I arrive at the mission hospital on the outskirts of Phnom Penh, Cambodia, relieved. I survived the morning traffic once again. My first patient is from the countryside. 

They seem uncomfortable with me – the foreigner. I ask a question and the patient’s daughter starts laughing. Apparently, I mixed up the word for ‘nausea’ with ‘crazy’. 

Communication is strained. I’m racking my brain to find the right words for the patient’s context but her life in the village is unfamiliar to me. Their words and pronunciation are so different from the city talk I know. 

Lunchtime with the staff is challenging. 

My clinical Khmer is quite good but I follow less than half of the conversation around the table. Everyone laughs. 

I didn’t even know they were telling a joke. 

I finish work and negotiate the traffic gauntlet to arrive back home. 

It’s hot and I am physically and mentally spent. I have a couple of hours spare. 

I should practise language with my neighbours down the street. Too tired. Maybe tomorrow.

This is a small glimpse into my nine years as a physiotherapist in Cambodia. 

This experience as a student and practitioner from a culturally and linguistically diverse (CALD) background shaped my practice as a clinical supervisor of students in the following years and ultimately sparked my desire to research ways to improve the clinical learning outcomes of students from CALD backgrounds in Australia. 

International students and those from CALD backgrounds find clinical placements more difficult (Attrill et al 2016, DeBrew et al 2014, Naylor et al 2014). 

Yet these students are an important part of the future for our growing physiotherapy workforce and multicultural population. It is vital that students from CALD backgrounds are fully equipped for learning and practice so they can realise their potential as Australian physiotherapists. 

The goal of our research is to find out how this can be achieved. 

We interviewed physiotherapy students from various CALD backgrounds and universities across Australia about their experience of clinical placements and what they found helpful. Along with clinical educators, they were also asked what helped to prepare for clinical placements. 

The following reflections provide valuable insights for students and educators alike. 

Preparing for clinical placements 

‘I’ve noticed that when I prepare well in advance it makes everything flow much more smoothly.’ 

Preparation for clinical placements requires growth across multiple skill sets, especially communication, in the preceding months or years. 

Strategies include the following. 

Gain clinically authentic experience 

This should be introduced early in the university program to help students develop a broad range of relevant skills and identify challenges they need to start working on before clinical placements. 

Students from CALD backgrounds asked for ‘real exposure to real patients in a real clinical setting’ including activities like clinical observations or shadowing and working as a physiotherapy assistant or sports trainer. 

Because of issues with equitable access and student insurance coverage, it would be wise for universities to facilitate these opportunities. 

Learn to interact 

Communication and interpersonal skills are essential to clinical practice. 

Making local friendships, joining clubs, working part-time or volunteering are all great ways to practise English. 

However, these activities require initiative, perseverance and vulnerability and can be particularly challenging for students from CALD backgrounds. 

‘I feel it’s a lot of uncertainty for me. When we start small talk there’s some risk that I couldn’t understand. It’s embarrassing.’

We know that many local students can be reluctant to form relationships with students from CALD backgrounds (Andrade 2006, McKenzie & Baldassar 2017). 

Cross-cultural relationships are difficult for both sides. 

However, universities can help facilitate these by introducing partner or group allocation procedures that enable students from different backgrounds to work together in practical classes, group assignments and presentations. 

Focus on clinically relevant communication 

Students from CALD backgrounds want to learn English that’s relevant to their physiotherapy course. 

Universities can include more clinical communication opportunities throughout their course such as clinically based role-plays, simulation exercises and exemplars of effective communication. 

These opportunities are important for all students as communication challenges are common to everyone. 

Listen to previous students from CALD backgrounds 

Clinical placement expectations drive placement preparation. 

To better understand placement expectations, students from CALD backgrounds prefer to talk to senior students, particularly those from CALD backgrounds, to obtain a more realistic view of placements. 

‘I want to talk to culturally and language diverse students more, because we sort of share the same background. And we might face like similar issues, from culture and language perspective, and think they might already have some strategies they developed.’ 

We suggest that early in the university program, universities enlist previous or final-year students, including some from CALD backgrounds, to talk to junior students about what clinical placements will require and what strategies will help students prepare for them. 

This will give students from CALD backgrounds time and direction to develop in the important areas they may find most challenging, such as communication and social and cultural understanding (West-Newman et al 2025). 

While on clinical placements 

The following strategies may help students from CALD backgrounds to have a successful experience on clinical placements.

Recognise and reduce cognitive load 

The magnitude of new and challenging things encountered by students from CALD backgrounds during clinical placements creates cognitive overload. 

These students may find that the thinking effort required for communication makes other tasks more difficult. Likewise, if concentration is focused on a clinical task, communication may suffer. 

‘I just forget. I miss things in my assessment, in my treatment… (because) I need to communicate with my patient all the time… When I need to deal with lots of things… sometimes my English just become very funny.’ 

Preparing scripts or planning sheets can help. 

Students from CALD backgrounds often find that if they write down what they want to say or do, they do it better, with more confidence and less thinking effort. 

However, this is a short-term strategy that will need to be gradually scaled back as students develop fully into professionals.

Practice also helps – students from CALD backgrounds may find that any strategy that improves their communication readiness (eg, rehearsal) improves performance and reduces thinking effort during communication. 

‘But I prepared a lot. I practised a lot. I really do well.’ 

Make expectations clear 

Clarity is king. Students from CALD backgrounds are new to so many things that are required on clinical placements including clinical, operational, cultural and social aspects (Lee et al 2021). 

Expecting them to be aware of the many unwritten rules that shape everyday clinical work is unrealistic. 

‘Whereas Australia, there’s more room for active exploration. 

It’s good for active learning. But when it comes to the things we don’t know, we don’t know.’ Clear orientation is important here. 

Performance and learning expectations for placement need to be made explicit by clinical educators from day 1. 

This helps students from CALD backgrounds to focus on what matters most and not get lost in the myriad new things happening around them (Sewell et al 2019, Sweller 2020). 

Clear and open communication and feedback are also important.

Expectations must be reinforced through open communication channels and regular, quality feedback, preferably written. 

This lets students from CALD backgrounds know how they are performing against expectations.

‘I also would appreciate them (clinical educators) giving more feedback on how I can improve and what I should reflect on… I don’t know what’s good and what’s bad.’ 

Students from CALD backgrounds often require clinical educators’ help to initiate communication and feedback as approaching educators may be intimidating or inappropriate within their culture. 

Adapt to the clinical environment 

Students from CALD backgrounds find shadowing experienced or student physiotherapists helps them to gain a broad understanding of the clinical context and approaches to communication. 

Practical speech strategies are also helpful. 

Altering the pacing and volume of students’ speech can improve patients’ comprehension and lessen students’ thinking effort. 

‘I think, speaking slower and louder, can sometimes help with the confidence. 

But it’s just give you a bit more time to think… speaking slower, can make the words clearer and make the patient feel like I’m patient.’ 

Strategies to build rapport with patients are crucial in becoming an effective therapist. 

This can include connecting with the cultural context. 

Students from CALD backgrounds reported the value of becoming familiar with Australian sport, local jobs and activities, and following current affairs to help them relate more effectively to their patients. 

Looking to the future 

Our next research project is investigating the experiences and helpful practices of new graduate physiotherapists from CALD backgrounds during transition to work. 

We hope to identify how students from CALD backgrounds can be best supported throughout their physiotherapy journey – from student to physiotherapist. 

Physiotherapists from CALD backgrounds bring rich experience, strengths and perspectives to the Australian workforce and community. Yet the CALD learning journey is a difficult one and best not done alone. 

If you have been a supervisor of new graduate physiotherapists from CALD backgrounds in any capacity, we would love to hear your perspective on their transition to the workplace. 

Email s.westnewman@uq.edu.au if interested. 

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>> Steve West-Newman MACP is an APA Titled Musculoskeletal Physiotherapist and a PhD candidate at the University of Queensland.