Students’ learning preferences and experience in a globalised world: Opportunity to optimise internationalisation in physiotherapy education

Article accepted

This article has been accepted for publication. Peer reviews and author responses are available at the end of the article.


Background: Hong Kong is at the cross-road between Eastern and Western cultures. Increasing globalisation allows student to gather experiences from various educational contexts. While internationalisation has been promoted in higher education world-wide, the focus was often put on students from Chinese cultures integrating into Westernised education systems. Not much is known about how students from Chinese background with exposures to Western cultures, reintegrate into a Hong Kong university, characterised by a highly competitive system that potentially affects students’ well-being. Aim: To identify learning preferences by Hong Kong physiotherapy students who have been exposed to educational contexts in USA, Australia or Canada, and to explore their subjective experiences regarding different educational approaches during their studies. Methods: Ten students participated in this phenomenological study. Semi-structured interviews were conducted in English, transcribed ‘ad verbatim’ and analysed using qualitative content analysis. Findings: Three themes emerged from the data: (1) Interaction between students and teachers, (2) past experiences that help with future dreams, and (3) obstacles and opportunities in learning.
Conclusion: Physiotherapy students with globalised experience rely on their past educational exposure to give meaning to their future. They believe that a student-centred approach is crucial for learning. Their experiences shed light on consideration factors for optimally internationalising the physiotherapy curriculum.


The paper provides information about the experiences of students who have been exposed to different international physiotherapy education systems

Please see my reviewer comments below:

Add a reference at the end of the first sentence.  The last sentence of the first paragraph is lengthy divide into 2 sentences to improve the flow.

To link paragraphs 2 and 3 firstly state that Asian students have challenges before highlighting  the challenges experienced by the students.

When was the data collected?

As part of the inclusion criteria you mention that the students  have previously been exposed? Did you consider length of time of exposure?

Include the type of sampling applied.

Add details about how the participants were accessed, specific location of data collection, who collected the data, how long were the interviews.

As part of the findings would it be possible to add information about the participants or would this affect anonymity.

It is not clear what the “past experiences and future dreams” were that was included as part of theme 2.

As part of theme 2, it is also stated that “this was a more Western style of learning…” it’s is not clear what is being referred to here, what was a more Western style of learning.

In theme 3, clearly state what the obstacles and opportunities were.

As part of theme 3 also indicate who experienced the “additional stress”

In the first paragraph the authors refer to “differences in pedagogical approaches…“. This aspect was not clear in the findings.

It is not clear how the second paragraph in the discussion is linked to the study.

In paragraph 3 of the discussion, where you refer to a “student centred-approach..” link to the supportive role that was part of the findings.

In paragraph 4 of the findings discuss the specific challenges that were highlighted in the findings by the participants and not clinical training in general.

The conclusion of the study should be more aligned with the aim of the study.

Thank you for the opportunity to peer-review this manuscript aiming to identify the learning preferences of Master in Physiotherapy students in Hong Kong who had prior exposure to westernised educational contexts.

The material presented in the manuscript seem to be part of another study that looked at stress levels in Physiotherapy students. This also becomes evident from the questions that were included in the interview guide. You state that in the limitation section at the end of the manuscript. In my opinion, this needs to be clearly explained in the methods section of the manuscript and in the abstract, as this has major implications in the depth and richness of available data. While the introduction and discussion sections talk about internationalisation, the direct link with the findings is sometimes missing or is not clear.


Could you please explain what aspects of your manuscript justify the use of the phrase “critical reflection”? Also, as I describe below, findings touch upon some specific aspects of the students’ learning experiences, especially in relation to stress. Overall, I feel that the title is ambitious when considering the findings of the study.


Generally, well-written abstract.


  • The introduction provides useful background information and generally follows a logical sequence.
  • The first sentence needs a reference and preferably an explanation.
  • The second part of the aim states “…and to describe their experiences during their studies”. In my opinion, this is very general and needs to be specified further.
  • Would you consider using terms such as “westernised/ non-westernised” or “western-type/ eastern-type” given that some universities or educators in Eastern countries may have adopted a westernised teaching approach?


  • Overall, the methods section lacks important information. Please consider the COREQ checklist (COnsolidated criteria for REporting Qualitative research) and the full paper by Tong et al 2007. The current version of the manuscript provides information for only 9 out of 32 COREQ items. Please address the remaining 23 COREQ items. I would advise that you complete the checklist and you provide it as an appendix or attachment to your submission.
  • The first aim of the study was “to identify learning preferences by Hong Kong physiotherapy … students…”. When looking at the interview guide, nine out of 13 questions ask about stress, and another question asks students to comment on them being mature students. Could you clarify which questions of your interview guide are directly linked with the objectives of the manuscript (and how)?
  • Were the objectives of the current manuscript (those stated in the last paragraph of the Introduction section) stated in the information letter that you provided to the participants, or were these objectives formulated during the data analysis process?
  • Did you use any strategies to enhance aspects of trustworthiness?


  • The first quote under the second theme suggests that Master of Physiotherapy students were outspoken and were not afraid of speaking their mind because they were mature students. However, you state “This is a more Western style of learning which is characterised …”. Could you please clarify how the provided quote is related to the objectives of the current study?
  • The last sentence of the findings section does not seem to be a finding of the current study, but rather a reflection about the potential usefulness of the current study. In that case, consider moving that sentence to another section of the manuscript.
  • I personally cannot see how most of the provided quotes refer to internationalisation or link with the previous international experience of the students. It is important that the quotes are linked to the sub-categories/ categories/ themes, and the themes to the objectives of the study. In my opinion, these links are currently missing.

One way to achieve this is by developing an illustration or a table linking illustrative quotes with sub-categories, sub-categories with categories, and categories with themes. This illustration can then be part of the manuscript, either directly or as an appendix.

  • Surely, you collected data that included aspects relevant to internationalisation. However, I wonder whether you collected enough data that would allow you to explore the topic in a sufficient manner. I suspect that this was because participants were not asked to comment on aspects related to internationalisation.


The discussion is generally well written. However, the link with the actual findings of the study is not always present.  For example:

  • Paragraph 1: “Their previous participation in other cultural contexts enabled them to more purposefully formulate and…”. How is the word “more” supported by your data?
  • Paragraph 3: “From the results of this study, they (students) have a preference towards the Western educational approach”. What data support this statement?
  • Implications – students and teachers, 1st paragraph: “From this small-scale study, there is no doubt that the classroom is becoming more globalised…”. What data support this statement?

“Internationalisation at home” is an established concept. Would you need to provide a reference for that concept and potentially explain it?

Implications – institutions: the first sentence needs to be rephrased.

General comment

There are some very long sentences in the manuscript, e.g. last sentence of the 1st paragraph of the introduction, last sentence of the 2nd paragraph of the discussion. Please shorten and simplify long sentences.

Kind regards,

Anestis Divanoglou, PT, PhD, Assistant Professor, Department of Physiotherapy, University of Iceland

Amendments made to this article following review

Finished editing - all edits were made explicit in our responses to the reviewers.

Conflict of interest statement

The authors report no conflict of interest.

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