METHODS: We conducted a multicentre instrumental case study across three international medical programmes, all of which were characterised by an international student intake, an internationalised curriculum and international partnerships, and all of which used English as the medium of instruction. We conducted 24 semi-structured interviews with purposively sampled curriculum directors and teaching staff. Participants shared their personal experiences and responded to ethical concerns expressed in the literature. Our multidisciplinary team performed a template analysis of the data based on theoretical frameworks of ethics and social responsibility.
RESULTS: Participants primarily experienced the internationalisation of their institutions and programmes as having a positive impact on students, the university and the future global society. However, they did face several ethical dilemmas. The first of these involved the possibility that marketisation through international recruitment and the application of substantial tuition fees might widen access to medical education, but might allow weaker students to enter medical schools. The second concern referred to the homogenisation of education methods and content, which offers opportunities to expose students to best practices, but may also pose a risk to education quality. The third issue referred to the experience that although student diversity helped to promote intercultural learning, it also jeopardised student well-being.
CONCLUSIONS: In the eyes of teaching staff in international medical education, internationalisation can benefit education quality and society, but poses ethical dilemmas through the forces of marketisation, homogenisation and diversification. The findings reflect a tension between the views of scholars and those of practitioners. The critical perspective found in academic debates is largely missing in practice, and theoretical frameworks on ethics possibly overlook the benefits of international education. To facilitate ethical decision making, we propose that scholars and practitioners globally try to learn from each other.
DISCUSSION: Creating an inclusive assessment culture is important for equitable education, even if priorities for inclusion might differ between contexts. We recognise challenges in the enactment of inclusive assessment, namely, the notion of lowering standards, harming reliability and robustness of assessment design and inclusion as a poorly defined and catchall term. Importantly, the lack of awareness that inclusion means recognising intersectionality is a barrier for well-designed inclusive assessments. This is why we offer considerations for HPE practitioners that can guide towards a unified direction of travel for inclusive assessments. This article highlights the importance of contextual prioritisation and initiatives to be considered at the global level to national, institutional, programme and the individual level. Utilising experience and literature from undergraduate, higher education contexts, we offer considerations with applicability across the assessment continuum.
CONTEXT: In this state of science paper, we were set the challenge of providing cross-cultural viewpoints on inclusive assessment. In this discursive article, we focus on inclusive assessment within undergraduate health professions education whilst looking to the wider higher education literature, since institutional policies and procedures frequently drive assessment decisions and influence the environment in which they occur. We explore our experiences of working in inclusive assessment, with the aim of bridging and enhancing practices of inclusive assessments for HPE. Unlike other articles that juxtapose views, we all come from the perspective of supporting inclusive assessment. We begin with a discussion on what inclusive assessment is and then describe our contexts as a basis for understanding differences and broadening conversations. We work in the United Kingdom, Australia and Malaysia, having undertaken research, facilitated workshops and seminars on inclusive assessment nationally and internationally. We recognise our perspectives will differ as a consequence of our global context, institutional culture, individual characteristics and educational experiences. (Note that individual characteristics are also known as protected characteristics in some countries). Then, we outline challenges and opportunities associated with inclusive assessment, drawing on evidence within our contexts, acknowledging that our understanding of inclusive assessment research is limited to publications in English and currently tilted to publications from the Global North. In the final section, we then offer recommendations for championing inclusion, focussing firstly on assessment designs, and then broader considerations to organise collective action. Our article is unapologetically practical; the deliberate divergence from a theoretical piece is with the intent that anyone who reads this paper might enact even one small change progressing towards more inclusive assessment practices within their context.