Embracing culture & various healthcare systems through the eyes of our peers

Decorative photo of tag on while wall with the words 'come together'
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In this extra post, Michelle King-Okoye shares insights into an initiative they led during the COVID-19 pandemic of designing a virtual clinical elective (VCE) which brought students from six different countries together, online, via pair and group work. Dr King-Okoye is a lecturer in Nursing Studies at the School of Health in Social Science, and co-director at the Centre for Research on Families and Relationships at The University of Edinburgh.

In this blog post, I reflect on my academic journey at the University of Edinburgh, whilst presenting my poster↗️, “Student nurses and academics’ experiences of ‘first ever’ international Virtual Clinical Elective (VCE)” at the 2023 NHS Education for Scotland (NES) conference.

Being able to develop and host a virtual clinical elective (VCE) during the pandemic, required lots of groundwork, planning, discussions, and background reading. Having a vision and working towards this by marrying different pedagogical approaches was important to bring the VCE to life. This blog gives just a snapshot of my (and others’) experiences.

The pandemic forced academic institutions to find alternative ways of teaching and learning. The clinical elective for the Bachelor of Nursing (honours) programme (3rd years) was ‘almost’ disrupted due to travel restrictions imposed.

My idea inspired the development of the VCE in 2021, utilising existing (and newly formed) partner academic institutions across six countries. This opened up possibilities for students and nurses from developed, developing and low-income countries to engage and ‘tap-into’ the lived experiences of their peers.

Working together with Professor Pam Smith, Daniela Castillo Mansilla, Claudia Collado Quesada, other virtual facilitators, and international peers was instrumental to developing a successful VCE.

“For me, the enduring memory was of the amazing collective international spirit and goodwill from across the world, which built on and strengthened existing partnerships and forged new ones,” Prof Pam Smith.

The VCE was based on learning culture and nursing through the eyes of international peers, drawing mainly from constructivist, collaborative and reflective pedagogical approaches. The international students that participated ranged from undergraduate to postgraduate levels. Guided by a workbook with ongoing support from virtual facilitators, students were allocated pairs and small groups over two weeks. The workbook used symbols that were geared to make the experience engaging and memorable. Resources corner, virtual story, cultural moments are some examples of these (see Figure 1).

Image shows table of symbols and meanings used for the VCE
Figure 1: Symbols and meanings used for the VCE (taken from the workbook developed by Dr Michelle King-Okoye)

Students were encouraged to choose the country they wanted to virtually visit, including the setting, whether this was clinical or non-clinical. Table 1 below highlights the options available to students.

I remember developing the workbook and various documents to support the VCE, such as the role of the virtual facilitator and clinical/healthcare scenarios.

It was quite thorough. I had to include flags for each country, do research on the food, customs, population, and traditions and incorporate these into the clinical scenarios. When I met with the facilitators, I had to guide them towards the types of discussions and support students may need on a daily basis; as well as obtain valuable feedback.

Table with icons that show the options available to students for the VCE.
Table 1 shows the options available to students for the VCE..

Here is an illustration of my journey↗️ from ideation to execution.


Culture is best experienced by being immersed in an environment. Preparation through having an open mind and doing background reading is critical to provide the foundation for students’ experience. Informal meetings were held with students prior to the VCE to discuss their perceptions, expectations and address any questions and/or concerns.

Virtual profiles (headshots and brief information) were shared between pairs and small groups one week prior to the VCE for students to get acquainted. In order to make the experience real, a travel package was developed displaying the flight time and information about the country (basic geography) – see examples in Figure 2 below.

Figure 2 shows some information taken from the virtual package for the VCE developed by Dr Michelle King-Okoye.

Post-VCE and lessons learned

Following the VCE, students were invited to share their experiences during the closing session as well as via a post-VCE questionnaire. Each participant received a certificate of attendance.

Figure 3 shows some feedback from various VCE attendees.

IT, network, and facilitator support are critical to having a successful VCE. Considering the positive feedback received from both academics and students, including how cost-effective a VCE can be, this would be useful to continue alongside the in person clinical elective. This is especially useful for students who may not be able to afford costs of flight tickets and international accommodation.

I am delighted to have led on this innovative project during the pandemic and hope that this model will be embraced by the university moving forward particularly for aspiring nurses from low- and middle-income countries.

Photograph of author 1 Dr Pauline FergusonMichelle King-Okoye

Dr Michelle King-Okoye is a lecturer in Nursing Studies at the School of Health in Social Science, and co-director at the Centre for Research on Families and Relationships, University of Edinburgh. Michelle enjoys utilising innovative and novel teaching/learning activities at undergraduate and postgraduate levels.

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