Facilitating Reflection During an International Clinical Education Experience in South Africa: A Case Study


Northeastern University and the Department of Physical Therapy, Movement and Rehabilitation Sciences value global education. After participating in two international learning experiences in South Africa, our student expressed interest in completing her final clinical education experience there. After assuring all CAPTE criteria for international clinical education were met, a clinical affiliation was established with a public trauma hospital in Cape Town, South Africa. The 14-week experience was split between inpatient and outpatient settings. Their clinical education model included a high Clinical Instructor(CI): student ratio of 6 students:1 CI..To allow for frequent communication with the ACCE, and ensure proper development of clinical reasoning skills. I used a SOAP. note format that utilized critical Incidents. Reflection during international clinical education experiences develop cultural awareness and sensitivity and allow for communication of any difficulties.


The student submitted a weekly SOAP note highlighting a Critical Incident. A critical incident is a positive or negative incident, a situation where the student felt their skills were inadequate, a unique or complex cultural difference, a situation that made the student uncomfortable or when challenged by a surprising outcome. The “S” represents subjective feelings pertaining to the critical incident including content, process and premise. The “O” is a summary of what the student learned with respect to the critical incident. The “A” is a self-assessment of their performance and how the incident was handled in South Africa vs. the US. The “P” represents how the student would handle the situation in the future. Weekly correspondence between the ACCE and the student was via email and consisted of dialogue surrounding the critical incidents. The culmination of this was a final reflection summary paper to capture the student’s growth and professional development.


In her final reflection, the student noted she was “leaps and bounds more independent and confident in her clinical judgement skills and treatment planning”. The SOAP note and discussion demonstrated this student’s progression from struggling with language barriers during a neurological evaluation to serving as a mentor and educator for newer students. Her increased knowledge and skills in a foreign healthcare system were highlighted. She progressed from shock regarding economic decisions that impacted patient and visitor safety to advocating for a specialist appointment following clinical reasoning through a complex diagnosis and complex psychosocial history. Through reflection on processes in the department, she helped design an outcomes project for the physiotherapy department.

Conclusions/Relevance to the conference theme: Through the Looking Glass: Transforming Physical Therapy Education

While incorporating weekly S.O.A.P notes into all clinical education experiences may not be feasible, this case highlights the benefits of incorporating reflection using critical incidents to enhance cultural awareness, confidence and clinical reasoning.


1. Balandin S, Lincoln M, Sen R, Wilkins D, Trembath D. Twelve tips for effective international clinical placements. Medical Teacher. 2007;29: 972-877.
2. Pechak CM, Black JD. Proposed guidelines for international clinical education in a US-based Physical Therapist Education Program: results of a focus group and Delphi study. 2014;94:523-533.
3. CAPTE. Position Papers Accreditation Handbook: International Clinical Education. http://www.capteonline.org/accreditationhandbook/.
4. Dye D. Enhancing critical reflection of students during a clinical internship using the self S.O.A.P. note. The internet Journal of Allied Health Sciences and Practice. http://ijahsp.nova.edu. 2006;3(4).
5. Dunfee H, Rindflesch A, Driscoll M, Hollman J, Plack M. Assessing reflection and higher-order thinking in the clinical setting using electronic discussion thread. J Phys. Ther Educ. 2008;22(2):60-67.
6. Aronson L, Niehaus B, Lindow J, Robertson P, O’Sullivan P. Development and pilot testing of a reflective learning guide for medical education. Medical Teacher. 2011;33:515-521.
7. Delaney C, Watkin D. A study of critical reflection in health professional education: ‘learning where others are coming from’. Adv in Health Sci Educ. 2009;(14):411-429.

BACK to Abstract Results

  • Control #: 2752476
  • Type: Posters
  • Event/Year: ELC2017
  • Authors: Debra Bangs
  • Keywords:

BACK to Abstract Results