International knowledge exchanges in healthcare have observed a shift in the method of delivery post Covid-19 pandemic, particularly virtual engagement has gained favour as a viable option. Virtual method of engagement offers alternatives which remove barriers of time, distance and finance associated with traditional exchanges, while still facilitating engagement with other international healthcare colleagues. Applying an overlay of robust pedagogical theory would strengthen and provide structure to the international exchange activity.¹ De Montfort University (DMU) has been running the DMU Global international experience programme since 2014 to provide students opportunities to broaden cultural horizons, equip with skills valued by employers, and empower to become a global citizen.² The virtual project was developed by the Diagnostic Radiography department in response to COVID-19 and time constraints of running the new programme.

A collaboration was developed and implemented through a number of virtual engagements between two diagnostic radiography (medical imaging) programmes from different countries, the UK and Malaysia, which benefitted healthcare students, academics and clinical practitioners from local trusts. This project explored a sustainable, feasible and replicable structure of virtual international knowledge exchange in healthcare education and practice. It is also an effort to decolonise healthcare education through knowledge exchange with similar healthcare programmes from other countries, in regard to radiography practice and training delivery. This provides participants opportunities to work on shared challenges with people who are from different countries, from themselves, either in the classroom or in other part of the world, fostering diversity and inclusivity. The project was designed in accordance with UN sustainable development goal 4 to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.³

“UN SDG 4.7: By 2030, ensure that all learners acquire the knowledge and skills needed to promote sustainable development, including, among others, through education for sustainable development and sustainable lifestyles, human rights, gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development.”

Knowledge exchange delivery format 

The project was developed and inaugurated through a virtual method of engagement with international universities, between De Montfort University, UK and MAHSA University, Malaysia. Focusing on 3 main components (figure 1) a structure was assembled with an emphasis on sustainable, viable and replicable format of knowledge exchange in healthcare education and practice

1. Clinical practice component:

• General healthcare framework of both countries
• Regulatory body requirements to practice
• Radiography specific clinical practice

2. Education and training component:

• Academic programme structure
• Lectures and workshops

3. Cultural and social component:

• Social interaction and cultural exchanges

Figure 1 (scroll to reveal)

Participants from both countries engaged in various activities which were delivered over a two-week timeframe, taking into consideration the time zone difference of 7 hours. There was a mixture of both synchronous and asynchronous activities for the participants to attend and take part. Padlet was utilised as an online platform to facilitate this event which enabled participants to upload and interact with the activities within an allocated time, whilst Microsoft Teams was used as a platform for synchronous delivery.

Prior to the start of 2-week event, students were encouraged to upload their introductory one-minute videos which worked as an icebreaker exercise among them. The video included brief introduction of themselves, family and hometown as well as the course they are studying.  This added some informal relationships right at the beginning of the project and helped to establish friendly connections, whilst reducing participant anxiety.

The activities for the components of the structure (figure 2) included talks on healthcare systems and imaging education. Students discovered that the healthcare framework in both countries were very similar, for instance the Malaysian public healthcare system is administered under the Ministry of Health (MoH) which is analogue to NHS in the UK. Both countries also have a regulatory body to oversee the healthcare practitioner; in Malaysia, the Malaysian Allied Health Professions Council (MAHPC) is equivalent to Health Care and Professions Council (HCPC) in the UK. A mini conference was held focusing on clinical practice in both countries including speakers from both UK and Malaysia hospitals, presenting on topics such as ultrasound, MRI, CT scan, DXA and the radiographer professional journey. The students valued these sessions exposing them to different practices in both countries as well as having an insight on the trajectory of the profession of being a radiographer. It was interesting to hear from a clinical radiographer who moved to the UK from Nigeria on their experiences of adjusting and settling to the UK healthcare system and patient population.

Having exchanges in relation to the education structure was important, one difference is in Malaysia the undergraduate radiography programme is 4 years in comparison to the traditional 3 year programme in the UK; nonetheless it was noted there were more similarities than expected by students. For instance, a virtual tour of the teaching facilities including the X-ray equipment on both university campuses underlined the resemblance in the programme delivery for both countries. In addition, teaching sessions on selected topics such as anatomy and physiology and ultrasound imaging delivered by academics from both universities exposed students to the diverse teaching styles and enabled further sharing of the students’ experiences in studying radiography.

Moreover, social and intercultural exchanges were planned to encourage interactions between students. For example, students posted information such as videos to include places of interest in the local region and food, which they had to discuss and comment on. Furthermore, staff organised an interactive 1-hour online escape room game in the first week where students had to solve a case working in a small team of 4 (mixed from both universities). The fun aspect of the informal communication has been really appreciated by all students.

Figure 2 (scroll to reveal)

Challenges

Some challenges were encountered but appropriate measures were taken to overcome the issues. Apart from the staffing resource demand, time constraints were one of the main challenges particularly the commitment in investing and devoting the time to set the project up which was intensified by the difference in time zones. It was important that the synchronous sessions were organised within a reasonable time to ensure equity and accessibility for participants from both countries. Time zone differences is often recognised as a common challenge in delivering online international knowledge exchange activities.^4,5

Encouraging online interactions and engagement between participants during the synchronous sessions was one of the biggest concerns. However, in order to optimise participant interaction, students were divided into smaller groups using breakout virtual rooms, this ensured there was a good mix of participants from both universities as well as from different level of their studies. The small group discussions were arranged at the end of every synchronous session allowing the opportunity for students to further discuss and exchange their thoughts and ideas on the topic that was delivered.  

Evidencing positive impact

Through engagement with similar education programmes and clinical backgrounds from other countries, it allowed participants to gain the knowledge and skills of global citizenship, fostering diversity and inclusivity. The success of the event is reflected through overwhelmingly positive feedback from participants (figure 3). An example of feedback received by organisers from a participant is shown below:

‘Overall, very impactful and eye opening two weeks. It was very interesting as we got to get information from diversity of the lecturers and speakers and their experiences.’

The project also forged a personal connection between students from both countries which was encouraged throughout the project by pairing students up between the universities. It further enhanced the student’s knowledge of the radiography profession and clinical practices in different countries, which overall supported the student learning in one of the modules in the programme.

This experience facilitated further developments of the knowledge exchange project affording De Montfort University students the opportunity to visit a Southeast Asian country in person the following year. Final year students had an exciting opportunity to attend an elective clinical placement and to have a first-hand experience how a healthcare system is delivered in a different part of the world.

Also, it was noted that an additional benefit of participation in this project was enhancement of learners’ soft skills in areas such as team working and communication. Furthermore, the overall student experience was strengthened by this activity as evidenced in the National Student Survey (NSS 2024) data for De Montfort University Diagnostic Radiography programme.⁶

Figure 3 (scroll to reveal)

Conclusion 

The developed sustainable method and repeatable structure can be adopted by others to deliver international knowledge exchange for healthcare students and professionals. The benefits of affordability and inclusivity of the event suggests that this learning event can be replicated not only in the educational setting but also in clinical departments. The length of the event can be adapted and customised to the specific task and departmental needs.

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