Preparing for work placements: sensemaking among international health science students

ABSTRACT

Work placement is an important aspect of higher education studies and career preparation. Effective preparation is crucial for students to succeed in placements, yet little is known about international students’ placement preparation, particularly regarding their sensemaking. This qualitative study, guided by an integrative theoretical framework, examined international health science (HSc) undergraduate students’ sensemaking behaviors as they prepare for in-person placements in a host country. Data were gathered through 36 semi-structured interviews with 12 international HSc undergraduate students (three with each student). Findings unravel complicated psychological and interpersonal processes undergone by student participants during pre-placement sensemaking. These insights can inform institutional strategies to support international students in building sensemaking capacities to effectively prepare for placements and post-study work transitions.

KEYWORDS:

• Work placement preparation
• higher education
• international students
• sensemaking
• transition

Introduction

Clinical placements (placements) hold great importance in health science (HSc) degree programs, as they offer students invaluable opportunities to put theoretical knowledge into practical, real-life settings (Attrill et al., 2016; Farias et al., 2023). Placements bridge the gap between theory and practice, thus helping students become competent, self-assured, and safe healthcare professionals who meet professional performance standards (Lalor et al., 2019). Students acquire practical skills and competencies by effectively engaging in placements to succeed in their respective fields (Lalor et al., 2019).

For international HSc students, placements in their host country provide valuable opportunities to acquire knowledge of local clinical practices and improve intercultural communication skills, enhancing their global graduate employment prospects (Farias et al., 2023). Research indicates that international HSc students often face significant challenges when undertaking placements in their host country, such as cultural and language barriers and lack of local work experience (Attrill et al., 2016; Newton et al., 2016). While these challenges are exacerbated by inadequate or ineffective preparation, little is known about how students prepare for their placements, especially regarding their sensemaking – ‘the process through which individuals work to understand novel, unexpected, or confusing events’ (Maitlis & Christianson, 2014, p. 58).

The current study aimed to identify international HSc undergraduate students’ sensemaking behaviors when preparing for in-person placements in a host country. Their sensemaking when engaging in pre-departure programs provided by the university was beyond the scope of the study. The present study is significant as individuals ‘experience and observe their world differently and need to create meaning or make sense of their world’ (Dervin, 1992, p. 62). Students often engage in sensemaking, especially when pushed beyond their comfort zone, as part of the learning process (Bowen, 2018). The study’s findings will be useful in informing research and practice to improve international students’ sensemaking capacities to enhance placement preparation, experiences, and outcomes.

Literature review

International students of various disciplinary backgrounds often encounter significant challenges when undertaking placement in their host country (Jackson, 2017; Mikkonen et al., 2016). These challenges stem from international students’ negative personal and contextual factors (Vu et al., 2022) and the interplay between these two categories of factors (Vu et al., 2023). The literature review conducted to guide the present study supports and extends this categorization of causes of challenges by identifying the particular challenges faced by onshore international HSc students when they prepare for placements in local clinics.

Personal factors that challenge international HSc students on placement include limited knowledge of the local cultures, the local healthcare system, and the typical practices in local clinical workplaces (Bennett & Ferns, 2017; Mikkonen et al., 2016). Difficulty adapting to local clinical workplaces undermines student performance and outcomes (Attrill et al., 2016; Mikkonen et al., 2016). Additionally, limited intercultural and language competencies prevent students from communicating effectively in the workplace and providing optimal patient care (San Miguel & Rogan, 2012; Mikkonen et al., 2016).

Challenges encountered by international HSc students during placement can also arise from contextual factors. Workplace discrimination can negatively affect their emotional well-being, learning experiences, and learning outcomes (Attrill et al., 2016; Newton et al., 2016). In addition, research indicates that workplace supervisors may struggle to provide practical training, conduct appropriate assessments, or provide constructive feedback due to time constraints, limited intercultural competence, and a lack of culturally sensitive pedagogy (Attrill et al., 2016; Farias et al., 2023; Newton et al., 2016). Thus, supervisors can also be a source of challenges.

Furthermore, difficulties experienced by international HSc students on placement are caused by the interplay between negative personal factors and disadvantageous contextual factors. Cultural and language differences affect workplace communication, sometimes leading to misunderstandings between students, clinical supervisors, and patients (Mikkonen et al., 2016; Newton et al., 2016). Such misunderstandings potentially affect the quality of patient care carried out by international students (Morgan, 2017). Moreover, international HSc students’ and clinical supervisors’ limited intercultural competencies can lead to cultural conflicts and incompatible expectations, creating tension in supervisor–student relationships and undermining students’ learning (Attrill et al., 2016; Farias et al., 2023; Newton et al., 2016). In addition, cultural and language barriers in the workplace cause international students to feel isolated, affecting their emotional well-being and performance (Lalor et al., 2019; Mikkonen et al., 2016).

The above challenges can lead to anxiety and stress, decreased motivation, and low self-confidence, negatively affecting students’ overall placement experiences and outcomes (Attrill et al., 2016; Morgan, 2017). Given the literature-informed challenges international HSc students encounter during placement, it is essential to identify how they prepare to address those challenges in the pre-placement phase. However, there is a paucity of research on international HSc students’ placement preparation, particularly concerning their sensemaking. This research gap is concerning because inadequate preparation exacerbates the challenges faced by international HSc students during placement and negatively impacts workplace learning experiences and outcomes (Morgan, 2017; Newton et al., 2016; O’Reilly & Milner, 2015). The present study addressed this gap using an integrative theoretical framework to provide unique insights into this under-researched phenomenon. This research is significant as it seeks to identify international HSc students’ information and support needs and sensemaking behaviors in the pre-placement phase, hence informing institutional strategies to better support this student population.

Theoretical framework and research questions

An integrative theoretical framework for sensemaking research (Vu, 2023) guided the study. This integrative framework incorporates the key elements of two complementary theories: sensemaking theory (Dervin, 1999; Dervin et al., 2003) and transition theory (Anderson et al., 2012; Schlossberg, 1981). Integrating these theoretical perspectives helps examine the salient aspects of international students’ sensemaking when preparing for placements.

Sensemaking theory proposes that reality is both ordered and chaotic and that sensemaking occurs when individuals recognize that order is disrupted by chaos, leading to perceived knowledge gaps that need to be bridged (Dervin, 1999). For students preparing for placements, sensemaking occurs when they recognize that order (what they know) is disrupted by chaos (confusion or uncertainty), leading to perceived knowledge and skill gaps and the need to bridge them. Sensemaking theory (Dervin, 1999; Dervin et al., 2003) offers a research framework comprising four components: Situation (triggers of sensemaking), Gap (confusion arising when an individual perceives the Situation), Bridge (the individual’s tactics in bridging the perceived cognitive gaps), and Outcomes (positive/negative results of gap bridging).

The integrative framework integrates sensemaking theory with transition theory (Anderson et al., 2012; Schlossberg, 1981) to ensure the inclusion of individual characteristics (e.g., perceived strengths/weaknesses) not explicitly captured in sensemaking theory. A transition is ‘any event or non-event that results in changed relationships, routines, assumptions, and roles’ (Anderson et al., 2012, p. 39). Placement preparation among international students is viewed in this study as a transition as it leads to changes in relationships (e.g., support networks), assumptions (e.g., self-perceived strengths/weaknesses), routines (e.g., activities relating to preparation), and roles (e.g., from a student to a placement-ready individual). Transition theory offers a four-element framework (4S’s) for researching individuals’ engagement in transitions (Anderson et al., 2012, p. 61): Situation (What is happening?); Self (To whom is it happening?); Support (What help is available?); and Strategies (How does the person cope?).

The 4S’s have been employed to investigate factors influencing international students’ experiences before and during placements. They enable the examination of students’ personal factors (Self), contextual factors (Situation and Support), and students’ tactics for working towards the goals of themselves and stakeholders (such as academics and site supervisors). For example, a review study (Vu et al., 2022) established that challenges faced by international students before and during placements stem from students’ negative personal factors (i.e., negative aspects of Self) and disadvantageous contextual factors (i.e., negative aspects of Situation and Support). In addition, an empirical study (Vu et al., 2023) found that the interplay between these two categories of factors causes challenges for international students as they seek placements in a host country.

The integrative framework integrates the 4S’s with the sensemaking theory components: Situation, Gap, Bridge, and Outcomes. This integrative framework addresses individuals’ sensemaking behaviors and does not measure sensemaking results, thus excluding the Outcomes component. The final integrative framework comprises five elements (Table 1).

Table 1. Integrative theoretical framework for sensemaking research (Vu, 2023).

Sensemaking theory (Dervin, 1999; Dervin et al., 2003)	Transition theory (Anderson et al., 2012; Schlossberg, 1981)	Integrative framework
Situation	Situation	Situation: External triggers of sensemaking
	Self	Self: Internal triggers of sensemaking; individual characteristics
Gap		Gap: Knowledge gaps; confusion/uncertainty
	Support	Support: Available information and support
Bridge	Strategies	Strategies: Tactics to control the situation, the meaning of the situation, and stress

The study utilized this integrative framework to examine how international undergraduate HSc students engage in sensemaking when preparing for clinical placements in a host country. Three questions guided the study:

1. What knowledge gaps do international HSc undergraduate students seek to bridge when preparing for in-person placements in a host country? (Gap)

2. What are their perceptions of internal and external causes of these gaps? (Situation and Self)

3. What support and strategies do they employ to address the perceived gaps? (Support and Strategies)

Method

Research context

This study forms part of a larger project that examines international students’ experiences before (the present study’s focus), during, and following placements. Student participants were from the Faculty of Health Sciences at an Australian university. Most HSc degree programs in Australia undergo professional accreditation conducted by a professional body external to the university. In this study, placements were arranged by the university, embedded in the curriculum, and formally assessed. The placement could be a component of a subject or a subject on its own. Academic and/or clinical supervisors were assigned to support students and assess their performance during placement. Student participants undertook their placements at different sites and times.

Research design

A qualitative research design was adopted to investigate the under-researched phenomenon (Creswell & Creswell, 2018) of international HSc students’ sensemaking during placement preparation. Narrative, semi-structured interviewing was employed to facilitate participants’ recall and narration of meaningful experiences (Mueller, 2019) in their ‘own spontaneous language’ (Jovchelovitch & Bauer, 2000, p. 61). Data collection complied with Dervin et al.’s (2003) principles of sensemaking methodology so that participants were encouraged to narrate their experiences in their own ways.

Participants and data collection

Ethics approval was granted by the student participants’ university. Informed consent was obtained, and participants were assured anonymity and voluntary participation. Student participants were recruited through the Faculty’s Facebook page and a snowball approach. Participants were onshore international HSc undergraduate students from the university who were preparing for or had completed at least one placement in Australia. The sample included international undergraduate students from diverse HSc disciplines and countries of origin (Table 2).

Table 2. Participant demographics.

No.	Pseudonym	Discipline	Year of study	Gender	Country of origin
1	Chang	Physiotherapy	4	M	China
2	Ryan	Physiotherapy	4	M	Singapore
3	Feng	Health Science	3	M	China
4	Hong	Nursing	3	F	Vietnam
5	Ping	Occupational Therapy	4	M	China
6	Nisa	Speech Pathology	3	F	Brunei
7	Juan	Physiotherapy	3	F	China
8	Dhia	Physiotherapy	4	F	Malaysia
9	Ling	Physiotherapy	3	F	China
10	Phuong	Pharmacy	3	F	Vietnam
11	Emma	Speech Pathology	4	F	Singapore
12	Thuy	Nursing	2	F	Vietnam

Interviews were conducted online (via WebEx), and recordings were transcribed using the Otter software. Every participant attended three 45-minute semi-structured interviews, each addressing their experiences before, during, or following a placement. The topic of sensemaking in placement preparation was intentionally explored and emerged across the three interviews. Participants were asked about their preparation for the most recent clinical placement. Interviews used broad questions to allow participants to select and relate events meaningful to them (Dervin et al., 2003) and specific questions to facilitate participants’ recall (Appendix).

Analysis

A combination of deductive and inductive thematic analysis was deployed to identify, analyze, and compare data patterns (Braun & Clarke, 2006; Saldaña, 2016). The deductive thematic analysis was framed by the integrative theoretical framework adopted for the study, while the inductive thematic analysis enabled new themes to emerge during the analysis process (Braun & Clarke, 2006; Creswell & Creswell, 2018; Saldaña, 2016). Before coding, interview scripts were imported into NVivo (version 12) to systematically identify, compare, and synthesize data. Coding included iterative segmenting, regrouping, and synthesizing data for meaning identification (Saldaña, 2016). Data coding identified codes, categories, and themes. A code is ‘a salient, essence-capturing, and/or evocative attribute for a portion of language-based or visual data’; a category is a group of codes with similarities; and a theme is the ‘outcome of coding, categorization, or analytic reflection’ (Saldaña, 2016, p. 4, p. 15).

Findings

Most international HSc student participants (identified using pseudonyms) experienced significant uncertainties and received inadequate information and support when preparing for their placements in local clinical settings. Those uncertainties and inadequacies resulted in stress and anxiety, triggering students’ active sensemaking to increase their preparedness for their placements. They addressed the inadequacy of information and support from their university and host organizations by proactively building and harnessing networks with peers and senior students (collectively referred to as ‘near peers’). Interestingly, some participants adopted a long-term approach to sensemaking by immersing themselves in the local culture and work contexts through part-time work and volunteering. Table 3 outlines the key findings corresponding to each research question (RQ) and indicates related aspects of the integrative theoretical framework.

Table 3. Summary of findings.

Question	Theoretical framework	Summary of findings
RQ1: Perceived knowledge and skills gaps	Gap	Lack of local work experience Limited information about host organizations regarding, for example, their common practices and client/patient populations Lack of information about clinical supervisors’ requirements and expectations Limited competence in intercultural communication Limited English language competence for effective professional practice
RQ2: Identifying gaps	Situation	Perceived high standards required for professional practice in local clinics regarding English language competence and professional practice Perceived high-stakes placements with assessments conducted by site supervisors leading to a fail/pass result Concerns about the subjective nature of clinical supervisors’ assessment Concerns about discrimination in local clinical settings
	Self	Perceived strengths: mastery of theoretical knowledge Perceived limitations: intercultural and language competencies
RQ3: Bridging gaps	Support	Perceived inadequate support from the university and host organizations Perceived mismatch between students’ information and support needs and what is provided by the university and host organizations Lack of connections with host organizations and site supervisors prior to placement
	Strategies	Establishing and harnessing support networks, especially among co-nationals Getting exposure to local culture and work contexts through part-time work and volunteering

Perceived knowledge and skills gaps and resultant anxiety (RQ1)

Most student participants indicated a lack of local work experience and unfamiliarity with local clinical environments. This limited experience led to two perceived knowledge and skills gaps, which caused stress and anxiety and lowered students’ self-confidence as they entered placement.

The first knowledge gap was associated with host organizations’ typical professional practices and target client (patient) populations. For example, Juan expressed concern about ‘how to treat a patient well, with professionalism’ in local clinical settings. Nisa stated, ‘I wasn’t very confident because I’ve never worked with this [patient] population in this kind of setting’. A second knowledge gap was related to site supervisors’ requirements for, and expectations of, student performance during placement. Juan, for instance, emphasized his limited knowledge of ‘what the supervisors expect you to have’. Participants regarded this knowledge gap as crucial since, according to their peers who had completed placements before, site supervisors’ assessment was subjective and was based on brief impressions. Ping commented, ‘[d]ifferent supervisors have different standards. The scoring is a bit subjective to the supervisor’. Juan added that if ‘they don’t have a good image of you, then the placement is going to be really hard for you’.

Student participants were also concerned about their skill gaps in language and intercultural competencies, indicating limited self-confidence in meeting the demands of local clinical workplaces. The first skill gap perceived by most participants was related to verbal English communication. For example, Ping stated, ‘[i]n a hospital environment, everything might go very fast. I was really worried about my English’. A second skill gap that worried most participants was related to intercultural communication. Like other participants, Ling was concerned that this skill gap would affect her communication and performance in local clinical settings. She anticipated it would be ‘hard to find something to talk to patients [and was] worried about, like, how can I chat more and develop better relationships with my patients’. She indicated concerns about cultural adaptation into local clinical settings: ‘I was a bit afraid that I wouldn’t be able to adapt to this kind of cultural change’. Similarly, Dhia worried about her capacity to cope with a scenario when a patient

doesn’t see me as equivalent as my peers who speak, like, Australian English, and that will affect, like, the patient’s experience and my experience during the treatment session.

The aforementioned knowledge and skills gaps perceived by student participants led to significant concerns about meeting the requirements and expectations of local clinical workplaces, particularly site supervisors. These concerns, in turn, caused stress and anxiety regarding the inability to complete their placements and degree programs. Dhia noted,

It’s quite, like, scary and a lot of uncertainty [concerning] what is going to come and what is expected of me. … In our entire year, we are just, like, scared of our placements. There’s a high chance of failing.

Identifying gaps by interlinking personal and contextual factors (RQ2)

International student participants’ sensemaking of knowledge and skills gaps involved three key phases. Initially, they developed perceptions of placement circumstances and requirements. Next, they evaluated their strengths and limitations in relation to the perceived circumstances. Following this, they critically analyzed the interconnection between the placement circumstances and self-perceptions to identify knowledge and skills gaps.

Firstly, student participants made sense of the circumstances and requirements of their placements through informational exchanges with near peers who had completed placements before. They recognized the high standards required for professional practices in local clinical settings, the high stakes of their placements, and potential subjectivity in site supervisors’ assessment practices. Participants found it challenging to meet the professional practice standards required by local clinical workplaces. They learned from their near peers that to fulfill placement roles, international students need to possess high-level English competence and intercultural communication skills. A physiotherapy student participant shared what he had learned from near peers about the characteristics of professional practices in local work contexts: ‘[as] physios nowadays, we don’t treat with our hands too much. It’s more [of] treating with our mouth. So, it’s a lot of communication and talking with patients’ (Chang). Similarly, an occupational therapy student learned from near peers that during placement, students ‘need to talk really well to build rapport with the client, explain a lot of, like, jargons to the patient, [and] do a lot of interviews and assessment. [All require] a very high level of English’ (Ping). Most participants were concerned about the high stakes of their placements, which involved assessment conducted by site supervisors leading to a pass or fail. Participants were particularly worried about the implications of potential subjectivity in site supervisors’ assessment, which might affect their placement completion.

Secondly, participants evaluated their strengths and weaknesses in relation to the perceived circumstances and requirements. Concerning self-perceptions, most participants regarded themselves as ‘hard-working, willing to learn, [and] very good in the knowledge part of the subject’ (Ping). However, they were ‘worried about communicating with people’ (Ling).

Thirdly, participants identified their knowledge and skills gaps by comparing perceived placement requirements with self-perceptions. Their perceptions of local clinical workplaces’ professional practice standards led to perceived knowledge and skills gaps that need bridging to fulfill placement roles. In addition, their concerns about the potential subjectivity of site supervisors’ assessment resulted in the compelling need for specific information about individual site supervisors’ assessment criteria and expectations.

Bridging gaps by mobilizing support networks and getting exposure to local culture and work contexts (RQ3)

Most student participants asserted they experienced inadequate information and support from the university and host organizations. Participants actively employed two approaches to bridging their knowledge and skills gaps to enhance placement preparation. They established and harnessed support networks, particularly among near peers. Some participants also adopted a longer-term approach to gap bridging by getting exposure to local culture and work contexts.

After identifying their knowledge and skills gaps, most student participants (e.g., Hong and Nisa) found it ‘nerve-racking’ and indicated a need for support in preparing for placement. Chang, for example, acknowledged a lack of self-confidence and stated his need for support: ‘I wasn’t that confident, so I will always need a bit of support to push me out there to, sort of, the edge of my comfort zone or maybe even step out of my comfort zone’. However, most participants experienced inadequate information and support from the university and host organizations. The university relied on digital resources to provide general information about placement requirements, but specific guidance on host clinics or clinical supervisors’ expectations was unavailable. Students could also seek support from placement coordinators, lecturers, tutors, and clinical supervisors. Some participants had positive experiences from these support sources: Dhia received detailed emails from her lecturer, Juan learned through workshops, and Chang received helpful information from clinical supervisors before placement. However, other participants expressed dissatisfaction, with Juan emphasizing that the digital resources ‘didn’t really say what is expected of us’. Likewise, Ping stated that the university did not sufficiently support international students. Although the university offered free English classes, Ping felt they were useless for placement preparation.

Consequently, student participants felt confused and unsure about how to prepare for their placements. Ping noted, ‘I had no idea what I needed to prepare’. Similarly, Dhia was concerned about ‘what is going to come and what is expected of me’. Participants recognized the importance of actively seeking and using information and support sources to bridge their knowledge and skills gaps. For instance, Chang emphasized, ‘the information is always out there; you just need to know whom to ask’. Student participants generally deployed two approaches to addressing their knowledge and skills gaps, as indicated in the forthcoming sections.

Bridging gaps by establishing and harnessing support networks

Most student participants established and harnessed support networks among near peers to address inadequate information and support from the university and site supervisors. They actively engaged with these networks, exchanging experiences of placements in local clinical settings, discussing effective strategies for workplace learning, and planning for mutual support while on placement. Some participants asserted that engaging with co-nationals was particularly beneficial as it facilitated technical and mental preparation for placements in local clinical settings. Ling, for example, shared her strategies:

My Hong Kong friends talk to me about the challenges they have encountered during their placement and what kind of communication difficulties they have encountered. They share their experience and also tell me what should I [I should] do or just tell me to pay attention if these kinds of situations happen. And we just share experiences of what we think is different than [from] Hong Kong.

Several participants connected with other students who would be placed at the same clinical site to discuss challenges and opportunities they might experience during placement and strategize for workplace learning. This approach helped student participants bridge knowledge gaps to better prepare for placements, initiated mutual support between themselves and other students when on placement, and aided their cultural transition into the local clinical workplace. As Ling noted,

Before the placement, my [placement] partner and I talked to each other and shared our concerns. We discussed what we thought we should prepare for and what we might have to do during the placement. We prepared different kinds of things together for the placement so that if something unexpected happened, we could support each other.

Notably, participants also collaborated with their near peers to reflect on their experiences in identifying and bridging gaps and adjusted their strategies accordingly. Reflecting on their experiences in identifying gaps, some participants emphasized the importance of critically evaluating their placement circumstances and understanding the unique expectations of each site. For instance, Chang noted, ‘Different sites and different placements have different expectations. So, get to know the expectations of what you are supposed to be doing there and what they want you to know’.

Reflecting on their experiences in bridging gaps, several participants underscored the importance of building and using support networks in response to inadequate support from the university and host clinics. As Chang noted, ‘You need to have your support network when you’re overseas’. Some participants asserted that reflective practices with near peers helped them better understand their roles and responsibilities. For example, Ling explained how reflections with near peers guided her placement preparation: ‘They told me it’s really more about communication, so I actually did more preparation on that aspect’. Thuy similarly noted that this reflection approach helped her understand ‘what to expect during placement, what to do, what the nurses will be like, and what the patients will be like’.

Practicing reflection with near peers enabled participants to strategize their next steps effectively. For instance, some participants suggested finding friends who only speak English to practice the language and improve intercultural communication skills. Others planned to join more university clubs to meet people from different cultures and improve their conversation skills. Feng noted,

I will maybe join more clubs in my university to meet more new people from different cultures and different countries. I think this will help me know more about the cultures and improve my conversation.

Thus, this reflective process enabled the participants to better understand their strengths and weaknesses and the effectiveness of their strategies for placement preparation. Furthermore, by reflecting with near peers, the participants received feedback and insights from individuals who had similar experiences, helping them refine their approaches and improve learning outcomes.

Bridging gaps by getting exposure to local culture and work contexts

Some participants addressed their knowledge and skills gaps by seeking and using opportunities to get exposure to local culture and work contexts. They recognized the benefits of immersing themselves in the local culture and community to improve their language skills, cultural awareness, and knowledge of local clinical practices. They, therefore, engaged with local communities, working part-time and volunteering to address perceived knowledge and skills gaps.

Some engaged with local communities and acquired information about local clinics, which was useful for their placement preparation. Feng, for example, noted, ‘I connect to a church that has a lot of senior students there and get some more information about the placement’. Similarly, Ling emphasized that networking with locals was beneficial for international students to bridge their knowledge gaps regarding the typical practices in local clinical workplaces. This student noted,

my local friends told me about their senior friends’ experiences. … When you know what kinds of things they usually do, you can actually engage in and ask them more about it.

Several participants worked part-time, including in jobs unrelated to their primary HSc disciplines, through which they developed confidence in intercultural communication and conversation with strangers. For example, Emma worked at a casino and regarded this as a transformative experience that led to her developing a more open-minded and empathetic attitude toward others. Other participants volunteered in healthcare to build essential knowledge and skills regarding clinical practice in local work settings. Nisa, for example, shared that she undertook ‘voluntary work before placement to get a taste of what it would be like’.

In summary, the international HSc student participants addressed inadequate information and support from their university and host organizations by adopting two approaches. They established and engaged with support networks among near peers, which enabled them to bridge knowledge gaps of local clinical workplaces’ professional standards, target client populations, and site supervisors’ assessment criteria. Several participants also worked part-time and participated in voluntary activities to immerse themselves in the local culture and work contexts. Through this approach, they bridged their knowledge and skills gaps and built the essential capacities for adapting to unfamiliar work environments.

Discussion

The integrative theoretical framework (Table 1) enabled a holistic and context-specific account of the participants’ sensemaking when preparing for in-person placements in local clinical settings. The findings suggest that the framework’s five components are interrelated and that sensemaking research and placement preparation activities should consider these interrelations. Such interactions were revealed in the findings corresponding to each of the study’s research questions. In responding to Research Questions 1 and 2, which explored participants’ perceptions of their knowledge gaps and internal and external triggers of sensemaking, the integrative framework guided investigations of how the participants developed an understanding of internal (Self) and external (Situation) factors, and how participants interlinked the two factors to identify their knowledge gaps. The framework enabled the examination of Research Question 3 by identifying participants’ perceptions of the available information and assistance sources (Support) and how these perceptions shaped their generation and implementation of gap-bridging tactics (Strategies). The results demonstrated a clear relationship between the five components of the theoretical framework: in evaluating the interplay between personal factors (Self) and contextual factors (Situation), combined with assessing available information and assistance sources (Support), participants recognized knowledge limitations (Gaps) and accordingly adjusted their gap-bridging tactics (Strategies). Overall, the integrative framework enabled the examination of salient aspects of sensemaking, including how the participants made sense of personal factors (Self), contextual factors (Situation and Support), and the impact of the interplay between these two factors on participants’ generation and implementation of gap-bridging tactics (Strategies).

The remainder of this section discusses the findings corresponding to each research question. The contributions and practical implications of the findings on each question are discussed. Next, the study’s limitations and suggested avenues for future research are presented.

Perceived knowledge and skills gaps and issues with equitable support for international students (RQ1)

The findings revealed two major knowledge gaps the international HSc student participants perceived, including information about their host organizations’ typical professional practices and the client population, and site supervisors’ assessment criteria and expectations. The findings also indicated participants’ two main skills gaps, which were the language and intercultural competencies required to fulfill their placement roles in local clinical settings. These findings align with previous research findings related to challenges faced by international students undertaking placements in a host country (Attrill et al., 2016; Mikkonen et al., 2016). The study’s results also support previous research findings regarding the difference between what international students need and what is provided by universities and host organizations (Jackson, 2017; Morgan, 2017).

Contributions of the findings and practical implications

The current study contributes to the literature by offering evidence about the imbalance between international HSc students’ pre-placement information and support needs and the assistance provided by universities and host organizations. Such an imbalance needs addressing to ensure equitable experiences for international students during placement preparation. Notably, student participants were particularly concerned about a lack of information on site supervisors’ assessment criteria and expectations. Addressing this knowledge gap is crucial for international students engaging in compulsory placements where site supervisor assessment leads to a pass or fail, as this affects degree completion.

The findings related to participants’ concerns about site supervisors’ subjectivity in assessment practices have practical implications for universities and host organizations. In the pre-placement phase, students often lack connections with their host organizations; therefore, support from the university is vital in their successful transition into placements in local clinical settings (Vu et al., 2023). In particular, universities could improve collaboration with host organizations, especially site supervisors, to clarify assessment criteria and provide a rubric to ensure alignment between site supervisors’ mentoring and assessment practices. In addition, universities could facilitate connections between international students and site supervisors for informational exchanges before placements. It is also important for universities to conduct training on intercultural competencies for international students and site supervisors to enhance the experiences for both stakeholder groups before and during placements, as suggested by previous studies (Jackson, 2017; Mikkonen et al., 2016).

Importance of student ability to interlink personal and contextual factors to identify gaps (RQ2)

Identifying knowledge and skills gaps is crucial in sensemaking, as it partly shapes students’ gap-bridging strategies. Student participants identified their knowledge and skills gaps by interlinking perceived placement circumstances and requirements (Situation) with self-perceptions (Self). Specifically, their perceptions of placement circumstances and requirements shaped their idea of effective placement preparation. By then evaluating their strengths and weaknesses, student participants identified gaps in their knowledge and skills. Participants then compared these perceived contextual factors with self-perceptions to identify their knowledge and skills gaps.

Contributions of the findings and practical implications

The findings on participants’ gap-identification process support the results of a previous study (Vu et al., 2023) regarding how international students linked personal factors to contextual factors to identify challenges in seeking placements in a host country. However, the current study’s findings make a theoretical contribution to sensemaking research by suggesting how international students identify the knowledge and skills gaps that need bridging in their placement preparation. These results highlight the importance of international students’ ability to self-evaluate, analyze contextual factors, and critically interlink self-perceptions and perceived contexts. It follows that research and practice aimed at enhancing international students’ gap-identification capacities could employ the integrative framework (Vu, 2023) to equip them with the necessary knowledge and skills in developing perceptions of their personal factors (Self) and contextual factors (Situation and Support) and interconnect these two categories of factors to identify their knowledge and skills limitations (Gaps).

Importance of student ability to mobilize support sources and to practice self- and peer-reflection (RQ3)

Most international student participants asserted that their information and support needs were unmet by their university and host organizations, aligning with previous research findings (Jackson, 2017; Mikkonen et al., 2016). Participants responded by proactively building and engaging with support networks among near peers. They practiced self-reflection and reflection with near peers, exchanging placement experiences and information relevant to placements in specific local clinical settings. This approach helped participants bridge knowledge gaps related to supervisors’ assessment criteria and expectations, and host organizations’ typical practices and target client populations.

Contributions of the findings and practical implications

The findings corresponding to RQ3 contribute to the literature by suggesting the impact of international students’ perceptions of contextual factors (Situation and Support) on generating and implementing gap-bridging strategies. The results revealed how participants addressed perceived inadequate information and support from their university and host organizations to enhance sensemaking during placement preparation. These insights underscore the pivotal role of international students’ proactivity and capacity for building and harnessing support networks, engaging in self-reflection and peer reflection, and seeking opportunities to immerse themselves in the local culture and work contexts.

Student participants commented that proactively building and engaging with support networks among near peers, especially co-nationals, strengthened their gap-bridging and facilitated their cultural transition into local clinical settings. Therefore, universities could encourage and promote the formulation and operation of international student support groups, including senior and placement-experienced students who can share experiences with less experienced students. It is also essential to support international students in developing self-reflection and peer reflection skills to enhance sensemaking and placement preparation.

Participants also highlighted the importance of immersing themselves in local culture and work contexts by working part-time and volunteering. Through such exposure to local culture and clinical workplaces, they addressed their knowledge and skills gaps to enhance preparedness for placements. It is essential to note that this approach necessitates long-term efforts involving seeking and engaging with part-time work and volunteering and reflecting on those experiences to strategize for placement preparation. Thus, universities could support international students to build the necessary knowledge and skills to actively seek and engage with part-time work and volunteering and make the most of these opportunities, as suggested by previous studies (Jackson, 2017; Vu et al., 2023). This institutional support should be provided early in international students’ university years to enhance their preparedness for placements in later years and subsequent transitions into post-study work, as emphasized by previous research (Bennett & Ferns, 2017; Vu et al., 2023). In addition, encouraging and facilitating intercultural friendships between international and domestic students should be on the institutional agenda to enhance international students’ connectedness with and adaptation to local cultures (Willoughby-Knox & Yates, 2022).

Limitations and suggestions for future research

Three limitations are mentioned here. Firstly, the study did not measure the outcome of student participants’ sensemaking in the pre-placement phase. Future studies could compare students’ self-perceptions at the start and the end of their placement preparation to measure their sensemaking outcomes. Secondly, the study did not investigate the impact of pre-placement preparation on workplace learning, a relationship which could be examined in future research. Thirdly, the study focused on sensemaking through interpersonal interactions and did not consider non-human information sources such as the Internet and text documents. Future research that addresses these limitations could provide a more comprehensive picture of international students’ sensemaking during placement preparation.

Conclusion

The study addressed a crucial research gap regarding how international HSc students navigate challenges to enhance sensemaking while preparing for placements in a host country. By employing an integrative theoretical framework, the study offers unique insights into international students’ sensemaking behaviors during placement preparation. Students’ sensemaking capacities are indicated in their abilities to critically interlink personal and contextual factors to identify knowledge gaps and generate and implement strategies for gap bridging. Thus, sensemaking entails complicated psychological (e.g., self-evaluation) and interpersonal processes (e.g., informational exchanges with peers), highlighting the pivotal role of students’ proactiveness and capacity to engage in these processes.

The findings underscore that sensemaking is integral to placement preparation and that institutional strategies could equip students with the essential knowledge and skills to critically evaluate and interlink personal and contextual factors to identify and bridge their knowledge gaps. When transitioning into work in local clinical settings, participants’ effective sensemaking strategies enabled them to evaluate their placement circumstances. By then mobilizing external information and support sources rather than relying on assistance from their university and host organizations, participants overcame the challenges arising from disadvantageous placement circumstances, while also managing the stress caused by the high stakes of their placements. Thus, the results highlight the pivotal role of international students’ proactively addressing inadequate information and support in the pre-placement phase by establishing and harnessing support networks among near peers. Therefore, institutional efforts could also prioritize empowering international students to mobilize such information and support sources actively and effectively. This will enhance their placement preparation and facilitate their transitions into post-study work in unfamiliar environments.

Acknowledgement

Thai Vu is a recipient of an Australian Government Research Training Program Scholarship.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Appendix. Sample interview questions.

Table

Theoretical framework	Interview question Central question: How did/are you prepare/preparing for your most recent placement?
Gap	What information did/do you need?How did/do you recognize your information needs?
Situation	Why did/do you need that information?
Self	What are your strengths and weaknesses concerning placement preparation and information seeking?
Support	What support did/do you seek and/or use? What were/are your experiences with those support sources?
Strategies	What strategies did/do you use to acquire information from those support sources?