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03-02-2020 | Original Article | Uitgave 1/2020 Open Access

Perspectives on Medical Education 1/2020

Finding your feet: student participation during initiation of international clinical placements

Student participation during initiation

Perspectives on Medical Education > Uitgave 1/2020
Miriam H. Wijbenga, Robbert J. Duvivier, Dale C. Sheehan, Stephan P. J. Ramaekers, Pim W. Teunissen, Erik W. Driessen
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The online version of this article (https://​doi.​org/​10.​1007/​s40037-020-00561-9) contains supplementary material, which is available to authorized users.
Note: For purposes of enhanced coherence and legibility, quotes have been subject to light editing before journal submission. The authors, however, based their analysis on the original, raw transcripts. Original transcripts are available upon request from the first author.
The authors alone are responsible for the content and writing of this article.



International placements challenge students to find the right level of participation, as local practices, language and time pressure may affect their engagement in patient-related tasks or team activities. This study sought to unpack the initiation process during international clinical placements with the ultimate aim to achieve active student participation.


Following a constructivist grounded theory approach, we conducted two individual interviews with 15 undergraduate healthcare students (before departure and whilst on placement). To identify emerging themes, we applied an iterative process of data collection and constant comparative analysis. Several team discussions informed further analysis, allowing us to reach a more conceptual level of theory.


From our findings we constructed a four-phase model of healthcare students’ initiation of international clinical placements, which brings into focus how the phases of ‘orientation’, ‘adjustment’ and ‘contribution to patient care’ build up towards a ‘sense of belonging’. We identified several factors that induced active student participation in practice, such as a favourable workplace setting, opportunities for learning and a local support network.


Active student participation is aimed at different goals, depending on the four phases of initiation that eventually lead to a sense of belonging and support workplace learning.
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