Review (Divanoglou) – Hong Kong students’ learning experience in a globalised world: Critical reflection on internalisation in physiotherapy education

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.

Title

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.

Abstract

Generally, well-written abstract.

Introduction

  • 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?

Methods

  • 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?

Results

  • 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.

Discussion

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

One thought on “Review (Divanoglou) – Hong Kong students’ learning experience in a globalised world: Critical reflection on internalisation in physiotherapy education

  1. Responses to Reviewer 1 (Anestis Divanoglou)

    Thank you very much for your feedback and the suggestions – your comments definitively make our paper stronger. Below we highlighted the changes
    Title : As you suggested we changed the title in order to make it more representative of the content. Instead of “critical reflection” we formulated it as ““Opportunity to optimise internationalisation in physiotherapy education”.
    Introduction: We added a reference (Marginson 2004) to clarify the argument and revised the second part of the aim as follows: “The aim of this study was to identify learning preferences by Hong Kong physiotherapy Master entry-level students who have been exposed to different educational contexts, and to describe their experiences during their studies, comparing prior and current studies.”
    Methods: Feedback was that the methods section lacks important information. We included the COREQ checklist (COnsolidated criteria for REporting Qualitative research) and rewrote the methods section accordingly. We also attached the completed checklist as suggested.
    One of the comments was related to the interview guide that was not explicitly linked to the objectives of the study. In fact, we think that all questions directly or indirectly related to the aims but particularly questions 7 to 13. This has been clarified in the interview guide. In general, when participants were asked to describe their current experiences of stress in class or clinical placements, students often referred to their past experiences (abroad) and how these compare to the experiences in Hong Kong. This allowed us to understand this group of students’ preferred learning styles. Furthermore, the information sheet given to the participants stated the general aims of the study (experiences of students from an international environment in a Hong Kong physiotherapy education).
    Strategies of enhancing trustworthiness are described more explicitly in the manuscript: “Both researchers were involved in the process of content analysis (discussion during preliminary analysis, cross-checking of findings). Results including data saturation was discussed among the researchers to ensure thoroughness.”
    Results: We provided more clarification about the first quote under the second theme as suggested by the reviewer. Furthermore, the feedback was that 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. This point was moved to the discussion section.
    As suggested by the reviewer, the link between the provided quotes and the previous international experience of the students was not clear enough and we provided therefore a table linking illustrative quotes with sub-categories, sub-categories with categories, and categories with themes. This table (Table 1) is now part of the methods section.
    The reviewer also wondered whether we collected enough data that would allow us to explore the topic in a sufficient manner. While the original aims of the study were broader than “internationalisation” it was after data analysis that this theme was becoming more salient and that this article was conceived in view of the findings.
    Discussion: Some minor points were made by the reviewer that helped us revise paragraphs 1 and 3. Furthermore, as suggested by the reviewer, we revised the section related to the definition of the concept of “Internationalisation at home”, included a reference and streamlined the argument to make the link between data and findings more clearly.
    General comment: Some long sentences in the manuscript were shortened and others modified to ensure clarity.

    We would like to thank both reviewers for their comments and constructive feedback.

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