Navigating Global Education: Students’ Perception of a Transcontinental COIL

Abstract

Introduction

This study explores students’ perceptions of a transcontinental Collaborative Online International Learning (COIL) project involving participants from Brazil, Ireland, the Philippines, South Africa, and Spain. Leveraging principles of green pedagogy and intercultural collaboration, the virtual exchange (VEX) was designed to cultivate disciplinary knowledge, professional skills, intercultural awareness, and digital literacy, ultimately fostering global citizenship.

Methods

This was an exploratory mixed-methods study, that combined quantitative survey data on student–lecturer engagement, vocational skills development, cultural diversity, and digital learning platforms, alongside qualitative insights from semi-structured interviews.

Results

Our findings highlight how the VEX enriched professional learning, critical analysis abilities, and cross-cultural understanding while supporting networking and collaborative research across five time zones. Students reported overcoming language barriers, strengthening communication, and expanding their awareness of global health contexts. During this time, COVID-19 posed challenges to higher education, however, it also served as a catalyst for accelerating international virtual collaboration and digital pedagogies. Despite variations in technology access and language proficiency, the experience fostered unity, empathy, and resilience.

Conclusion

The findings should be interpreted as exploratory and perception-based rather than evidence of confirmed educational impact. This study contributes to the growing body of research on COIL by providing empirical insight into how students experience transcontinental virtual collaboration in health education contexts.

Introduction

The COVID-19 crisis underscored the need for global collaboration across the health, economic, and education sectors to address health-related Sustainable Development Goals (SDG 3) of the 2030 Agenda.^1,2 Opportunities for collaboration across geographical boundaries, largely due to advancements in virtual engagement tools and practices was however, notable.³ This transformation accelerated digital integration and enabled innovative forms of cooperation and shared knowledge,⁴ emphasising the urgency of developing intercultural competencies to address complex global challenges.^5,6

International collaboration enhances students’ awareness of global health issues and strengthens their professional competencies.^5,7 In health professions education, such collaboration is integral in developing basic graduate attributes, such as teamwork, communication skills, and intercultural competencies, essential for efficient patient-centred care in diverse contexts. Global collaboration in higher education is essential for achieving SDG 3, with virtual engagement now offering increased opportunities for cooperation and knowledge sharing across borders.^1–3 This shift has accelerated digital integration, highlighting the importance of developing intercultural and digital competencies and establishing equitable partnerships grounded in mutual respect, trust, and open communication.^5–9 Within the context of health sciences, fostering intercultural competence is essential, and is supported by human-centric curricula, intercultural competence and sensitivity, sustainability, and decoloniality.^10–14 Such approaches cultivate empathy, ethical awareness, and respect for diversity qualities that underpin effective communication and collaborative teamwork in healthcare environments. Approaches centred on empathy, respect, and care build the foundation for responsive, inclusive graduates with attributes necessary to address global inequalities and climate justice.¹⁵ Despite limitations such as infrastructural and linguistic diversity, especially within the Global South,¹⁶ collaborative models like COIL and green pedagogy provide a transformative path for advancing equity, sustainability, and intercultural competence in global education.

The virtual exchange through COIL, has become an essential tool for fostering curriculum internationalisation by developing intercultural competencies, digital literacy, global self-awareness, and collaborative learning across borders.⁵ COIL connects students from different countries and disciplines using web-enabled methods and tools, enabling reflective, project and practice-based learning through equitable, beneficial partnerships, especially when physical mobility is constrained.^17–19 Students start engaging in meaningful discussions that promote social justice, respect for diversity, and epistemic plurality, factors essential for effective global citizenship.^20,21

Central to the pedagogical integration in COIL is the Technological, Pedagogical, and Content Knowledge (TPACK) model, which blends technology, pedagogy, and content to support adaptive and context-sensitive curricula.²² The TPACK model posits technology as the mediator of the web-enabled learning, requiring alignment with pedagogical purpose and content within specific contexts to create effective learning experiences.²³ As Generation Z and the Fourth Industrial Revolution shift educational demands, TPACK’s flexibility makes it highly relevant for diverse and evolving digital environments.²⁴ In South Africa and the broader Global South, this model supports inclusive learning, intercultural dialogue, and equitable access.²⁵

Humanising pedagogy is one theoretical foundation beneficial for COIL, advocating empathy, dignity, and critical consciousness among learners.¹¹ This approach, as embedded in decolonial and inclusive pedagogies, prioritises the development of agency, dialogue, and collective knowledge-making, particularly for historically marginalised learners.^20,26 Freire’s (1970) pedagogy of the heart encourages compassion, while the pedagogy of collapse sensitises learners to global injustices and ecological crises.^11,15,21

Intercultural competence development sits at the heart of successful COIL initiatives and is sustained through curricula that centre inclusion, empathy, and learning from difference.^10,12–14 Furthermore, COIL dismantles traditional knowledge hierarchies, fosters mutual respect, and empowers students to function as global citizens who question, reflect, and act to address global inequalities.^27,28 Additionally, when students confront diverse perspectives and societal challenges collaboratively, they emerge as resilient and reflective practitioners committed to social change.²⁹

Green pedagogy is closely linked to both COIL and intercultural learning, aligning education with ecological justice, local-global thinking, and interdisciplinarity.^30–32 Integrating local knowledge systems and community-based learning allows for contextually relevant curricula, ensuring that students develop sustainability competencies along with intercultural and ethical responsibilities.^33–35 The convergence of COIL, green pedagogy, and robust theoretical models like TPACK offers a transformative framework for advancing equity, inclusivity, and global citizenship across higher education, especially in the Global South.¹⁶

Together, these approaches empower graduates to critically reflect, collaborate across borders, and practise inclusively, thereby embodying the qualities needed for effective intercultural engagement in different countries.

Materials and Methods

Study Context

This exploratory, convergent mixed-methods study was conducted between March 18 and April 23, 2021, and stemmed from a previous project conducted by Barreto Belian and coworkers.³⁶ The participating institutions included the Federal University of Pernambuco (Brazil), Santa Barbara Healthcare College (Spain), Letterkenny Institute of Technology (Ireland), San Pedro College (Philippines), and Durban University of Technology (South Africa). The 5-week timeframe was appropriate for capturing short-term educational experiences within a structured virtual exchange, although it did not allow for the assessment of long-term or sustained learning outcomes.

Participants

A total of 84 students organized into 12 groups of seven students, with equal distribution per country, were included. Only 64 completed the evaluation form and participated in the interviews. Participants were from various disciplines, including medicine, nursing, pharmacy, psychology, biomedicine, dentistry, and medical orthotics and prosthetics. This provided an opportunity for multidisciplinary collaboration, with a focus on developing basic professional competencies such as teamwork, communication skills, and intercultural collaboration in diverse global contexts. The program was designed to simulate real-world, multidisciplinary health teams and thus focused on developing interpersonal skills within multicultural and heterogeneous student teams. Eligibility criteria included enrollment in the courses taught by the participating faculty members.

COIL Programming

Prior to implementation, collaborative planning with the participating faculty members established shared leadership, clear communication protocols, the adoption of English as the common global language and a commitment to cultural sensitivity. The “ImmerseU” learning management platform, developed by IIGE and Class2Class³⁷ was used to facilitate student engagement. Students participated via mobile devices to share text messages, documents, images, video-calls and related content. Semi-synchronous technology-mediated platforms like WhatsApp were used because of its popularity to enhance synchronous and asynchronous communication. Groups were tasked with identifying and discussing mutually agreed-upon topics of interest related to the impacts of COVID-19 on mental, physical, and social aspects. Each group had a designated facilitator responsible for directing student engagement, addressing teaching and learning queries, and resolving platform-related issues. The project was integrated into the courses taught by participating faculty members, and student attendance in online meetings and planned activities was monitored. Each student was responsible for highlighting their online participation through exchange of ideas with peers and/or preparation of materials.

Expected Student Outputs

Expected outcomes included the submission of a “scrapbook” (a visual compilation of relevant information), a cultural audiovisual artifact as a creative expression, and a written and/or online reflective feedback. Collaborative scrapbooks allow learners to express their histories and cultural experiences through images, personal reflections, and multimodal content. These participatory and multimodal approaches allow students from different social, linguistic, and cultural backgrounds to engage meaningfully, regardless of their access to traditional academic resources or dominant languages. Furthermore, they bridge linguistic and cultural gaps as well as validate personal and culturally grounded knowledge, providing spaces where indigenous and lived ways of knowing can be acknowledged and shared. Such practices affirm the value of learners’ backgrounds and counter the dominance of Western epistemologies in curriculum design,³⁸ enabling learners to develop intercultural competencies while also deepening their understanding of their own identities and histories. This contributes to social justice and transformation by challenging who is seen as a “knower” and what counts as knowledge.³⁹

The learning objectives and expected outcomes of the project are described (Table 1). All learning outcomes were evaluated based on participation, creativity, and the demonstration of intercultural collaboration skills. The scrapbook was assessed for content (20%), their reflection of cultural differences and similarities (40%), visual resources (10%), insights from international collaboration (10%) and presentation (20%).

Table 1.

Learning Objectives and Outcomes of COIL Project Implementation

Time Frame	Learning Objectives	Learning Outcomes
Two weeks prior to implementation	Each institution prepares students for the COIL collaborations (Complete ImmerseUa training). Brief students on ground rules for respectful collaboration. Allocation of facilitators (academic link) to encourage student engagement.	Disciplinary related Knowledge Able to understand and compare issues pertaining to topic (impact of COVID-19) in the 5 COIL. Recognize diverse international health contexts and policies related to COVID-19 responses. Professional Knowledge Analyze COVID-19 issues at multiple levels (population, health services, governance, and policies). Develop recommendations based on the diversities. Skills Information retrieval and sharing. Intercultural teamwork across diverse cultural. Flexibility regarding collaboration across 5 time zones Communicate in English using translation tools as needed. Information and communication technology (ICT) competency via the ImmerseUa platform, video creation, YouTube Collaborative Research and Dissemination
Week 1- Official Start	Group introductions, complete bio-videos, ice-breakers, post country-specific COVID info, Review and confirm ground rules
Week 2	Elect group leader and finalize topics
Week 3	Discuss and create scrapbooks using templates
Week 4	Develop cultural artifact (eg song with original lyrics, etc.)
Week 5	Submit assessments. Final two days: peer review other group’s submissions

Notes: ^aImmerseU platform Educational software, https://www.immerseu.org/.

Data Collection

Quantitative data were collected using a 5-point Likert Scale Questionnaire which evaluated engagement, skills development, cultural diversity, use of the learning management system, mental health, and the learning experience (Table 2). The 6 domains of the questionnaire were developed using Rubin’s (2017) COIL framework, which were adapted to reflect the specific context of student–lecturer engagement, vocational skills, and learning management system use, etc.⁴⁰ The relevance and alignment of the questionnaire items was reviewed by the participating faculty members. Constructs such as vocational skills development and communication were represented by multiple items to reflect their multidimensional nature. In contrast, constructs such as mental health and learning experience were assessed using single items because they were included as contextual indicators rather than primary outcome variables. This approach is consistent with exploratory survey designs, although it limits the depth of construct measurement.

Table 2.

Description of the Study Outcomes

Likert Scale Variables	Description
Student/Lecturer Engagement and Communication (SLE)	I knew my instructor well during the VEX.
	I had a good relationship and communication with my group.
	Communication in English was easy for me.
	Communication in English contributed to my learning experience of the language.
	I experienced difficulties with the proposed activities during the VEX.
Vocational skills development (VSD)	The VEX experience had a great impact on my professional education.
	I think this VEX would help me in a future partnership between people from different countries.
	In my opinion, at the end of the module, I should be able to analyse a specific COVID-19 topic, for eg, mental health, and propose new ideas for health response.
	I had good learning and networking experiences during the VEX activities.
Cultural diversity (CD)	Intercultural issues were very clear and I could identify them easily.
	My experience with other cultures will influence my attitudes in future international collaborations.
	I think the cultural differences promoted conflicts among the students
Learning Management System (LMS)	I think the ImmerseU platform was very easy to use during the VE.
	I am very satisfied with the ImmerseU platform.
Mental Health	My mental health was negatively impacted by the pandemic.
Learning Experience	My learning experience in my course was negatively impacted by the pandemic.

Open-ended questions were also included within the quantitative tool to allow participants to provide additional feedback regarding communication experiences, intercultural interaction, and the perceived benefits or challenges of the COIL programme. The responses from the open ended questions provided preliminary qualitative insights that informed the development of interview questions and supported the interpretation of quantitative findings.

Qualitative data was collected using semi-structured online interviews conducted via Zoom Video Communications (https://zoom.us/). The interviews were approximately 30 minutes in duration and conducted between May and June 2021. The interview questions were designed to explore a deeper interrogation of the open ended variables defined in the quantitative questionnaire. All interviews were recorded, transcribed verbatim, and anonymized before analysis.

Data Analysis

The convergent mixed-methods approach allows for quantitative and qualitative data to be analysed separately and then integrated during interpretation. The quantitative survey findings informed the interpretation of interview data, and qualitative insights were used to explain and contextualise quantitative trends. This enabled a more comprehensive understanding of student experiences across multiple dimensions.

Quantitative Data

Responses from the Likert scale were analyzed using descriptive statistics, such as percentages and response distribution per category. The choice of descriptive statistics was justified by the ordinal nature of the responses and because of this is an exploratory study.⁴¹

Qualitative Data

Interview transcripts were analyzed descriptively and exploratorily using NVIVO software for data organization.⁴² The main analytical categories of themes that emerged include engagement, communication, vocational skills, cultural diversity, mental health, and learning experience, which were used as a-priori key-categories to organize the corpus.

Rigor and Trustworthiness

To ensure rigor and trustworthiness, the research team, composed of professionals from different fields, further advancing the interdisciplinarity of the COIL into the research space, independently reviewed the data before discussing findings in weekly meetings. Triangulation was performed by comparing quantitative and qualitative results, and participants’ identities were protected throughout the process. Anonymous forms were used to collect data, and during the transcription of interviews, the same code was maintained to identify students. Although items were grouped under broader aspects, these constructs encompass multiple dimensions. For example, student–lecturer engagement and communication include elements of peer interaction, language use, and perceived participation challenges. Therefore, analysis was conducted primarily at the item level to avoid overgeneralisation of conceptually distinct variables.

Results

Characteristics of Study Population

The demographic profile of the study population is presented in Table 3. Of the total population, 58 (90.62%) were aged between 18 and 25 years, and 43 (67.19%) were female. The majority were enrolled in biomedicine (n=23; 35.94%) and nursing (n=22; 34.38%). Zoom was identified as the preferred platform for both peer and academic engagement.

Table 3.

Demographic Profile of Participants

Demographic Variable	Frequency n (%)
Age
18-25	58 (90.62)
≥26	6 (9.38)
Gender
Male	19 (29.69)
Female	43 (67.19)
Prefer not to say	1 (1.56)
Other	1 (1.56)
Course Registered
Nursing	22 (34.38)
Medicine	6 (9.38)
Psychology	2 (3.12)
Pharmacy	2 (3.12)
Biomedicine	23 (35.94)
Odontology	4 (6.25)
Other undergraduate course	5 (7.81)
Participating Countries
Brazil	13 (20.31)
Ireland	3 (4.69)
Philippines	25 (39.06)
South Africa	14 (21.88)
Spain	9 (14.06)
Alternative Learning Management Platforms
ImmerseU	2 (3.12)
Google classroom	12 (18.75)
Google Meet	2 (3.12)
Other	48 (75.01)

Student Outcomes

Communication and Student-Lecturer Engagement

Effective communication between students and facilitators in a COIL project plays a key role in promoting equity, inclusion, and the valuing of diverse knowledge systems. It creates a safe space for all participants to express themselves freely, especially those from historically marginalised backgrounds, thus fostering active participation and collaboration.³⁸ Through ongoing dialogue, students can critically engage with different worldviews and challenge the dominance of Western knowledge, supporting decolonial aims within higher education.³⁹ This engagement also helps build intercultural understanding and mutual respect, contributing to socially just and inclusive learning environments.⁴³

The responses (Frequency %) from the Likert scale variables are presented in Figures 1–4 based on all participants’ responses. These data are complemented by emerging categories of qualitative data identified from the interviews conducted with the students and from the open-ended fields of the data collection instrument (Table 4). Approximately 56% (n=36) of the study population reported being able to communicate in English without difficulty, demonstrating an improvement in their language skills (61%; n=39) (Figure 1). There was a general consensus that communicating in English was achievable and motivating despite the language barriers, as it allowed them to improve their English language skills. Majority also reported a positive relationship with their academic instructor/s and group members throughout the VEX. Participants reported that conversations regarding the project were easy to navigate and discuss with group members. Furthermore, brainstorming with team members enabled them to articulate practice solutions and develop problem-solving skills.

Figure 1.

Cross Cultural Communication and Student-lecturer engagement. SLE1-I knew my instructor well during the VEX. SLE2-I had a good relationship and communication with my group. SLE3-Communication in English was easy for me. SLE4-Communication in English contributed to my learning experience of the English language. SLE5-I experienced difficulties with the proposed activities during the VEX.

Figure 2.

Development of Globally-Relevant Vocational skills. VSD1-The VEX experience had a great impact on my professional education. VSD2-I think this VEX would help me in a future partnership between people from different countries. VSD3-In my opinion, at the end of the module, I should be able to analyse a specific COVID-19 topic, for example, mental health, and propose new ideas for health response. VSD4-I had good learning and networking experiences during the VEX activities.

Figure 3.

Cross Cultural Awareness and Diversity. CD1-Intercultural issues were very clear and I could identify them easily. CD2-My experience with other cultures will influence my attitudes in future international collaborations. CD3-I think the cultural differences promoted conflicts among the students.

Figure 4.

Learning Management System for Global Partnerships. LMS1-I think the ImmerseU platform was very easy to use during the VE.LMS2-I am very satisfied with the ImmerseU platform.

Table 4.

Summary of Qualitative Themes, Subthemes, and Representative Quotations

Main Theme	Subthemes	Description of Pattern	Quote
Communication and Engagement	Ease of interaction	Described as smooth and constructive.	Conversations regarding the project were easy to navigate and discuss with group members.
	Language development	Reported improvement in English communication skills.	Communication in English contributed to my learning experience of the language.
	Language barriers	Some experienced challenges communicating in English.	Communication was sometimes difficult due to language differences.
	Collaborative dialogue	Group discussions supported problem-solving.	Brainstorming with team members enabled us to develop solutions.
Vocational Skills Development	Global awareness	Developed understanding of global health issues.	I now have a better understanding of how Covid-19 affected other countries.
	Interdisciplinary collaboration	Valued working across disciplines.	We learned how different countries respond to global challenges.
	Professional skill development	Growth in critical thinking and collaboration.	This experience helped me analyse pandemic-related issues.
	Networking	Formed international connections.	This will help me in future partnerships.
Cultural Diversity	Appreciation of diversity	Valued cultural differences.	I have had the opportunity to meet people from different cultures.
	Intercultural understanding	Engagement promoted empathy.	We have differences but also similarities.
	Absence of conflict	Minimal conflict reported.	No one treated each other badly.
Learning Experience	Peer relationships	Strong friendships formed.	I ended with 7 friends.
	Engagement	Experience described as enjoyable.	It was amazing getting to know each other.
Learning Management System	Platform usability	Platform manageable but imperfect.	The platform was manageable.
Mental Health	Negative impact	Pandemic affected wellbeing.	The pandemic affected my mental health.
	Emotional support	COIL reduced isolation.	Meeting others was the best moment.

In diverse linguistic spaces, easy and open communication in COIL projects can be challenged by the dominance of English as a major global language, often resulting in feelings of exclusion or limited participation, and consequent inequalities, referred as “linguistic imperialism”.⁴⁴ Although English as a “lingua franca” allows for broader participation, it potentially undermines the recognition and inclusion of other languages, such as indigenous, spanish, portuguese or irish, as knowledge.⁴⁴ Thus, a balance between practical communication needs and the celebration and/or accommodation of all languages presented is integral in ensuring no participant feels linguistically marginalised.⁴⁵ In this study, cognizance was taken to actively incorporate and respect all languages (Portuguese, Spanish, African and Irish) and multilingual practices to promote successful participation and genuine transformation.⁴⁴

Vocational Skills Development

Approximately 66% (n=42), agreed that this virtual exchange provided them with opportunities to acquire and develop professional skills applicable to future collaborations, as well as boosted their confidence to critically analyze future pandemic-related issues and propose appropriate solutions (Figure 2).

Intercultural interaction an emerging category also positively influenced the participant’s perspective on future international partnerships. Furthermore, the virtual exchange enhanced the learning experience of most participants, while also creating opportunities for networking another emerging category and fostering meaningful engagement with peers. Below are two participant responses drawn from reflective narratives.

During the communication process and research the vital importance of being united globally to learn from different countries, how we are all challenged during this pandemic, how countries are responding, the impacts on global health and how we can get through these challenging times together and help each other is important.

I now have a better understanding of how Covid-19 affected the other countries and how their health care system responded. I now understand how the health care systems in the different countries work.

Our findings align with those of the EVOLVE project, which examined students’ attitudes toward virtual exchange and reported an overall positive response (Jager, 2021). According to the EVOLVE project, many students viewed virtual exchange as a “valuable part of their higher education course” and believed “it should be continued in the future.” Furthermore, the data suggest that

a major factor influencing students’ appreciation of virtual exchange appears to be their perception of it as an opportunity for developing transversal and discipline-specific skills.

Noteworthy, our findings also suggest the accomplishment of critical ecological consciousness, interdisciplinarity, and local-global thinking by encouraging students to reflect critically on global challenges such as the COVID-19 pandemic.²⁵ Through participation, students demonstrated ecological awareness by recognising shared global vulnerabilities and the need for united responses to health crises, indicating an understanding of interconnected systems, as previously reported.⁴⁴ An earlier report also highlighted that interdisciplinary and global collaborations encouraged students to apply professional skills.⁴⁶

Additionally, our findings demonstrated efficient application of interprofessional skills through their ability to propose contextually appropriate solutions to complex global issues, as seen in the 66% who felt they had developed relevant collaborative skills. Furthermore, local-global thinking was fostered through exposure to diverse perspectives, with 60% of students reporting that intercultural interaction deepened their understanding of how healthcare systems function in different contexts, as previously reported.⁴⁷ These outcomes highlight the transformative potential of COIL in supporting socially responsive and inclusive global education.

Cultural Diversity

Our students agreed that this experience allowed them to identify and appreciate cultural differences among their group members. Furthermore, many noted that interacting with individuals from diverse cultural backgrounds had a significant impact on their perspectives regarding future international partnerships (an emerging category). Conversely, the majority disagreed that cultural differences led to conflicts within their groups, as shown in Figure 3 and outlined below.

I am grateful to have participated in a programme like this. Though it was challenging at times, the overall experience is unforgettable. I’ve had the opportunity to meet and learn about people from different cultures which was very interesting. I’ve learnt that we have our differences but we also have many similarities, especially going through this pandemic together. I’ve witnessed that with international collaboration, we can devise solutions to tackling a pandemic like Covid-19.

It’s a great experience building relationships with other cultures because you get to know them and it is very overwhelming talking to other students from different places. Listening to different ideas from them was very nice because they suggested unique ideas and our team was the best!

The unity we had and showed to each other was one of the best things ever; no one treated each other badly because of his or her race; we were so happy, and it was enjoyable.

Our findings illustrate how students were empowered to engage critically with issues of power, identity, and social justice in the context of global challenges. Students highlighted the significance of encountering and appreciating the cultural differences within their diverse groups, noting that these interactions broadened their understanding of international collaboration and challenged their preconceptions about others. The survey responses and testimonials reflect that students were able to reflect on their own identities while learning from others’ perspectives, fostering a deepened sense of unity and empathy across cultural boundaries.

Most participants specifically reported that navigating differences did not lead to conflict but instead encouraged collaborative problem-solving, particularly in relation to shared challenges like the COVID-19 pandemic. The data is indicative that the learning environment allowed them to recognise both differences and similarities, breaking down stereotypes and reconsidering issues of social justice as experienced globally and locally. Furthermore, the ability to engage with each and listen to unique ideas, as well as valuing each member’s contribution, highlights respect for local knowledge systems and the notion that solutions to complex issues often emerge from a blending of global perspectives with indigenous or community-based wisdom. Such engagement not only amplifies marginalised voices but also cements the importance of local knowledge in addressing broader societal issues, ensuring that learning within the COIL project is inclusive and transformative for all participants.

Effectiveness of Resources, Tools, and the Learning Management System Used

Most participants indicated that using ImmerseU as a learning management and information dissemination platform was manageable, suggesting that with some adjustments, it could be effectively utilized in other online exchanges (Figure 4). While students did not feel a strong natural connection to the platform, they nonetheless found it practical and manageable.

Pandemic Impacts on Students’ Mental Health and the Learning Experience

Our findings indicate that 50% of participants agreed that the pandemic, combined with lockdown restrictions, negatively affected their mental health and overall learning experiences. This impact was further intensified in both their personal lives and home environments. However, many students highlighted positive aspects of participating in COIL during the COVID-19 pandemic during the interviews. Their involvement in COIL appeared to foster feelings of belonging, reduce isolation, and bring joy, hope, and a sense of lightness to the challenges they faced, as illustrated by some of their reflections below (emerging categories).

As I’ve dealt deeper with the mental health impacts due to pandemic, I’ve been more worried and well-informed with the situation of our co-health workers that have been the heroes as front liners during this COVID-19 season and this led me to be more motivated on studying and more compassionate not just for the sick but also for our own field, the health workers.

Meeting others from different parts of the world was the best moment ever to me as a girl from rural areas in SA.

I started this program with one friend but ended with 7 friends in total. What I enjoy the most is the fact that I was able to gain friends after this amazing program.

I mostly enjoyed being with my group mates because we not only talked about the school work itself, but also shared our thoughts and experiences getting to know each other. It was amazing.

Overall, the findings indicate that participation in the COIL programme supported the development of key competencies, including communication, teamwork, intercultural awareness, and professional skills. Students reported positive learning experiences, meaningful intercultural engagement, and increased confidence in collaborating across global contexts, despite challenges related to language and digital platforms.

Discussion

This study explored students’ perceptions of a transcontinental COIL experience, with a focus on communication, vocational skills, intercultural competence, and learning experiences during the COVID-19 pandemic. The findings provide evidence that participation in COIL supports the development of key competencies relevant to health professions education, particularly in relation to communication, teamwork, and intercultural collaboration, similar to that reported by Hackett et al.¹⁸ The predominant age group in this COIL was 18–25 years, a generation known for being open to new educational and intercultural experiences in the health field.⁵ Young adults were particularly affected by the pandemic, facing an overload of (dis)information and constant connections on social media, combined with a high degree of uncertainty regarding their education and future prospects.⁴⁸ Many were also exposed to new teaching, monitoring, and evaluation methods in higher education that they were not accustomed to.⁴⁸ This shift from face-to-face teaching to online learning, coupled with restrictions on leisure activities and reduced social interaction, contributed to feelings of isolation, anxiety, and reported depressive symptoms. In this challenging context, COIL offered a sense of lightness by fostering peer interaction and the exchange of shared experiences with other young people from diverse cultures and places. The program did not focus mainly on evaluating students’ performance but instead emphasized the development of soft skills, information sharing, and teamwork to address global health challenges such as the pandemic. Through this approach, students had opportunities to build resilience and engage in collaborative learning, which we hoped enhanced their empathy and global perspective during these unprecedented times.

Communication emerged as a central component of the COIL experience. Several participants reported increased confidence in communicating in English and engaging in discussions across cultural and linguistic boundaries, indicative of the authentic opportunities that COIL can provide for developing communication competence in real-world contexts. Our findings align with a previous study, which demonstrates that virtual exchange environments enhance language development, confidence, and enables meaningful interaction.⁴⁹ Despite the perceived positivity associated with COIL and improved communication, there still remained challenges associated with language. Even though the use of English as a “lingua franca” facilitated participation, it is possible that may have introduced barriers for some students. Similar experiences were reported in global virtual exchange contexts, highlighting that language may simultaneously enable and constrain engagement.⁴⁹ This therefore highlights the need for pedagogical strategies that support inclusive communication practices and accommodate varying levels of language proficiency. The use of digital tools and skills in the program supported teaching and learning processes, reflecting the increasing importance of digitization in post-pandemic education.^50,51 These findings reinforce the role of digitally mediated environments in fostering communication skills that are essential in contemporary health professions education.

Our findings indicate that COIL also contributed to the development of vocational and professional skills, including teamwork, critical thinking, and collaborative problem-solving. Students reported increased confidence in engaging with global health issues and working within interdisciplinary teams, which are core competencies in health professions education. Our findings are consistent with the EVOLVE project, which identified virtual exchange as a valuable approach for developing both transversal and discipline-specific skills.⁵² Several students emphasised that the COIL program served as an opportunity to acquire skills critical for future interdisciplinary collaborations. Through critical reflection on global challenges, students were able to recognise shared global challenges within the context of health, highlighting the interconnected systems created through the COIL Project.

Intercultural competence emerged as a key outcome of the COIL experience. Students reported increased awareness of cultural diversity, improved ability to engage with different perspectives, and a greater appreciation of global interconnectedness. These findings corroborate existing literature that identifies intercultural competence as a critical outcome of internationalised higher education.^53,54 In the context of a globalized world, intercultural competence is recognized as an essential skill for successful navigation in diverse cultural settings.⁵⁵ Bennett (2015) defines it as a set of cognitive, affective, and behavioral skills and characteristics that enable effective and appropriate interaction across cultures.⁵³ Developing intercultural competence requires not only knowledge but also skills, motivation, and a respectful attitude. During the virtual exchange, students were encouraged to share diverse perspectives, which promoted critical learning capable of challenging dominant or one-sided views of knowledge.³⁸ Students were consistently encouraged to cultivate respect and sensitivity, which enhanced their ability to engage constructively in an intercultural environment.

The choice of the learning management system (LMS) played a significant role in facilitating engagement during the COIL. The availability of a user-friendly LMS is essential to support seamless collaboration and should not be seen merely as a platform for content sharing but as a tool to promote and enhance student interaction.⁵⁶ Despite barriers such as time zone differences, language challenges, and cultural dynamics, students should have access to reliable LMS’s that enable active engagement throughout the program.

Finally, the COVID-19 pandemic had a profound impact on students’ mental health and learning experiences. The use of COIL created a sense of community across geographical boundaries during the pandemic-related restrictions. Our findings are corroborated by an earlier report, which reported that the structured interaction and peer engagement characteristic of online learning were instrumental in supporting the overall academic interest and wellbeing of students.⁵⁷ The disruptions in teaching and learning delivery during the pandemic affected students’ ability to participate, concentrate, and interact with teachers and peers effectively. Fortunately, COIL provided a space for greater interaction and participation through synchronous sessions, fostering a sense of belonging and community among students.⁵⁸ The shared experience of the pandemic, along with the recognition of both differences and similarities, fostered inclusive learning. The COIL program mitigated feelings of isolation and created opportunities for meaningful engagement and learning during a time of significant global challenges.

Overall, our findings demonstrate that COIL is an effective pedagogical approach for supporting the development of communication, teamwork, intercultural competence, and professional skills in health professions education. By enabling collaboration across geographical and cultural boundaries, COIL provides students with meaningful opportunities to engage with global health challenges and develop competencies required for practice in diverse and interconnected contexts.

Limitations

Self-reported data may introduce response bias and the use of single item constructs may reduce data reliability that a multi-item scale could capture. The study only captures immediate or short-term learning outcomes and does not allow for assessment of long-term competency development.

Conclusion

Our findings demonstrates that participation in a transcontinental COIL programme can effectively support the development of key competencies in health professions education, particularly communication, teamwork, intercultural competence, and collaborative problem-solving. Students reported positive learning experiences, meaningful intercultural engagement, and increased confidence in addressing global health challenges within a virtual environment. Overall, COIL offers a flexible and impactful approach to preparing students for practice in diverse and interconnected healthcare settings. While the programme highlighted the potential of COIL to enhance global learning and foster inclusive collaboration, it also revealed challenges related to language use and digital access, which may influence participation. Regardless, these findings reinforce the value of COIL as a strategy for internationalisation at home, particularly in contexts where physical mobility is limited. Further research is needed to explore the long-term impact of such initiatives on professional competency development.

Funding Statement

The authors did not receive support from any organization for the submitted work.

Data Sharing Statement

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration, including its later amendments or comparable ethical standards. The study was approved by the Institutional Research Ethics Committee of Durban University of Technology (IREC 055/17). All participants provided written informed consent, which included the publication of anonymized responses and/or direct quotes.

Biographical Note

Nalini Govender is an Associate Professor at the Durban University of Technology. Her research focuses on medical education and women’s health. Professor Silvia W. Sarinho is based at the Center for Medical Sciences and the Digital Health Discipline of the Medical Program at the Federal University of Pernambuco, where she is involved in postgraduate medical education in Children and Adolescent Health. Rosalie Barreto Belian is a Professor in the Department of Medicine at the Center for Medical Sciences, Federal University of Pernambuco, Recife, Brazil. Her research focuses on methodologies and the use of digital technology in health education. Dr Divinia Jithoo is a Specialist in international Education, Durban University of Technology, South Africa.

Author Contributions

All authors made a significant contribution to the conception, study design, execution, acquisition of data, analysis and interpretation. All authors also took part in drafting, revising and reviewing the manuscript and have provided final approval of the version to be published. All authors have agreed on the journal to which the manuscript has been submitted and agree to be accountable for all aspects of the work.

Disclosure

All authors declare no competing interests.