📄 social science

Students' perceived value of a Collaborative Online International Learning-enhanced, team-based healthcare education program: a cross-sectional mixed-methods study.

This mixed-methods study of 104 health science students reveals that the perceived educational value of a COIL-enhanced team-based healthcare program is primarily driven by the relevance and meaningfulness of the course content rather than learner characteristics or instructional processes, highlighting the importance of clearly positioning such virtual exchanges within the curriculum to maximize educational effectiveness.

Original authors: Fumiyo Matsuda, Saori Yamaguchi, Yuriko Ikeda, Rika Yatsushiro

Published 2026-09-15

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Fumiyo Matsuda, Saori Yamaguchi, Yuriko Ikeda, Rika Yatsushiro

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

In the modern world, healthcare is no longer a solitary pursuit. A patient's well-being often depends on a team of specialists—nurses, physical therapists, and occupational therapists—working together to understand not just a disease, but a whole life. To prepare for this reality, universities are increasingly trying to teach students how to collaborate across two difficult boundaries: professional silos and national borders. One powerful tool for this is a method called Collaborative Online International Learning. Imagine a classroom where students from different countries meet virtually to solve a shared problem, learning to respect different cultures while mastering their own disciplines. While this approach is becoming common, many programs are "enhanced" versions that use the spirit of international collaboration without meeting every strict formal requirement. It remains unclear how students actually feel about these hybrid experiences. Do they see them as valuable training for their future careers, or just as another online assignment?

A team of researchers at Kagoshima University in Japan set out to answer this question by studying a specific course designed for fourth-year health science students. The program brought together nursing, physical therapy, and occupational therapy students to work on a case study involving an elderly person living on a remote island. The students analyzed the patient's needs using a global framework that looks at health, disability, and social support. They then connected with peers from universities in South Korea and the United States through a series of online meetings and shared tasks. The goal was to see how these students perceived the value of this international, team-based learning and to understand what specific parts of the experience made it meaningful to them.

The researchers asked 104 students to fill out a survey after the course ended. The students rated their experience on a scale from one to five, answering questions about their preparation, the teaching methods, the difficulty of the work, and how much they valued the course overall. They also had the chance to write a short paragraph describing what helped them learn. The team then used statistical tools to see which factors were most closely linked to a high rating of the course's value. They also analyzed the written comments to find patterns in the words students used, looking for differences between those who loved the course and those who felt it was just okay.

The results showed that the students generally liked the course, giving it an average rating of nearly four out of five. However, the statistical analysis revealed something surprising about what drove that positive feeling. The researchers found that a student's personal attitude or how well they prepared for class did not strongly predict whether they thought the course was valuable. Similarly, while the way the instructors taught and the flow of communication mattered, these factors were not the main reason students felt the course was a success. Instead, the strongest predictors were two specific things: how appropriate the students felt the course content was for their future careers, and whether they would recommend the course to a friend. In other words, the students valued the experience most when they felt the material was relevant and meaningful, rather than simply because the class was easy or the teacher was nice.

When the researchers looked at the written comments, a clear divide emerged between the students who gave the highest ratings and those who gave moderate ones. The students who rated the course as highly valuable spoke about big concepts. They used words related to professional identity, human dignity, and the importance of seeing a patient's life from multiple professional perspectives. They seemed to have integrated the international and team-based aspects into a deeper understanding of how to care for a person as a whole. In contrast, the students who gave the course a moderate rating focused almost entirely on the process of working together. Their comments were filled with words like "communication," "group," and "members." They valued the act of talking and collaborating, but they did not seem to connect those interactions to the deeper, conceptual goals of the course in the same way.

This study suggests that for international online learning to feel truly valuable to healthcare students, the content must be clearly tied to their professional identity and future practice. Simply putting students from different countries in a virtual room is not enough; the work they do together must feel relevant to the kind of doctors, nurses, or therapists they are becoming. The research indicates that when students can see how their cross-cultural teamwork helps them understand a patient's life more holistically, they recognize the educational worth of the experience. While the mechanics of the class and the attitude of the learners play a role, the ultimate measure of success is whether the students feel the learning is appropriate for their future and are willing to share that opportunity with others.

Technical Summary: Students' Perceived Value of a COIL-Enhanced Team-Based Healthcare Education Program

Problem Statement
As universities increasingly adopt Virtual Exchange (VE) to foster global and intercultural learning, Collaborative Online International Learning (COIL) has emerged as a prominent pedagogical model. However, many institutions implement "COIL-enhanced" programs that integrate core principles—such as international collaboration and joint task engagement—without fully adhering to the formal SUNY COIL framework (e.g., lacking jointly designed curricula or fully reciprocal partnerships). While COIL is known to enhance global perspectives, there is limited understanding of how students perceive the educational value of programs that blend COIL-enhanced VE with team-based healthcare education. Specifically, it remains unclear which learner characteristics, instructional processes, or course-level factors most strongly predict these perceptions, and how students conceptually interpret their learning experiences in such complex, multiprofessional environments.

Methodology
This study employed a cross-sectional mixed-methods design involving 104 fourth-year health science students (nursing, physical therapy, and occupational therapy) from Kagoshima University. The participants engaged in a "Team-based Healthcare Practicum" course conducted in October 2022. The program utilized a COIL-enhanced VE model, featuring synchronous interactions with Chung-Ang University (South Korea) and asynchronous activities with Berea College (United States). The curriculum focused on supporting older adults in remote island communities using the WHO's International Classification of Functioning, Disability, and Health (ICF) framework.

Data collection occurred post-course via an anonymous online questionnaire comprising:

Quantitative Measures: An 11-item Likert-scale questionnaire assessing attendance, preparation, course content appropriateness, syllabus adherence, difficulty, recommendation intention, perceived value, communication bidirectionality, instructor strategies, task progression ability, and learner motivation.
Qualitative Measures: One open-ended question asking students to describe factors contributing to achieving learning goals.

Analytical Approach:

Quantitative: Pearson's correlation analysis examined relationships among variables. A hierarchical multiple regression analysis, guided by Biggs' Presage–Process–Product (3P) model, was used to identify predictors of perceived educational value. Variables were entered in three blocks: Presage (learner factors), Process (instructional factors), and Product (course-level evaluative factors).
Qualitative: Text mining techniques, including co-occurrence network analysis and hierarchical clustering, were applied to open-ended responses. The analysis compared high-value raters (score 5) against moderate-value raters (score 3) to identify thematic differences.

Key Results

Descriptive Statistics: Students evaluated the course positively overall (Mean Perceived Value = 3.99 ± 0.84). High scores were noted for attendance (4.84) and attitude/motivation (4.17), while preparation/review (3.42) and intention to recommend (3.59) received comparatively lower ratings.
Correlation Analysis: Perceived educational value showed strong positive correlations with the intention to recommend the course ( $r = .73$ ) and the perceived appropriateness of course content ( $r = .63$ ).
Hierarchical Regression: The final model explained 64.5% of the variance in perceived value.
- Step 1 (Presage): Learner factors explained 15.1% of the variance; only attitude/motivation was a significant predictor.
- Step 2 (Process): Adding instructional process factors increased explained variance to 31.9%.
- Step 3 (Product): The inclusion of course-level factors significantly improved the model ( $\Delta R^2 = .327$ ). The strongest independent predictors were intention to recommend the course ( $\beta = .539, p < .001$ ) and appropriateness of course content ( $\beta = .337, p < .001$ ). Notably, once course-level factors were included, learner and process factors lost their independent predictive power.
Text Mining:
- High-Value Raters: Their responses formed a conceptual network centered on professional identity, multiprofessional perspectives (nursing, PT, OT), and holistic care (ICF-based understanding, human dignity, support).
- Moderate-Value Raters: Their responses formed a process-oriented network centered on "communication," "group," and "members," focusing on interaction dynamics rather than conceptual integration.

Key Contributions
The study provides a multifaceted understanding of how students construct educational value in COIL-enhanced, team-based healthcare education.

Predictive Drivers: It identifies that perceived educational value is driven primarily by the relevance and meaningfulness of the course content (Product factors) rather than by learner characteristics or instructional processes alone.
Conceptual vs. Process Focus: It distinguishes between students who achieve deep, holistic learning (integrating professional identities and intercultural perspectives) and those who focus primarily on the mechanics of collaboration and communication.
Framework Application: It validates the utility of the 3P model in this context, demonstrating that while Presage and Process factors contribute to the learning experience, Product-related evaluations (content appropriateness and recommendation) are the primary determinants of perceived value.

Significance and Claims
The authors claim that these findings offer guidance for designing COIL-enhanced VE programs in health professions education. The study suggests that to enhance educational effectiveness, educators must:

Clearly position COIL-enhanced VEs within the curriculum to ensure relevance to professional practice.
Actively support students in integrating intercultural and multiprofessional experiences into their developing professional identities.
Foster psychologically safe, interactive learning environments.

The paper modestly notes that while positive attitudes and effective instruction are necessary, they are insufficient on their own to produce meaningful educational experiences without the integration of relevant, holistic content. The authors acknowledge limitations regarding the single-institution design, the cross-sectional nature of the data, and potential common method bias, calling for future multi-institutional and longitudinal research to examine long-term professional growth.

Technical Summary: Students' Perceived Value of a COIL-Enhanced Team-Based Healthcare Education Program

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