title: The Ecuador Project: the five 'R's' of an education collaboration.
abstract: BACKGROUND
  The Ecuador Project is an ongoing venture with hospitals in Guayaquil, Ecuador owned by the Junta de Beneficencia working with the College of Nursing at Brigham Young University, Utah, USA.
  
  
  OBJECTIVE
  In efforts to positively change patient outcomes in these large charity hospitals, a cultural exchange of staff and student experiences have taken place for the past 6 years.
  
  
  METHODS
  Over 900 hospital personnel in Ecuador have participated in classes including neonatal resuscitation, paediatric and adult advanced life support, and basic life support. The courses were organized and implemented through combined efforts from both groups and have been well received by all participants.
  
  
  RESULTS
  Positive changes have been observed and are improving health care in Ecuador.
  
  
  CONCLUSIONS
  This paper reviews our experiences through the 'Ecuador Project' which have shown there are five 'R's' that guide an international educational exchange: realistic goals, repetition, reinforcement, reassessment and remaining open to change (Table 1). First, realistic expectations must be set. Are the intended outcomes desired by all individuals involved, and are they attainable? Repetition and reinforcement of new concepts are important in all types of education, especially where there are cultural and language differences. Reassessment of the outcome is essential in determining the effectiveness and alignment of teaching strategies. Lastly, remaining open to change is vital to maintaining open and lasting relationships in an international setting.
  
  
  CONCLUSIONS
  Using these five 'R's' can guide the success of any international venture.
authors.affiliation: Brigham Young University, SWKT, Provo, UT 84602, USA. sheri_palmer@byu.edu
authors.forename: S P
authors.initials: SP
authors.lastname: Palmer
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Bracken
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000193:education; D003299:Cooperative Behavior; D003422:Critical Care; D004484:Ecuador; D004508:Education, Nursing, Baccalaureate / Q000458:organization & administration*; D004509:Education, Nursing, Continuing / Q000458:organization & administration*; D006788:Hospitals, Voluntary / Q000458:organization & administration; D006801:Humans; D017053:Infection Control; D007373:Interinstitutional Relations; D007393:International Educational Exchange; D017145:Models, Educational; D020380:Needs Assessment; D015402:Nursing Education Research; D009937:Organizational Objectives; D010564:Personnel, Hospital / Q000193:education*; D015397:Program Evaluation; D012579:Schools, Nursing / Q000458:organization & administration; D014589:Utah