Differences as catalysts for professional learning—Participating in a student exchange program between Sweden and Uganda

Abstract The aim was to describe the experiences of some university students and the effect on their own learning and professional development by participating in an exchange program. Data were derived from two focus group interviews with students (n = 12) who enrolled in a 12-week international exchange program between: (a) the occupational therapy education department at the Institute of Allied Health and Management Sciences in Kampala and its equivalent b) the Karolinska Institutet (KI), Sweden. The findings comprised five categories reflecting the students learning experiences: (1) Learning through the unfamiliar, (2) Differences as catalysts for professional learning, (3) The importance of interaction with others for beneficial learning, (4) Learning related changes in professional identity and one’s own persona, and (5) Experienced transfer of learning toward a sustainable lifelong learning style. The findings reflected a spectra of similarities between the students, almost regardless of their background and culture, also that students can learn substantially by being confronted by the unfamiliarity during an international exchange.


ABOUT THE AUTHORS
The Swedish researchers linked to the Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Sweden. The Uganda researchers are linked to the Occupational Therapy School, Institute of Allied Health and Management Sciences-Mulago, Kampala, Uganda.
Sofia Vikström (PhD) is a senior lecturer, awarded into the Pedagogical Academy of KI for promoting educational development, commitment in educational issues and for demonstrating teaching excellence.
Julius Kamwesiga, OT (Reg), BSc in social science, PhD student at KI.
Andrew Mubangizi, Head master of the Occupational Therapy program in Kampala, Uganda.
Susanne Guidetti is a senior lecturer acting as the international coordinator. She has received her PhD in Occupational Therapy. Her main area of research is to develop and evaluate complex interventions both in Sweden and Uganda.

PUBLIC INTEREST STATEMENT
To take part as a University student of an international mobility program creates beneficial positive learning effects and supports the professional identity. Interestingly enough, there have not been seen any major differences when interviewing a group of students coming to Sweden from Africa (here Uganda) and vice versa. The 12 participants in focus group conversations on their exchange-in relation to their profession and learning-showed that the exchange program could make a change in a person's development in becoming a professional. But it also showed how the exchange had an empowering effect, with an educational impact of the learning situation as well as the context. By creating conditions for students to be in an international environment during their education, students can examine their implicit and explicit beliefs about welfare issues, and develop an increased globalized sense of responsibility and citizenship according to UNESCO.

Introduction
There are many reasons to internationalize the higher curriculum today, in an increasingly globalized world, and any educational program should comprise an international perspective (The Council of European Union, 2011). The purpose of internationalization is to strengthen the quality and diversity of education and equip students to be actors in a more multicultural society (European Higher Education in the World, 2013; Karolinska Institutet, 2015). One of the most commonly used definitions of internationalization of higher education reads as follows: "the process of integrating an international, intercultural and/or global dimension into the goals, functions (teaching/learning, research, services) and delivery of higher education" (Knight, 2015).
Creating conditions for students to work in an international environment during their education, such as for the students in this study, contributes positively to the students' opportunities to examine their implicit and explicit beliefs about welfare issues, as well as developing an increased globalized sense of responsibility and citizenship (Pigozzi, 2006). However, there is limited knowledge of educational benefits from such exchanges, which is particularly true for exchanges involving lowincome countries (EHEA, 2012). Thus, the focus of this study is to contribute to the area of knowledge above by describing the experiences of a student exchange program between a university in Sweden and one in Uganda with regard to competence building, mutual gains and challenges.
In a global perspective, research identifies a few dominating outcome-tracks of international university exchanges involving low-and middle-income countries. Commonly, studies that describe international exchange focusing on experiences related to culture in a spectrum of surprising variations in views and traditions of the aspects described within an overarching umbrella of experiences that can be defined as cultural shocks. Some recent publications focusing on existing evaluations of international exchange with regard to sensitizing the cultural differences participants perceives (Ruddock & Turner, 2007), on how they have changed as individuals as a consequence of the exchange (Button, Green, Tengnah, Johansson, & Baker, 2005) or on how their views on their own culture have been re-constructed (Johns & Thompson, 2013).
Secondly, there are studies that have focused on international collaboration from an organizational or logistical viewpoint, where aspects like contracts, prerequisites and setups are discussed (Cameron et al., 2013), or models tested (Suarez-Balcazar, Hammel, Mayo, Inwald, & Sen, 2013). For example, Bartram (2008) has presented a hierarchy of requisites for international students as sociocultural, academic, and practical needs. In a similar vein, yet other studies have taken the approach of analyzing the ongoing internationalization exchange from a quality improvement and development perspective (Green, Johansson, Rosser, Tengnah, & Segrott, 2008). There are also evaluation studies that have had research exchange in the forefront (e.g. Njelesani, Stevens, Cleaver, Mwambwa, & Nixon, 2013) that illustrates strives to match existing collaborations with existing courses at the partner universities. A third track includes studies focusing on pedagogical and developmental aspects of students' learning (Elliot, 2015). According to Knight (2004) the internationalization can be studied at both the institutional level and the national/sector level. Both levels are important and have influence on the international dimension of higher education through policy, funding, programs and regulatory frameworks. In this study, we examine the individual on an institutional level and those activities that happen specifically abroad or in other words, across borders.
The Linnaeus-Palme (LP) exchange is financed by the Swedish International Development Cooperation Agency (SIDA) with aim to strengthen the cooperation between Swedish universities and their counterparts in low-income countries (The Swedish Council of Higher Education, 2015). The LP exchange is set up in accordance with an initiation grant, with a limited approval of eight years, all of which requires separate annual applications and reports. The overall objective is to increase participants' international awareness, where each project should have a specific academic objective for its exchange. Mutual benefit is central to the LP program, and the intention is to reach a mutuality where the partners should be able to cooperate on equal terms, despite the fact that there may be a considerable difference in respective available resources.
Thus, the aim of this study is to describe the students' experiences with regard to their own learning and professional development by participating in an exchange program.

Methods
This study has a qualitative design based on data collected in two focus group interviews, with Ugandan students (n = 6) who have been in Sweden and with Swedish students (n = 7) who have been in Uganda.

Context
The study addresses experiences of students who participated in a LP international mobility exchange between the occupational therapy programs at: (a) The Occupational Therapy School Institute of Allied Health and Management Sciences-Mulago, Kampala, Uganda (OTSU), which was affiliated to Makerere University (MU), and (b) The Karolinska Institutet (KI), Stockholm, Sweden. The OTSU has approximately 3,000 students enrolled, while the KI equivalent comprises about 6,000 students, both universities being located in their country's capital and thus constituting one of their respective nation's larger educational institutions.
Accredited by the World Federation of Occupational Therapy (WFOT), the occupational therapy program in Uganda started at a registered (Diploma) level in 1994 with the initial enrollment of eight students. Today the school enrolls 20-25 students annually. As of 2014 a total of about 240 occupational therapists (OTs) have qualified from the school.
The occupational therapy program at KI, Sweden entered the university setting in 1994 and currently enrolls 50 students bi-annually. The program covers six semesters and qualifies as a double degree, where graduates register as professional OTs as well as bachelors of medicine. The LP program was initiated in 2005 with a planning trip to Uganda, followed by bi-annual reciprocal teachers' exchanges to thoroughly plan the upcoming student exchanges, as from 2007. The LP collaboration has enabled an exchange of students (n = 18) at the undergraduate level and teachers (n = 10), this being the total going in both directions of the exchange program.

Participants
All former students who had been involved in the LP exchange between the OT program at KI and OTSU were approached regarding participation in the study. Of those contacted, five students from Uganda and seven students from Sweden agreed to participate in the focus group interviews. One former student from Uganda who was living in Botswana sent an email with her responses. The students that did not participate gave reasons for not participating, such as due to the long distance, or other duties, and there might have been some unresponsive that did not receive the invitation. From Uganda there were four women and two men, from Sweden there were six women and one male student who responded. The exchange was carried out between the years 2006 and 2013. The length of the exchange period was 12 weeks, including clinical practice and coursework for all students. All former students were now working within the health care sector.

Data collection
An interview guide was developed by the Ugandan and Swedish teachers that have had participated in the exchange program. The guide was used to initiate and direct the focus group conversation with topics included how the exchange may have affected their discipline, their clinical reasoning and learning. The focus group in Uganda took place at a venue in a hotel, during the first National Congress of Occupational Therapy, in Kampala, November, 2011. The focus group discussion in Uganda was led by two moderators (one Swedish teacher and one Ugandan teacher). The discussion was conducted in English and continued for approximately 130 min and was recorded and transcribed verbatim. The focus group in Sweden took place at KI, in May 2013. The interviews lasted for approximately 80 min in Swedish, led by one moderator (a Swedish researcher) and one observer. The observer took field notes and did the transcription of the recorded interviews (Charmaz, 2006).
In the two different focus group interviews, the discussion was characterized by an "open atmosphere" where the participants were highly engaged and actively listened to the person sharing his or her experiences.

Data analysis
Data from the focus group discussions were transcribed and analyzed using a constant comparison approach (Strauss & Corbin, 1998). The analysis began with the initial coding of the transcribed focus group interviews. In the initial phase of the analysis, the transcribed texts from the interviews were read through repeatedly to gain a sense of the details of the data, as well as of the whole. A detailed line-by-line analysis was the first step of open coding and meaningful contexts emerged. The codes were labeled in terms that were close to the participants' own wording. Memos were written, sorted and used throughout the analysis, which began with the set of interviews and the written observations. By axial coding (Strauss & Corbin, 1998), which involved moving across the interviews and the written observations, comparing the participants' descriptions of the exchange, the different categories emerged. During the analysis, categories emerged that together described the experiences and professional development the participants assumed. Quotes from participants have been selected for illustration. All text from the focus group discussions was categorized as described above.

Findings
The data analysis resulted in the establishment of five main categories including subcategories; (1) Learning through the unfamiliar, (2) Differences as catalysts for professional learning, (3) The importance of peers for beneficial learning, (4) Learning related changes in professional identity and one's own persona, and (5) Experienced transfer of learning toward a sustainable lifelong learning style. The categories will be presented below and illustrated with quotes. In some cases the perspectives differed between the two student nationalities. In such cases, the examples have been marked with the letter U, signifying the Ugandan students' perspectives, or S for the Swedish students.

Learning through the unfamiliar
One of the categories emerging from the analysis was the students' need of learning to cope with unfamiliarity when participating in the exchange. The students seemed to have learned during the exchange by experiencing and seeing the unfamiliar in comparison to the familiar. The students from both Uganda and Sweden described how they became confronted and challenged with new situations in another context and country. By being confronted with unfamiliarity they discovered new things that contribute to new knowledge and their personal development, as well as in relation to their professional development. For example one Ugandan student expressed: "In Europe, if anything happens, one would say: How can I see a doctor? But here in Africa the first perspective [author's note: thought that comes to mind] is that you have been bewitched." Students from both countries described how they faced other challenges than they had anticipated and were used to from home. They gained insights through differences in views on lifestyles, illness, disability and health, and that added to their learning situation. Also, all participants observed and valued the frailty of services and living conditions, but from different perspectives. One Swedish student, facing a family with complex challenges where the members experienced a lack of income, mental exhaustion and poor education, described the following: "… the mother have a chronic disease, or they have no job where they can earn a living. In addition to that, they have a disabled child who has been kept indoors to avoid exposure to, and stigma from, the community." When in Sweden, client independence was prioritized, and the rehabilitation was not set up to enable family caregiver involvement, the Ugandan students' reflected that the responsibility for care and healthy routines is a professional duty in Sweden. This could be valued as providing good services, but the Ugandan students also reflected that it could be viewed as a sign of poor living conditions, in that the close support and proximity of a caring family seemed lacking (U). When in Uganda, the family members of a person with disability can oppose client engagement in treatment. The unfamiliar situation with a health care system sometimes without family members in comparison to the familiar situation back in Uganda was most of the people living close to their families.

Cultural heritage and preconceived ideas
All students described how they realized that they were more affected by their own cultural heritage than they thought. Such insight into the influence of culture was not clear to the students in the initial part of the mobility exchange, and therefore was described as something that could block their open-mindedness toward things. For example regarding the new teaching-learning culture, where Swedish students expressed having had thoughts of the Ugandan teaching as being old fashioned, as well as the courses at OTSU being too medically oriented. However, all students described that they learned to see beyond pure culture over time, and viewed such phenomena as unique values whose purpose was to meet particular local needs. One Swedish student describe a change in value of her capacities: "There are many situation you think of. For example one boy at the spinal ward had stopped eating and the doctor asked for me to do something. The boy seemed to have given up since he had very limited body functioning, beside a hand with some function left. We started to work with him and that actually made a change, […] that provided him with hope." Students from both countries described how their previous knowledge which they had taken for granted, was challenged. One student expressed the following: "When I arrived at the clinical placement, they had not taught us about cultural sensitivity yet. So, after an incident, I had to realize that I had to be sensitive. e.g. not everybody has to shake hands when greeting one another" (U). Some students described that, in the process of getting acquainted with the activities, habits and roles central to the client, they gained an increased insight into the cultural perspectives and beliefs of the client. Such insights made the students learn how to adapt a standard treatment to better fit particular clients and their actual contexts. The students claimed that they grew as professionals, since they felt that they became better at seeing potentials in the different clinical situations. All students further expressed how they had developed a greater understanding of social exclusion and class and that they now possessed knowledge to explain that such problems must be viewed from a global or systemic perspective. In that realization, a frustration from both student groups was depicted in relation to Swedish health care; that, despite high socioeconomic standards, Swedish people did not always value the high quality of care and special resources they had.
In conclusion, students from both universities identified that a lot of the things done in their practice training prepared them for future challenges that might emerge from facing one's preconceived ideas about cultures in general and health systems in particular. By being confronted with new, unfamiliar situations the students claimed that they had gained new, valuable knowledge that stimulated their readiness to cope with the unforeseen.

Differences as catalysts for professional learning
The analysis illustrated ways in which the differences in health care context and learning regimen affected students' professional learning. Several described that such differences initially created confusion and a sense of lack of control. Some students experienced that the education they faced included expectations from teachers and staff which they were not used to (S) as well as frustration over lack of resources. Some lacked the possibility to look things up in books (U), while others got frustrated over lack of, or slow, internet connections (S). Some of the responding students had reflected further on their experiences of student-driven learning in Uganda, and expressed criticism toward the more traditional lecture based pedagogics used at home (S). For example that it omitted to stimulate creative thinking. Within the practical training in Uganda a high reliance on, and trust in, reading relevant literature was shown. Due to a lack of materials to support clients, they felt forced to identify other resources they possessed, so as to provide comfort, give hope, or even joy to clients. One Swedish student expressed the following: "But eventually, you know, children are just children. No matter how ill they are, you can still play with them. So those contrasts were evident, that you do not always have the means, but you can make a difference on other levels. Make them happy at least". They argued that, no matter in which cultural context they would work, they have learned creative rehabilitation solutions for their clients. One student described a typical, but unique and challenging care situation: "complex challenge of finding out the best way to perform rehabilitative interventions for a person with spinal cord injury at a ward where patients lay in rows and family members slept on the floor beside them to be of constant assistance" (S). The students seemed to have gained inspiration to more bravely act creative and think "outside the box'. Some students from Uganda also experienced a difference, and a challenge, in the request to work in teams, but they acknowledged that different professionals were important to clients. "[During the exchange] … I became aware of how the professionals consulted one another in the community". The experiences they gained from the different situations seemed to inspire creative and innovative thinking and contributed to their development in problem-solving situations.
Students from Uganda expressed that they had had very few interactions with the clients' family members in Sweden this made student's value the necessity to listen to, and interact with the clients. One Ugandan student expressed the following: "I knew before I left for Sweden that OT's needed to get close to the client, listen to their views as well as respect them, but I didn′t know the depth of that sensitivity until I experienced it." The same student concluded how what she took for granted had changes her perspective: "Back at home, I became more respectful and understanding of others (U)." For all students, it seemed that the international exchange experience created a greater understanding of the profession's breadth and that the (abundance or lack of) material resources and the conditions in the clinics had an impact on the depth of learning of the students; e.g. they realized that some technical aids could be seen as items with a far broader potential than was often the case. Equally, they had to learn that it was possible to work with limited resources and without prefabricated technical aids (S). One student illustrated the new creative mindset required: "It did not have to be so complicated. You could make a difference with small means and simple tools. For example, a wheelchair could consist of bicycle wheels and a garden chair". Hence, the international exchange seemed to develop the students' professional creativity and it also seemed to have given them a perspective on their own professionalism. It appeared as the differences they become exposed for become a catalysts for professional learning.

The importance of interacting with others for beneficial learning
The analysis showed the students' awareness of the importance other colleagues played in their professional learning. They emphasized how crucial the supervision of a more knowledgeable peer was for their development of trust in the profession. Further, the feedback from the extended environment, both within and between professions strengthened the students' trust in their own competence. The students from both countries described that the feedback they received from the clinical fieldwork training strengthened their trust in their own personal competence and increased the strength of their skills to act independently. For example, the students expressed that it felt good to be trusted and to be empowered when they tried to develop intervention programs single handedly. One Swedish student described: "I took part in a session on burn-injuries, just out of curiosity, although it was for nurses. But they didn't seem to know how to put bandages on a hand so I taught them. You just can't bandage a hand in a closed fist position." One student also described how by standing on the side when another professional and the client spoke the foreign language in question was a good experience (S). These strategies of non-verbal communication were described as now being used by her at her current workplace with people who lack the ability to speak. In contrast, some got positive feedback from patients, like the student who stated that a client gave her the following feedback: "Do you realize what this means? That I can hold a pen in my hand that is my major possibility for income".
In the student-driven learning environment, the peer-learning activities with others, both clinicians and students, were described as of great importance since their presentations in classroom settings yielded important feedback from the teachers.
In conclusion, the analyses highlighted a spectrum of aspects of interaction with others that was perceived to be beneficial to the students' own learning. Since students received a limited number of lectures as a resource, the inter-professional encounters and knowledge exchange were seen as highly important.

Learning related changes in professional identity and one's own persona
The analyses showed that the international exchange also had a more sustainable learning effect related to change. Some students' had changed views of their own professional competencies, as they saw a new role for themselves as contributors to change for individuals. One student described his experience as: "In Sweden an emphasis was put on inter-professionalism as well as on avoidance of role-blurring. This made me really aware of my role and stance in the team."(U) They identified new roles as contributors of change in the communities, where several students described making use of their knowledge in health care and transferring that knowledge into other situations. It seems as the new insights and experiences they gained not only inspired them to trust in their own potential, but also to move toward a more sustainable lifelong learning style and to use that strategically.

Changed views on one's own professional competencies
Something that all students had in common was how they had made the most out of the unique opportunities that participating in the mobility exchange offered. They realized that they were more prepared and empowered to adjust to new situations. On another note, they all described having faced unique and diverse positive challenges in relation to unusual diagnoses as well as organizational setups, underscoring professional competencies that were unique and highly beneficial for clients as one student express "I had realized that once I had understood the culture of the person, I can easily intervene and provide care that has a positive impact". Similarly, quotes relating to empowerment were common. This is illustrated by one student claiming: "I feel more informed and can think beyond the obvious interventions at hand. I am also more empowered and also [feel] capable of empowering other people." The findings further describe new theoretical insights and an awareness in students; e.g. social constructivist views that might prevail and that social stigma might impact people with long term illness. One student expressed what impact occupational therapy contributions could have on the clients' conditions: "I have realized occupational therapy is a more important profession than as I used to know it. Now I have the ability to go to various communities, introduce myself, what I can do, and tell them about the stigma many people with disabilities [feel], and then give them the scientific evidence and the right guidelines. So it has really helped" (U). In general, the students' found themselves having improved their problem-solving techniques as well as professional expertise.

Being change agents for individuals and communities
The students described that through participating in the exchange program they have had become contributors to change. Several students described that they perceived the international exchange opportunities they got as a calling, and themselves as resources for the citizens in their country (U). As most students gained knowledge in treating clients as equals, of no lesser status, and included them in decisions, they could be contributors to change through being role models for a new therapeutic approach in the national community rehabilitation. For example, how you could support clients to manage without technical aids, or to encourage the use of aids and go out into society to break stigmas. The students expressed how they were getting valuable insights into rehabilitation gains: How very small interventions can create a large positive change in people's lives and their health.
Some perceptions showed in the analyses that the students initially did not recognize the benefits that the learning offered. For example, one student from Uganda expressed having difficulties appreciating the learning during the exchange due to difficulties seeing how the experience could transfer to Ugandan conditions. Not until having been confronted with aspects related to the learning from the exchange did she see a practical and tangible use for it, and felt that she had the means to change practices.

Experienced transfer of learning toward a sustainable lifelong learning style
The Swedish students, who faced a higher degree of student-driven learning abroad than they were used to at home, were impressed with the Ugandan students' drive to constantly learn more. The Ugandan students' thirst for more knowledge was a driving force that made the Swedish students reflect on their own views on learning and knowledge acquisition. Some students expressed the great benefits in learning they had discovered when reading a course book from page to page (S). Some Ugandan students emphasized a transfer of learning from mainly using books, to also using the internet and digital databases to keep updated with the latest research. They also described feeling proud of having experienced professional and personal growth, as for example how they now could identify their own resources and creativity potentials. One student underscored the benefits by concluding: "Students should have the chance to feel they have contributed to making a difference for someone". Their professional growth included a structure similar to the research process, where students now described achieving goals to search for explanatory information, assess and see resources in every individual they meet, and then plan the treatment accordingly.
One key finding that the students chose to emphasize was a realization that occupational therapists make a significant difference to the future lives of individual people: "I can now see other opportunities for OT's in community care". However, students also expressed how they had learned not only to acknowledge the skills of other health care professionals, but also had experienced how they might have to work side by side with caregivers, and to include them so they become a resource of the rehabilitation (S). With a deepened understanding of the profession, and the rehabilitation possibilities, they also discussed ways to market oneself: "I value and use the occupational therapy competences I have and use that knowledge and my newly developed skills to sell my services".
The students described how they were taking responsibility for the profession by way of talking about occupational therapy in every situation. One student says: "I have been able to tour around Kampala and sometimes when I go in the village (like on holidays) then I also visit a few villages and identify such [OT related] issues and try to support and help them professionally." The analysis showed an awareness of the unique potential of the profession, and illustrated that they returned to their countries more equipped to act strategically to advocate the need for their services.

Discussion
This study presents the experiences of both Swedish and Ugandan students who participated in an international mobility exchange. The international exchange seemed to function as a catalyst that empowered students to take responsibility for developing the profession, both during the exchange but also afterwards, with regard to several various aspects. Further, the students had learned not to always adapt and be humble to conditions, but rather to empower people or families to change their own situation.
The uniqueness in this finding is that it emerges from data from the students of both university partners, hence mirroring a reciprocal perspective on the exchanges (Kulbok, Mitchell, Glick, & Greiner, 2012). The finding presented did not display a great difference between the students, nor the countries they came from, which was to some extent surprising as the students come from such different conditions and environments. Instead the study showed that an international mobility exchange program could make a change in a person's development in becoming a professional. But it also showed how the exchange had an empowering effect, with an educational impact of the learning situation as well as the context, which seem to have been explored as a student-driven learning environment. The international exchange seemed to contribute to the students' learning as an investment for future gains.
The extent to which this study has focused on learning experience points of view is different to what we have previously found in the literature, which mainly focused on the exchange itself and thus presented results in relation to cultural diversity and needs to adjust emotionally to differences (Ruddock & Turner, 2007). Additionally, previous studies concerned students who had travelled from the USA and Europe, while our results reflect both the perspective of change from a low-to middleincome country as well as a more high-income country (Kulbok et al., 2012).
Teaching others has been argued to be of one of the higher orders in the benefits of a learning hierarchy (Biggs & Tang, 2007). Our findings also illustrate how important the supervision of a peer was for the students' development of trust in their own profession. A study by McClure (2007) found that the importance of support was a key coping strategy for international student adjustment. The findings also correspond to a recent European definition of interprofessional education (IPE), where it is claimed to enhance trust in one's own profession (Pelling, Biguet, Lindquist, Martin, & Pettersson, 2015). The students described great value in peers' contributions to a collective learning, both within and between professions, which correlates with the IPE foundation, not only to learn about, but also from, and ultimately together with each other. In anecdotal entrepreneurial skills data within the KI medical education setting (Larsson & Vikström, 2017), a lack of professional identity constitutes a large and important part of students' and teachers' concerns. Such concerns might in turn lead to medical programs hesitating to take on IPE-initiatives within the university. In contrast, our findings strengthen the hypothesis that IPE has the potential to be beneficial to the shaping of one's own professional identity. However, the findings illustrated how unknown cultural encounters can have a catalytic effect on the students' innovative traits, in that they provoke them to come up with creative solutions to unforeseen challenges.
The findings indicate a general alteration of the students' perception of the acquisition of knowledge; for example, in that they reflect on the pros and cons in applying student-driven learning. The students seem to value pedagogics in a more nuanced manner, where indications are that quality does not necessarily have to be positively related to resources. Also, the opposite prevails. These insights might be catalysts for the building of their professional identity and reasoning. Besides the LP exchange, and deepened and broadened knowledge skills, they also expressed a change in their views on their own society. The students shared perceiving reduced preconceptions of circumstances, and how they had changed their views on the cultures they originated from -or had met -and had become more developed and richer as persons.
The focus group interview findings may well have turned out differently if the students had received what is described by Wickford (2014) as a structured narrative and communicative approach for reflection, which facilitates the students' reflective processes over time. On the other hand, the analysis of the data in this study has purely been inductive, without influence or references to the students' expectations prior to the exchange. One limitation of the study might be that the students who participated could have had positive learning experiences and students who did not participate in the focus group interviews might have had divergent views.
Overall, the interviews constituted the majority of the students that contributed their experiences, taking time off from their workplace to participate. This exchange seems to have contributed to their learning and professional development, that they will share with others. Interestingly, expressions of coping and cultural shocks were not in the foreground in this study. One hypothesis to explain that, might be related to the fact that the interviews were carried out after some time had passed since the students had participated in the exchanges. The time which passed could have made deeper reflections and the beneficial consequences experienced from the exchange come in the fore.

Conclusion
This study describes the experiences and effects on university students own learning and professional development through their participation in an exchange program. The findings indicate that taking part of an exchange program enhanced the students learning process, and more specifically to cope with unfamiliar situations as well as new environments, which are important competences within the professional education. The fact that the exchange environmental context is significantly different from the home university setting provides positive learning effects. It is illustrated explicitly by how unknown cultural encounters have a catalytic effect on the students' innovative qualities through provoking the students to develop new strategies when needed to find creative solutions to unforeseen challenges. The students appreciate the continuous learning challenges perceived abroad and concludes that the exchange had made them even more suited to go back to their home countries and to develop further in the profession. Even if this study is set in Uganda and Sweden, the knowledge of adapting to specific environmental situations generated from this participation of an exchange program contributes to an international insight of various novel challenges conveyed in order to be able to make available adequate preparation for students and teacher. The insight reflecting on the students learning experiences can most certainly be used in several other areas of education since the exchange seemed to contribute to the students' learning as an investment for future gains.