title: Supervising international students in clinical placements: perceptions of experiences and factors influencing competency development.
abstract: BACKGROUND
  Health professional education programs attract students from around the world and clinical supervisors frequently report that international students find learning in clinical placement contexts particularly challenging. In existing literature clinical supervisors, who support international students on placement have identified concerns about their communication and interactions within clinical environments. However, clinical supervisors' perspectives about their experiences with international students on placement and the strategies they utilise to facilitate international student learning have not been described. As a result we have little insight into the nature of these concerns and what clinical supervisors do to support international students' competency development.
  
  
  METHODS
  Five focus group interviews were conducted with twenty Speech-Language Pathology clinical supervisors, recruited from 2 Australian universities. Interview data were analysed thematically. Themes identified were interpreted using cognitive load and sociocultural learning theories to enhance understanding of the findings.
  
  
  RESULTS
  Four themes were identified: 'Complex teaching and learning relationships', 'Conceptions of students as learners'; Student communication skills for professional practice', and 'Positive mutual learning relationships'.
  
  
  CONCLUSIONS
  Findings indicated that clinical supervisors felt positive about supporting international students in clinical placements and experienced mutual learning benefits. However, they also identified factors inherent to international students and the placement environment that added to workload, and made facilitating student learning complex. Clinical supervisors described strategies they used to support international students' cultural adjustment and learning, but communication skills were reported to be difficult to facilitate within the constraints of placements. Future research should address the urgent need to develop and test strategies for improving international students' learning in clinical settings.
authors.affiliation: The University of Sydney, Adelaide, Australia. Stacie.Attrill@flinders.edu.au.|Speech Pathology and Audiology, Flinders University, GPO Box 2100, Adelaide, SA, 5000, Australia. Stacie.Attrill@flinders.edu.au.
authors.forename: Stacie
authors.identifier: http://orcid.org/0000-0001-6194-8987
authors.initials: S
authors.lastname: Attrill
authors.affiliation: The University of Sydney, Adelaide, Australia.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lincoln
authors.affiliation: Flinders University, Adelaide, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: McAllister
mesh_terms: D001315:Australia; D003162:Competency-Based Education / Q000379:methods; D018864:Cultural Diversity; D000071195:Educational Personnel / Q000523:psychology*; D017144:Focus Groups; D006801:Humans; D007391:International Cooperation; D007858:Learning; D010465:Perception; D013066:Speech-Language Pathology / Q000193:education*; D013336:Students, Health Occupations / Q000523:psychology*; D016526:Workload
keywords: Clinical placement; Competency; Cultural diversity; Focus groups; International students; Internationalization; Supervision