have] meaningful experiences because when the interview comes around, you should be able to elaborate…to them and give some real meaning to the experience.” Expressing similar professional benefits, Tammy explained, “…the advantage is this is an experience you will get to put on your CV...[it’s] an experience you can talk about in applications to residencies.” Angeline mentioned how the Costa Rica program was important to her career development in the event she wanted to practice medicine abroad. She said, “I think [education abroad] helps get my feet wet, so to speak. Doing something abroad as a medical student, which I think is very different than when you’re an undergraduate student.” She continued, “Almost everything I do now, I think of in terms of my career…What tools can I get from this that will help me as a physician in the future?” Additionally, participants believed working with GMI and PLAC to help underserved communities were complimentary to goals and expectations of their graduate certificate programs. Demonstrating this idea, a participant wrote in their application, “…as a student of the [certificate program], I hope to improve my understanding of socioeconomic barriers that play a role in the access and attainment of healthcare.” Additionally, Tammy believed the Costa Rica program would expand her knowledge for her certificate program by understanding policies affecting underserved communities abroad. She said: 127 I got into [certificate program]…I'll be learning a lot more about public health. And I'm sure we'll talk about public health in global communities as well. But I think having the backing to that educational background, to know what policies are affecting things and how I can use that to move my personal mission of serving underserved communities forward will be beneficial. As a few participants viewed the Costa Rica program advancing knowledge and skills for their certificate programs, they showed an investment in their professional development. Other participants aligned their education abroad experiences with career aspirations working with public healthcare policy, advocacy, and outreach. For example, Fred explained: I think it influences my trajectory in the medical field…I think having that exposure to that kind of NGO means that my future pursuing global health work as a physician will have at least helped me determine what kind of global health work I want to do... Moreover, Mary explained, “I was interested in public health before, but I think that even more I'm interested in getting involved with policy implementation and public health in the US.” Prior to the trip, Yondu stated, “I'm interested in public health, not only here in the US, but abroad as well…and I think this [gives] me that first type of experience of looking at public health in a setting that I'm not living in.” After returning from Costa Rica, Yondu said, “…now that I did go on this trip, it drives me to want to get into the more public health aspect of medicine.” Finally, reflecting on the influence of the Costa Rica program, one participant wrote, “…I solidified my desire to do international work as a physician.” Overall, these accounts showed connection between outcomes of the education abroad program and an investment in building knowledge and skills for their future careers. 128 The Context of Curriculum and Pedagogy Influencing Graduate Student Experiences A third theme constructed from the data was the context of curriculum and pedagogy. Curriculum and pedagogy encompass content, coursework, and instructional methods designed to guide what students learn and how they engage in an educational experience (Toombs & Tierney, 1993). I begin this section with participants’ beliefs about how the College of Medicine curriculum and pedagogy shaped their learning and development. These initial participant accounts about curriculum and pedagogy set the groundwork for two main sub-themes supporting this context. First, participants displayed a level of awareness about the curricular and pedagogical practices in the College of Medicine when asked about their goals, experiences, and outcomes of the Costa Rica program. Second, the design and facilitation of the Costa Rica program influenced participants’ experiences around learning and engagement. Curriculum and Pedagogy Influencing Learning and Development When asked to explain what led them to enroll in the College of Medicine, several participants described aspects of the curriculum and pedagogy that influenced their learning and development. Participant responses painted a picture suggesting unique curricular organization and pedagogical instruction contributed to their success within the program. For example, Mary said: Our curriculum is very unique…It's based on the idea that we're adult learners. All of it is a flipped classroom. So, we're not lectured on material. We prep material and then we go in and have discussions, or they present things that are really hard to us so that we can cement it or whatever it is. It has absolutely changed the way I learn. 129 Additionally, other participants identified the importance of having an integrative curriculum, where learning went beyond skill development to a holistic comprehension of the material. Highlighting this aspect, Tammy said: The curriculum here is very different than other medical schools. It's very integrative…When I think of my learning, I feel like I have to see the big picture and then go into the smaller details. So, being able to connect all those dots, I think helps me in the way that I learn. Similarly, Natasha stated, “…being able to get the patient experience early was a huge thing for me...the curriculum is more integrated…Whereas, in undergrad, you have set classes...Here, you're having to think about all those things at once.” In these responses, participants made connections between the medical school curriculum and their learning process. Guiding principles for the College of Medicine’s curriculum placed importance on community service, patient-centered care, and the integration of healthcare systems, which carried over into some participants’ learning and experiences during the Costa Rica program. Experiencing the Costa Rica Program Through the College of Medicine Curriculum Talking about her expectations for students connecting their education abroad experiences with the College of Medicine curriculum, Joan explained, “My experience has been anything with the healthcare pieces, like the academic curriculum pieces; they're always in-tune to...[and] those things are already on their radar...” Indeed, participants framed the Costa Rica program with their understanding of the College of Medicine curriculum. This frame influenced participants in setting expectations, talking about learning, and defining outcomes for their experiences of the Costa Rica program. Two examples demonstrate how competencies and practices of the College of Medicine curriculum and pedagogy were intertwined with 130 participants’ learning and experiences of the Costa Rica program. First, participants talked about aspects of the Costa Rica program that complimented the unique hands-on training were accustomed to receiving in the College of Medicine curriculum. Second, participants gained confidence in the College of Medicine curriculum as the result of experiences talking with doctors in Costa Rica. Hands-on Learning Complimenting Curriculum and Pedagogy. Participants held expectations of a hands-on education abroad experience complimenting the patient-centered clinical training they received in their medical school curriculum. Clinical experiences were a major component of the College of Medicine’s curriculum that encouraged students to build skills in a healthcare center through hands-on learning. In applications and pre-departure interviews, participants described their interests in shadowing doctors, touring hospitals, and working directly with patients in Costa Rica, mirroring the types of hands-on learning experiences they expected from their curriculum. Highlighting the importance of hospital tours and patient interviews adding to her understanding of the Costa Rican healthcare system, Mary said, “…looking at pictures only does so much when you're learning about these things...” Likewise, Tammy stated: It's so different to read about it than being there and experiencing it because you're not only getting to see what their day-to-day life feels like, but then you see how that contributes to the systemic issues there as well. Natasha also believed interacting with patients in Costa Rica would improve her skills for clinical training back home. She said: 131 I think developing patient skills, like interactional skills, because I think some of the things that we'll learn or see in Costa Rica could have benefits or change how our clinical experiences go here… Similar to pre-departure expectations, participants identified outcomes of the Costa Rica program complimenting hands-on training and development in the medical school curriculum. For example, Angeline said, "[An] advantage is just to do something outside of class...It's just important to see healthcare beyond the books...” She continued, “People look at you as a future physician. So, [you] go out into the world and do those things and learn from other physicians. So, I just think it's important.” Hands-on interactions with patients and physicians in Costa Rica proved to be a valuable experience for participants. For instance, Tammy indicated the importance of having conversations with patients and doctors in Costa Rica by saying: I don't think that just reading about the Costa Rican healthcare system, I could have walked away with as great of an appreciation as I have for the individuals within that system, as I do now. I think a big part of that was being able to have personal interaction with them, being able to have conversations with them, [and] being able to see they’re just as passionate as Americans about certain healthcare issues. Also, Jay mentioned how shadowing and talking with physicians in Costa Rica reinforced skills he learned in the College of Medicine curriculum. He explained: …a lot of things we did discuss [with] the physicians over there realigned [with] what we understood…it really affirms what we did over there. Mainly because, not only are we're learning [about] the basic techniques, but we're also the main techniques that they use. 132 Finally, Yondu stated, “I feel like I got a really well-rounded view of Costa Rica's healthcare [system], and that's really what I wanted. I got to hear not only from physicians point of views but from other professionals point of views and even patients and point of views.” Solidifying Confidence in the Curriculum. Many participants described how experiences during the education abroad program solidified their confidence in the College of Medicine curriculum. A unique aspect of the College of Medicine curriculum was encouraging students to focus on patient complaints and concerns in addition to traditional disciplinary competencies. For example, students were taught to approach shortness of breath symptoms from a patient perspective rather than cardiac or pulmonary theoretical frames in order to establish patient-centered practices. Students understood these integrated learning methods were different from the traditional coursework of other medical schools. However, students participating in the education abroad program realized the practical value of these curricular practices through talking with doctors and healthcare professionals in Costa Rica who were impressed with their readiness to diagnose patient concerns in a clinical setting. These experiences were encouraging to several of the participants. Demonstrating this point, Angeline explained: I honestly think that going to Costa Rica really solidified the curriculum at NSU compared to other schools…[and] how important it really is in a practical standpoint...I have complained about how the curriculum works just because it's kind of overwhelming…But when we talk to providers and they're talking about how physicians think, and what they think is important for medical students to know. And then you're like, “Oh, well, we're learning that in the curriculum” ...Then you're like, “Wow, okay! Now I see why it's important to learn things the way that we're learning. 133 In a similar way, Nala mentioned an interaction with a Costa Rican doctor who fortified her confidence in the knowledge and skills she developed through the curriculum. She said, “We went to another physician who grilled us, which was really fun...I'm not sometimes the biggest fan of the curriculum... So, I was like, "Oh, wow! The curriculum was actually working.” Speaking about how education abroad experiences erased some students’ uncertainty about the effectiveness of the College of Medicine curriculum, Monica said: One of the things that they really hit hard when we were in Costa Rica talking to the healthcare professionals was the patient presents to you with a symptom. They don't command and say, ‘I have a problem with my heart, or I have a neurological problem.’ So, you have to backtrack from that symptom to what could be causing that. They were actually really impressed when we told them that our curriculum goes off of the symptoms they present with, and we focus on all the different potential causes, whether it has to do with one system or the other…I think [it] made a lot of us feel good about how we’re learning medicine here in a very different way. Because I think a lot of times it can be very frustrating and we're questioning how productive the way that we're learning is...because it's so different than all other medical schools and what friends [at] other places are doing. So, I walked away feeling pretty good about how we learn things, and it was good to know that it's going to be beneficial in the future. Finally, Jay elaborated on his appreciation for a patient-centered curriculum by saying: It made me feel that the curriculum was really geared towards making a physician that is compassionate about their patients. That's a reason why I chose the [College of Medicine], and I felt that my trip to Costa Rica really affirmed that. 134 As the result of education abroad experiences, participants who felt overwhelmed and frustrated by the College of Medicine curriculum solidified and affirmed confidence in their patient- centered training. These participant accounts suggested an advantage of the education abroad program was the opportunity to see the curriculum as a benefit rather than a burden. Education Abroad Curriculum and Pedagogy Influencing Student Experiences As a second sub-theme, facets of the education abroad curriculum and pedagogy influenced participants’ experiences including pre-departure meetings, course objectives, on-the- ground activities in the itinerary, the service project, and faculty leadership. Aspects of how the Costa Rica program was designed and facilitated guided participant experiences, learning, and engagement. Pre-departure Meetings. Three seminar pre-departure meetings were organized by Joan to prepare her students for the Costa Rica program. The first two meetings provided opportunities for Joan to review logistical details about the program, students to build relationships, and groups to make progress on their service projects. Based on my observations, I felt these meetings engaged students in developing relationships and teamwork, especially for those who were coming from different cohorts and campus locations. A specific activity that engaged students in learning about one another was an icebreaker where they chose from a series of pictures featuring Costa Rican art, food, scenery, and architecture to describe themselves. Students were then asked to talk about the picture and explain why they identified with it. At the next pre-departure meeting, students were asked to talk about the picture again and describe the reasons they were excited for the Costa Rica program. Although a small portion of the pre- departure meeting, the icebreaker activity seemed to build initial connections between students. 135 The final meeting included a virtual conference with GMI and PLAC to review the program itinerary and provide updates on the service projects. Students were encouraged to introduce themselves and then divided into their project groups to report their progress. This meeting occurred in Spanish, providing students with a chance to prepare for translating and navigating cross-cultural dynamics when working with PLAC. Ultimately, the meetings were fruitful in helping students understand their projects, learn about their Costa Rican partners, and develop relationships with one another. Some participants mentioned the value of pre-departure meetings in their feedback summaries. One participant wrote, “I really think the in-person meetings were a great idea. It really allowed me to get to know the group better, especially participants from [Campus 2] who I would not normally see.” Another participant wrote: The pre-departure meetings, specifically the second meeting, was important for finishing or making good headway on our group assignments. The meetings were also useful for allowing us to get acquainted with one another, which I felt helped once we were in Costa Rica and made things function much better. Finally, a third participant wrote, “I felt much more prepared for the trip than I did for other trips abroad.” Indeed, pre-departure meetings seemed to positively influence participants’ experiences in the program. Course Objectives. Aspects of the course objectives influenced students experiences in Costa Rica. Prior to departing for Costa Rica, Joan listed two main objectives for the program. The first objective was “having students understand there are multiple facets to the way countries approach healthcare and taking care of their citizens.” Joan speculated that a majority of students enrolled in the program were “truly, genuinely, wanting that comparative healthcare piece.” The second objective was having students participate in the service project with PLAC. Joan said the 136 intention of the service project was “for students to really start to think about why they participate in service and how to actually really think about service as working with a community.” While the service projects were designed to fulfill service hour requirements, they were also intended to help students understand the importance of providing service as part of a global medical-professional community. In the syllabus for the education abroad program, written instructional objectives included (a) learning about the history and reform of the Costa Rican healthcare system, (b) comparing private and public healthcare, (c) speaking with patients about their experiences, (d) learning about rural healthcare clinics, (e) learning about tropical diseases, and (f) providing service to a non-profit organization. When asked to describe overall impressions of their experience in Costa Rica, several participants mentioned the value of learning about a different healthcare system. For example, Angeline stated, “It was really good to get a different experience of a different healthcare system. We were very fortunate to be able to see the healthcare system from a lot of different lenses.” Similarly, Jane said, “…the trip, I felt was overall very helpful for me to understand the healthcare system of Costa Rica. I felt like it was well structured to make me feel like there was a purpose for me in Costa Rica.” Yondu explained, “The most meaningful to me was learning about their healthcare system. And it was kind of something completely new to me because I feel like their healthcare system is so uniquely different than ours. Finally, a few participants wrote about the benefit of learning about the healthcare system in their feedback summary. One participant summarized: I think the greatest benefit I got from the trip in terms of my education and professional development is the understanding I have of the benefits and cons of a universal healthcare 137 system. I feel much more confident in talking about this and have referenced the trip in classes a number of times already. Another participant wrote, “Seeing a healthcare system so much different than our own really made me rethink how we do things here and gave me a much different perspective on health and disease.” Additionally, some participants mentioned the importance of speaking with Costa Rican patients during the education abroad program. An example was Natasha, who described an activity led by GMI where students got the chance to speak with patients of different demographics to hear about their experiences with the healthcare system. Natasha said about the experience: I think on one of the things I really enjoyed is one day at the institute, we were just kind of rotating room to room…there were three different rooms, and in each room, there were three different patients [of] different demographics. So, one room was just all these older ladies; another room was younger people…Another [room] had someone with a debilitating disease, and then some other younger woman mixed in with her. So, I really liked that because I was able to get a broad view of their whole system. And, I had the opportunity to hear the positive things in it, but also whatever critiques people had for the system, too. Additionally, several participants identified interviewing patients for the service-project as a meaningful part of their experience in Costa Rica, which is covered later in this section. Activities Organized into the Program Itinerary. Once students were on the ground in Costa Rica, GMI doctors and administrators engaged students in a variety of activities to learn about healthcare, patients, and NGOs. The partnership with GMI was intentionally designed to 138 provide students with host-facilitators who could highlight cultural and technical aspects of the Costa Rican healthcare system. In talking about the partnership with GMI, Joan explained: I don’t try to be an expert in the things I’m not an expert in. Meaning that it’s intentional that we work with GMI. Even when I was redeveloping the program, we were going to work with GMI. They have an entire track record and experience in teaching medical students about comparative healthcare and healthcare systems, and they are the experts in the healthcare system in their country…there’s lots of things I probably could do in an education abroad experience, but I don’t think I would ever do it without those partners on the ground… GMI arranged a majority of the Costa Rica program itinerary that featured many activities for students including a keynote session hosted by the GMI director, interviews with patients, and opportunities to shadow doctors in a clinical setting. In between some of the activities, the itinerary arranged for guided discussions focused on debriefing students’ experiences. For instance, after student participated in an activity that engaged them in conversations with Costa Rican patients about the healthcare system, a follow-up discussion was scheduled about the experience. Also arranged in the itinerary, students conducted hospital tours, attended a policy conference about sustainable healthcare, visited rural clinics, and worked with PLAC on their service projects. At the end of the program, students traveled to a coastal Costa Rican city to attend a seminar on tropical medicine before they were given a free day to rest and travel. Many of these activities were noteworthy to participants because they learned first-hand about resources, healthcare, policies, and patient practices in Costa Rica. Hands-on opportunities to shadow doctors and interview patients was also important to participants because they were 139 able to see healthcare practices be implemented and apply these experiences directly to their interests, goals, and development. For example, Fred stated: …it was definitely from a professional level, more relevant being able to work with the doctors, being able to work with public health professionals and experts in their field in Costa Rica. I think there are connections that were made. It was a way to see how these NGOs function there…it might advance where I want to go in my future. In addition to panel discussions and patient interview, Monica mentioned opportunities for discussion and conversation that kept everyone involved and engaged. She said: We had a couple of panels that were extremely informative. I also thought the interviews were helpful. Whether it was with other physicians or the patients, just because you get information right from the source…It was a lot of discussion which I thought was very helpful. So, we didn't get lectured at very much, which I thought really kept everybody engaged and interested, and it allowed for a very open and honest conversation about things. Jay mentioned how interactions with policymakers and practitioners during the policy conference benefitted his professional development. He said: I felt very thankful and grateful that a lawyer in the health system, one of the medical directors, [and] one of the busiest physicians in in the whole country [were] willing to sit down and talk with us about the issues...It was amazing because you got to listen [to] first-hand accounts, not only from a patient perspective, but a physician perspective, a congressmember's perspective, a medical director's prospective. You got to see all these perspectives of major leaders, major players in Costa Rican healthcare. 140 Finally, a few participants wrote about the importance of activities in their feedback summaries, further corroborating the interviews. One participant wrote: I particularly enjoyed touring the hospitals and NGOs because it gave us a realistic glimpse into the country’s healthcare system. In addition, I really enjoyed the shadowing experience because it allowed me to talk directly with those who are on the frontlines of the system. Another participant wrote, “I liked getting to see the physical buildings and their roles, as well as getting to hear about the healthcare system from all different types of people, such as patients, physicians, medical students, etc.” Overall, these accounts reflected the value students placed on activities organized into the Costa Rica program. Service Projects. During the last few days of the program, students focused their time on service projects, assisting PLAC with creating social media accounts and conducting patient interviews. These service-learning projects with PLAC provided meaningful learning and engagement for participants. Indicating the impact of service on students’ experiences, Joan said, “…I really think they started to understand and were really impacted by feeling good about being able to do service… I mean, I really felt that personal connection was there for them.” Moreover, several participants indicated their work with the service projects was a meaningful part of their education abroad experience. For example, Natasha stated: I guess what really sticks with me the most is having been able to help [PLAC] fulfill their mission at the end of the day. That was really moving for me. Just to the way they expressed their support and knowing what we did would have a lasting impact, not just for them, but for the patients that they serve, and the country in general. 141 Additionally, Jane said, “I felt like the service project that we conducted through the trip, it did feel meaningful for the nonprofit that we worked with.” For Fred, the service projects were less about providing assistance in the form of a traditional “service trip,” and more about getting to know the patients and learning about the healthcare system. Although Fred believed service was a smaller component of the trip than he initially anticipated, the projects were still valuable to his broader goals for understanding healthcare in Costa Rica. He explained: I'm not saying that we didn't really do service, but I think this was really about us to learn from the people there...And so, I guess in terms of learning about the healthcare system and learning about Costa Rica itself as a country, that part definitely aligned with some of my goals and kind of the intent of signing up for the trip. One of the service projects focused on guiding PLAC to create social media platforms to reach out to future patients and clients. Some participants were encouraged by the results of their efforts to help PLAC. Mary explained: I was very skeptical of how me teaching somebody [how to use] Instagram would be an opportunity at all. But in hindsight, I think I've pretty well expressed to you how meaningful working with [PLAC] was, and how much personal emotional value I got from it. I truly think we did beneficially impact the people of [PLAC] so I do think it was a good use of my service hours. Also, Jay spoke about the personal values the project brought up for him. He said, “…every day I see them post something new on Instagram, it puts a smile on my face because I knew I was part of that effort to get them that tool.” Another service project that was memorable for participants was the opportunity to conduct interviews with Costa Rican patients. During the interviews, patients described 142 hardships they faced in getting treatments for a disease or illness and the legal help they received from PLAC to petition the Costa Rican government to provide them with medical care. Several participants discussed how these interviews gave them in-depth perspectives about PLAC and practical examples of patients interacting within the Costa Rican healthcare system. Additionally, participants were moved by the patient interviews, with many citing them as the most meaningful part of the Costa Rica program. Mary explained: I only interviewed two patients. But, getting to talk to them, it was beyond amazing. The most cognizant one was the breast cancer patient [who received] the medicine she needed to treat her medical side of breast cancer. With the help of PLAC, she had to sue the security system in Costa Rica. And without that, she would have died. And she talked about how she has children at home. And it was very moving…I think that was the most impactful moment of the entire trip. Additionally, Jay said: …the most meaningful experience was actually sitting down with one of the patients. So, it was during the process of recording patients’ stories…to transcribe and understand where [patients] are really coming from. I never realized how much for granted we’ve taken the healthcare system in America. When asked about what he found to be the most personally meaningful part of the Costa Rica program, Fred mentioned listening to the patient stories and recognizing systemic issues in the healthcare system. Fred explained: …the patient’s stories we collected. I had a very big language barrier. But once it was translated to me, it was really moving but also, I felt very honored to have one of the people who had gone through the like basically all levels of the Costa Rican healthcare 143 and legal system to get the care that they needed. I thought that was incredibly touching and I was really honored to hear their story and how they dealt with it because they lost all their support systems… And then, to tie that patient's story into what we had learned in the panel about the legal and healthcare system was...I would say, that was probably the most impactful thing listening to the individual's story and then tying it to all the systemic levels and how that system broke down in a lot of different places. Finally, Jane talked about the applications of patient interviews. She stated: I think those kinds of conversations could be molded to whatever you are currently thinking about [and] whatever you're interested in. I think that I was able to learn more about people's experiences that I never knew beforehand [that] didn't occur to me before meeting them. Overall, participants demonstrated an appreciation for the service projects built into the Costa Rica program and found patient stories to be a meaningful part of their experience. Leadership and Guidance. While in Costa Rica, students were guided by the faculty director from the College of Medicine and administrators and doctors at GMI. Joan was primarily engaged with pre-departure objectives, scheduling, and preparation. For example, Joan said, “The parts that I do here that I think are my responsibilities is making sure we truly understand what those partners expect of our students and then prepare our students so that there aren't assumptions...” During the overseas portion in Costa Rica, doctors from GMI delivered a majority of the content and organizational pieces of the program. The doctors and administrators were also in charge of housing and transportation logistics in Costa Rica. For Joan, a majority of her role in Costa Rica involved mitigating schedule issues and “to really think about how the students were doing [and] how the students were appreciating what 144 they had.” Many participants viewed Joan’s leadership as beneficial to keeping them organized and focused while in a new learning environment. For example, Tammy stated, “I think even everything that [Joan] did to put it together...once we got there, it showed why she was so structured and went through the things she went through.” Likewise, Mary said of Joan’s organization in Costa Rica, “I think that it would have been much more chaotic in terms of our work with [GMI and PLAC] without her. She's very 'by the schedule,’ like 'by the books,' which is something we needed...” Finally, Natasha appreciated Joan’s approach to managing schedules. She explained: And [Joan], actually over the course of that trip, it was really nice to see she was very invested in trying to make sure our itineraries or schedules held up. Even though, obviously, there are some difficulties or troubles managing that, she was still trying to make sure we were getting the experiences and the major things out of it that we needed. Additionally, having doctors and administrators from the GMI guide students through lectures and discussions was helpful to students. Talking about GMI being student-centered, Joan said, “They have so much experience working with students, and academically, they have really good, thoughtful content.” Many participants found the doctors and administrators informative, engaging, and fun. For example, Monica stated, “…we were very fortunate to have very engaged and fun leaders because I think that really decides the dynamic of the group and how people are feeling, and their attitude when they walk away from things at the end of the day.” Additionally, Yondu talked about how the GMI administrators would help them understand Costa Rican healthcare by talking their experiences working in the system. He said, “I think we greatly benefited from not only the types of personalities they have, but their willingness to have us there, and really teach us as students.” For Fred, having knowledgeable local leaders made a 145 difference for his understanding of the Costa Rican healthcare system. He said, “…in a trip like this, where we're learning about a healthcare system, having these experts and leaders educate us about this system was extremely helpful. [I was] appreciative of their presence there.” As a result, the leadership of GMI doctors and administrators influenced and enhanced students’ experiences during the Costa Rica program. The Context of Interpersonal Development Influencing Student Experiences A fourth and final theme was constructed to include the context of interpersonal development. Participants’ responses highlighted interactions with peers during the Costa Rica program resulting in the development of new relationships. Additionally, participants discussed interactions in Costa Rica that were held in Spanish, which influenced their understanding about how to communicate across language barriers. Finally, cross-cultural interactions with host families, doctors, and patients influenced the perspectives and experiences of participants. For the purpose of this paper, I define interpersonal development to encompass interactions with others that frame a desire to manage relationships, recognize outside perspectives, and act with cultural competence. The following section consists of three sub-themes within the context of interpersonal development: (a) relationships between students, (b) language learning and immersion, and (c) cultural immersion. Relationships Between Students A major component of the Costa Rica program for students was interacting within a group setting. Students were encouraged to develop relationships with one another, and they were required to collaborate on the service projects for PLAC. Teambuilding icebreakers were built into pre-departure meetings so students could learn about each other and discuss common goals for the education abroad experience. Moreover, working to develop “group cohesion” was 146 a particular focus for Joan, who insisted to students in pre-departure meetings that teamwork would affect the success of the program as a whole. Before leaving for Costa Rica, Joan said about group dynamics, “…the goal is not that they have to be best friends, but they also have to be colleagues, learn from each other, and work together.” Some participants held similar goals about working in a group during the education abroad program. Mary said, “I'm hoping to learn more about functioning in a group… Medical care is a very group centered. Physicians don't work by themselves.” Additionally, Natasha stated in her pre-departure interview about teamwork, “I think that if we can all work together and have a good, cohesive, fun, professional environment over there, I think that would be a benefit.” Teambuilding in the Education Abroad Program Since students enrolled in education abroad from both of the College of Medicine campuses, there was a degree of unfamiliarity between participants of Campus 1 and Campus 2 at the start of the Costa Rica program. For example, Jane described her sense of unfamiliarity with her peers from Campus 1: I felt like with [university] having two campuses…it is very hard for us to get to know people from [Campus 1]. We do have our orientations together. However, that's only a few days in the beginning of the year, and we never see each other ever again. Therefore, teambuilding activities during pre-departure meetings were significant to developing cohesive group dynamics for students in the program. Joan highlighted the influence she believed the teambuilding activities and icebreakers had on group dynamics in Costa Rica. She explained: [Students] really were recognizing they were going as a group with a common purpose. They felt connected to each other…they all knew each other’s quirks…It took away from 147 the personalization of it, which was more objective because they were being presented as a person. All of those things came down to recognizing each other as people regardless of whether or not they were going to stay lifelong friends. They were all people that had a commonality about why they were traveling together. As a result of the teambuilder and icebreaker activities, students developed new relationships and collaborated together in Costa Rica. Student Relationships Developing in Costa Rica Once students were in Costa Rica, they continued to develop close and working relationships with one other. Many participants mentioned these relationships in their interviews. For example, Tammy said, “…it was really nice bonding with the students in general. So, for our med school, we have two different campuses, and I never really get the opportunity to interact with the [Campus 2] students at all. And so, I think we all left feeling much closer to each other.” The relationships that developed over the course of the program was something that stood out to other participants and enhanced their experience in the education abroad program. Monica stated: …we all built pretty strong friendships going there. You're with these people literally 24/7. You really bond, and you get to know each other fairly quickly…it was a lot of people that I don't typically interact with, so it was really cool to get to meet these people and get to know these people. In a similar way, Yondu said, “I got to meet some people from [Campus 2] that I did not know, and I don't know when I would have gotten the chance to know them…I got to learn more about them, and I think they enhanced the experience for me...” Natasha said: 148 …when you're mixing two different campuses…[Campus 1] and [Campus 2]…there was some worry about how that interaction is going to go. But I think by the end of those eight days, it's amazing…I feel like we're all friends now. Angeline felt a major benefit of education abroad was developing new relationships with second- year students who she did not interact with prior to the Costa Rica program. A goal she had after returning from Costa Rica was “to continue to build on the relationships that I already made prior to leaving and then the ones that we made in Costa Rica.” Gaining Different Perspectives and Viewpoints in Group Activities A few participants discussed the benefits of having varying perspectives and viewpoints when working in groups with other students in Costa Rica. Jay explained: I definitely learned that being in a group can really make an experience so much better...it actually made me appreciate that group setting not only because I had someone else looking out for me, but it was also [that] I got to hear someone else's thoughts. I got to hear somebody’s perspective...what did they agree with, what they didn't agree with, their experiences. Additionally, Mary recognized the importance of having different viewpoints from classmates in her service group. She stated, “it was cool to be able to interact with my classmates and see their thought processes when we were talking [to] our breast cancer patient.” During the interview with the breast cancer patient who was strong in her faith, Mary appreciated having a colleague there who had a religious background. Even though Mary did not consider herself very religious, she appreciated there were other colleagues who could speak more to those viewpoints. She said, “…it was really good to have different viewpoints and to remember that different people have 149 different things that affect their health. Religion is such an important one for so many people around the world.” Language Learning and Immersion The development of Spanish skills and communicating across language barriers was another sub-theme for medical students in the Costa Rica program. An outcome many participants discussed was language skills they learned through interactions with doctors, patients, and host families in Costa Rica. During pre-departure meetings, Joan encouraged her students to practice their language skills and handed out a packet with the course syllabus that included a tutorial of useful Spanish travel phrases, expressions, and medical terminology. Joan said she expected students to “…invest some time in actually [learning] Spanish or exposing [themselves] to Spanish.” Prior to leaving for Costa Rica, some participants spoke about their interests in practicing and improving their Spanish skills. When asked about how she saw the Costa Rica program being personally meaningful, Natasha said, “I get my first international experience. I get a chance to finally put my Spanish skills to real use communicating with native speakers in a different population, different dialect.” Additionally, language was an important factor for Angeline, who explained, “I’ve always been kind of interested in languages… you can’t learn a language without learning about someone else’s culture. And then just being interested in that and combined with healthcare is something that’s important to me.” Angeline viewed language skills as important to her career development. She continued: Right now, my work in clinic, there are a lot of people who are immigrants…where English isn’t their first language. And so, there’s a lot of miscommunication. So even a 150 simple being able to say, ‘hello and how are you’ in someone's native language, it allows for there to be trust.’ In a similar way, Kay said, “I want to pick up on some Spanish and have a basis to a point where I could maybe further that and be able to communicate to some degree with Spanish speaking patients or families.” Finally, Nala mentioned goals of improving her communication skills to work with ESL patients back home. She said, “I also want to work on my Spanish because I'm really rusty. I think it's important.” While some participants held goals improving and honing their Spanish skills in the program, experiences in Costa Rica led them to recognize challenges around language barriers. For example, Jane explained “…from the trip, I did realize that my Spanish was not sufficient in navigating the trip by myself…It does inspire me to continue learning Spanish.” Additionally, Angeline was somewhat fluent in Spanish but found the language transition in Costa Rica to be difficult yet rewarding. Angeline said, “…for me, being able to interact in Spanish was really important. I actually thought I had a better knowledge and understanding of Spanish, [but] it was a lot. I would say that it was more difficult than I thought it would be...” Jay, who was practicing one Spanish word per day prior to Costa Rica, said, “…of course, the language barriers are there, but I'm very thankful that I had translators with us...And again, reflecting on the whole language aspect of it, every day was a great practice day for me.” Despite the challenges of language barriers, a few participants described gaining confidence in connecting and communicating nonverbally with patients. Nala explained: …working with patients in different background, it was really good...Even sometimes when a patient was talking to me in Spanish, and maybe I couldn't say what I wanted to say, but I could understand them...just the eye contact thing and just the posture, and then 151 the composure that I was holding while talking to the patient, really still allowed me to kind of connect with the patient, although they only spoke Spanish. Nala’s experience of connecting with patients in Costa Rica encouraged her to overcome language barriers with patients in the future. Nala continued: I felt that I learned about myself that no matter what situation I'm in with a patient, whether I can connect to them or can't, that I'll still make a way to...I feel like I've learned that I actually do always try to put in the effort with that patient, despite what barriers [are] there. Similarly, working across language barriers led Tammy to reflect on her abilities to connect emotionally with patients. She described a patient who was crying during an interview about breast cancer who she connected with emotionally. After the interview, the patient gave Tammy a breast cancer survivor bracelet she was wearing, which she felt symbolized their emotional connection. Speaking to the importance of this experience, Tammy explained: Being able to connect emotionally with people, despite our cultural differences; despite not being able to speak the same language but knowing that both they had an emotional impact on us, and we had an emotional impact on them… being able to connect with people on that level, I think, was really fulfilling to me. These statements were further corroborated by a participant’s entry in their feedback summary: “This project also inspired me to find multiple ways to connect with someone beyond language barriers.” Overall, the development of Spanish skills and abilities to overcome language barriers shaped participant experiences in Costa Rica. 152 Cultural Immersion Cultural immersion was also important to participants’ experiences of the Costa Rica program. Culturally immersive interactions with host families, doctors, and patients in Costa Rica influenced participants’ personal perspectives about adaptability and openness. Additionally, experiences in Costa Rica were important for some participants to develop broader perspectives about healthcare and medicine. Culturally Immersive Interactions with Host Families Once in Costa Rica, students stayed in casas with host mothers or ‘Mamma Ticas,’ who would prepare them meals each morning and evening, as well as engage them in conversations about their day. Interactions with host mothers were an important part of participants’ experiences to learn about the Costa Rican culture and practice their Spanish speaking skills. For example, Monica stated, “…staying with the host families, we also got that cultural side, and getting to talk with just everyday people.” Additionally, Angeline said, “Doing the homes days was great. So, our ‘Mama Tica’ (that's what we called her), she was great. And she was Spanish speaking, so she didn't speak English at all. We would have a lot of pretty good conversations.” Finally, Jane explained: …having a host family, meeting, [and] seeing my host mama every day, that was also a way for me to integrate into the culture as well. Because we would eat Costa Rican food for dinner at the house and in the morning as well. Living arrangements within the casas also engaged some participants to adapt to a new environment. For example, Tammy stated, “…having to stay in the home of someone else. It forced me to get out of my comfort zone in terms of what I am used to in regard to living situations and environmental things.” Also, Nala said, “It was definitely a cultural shift, 153 especially with the living arrangement,” in referring to the culture shock she experienced with the number of bugs and roaches that would get into the houses. Yet, Nala still believed living with a host family was beneficial. She said, ‘being able to kind of live with a host family…gave me more insight with the culture...just being more involved with actual people who aren't in a touristy area.” Overall, these experiences allowed participants to learn about cultural differences between Costa Rica and the United States, which helped them to establish new perspectives about family, comfort, and hospitality. Understanding Culture in Relation to Healthcare and Medicine Finally, some participants mentioned how engagement in the Costa Rican culture helped them understand broader perspectives of healthcare and medicine. For example, Jay said: [Costa Ricans] have a saying called 'Pura Vida' that means 'for life’…It's one of those things where you realize they really [put] emphasis on living life and also sharing that with others, and that's what was really influencing me—not only through the different workshops we had [but] also the healthcare system as well. Also, Yondu said, “…the country, as a whole, places a bigger value on health. And it shines through in the way that their system works. I think it’s almost in a way a society that I would want to live in because of the value that they place on healthcare and access to healthcare.” Relatedly, Monica stated: I think the biggest takeaway was how it seemed like in Costa Rica they have...I don't know if I should say more respect for their patients, but a very different respect for their patients. One of the doctors from the geriatric hospital, he [quoted] ‘if you only have one potato, you make a soup.’ That really stuck with me because that pretty much summarized how they view things there, especially with healthcare, which I don’t think is 154 the same here in the United States. Where here, there's a very big gap between the people that have money and the people that don't, and the people that have access to care. Monica was referring to the culture in Costa Rica leading doctors to improvise with less resources to maximize healthcare for the most patients, rather than letting money drive access to care. She continued, “…it's really cool to learn about and be in a culture where they really do believe that everybody deserves the right to have a good life.” Also, Mary explained the importance of getting a professional experience with seeing healthcare outside of the United States. She said, “…there's something about leaving the country that makes you think about things more and makes you more aware of what you're doing.” Similarly, Angeline believed an advantage of the Costa Rica program was gaining a new perspective about healthcare abroad and building a stronger appreciation for collaborative global practices. She explained: I think in general, especially today more than ever, and you can see this [with] Coronavirus. Healthcare is not local anymore, it's global. And if you don't have an idea of what's going on across your border in healthcare, you're behind the times. So, you need to know what's going on in other countries, how their healthcare system is developed, [and] how they're diagnosing people. It's just important to have contacts in other countries in general. Fred was interested in gaining a better understanding of how social and cultural issues influenced healthcare policy in Costa Rica. When asked to recall aspects of his goals for the program that were realized, Fred said, “So, part of what I think is a constant learning experience is to learn about other healthcare systems at a global level because it's hard to compare country to country. But there's still something to be learned, no matter what healthcare system you're looking at.” From his experience visiting other Latin American countries during previous service trips, Fred 155 was interested in looking for parallels into social issues between the United States and Costa Rica—which is something he found. He explained: The NGO we were working with, they were saying that Nicaraguans to [them] are sometimes comparable to refugees and migrants coming from southern US borders…I think these kinds of comments and the opportunity to listen [to] those perspectives showed me there’s similarities in the issues…in how the locals and local governments handle those situations. Fred was happy the conversation about these parallel social issues came up organically in conversations because it was central to his goals for learning more about border medicine through the education abroad program. He continued: I was prepared to ask questions about [refugees and border medicine], but I was glad that came up almost right away. So that [goal] was, I think, realized, and it’s something that will help. [It] has kept me motivated to continue pursuing global health opportunities… I thought that was pretty important. Seeing parallels, pros and cons... how even some vastly different systems have very similar problems. Overall, conversations and interactions around healthcare policies and medical practices in Costa Rica gave participants an appreciation for perspectives outside of the United States. Conclusion In this chapter, I discussed an analysis of the findings demonstrating four contexts influencing participants’ experiences of the Costa Rica program: adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. Adult learning encompassed the experiential, transformative, and pragmatic approaches participants demonstrated through the Costa Rica program. Professional socialization included participant 156 experiences around program requirements, social and cultural influences, and professional development in the Costa Rica program. Curriculum and pedagogy included participants experiences with learning and engagement based on the design and facilitation of the Costa Rica program. Interpersonal development embodied participant experiences around relationship building, language development, and cultural immersion in Costa Rica. As a corresponding finding, these contexts intersected with one another to influence participants’ experiences of the Costa Rica program, which are highlighted in Chapter 6. 157 CHAPTER 6: FINDINGS – THE INTERSECTION OF GRADUATE STUDENT CONTEXTS INFLUENCING EXPERIENCES OF EDUCATION ABROAD This findings chapter examines how contexts intersect to influence graduate students’ experiences of the Costa Rica program. I define intersection as a point of commonality at which contexts overlap. In this chapter, I highlight the responses and reflections of four participants who demonstrate intersections between the contexts established in Chapter 5: (a) adult learning, (b) professional socialization, (c) curriculum and pedagogy, and (d) interpersonal development. While all participants in the study were influenced by intersections between contexts, I specifically highlight four because the elements of intersections between contexts for these four participants echoed the experiences of others in the Costa Rica program. I chose four of my initial 11 participants who demonstrated experiences allowing me to highlight contexts and their corresponding intersections more effectively and thoroughly. Each of the four participants embodied different examples of contexts and intersections which resonated with other participants in the study. Highlighting a smaller sample of my initial 11 participants also allowed me to go into more depth regarding the contexts and intersections influencing their experiences. In this chapter, I first summarize each of the four participants’ overarching themes. These themes are derived from their experiences and help me highlight intersections between contexts. Following, each section is organized by context and includes examples from the findings where the four participants’ experiences were influenced by intersections. Finally, I include a section summarizing how participants experiences fit together around intersections between the contexts. Table 1 is included below to provide an overview of themes and intersections of the four participants covered in this chapter. 158 Table 1: Overview of Participant Themes and Intersecting Contexts Overarching Theme for Experiences of the Costa Rica program Fred Gaining experience in global health Monica Improving professional practice through new perspectives Tammy Building cultural competence for working with underserved communities Jay Reinforcing the importance of patient-centered practices The Context of Adult Learning Fred Fred’s reflection on prior service trip experiences intersected with his goals for professional advancement in global health and awareness about the importance of gaining cross-cultural perspectives about healthcare. (Intersections: professional socialization, interpersonal development) Monica Monica was motivated to shadow doctors to learn about differences in patient practices between Costa Rica and the United States. After listening to doctors talk about patient practices, Monica planned to apply her experiences to her future training and gained awareness about the influence of culture on patient care. (Intersections: professional socialization, interpersonal development) Tammy Tammy was motivated to improve her cultural competence to strengthen her skills working with patients, which aligned with values in the College of Medicine. Also, Tammy began to reframe her perspectives about international medical education programs as the result of conversations and interactions with Costa Rican doctors that were designed into the program itinerary. (Intersections: professional socialization, curriculum and pedagogy, interpersonal development) Jay By reflecting on prior international work experiences, Jay recognized the value of cross-cultural experiences, which influenced his desire to participate in the Costa Rica program. (Intersections: interpersonal development) The Context of Professional Socialization Fred Fred’s professional trajectory in global health was shaped by discussions and activities providing him with exposure to NGOs and opportunities to learn about a different healthcare system. Fred recognized the professional value of learning about a new healthcare system by reflecting back on his prior service trip experiences. (Intersections: adult learning, curriculum and pedagogy) Monica Relationships forming between students in the Costa Rica program helped Monica expand her professional network and learn about strategies for navigating the medical school curriculum. These relationships were likely formed through teambuilding activities and group projects built into the curriculum of the Costa Rica program. (Intersections: curriculum and pedagogy, interpersonal development) Tammy Tammy believed the Costa Rica program aligned with her professional interests in public health and working with underserved communities, which was also a central focus of her certificate program. Additionally, Tammy connected her professional experiences of comparing healthcare systems with objectives built into the Costa Rica program. (Intersections: adult learning, curriculum and pedagogy) 159 Table 1 (cont’d) Jay Jay’s socialization around patient-centered practices was reinforced by opportunities in the program itinerary to interact with Costa Rican doctors to learn about their humanistic approach to patient care. (Intersections: curriculum and pedagogy, interpersonal development) The Context of Curriculum and Pedagogy Fred Based on his prior experiences participating in service trips, Fred believed the service project built into the Costa Rica program was beneficial because it improved his view of Costa Rican healthcare system. Also, Fred believed activities in the program itinerary to work with doctors and learn about NGOs contributed to his professional development in the field of medicine. (Intersections: adult learning, professional socialization) Monica As Monica was initially questioning the practical value of patient-centered learning methods in her curriculum, conversations with doctors in Costa Rica validated these learning methods and gave her confidence they were beneficial for her future. (Intersections: adult learning, professional socialization) Tammy Hands-on opportunities built into the education abroad curriculum allowed Tammy to gain a deeper cross-cultural appreciation for patients and healthcare issues in Costa Rica, which satisfied some of her pragmatic goals for developing cultural competence. (Intersections: adult learning, interpersonal development) Jay Jay’s ability to interview patients and meet with doctors in Costa Rica aligned with his goals for patient-centered practice and his development as a future physician. (Intersections: adult learning, professional socialization, interpersonal development) The Context of Interpersonal Development Fred Discussions with doctors and administrators allowed Fred to learn about parallel issues between healthcare systems such as refugee crises, which met some of his goals for the Costa Rica program and motivated him to continue pursuing global health opportunities. Fred’s open-minded approach to thinking about parallel issues seemed to be influenced by his prior experiences traveling abroad for service trips. (Intersections: adult learning, professional socialization, curriculum and pedagogy) Monica Through teambuilding and group activities built into the Costa Rica program, Monica established new relationships with peers in Costa Rica that contributed to networking and support in her medical program. (Intersections: professional socialization, curriculum and pedagogy) Tammy The built cultural competence through interactions with host families and the service project built into the Costa Rica program. These experiences helped Tammy achieve pragmatic goals for cultural competence she set prior to the Costa Rica program. (Intersections: adult learning, curriculum and pedagogy) 160 Table 1 (cont’d) Jay Jays goals for participating in the Costa Rica program centered around his reflection on the importance of culture and language to his development as a patient-centered physician. Also, Jay believed working in a group setting was beneficial to his experience, as a goal of the program was to encourage group- cohesion and teamwork. (Intersections: professional socialization, curriculum and pedagogy) Overarching Themes for Experiences of the Costa Rica Program For each of the four participants, experiences of the Costa Rica program were salient around an overarching theme. Moreover, these themes influenced how participants set goals, engaged in learning, and experienced the Costa Rica program. These overarching themes helped me highlight and clarify some of the intersections between participants’ contexts. In this section, I provide a brief summary of each participant’s overarching theme for their experiences of the Costa Rica program. Fred: Gaining Experience in Global Health An overarching theme for Fred’s experience in the Costa Rica program was gaining knowledge and skills for a career in global health. When asked about what he learned about himself through the education abroad experience, Fred stated, “Well, it definitely reinforced a lot of the passions I had for global health.” Fred’s goals around global health were inspired by his past international service trip experiences and strengthened his desire for cultural immersion during the Costa Rica program. Fred also made connections between conversations with doctors and patients in Costa Rica and his career trajectory in global health. Fred’s interests and experiences in global health helped highlight intersections between his contexts in the Costa Rica program. 161 Monica: Improving Professional Practice Through New Perspectives Many of Monica’s experiences of the Costa Rica program centered around improving her professional practice through new perspectives about culture, healthcare, and patient care. When asked about what she took away from the Costa Rica program that would benefit her responsibilities as a medical student, Monica said: I didn't have any experience with any healthcare systems outside of our own. And honestly, I didn't even know that much about the healthcare system here in the United States. So, through this, I learned a little bit more. And getting more perspectives, I think will be really helpful in allowing me to look at or adjusting how I look at things in the future. I think medical school is a good time to have that open mind, and get different perspectives, and learn as much as you can. Monica traveled to Costa Rica in the past for a volunteer experience and was very interested in the exploring the culture more, she noticed the education abroad program was focused on learning about healthcare and medicine. Experiences in Costa Rica informed Monica’s expectations around the training she received within the medical school curriculum and shaped her goals for applying medical practices to her development as a future physician. She also learned about how culture plays a role in patient care. Finally, Monica networked with second- year students in Costa Rica, which allowed her to source advice for navigating the medical program. Monica’s goals and experiences around improving professional practice helped highlight some intersections between her contexts in the Costa Rica program. Tammy: Building Cultural Competence and Working with Underserved Communities Some overarching themes for Tammy’s experiences of the Costa Rica program were a desire to build cultural competence and work with underserved communities. As a medical 162 student, Tammy was motivated to help underserved communities and used this objective to inform her career trajectory. For example, Tammy stated, “I think whatever I do [and] whatever community I end up servicing, I definitely want to serve underserved communities.” Overall, these career objectives were evident in some of Tammy’s goals for the Costa Rica program. For instance, she believed the Costa Rica program complemented her certificate program through learning about global healthcare policies and satisfied her “personal mission of serving underserved communities...” Additionally, Tammy wanted to build cultural competence in the Costa Rica program. She stated, “I think connecting with people is always very fulfilling and satisfying to me to be able to put myself in somebody else's shoes.” She believed interviewing patients in Costa Rica would give her a chance to connect with people from different backgrounds and improve her practice as a physician. In Costa Rica, Tammy appreciated opportunities to help underserved communities and work with diverse patients through the service projects built into the program. Tammy’s interests and experiences for improving cultural competence and assisting underserved communities assisted in clarifying some intersections between her contexts in the Costa Rica program. Jay: Reinforcing the Importance of Patient-Centered Practices A salient theme for Jay’s experiences involved his belief in patient-centered practices, which was reinforced through cross-cultural interactions with doctors and patients during the Costa Rica program. Even before departing for Costa Rica, Jay emphasized an interest in serving patients in compassionate and culturally sensitive ways. For example, during his pre-departure interview, Jay said, “I really want to be the type of physician who…not saying one hundred percent understands other cultures, but who’s open-minded and who understands the small things that are in common. So, I can identify ways to connect my patients.” During the program, Jay 163 reinforced his training in patient-centered practices when speaking with Costa Rican doctors who emphasized care for patients and communities. Additionally, Jay learned language skills in Costa Rica that he planned to utilize when working with Spanish speaking patients back in the United States. Jay’s experiences around reinforcing patient-centered practices assisted with clarifying some intersections between his contexts in the Costa Rica program. Intersections with the Context of Adult Learning For participants in the study, the context of adult learning intersected with other contexts of professional socialization, curriculum and pedagogy, and interpersonal development to influence their experiences during the education abroad program. At different points, participants demonstrated examples of experiential, transformative, and pragmatic learning. Moreover, the ability of participants to adopt past experiences, reflect upon their development, and set professional expectations for learning overlapped with their socialized skills in the field of medicine, training in the curriculum, and engagement in cross-cultural interactions while in Costa Rica. In the following subsections, I demonstrate how each of these four participants experienced education abroad within the context of adult learning and its intersection with professional socialization, curriculum and pedagogy, and interpersonal development. Fred Fred’s adoption of prior experiences as an experiential learner contributed to his goals for gaining experience in global health during the Costa Rica program. While completing a master’s degree in global medicine, Fred traveled abroad to Uganda, Panama, and Bali for professional service trips related to his studies. Moreover, Fred believed these experiences helped him to think more deeply about cultural immersion. He used the phrase “think globally, act locally” to describe his interests seeking to understand problems and solutions outside of a Westernized 164 context. Fred’s ability to reflect on past service trip experiences underscored his experiential approach as an adult learner but also influenced his professional outlook in global health. For example, Fred arranged a service trip to Bali towards the end of his master’s program where he worked for a small mental health organization, which informed his professional interests and goals for practicing global health in psychiatry. In relating this past experience to the Costa Rica program, Fred said, If I wanted to practice in a global health sense with psychiatry, it would force me to take some time and understand not just the individuals but the culture and the community that I’m looking to serve before moving forward with anything. So, that aspect of learning and immersion is something I look forward to. Fred’s prior experiences in Bali may have led to his interests in global health and psychiatry, but his cognizance about professional advancement being tied to specific values and skillsets likely intersected with his socialization as a medical student. Moreover, Fred assessed his fitness to succeed in the profession of global psychiatry, which showed he was also operating in the context of professional socialization. Additionally, Fred’s awareness about the importance of understanding “culture and community,” as well as his goals for obtaining a new perspective about Costa Rican policies and practices overlapped with the context of interpersonal development. Also, Fred’s motivations to pursue a career in global health influenced his decision to enroll in the Costa Rica program. He said, “I do want to work in global health, so I want to be able to do service trips in my professional degree because I want to show that I am committed.” When asked about how he saw the Costa Rica program influencing his goals and responsibilities as a medical student, he stated, “I think this would further reinforce my desire to work in a global 165 health capacity to further any global health skills…” By connecting his motivations for enrolling in education abroad with professional advancement for a career in global health, Fred’s experiences as an adult learner intersected with his professional socialization in the field of medicine. After returning from Costa Rica, Fred recalled several instances where interactions with NGOs, doctors, and patients influenced his career trajectory in the field of medicine and global health. These instances further demonstrated how Fred’s professional motivations for the international experience overlapped with knowledge and skills he developed as a medical student. Consequently, Fred’s experiences as an adult learner intersected with the context of professional socialization. Monica Monica was motivated to shadow doctors to learn about differences in medical or patient- centered practices between Costa Rica and the United States. She said: One of the biggest things I like about shadowing doctors is seeing how they interact with patients…I'm really excited to do that in Costa Rica, just to see if the dynamic is different there or if it's similar. Monica’s interests embodied a pragmatic approach centered around her motivation to gain relevant skills for her professional development. After returning from Costa Rica, Monica explained how speaking with doctors transitioned into a meaningful professional outcome for her to learn about the physical exam. She explained: …the physicians in Costa Rica really emphasize their physical exam because they don’t have the technology that we have here…When the doctors were telling us about the physical exams they do, it was amazing to hear about how in depth they go. Where sometimes you go to the doctor here, and they barely even touch you or they maybe just 166 listen to your lungs. There, they do everything based on their hands and what they can get out of that physical exam. In describing what the experience meant to her, Monica said, “…I walked away realizing how important and how informative that physical exam could be, which I hope to carry with me when I become a physician.” Monica’s plans to apply the physical exam to her future practice displayed an experiential approach to her learning in Costa Rica but also showed her capacity to source knowledge for her professional roles and responsibilities. As a result, Monica’s goals and experiences intersected with the context of professional socialization. Additionally, since opportunities to speak with doctors and engage in guided discussions were planned into the itinerary of the Costa Rica program, Monica’s ability to learn about the physical exam was to some extent dependent upon the curriculum and pedagogy Costa Rica program. Highlighting the importance of activities in the Costa Rica program curriculum, Monica said, “We had a couple of panels that were extremely informative. I also thought the interviews were helpful. Whether it was with other physicians or the patients, just because you get information right from the source.” Therefore, as Monica was also influenced by the context of curriculum and pedagogy. Monica also mentioned how interactions with Costa Rican doctors taught her about the importance of improvising with less resources and maximizing medical care for patients. She said about one of her conversations: One of the doctors from the geriatric hospital, he [quoted] ‘if you only have one potato, you make a soup.’ That really stuck with me because that pretty much summarized how they view things there, especially with healthcare, which I don’t think is the same here in the United States. Where here, there's a very big gap between the people that have money and the people that don't, and the people that have access to care. 167 While Monica was initially motivated to speak with doctors in Costa Rica about their experiences working with patients, she also gained awareness and introspection about the influence of culture on healthcare practices. Consequently, Monica’s experiences in the context of adult learning also intersected with interpersonal development. Tammy Tammy’s experiences as an adult learner, within perspectives of pragmatic and transformative learning, intersected with contexts of professional socialization, curriculum and pedagogy, and interpersonal development. When asked about how she viewed the Costa Rica program being professionally meaningful, Tammy said: Professionally, I think this will help improve my cultural competence, which is something that is definitely needed within our medical system here. Just because we’re not in another country doesn’t mean we don’t see patients from other countries. As pillars of the College of Medicine included diversity, inclusion, and taking a patient-centered approach, Tammy’s connections between professionalism and cultural competence suggested these values were likely socialized into her training as a medical student. Additionally, Tammy’s interests to improve her cultural competence suggested she was thinking about aspects of her interpersonal development. Therefore, Tammy’s experiences in this area intersected with the context of professional socialization and interpersonal development. Also, Tammy demonstrated elements of transformative learning when she mentioned reframing her beliefs about the inferiority of international medical education programs after Costa Rican doctors “blew her away” with their medical knowledge. Tammy believed the experience taught her to challenge some of her preconceived notions in the future regarding foreign doctors and medical programs. When asked about aspects of the experience that engaged 168 her to think differently about the medical training, Tammy mentioned opportunities to speak with Costa Rican doctors was critical to learning about their professional preparation and expertise. She said, “I'm not sure I would have been able to do it just by going to Costa Rica on my own without having those connections through GMI.” Since conversations and interactions with physicians were designed into the itinerary of the Costa Rica program, she was able to engage and reflect on her assumptions through the context of curriculum and pedagogy. Jay An aspect of adult learning influencing Jay’s experiences of the Costa Rica program was his prior work experiences. Jay spoke about attending an international trip in Berlin to market a medical device. While in Germany, Jay learned about cultural differences that led to him modifying the device. In reflecting on the importance of interacting with colleagues abroad, he said, “I wouldn't have known that if I didn't get to actually be there, meet them, understand them, and see what their version or their interpretation was like on the same device.” Jay’s account inspired him to participate in the Costa Rica program but also showed him the value of learning about cultural differences. Consequently, this experience likely shaped Jay’s willingness to interact across cultural differences in the Costa Rica program, showing intersection between contexts of adult learning and interpersonal development. Intersections with the Context of Professional Socialization For participants, the context of professional socialization intersected with other contexts of adult learning, curriculum and pedagogy, and interpersonal development to influence their experiences during the education abroad program. During the Costa Rica program, participants encountered opportunities that strengthened their career goals and reinforced their medical training and skill development. Additionally, participants’ formed networking relationships with 169 their peers in Costa Rica. These opportunities overlapped with participants’ abilities to reflect on their experiences, engage in the program curriculum, and interact with doctors, patients, and peers. In the following subsections, I demonstrate how each of these four participants experienced education abroad within the context of professional socialization and its intersection with adult learning, curriculum and pedagogy, and interpersonal development. Fred Fred’s education abroad experiences within professional socialization intersected with contexts of curriculum and pedagogy. Fred linked career goals of global health with opportunities to work with NGOs and learn about healthcare systems. After returning from Costa Rica, Fred said about the program: I think it influences my trajectory in the medical field…I think having that exposure to that kind of NGO means that my future pursuing global health work as a physician will have at least helped me determine what kind of global health work I want to do. With the Costa Rica program being heavily dependent upon partnerships with PLAC and GMI to facilitate discussions and activities, Fred was able to build confidence in his ability to pursue global health as a physician. Additionally, Fred noted the structure of the Costa Rica program contributed to his professional knowledge, saying, “In the past, I had only done service trips. And so, I was glad actually that I had this opportunity to also look at more about a healthcare system and not necessarily all service.” By reflecting back on previous experiences participating in service trips, Fred was able to appreciate the content and direction of the Costa Rica program that covered a variety of outcomes including comparing public and private healthcare systems. 170 Monica Some of Monica’s experiences within the context of professional socialization were also influenced by the contexts of curriculum and pedagogy and interpersonal development. Monica mentioned relationships she developed with second-year students during the Costa Rica program that provided valuable opportunities to network and receive advice for navigating the medical program. When asked about the advantages of working with other students in Costa Rica, Monica explained: There was also some second years, which was really cool because you can see how they’ve kind of grown over the past year. They are very open to giving advice, whether it was stuff we were doing in Costa Rica or even just in general—being a medical student. I had a couple of them show me their schedules that they did during intersessions and give me an idea of how to set that up. So, that was really helpful. Through networking, Monica learned helpful norms and expectations of the medical program that focused on strategies for managing her progress as a student. However, Monica was also encouraged to participate in teambuilding activities during pre-departure meetings and work in groups for the service projects. These aspects of the Costa Rica program facilitation also played a part in her abilities to develop networking and supportive relationships with peers. Additionally, in establishing new relationships with peers in Costa Rica, Monica was influenced by the context of interpersonal development. Tammy Some of Tammy’s experiences within the context of professional socialization intersected with her pragmatic approach as an adult learner and the objectives built into the Costa Rica 171 program. Tammy believed the Costa Rica program related to her interests in public health. She said: I’m also interested in public health and policy and how these things affect the healthcare that people are able to receive. I think that’s a great bridge with the Costa Rica trip because we’re getting to learn about how policies there are affecting the health that citizens are receiving. Tammy continued to explain that a component of her certificate program focused on public health in global communities, so participating in the Costa Rica program provided an opportunity to improve knowledge in this area. Tammy also felt the program was a great opportunity to learn about policies affecting underserved communities. Adult learners are typically motivated to engage in learning that enhances their personal and professional goals. As Tammy connected her motivations for participating in the program with opportunities to gain professional knowledge of public health policies for her certificate program, she represented a pragmatic approach to learning. Additionally, another example demonstrated Tammy’s experiences influenced by professional socialization also intersected with the context of curriculum and pedagogy. When she was asked about how her outcomes fit with the College of Medicine’s goals for the Costa Rica program, Tammy replied, “I think learning about a different healthcare model and the challenges that exist within that model, and also comparing it to the US model... was one of the goals they had for us. I think that was achieved.” Tammy’s ability to recognize her learning outcomes to assess her learning in the Costa Rica program, relative to expectations in the College of Medicine, demonstrated she was socialized to interpret her formal learning environment and identify opportunities for professional development. However, a part of this process also 172 involved the formal objective of comparing public and private healthcare that was listed in the syllabus and course description for the Costa Rica program. Jay Jay found alignment between his goals for enrolling in the College of Medicine and outcomes of the Costa Rica program. After returning from Costa Rica, he said, …originally, I came to [College of Medicine] because it really focused on the human aspect…The patient-centered care and also working with communities that are essentially underserved or don’t have many medical resources. Going to Costa Rica, it was actually a really great way for me to really connect the whole patient-centered aspect of it. These experiences inspired Jay to take a humanistic approach to clinical diagnosis, treatment, and outreach. He said: …one thing they really did emphasize in Costa Rica was talking to the patient…actually understanding what’s going on. Understanding not only the healthcare aspect of it…like the current condition…but also understanding how is this going to impact their life? How is going to impact their ability to work? [Going] beyond the clinical diagnosis and treatment. Jay’s understanding about the importance of patient-centered practices were socialized through formal competencies and the informal culture within the College of Medicine. Yet, Jay’s conversations with doctors and practitioners were incorporated into activities in the program itinerary, including visits to clinics and shadowing doctors. Thus, intersecting with professional socialization, Jay’s experiences of the Costa Rica program was also influenced by the contexts of curriculum and pedagogy. 173 Intersections with the Context of Curriculum and Pedagogy The context of curriculum and pedagogy intersected with other contexts of adult learning, professional socialization, and interpersonal development to influence participants’ experiences during the education abroad program. At many points during the Costa Rica program, the participants’ experiences were shaped by activities, goals, and outcomes embedded into the curriculum and pedagogy of the Costa Rica program. While learning in the program was facilitated by objectives and activities, participants were also influenced by their prior experiences, professional goals, and socialized knowledge as medical students. Additionally, participants were influenced by interactions with doctors and patients through activities built into the Costa Rica program. In the following subsections, I demonstrate how each of these four participants experienced the Costa Rica program within the curriculum and pedagogy and its intersection between contexts of adult learning, professional socialization, and interpersonal development. Fred Fred’s experiences within the context of curriculum and pedagogy intersected with adult learning and professional socialization. First, Fred’s past service trip experience in Panama allowed him to recognize the value of learning about the healthcare system through a service project in the Costa Rica program. Fred said about the service project being less about providing assistance and more about getting a well-rounded view of the healthcare system, “…I guess in terms of learning about the healthcare system and learning about Costa Rica itself as a country, that part definitely aligned with some of my goals and intent of signing up for the trip…” As Fred drew upon prior experiences of international service trips to evaluate activities in the Costa Rica program, he demonstrated intersections with the context of adult learning. 174 Second, activities in the Costa Rica program itinerary that provided Fred with opportunities to work alongside doctors and NGOs were relevant to his professional development. He said: …it was definitely from a professional level, more relevant being able to work with the doctors, being able to work with public health professionals and experts in their field in Costa Rica. I think there are connections that were made. It was a way to see how these NGOs function there…it might advance where I want to go in my future. By advancing Fred’s knowledge in the field and preparing him for his future as a medical professional, these activities demonstrated overlap between contexts of curriculum and pedagogy and professional socialization. Monica Some of Monica’s experiences tied to curriculum and pedagogy intersected with contexts of adult learning and professional socialization. An activity in the program itinerary encouraged Monica to speak with doctors about her training with diagnosing patient symptoms, which solidified her confidence in the medical school curriculum. She said: One of the things that they really hit hard when we were in Costa Rica talking to the healthcare professionals was the patient presents to you with a symptom. They don't command and say, ‘I have a problem with my heart, or I have a neurological problem.’ So, you have to backtrack from that symptom to what could be causing that. They were actually really impressed when we told them that our curriculum goes off of the symptoms they present with, and we focus on all the different potential causes, whether it has to do with one system or the other…I think [it] made a lot of us feel good about how we’re learning medicine here in a very different way. Because I think a lot of times it can 175 be very frustrating and we're questioning how productive the way that we're learning is...because it's so different than all other medical schools and what friends [at] other places are doing. So, I walked away feeling pretty good about how we learn things, and it was good to know that it's going to be beneficial in the future. Since the curriculum and pedagogy in the College of Medicine included patient-centered learning methods that were different from other medical schools, Monica was initially skeptical of its practical value to her development. Monica’s motivation for the medical school curriculum to be productive and purposeful intersected with her pragmatic approach as an adult learner. Additionally, as Costa Rican doctors confirmed to Monica the value of the curriculum and the skills she was learning, the experience contributed to her socialization process. Furthermore, Monica strengthened investment in her professional preparation as the result of validating the curriculum. Tammy Tammy’s experiences influenced by the curriculum and pedagogy in the Costa Rica program intersected with contexts of interpersonal development and adult learning. Tammy mentioned the importance of hands-on experiences built into the pedagogy in Costa Rica that provided to her a greater understanding of underserved patients and communities. She said, “It’s so different to read about it than being there and experiencing it because you’re not only getting to see what their day-to-day life feels like, but then you see how that contributes to systemic issues there as well.” Since the curriculum and pedagogy within the College of Medicine incorporated clinical experiences into early stages of students’ training, these hands-on opportunities in Costa Rica involving personal interactions with patients were valuable to Tammy’s experiences. As Tammy gained a deeper cross-cultural appreciation for patients and 176 healthcare issues, her experiences in this area overlapped with the context of interpersonal development. When asked what she found personally meaningful about her experience in the Costa Rica program, Tammy highlighted service projects with PLAC were a great way to serve special patient populations and provide resources to help underserved communities. Additionally, Tammy fulfilled some of the motivations she set before traveling to Costa Rica, such as connecting with patients across cultural differences and learning how international communities were affected by healthcare systems. As adult learners are often pragmatic and use their motivations to evaluate whether learning is purposeful, Tammy’s experiences overlapped with the context of adult learning. Jay Jay’s experiences within curriculum and pedagogy of the Costa Rica program also intersected with his development in the context of professional socialization. A valuable part of the education abroad curriculum and pedagogy for Jay was the hands-on experiences of interviewing patients in the service project. Jay said: I want to say the most meaningful experience was actually sitting down with one of the patients. So, it was during the process of recording patients’ stories …to help transcribe and understand where they are really coming from. These hands-on experiences were incorporated activities in the Costa Rica program but also aligned with Jay’s own focus on the human aspect of medicine and the socialized expectations for patient-centered practice within the College of Medicine. Relatedly, Jay mentioned how conversations with doctors during the Costa Rica program gave him confidence in the College of Medicine’s focus on patient-centered practices. He explained: 177 …a lot of things that we did discuss [with] the physicians over there realigned [with] what we understood… I felt that instead of having an experience where they’re learning from us, it was more so [that] we both learned from each other… one of their OBGYN professors actually commented on our curriculum [and] how we were focused on patient care. He said, ‘Yeah, that's how we do it here in Costa Rica.’ Jay continued about what it meant to his training as a medical student: It made me feel that the curriculum was really geared towards making a physician who is compassionate about their patients. That's a reason why I chose the College of Medicine, and I felt that my trip to Costa Rica really affirmed that. Seeing alignment between his training and professional practices in Costa Rica, Jay not only reinforced his confidence in the competency of patient care in the College of Medicine curriculum but also strengthened his commitment to values of patient-centered practices that were socialized into his training as a medical student. Intersections with the Context of Interpersonal Development For participants, the context of interpersonal development intersected with other contexts of adult learning, professional socialization, and curriculum and pedagogy to influence participants’ experiences during the education abroad program. Cross-cultural interactions with doctors and patients, as well as peer-to-peer relationships were central to many of the pragmatic and professional goals for many participants. Additionally, the opportunity to learn skills for working across language barriers was important to the professional experiences of some participants. Many interactions and cross-cultural experiences were purposefully incorporated into the curriculum of the Costa Rica program and aligned with expectations for training in the College of Medicine. In the following subsections, I demonstrate how each of these four 178 participants experienced the Costa Rica program within the context of interpersonal development and its intersection with adult learning, professional socialization, and curriculum and pedagogy. Fred Fred’s experiences within interpersonal development intersected with contexts of adult learning, curriculum and pedagogy, and professional socialization. A goal Fred had for the Costa Rica program was to gain a better understanding of social and cultural issues influencing healthcare policies such as refugee crises in Costa Rica. He said, “So part of what I think is a constant learning experience is to learn about other healthcare systems at a global level because it's hard to compare country to country. But there's still something to be learned, no matter what healthcare system you're looking at.” Through interactions and conversations with GMI administrators, Fred was able to see parallels between refugee issues for Costa Rica and the United States. He explained: The NGO we were working with, they were saying that Nicaraguans to [them] are sometimes comparable to refugees and migrants coming from southern US borders…I think these kinds of comments and the opportunity to listen [to] those perspectives showed me there’s similarities in the issues…in how the locals and local governments handle those situations. Fred believed these interactions met some of his goals for the Costa Rica program. He continued: I was prepared to ask questions about [refugees and border medicine], but I was glad that came up almost right away. So that [goal] was, I think, realized, and it’s something that will help. [It] has kept me motivated to continue pursuing global health opportunities… I thought that was pretty important. Seeing parallels, pros and cons... how even some vastly different systems have very similar problems. 179 Fred’s willingness to listen and observe in Costa Rica overlapped with his experiences from past service trips, where he learned to take an open-minded approach to understanding problems and solutions abroad. These prior experiences reflected in Fred’s approach to “think globally [and] act locally,” in Costa Rica showed he was also influenced by the context of adult learning. Also, objectives for the Costa Rica program engaged students to compare public and private healthcare systems. GMI administrators organized a policy conference into the program itinerary, which allowed for students to ask questions about social and cultural issues influencing healthcare. Thus, Fred’s experience was also influenced to some degree by the context of curriculum and pedagogy. Finally, Fred believed these interactions with Costa Rican administrators motivated him to continue pursuing a career in global health, which represented his advancement in the field of medicine and showed him to be influenced by the context of professional socialization. Monica Monica’s experiences with interpersonal development intersected with contexts of professional socialization and curriculum and pedagogy. Monica established new relationships in Costa Rica with peers in the medical program who she did not know prior to the enrolling in the program. She said: …we all built pretty strong friendships going there. You're with these people literally 24/7. You really bond, and you get to know each other fairly quickly…it was a lot of people that I don't typically interact with. So, it was really cool to get to meet these people and get to know these people. These relationships were an important part of Monica’s experience, since she also mentioned networking with second-year students to gain advice for navigating the medical program. 180 Through developing a support system, Monica was also influenced by informal aspects of the professional socialization process. Also, a key component for Monica to develop these relationships was likely the teambuilding activities and group projects built into the curriculum of the Costa Rica program—requiring students communicate and work with one another. Since the faculty-director for the program facilitated icebreakers and focused on bringing group cohesion to the program, Monica’s experience in this area likely intersected with the context of curriculum and pedagogy. Tammy After returning from Costa Rica, Tammy mentioned how interacting with her host family and navigating the local Costa Rican community engaged her to interact with others across language barriers and adapt to an environment outside of the United States. She said: I think that I was able to immerse myself in the culture by staying at someone’s house…our Mama Tica’s house, for the first part of our trip. And just simply going out and ordering food really challenged us to try to speak Spanish and not have the assumption or expectation that people should bend for us and speak English for us. Additionally, working with patients in the service projects allowed Tammy to develop skills in working across language barriers. She reflected: Being able to connect emotionally with people, despite our cultural differences; despite not being able to speak the same language but knowing that both they had an emotional impact on us, and we had an emotional impact on them… being able to connect with people on that level, I think, was really fulfilling to me. These interactions challenged Tammy to build cultural competence, which resembled the pragmatic goals she set for herself prior to departing for Costa Rica. Also, Tammy’s ability to 181 develop cultural competence was facilitated by the service project built into the program and the objective of speaking to patients about their experiences in the syllabus. Thus, Tammy’s experiences in this area also intersected with the contexts of adult learning and curriculum and pedagogy. Jay Jay’s experiences in interpersonal development intersected with the context of professional socialization and curriculum and pedagogy. One of Jay’s interests in the Costa Rica program involved learning language for interacting across cultural differences. Before departing for Costa Rica, Jay said: The main thing I wanted to do with my experience was actually [to] just put myself in an uncomfortable situation where I don’t know the language, [and] I don’t know anyone there…it’ll force me to break out of my US shell. Jay was encouraged by the faculty-director to learn basic Spanish skills, and he mentioned practicing one word per day prior to the trip. While in Costa Rica, a class was scheduled to teach students basic Spanish phrases. Jay found the class was helpful to his language development. He explained: …reflecting on the whole language aspect of it, every day was a great practice day for me…one of the first things they did for us was have an introductory class to learn different phrases; how to order food; things like that. So, they were very accommodating in that sense. So, my whole language deficit, even though I was at beginner, it was still able to meet the basic requirements. 182 The Spanish class built into the Costa Rica program translated into professional skills that Jay planned to utilize as a future physician. When asked about the advantages of participating in the Costa Rica program, Jay said: …[an] advantage is that you get to learn another language, which is always helpful. So, you can learn some key terms…for example, [when] a patient only [speaks] Spanish in the United states…you can key-in on certain things. In planning to applying the language skills to his work with patients as a future physician, Jay believed the knowledge he gained in Costa Rica was valuable to his training as a medical student. The Spanish class planned and facilitated by GMI administrators was a critical piece for Jay to build these language skills. Additionally, the link between knowledge and professional practice for Jay suggests working with patients across language barriers was socialized into his idea of a successful physician. Another aspect of the Costa Rica program that influenced Jay’s experience was working with other students in a group setting. Jay believed working with his peers gave him an awareness of alternative perspectives, which improved his overall experience in Costa Rica. He explained: I definitely learned that being in a group can really make an experience so much better...it actually made me appreciate that group setting not only because I had someone else looking out for me, but it was also [that] I got to hear someone else's thoughts. I got to hear somebody’s perspective...what did they agree with, what they didn't agree with, their experiences. As group projects were built into the service-learning experience with PLAC, students were able to work together to interview patients. Also, many of the discussions and activities built into the 183 program itinerary were group-based, as a goal of the faculty-director was for students to develop group-cohesion and learn to work together. Consequently, Jay’s experiences in this area likely intersected with the context of curriculum and pedagogy. Participant Summaries of Intersections Between the Contexts For each of the four participants, contexts fit together to comprise their experiences of the Costa Rica program. Although Chapter 5 presented each context in a siloed fashion to first provide evidence for graduate students’ experiences of the Costa Rica program, they also intersected with one another. As a result, summaries for each of the four participants are included in this section to provide an overview of how intersection between contexts influenced the entirety of their experiences of the Costa Rica program. Fred: Summary of Intersections Between the Contexts As an adult learner, Fred drew from his prior experiences with service trips to inform his open-minded approach to learning about parallels between social issues informing healthcare systems in the United States and Costa Rica. Additionally, Fred’s prior experiences allowed him to evaluate activities of the Costa Rica program curriculum that extended beyond service and catered to his career goals for pursuing global health work as a physician. Representing an overlap between his socialization as a medical student and the curriculum, Fred appreciated the ability to work with doctors and administrators to build connections toward his future. These activities were also culturally and socially immersive, helping Fred understand broader healthcare perspectives that tied back to his previous experiences and professional goals for pursuing global health. 184 Monica: Summary of Intersections Between the Contexts Monica’s experiences of the Costa Rica program were influenced by the intersection of contexts centering around her professional practice. As a pragmatic learner, Monica wanted to build skills in Costa Rica to improve her perspectives about healthcare and patient care. Interactions with Costa Rican doctors helped Monica learn about the importance of using the physical exam and also confirmed her patient-centered training in the College of Medicine curriculum. These experiences provided Monica with confidence in her professional development and an opportunity to reflect on cultural influences on patient care. As the result of group activities built into the program, Monica benefitted from forming new relationships and networking with peers in Costa Rica. Through these relationships, Monica built a support system for navigating the medical program. Monica’s experiences were influenced by intersections between her motivation as an adult learner, socialized training as a medical student, engagement in the College of Medicine curriculum, and the cultural and relational interactions taking place during the Costa Rica program. Tammy: Summary of Intersections Between the Contexts Before departing for Costa Rica, Tammy was motivated to improve her cultural competence by working with diverse patients and seeking to understand how underserved communities in Costa Rica were affected by the healthcare system. Through the service projects built into the program, Tammy learned to connect with patients across cultural differences and language barriers, which fulfilled some of her initial goals for the program. Additionally, opportunities to interact with doctors and administrators provided Tammy with a better understanding of universal healthcare and greater appreciation for medical professionals in Costa Rica. After conversations with Costa Rican doctors and administrators, Tammy began to reframe 185 her perspectives about the quality of medical training outside of the United States. As the result of her experiences in Costa Rica program, Tammy recognized an alignment between the College of Medicine’s goals for the program and some of the outcomes she accomplished by learning about a different healthcare system. Tammy’s experiences represented intersections between contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. Jay: Summary of Intersections Between the Contexts A prior work-related travel experience engaged Jay to appreciate cultural differences and influenced his interest to participate in education abroad. In Costa Rica, Jay interacted with doctors who emphasized taking a patient-centered approach similar with the professional culture within the College of Medicine. As doctors conveyed the importance of interacting with patients on a personal level, Jay reinforced his confidence in the medical school curriculum because he believed it was preparing him to be a compassionate practitioner. Additionally, Jay appreciated opportunities in the Costa Rica program to learn language skills, which he planned to utilize in his work with patients as a future physician. At the conclusion of the program, Jay felt motivated to serve patients in compassionate and culturally sensitive ways. Overall, these experiences showed overlap between contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. Conclusion In this chapter, I highlighted responses and reflections of four participants from Chapter 5 to demonstrate intersections between contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. The intersections presented in this chapter were representative of those manifesting for many participants in the study. Since the 186 intersection of contexts leads to a more coherent understanding of the whole student, these findings point to a holistic perspective regarding graduate students’ experiences of STFD education abroad programs. These ideas are discussed further in the final chapter of this study. 187 CHAPTER 7: DISCUSSION AND IMPLICATIONS The purpose of this final chapter is to interpret findings presented in Chapters 5 and 6 in order to discuss their contributions to the literature, implications for practice, and implications for future research. In Chapter 5, the findings highlighted four contexts influencing graduate students’ experiences of the short-term, faculty directed (STFD) education abroad program: adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. In Chapter 6, the findings addressed intersections between these four contexts that better explain their influence on graduate students’ experiences of the STFD education abroad program. Taken together, this discussion chapter provides a response to my research question and situates the findings within the purpose of this study. Throughout this dissertation, I explored graduate student experiences of an STFD education abroad program. As graduate students increasingly participate in STFD education abroad to meet career preparation for an increasingly global marketplace (CGS, 2010; Dirkx et al., 2014a; Dirkx et al., 2016; Sanger & Mason, 2019), very little is known about how they experience these programs (Dirkx et al., 2014b; Dirkx et al., 2016). Some preliminary research exploring education abroad programs at the graduate level suggest students and programs are different in terms of their developmental outcomes, professional approach, and curricular orientation (Dirkx et al., 2014a; Dirkx et al., 2014b; Dirkx et al., 2016; Sinclair, 2014; Loebick, 2017). To build upon this research, I examined how contexts of adult learning, professional socialization, and curriculum and pedagogy intersected to influence graduate students’ experiences of an STFD education abroad program. Through identifying contexts and their intersections, the purpose of this study was to help graduate education abroad programs account 188 for the goals, needs, and experiences of the graduate students they serve. More specifically, the research question for this study was: • How do contexts of adult learning, professional socialization, and curriculum and pedagogy intersect to influence graduate students’ experiences of a short-term, faculty-directed education abroad program? In this discussion, I first review findings from Chapter 5 demonstrating contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development influenced graduate students’ experiences of the Costa Rica program. Next, I discuss the findings from Chapter 6 highlighting intersections between these four contexts. Within these sections, I discuss how the findings are important to the literature and discussions encompassing contexts influencing graduate students’ experiences of STFD education abroad programs. Then, I provide a revised model for understanding graduate student experiences of STFD education abroad. Finally, I discuss implications for policy, practice, and future research. Contexts Influencing Graduate Student Experience of STFD Education Abroad The findings in Chapter 5 showed participants’ experiences of the Costa Rica program were influenced by four contexts: (1) adult learning, (2) professional socialization, (3) curriculum and pedagogy, and (4) interpersonal development. First, participants displayed characteristics of adult learners—taking into account their prior travel and work experiences, reframing their perspectives, and expressing pragmatic motivations for participating in the Costa Rica program. Second, the Costa Rica program reinforced formal and informal aspects of the professional socialization process for many participants. Third, the curriculum in the College of Medicine and pedagogical practices of the Costa Rica program shaped what students learned and experienced. Finally, interpersonal development highlighted participants’ interaction with others 189 and engagement across difference in the Costa Rica program that influenced a change in perspectives. I believe the findings in this area are relevant for at least three reasons. First, the findings begin to situate STFD education abroad programs as a graduate-level experience by accounting for graduate students’ personal, professional, scholarly, and interpersonal development. Faculty and administrators accounting for these contextual dimensions of graduate students are better able to meet their goals, needs, and orientation to learning in an STFD education abroad program. Second, the findings provide valuable insight into graduate students’ experiences of STFD education abroad programs that are embedded within the graduate learning environment. As such, knowledge about contexts leads to strategies for how programs can be structured to support education abroad at the graduate level. Finally, the findings add to the literature on graduate student experiences of education abroad, showing they are uniquely situated in their approach and orientation to these international programs. In the following sections, I highlight important findings for each context that advance the literature and discuss how they influence graduate student experiences of STFD education abroad programs. The Context of Adult Learning The first context found to influence graduate students’ experiences of the Costa Rica program was adult learning. These findings support literature suggesting graduate students in education abroad programs are experienced, self-aware, and motivated to build professional and academic skills (Dirkx et al., 2014a; Dirkx et al., 2016; Peppas, 2005; Tang & Rose, 2014). As adult learners, graduate students were influenced to set specific goals and expectations for their experiences of the Costa Rica program based on prior experiences and professional goals. Also, some participants reflected on their education abroad experiences in a way that demonstrated a 190 level of maturity and self-awareness consistent with adulthood. Three sub-themes were highlighted in the findings to account for different perspectives of adult learning that influenced participants’ experiences of the Costa Rica program: (a) experiential learning, (b) transformative learning, and (c) pragmatic learning. Experiential Learning Within the context of adult learning, a sub-theme was experiential learning. Some participants adapted prior international travel and occupational experiences to inform their goals for the Costa Rica program. Participants who previously traveled or studied abroad seemed to have an appreciation for international experiences and cross-cultural awareness. Ultimately, these prior experiences both served as a resource for learning and influenced some participants in the decision to enroll in the STFD education abroad program. Experiences are an important source of motivation and engagement in the learning process, which influences how adult learners adapt to the world around them (Merriam & Bierema, 2014). An adult’s adaption of life experiences is central to many perspectives of adult learning, including experiential learning. A key proposition behind experiential learning is “All learning is relearning. Learning is best facilitated by a process that draws out the students’ beliefs and ideas about a topic so that they can be examined, tested, and integrated with new, more refined ideas” (Kolb & Kolb, 2005; p. 194). The findings in this area highlight the importance of accounting for the experiences graduate students bring into STFD education abroad programs. Graduate students may have already traveled internationally or participated in an education abroad program, leading to an advanced understanding of global engagement and intercultural competence. Also, graduate students may set goals for an STFD education abroad program based on their life, family, and work experiences. 191 Additionally, while in Costa Rica, some participants reflected on prior experiences, which they used to build new knowledge, engage in new perspectives, and set new goals. These prior experiences seemed to serve as a foundation for their learning process in the Costa Rica program. Although Kolb’s (1984) experiential learning cycle was designed to address knowledge creation through the application of immediate experiences (Kolb & Kolb, 2005), there may be other ways to think about how this process can accommodate for the reinterpretation of a past or existing experience. As adults engage in a continuous process of adapting and evaluating experiences (Lindeman, 1926 as cited in Brookfield, 1995), the experiential learning cycle might play out on a larger, more cumulative scale. The experiential learning cycle, when comprised of multiple experiences, can happen continuously over a period of time in an adult learner’s life— accounting for an accumulation of knowledge and awareness that shapes their learning process. During education abroad, graduate students who previously travel, study, or work internationally may have experiences that act as a foundation to the learning and development they will accomplish in a program. Graduate students may recognize connections between their prior experiences that furthers their learning process while abroad, contributing to the experiential learning cycle. Finally, some participants spoke about applying experiences from an activity where they spoke with Costa Rican doctors to learn about their use of a physical examination technique. The participants were struck by the effectiveness of the physical examination and made plans to apply the experience to their future clinical training. Based on their accounts, the participants exhibited dimensions of Kolb’s (1984) experiential learning cycle by immersing themselves into a new experience (learning about the physical exam), reflecting on new perspectives (thinking about the usefulness of the physical exam), formulating new approaches (considering using the 192 physical exam in their clinical training), and incorporating new practices (planning to apply the physical exam in the future). Lutterman-Aguilar and Gingrich (2002) contend discussion and reflection are needed for students to maximize experiential learning during an education abroad program. I posit conversations with Costa Rican doctors and the nature of the discussion engaged students in some of the reflection and processing to make their experiences educational. These findings provide support for experiential learning in graduate education abroad programs (Loebick, 2017; Roholt & Fisher, 2013), and specifically experiences that expose students to new policies and practices for their professional roles (Gilin & Young, 2009). Furthermore, the results suggest graduate students may apply education abroad experiences to their learning when they are engaged in activities that cause them to encounter and reflect on new professional practices. Finally, the findings highlight the importance of having graduate students engage with other professionals in STFD education abroad programs, especially those who can facilitate meaningful discussions to assist them in reflecting on and processing their experiences. Elements of Transformative Learning Another sub-theme within the context of adult learning was participants’ demonstrating elements of transformative learning. A number of scholars link graduate education abroad programs with the potential to transform students’ perspectives or frames of reference (Dirkx et al., 2016; Litzelman, et al., 2017; Roholt & Fisher, 2013). Specifically, Litzelman et al. (2017) argued medical students have the ability to shift their perspectives as the result of disruptive experiences working with patients and engaging in international healthcare environments. In the study, participants demonstrated elements of transformative learning as they began acknowledging a change in perspectives and considering new approaches for their professional roles. Transformative learning is often identified as a process of reflection and meaning-making 193 where a disorienting dilemma causes an individual to question their assumptions or worldviews (Mezirow, 1991; 1997). In relation to Litzelman et al.’s (2017) claims, a few participants reexamined their views about healthcare policies and medical practices after working with patients and speaking with doctors in Costa Rica. Participants in the study began to engage in parts of the process of transformative learning as events abroad encouraged them to reflect on their professional and occupational goals, experiences, and beliefs. However, there were some limitations, as participant experiences were consistent with transformative learning only in their readiness to reexamine perspectives and begin to explore new responsibilities for their professional development. Although some participants began acknowledging a change in perspectives and considered alternatives for their professional development, they stopped short of fully transforming their ways of being and knowing. Students were just beginning to grapple with critical self-reflection about themselves in relation to their education abroad experiences, and they may have continued to reflect on their experiences and question their assumptions long after the conclusion of the program. As a researcher, I was unable to directly observe the reflection process or the disorienting dilemmas that occurred for students on-the-ground in Costa Rica, which could have strengthened the findings in this area. Nevertheless, based on my interviews with participants, their experiences still comprised some elements of transformative learning. The findings of this study align best with the work of Dirkx et al. (2016), who found graduate students have the potential for transformative learning but gain more of a professional self-understanding as the result of an education abroad program. Moreover, graduate students, rather than totally uprooting their self-concept as the result of an STFD education abroad program, engage in elements of transformative learning through beginning to reframe occupational dimensions of their professional selves. Through reflection 194 and meaning making during their experiences, STFD education abroad programs may offer a space for graduate students to develop a readiness to engage in transformative learning. Pragmatic Learning Pragmatic learning was a final sub-theme within the context of adult learning. When asked to explain their interests for enrolling in the Costa Rica program, participants mentioned specific goals, such as preparing for an international career, broadening knowledge about universal healthcare, and improving cultural competence for serving patients. By prioritizing career interests and the desire to be competent professionals, these participants took a pragmatic approach to learning and demonstrated characteristics consistent with adult learners in education abroad programs (Shallenberger, 2009). Adults are highly pragmatic learners because they are motivated to apply new information and experiences directly to their lives and gain skills to be competent professionals (Wlodkowski & Ginsberg, 2017). Moreover, adults desire to be successful, purposeful, and competent learners. The findings within pragmatic learning align with literature suggesting medical students are typically motivated to participate in education abroad programs to fulfill professional interests such as, building networks, enhancing their training, and providing care to underserved patient populations (Melby et al., 2017; Ventres & Wilson, 2020). Additionally, Dirkx et al. (2016) determined graduate students brought rich occupational backgrounds to their education abroad experiences and were more focused on gaining academic and professional outcomes as a result of their international experiences. As translational skills are needed to compete in the global workforce (CGS, 2010; Nerad, 2010; 2012), many graduate students likely participate in education abroad programs with the motivations to enhance their academic, career, and professional skills. The results of this study suggest graduate students may prioritize gaining 195 practical skills in an STFD education abroad program they can meaningfully apply to their lives and careers. The Context of Professional Socialization Professional socialization was a second context found to influence graduate students’ experiences of the Costa Rica program. Professional socialization is a process that graduate students undergo in adopting the norms, knowledge, skills, and expertise to assimilate into a profession (Gardner & Mendoza, 2010; Golde & Walker, 2006; Weidman et al., 2001). During the Costa Rica program, participants were influenced by formal requirements and competencies, informal norms and relationships, and connections with professionals. Additionally, participants demonstrated an interest in applying knowledge gained from the Costa Rica program to their professional and career development. Ultimately, the results of this study suggest STFD education abroad programs have the potential to reinforce the professional socialization process for graduate students. The following section includes four areas where I discuss how the findings fit into the context of professional socialization: (a) formal requirements and competencies, (b) social and cultural influences, (c) professional identity formation, and (d) career and professional advancement. Formal Requirements and Competencies Formal requirements and competencies shaped graduate student goals and experiences in the program. Some participants believed service-learning was an advantage of the Costa Rica program because they could complete all 40 of their required service hours through participation in education abroad. Additionally, many participants identified outcomes of the Costa Rica program strikingly similar to official competencies in the College of Medicine. Together, these findings advance a growing body of literature showing graduate education abroad programs are 196 driven by professional competencies and suggesting graduate students have the potential to identify when these programs complement their skill development as professionals (Gilin & Young, 2009; DuVivier & Patitu, 2017; Peppas, 2005; Slantcheva-Durst & Danowski, 2018; Witkowsky & Mendez, 2018). The ability to identify requirements and competencies demonstrated participants were influenced by formal stages of professional socialization, in which students understand values and ideologies within their professions (Weidman & Stein, 2003; Weidman et al., 2001). These findings suggest graduate students may set expectations for STFD education abroad programs based on requirements and competencies advancing their formal socialization process. Social and Cultural Influences Conversations with faculty and peers influenced participants to internalize how professional culture in the medical program fit with the Costa Rica program. With participants internalizing their professional development in the Costa Rica program based on informal interactions with faculty and peers in medical program, the findings of this study support scholars who argue academic climate contributes to the professional socialization of students (Weidman & Stein; 2003; Weidman et al., 2001). A large portion of the socialization process is informal, conveying values for professional life through implicit structures, rituals, and advice (Sadeghi et al., 2019). Specifically, for medical students, professional culture determines what actions and goals are worthwhile (Vaidyanathan, 2015). Thus, findings here suggest graduate students may experience STFD education abroad programs within implicit social and cultural structures of their socialization process. 197 Professional Identity Formation Interestingly, some participants who previously went to Costa Rica noticed differences in their approach to travel and engagement due to a new professional focus on medicine. This shift in participants’ mindset indicated they were beginning to assume the role of a professional in the field of medicine. This process was particularly salient for Yondu, who mentioned interactions with doctors in Costa Rica offered him the chance to see himself as a future medical professional. Teaching students to develop a professional identity is a major goal of the socialization process in medical education (Cruess et al., 2014; Cruess et al., 2015). A professional identity represents the internalization of knowledge, norms, and values within a profession, which often develops in the personal stage of socialization through mentorship, training, and connections with other professionals (Weidman et al., 2001). Thus, relationships developed with doctors and administrators in Costa Rica were important to Yondu’s professional identity and values he associated with professionalism. In providing graduate students opportunities to engage with an international community of professionals, STFD education abroad programs have the potential to influence professional identity development. Additionally, graduate students may focus on aspects of STFD education abroad programs that advance their knowledge and skills within their chosen professional field. Career and Professional Advancement A final area where the context of professional socialization influenced graduate student experiences was through professional knowledge acquired in the education abroad program. As students move through stages of socialization, they acquire knowledge to perform professional roles and responsibilities (Weidman et al., 2001). In the current study, participants were influenced to enroll in the Costa Rica program to improve their knowledge about healthcare 198 systems, enhance their training, and strengthen their medical competence as future physicians. Also, participants were committed to apply the knowledge they acquired in Costa Rica to strengthen their resumes for residency interviews, compliment their certificate programs, and prepare them for an international career. The findings relate to the work of other scholars who found graduate students made sense of their education abroad experiences as practicing professionals (Dirkx et al., 2016; Gilin & Young, 2009; Peppas, 2005). As a result, some graduate students may be influenced to seek out opportunities to enhance their technical training and skill development through an STFD education abroad program. The Context of Curriculum and Pedagogy A third context influencing graduate students’ experiences of the Costa Rica program was curriculum and pedagogy. Recent evidence suggests faculty play a critical role in designing education abroad programs to fit the larger curriculum in their academic departments and align them with competencies in their professional fields (Loebick, 2017; Sinclair, 2014). According to Loebick (2017), “Graduate education abroad has become an integral experience for graduate students to integrate academic knowledge, professional practice, and immersive application of learning” (p. 182). The findings within this context demonstrated that graduate students were influenced by aspects of the Costa Rica program when structured to align with competencies in the College of Medicine curriculum. Additionally, the findings showed some graduate students looked for opportunities to connect their education abroad experiences with practices they believed would complement their training in the College of Medicine curriculum. Finally, the findings demonstrated that components of how the Costa Rica program was designed and facilitated influenced the experiences of graduate students. 199 In this section, I use Toombs and Tierney’s (1993) matrix of curricular design as a tool to frame the context, content, and form of curriculum and pedagogy at the graduate level influencing graduate student experiences of the Costa Rica program. First, context highlighted the social and cultural aspects of the College of Medicine curriculum influencing participant expectations about their engagement in the Costa Rica program. Second, content addressed competencies in the College of Medicine curriculum guiding participant experiences of the Costa Rica program. Finally, form emphasized how pedagogical decisions and strategies for the Costa Rica program influenced graduate student experiences. In the sub-sections that follow, I discuss how the findings fit into these components of curriculum and pedagogy at the graduate level. Context: Social and Cultural Influences on the Curriculum Social and cultural norms of the medical school curriculum influenced participant experiences of the Costa Rica program. Hands-on learning was a valuable component for medical students to develop skills in their early clinical experiences in the College of Medicine. Since physicians were expected to demonstrate abilities to perform physical exams, engage with patients, and collaborate with other doctors in a clinical setting, the College of Medicine engaged students in hands-on training. Accordingly, some participants talked about their expectation to engage in hands-on activities in Costa Rica they believed would complement their early clinical experiences. Noteworthy activities in the Costa Rica program cited by participants included touring hospitals, shadowing doctors, and interviewing patients. Interacting with doctors and patients were recognized by participants as directly influential to their professional development. Sullivan (2005) points out that graduate students tend to model their learning on what a program deems valuable to professional training and development. Based on the findings, graduate 200 students applied what they considered valuable contexts of the curriculum to their expectations and evaluation of activities in the Costa Rica program. In addition to being a competency, service was a value integrated into the College of Medicine curriculum that encompassed students’ abilities to understand social issues and respond to community needs. As a result, Joan intentionally incorporated service-learning into the Costa Rica program to help students understand the value of sustainable community engagement. Joan’s main intent for the service project was for students to think about why they participated in service and how it related to working sustainably with a community as a healthcare professional. In general, participants believed the service project was valuable to connecting with patients, understanding the healthcare system, and learning about the Costa Rican community. Sinclair (2014) noted faculty leaders often organized graduate international experiences to fit the culture, values, and missions of their academic departments. As the Costa Rica program prioritized service learning to fulfill social and cultural norms within the College of Medicine, graduate students were influenced to think more deeply about service as it related to their professional development. Consequently, these findings suggest graduate students are responsive to activities in an education abroad program that align with social and cultural norms of their curriculum. Content: Competencies and Structure of the Curriculum Competencies and structure of the College of Medicine curriculum influenced participants’ experiences of the Costa Rica program. A noteworthy finding was the Costa Rica program affirmed the competency of patient-centered practice for some graduate students who were initially skeptical about its relevance to their training in the College of Medicine curriculum. Several participants spoke about gaining confidence in their curriculum after Costa 201 Rican doctors were impressed with their readiness to diagnose patient complaints and concerns. As a result, participants’ experience in the Costa Rica program influenced them to recognize the structure of their curriculum as a practical value for their professional development. While I believe this outcome of the Costa Rica program may have been unintended, opportunities for students to connect with doctors about topics specific to their disciplinary learning was important for them to acknowledge the value of their curriculum. Thus, the nature of graduate education abroad, in prioritizing discipline-specific content knowledge, likely influences graduate students to think about their academic and professional development in new ways. The findings in this area show graduate education abroad programs have the potential to affirm students’ confidence and commitment in professional competencies. Additionally, intended outcomes, reflecting content-related decisions made by the faculty director, influenced graduate student experiences of the Costa Rica program. Specifically, competencies of service, care for patients, and integration (i.e., knowledge of how social and cultural systems affect healthcare) were reflected through education abroad objectives and activities—shaping participants’ experiences in the program. For example, the partnership Joan arranged with PLAC gave participants an opportunity to interact with patients and learn about service. When asked why she integrated the service project into the program, Joan specifically mentioned they were part of students’ competencies and requirements. Generally, participants described the service projects as the most meaningful part of their Costa Rica experience because they were able to work closely with patients, help PLAC meet the needs of its clients, and learn more about universal healthcare. Also, an objective of the program was providing students with opportunities to compare public and private healthcare, which related to the competency of integration. Speaking with patients, doctors and policymakers, participants recognized the 202 implications of social and economic systems impacting cost and patient care. Many participants cited the importance of learning about a different healthcare system as integral to their experience in the Costa Rica program. Existing literature highlights how faculty are often strategic in developing graduate education abroad programs to reinforce professional competencies and disciplinary learning within their academic disciplines (Loebick, 2017; Sinclair, 2014). The findings in this area advance the work of these scholars by suggesting STFD education abroad programs reinforce graduate students’ commitment to professional and disciplinary learning. Form: Pedagogical Decisions and Strategies Pedagogical decisions about preparation and facilitation of education abroad influenced graduate student experiences in the program. Pre-departure meetings served as the primary instructional method leading up to the trip. Based on my observations, these meetings helped students gain a better understanding about what to expect in Costa Rica and how they would navigate cultural differences to accomplish their projects. Students also developed relationships in the meetings as the result of icebreakers and group activities. Previous studies linked pre-trip meetings with preparing students to develop relationships, team-build, and navigate different cultural, political, and social spaces while participating in education abroad (Donnelly-Smith, 2009; Mills et al., 2010; Mullens & Cuper, 2012). At the graduate level, scholars also assert pre- departure training is a critical component to prepare students for learning and engagement with host communities (Loebick, 2017; Melby et al., 2016; Tang & Rose, 2014). The results of this study echo the significance of pre-departure meetings and suggest they influence graduate students to build relationships and navigate cross-cultural engagement in STFD education abroad programs. 203 Additionally, activities incorporated into the Costa Rica program provided participants with opportunities to learn about social, cultural, and political characteristics of a universal healthcare system. Participants shadowed Costa Rican doctors to learn about patient-centered practices, toured hospitals, and interacted with patients. Many of these activities were led by doctors and administrators from GMI, who facilitated a majority of the program itinerary in Costa Rica. When asked about her approach to designing the Costa Rica program, Joan explained it was intentional for her to work with GMI because they had the experience and expertise needed to engage students in learning about the Costa Rican healthcare system. In letting GMI facilitate a majority of teaching on-the-ground in Costa Rica, Joan ensured her students were getting an authentic experience and learning first-hand from experts working in the system. A few scholars argue short-term education abroad programs are more effective when they incorporate opportunities for students to understand the local, political, social, and cultural attributes of a host country (Donnelly-Smith, 2009; Mills et al., 2010). As the result of activities led by GMI, many participants highlighted the benefits of learning about healthcare and medicine directly from Costa Rican professionals within the system. These findings suggest activities intentionally designed to provide social, cultural, and professional perspectives of host partners and systems positively influence graduate students’ experiences of STFD education abroad programs. Finally, leadership provided by the faculty-director played an important role in organizing pre-departure meetings that prepared students to interact with host partners and complete their service projects. Once the group arrived in Costa Rica, Joan kept students organized and on-task with the program itinerary and helped them interpret PLACs vision for the service project. Many participants appreciated the leadership Joan brought to the program, and 204 they believed she was critical to their learning, organization, and engagement in Costa Rica. Loebick (2017) concluded that faculty were the main drivers of graduate education abroad programs, meaning they played the key role in oversight, logistics, planning, and development. This study further illuminates the value faculty leadership adds to graduate student experiences of an STFD education abroad program. The Context of Interpersonal Development A fourth context influencing participants’ experiences of the Costa Rica program was interpersonal development, which highlighted relationship building, language learning, and cultural immersion. Interpersonal development was an unexpected context based on my initial review of literature on STFD graduate education abroad programs. The findings in this area centered around participants’ interaction with others and an engagement across differences. Participants recalled the importance of teamwork and relationships that formed in Costa Rica between students from two medical school campuses. Additionally, participants expressed interests in improving their Spanish skills and highlighted the importance interacting with others across language barriers in Costa Rica. Finally, participants discussed culturally immersive interactions in Costa Rica leading them to broaden perspectives about community, healthcare, and medicine. Overall, these findings suggest additional contexts may influence graduate students’ experiences of STFD education abroad programs outside the scope of adult learning, professional socialization, and curriculum and pedagogy. In this section, I provide a definition of interpersonal development and situate it within the broader literature on education abroad. A Definition of Interpersonal Development When looking across the data, a theme of interpersonal development was appropriate as a context because it encompassed participants’ relational, lingual, and cultural experiences and fit 205 traditional outcomes within the field of medicine. Training medical students increasingly includes interpersonal skills (Gilligan et al., 2016), which cover patient-centered communication, interaction with other physicians, and working as a member of a healthcare team. Skinner et al. (2016) proposed a definition of interpersonal skills in the health professions to include “effective communication, empathy, active listening, and cultural competence as well as professionalism” (p.22). Outside the field of medicine, higher education literature uses the outcome of interpersonal competence to describe college student abilities to establish meaningful relationships, collaborate, and engage across differences (Council for the Advancement of Standards in Higher Education, 2015; Keeling, 2006). For the purpose of this study, I define interpersonal development to encompass interactions with others that frame a desire to manage relationships, recognize outside perspectives, and act with cultural competence. Interpersonal Development and Education Abroad Within the context of interpersonal development, interactions between peers, across language barriers, and in culturally immersive situations influenced graduate students’ experiences of the STFD education abroad program. In the following sub-sections, I explore these areas to show how they fit into the broader literature on education abroad. Relationships Developing Between Students. In the current study, many participants mentioned the importance of interactions with their peers that resulted in the formation of new relationships during the Costa Rica program. Since the education abroad program enrolled students from two separate campuses, participants often spoke about new relationships forming with peers who were just acquaintances prior to pre-departure meetings. Also, a few participants highlighted how they appreciated having multiple viewpoints to process their experiences when they worked in groups to complete projects and engaged in discussions in Costa Rica. 206 Similar to participants in the current study, literature suggests relationships are an important part of graduate student experiences in education abroad programs. Dirkx et al. (2016) found graduate students highlighted personal relationships with colleagues as an important aspect of their education abroad experiences and expressed an appreciation for having multiple perspectives when working as a group. Additionally, Slantcheva-durst and Danowski (2018) discovered graduate students formed lasting relationships and learned to navigate group dynamics as the result of participating in a short-term education abroad program. Finally, Coryell (2011) used a community of practice framework to understand the influence of interactions among adult learners in short-term education abroad programs. Although participants in the study were a mixed cohort of graduate and undergraduate students, Coryell (2011) discovered interactions between adult learners were meaningful to their development of interpersonal skills. In group discussions, students were able to broaden their perspectives through feedback and the consideration of others’ viewpoints. Thus, the findings, coupled with these studies, show the importance of interactions with peers during graduate education abroad programs. Since graduate students typically function in cohort groups (Weidman et al., 2001), they may value having feedback from others when processing their STFD education abroad experiences. Language Learning and Immersion. Before departing for Costa Rica, participants cited goals of improving their Spanish skills to better communicate with ESL patients and families. While in Costa Rica, interactions with patients, doctors, and administrators in Spanish influenced participants to recognize the difficulty of communicating across language and cultural barriers. Despite these difficulties, a few participants gained confidence in their abilities to connect and nonverbally communicate with patients, which they planned to implement in their work as future physicians. While foreign language proficiency is recognized as a goal of education abroad 207 programs (Engle & Engle, 2003; Savicki, 2011; Savicki et al., 2013; Twombly et al., 2012), participants in the current study utilized their experiences more to build motivation and confidence for engaging in cross-cultural exchange. These findings relate more with sociolinguistic awareness, which Deardorff (2006) uses in her model of intercultural competence and defines as “awareness of relation between language and meaning in societal context” (p. 250). In this sense, language learning was seen by participants as an opportunity to explore and gain awareness for cultural differences, which they could then apply to their personal and professional development. The findings in this area also support a few other studies showing language and communication influencing graduate student experiences of education abroad. First, Dirkx et al. (2016) found some graduate students experienced interference in their sociolinguistic norms during education abroad, which encouraged them to consider the perspectives of others. Second, DuVivier and Patitu (2017) discovered graduate students gained confidence in communication skills as the result of working through language barriers during their international experiences. Ultimately, language learning and immersion during an STFD education abroad program may serve as an important tool for graduate students to develop alternate perspectives and learn new ways of connecting with others. Cultural Immersion. Participant experiences were influenced by cultural immersion, which accounted for interactions with host families, doctors, and patients in Costa Rica, helping participants establish new perspectives about family, community, and hospitality. Also, participant experiences interacting with Costa Rican doctors and NGO administrators encouraged participants to acknowledge social and cultural issues affecting healthcare and medicine. An interesting finding was some participants began to think about their professional 208 learning and practices more from a global health perspective—seeing American healthcare values and policies in a different light. As cross-cultural connections are recognized as foundational goals of education abroad programs (Hoffa & DePaul, 2010), these findings suggest graduate students are also influenced by culturally immersive experiences. Participant experiences in this area related to traditional outcomes of education abroad programs, including intercultural competence (Deardorff, 2009; Engle & Engle, 2003; Hoffa & DePaul, 2010; Lincoln Commission, 2005), global mindedness (Chieffo & Griffiths, 2004; Hadis, 2005), and cultural sensitivity (Anderson et al., 2006; Engle & Engle, 2004). Yet, these outcomes also occurred for many participants within the framework of their professional development. Gaining a comparative understanding of healthcare values, polices, and practices was a central piece of participants’ cultural competence, suggesting this outcome was experienced within the bounds of the professional discipline. Loebick (2017) found faculty leaders incorporated education abroad programs as an internationalization strategy to fulfill cultural competencies for students, “to best prepare them for their professional endeavors” (p. 76). Similarly, Sinclair (2014) discovered cultural competence related to knowledge within a discipline was a rationale for faculty to implement graduate international experiences into their curriculums. Coupled with these studies, the findings in this area show cultural engagement in an important component of graduate student experiences in an STFD education abroad program. For graduate students, their professional and disciplinary knowledge likely shapes their cultural immersion and the different cross-cultural perspectives they take away from an international experience. 209 Intersections Between Contexts Influencing Graduate Student Experiences of STFD Education Abroad The findings in Chapter 6 highlighted the experiences of four participants to show intersections between contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. Participants experienced the Costa Rica program through intersections between personal, professional, scholarly, and interpersonal dimensions of their goals, characteristics, and engagement. Intersections existed when participants’ experiences of the Costa Rica program overlapped between the contexts. These intersections are noteworthy because they represent a more comprehensive understanding of each context, leading to a holistic perspective of graduate students’ experience of STFD education abroad programs. In other words, I obtain a more comprehensive understanding of a context’s influence on graduate students’ experiences by understanding its intersections with other contexts. While there were examples where several contexts intersected at multiple points, I discuss intersections that were most prevalent in the findings: (a) adult learning and professional socialization, (b) professional socialization and curriculum and pedagogy, (c) curriculum and pedagogy and adult learning, and (d) interpersonal development and curriculum and pedagogy. For each of these intersections, I discuss how they provide a more comprehensive understanding of graduate students’ experiences of STFD education abroad programs. Below, table 2 is included to provide an overview of prevalent intersections between contexts that influenced graduate students’ experiences in the education abroad program. 210 Table 2: Overview of prevalent intersections between contexts influencing graduate students’ experiences Prevalent Intersections Between Contexts Influence on Graduate Students’ Experiences Intersections between • Pragmatic motivations for learning coincided with a adult learning and commitment to professional and career advancement professional socialization • Applied experiences to inform professional development Intersections between • Satisfied professional training and development through professional competencies in the curriculum and the design of the education socialization and abroad program curriculum and pedagogy Intersections between • Opportunities for language and cultural immersion were interpersonal facilitated by service-learning activities and the chance to work development and with patients curriculum and pedagogy • Peer-to-peer relationships were influenced by teambuilding activities Intersections between • Pedagogical strategies engaged adult learners in hands-on curriculum and experiences and opportunities for reflection—helping them pedagogy and adult make sense of their learning learning Intersections Between Contexts of Adult Learning and Professional Socialization Intersections between the contexts of adult learning and professional socialization influenced some participant experiences of the Costa Rica program. Because the context of adult learning was broken up into three distinct perspectives, the most salient examples were highlighted: pragmatic and experiential learning. First, as pragmatic learners, participants desired to build skills for their personal and professional development. Second, experiential learning framed participants desires to apply their experiences to inform their professional roles and responsibilities. In the following sub-sections, I discuss how these perspectives of adult learning 211 overlapped with aspects of professional socialization to influence graduate student experiences of the Costa Rica program. Pragmatic Learning Intersecting with Professional Socialization Some participants’ motivation to learn in Costa Rica intersected with their commitment for professional development and career advancement in the field of medicine. For example, Monica was motivated to shadow doctors in Costa Rica, which resulted in a meaningful experience because she adopted practices to apply in her future role as a physician. Additionally, Tammy saw the Costa Rica program as an opportunity to improve her cultural competence for interacting with patients. Finally, Fred expressed a desire to show commitment to building global health skills through participation in the Costa Rica program. For adult learners, social responsibility shapes motivation for learning because they desire to be competent and respected in their professional communities (Wlodkowski & Ginsberg, 2017). Also, adults are motivated to learn information they find useful and valuable to their lives and careers. These motivations relate to the socialization process, which depends on a graduate student’s goals, commitment, and investment into a professional role (Weidman et al., 2001). Hegarty (2011) sought to understand graduate students as adult learners and noted overlaps between their desire to satisfy professional development within a discipline and personal motivations to advance their careers. Within the literature on graduate education abroad, scholars highlighted career and professional development influencing student goals and outcomes of programs (Dirkx et al., 2014a; Dirkx et al., 2016; Ventres & Wilson, 2020). Thus, intersections between an adult learner’s motivations to build competence and a graduate student’s investment in professional preparation provides a more coherent understanding of the goals graduate students may bring into an STFD education abroad program. 212 Experiential Learning Intersecting with Professional Socialization In the current study, a few of the participants applied their experiences to inform their professional goals and development in the Costa Rica program. Fred utilizing his past experiences participating in service trips to think about the professional applications of the Costa Rica program related to his career interests in global health. Additionally, Monica considered applying her experience learning about the physical exam techniques in Costa Rica to her professional goals and responsibilities as a future physician. For adult learners, experiences are both an important source of motivation for learning and a means for building new knowledge (Brookfield, 1995; Merriam & Bierema, 2014), which may also contribute to their professional development. The process of applying experiences to inform professional development relates to knowledge acquisition, which is a core element of the socialization process (Weidman et al., 2001). As students are socialized into a professional role, they begin to think about how their experiences contribute to specialized knowledge that prepares them for their professional roles and responsibilities (Weidman et al., 2001). In an education abroad program, experiences interacting with other professionals in a different context may apply to new knowledge and skills, shaping a professional identity. For instance, Gilin and Young (2009) discovered graduate students applied their experiences in an education abroad program to influence their professional roles, responsibilities, and identities as future social workers. Thus, intersections between an adult learner’s application of experiences and knowledge acquisition for a professional role provides a more comprehensive understanding of graduate student engagement in an STFD education abroad program. Through their experiences in an education abroad program, graduate students may be influenced to extend their professional knowledge beyond what they learn in 213 their professional programs. Experiences also serve as a foundation for some graduate students to recognize how their participation in an education abroad program prepares them professionally. Intersections Between Professional Socialization and Curriculum and Pedagogy Several participants’ experiences were influenced by intersections between the contexts of professional socialization and curriculum and pedagogy. Generally, participants identified activities in the Costa Rica program that helped them advance, validate, and improve upon their professional training and development. Through conversations with Costa Rican doctors, Monica and Jay gained confidence in the College of Medicine curriculum and confirmed value in the skills and practices they were learning. Additionally, Fred believed opportunities to work alongside doctors and NGOs in Costa Rica contributed to his confidence to pursue global health as a physician. Finally, Tammy connected her professional outcomes of learning about a different healthcare model with formal objectives that were built into the Costa Rica program. These participant experiences demonstrated a synergistic relationship between contexts of professional socialization and curriculum and pedagogy that revolved around student learning and development in the STFD graduate education abroad program. Within the literature on professional socialization, curriculum is recognized as a component influencing students’ professional development (Cruess et al., 2015; Sadeghi et al., 2019; Weidman et al., 2001). Formal dimensions of professional socialization include course requirements, examinations, and expectations within an academic department (Weidman & Stein, 2003), which are shaped by faculty decisions about curriculum and instruction. According to Weidman et al. (2001), “While the differences in curricular content across fields are obvious, the instructional delivery of that curriculum most assuredly sets the tone for how students are socialized into that profession” (p. 58). In the field of medicine, the socialization process is 214 informed by components of the curriculum encompassing formal teaching, role models, learning environments, and educational objectives (Cruess et al., 2015). These aspects of the curriculum play a part in guiding medical students to develop competence needed to adopt the professional identity of a physician. Since the socialization process is supported by components of a curriculum (Cruess et al., 2015; Sadeghi et al., 2019; Weidman et al., 2001), this overlap is part of the graduate student experience influencing their involvement and engagement in programs such as education abroad. Within the literature on graduate education abroad, scholars found that faculty directors often organized programs to reinforce competencies, norms, and curricular structures within their disciplines and departments (Loebick, 2017; Sinclair, 2014). In responding to goals and outcomes of education abroad programs, graduate students are influenced to focus on professional training and development. These intersections between contexts of professional socialization and curriculum and pedagogy provide a more comprehensive perspective of graduate student experiences in an STFD education abroad program. For graduate students, education abroad programs can both serve as a microcosm of the socialization process and an extension of the graduate curriculum. When these overlaps occur, graduate students are influenced to build confidence in their training and professional development. Intersections Between Curriculum and Pedagogy and Adult Learning Participant experiences were influenced by intersections between the contexts of curriculum and pedagogy and adult learning. First, the curriculum and pedagogy of the Costa Rica program aligned with pragmatic goals of some participants, who were motivated to build professional competencies and skills as the result of education abroad. Second, a few participants 215 who demonstrated outcomes of transformative and experiential learning were influenced by activities integrated into the curriculum and pedagogy of the Costa Rica program. Curriculum and Pedagogy Intersecting with Pragmatic Learning A few participants who held motivations for connecting with patients and physicians across cultural differences were influenced by hands-on activities built into the Costa Rica program itinerary. The service project with PLAC provided a space for Tammy to interact with patients across cultural differences and understand how to provide resources to underserved communities. For Monica, panel discussions and patient interviews were a valuable resource for information about differences in healthcare practices between the United States and Costa Rica. These activities allowed participants to build competencies and skills they were initially motivated to develop in the STFD education abroad program. In catering to the needs of adult learners, instructors must recognize they are motivated to apply new information and experiences directly to their lives and gain skills to be competent professionals (Wlodkowski & Ginsberg, 2017). At the graduate level, curriculum represents a focus on content knowledge that is advanced and specialized (CGS, 2011). For professional fields such as medicine, curriculum is deliberate and organized around specific skills and competencies students are expected to learn (Weidman et al., 2001), through specialized modes of training such as clinical experiences (Cruess et al., 2015; Sullivan, 2005). As graduate students expect to satisfy knowledge and training requirements within their professional programs, they also interpret their learning to be purposeful (Hegarty, 2011). Thus, curriculum and pedagogy at the graduate level likely cater to the needs of graduate students who are pragmatic adult learners. Within the literature on graduate education abroad, Dirkx et al. (2016) found graduate students were motivated to engage in international experiences to fulfill academic and 216 professional goals. Graduate students experienced education abroad as both adult learners and emerging professionals. As the result of their findings, Dirkx et al. (2016) asserted that for graduate students in education abroad programs “there is a need to create curricular and pedagogical environments that are more closely aligned with their professional development needs” (Dirkx et al., 2016, p. 515). Similarly, the current study supported this claim, as participants indicated activities embedded into the Costa Rica program helped them meet their professional goals and needs. Intersections in this area show how the design and facilitation of an STFD education abroad program may influence the satisfaction of graduate students who are motivated to participate for professional interests and goals. As adult learners are motivated to be successful in their learning process, graduate students may desire to gain knowledge and skills from an education abroad program they will later apply to their training or coursework. Curriculum and Pedagogy Intersecting with Experiential and Transformative Learning Intersections for participants also occurred between the curriculum and pedagogy of the Costa Rica program and adult learning perspectives of experiential and transformative learning. First, Monica demonstrated aspects of experiential learning when she spoke about her desire to apply a physical examination to her future training and development. Monica’s capacity to recognize the value of the physical examination appeared to be the result of listening to Costa Rican physicians emphasize hands-on techniques with their patients. She also highlighted the importance of activities such as panels and discussions because they engaged students in open and honest conversations about what they were learning. Second, Tammy demonstrated elements of transformative learning when she indicated that dialogue with physicians in the Costa Rican healthcare system and connections with GMI engaged her to reframe her perspectives about medical training outside of the United States. 217 Both Tammy and Monica’s experiences were influenced to some degree by curriculum and pedagogy of the Costa Rica program, which engaged students in activities to shadow physicians, attend seminars, and interview patients. Also, guided discussion sessions were incorporated into the Costa Rica program itinerary, allowing students to engage in meaningful and candid conversations about their experiences. For adult educators, curricular and pedagogical approaches for experiential and transformative learning often revolve around facilitating reflection and engaging learners in environments that inspire meaning making and change. Kasworm and Bowles (2012) point out that transformative learning can be fostered through intentionally designed learning environments and curricular approaches that engage learners in new or unfamiliar experiences. These scholars note the primary instructional method for facilitating transformative learning is developing intentional opportunities for learners to engage in self-reflection through mediums such as reflective essays and critical discussions. Similarly, experiential learning emphasizes the importance of reflection and analysis to make experiences educational (Kolb, 1984; Joplin, 1995). Kolb and Kolb (2005) posited, “The enhancement of experiential learning in higher education can be achieved through the creation of learning spaces that promote growth-producing experiences for learners” (Kolb & Kolb, 2005, p. 205). Educators create spaces for experiential learning through opportunities for discussion, conversation, action, and reflection. Thus, the process of learning is dependent upon an aspect of pedagogy, in facilitating and nurturing experiential and transformative experiences for learners. Within the literature on graduate education abroad, some scholars argue the importance of facilitating opportunities for students to learn, grow, and change from their international experiences (Dirkx et al., 2016; Roholt & Fisher, 2013; Tang & Rose, 2014). Roholt and Fisher (2013) assert education abroad must support reflection and discussion to facilitate and enhance 218 learning and perspective transformation for students. These scholars also highlight the value of having host facilitators lead reflection and debriefing sessions because they are able to communicate local context and practices. Additionally, Dirkx et al. (2016) recommend instructors build time for reflection and debriefing into their graduate education abroad programs to help graduate students make sense of their experiences in ways resonating with their personal and professional development. Finally, Tang and Rose (2014) suggest learning activities structured into an education abroad program aid students in gaining relevant knowledge and building stronger networks with host organizations. The intersections in this area extend the literature by providing a more coherent understanding about the link between graduate student learning and the pedagogy of an STFD education abroad program. Thus, some components of the graduate student experience within the context of adult learning (i.e., critical reflection, applying experiences to inform new situations) are likely dependent upon activities integrated into an STFD education abroad program. Those facilitating opportunities for reflection and discussion are influential to what graduate students learn and experience in an STFD education abroad program. Intersections Between Interpersonal Development and Curriculum and Pedagogy Participant experiences were influenced by intersections between interpersonal development and curriculum and pedagogy. These intersections occurred in two main areas. First, participants engaged in interactions with patients as part of the service project built into the Costa Rica program that influenced language and cultural immersion. Second, participants developed relationships with peers as the result of interactions and teambuilding activities designed into the Costa Rica program. These intersections highlighted the influence of the design and facilitation of an STFD education abroad program on the types of language, cultural, and 219 relational interactions experienced by graduate students. In the next two paragraphs, I highlight elements of interpersonal development that intersected with curriculum and pedagogy: cultural and language immersion and peer-to-peer interactions. First, participants interacted with Costa Rican patients across language and cultural barriers as part of the service project built into the education abroad program. Fred mentioned how listening to patient stories was both a meaningful experience for him and helped him understand the Costa Rican healthcare system. Additionally, Tammy felt the service projects allowed her to connect with patients on a personal level, which helped her develop a cross- cultural understanding of how international communities were affected by healthcare systems. Tammy also gained confidence in communicating across language barriers as the result of an emotional exchange with a patient during the service project. A central aim of education abroad programs is to promote cross-cultural experiences for students that aid them in developing intercultural competence (Anderson et al., 2006; Hoffa & DePaul, 2010; Lincoln Commission, 2005; Lutterman-Aguilar & Gingerich, 2002). Within intercultural competence, a factor includes sociolinguistic awareness, which accounts for the use of language in social and cultural contexts (Deardorff, 2006). As such, best practices for education abroad programs include providing students with opportunities to engage with members of a host community (Donnelly-Smith, 2009; Mills et al., 2010). At the graduate level, cultural competence is a goal for education abroad that is tied to professional preparation within an academic discipline (Sinclair, 2014; Loebick, 2017). Specifically, Sinclair (2014) found that goals for international experiences in the field of medicine centered around opportunities for students to interact with diverse patient populations and understand healthcare from a global perspective. In the current study, opportunities to interact with patients in the service project allowed participants develop cultural 220 competence and develop new perspectives about healthcare and medicine. Interactions also provided a hands-on component within the education abroad curriculum that engaged participants in learning about patient stories, concerns, and ways they persisted within the healthcare system. Ultimately, the intersections in this area show graduate students benefit from culturally immersive activities built into an STFD education abroad program—especially those promoting hands-on learning and interpersonal development. A second example of interpersonal development intersecting with the context of curriculum and pedagogy was peer-to-peer relationships that developed through teambuilding and group activities built into the Costa Rica program. Monica mentioned the benefits of building relationships with peers who she did not know prior to the Costa Rica program. Also, Jay spoke about the benefits of having multiple perspectives when interacting in a group setting during the Costa Rica program. Prior studies highlight the benefits of peer-to-peer relationships for graduate students in education abroad programs (Dirkx et al., 2016; Slantcheva-durst & Danowski, 2018). Additionally, Loebick (2017) cited peer-to-peer learning as an important outcome that faculty espoused for graduate students in their education abroad programs because they offered opportunities to broaden perspectives further and learn from one another. Some faculty noted interpersonal learning often happened simultaneously with individual learning when students shared an experience and processed it in different ways. Ultimately, peer-to-peer learning is an important aspect of interpersonal development for students that can be facilitated through group projects, discussions, and activities incorporated into a graduate education abroad program. Thus, the intersections in this area demonstrate the influence of program design on graduate students’ abilities to build relationships in an STFD education abroad program. 221 A Holistic Perspective of Graduate Student Experiences of STFD Education Abroad Based on the intersections highlighted above, participants’ experiences of the Costa Rica program were mutually influenced by contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. At the end of Chapter 6, I provided a series of summaries to show how intersections between the contexts influenced several aspects of participants’ experiences of the Costa Rica program. Examining intersections between the contexts allow for a holistic perspective on graduate student experiences in STFD education abroad programs—where goals, characteristics, and outcomes are interconnected with the student at the center. A holistic perspective is important because it allows faculty-directors to approach the design and facilitation of programs with a more coherent understanding of the whole graduate student. With a better understanding of how contexts intersect, STFD education abroad programs can engage graduate students in more effective ways by attending to their needs as sojourners, scholars, learners, and emerging professionals. In this section, I present a revised model for understanding the intersection of contexts influencing graduate students’ experiences of an STFD education abroad program. This model helps to further explain the importance of taking a holistic viewpoint of graduate students’ experiences in an STFD education abroad program. A Revised Model for Understanding Graduate Student Experiences of STFD Education Abroad In my conceptual framework, I provided an integrated model (see figure 1), which illustrated intersections between contexts of adult learning, professional socialization, and curriculum and pedagogy. This initial model was grounded in the literature and acted as a tool to 222 inform my understanding around how these contexts and their intersections influenced graduate student experiences of STFD education abroad. The findings in the current study provided greater insight regarding contexts and their intersections that influenced graduate student experiences, which led to opportunities to strengthen my initial model. Also, the findings added to the model, as a new context of interpersonal development was constructed to account for graduate students’ interactions with others that framed their experiences in the STFD education abroad program. When examining how contexts intersected to influence graduate student experiences, components of the model became more defined. Intersections between the contexts became clearer. As a result, a revised model (see figure 2) was constructed to provide a more comprehensive framework for understanding contexts and their intersections as they relate to graduate student experiences of STFD education abroad. 223 Figure 2: A Revised Model for Understanding Graduate Student Experiences of STFD Education Abroad 224 The revised model integrates contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development together to show how they intersect with one another. Each of the four contexts are represented by porous circles that intersect at multiple points around the graduate student at the center of the model. Intersections are highlighted at points where contexts are interrelated with one another and share mutual goals, outcomes, or processes. These intersections are evidenced by examples provided in Chapter 6 and highlighted in the discussion above. Since all of the intersections could not be displayed within the core diagram itself, two text boxes were included to show intersections between adult learning and professional socialization, as well as intersections between interpersonal development and curriculum and pedagogy. The fact that text boxes were needed to show all of the intersections between the contexts indicates the complexity of the graduate student experience. Central to this model are graduate student experiences to show how they are mutually influenced by contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. Graduate students’ goals, interests, and experiences during an education abroad program have the potential to overlap at multiple points. For example, Fred’s prior experiences with international service projects motivated him to engage Costa Rican doctors in conversations about refugee crises, which influenced his desire to continue pursuing global health as a career option. Monica recognized networking opportunities were gained as part of the relationships she developed with peers in Costa Rica through group projects built into the program curriculum. Jay’s ability to interact with Costa Rican doctors through planned shadowing activities helped him develop professional values of patient-centered practices. In 225 these instances, the model is beneficial because it provides a way to identify the potential for these intersections. Overall, this model provides an initial foundation for understanding how graduate students experience STFD education abroad programs. The model represents the complexity of graduate student experiences, which affords an opportunity to take a more holistic approach to designing and facilitating their engagement in STFD education abroad programs. A holistic approach means thinking about graduate student engagement and development in multiple ways and from various perspectives. Faculty-directors and administrators can utilize this model to visualize intersections and design STFD education abroad programs that more closely align with the students’ personal, professional, scholarly, and interpersonal needs. Implications for Policy and Practice This current study has shown how the contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development and their intersections influence graduate students’ experiences of an STFD education abroad program. This case study allows faculty-directors and administrators who design and facilitate graduate education abroad programs to better understand how they can support graduate students in ways that address their goals, needs, and experiences within these contexts. As these contexts are complex and intersecting, STFD education abroad programs should be designed and facilitated with a holistic view of the graduate student in mind. The next section includes implications for each of the four contexts to encompass design, facilitation, and policy implementation of graduate STFD education abroad programs. Throughout this section, I highlight how intersections between the contexts also factor into implications for the design and facilitation of STFD education abroad 226 programs. I conclude this section by discussing implications for intersections between the contexts. The Context of Adult Learning Given the findings of the current study, graduate students represented characteristics of adult learners that shaped their experiences of an STFD education abroad program. Therefore, faculty-directors should consider the needs, goals, and experiences of adult learners when designing and facilitating STFD education abroad programs for graduate students. There are three implications where STFD education abroad programs can account for graduate students as adult learners: (a) recognizing prior goals and experiences; (b) incorporating opportunities for hands-on learning; and (c) structuring time for reflection and analysis. First, faculty-directors and administrators should create methods to assess the prior experiences and professional goals that graduate students bring with them into an STFD education abroad program. Shallenberger (2009) notes adult learners often bring rich experiences with them into education abroad programs, and they seek international experiences that relate to their personal and professional development. As adult learners, graduate students may be motivated to learn skills in an STFD education abroad program they deem valuable to their lives and careers. Prior experiences can provide graduate students with more confidence in approaching new international settings and a better understanding of the goals they want to accomplish. Methods of assessing student motivations and prior experiences could include an application essay or survey that students are required to complete when enrolling into an STFD education abroad program. As faculty-directors consider intersections between adult learning and curriculum and pedagogy, this information can be useful when designing a program itinerary. Activities can be included that cater to the goals, needs, and experiences of adult learners. 227 Additionally, information about personal and professional goals can be used to implement engaging conversations and discussions about how students can apply education abroad experiences to their future roles and responsibilities. Ultimately, pre-assessments can help faculty-directors and administrators account for the needs of graduate students who are engaging in STFD education abroad—to ensure these programs are something they care about and find useful. Second, faculty-directors and administrators should incorporate opportunities for hands- on learning into an STFD education abroad program to support graduate students in applying theoretical knowledge to real-life situations related to their professional development. In the current study, opportunities to shadow doctors, interview patients, and attend a policy conference were important to participant learning. Some participants planned to apply medical techniques they learned from experiences directly observing and talking with Costa Rican doctors. Adult learners are motivated by hands-on learning because they can connect skills and promote the retention of new knowledge through experiences (Conlan et al., 2003). Purposefully planning hands-on activities into an STFD education abroad program can help ensure graduate students are able to engage in experiences that lead to professional and practical outcomes. In the planning process, faculty-directors and administrators should consider other contexts such as professional socialization and curriculum and pedagogy—to understand how integrating hands- on activities can also satisfy professional competencies embedded into the curriculum. Students may gain knowledge and skills that engage them as emerging professionals. Additionally, hands- on activities may promote concrete experiences that start learners in the experiential learning cycle and bring about critical incidents where their knowledge, norms, or values are challenged. Types of hands-on activities could include shadowing professionals in their roles, engaging in 228 service-learning projects, touring facilities, and interviewing individuals about their experiences. While experiences alone will not result in knowledge construction without some type of reflection and analysis (Joplin, 1995; Lutterman-Aguilar & Gingerich, 2002), hands-on activities can influence the chance for experiential learning and professional development for graduate students in an STFD education abroad program. Finally, faculty-directors should structure opportunities for reflection and analysis into the design and facilitation of STFD graduate education abroad programs. Opportunities for group reflection and discussion following major activities and events helps to ensure graduate students are able to process where they may have encountered new perspectives, experienced uncomfortable situations, and made practical connections to their coursework. Also, post- program reflective interventions, such as debriefing sessions or end-of-program reflection assignments are also important to help graduate students make sense of disorienting experiences or opportunities to reframe their personal and professional perspectives. Finally, faculty-directors might also think about intersections between the context of curriculum and pedagogy to plan reflection and discussion sessions into a program itinerary. Whenever possible, host-country facilitators should be incorporated into reflection and discussion sessions because they can add local expertise and context to student experiences (Roholt & Fisher, 2013). Graduate students may benefit from having host-country professionals lead conversations and discussions about policies or practices outside the scope of their coursework and training. Faculty-directors should also be conscious of critical incidents that may arise during the course of an STFD education abroad program, causing students to question values, beliefs, and perspectives. At the graduate level, critical incidents might include dimensions of students’ professional roles and practices. In these situations, faculty-director 229 intervention can help graduate students move from reflecting on an experience to thinking deeply about how to implement new values, knowledge, or skills into their everyday practice (Dirkx et al., 2016). As graduate students have the potential to transform their ways of being and knowing during an STFD education abroad program, group reflection facilitated by a faculty-director can support them to make connections between their experiences and personal or professional development. Finally, individual reflection assignments should be designed into an STFD education abroad program to encourage graduate students to evaluate their experiences and acknowledge aspects where they gained new awareness about themselves or their professional roles. The Context of Professional Socialization The findings of the current study show that STFD education abroad programs can complement the professional development of graduate students. Moreover, components of an STFD education abroad program can satisfy formal requirements and competencies, contribute to social norms within an academic discipline, and engage students in developing their professional identities. As such, STFD education abroad programs should be designed to complement and reinforce the professional socialization process for graduate students. There are two implications where faculty-directors and administrators can account for graduate students as emerging professionals: (a) implementing departmental policies that include education abroad as an option to complete formal requirements, and (b) creating opportunities for professional development and knowledge acquisition. First, faculty-directors and administrators should consider implementing departmental policies that include STFD education abroad as an option for students to complete formal requirements in their academic or professional programs. Formal requirements might include 230 service-learning hours, international coursework electives, or field experiences (i.e., observations, consulting, shadowing), for which education abroad can be listed in departmental handbooks as an option to fulfill them. Since graduate education abroad is utilized to enhance disciplinary content by providing graduate learners with opportunities to apply their knowledge and skills in international contexts (Loebick, 2017; Sinclair, 2014), there are benefits to linking these types of programs to formal requirements. Faculty-directors can reliably design components of STFD education abroad around formal requirements and there is less of a burden to rationalize the value these programs provide to students and departments. Additionally, graduate students will be able to see how these programs fit into professional expectations, skills, or competencies in their academic disciplines. As a result, graduate students may be encouraged to participate in education abroad programs when they are tied to formal requirements. However, STFD education abroad programs should not be the only means to achieve a formal requirement, as they may not be a viable option for all students. Nevertheless, these policies can lead to more consistency with the development of STFD education abroad programs and allow for graduate students to set clearer expectations about an international experience factors into their professional socialization process. Second, the professional needs of graduate students must be accounted for when designing and facilitating STFD education abroad programs. As part of the socialization process, graduate students are interested in acquiring knowledge and skills to improve their professional roles and responsibilities (Weidman et al., 2001), which likely factors into their decision to participate in STFD education abroad programs. As pragmatic learners, graduate students may have motivations to build skills for their lives and future careers. In the current study, several participants viewed education abroad as a way to strengthen their knowledge about healthcare 231 systems and enhance their competence for working cross-culturally with patients. By recognizing intersections between the contexts of adult learning, professional socialization, and curriculum and pedagogy, faculty-directors can build an education abroad itinerary to engage students in aspects of professional preparation and satisfy their pragmatic motivations for learning. Also, opportunities for students to gain mentorship, training, and networking can be integrated into an STFD education abroad program through developing intentional partnerships with other professionals at host-country universities, institutes, and non-profit organizations. These partnerships help facilitate connections with experts, policymakers, and administrators—offering a chance for graduate students to expand their professional network and perspectives. These types of activities where students are able to observe and network with other professionals in their field can increase the likelihood they will expand upon their identities as emerging professionals. The Context of Curriculum and Pedagogy Graduate education abroad programs represent key opportunities to extend the graduate curriculum for graduate students. Additionally, the pedagogical decisions made by faculty- directors can influence student experiences regarding relationship building, preparedness, and cross-cultural navigation in an education abroad program. There are two implications where faculty-directors can account for graduate student experiences within the context of curriculum and pedagogy: (a) aligning learning outcomes with competencies in the broader curriculum, and (b) incorporating pre-departure meetings into pedagogical practices. First, faculty-directors should design learning outcomes for STFD education abroad to align with curricular content and competencies in their academic or professional programs. Graduate students should be able to connect where an STFD education abroad program meets 232 competencies in their curriculum. Faculty-directors should also consider the context of professional socialization, to help graduate students understand how an STFD education abroad program enhances the knowledge and skills they are developing within their curriculum. In the current study, participants spoke about their expectations to enhance their curricular training and development during the Costa Rica program. Moreover, participants positively responded to activities that instilled and reinforced their skills and competencies within the College of Medicine curriculum. To enhance the learning experience of graduate students, curricular competencies should drive the types of activities structured into an STFD education abroad program. Second, faculty-directors should incorporate pre-departure meetings into their education abroad programs to help graduate students build relationships, prepare for activities, and navigate expectations. Pre-departure meetings should take place in-person whenever possible, so graduate students have a chance to familiarize themselves with one another before traveling abroad. In considering the interpersonal development of students, faculty-directors should plan icebreaker or teambuilding activities to create a foundation for relationships to develop over the course of a program. Pre-departure meetings should also include opportunities for graduate students to meet virtually with host partners before they arrive in-country. Video conferencing applications such as Zoom or Skype are valuable tools to utilize in these situations because they allow for real-time interactions between host partners and graduate students. As a result of these types of virtual interactions, graduate students may gain a better understanding about navigating cross-cultural dynamics and more clarity regarding collaborative projects with host partners. Students will feel more prepared for their education abroad experiences. 233 The Context of Interpersonal Development The findings within the context of interpersonal development offered insight regarding the importance of peer-to-peer and cross-cultural interactions for graduate students during an STFD education abroad program. Two implications within the context interpersonal development are for faculty-directors to facilitate opportunities for graduate students build relationships and interact with local community members of a host country. First, faculty-directors should facilitate opportunities for graduate students to interact with one another and build relationships during an education abroad program. Since graduate programs typically operate within cohort systems (Weidman et al., 2001), graduate students may be more inclined to view peer-to-peer interactions as a positive outcome of their STFD education abroad experience. Additionally, faculty-directors should consider overlaps with the context of professional socialization in this area, as some graduate students might benefit from opportunities to network with peers and extend their support system within their professional program. Group projects and teambuilding activities incorporated into an education abroad program can engage graduate students in bonding, collaborating, and developing relationships. Also, facilitating group discussions after major events or activities can provide graduate students with new perspectives and viewpoints from their peers. Finally, faculty-directors can facilitate opportunities for graduate students to interact with one another during periods of downtime such as meals or traveling between destinations. Second, education abroad programs should be designed in a way that engage graduate students to interact with local community members of a host country. Creating opportunities for graduate students to stay with host families provides greater capacity for them to encounter new perspectives about family, hospitality, and community. Additionally, activities planned for 234 graduate students to interact with host country professionals can encourage them to consider policies and practices outside of a US context. In these instances, graduate students may develop cultural competence by learning to overcome language barriers and thinking about broader perspectives and values beyond their professional training. In these instances, faculty-directors should be mindful of the context of professional socialization to help graduate students see how cultural competence they gain can benefit their professional skills and disciplinary knowledge. Intersections Between the Contexts Throughout this section, I indicated several areas where intersections between the contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development were important to implications for the design and facilitation of STFD education abroad programs. These examples show that intersections between the contexts matter to graduate student experiences as much as the contexts themselves. As such, faculty-directors and administrators must account for intersections between the contexts to account for the whole graduate student. Education abroad programs represent a broad type of learning experience that engages graduate students as people, emerging professionals, scholars, sojourners, and learners. By recognizing that intersections exist, faculty-directors and administrators place themselves in a position to design better education abroad programs that simultaneously attempt to satisfy curricular competencies, support the needs of adult learners, complement the professional socialization process, and engage students in cross-cultural and peer-to-peer interactions. Learning outcomes, activities, and program itineraries for STFD education abroad programs should incorporate the multiple and overlapping goals, needs, and experiences of graduate students. As a result, graduate students stand to benefit from STFD education abroad programs that place them at the center of the experience and strive to engage them in a holistic way. 235 Implications for Future Research The findings of the current study provide more information about how to better support graduate students who participate in STFD education abroad programs. However, additional research is needed to better understand graduate student experiences of education abroad programs. The results of this study led to the following implications for future research. First, as the findings of the current study represented the experiences of graduate students within the field of medicine, future research should expand upon these efforts to explore other professional disciplines. Sinclair (2014) noticed some differences between professional disciplines of law, medicine, and dentistry in terms of how international experiences were established to reinforce specific values, skills, and practices for participating students. In addition to professional values and competencies being different, graduate disciplines likely vary by student enrollment, curricular structures, and academic requirements. By expanding research to include other professional disciplines, there may be circumstances where new contexts and intersections emerge. Additionally, contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development may manifest themselves in new and different ways for graduate students within a different discipline. Further research could provide more perspectives into disciplinary trends of graduate student experiences of STFD education abroad programs. While my revised model was created as a way for me to visually understand the contexts and their intersections influence on graduate students’ experiences in STFD education abroad programs, there may be variation in degree for how students exist in the model depending upon the type and focus of a graduate discipline. Ultimately, I believe the contexts will likely remain similar in scope, as graduate programs are typically recruiting from populations of adult learners, 236 engage in the process of socialization through the implementation of training, and link education abroad to learning outcomes and practices. Nevertheless, future research can explore graduate student experiences in different disciplines to understand how there may be subtleties or variation in degree to how these contexts manifest and intersect. Understanding additional points of nuance between the graduate disciplines may strengthen the model and make it more robust to advise faculty across multiple disciplines in planning, implementing, and facilitating education abroad programs to account for the goals, needs, and experiences of graduate students. Second, there is an opportunity to examine the sustainability of outcomes and experiences for graduate students who participate in education abroad programs. While the current study found graduate students intended to apply knowledge and skills acquired in the Costa Rica program to professional training and career advancement, questions remain about the long-term sustainability of these experiences. How do graduate students apply the knowledge and skills they gain during and education abroad program to their personal and professional lives? What effects do education abroad programs have on the professional and career advancement of graduate students? How do graduate students utilize knowledge and skills gained in an education abroad program to support their learning and development in their coursework? As other studies similarly suggest education abroad programs represent professional development opportunities for graduate students (Dirkx et al., 2014a; Dirkx et al., 2014b; Dirkx et al., 2016; Loebick, 2017; Sinclair, 2014), few explore the long-term effects of these experiences. A longitudinal-type study could follow a group of graduate students throughout their academic careers to understand the ways in which they are influenced by their education abroad experiences. This longitudinal study could examine elements of transformative learning that connect back to their education abroad experiences to see how their personal or 237 professional perspectives further shifted and developed. Understanding how graduate students continue to reflect and process their education abroad experiences could shed light on the lasting value these programs contribute to their learning and development. Finally, additional research should explore how graduate students’ experiences are influenced by the host country they visit during an education abroad program. The findings of the current study showed graduate students were informed by policies and practices specific to Costa Rica. Various factors unique to a host country may shape types of interactions, activities, discussions, and cultural immersive experiences for students. Graduate programs may offer multiple opportunities for students to participate in education abroad, through partnerships established with different host countries. For example, the College of Medicine offered an additional education abroad program to Cuba, which rotated every other year with the Costa Rica program. For graduate programs that offer multiple options for students to participate in education abroad, a comparative study could examine how student goals, interests, and experiences change or stay the same between host countries. Conclusion This study advances an understanding of graduate students’ experiences of STFD education abroad programs, through contexts of adult learning, professional socialization, curriculum and pedagogy, and interpersonal development. Also, intersections between these contexts provide additional nuance regarding the complexity of graduate students’ experiences of STFD education abroad and lead to a more holistic perspective of their engagement in these programs. As graduate students are a key piece of education abroad initiatives at the graduate level, acknowledging their goals, needs, experiences, and orientation to learning is paramount to achieving successful programs. By illuminating contexts and their intersections, this study offers 238 valuable insight for designing STFD education abroad programs to better support graduate students’ as adult learners, scholars, emerging professionals, and sojourners. While this study represents an initial exploration of contexts and intersections to understand graduate students’ experiences of STFD education abroad, further research is needed to fully understand how they account for disciplinary differences between graduate and professional programs. With graduate education abroad increasingly serving as an internationalization strategy for graduate and professional programs, scholars and practitioners must recognize they also represent a valuable opportunity for student development. 239 APPENDICES 240 APPENDIX A: INTERVIEW PROTOCOL Graduate Student Interview: Pre-Completion of STFD Education Abroad Program Introduction: Hello! My name is Jake Lemon, I’m a doctoral candidate in the Higher, Adult, and Lifelong Education (HALE) program at Michigan State University. The purpose of this dissertation study is to better understand the characteristics of graduate/ professional students that influence their experiences with education abroad. Thank you for taking the time to talk with me today! I would like you to feel comfortable saying what you really think and how you really feel. If it’s okay with you, I will be digitally recording our conversation since it is hard for me to write down everything while simultaneously carrying an attentive conversation with you. During this voluntary interview, you may pause to ask questions or stop at any time. At the conclusion of the interview, I will ask you to choose a pseudonym so that everything you say will remain confidential, meaning that only I will be aware of your identity in connection to your responses. Additionally, I will be asking to conduct an interview with you when you return from Costa Rica. Hopefully, we can coordinate another time for an interview once you return from the overseas portion of the program. After coding and transcribing all recordings, they will be stored in a private and secure server. I greatly appreciate your participation, as this is for my dissertation. 1. Personal: Tell me a little bit about yourself. a. What are past cross-cultural or international experiences that are memorable to you? b. Tell me about your family. Did they factor into your decision to participate in education abroad? If so, how? 2. Educational: Tell me about your educational background. a. Prior to medical school, where did you go to school and what did you study? b. What led you to enroll in this medical school? c. Were you involved in any international courses, activities, or experiences during your time in school? 3. Career/Work: Tell me about your professional experiences. a. What has been your work experience prior to enrolling in medical school? b. What is your career trajectory? Where do you see yourself in the future as a professional? 4. What interested you in this education abroad program? 5. What do you hope to gain both personally and professionally from this education abroad experience? a. How do you see this education abroad experience being personally meaningful? b. How do you see this education abroad experience relating to your career goals and/or trajectory? c. How do you see this education abroad experience influencing your goals and responsibilities as a medical/professional student? 241 6. How do you think the coursework for [Costa Rica Program] prepared you for this education abroad experience? a. What types of readings, conversations, activities, or assignments have prepared you for this experience? (Why?) b. Is there anything missing in the coursework that you feel will prepare you for this experience? (Why?) 7. Is there anything else about your upcoming education abroad experience that you would like to add that I haven’t already asked you about? Do you have any questions for me regarding the interview process? Graduate Student Interview: Post-Completion of Education Abroad Program Introduction: Thanks for taking the time to talk with me again regarding your experiences participating in education abroad! Again, the purpose of my dissertation study is to better understand the characteristics of graduate students that influence their experiences with education abroad. I would like you to feel comfortable saying what you really think and how you really feel. If it’s okay with you, I will be digitally-recording our conversation since it is hard for me to write down everything while simultaneously carrying an attentive conversation with you. After transcribing this interview, I would like to share the transcript with you as a part of a process called member-checking, where you will have the opportunity to review and reflect on the dialogue we had. This will help me to validate and verify if the interview accurately represented your thoughts, feelings, and experiences. All data from these interviews will be used in conjunction with the pseudonym you picked for yourself, and all materials will be securely stored in a private server. If you have questions or comments at any time during the interview, please feel free to pause. Also, this is completely voluntary, and you can stop at any time. Thank you again for your participation! 1. What were some general experiences you had while on this education abroad program? Describe for me generally what things were like for you and your overall impressions of the experience. 2. Before going, you reflected on some of your interests, goals, and expectations for this education abroad experience. [Review these with interviewee if needed]. a. What aspects of your interests, goals, and expectations were realized? Why was this important to you? b. What about this experience did not meet your goals and/or expectations? Why would this have been important to you? c. How do you think the goals that you achieved fit with the [Medical Program's] goals for this education abroad program? 3. What did you find personally meaningful during the education abroad experience? a. Did anything surprise you? (Why?) b. Did anything engage you to reflect on your past experiences? (Why?) c. What did you learn about yourself through this education abroad experience? 4. What did you find were major professional or career-related outcomes of this experience for you? 242 a. What did you take from this education abroad experience that you feel will benefit your goals and responsibilities as a graduate or professional student? b. What did you learn most about during this experience? What do you wish you had learned about? c. How do you see this education abroad experience being influential to your career- trajectory? (Why?) d. As a medical student, what do you feel were the advantages and disadvantages of participating in the education abroad program? 5. How do you think each aspect of the course itinerary (e.g., visits, observations, lectures, discussions, presentations) contributed to your development? a. What aspects of the course itinerary were the most meaningful to you? (Why?) b. What aspects of the course itinerary contributed most to your personal development? c. What aspects of the course itinerary contributed most to your professional development? d. How did the faculty director and GMI administrators influence your experience in Costa Rica? e. What were group dynamics like during the education abroad program? How did your work with other students influence your experience? 6. Is there anything else you would like to add that I haven’t already asked about? Do you have any questions for me regarding the interview process? Faculty-Director Interview: Pre-Completion of Education Abroad Program Introduction: Thanks for taking the time to talk with me about your education abroad program! Again, my name is Jacob Lemon, and I’m a doctoral candidate working on my dissertation in the Higher, Adult, and Lifelong Education (HALE) program at Michigan State University. The purpose of my dissertation study is to better understand the characteristics of graduate students that influence their experiences with education abroad. I will be asking you about your thoughts, perceptions, expectations, and experiences regarding how you plan, organize, and facilitate your education abroad program. I would like you to feel comfortable saying what you really think and how you really feel. If it’s okay with you, I will be digitally recording our conversation since it is hard for me to write down everything while simultaneously carrying an attentive conversation with you. During this voluntary interview, you can pause to ask questions or stop at any time. At the conclusion of the interview, I will ask you to choose pseudonyms so that everything you say will remain confidential, meaning that only I will be aware of your identity and your academic program’s identity in connection to the answers you provide. Additionally, I will be asking to conduct an interview with you when you return from your travel with the education abroad program, so hopefully we can coordinate that at another time. After coding and transcribing all recordings, they will be stored in a private and secure server. I greatly appreciate your participation, as this is for my dissertation. 1. Please briefly describe your current position and your experience with education abroad. a. What do you do in your position? b. How are you currently involved with international activities within your department? c. How many education abroad experiences have you directed? 243 d. Tell me about your favorite education abroad story. 2. How did you get involved with short-term, faculty-directed, graduate education abroad? a. Why did you become involved? b. What influenced your decision? 3. Please tell me about your experience with planning and directing your current short-term, graduate education abroad experience. a. What is the goal/purpose of the education abroad experience? b. What do you hope graduate students gain from the education abroad experience? c. How did you design and develop the education abroad experience? d. How do you know that students are achieving the goals and outcomes you espouse for this education abroad experience? 4. How do you engage students while abroad, and what is your role in these this process? a. What types of activities, conversations, and assignments did you plan, and why did you plan them? 5. Are you coordinating with other faculty/administrators (either domestic or host) during the education abroad experience? a. What is their role in the planning and facilitation process compared to yours? b. How do you intend for this collaboration to influence students as part of the overall short-term, graduate education abroad experience? 6. How does your academic discipline inform the approach your take to designing and developing a short-term education abroad experience? a. What about your own understanding of learning, professionalism, and knowledge construction influenced this process? b. To what extent did you rely on ‘best practices’ or ‘advice’ to approach the design and development of your short-term graduate education abroad experience? Where is the source of this information? 7. Is there anything else you would like to add that I haven’t already asked about? Do you have any questions for me regarding the interview process? Faculty-Director Interview: Post-Completion of Education Abroad Program Introduction: Thanks for taking the time to talk with me again! The purpose of my dissertation study is to better understand the characteristics of graduate students that influence their experiences with education abroad. I would like you to feel comfortable saying what you really think and how you really feel. If it’s okay with you, I will be digitally-recording our conversation since it is hard for me to write down everything while simultaneously carrying an attentive conversation with you. After transcribing this interview, I would like to share both transcripts with you, so you will have the opportunity to review and reflect on the dialogue we had. This will help me to validate and verify if the interview accurately represented your thoughts, feelings, and experiences. All data from these interviews will be used in conjunction with the pseudonyms you picked for yourself and your academic program. All materials will be securely 244 stored in a private server. If you have questions or comments at any time during the interview, please feel free to pause. Also, this is completely voluntary, and you can stop at any time. Thank you again for your participation! 1. Talk about your general experience with directing the short-term, graduate education abroad experience. Describe for me generally what things were like for you and your overall impressions of the experience. 2. Think back to your experience with planning the short-term, graduate education abroad experience. [Review these with Interviewee if needed] a. Do you think the program achieved its goals, purpose, and outcomes? (Why?) b. What do you think graduate students gained from the experience? c. How do you know students achieved the goals and outcomes you espoused? What did this look like? 3. Think back to the types of activities, conversations, and assignments you planned and facilitated for students to engage in during the short-term, graduate education abroad program. [Review these with interviewee if needed] a. How do you think they went? How did students engage in them? b. Is there anything you would change? (Why?) c. How do you think you influenced student learning and development as part of the overall short-term, graduate education abroad experience? d. What influence did other collaborating faculty (either domestic or host) have on students? 4. How do you think this short-term, graduate education abroad experience influenced student learning and development within your academic or professional discipline? a. What aspects about this short-term education abroad experience were valuable to graduate students’ personal development? What about their professional development? b. How do you think this education abroad experience internationalized participating graduate students? 8. Is there anything you would like to add that I haven’t already asked about? Do you have any questions for me regarding the interview process? 245 APPENDIX B: RESEARCH INFORMATION AND CONSENT FORM Research Participant Information and Consent Form You are being asked to participate in a dissertation research study. Researchers are required to provide a consent form to inform you about the research study, to convey that participation is voluntary, to explain risks and benefits of participation, and to empower you to make an informed decision. You should feel free to ask the researchers any questions you may have. Study Title: Graduate Student Experience of Short-term, Faculty-directed Education Abroad 1. PURPOSE OF RESEARCH The purpose of this dissertation research study is to better understand characteristics of graduate students that influence their experiences with education abroad. The goal of this study is to explore whether characteristics of graduate students including adult learning, academic socialization, and curricular and pedagogical practices intersect to influence their experiences of short-term, faculty-directed education abroad. 2. WHAT YOU WILL DO This study will consist of an informal interview process where participants will be asked 8-10 questions, about their motivations, perceptions, expectations, and experiences with graduate education abroad. The interview process will consist of an informal conversation lasting approximately 60-90 minutes, both before and after participants travel overseas for their education abroad program. Additionally, major components of a graduate education abroad including meetings, conversations, and travel will be directly observed to gather deeper contexts of the program influencing graduate student experiences. 3. POTENTIAL BENEFITS You may benefit personally from being in this study with the opportunity to reflect further on your experiences of graduate education abroad. Additionally, I hope, in the future, others might benefit from this study because it aims to identify various ways to engage and support graduate students who participate in education abroad programs. 4. POTENTIAL RISKS There are no foreseeable risks to participating in this study. 5. PRIVACY AND CONFIDENTIALITY Some questions during the interview process will ask participants to share their motivations, perceptions, expectations, and experiences of graduate education abroad. The interviews will be recorded electronically and coded for research purposes. There will be provisions used to safeguard recordings and coded material, participant identity and confidentiality. Participants will be encouraged to select a pseudonym, which will be used in all transcripts and written materials. Any data and identifying information including signed consent forms will be kept for 5 years. Specifically, audio-recordings will be kept for 5 years and thereafter will be destroyed. None of the recordings or transcripts will be used for other purposes than this research project. All data associated with the study will be stored in a secure server. 6. YOUR RIGHTS TO PARTICIPATE, REFUSE TO ANSWER QUESTIONS, SAY NO, OR WITHDRAW You have the right to say no to participate in the research or the right to refuse to answer interview questions asked by the researcher. You can stop at any time after an interview has already started. There 246 will be no consequences if you stop and you will not be criticized. You will not lose any benefits that you normally receive. 7. COSTS AND COMPENSATION FOR BEING IN THE STUDY You will not receive money or any other form of compensation for participating in this study. 10. CONTACT INFORMATION If you have concerns or questions about this study, such as scientific issues, how to do any part of it, or to report an injury, please contact the researcher: Jacob Lemon; 313 N. Cedar Street, Apt. 407, Lansing, MI 48912; lemonjac@msu.edu; (419)-707-1838. If you have questions or concerns about your role and rights as a research participant, would like to obtain information or offer input, or would like to register a complaint about this study, you may contact, anonymously if you wish, the Michigan State University’s Human Research Protection Program at 517- 355-2180, Fax 517-432-4503, or e-mail irb@msu.edu or regular mail at 4000 Collins Rd, Suite 136, Lansing, MI 48910. 11. DOCUMENTATION OF INFORMED CONSENT. Your signature below means that you voluntarily agree to participate in this research study. Signature:_________________________ Date:___________ 12. IF APPROPRIATE o If subjects will be identified, specific permission for identification must be obtained. I agree to allow my identity to be disclosed in reports and presentations. Yes No Initials____________ o Inform subjects if they are being audiotaped or videotaped – indicate if this is required to be in the project, if not required, a separate check box with signature or initials is appropriate. I agree to allow audiotaping/videotaping of the interview. Yes No Initials____________ Discuss how the tapes will be stored, protected, and when erased or destroyed. 247 APPENDIX C: PROGRAM RECRUITMENT LETTER Hello: My name is Jacob Lemon, and I’m a doctoral candidate in the Higher, Adult, and Lifelong Education (HALE) program at Michigan State University. I write to ask if I might speak to you about your department’s graduate education abroad program in connection to research for my dissertation study. Dissertation Title: Graduate Student Experience of Short-term, Faculty-directed Education Abroad For my dissertation study, I am interested in researching a graduate education abroad program in-depth to better understand the different characteristics that intersect to influence graduate students experience of participating in education abroad. Furthermore, I am looking to recruit a short-term, faculty-directed education abroad program within a graduate or professional discipline that is both intentionally designed and credit bearing for students. I will take a constructivist approach in conducting a case study on a single graduate education abroad program. For data collection, I will use three primary methods: a) participant observation of meetings, activities and travel; b) interviews with students and faculty; and c) and document analysis of syllabi and other course materials. I would like to talk with you about how your graduate education abroad program could be a potential candidate to collaborate with for my dissertation study. Participating would mean that directing faculty and participating graduate students will be asked to be interviewed regarding their experiences of the short-term education abroad program, both before and after going abroad. Specifically, directing faculty will be asked regarding the organization and facilitation of the program while graduate students will be asked about their motivations, perceptions, and experiences. Additionally, directing faculty will be asked to provide a syllabus for the education abroad course for document analysis, along with other course materials deemed noteworthy. Finally, I will ask to observe preparatory and closing course meetings and activities—while also negotiating the ability to join the actual education abroad trip as a participant observer in order to gather deeper context of the program. Data collection for this research project will take place before, during, and after the completion of the graduate education abroad program. Interviews will be held at a convenient location determined collectively by the researcher and participant. The interview will consist of an 10-15 question informal conversation lasting approximately 60-90 minutes. This research is supervised by my faculty advisor and dissertation chair, Dr. Matthew Wawrzynski and is subject to the ethical research oversight of Michigan State University’s Human Research Protection Board (https://hrpp.msu.edu). 248 This letter is not a consent form but a recruitment letter seeking interest in participating in my dissertation study. I do want to share that all information collected for my study will be subject to the confidentiality and security standards required by Michigan State University’s Institutional Review Board. Your name, the name of your department and other identifying markers will be replaced with pseudonyms; they will not be used in any writing, publications, or presentations. The specifics of these ethical standards will be presented and discussed as part of a consent process should you agree to participate. I do not anticipate risks to your participation. Benefits may include a chance to think and reflect on important issues associated with graduate education abroad. I am also happy to help connect you to resources on this topic, and to responsibly share what I learn with you and others if this can be helpful. For example, a participating department may take the opportunity to utilize my findings to strengthen strategies and learning outcomes for their education abroad program. I will be contacting you in the next week by email and by phone to ask if you would speak to me about this possibility. I hope at that time you will ask any questions you have or express any concerns. 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