Type of the Study: Empirical Study Evaluating Intercultural Competence: A Case Study of an Intercultural Training Program for Traditional Chinese Medicine (TCM) Professionals

Type of the Study: Empirical Study Evaluating Intercultural Competence: A Case Study of an Intercultural Training Program for Traditional Chinese Medicine (TCM) Professionals | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Type of the Study: Empirical Study Evaluating Intercultural Competence: A Case Study of an Intercultural Training Program for Traditional Chinese Medicine (TCM) Professionals Kewen Mao, Qiang Sun This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6277862/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Many scholars have investigated and theorized about various aspects of intercultural training program design, relatively few have focused their efforts on the evaluation of these programs’ effectiveness. This study intends to explore how Traditional Chinese Medicine (TCM) Professionals develop their intercultural competence in an intercultural training program by using Kirkpatrick’s Four-level Evaluation Model. This study mainly adopts a qualitative method, including face to face interview and online interview to take a long-term follow-up survey, so it can give full details of trainees’ development of intercultural competence. Results show that on the reaction level of Kirkpatrick’s Four-level Evaluation Model, trainees are quite satisfied with the training project; on the learning level, their intercultural competence improve mainly on two dimensions: knowledge and attitudes; on the behavior level, their intercultural competence improve on three dimensions: knowledge, attitudes and skills; on the results level, the feedback from home and abroad organizations are also pretty positive. In conclusion, Kirkpatrick’s Four-level Evaluation Model is feasible and effective in the field of intercultural communication evaluation. Kirkpatrick’s Four-level Evaluation Model Deardorff Pyramid Model of Intercultural Competence Intercultural Training Evaluation Intercultural Competence Traditional Chinese Medicine (TCM) Figures Figure 1 I. Introduction In the past several decades, TCM has gained rapid development at home and abroad. Particularly, the internationalization of TCM is expanding extensively. Up to now, seventeen overseas Chinese medicine centers and hundreds of TCM institutions have been set up in more than 30 countries and regions (Li, 2024 ). Thousands of Chinese TCM professionals were working abroad such as America, Thailand, Morocco, Malta, Czech and so on and providing medical service to local people. However, TCM is confronted with many difficulties as it goes out due to the differences between TCM theories and Western medicine theories. It is not easy for internationals to understand the treatment concepts of TCM which are inextricably related to Chinese culture (Fang, 2018 ). Thus, besides professional skills, TCM professionals’ intercultural competence needs to be improved and relevant intercultural training needs to be provided. This study aims to evaluate the effectiveness of a particular intercultural training program for TCM professionals by using Kirkpatrick’s Four-level Evaluation Model (Kirkpatrick & Kirkpatrick, 2005 ). The study mainly relies on qualitative methods including face to face interview and online follow-up interview, and then uses thematic analysis to analyze the dialogue. The significance of the study is two-fold. Theoretically, this study explores the feasibility and effectiveness of Kirkpatrick’s Four-level Evaluation Model (Kirkpatrick & Kirkpatrick, 2005 ) in the field of intercultural communication evaluation through an empirical study. Practically, evaluation results of this intercultural training provide detailed information, including trainees’ reaction to the training project, their suggestions and their intercultural competence changes for trainers, which will help them to better design and carry out intercultural training programs for TCM professionals in the future. Thus, trainees will gain more in the future intercultural training programs and perform better in their overseas work, so it is also beneficial for TCM culture “going out”. II. Literature review 2.1 Intercultural competence Intercultural competence is a complex concept. Many scholars from different backgrounds have conceptualized it from various perspectives. Spitzberg, for example, says that “ICC is appropriate and effective management of interaction between people who, to some degree or another, represent different or divergent affective, cognitive, and behavioral orientations to the world” (1989, p.98). Deardorff defines it as “the ability to communicate effectively and appropriately based on one’s intercultural knowledge, skills and attitudes” (2009, p. 194). Bennett views it as “a set of cognitive, affective, and behavioral skills and characteristics that support effective and appropriate interaction in a variety of cultural contexts” (2008, p. 97). To conclude, “cognitive”, “affective” and “behavioral” are often referred to as required elements and “effectively” and “appropriately” are often referred to as desired outcomes in the definitions of intercultural competence. Deardorff illustrated the components of intercultural competence with a Pyramid Model (2008). She employed a Delphi methodology in which 23 intercultural experts participated, resulting in the first research study to document a consensus on a definition and components of intercultural competence. This reiterative grounded-theory method relies on the experts to invoke their own conceptual perspectives and theories to inform the process in terms of raw inputs yet employs an inductive technique to build a model from those data through documented consensus (2006). Deardorff synthesized the resulting data in a pyramid model of intercultural competence, as shown in Figure 1 Deardorff Pyramid Model of Intercultural Competence (Deardorff, 2008), in which the lower levels are viewed as enhancing the higher levels. As shown in Figure 1, there are three dimensions in this model: knowledge and comprehension, skills, and requisite attitudes. Knowledge and comprehension consist of cultural self-awareness, deep cultural knowledge, and sociolinguistic awareness. The skills include the ability to listen, to observe, to evaluate, to analyze, to interpret, and to relate. The requisite attitudes include respect (valuing other cultures), openness (withholding judgment), and curiosity/discovery (tolerating ambiguity and uncertainty). Knowledge and comprehension, skill and requisite attitudes together support the internal and external outcome. The internal outcome is having “a frame of reference shift, in which adaptability and flexibility play a central role” (Deardorff, 2008, p. 38). The external outcome of intercultural competence is “effective and appropriate communication and behavior in intercultural situations” (Deardorff, 2008, p. 39). 2.2 Intercultural training evaluation Many scholars have investigated and theorized about various aspects of intercultural training program design, relatively few have focused their efforts on the evaluation of these programs’ effectiveness. Most of intercultural training evaluation studies are theoretical. Take two intercultural training evaluation studies as examples. Ma and Wang (2020) discussed the methods of intercultural training evaluation. The methods could be classified into two types: qualitative methods and quantitative methods. Qualitative methods include the comparative analysis method and the critical incident assessment method. Comparative analysis method refers to a method of verifying the training effectiveness of trainees through comparison, which can be further divided into horizontal and vertical comparison methods. Horizontal comparison is the process of comparing the evaluated individual with other trained employees, which provides a visual understanding of the overall effectiveness of the employee's training; vertical comparison refers to comparing the current situation of the evaluated employee with their pre training state, using historical and current comparisons to intuitively grasp the changes in their abilities before and after receiving cross-cultural training. The critical incident assessment method refers to an evaluation method in which the evaluator asks the trainee some questions or observes the employee's response and handling methods when dealing with key issues in daily work. Through these typical events, the evaluator can understand the changes in their abilities and qualities, and grasp the training effect of the employee at this stage. Quantitative methods include questionnaire survey method and training effect valuation method. Questionnaire survey method uses some important indicators of cross-cultural training through a survey questionnaire, analyzes and processes the collected data, and evaluates the relevant indicators according to certain standards to ultimately determine the final effect of cross-cultural training. The training effect valuation method refers to a quantitative evaluation method in which the training evaluator determines the final effect of cross-cultural training at a certain stage by comparing the input-output of cross-cultural training at that stage . Pan and Zhu discussed the method of intercultural training evaluation in their study (2017). They put forward that traditional cross-cultural education and training commonly use scales to measure the cross-cultural communication skills of training subjects before and after training, and demonstrate the training effectiveness through comparisons. Although these methods are still effective in evaluating the improvement of cross-cultural competence, their applicability in evaluating cross-cultural communication teaching ability is limited. This is not only because quantitative evaluation lacks the depth of educational assessment in evaluating cross-cultural communication competence, but also because traditional cross-cultural scales fail to cover the evaluation of cross-cultural teaching competence. They put forward portfolio assessment can more accurately reflect the learning process and outcomes of training subjects as a formative qualitative evaluation method. The trainees can put their assignments from each stage into a folder, which can be self evaluated or peer evaluated. Finally, two or more trainers will conduct a final evaluation. Some studies regarding intercultural training evaluation are empirical, but they do not focus the evaluation process itself. Their focus is specifically on the design process of intercultural training programs and they only refer to intercultural training evaluation at the end of the study. Take three studies as examples. Qiao discussed the intercultural training evaluation methods she used at the end of her study “Designing an intercultural training project for short-term international students”(2017). She evaluated an intercultural training project for short-term international students using reaction questionnaires, Intercultural Sensitivity Inventory (ICSI) (Bhawuk & Brislin, 1992), observation and interviews. Results showed that most participants were satisfied with this intercultural training program and there was a considerable increase in participants’ intercultural sensitivity according to students’ pre and post scores of ICSI, but the qualitative results through observation and interviews were not given. Jiang also discussed the intercultural training evaluation methods she used at the end of her study, “Designing an intercultural training project for foreign-related tour guides of Huangshan scenic spot” (2011). She did post-training evaluations after the three-day entire process of intercultural training for Huangshan National Park tour guides for foreign visitors. Quantitative methods like questionnaires based on BASIC instrument (Koester & Olebe, 1988) were adopted to make a statistical comparison and qualitative methods like interviews with 12 foreign tourists were conducted at the same time. The quantitative results showed that the mean score and peak value of the frequency of every dimension were higher than its counterpart respectively in the past and the qualitative results also showed that most of tourists were quite satisfied with their tour guide’s performance during their trip, but the qualitative results through interviews were not given either. Li also referred to the evaluation methods and results at the end of the study, “ Cross cultural training for foreign language teachers in rural primary and secondary schools” (2009). Only the quantitative method is used. The results of 150 questionnaires show that 71.6% of trainees are quite satisfied with the training, and 54% of trainees are relatively satisfied with the training; 86% of trainees think the training increases their interests, and 69% of trainees think that they have learned rich knowledge and skills; 60% of trainees think that the most beneficial part in the training is the lectures, and 31% of trainees think that it is better to add more Interactive activities, games, and video aids in the training. These three empirical studies use quantitative methods or combine quantitative methods and qualitative methods including questionnaires, interviews and observation to evaluate intercultural training programs. However, these studies only focused on the results of quantitative methods and did not give full description of the results of qualitative methods, so it was still unclear that on what aspects trainees’ intercultural competence improved. The most important is that no evaluation theoretical framework is used in these study. Therefore, it is important to find an evaluation theoretical framework to achieve more comprehensive evaluation. 2.3 Training Evaluation Upcraft and Schuh (1996) defined training evaluation as any effort to gather, analyze, and interpret evidence that describes effectiveness. Palomba and Banta defined training evaluation as “the systematic collection, review, and use of information about educational projects undertaken for the purpose of improving learning and development” (1999, p. 4). In a word, training evaluation is the process of collecting, interpreting and improving. To complete an overall evaluation, an evaluation model is needed. Evaluation models give evaluators direction and illustrate which aspects they need to cover and which steps they need to follow in order to carry out a thorough evaluation. As Rajeev, Madan and Jayarajan said, “the most influential framework for the evaluation of training projects has come from Kirkpatrick. Kirkpatrick’s model follows a goal-based approach. Even now this is the most popular model being used with required modifications and is applicable to any organization setting (2009, p.273)”. The central concept of Kirkpatrick’s Four-level Evaluation Model was formed in 1954. At that time, Don Kirkpatrick was pursuing his Ph.D. at the University of Wisconsin, and he wrote a dissertation on how to evaluate the effectiveness of training projects in enterprise supervision and management. He used four terms—reaction, learning, behavior and results—to clarify four different levels of training evaluation, which together can be regarded as the foundation of the Kirkpatrick Four-level Evaluation Model. In 1959, he was invited to write four articles on the assessment of reaction, learning, behavior and results, which was later published in Training and Development , which marked the official birth of Kirkpatrick Four-level Evaluation Model (Kirkpatrick, 2009). Table 1 shows the definition of each level in Kirkpatrick’s Four-Level Evaluation Model. Table 1 Kirkpatrick’s Four-level Evaluation Model (Kirkpatrick & Kirkpatrick, 2005) Four levels Definition Level 1: Reaction level Evaluates trainees’ attitudes toward training. Level 2: Learning level Evaluates to what degree learning has occurred. (knowledge, skills, attitudes) Level 3: Behavior level Evaluates to what extent behavior has changed as a result of the project. Level 4: Results level Evaluates to what extent results have occurred because of the training. The Reaction level evaluates trainees’ attitudes towards training programs after the training program has completed. The training evaluation on the reaction level is always carried out as soon as the training ends. A satisfaction questionnaire is often used. Universities, professional organizations, and consultants who conduct these kinds of projects should be very interested in participants’ reactions, in order to show participants that the trainers value their reactions, as well as to measure their reactions and obtain suggestions for improvement. The Learning level evaluates to what extent learning has occurred. Three aspects are included on the learning level: First, understanding the concepts, principles, and techniques being taught; second, developing and improving skills; and third, changing attitudes. Common and effective assessment mechanisms at this level include competency pen and paper tests, performance tests, surveys from trainees and their supervisors, interviews, and combinations of these. The Behavior level evaluates to what extent on-the-job behavior has changed as a result of the project. Evaluating behavior is very important, because if training projects do not have any influence on trainees’ behaviors, the training has no meaning. The most often used mechanism for this level of assessment is interviews conducted at key time intervals after the training program has completed and participants have started or returned to their jobs. The Results level evaluates to what extent results have occurred because of the training. Results could be shown in many ways and in many areas, including less turnover of foreign assignment positions, improved quantity or quality of work, reduction of waste, reduction in wasted time, increased sales, reduction in costs, increase in profits, and return on investment (ROI) (Kirkpatrick & Kirkpatrick, 2005; Duke, 2017). Each level in Kirkpatrick’s Four-level Evaluation Model is interrelated. It is unrealistic to expect a change in behavior if appropriate learning has not occurred and it is unrealistic to expect learning to occur if steps have not been taken to create a positive learning atmosphere. As for the third and the fourth level, they are always challenging for any project organization committee and should not be conducted before completing level one and two evaluations (Smidt, Balandin, Sigafoos & Reed, 2009). The following three empirical studies will illustrate how Kirkpatrick’s evaluation model is used. The first one is a leadership training program; the second one is a employment training program; the third one is a educational technology program. Wang (2012) used Kirkpatrick Four-level Evaluation Model to evaluate a leadership training project for supervisors in GAP, one clothing retailer. On the reaction level, they used a survey with a five-point Likert Scale to evaluate trainees’ satisfaction towards the training project. Questions covered expectations, relevance, activities, and so on. On the learning level, they used pen-and-paper tests to evaluate trainees’ command of basic concepts of leadership. On the behavior level, two different versions of surveys using a 6-point Likert Scale were handed out to trainees and their subordinates respectively to evaluate the trainees’ performance on work. On the results level, through follow-up investigations, evaluators found a positive correlation between revenue and evaluation score both after one and two years. Liu, Liu and Fang (2021) evaluated the employment training effectiveness for persons with disabilities using Kirkpatrick’s Four-level Evaluation Model. Based on the results of open-ended interviews with people with disabilities, support personnel, and employers, they select universal themes from three aspects: reaction layer, learning layer, and outcome layer. The employment training evaluation questionnaire with 28 questions is developed. Due to the particularity of the research subjects, evaluation on the behavior level is excluded in the questionnaire. Chu and Lu (2013) evaluated the effectiveness of educational technology training for university teachers based on Kirkpatrick’s model. They collected data from the “Survey on Satisfaction with Educational Technology Training for College Teachers” to understand the training effectiveness of participating teachers at the reaction level; In order to evaluate the level of knowledge and skills acquired by participating teachers through training, they compared the differences in educational technology abilities between participating and non participating teachers using an independent sample t-test based on the scores of the “College Teacher Educational Technology Ability Survey Questionnaire”. To examine the changes in teaching behavior of participating teachers after training, they collect information on teachers’ classroom teaching behavior using “Teacher Classroom Teaching Behavior Observation Scale”. To evaluate the training effectiveness of the results level, the researchers observed and recorded the reactions of students in the classroom from both participating and non participating teachers, and conducted a self-evaluation survey on the learning situation of students from participating teachers. These three studies give us insights into what kinds of methods can be used on each level of Kirkpatrick’s Four-level Evaluation Model. On the reaction level, training feedback questionnaires are always adopted. On the learning level, pen-and-paper tests are always used. On the behavior level, self-assessment and others’ assessment of work performance are often adopted as evaluation methods. On the results level, the effectiveness of training projects is always based on statistical analysis of, for example, revenue, quantity of publication, and so on. 2.4 Research Gaps in intercultural training evaluation As for intercultural training evaluation studies discussed before, few of them are empirical, and these empirical studies do not focus the evaluation process itself. Their focus is specifically on the design process of intercultural training programs and they only refer to intercultural training evaluation at the end of the study. In addition, these studies only focused on the results of quantitative methods and did not give full description of the results of qualitative methods, so it was still unclear that on what aspects trainees’ intercultural competence improved, and there is no long-term follow-up evaluation. As we can see in some training evaluation studies in other fields, Kirkpatrick’s Four-level Evaluation Model is used to give a more comprehensive evaluation, but this evaluation model has not been used in the field of intercultural communication. This study intends to apply this classic training evaluation model to the field of intercultural training based on an intercultural training for TCM professionals who will be dispatched abroad to explore the feasibility of this evaluation model in intercultural training evaluation. Thus, based on the theoretical framework one overarching research question and four sub- questions are raised: To what extent did this program successfully accomplish its desired goals and reach its desired outcomes? On the reaction level, from the trainee’s perspective, is the training project well designed and implemented? What are the strengths and weaknesses? On the learning level, in what ways did the project influence the trainees’ intercultural competence? On the behavior level, in what ways have trainees’ on-the-job behavior changed? On the results level, to what extent have results occurred because of the training？ III. Methodology This study uses Kirkpatrick’s four-level evaluation model to take a long-term follow-up survey for an intercultural training project for TCM professionals. Participants, the TCM project, and the evaluation process will be introduced in this part. 3.1 Participants Trainees joining the intercultural training project were recruited as participants of the study. They were acupuncturist, orthopedist, cardiologist massage therapist, or neurologist, who would be dispatched to abroad in the near future. A total of twenty-two TCM professionals consisting of thirteen males and eight females participated in the study and they all provided their written consent forms. 3.2 The TCM Training Project Overview This intercultural training project was designed for TCM professionals who would be dispatched to work abroad. The project aimed to improve TCM professionals’ intercultural competence, especially their ability to adapt to life in another culture and to successfully carry out their professional responsibilities. The training program focused on the following aspects: (1) understanding the target culture, (2) developing intercultural communication skills, (3) improving English competencies of TCM professionals, and (4) promoting TCM culture overseas. The program adopted various training methods, such as simulation games, critical incidents, role plays, intercultural dialogues, and case studies to achieve the training goals. The team of trainers included three leading educators, seven mentors, and twelve foreign guest speakers, from other countries, including The Czech Republic, Thailand, the USA, Russia, and so on. Twenty-two TCM professionals participated in the intercultural training program. The intercultural training project ran from March 17, 2018 to June 2, 2018, every Saturday from 9am to 12 am, then from 1pm to 4pm. The 12-week training project covered the following topics (see Table 2 ). Table 2 Topics Covered in Intercultural Training Project for TCM Professionals Time Topics March 17 Nature of intercultural communication and TCM going global March 24 Cultural identity and professional image management March 31 Cultural differences: value dimensions April 7 Traditional Chinese values and TCM culture April 14 Intercultural dialogue (1): verbal communication April 21 Intercultural dialogue (2): nonverbal communication April 28 Intercultural relationship (1): living abroad May 5 Intercultural relationship (2): working abroad May 12 Conflicts management strategies May 19 Cultural adaptation and coping strategies May 26 Developing intercultural competence June 2 Group presentation and wrapping up Each week’s learning activities included four modules: themed lectures, intercultural learning activities, English for TCM Professionals, and a ‘face-to face’ encounter with someone from another culture. Each themed lecture focused on an intercultural communication (IC) related topic. Trainers presented, discussed, and applied IC theories to the medical context and seek to develop trainees’ IC competencies in real life. For the intercultural learning activities, the trainers adopted various intercultural training methods to improve trainees’ intercultural competence in different contexts. Such training methods include but are not limited to simulation games, critical incidents, role plays, intercultural dialogues, and case studies. The third section, English for TCM professionals, gave opportunities for trainees to practice their English during the training, especially listening and speaking. The training focused on practical skills, such as common conversation topics in the TCM context, public speaking skills, communicating at conferences, and writing emails and letters in English. During the final section, ‘Face-to-Face’ with cultures, guest speakers were invited to participate in face-to-face interaction with the trainees. Such guest speakers included returnees from overseas posts, international students, and faculty from target cultures. Returnees from their overseas posts shared their first-hand experience with the trainees, so that they were better prepared for their own cross-cultural transitions. International students and faculty would give an insider’s point of view regarding their home culture and discuss any topics selected by the trainees. 3.3 The Evaluation Process The evaluation process is in line with Kirkpatrick’s Four-level Evaluation Model (Kirkpatrick & Kirkpatrick, 2005 ). The specific evaluation content and evaluation methods on each level are as follows in Table 3 . Table 3 Evaluation content and methods on Kirkpatrick’s Four-level Evaluation Model Four levels Evaluation Content Evaluation Content Level 1: Reaction level Trainees’ satisfaction towards the training programme 1. Satisfaction questionnaire online 2. face to face interview of trainee immediately after the training Level 2: Learning level The development of intercultural communication competence shown in class 1. face to face interviews of trainee immediately after the training Level 3: Behavior level The development of intercultural communication shown in the workplace 1. In-depth interviews interviews of dispatched trainees online Level 4: Results level The development of intercultural communication shown on the organizational level 1. Face to face interview of dean of Shanghai University of TCM 2. Online interview of the dean of one of the dispatched hospitals in Morocco Level 1: Reaction level evaluates trainees’ attitudes toward training. Specifically, in this project, it evaluates whether the TCM professionals are satisfied with the training project or not. The methods include a satisfaction questionnaire (see Appendix 1) and face to face interviews (see Appendix 2). Both the satisfaction questionnaire and face to face interviews are carried out immediately after the training is finished. During the face to face interview, trainees are asked to give their overall evaluation of the training project. Level 2: Learning level evaluates to what degree learning has occurred (knowledge, skills, attitudes). Specifically, in this project, it evaluates the development of intercultural communication competence changes of TCM professionals shown in class. The evaluation method on this level is face to face interviews (see Appendix 2). The face to face interviews are carried out immediately after the training is finished. During the face to face interview, trainees are asked to reflect their intercultural competence changes during the training project. Level 3: Behavior level evaluates to what extent behavior has changed as a result of the project. Specifically, in this project, it evaluates to what degree trainees’ intercultural communication competence has changed in the working environment twenty days after they have been dispatched abroad. Online interviews were carried out through Wechat twenty days after the TCM professionals are dispatched to Morocco (see appendix 3). Level 4: Results level evaluates to what extent results have occurred because of the training, that is to say, if there is any influence at the organizational level. Specifically, in this project, it evaluates to what extent the development of intercultural communication shown on the organizational level. In the case of this particular intercultural training program for TCM professionals, the “organizations” in question are (a) the institution that dispatches TCM professionals and (b) its overseas cooperative organizations where these professionals will be dispatched. Therefore, the dean of Shanghai University of TCM, and the dean of one of the dispatched hospitals in Morocco were interviewed respectively (see appendix 4). IV. Data Analysis This part mainly talks about the data analysis based on each level of Kirkpatrick’s Four-level Evaluation Model, specifically, reaction level, learning level, behavior level and results level. 4.1 Results on Level 1: Reaction Level Evaluation at the Reaction level evaluates trainees’ attitudes toward the training project. Two methods were utilized—a satisfaction survey and face-to-face interviews. The satisfaction surveys were sent to trainees through Wechat at the end of the training project. The survey used a five-point Likert Scale, ranging from strongly disagree to strongly agree, and covered many aspects of the training project, including trainers, materials used, facilities, schedule, relevance to their work, and so on. One open-ended question, “What suggestions do you have for this training?” was also included at the end of the survey.Trainees filled out the survey, and the results are shown in the Table 4. Table 4 The Results of Satisfaction Survey As shown in Table 4, all items received a score above 4.0, with especially high scores for the two items: “The trainers have strong communication skills” and “The trainers are well prepared”, which indicates that trainees were quite satisfied with the training project and the training team. However, one item, “The schedule is suitable” received a comparatively low average score. It seems that the schedule of the training project is not appropriate. To obtain more detailed information, the trainees were interviewed face-to-face. All the interview questions were open-ended (semi structured interview). In total, twenty-two were interviewed separately. As for the overall evaluation of the training project, many trainees said that this training project was very systematic, practical, and engaging. Nearly all of them stated that they appreciated the combination of didactic teaching and experiential teaching. They also said that trainers are very active, innovative, and well-organized. As for their favorite activities, most trainees chose the case studies. They said it was easier for them to understand and very practical. Many trainees also liked the panel discussions and games, because these activities gave them opportunities to talk with each other and share ideas. Some people liked the video clips, because this amplified art was very typical and interesting. As for the evaluation of “culture face-to-face”, all the trainees said they liked this part very much, as it gave them a chance to communicate with foreigners and know the status quo of TCM in their countries and their medical system. At the same time, trainees also gave some suggestions. The most often stated suggestion is that trainees would like more interaction with guest speakers, which will help them to understand what the guest speakers said, because the trainees’ English ability is not that good. In addition, they said that it would be better if the foreign guest speakers have medical backgrounds, for example, inviting foreign students in medical school as guest speakers, and it would be better if guest speakers come from countries where TCM professionals have been or where they are going. They also hope that guest speakers can talk about their own culture shock in China related to the medical system. And trainees hope to know more information about local people’s attitudes towards TCM and medical help, ideally from those countries where trainees will be going. 4.2 Results on Level 2: Learning Level Level 2, learning level evaluates to what extent learning has occurred because of the training. This study evaluates in what ways the training project changes trainees’ intercultural competence. Trainees were interviewed at the end of the training project and each interview lasted for about fifteen minutes. The trainees reflected on their own development of intercultural competence throughout the course of the intercultural training project. Finally, the answers are analyzed through thematic analysis based on Deardorff’s Pyramid Model of Intercultural Competence (2008). Two dimensions and seven components emerge as shown in Table 5. For each component, two interview extracts are provided hereafter. Table 5 Results on Level 2: Learning Level Dimensions emerged Components emerged Manifestations in Interview Knowledge and Comprehension (1) Cultural self-awareness Realize cultural differences in past intercultural encounters (2) Deep understanding and knowledge of culture Learn about intercultural theories such as high context and low context, cultural taboos, values and so on; have a deeper understanding than before. (3) Culture-specific information Learn about different medical systems and the status quo of TCM in foreign countries (4) Sociolinguistic awareness Become more aware of nonverbal communication. Requisite attitudes (5) Respect (valuing other cultures, cultural diversity) Respect cultural diversity and cultural difference; Try to see from the perspective of other cultures. (6) Openness (to intercultural learning and to people from other cultures, withholding judgment) Be nonjudgmental; Be open to cultural difference. (7) Curiosity and discovery (tolerating ambiguity and uncertainty) Become more confident and more willing to speak to foreigners. (1) Cultural Self-awareness Cultural self-awareness means understanding one’s own cultural patterns. Only then can we begin exploring the gap between our values, beliefs, and behaviors and those of others. Many trainees discussed changes related to cultural self-awareness through the training project. They said that they did not realize cultural differences in their past intercultural encounters until they had this training project. See the following interview extracts: [Respondent 6, acupuncturist] “Every time I learn a lot in class. Many things are new to me. When I worked abroad, I did not realize what I had been through came from cultural difference. Now through all the cases the teachers presented, I have a feeling of dawning...” [Respondent 8 acupuncturist] “For example, I once worked in Malta. At that time, we were sent to Malta without any training. In Malta, when we talked about something, we always sent emails. For some emails, I felt that they did not talk anything important, so I just had a look at it. After this training, I realize that the emails that I did not pay much attention to did need my reply. As taught in our class, for many details, maybe we think they are not important, but people in some culture need specific information. For many emails, I just looked at it and even did not rely it, but maybe they thought that was a very important point...” (2) Deep Understanding and Knowledge of Culture Deep understanding and knowledge of culture means understanding contexts, role and impact of culture and others’ world views. During their interviews, many trainees mentioned that their understanding and knowledge of culture had improved. They said they had learned intercultural communication theories such as high context and low context, cultural taboos, values and so on and had deeper understanding what they have been through before. Here are some interview extracts. [Respondent 2, orthopedist] “If I had had the training before I went abroad, it would have saved me a lot of trouble. In turn, having the training after experiencing working abroad, I am more aware of the importance of the knowledge and concepts taught in class and know how to analyze my experiences rationally. I know where I did wrong and how to avoid similar mistakes in the future. I felt very desperate at that time, but if I had had the training project before, I would have been more mentally prepared...” [Respondent 9, cardiologist] “Before taking this training, I saw everything from only the Chinese perspective. Now I know that every country has their own understanding about ethnicity, religion and culture. We may have different understandings about the same thing...” (3) Culture-specific Information Culture-specific information refers to information about a given culture and guidelines for interaction with members of that culture. In their interviews, trainees said that their culture-specific information improved. In particular, they learned about foreign medical systems and the status quo of TCM in certain countries and nearly all aspects of life abroad during the “culture face-to-face” part. Here are some interview extracts: [Respondent 7, acupuncturist] “I did not have many chances to interact with so many foreigners before. From this training, I know their understanding of traditional Chinese medicine, the status and background of traditional Chinese medicine in their countries.” [Respondent 10, acupuncturist] “In culture face to face part, we learn much about their local medical situations, insurance policies, medical payment, and doctor’s appointment process and so on. It is very helpful...” (4) Sociolinguistic Awareness Sociolinguistics is the effect of the society on the language. From interview, trainees also show their sociolinguistic awareness development. Many trainees referred to that nonverbal communication was very important for TCM and they were more aware of it because of the training. Here are two examples. [Respondent 5, acupuncturist] “I remember that during the last session one of our trainers talked about nonverbal communication which is very important when we work abroad. Traditional Chinese medicine uses four ways of diagnosis, looking, listening, questioning, feeling the pulse, so knowing some nonverbal communication is very necessary. That is very practical...” [Respondent 12, massage therapist] “I learned some gestures. Like this, in some culture, it means OK, but in some cultures, it means asshole. I become more aware of what I say and what I do...” (5) Respect (valuing other cultures, cultural diversity) Respect means valuing other cultures and cultural diversity. Many trainees mentioned in the interviews that they needed to respect cultural diversity and cultural difference and see from the perspectives of other cultures. Here are some interview extracts: [Respondent 1, acupuncturist] “I think intercultural communication is like yin and yang in traditional Chinese Medicine, like black and white. It does not mean we need to become gray when we interact with each other. Both yin and yang are important for their dynamic interaction…” [Respondent 9, cardiologist] “I did not realize the culture difference before. After taking this training, I think that the interaction between different cultures is similar to the interaction between doctors and patients. When we talk with patients, we also need to see from their perspective. If I have a chance to go abroad, I also need to see from their perspective...” (6) Openness (to intercultural learning and to people from other cultures, withholding judgment) Openness means withholding judgment and being open to intercultural learning and to people from other cultures. Many trainees noted that we needed to understand cultural difference and be open to different cultures. Here are two examples. [Respondent 7, acupuncturist] “I think high context and low context are very interesting. It is similar to our individual characters. Some people are very straightforward. They say what they think. Some people are very introverted. Maybe they just say half of what they think. You do not know what they are thinking and you can only guess. It is similar to intercultural communication. You need to get along with different people. There is no right or wrong. You need to adjust to their communication styles...” [Respondent 10, acupuncturist] “Cultural differences exist among countries as well as among individuals. We need to tolerate differences and seek common ground while respecting difference. Resolving cultural difference does not mean that we want you follow our culture or we totally give up our culture. We need to seek balance to better communicate with each other...” (7) Curiosity and Discovery (tolerating ambiguity and uncertainty) Curiosity and discovery mean tolerating ambiguity and uncertainty. Some trainees said that they became more confident and more willing to speak to foreigners, which demonstrates an underlying attitude of curiosity and discovery. Here is one example: [Respondent 7, acupuncturist] “... I think I got improvement at least on one point. I have many foreign outpatients every day. Before taking this training, I was a little afraid when they came. Now I am more confident and I am not afraid anymore. I am more confident when talking with them. Now when foreigners come, I am very happy, because I have a chance to communicate with them...” 4.3 Results on Level 3: Behavior Level The Behavior level evaluates to what extent trainees’ behavior has changed as a result of the training. In-depth interviews were carried out through Wechat twenty days after trainees were dispatched to Morocco. The in-depth interviews includes the following four questions as shown in Appendix 3. Finally, the answers are analyzed through thematic analysis based on Deardorff’s Pyramid Model of Intercultural Competence (2008). Three dimensions and six components emerge as shown in Table 6. For each component, two interview extracts are provided hereafter. Table 6 Results on Level 3: Behavior Level Dimensions emerged Components emerged Manifestations in Interview Knowledge and Comprehension (1) Cultural self-awareness communicate in a way that local people could accept and understand; improve national confidence. (2) Culture-specific information communicate in a way that local people could accept and understand Requisite attitudes (3) Respect (valuing other cultures, cultural diversity) be more tolerant of cultural differences (4) Openness (to intercultural learning and to people from other cultures, withholding judgment) be more tolerant of cultural differences (5) Curiosity and discovery (tolerating ambiguity and uncertainty) interested in how to better understand the local culture and the mentality of the recipients Skills (6) Relate communicate in a way that local people could accept and understand 1. When asked whether this training helped them work abroad, most of them said that the training program helped her to be more tolerant of cultural differences, which showed their respect and openness. Here are some interview extracts. [Extract 1]”…The local people sometimes will thank you in the way of “kissing the back of your hand”, which makes me feel uncomfortable and seemed far too formal, but I still tell myself, ‘This is ceremonious gratitude. Accept it and thank their great kindness’...” [Extract 2]”...I think in both work and life, I have more tolerance because of the training program. In other words, I am more willing to tolerate and more willing to believe the”kindness” behind “difference”. It is easier for me to be happy...” 2. When asked whether this training gave them any new insights on spreading TCM culture, most of them said that we needed to respect each other and communicate in a way that local people could accept and understand, which displayed her cultural self-awareness, culture-specific information, her skills of relating. Here is one interview extract. [Extract 1]”...During the process of sharing TCM culture, we need to relate to local culture and communicate in the way that local culture can accept. For example, in Islam, there is the concept of the only true God, so we do not have to force others to understand Chinese Medicine on the basis of accepting our traditional materialist philosophy. We can blur or leave out some concepts about “ism” under the circumstances of respecting cultural difference...” 3. When asked what difficulties they face now in their overseas work. They have referred to two difficulties. One is the language and the other is how to better understand the local culture and the mentality of the recipients, which also showed curiosity and discovery (tolerating ambiguity and uncertainty). Here is the interview extract. [Extract 1] “...The biggest difficult is language. My language ability is very poor. Luckily, this time we have a professional translator to help us, so we can get much help, but we still do not know enough about Islam and the mentality of African recipient nationals...” 4. Finally, when asked for their suggestions for future intercultural training for TCM professionals, most of them said that intercultural training should put more efforts on improving TCM professionals’ intercultural competence, in particular, tolerance of cultural differences. At the same time, they said that TCM professionals should try to improve their professional skills and national confidence, which showed cultural self-awareness. Here is the interview extract. [Extract 1] “...Working abroad, especially for TCM doctors who have a strong cultural background, on one hand, we need to improve our cultural tolerance, on the other hand, our professional skills and national confidence are also very important. With the development of our country, our discourse power in the world is increasing. As individual, we also need to improve our professional skills and our confidence, but we should not be complacent. We should neither be too humble nor too pushy...” According to the difficulties the trainees face now and their suggestions, for later intercultural training, trainers need to continue combining language training into intercultural training. Trainers also need to provide more information about local culture and local people’s mentality towards TCM and medical help. At the same time, trainers need to try to cultivate trainees’ national confidence and attitudes of respect, openness, curiosity, discovery towards different cultures. 4.4 Results on Level 4: Results Level Level 4 evaluates the impact of the training program at an organizational level. To evaluate the impact on the institution that dispatches TCM professionals and the impact on overseas cooperative organizations (hospitals, schools, clinics, associations), the dean of Shanghai University of TCM was interviewed face to face and the dean of one of the dispatched hospitals in Morocco was interviewed online. The interviewing questions are in the Appendix 4. When the dean of SUTCM was interviewed, he said that he had talked with cooperative organization abroad, and they thought very highly of these dispatched doctors. When the dean of one of the dispatched hospitals in Morocco was interviewed online, he said that the feedback of local patients were very positive and more and more local patents were willing to try TCM. Besides, he said that the dispatched doctors were cooperating with the local doctors well and some of them established friendship. He also said he would be very willing to cooperate with SUTCM in the future to learn more about TCM. V. Results In summary, the answer to the overarching research question and four sub-questions put forward before are as follows. To what extent did this program successfully accomplish its desired goals and reach its desired outcomes? (1) On the reaction level, from the trainee’s perspective, is the project well designed and implemented? What are the strengths and weaknesses? On the reaction level, based on the results of questionnaire and interview, trainees are quite satisfied with the training project. Nearly all the trainees stated that they liked the combination of didactic training with experiential training, which was very systematical, practical and engaging. Trainees like case studies, panel discussions, games, and video clips most, as they said these activities helped them to understand the intercultural theories and concepts and gave them chances to communicate with each other. As for the “culture face-to-face” part, they said this part gave them a chance to communicate with foreigners and learn about different medical systems and the status quo of TCM abroad. The most often stated suggestion is that trainees would like more interaction with guest speakers, which will help them to understand what the guest speakers said, because the trainees’ English ability is not that good. (2) On the learning level, in what ways did the project influence the trainees' intercultural competence? Based on face-to-face interviews, both the trainees’ intercultural competence improved. The trainees’ intercultural competence improved on two dimensions—knowledge and comprehension dimension and requisite attitudes dimension. Four components were related to knowledge and comprehension dimension, including cultural self-awareness, deep understanding and knowledge of culture, culture-specific information, and sociolinguistic awareness. Three components were related to requisite attitudes dimension, including respect, openness, and curiosity / discovery. (3) On the behavior level, in what ways have trainees’ on-the-job behavior changed? On the behavior level, based on the follow-up interview (twenty days after the training project), it is found that trainees’ intercultural competence also improved in their work. The follow-up interview with the TCM professionals sent to Morocco show that trainees’ intercultural competence improved on three dimensions—knowledge and comprehension, requisite attitudes, and skills. Two components were related to knowledge dimension, including cultural self-awareness and culture-specific information. Three components were related to requisite attitudes dimension, including respect, openness, and curiosity / discovery. One component was related to skills dimension, that is relate. (4) On the results level, in what way can we evaluate this intercultural training project? The Results level evaluates the impact at the organizational level, which includes two bodies, the institution that dispatches TCM professionals and the overseas organizations it cooperates with. The dean of Shanghai University of TCM and the dean of one of the dispatched hospitals in Morocco were interviewed respectively. Both of them spoke highly of the performance of trainees. The dean of SUTCM said that he had talked with cooperative organization abroad, and they thought very highly of these dispatched doctors. The dean of one of the dispatched hospitals in Morocco said that more and more local patents were willing to try TCM and he would be willing to cooperate with SUTCM in the future to learn more about TCM. VI. Discussion The findings match the application of Kirkpatrick’s Four-level Evaluation Model in other fields, so this theoretical framework can be used in the field of intercultural communication. As put forward by Kirkpatrick, the training evaluation on the reaction level is always carried out as soon as the training ends (Kirkpatrick & Kirkpatrick, 2005; Duke, 2017). In this study, a satisfaction questionnaire is used, which matches the methods in empirical studies in other fields using Kirkpatrick’s model(Wang, 2012; Liu, Liu, & Fang; 2021, Chu & Lu, 2013). Furthermore, this study adds face-to face interview to provide more detailed information about trainees’ opinions. As put forward by Kirkpatrick, common and effective assessment mechanisms at this level include competency pen and paper tests, performance tests, surveys from trainees and their supervisors, interviews, and combinations of these (Kirkpatrick & Kirkpatrick, 2005; Duke, 2017). Some empirical studies choose scale or pen-and-paper tests on this level(Wang, 2012; Liu, Liu, & Fang; 2021, Chu & Lu, 2013). Due to the specialty of intercultural competence, this study didn’t choose pen-to-paper test, and due to the limitation of number of trainees, this study didn’t choose training scale. This study uses face-to-face interview as soon as the training ends. Trainees are asked to reflect their intercultural competence. The detailed dialogue was recorded to provide readers with more information. As put forward by Kirkpatrick, the most often used methods for this level of assessment is interviews conducted at key time intervals after the training program has completed and participants have started or returned to their jobs (Kirkpatrick & Kirkpatrick, 2005; Duke, 2017). Some empirical studies choose scale or observation on this level (Wang, 2012; Liu, Liu, & Fang; 2021, Chu & Lu, 2013). Due to the limitation of distance, this study didn’t choose observation, and due to the limitation of number of trainees, this study didn’t choose training scale. This study uses online interview twenty days after trainees were dispatched to Morocco. The detailed dialogue was recorded to provide readers with more information. As put forward by Kirkpatrick, results could be shown in many ways and in many areas, including less turnover of foreign assignment positions, improved quantity or quality of work, reduction of waste, reduction in wasted time, increased sales, reduction in costs, increase in profits, and return on investment. Wang (2012) did a research to find out the relationship between revenue and evaluation score both after one and two years through follow-up investigation evaluators found a positive correlation. Liu, Liu, & Fang (2021) used evaluation scale to complete evaluation on this level. Chu & Lu (2013) observed and recorded the reactions of students in the classroom from both participating and non-participating teachers, and conducted a self-evaluation survey on the learning situation of students from participating teachers. Due to the limitation of number of trainees, this study didn’t choose training scale. And due to the limitation of time, it is hard to find out the correlation between training effectiveness and revenue. In this study, the dean of Shanghai University of TCM was interviewed face-to-face and the dean of one of the dispatched hospitals in Morocco was interviewed online. VII. Conclusion & Limitation This study carries out a long-term follow-up evaluation of an intercultural training project for TCM professionals using Kirkpatrick’s Four-level Evaluation Model. The study mainly uses qualitative method, including face to face interview and online interview, then uses theme analysis to analyze trainees’ intercultural competence. Results show that Kirkpatrick’s Four-level Evaluation Model is applicable in evaluating intercultural training project. On the reaction level trainees are quite satisfied with the training project; on the learning level their intercultural competence improve mainly on two dimensions: knowledge(cultural self-awareness, deep understanding and knowledge of culture, culture-specific information, sociolinguistic awareness) and attitudes (respect, openness, curiosity and discovery); on the behavior level their intercultural competence improve on three dimensions: knowledge (cultural self-awareness, culture-specific information), attitudes (respect, openness, curiosity and discovery ) and skills (relate); on the results level the feedback from home and abroad organizations are also pretty good. Besides, this study put forward useful suggestions for improving future intercultural training programs for TCM professionals based on the results at the end of the paper. The significance of the study is two-fold. Theoretically, this study explores the feasibility and effectiveness of Kirkpatrick’s Four-level Evaluation Model (Kirkpatrick & Kirkpatrick, 2005 ) in the field of intercultural communication evaluation. Practically, evaluation results of this intercultural training provide useful information for trainers, which will help them to better design and carry out intercultural training programs for TCM professionals in the future. Thus, trainees will gain more in the future intercultural training programs and perform better in their overseas work, which is also beneficial for TCM culture “going out”. Nevertheless, there is one limitation in this study. Due to geographical and economic limitations, some evaluation on the third and fourth level could only be carried out online through WeChat , which may constrain the information provided by the interviewees. Declarations Ethics approval and consent to participate This study was reviewed and approved by Henan Polytechnic University Human Participants Ethics Committee and the Reference No. is SKJYB2023-20. We ensured that the study complied with the Declaration of Helsinki, and obtained written informed consent from all participants. Consent for publication “Not applicable” Clinical trial number “Not applicable” Availability of data and materials The data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical considerations. Competing interests “The authors declare that they have no competing interests” Funding the Fundamental Research Funds for the Universities of Henan Province (Grant No. SKJYB2023-20). Authors’ contributions “KM designed the research, analyzed and interpreted the participate data regarding Intercultural training evaluation. QS improved the research method and edited the manuscript. All authors read and approved the final manuscript.“ Acknowledgements We would like to extend our gratitude to Prof. Zhang Hongling who provided insightful advice to our manuscript. We also appreciate all participants who agreed to participate in this study. We are finally thankful to the editor and reviewers for their hard work in processing our manuscript. References Bhawuk DPS, Brislin R. The measurement of intercultural sensitivity using the concepts of individualism and collectivism. International Journal of Intercultural Relations. 1992; 16: 413-436. Bennett JM. Transformative training: Designing projects for culture learning. In: Moodian MA, editors. Contemporary leadership and intercultural competence: Understanding and utilizing cultural diversity to build successful organizations. Thousand Oaks, CA: Sage；2008.p.95-110 Chu YM, Lu H. Evaluation of the effectiveness of educational technology training for university teachers based on Kirkpatrick’s model. Modern Educational Technology. 2013; 23:34-37. Deardorff DK. Identification and assessment of intercultural competence as a student outcome of internationalization. Journal of Studies in International Education.2006; 10:241–266. Deardorff DK. Intercultural competence: A definition, model, and implications for education abroad. In: Savicki V, editors. Developing intercultural competence and transformation: Theory, research, and application in international education. Sterling, VA: Stylus; 2008. p.98-151. Duke PL. How to Evaluate Training Using the Kirkpatrick Model. Professional Safety. 2017; 62: 20-21. Fang L. The road to internationalization of traditional Chinese medicine is still long. 2018. http://news.sina.com.cn/o/2018-03-21/doc-ifysnamt4918920.shtml. Accessed 21 Mar 2018. Jiang SC: Designing an intercultural training project for foreign-related tour guides of Huangshan scenic spot. CNKI. 2011. https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2tZ3YvW89IH88io096udSlcr-aFxOYidbX7lKz_7ZCOFxI5AjpmB9aP0YLCix7X7Wv7wdPDXV2Xj-MT4XCvsC6XVXIiriJbdFuMu7j_YyoJCrEUdHtFRCdeqrhDroYRrsIKCaniP4hKrPWc77 waauxbs3Lu9otDDwySLr9_G7U28KsJJ4WDEXfnYfuWkM5gmw0=&uniplatform=NZKPT&language=CHS Koester J, Olebe M. Behavioral assessment scale for intercultural communication. Sacramento, CA; 1988. Kirkpatrick DL, Kirkpatrick JD. Transferring learning to behavior: Using the four levels to improve performance. San Francisco, California: Berrett-Koehler Publishers, Incorporated; 2005. Kirkpatrick JD, Kirkpatrick KW. The Kirkpatrick Model: Past, Present and Future. Chief Learning Officer. 2009; 55, 21-22. Li JL. Going global to serve the world: The road to internationalization of traditional Chinese medicine is getting more stable. 2024. https://news.sina.cn/gn/2024-12-21/detail-ifypxmsq8749060.d.html?oid=3828239526606196&vt=4&pos=3. Accessed 21 Dec 2024. Li J. Cross cultural training for foreign language teachers in rural primary and secondary schools. Teacher Education; doi: 10.16194/j.cnki.31-1059/g4.2009.09.026. Liu HY, Liu Y, Fang Y. Evaluation of employment training effectiveness for persons with disabilities based on Kirkpatrick’s model. Disability Research. 2021; 2: 65-73. Ma DW, Wang X F. Analysis of cross-cultural training strategies for enterprises in the context of globalization. Social Science Review. 2020;1: 65-68. Pan XQ, Zhu LH. Preliminary exploration of cross cultural teaching training program for English teachers. Teacher Education Research. 2017; 3:14-18. Palomba CA, Banta TW. Assessment essentials: Planning, implementing, and improving assessment in higher education. San Francisco: Jossey-Bass; 1999. Qiao LJ. Designing an intercultural training project for short-term international students. CNKI. 2017.https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2vQ-IsFst4y898_pA86lHHNCCZOH7t78FRRhvI21zhVewuHTOo0u0dm_Doqk6RVW690Q NAaLot3mX1eUaabexaIfMYcHunxRYTdiE7TE5qWULjbVwCrqSj_VUatTCsWuJwBozNucCuTMOjb5v80NPuebNi __mlMQlfW9Lp_Ydq9LtSedFFR7OW0S1Jq8CcAONc=&uniplatform=NZKPT&language=CHS Rajeev P, Madan MS, Jayarajan K. Revisiting Kirkpatrick’s model-an evaluation of an academic training course. Current Science. 2009; 96: 272-276. Smidt A, Balandin S, Sigafoos J, Reed VA. The Kirkpatrick model: A useful tool for evaluating training outcomes. Journal of Intellectual and Developmental Disability. 2009; 34:266-274. Spitzberg BH, Cupach WR. Handbook of interpersonal competence research. New York: Springer-Verlag; 1989. Upcraft ML, Schuh J H. Assessment in Student Affairs: A Guide for Practitioners; 1996. Wang K. Case analysis of Kirkpatrick’s four levels and its application strategies. 2013. https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2uBn-y4Yl7v3LOptlfFR-totdgkMIczEb82GN-oFn4WxuKFawfIIlFmGBa_TXNEMZCxMjgNiPn43P4S6CD8r-h6_5mUqvbxE4edn2IVHVoU3dpaoMSBH9qxKQnvAN9CQzCpKwf1iKf_dkv NDIDkq1GYosSHLDWE_Mkts9nQArHT2hSahjj3TfVfFJHD5hMHrjI=&uniplatform=NZKPT&language=CHS Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6277862","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":453478622,"identity":"c708e329-dc45-4a0f-ac3a-f4ff76a2916b","order_by":0,"name":"Kewen Mao","email":"","orcid":"","institution":"Henan Polytechnic University","correspondingAuthor":false,"prefix":"","firstName":"Kewen","middleName":"","lastName":"Mao","suffix":""},{"id":453478623,"identity":"b54c7b3b-9690-44fd-8606-92c7e204f728","order_by":1,"name":"Qiang Sun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYBACAwY2KIsZRFRIyMmTqOWMhbFhA9FaQICxrSKR4QABLebsxxIfV/w5nMd3nPnZw6/zJBIYG5gfPrqBR4tlT9phw7Nth4slD7OZG8tuk8hjZ2AzNs7B57AD6W2SjQ2HEzccZjCTltwmUczYwMMmjVfL+eftPxv+gLSwf5OWnCOR2HCAkJYbaccYG9hAWnjMJD82EKHFcsazZMnGtvTEmYd5yqQZjkkYGzYT8Is5f5rhx4Y/1ol9549vk/xRUycnz9788DE+LQhwABibPCAGM1HKoVoYfxCtehSMglEwCkYSAADKQU6gjiMfWgAAAABJRU5ErkJggg==","orcid":"","institution":"Henan Polytechnic University","correspondingAuthor":true,"prefix":"","firstName":"Qiang","middleName":"","lastName":"Sun","suffix":""}],"badges":[],"createdAt":"2025-03-21 13:08:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6277862/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6277862/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82352746,"identity":"c77d842c-6aa9-4c5a-a527-b2e1339792c0","added_by":"auto","created_at":"2025-05-09 11:02:47","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":219068,"visible":true,"origin":"","legend":"\u003cp\u003eDeardorff Pyramid Model of Intercultural Competence (Deardorff, 2008)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6277862/v1/70597beb0c4c41f9fab1af98.png"},{"id":86433904,"identity":"99527055-1fc3-4574-a177-dbbf20f68bff","added_by":"auto","created_at":"2025-07-10 15:08:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":705298,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6277862/v1/15f0f4d4-7b2e-49df-9545-7105197435e1.pdf"},{"id":82354686,"identity":"2306474d-0e3f-4b55-b457-b028e343dc4c","added_by":"auto","created_at":"2025-05-09 11:10:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":23398,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-6277862/v1/7808f75714ad11e64e6d5db9.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Type of the Study: Empirical Study Evaluating Intercultural Competence: A Case Study of an Intercultural Training Program for Traditional Chinese Medicine (TCM) Professionals","fulltext":[{"header":"I. Introduction","content":"\u003cp\u003eIn the past several decades, TCM has gained rapid development at home and abroad. Particularly, the internationalization of TCM is expanding extensively. Up to now, seventeen overseas Chinese medicine centers and hundreds of TCM institutions have been set up in more than 30 countries and regions (Li, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Thousands of Chinese TCM professionals were working abroad such as America, Thailand, Morocco, Malta, Czech and so on and providing medical service to local people. However, TCM is confronted with many difficulties as it goes out due to the differences between TCM theories and Western medicine theories. It is not easy for internationals to understand the treatment concepts of TCM which are inextricably related to Chinese culture (Fang, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Thus, besides professional skills, TCM professionals\u0026rsquo; intercultural competence needs to be improved and relevant intercultural training needs to be provided.\u003c/p\u003e \u003cp\u003eThis study aims to evaluate the effectiveness of a particular intercultural training program for TCM professionals by using Kirkpatrick\u0026rsquo;s Four-level Evaluation Model (Kirkpatrick \u0026amp; Kirkpatrick, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). The study mainly relies on qualitative methods including face to face interview and online follow-up interview, and then uses thematic analysis to analyze the dialogue.\u003c/p\u003e \u003cp\u003eThe significance of the study is two-fold. Theoretically, this study explores the feasibility and effectiveness of Kirkpatrick\u0026rsquo;s Four-level Evaluation Model (Kirkpatrick \u0026amp; Kirkpatrick, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) in the field of intercultural communication evaluation through an empirical study. Practically, evaluation results of this intercultural training provide detailed information, including trainees\u0026rsquo; reaction to the training project, their suggestions and their intercultural competence changes for trainers, which will help them to better design and carry out intercultural training programs for TCM professionals in the future. Thus, trainees will gain more in the future intercultural training programs and perform better in their overseas work, so it is also beneficial for TCM culture \u0026ldquo;going out\u0026rdquo;.\u003c/p\u003e"},{"header":"II. Literature review","content":"\u003cp\u003e2.1 Intercultural competence\u003c/p\u003e\n\u003cp\u003eIntercultural competence is a complex concept. Many scholars from different backgrounds have conceptualized it from various perspectives. Spitzberg, for example, says that \u0026ldquo;ICC is appropriate and effective management of interaction between people who, to some degree or another, represent different or divergent affective, cognitive, and behavioral orientations to the world\u0026rdquo; (1989, p.98). Deardorff defines it as \u0026ldquo;the ability to communicate effectively and appropriately based on one\u0026rsquo;s intercultural knowledge, skills and attitudes\u0026rdquo; (2009, p. 194). Bennett views it as \u0026ldquo;a set of cognitive, affective, and behavioral skills and characteristics that support effective and appropriate interaction in a variety of cultural contexts\u0026rdquo; (2008, p. 97). To conclude, \u0026ldquo;cognitive\u0026rdquo;, \u0026ldquo;affective\u0026rdquo; and \u0026ldquo;behavioral\u0026rdquo; are often referred to as required elements and \u0026ldquo;effectively\u0026rdquo; and \u0026ldquo;appropriately\u0026rdquo; are often referred to as desired outcomes in the definitions of intercultural competence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDeardorff illustrated the components of intercultural competence with a Pyramid Model (2008). She employed a Delphi methodology in which 23 intercultural experts participated, resulting in the first research study to document a consensus on a definition and components of intercultural competence. This reiterative grounded-theory method relies on the experts to invoke their own conceptual perspectives and theories to inform the process in terms of raw inputs yet employs an inductive technique to build a model from those data through documented consensus (2006). Deardorff synthesized the resulting data in a pyramid model of intercultural competence, as shown in Figure 1 Deardorff Pyramid Model of Intercultural Competence (Deardorff, 2008), in which the lower levels are viewed as enhancing the higher levels.\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 1, there are three dimensions in this model: knowledge and comprehension, skills, and requisite attitudes. Knowledge and comprehension consist of cultural self-awareness, deep cultural knowledge, and sociolinguistic awareness. The skills include the ability to listen, to observe, to evaluate, to analyze, to interpret, and to relate. The requisite attitudes include respect (valuing other cultures), openness (withholding judgment), and curiosity/discovery (tolerating ambiguity and uncertainty). Knowledge and comprehension, skill and requisite attitudes together support the internal and external outcome. The internal outcome is having \u0026ldquo;a frame of reference shift, in which adaptability and flexibility play a central role\u0026rdquo; (Deardorff, 2008, p. 38). The external outcome of intercultural competence is \u0026ldquo;effective and appropriate communication and behavior in intercultural situations\u0026rdquo; (Deardorff, 2008, p. 39).\u003c/p\u003e\n\u003cp\u003e2.2 Intercultural training evaluation\u003c/p\u003e\n\u003cp\u003eMany scholars have investigated and theorized about various aspects of intercultural training program design, relatively few have focused their efforts on the evaluation of these programs\u0026rsquo; effectiveness. Most of intercultural training evaluation studies are theoretical. Take two intercultural training evaluation studies as examples.\u003c/p\u003e\n\u003cp\u003eMa and Wang (2020) discussed the methods of intercultural training evaluation. The methods could be classified into two types: qualitative methods and quantitative methods. Qualitative methods include the comparative analysis method and the critical incident assessment method. Comparative analysis method refers to a method of verifying the training effectiveness of trainees through comparison, which can be further divided into horizontal and vertical comparison methods. Horizontal comparison is the process of comparing the evaluated individual with other trained employees, which provides a visual understanding of the overall effectiveness of the employee\u0026apos;s training; vertical comparison refers to comparing the current situation of the evaluated employee with their pre training state, using historical and current comparisons to intuitively grasp the changes in their abilities before and after receiving cross-cultural training. The critical incident assessment method refers to an evaluation method in which the evaluator asks the trainee some questions or observes the employee\u0026apos;s response and handling methods when dealing with key issues in daily work. Through these typical events, the evaluator can understand the changes in their abilities and qualities, and grasp the training effect of the employee at this stage. Quantitative methods include questionnaire survey method and training effect valuation method. Questionnaire survey method uses some important indicators of cross-cultural training through a survey questionnaire, analyzes and processes the collected data, and evaluates the relevant indicators according to certain standards to ultimately determine the final effect of cross-cultural training. The training effect valuation method refers to a quantitative evaluation method in which the training evaluator determines the final effect of cross-cultural training at a certain stage by comparing the input-output of cross-cultural training at that stage .\u003c/p\u003e\n\u003cp\u003ePan and Zhu discussed the method of intercultural training evaluation in their study (2017). They put forward that traditional cross-cultural education and training commonly use scales to measure the cross-cultural communication skills of training subjects before and after training, and demonstrate the training effectiveness through comparisons. Although these methods are still effective in evaluating the improvement of cross-cultural competence, their applicability in evaluating cross-cultural communication teaching ability is limited. This is not only because quantitative evaluation lacks the depth of educational assessment in evaluating cross-cultural communication competence, but also because traditional cross-cultural scales fail to cover the evaluation of cross-cultural teaching competence. They put forward portfolio assessment can more accurately reflect the learning process and outcomes of training subjects as a formative qualitative evaluation method. The trainees can put their assignments from each stage into a folder, which can be self evaluated or peer evaluated. Finally, two or more trainers will conduct a final evaluation.\u003c/p\u003e\n\u003cp\u003eSome studies regarding intercultural training evaluation are empirical, but they do not focus the evaluation process itself. Their focus is specifically on the design process of intercultural training programs and they only refer to intercultural training evaluation at the end of the study. Take three studies as examples.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eQiao discussed the intercultural training evaluation methods she used at the end of her study \u0026ldquo;Designing an intercultural training project for short-term international students\u0026rdquo;(2017). She evaluated an intercultural training project for short-term international students using reaction questionnaires, Intercultural Sensitivity Inventory (ICSI) (Bhawuk \u0026amp; Brislin, 1992), observation and interviews. Results showed that most participants were satisfied with this intercultural training program and there was a considerable increase in participants\u0026rsquo; intercultural sensitivity according to students\u0026rsquo; pre and post scores of ICSI, but the qualitative results through observation and interviews were not given.\u003c/p\u003e\n\u003cp\u003eJiang also discussed the intercultural training evaluation methods she used at the end of her study, \u0026ldquo;Designing an intercultural training project for foreign-related tour guides of Huangshan scenic spot\u0026rdquo; (2011). She did post-training evaluations after the three-day entire process of intercultural training for Huangshan National Park tour guides for foreign visitors. Quantitative methods like questionnaires based on BASIC instrument (Koester \u0026amp; Olebe, 1988) were adopted to make a statistical comparison and qualitative methods like interviews with 12 foreign tourists were conducted at the same time. The quantitative results showed that the mean score and peak value of the frequency of every dimension were higher than its counterpart respectively in the past and the qualitative results also showed that most of tourists were quite satisfied with their tour guide\u0026rsquo;s performance during their trip, but the qualitative results through interviews were not given either.\u003c/p\u003e\n\u003cp\u003eLi also referred to the evaluation methods and results at the end of the study, \u0026ldquo; Cross cultural training for foreign language teachers in rural primary and secondary schools\u0026rdquo; (2009). Only the quantitative method is used. The results of 150 questionnaires show that 71.6% of trainees are quite satisfied with the training, and 54% of trainees are relatively satisfied with the training; 86% of trainees think the training increases their interests, and 69% of trainees think that they have learned rich knowledge and skills; 60% of trainees think that the most beneficial part in the training is the lectures, and 31% of trainees think that it is better to add more Interactive activities, games, and video aids in the training.\u003c/p\u003e\n\u003cp\u003eThese three empirical studies use quantitative methods or combine quantitative methods and qualitative methods including questionnaires, interviews and observation to evaluate intercultural training programs. However, these studies only focused on the results of quantitative methods and did not give full description of the results of qualitative methods, so it was still unclear that on what aspects trainees\u0026rsquo; intercultural competence improved. The most important is that no evaluation theoretical framework is used in these study. Therefore, it is important to find an evaluation theoretical framework to achieve more comprehensive evaluation.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc15328\"\u003e2.3 Training Evaluation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUpcraft and Schuh (1996) defined training evaluation as any effort to gather, analyze, and interpret evidence that describes effectiveness. Palomba and Banta defined training evaluation as \u0026ldquo;the systematic collection, review, and use of information about educational projects undertaken for the purpose of improving learning and development\u0026rdquo; (1999, p. 4). In a word, training evaluation is the process of collecting, interpreting and improving.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo complete an overall evaluation, an evaluation model is needed. Evaluation models give evaluators direction and illustrate which aspects they need to cover and which steps they need to follow in order to carry out a thorough evaluation. As Rajeev, Madan and Jayarajan said, \u0026ldquo;the most influential framework for the evaluation of training projects has come from Kirkpatrick. Kirkpatrick\u0026rsquo;s model follows a goal-based approach. Even now this is the most popular model being used with required modifications and is applicable to any organization setting (2009, p.273)\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eThe central concept of Kirkpatrick\u0026rsquo;s Four-level Evaluation Model was formed in 1954. At that time, Don Kirkpatrick was pursuing his Ph.D. at the University of Wisconsin, and he wrote a dissertation on how to evaluate the effectiveness of training projects in enterprise supervision and management. He used four terms\u0026mdash;reaction, learning, behavior and results\u0026mdash;to clarify four different levels of training evaluation, which together can be regarded as the foundation of the Kirkpatrick Four-level Evaluation Model. In 1959, he was invited to write four articles on the assessment of reaction, learning, behavior and results, which was later published in \u003cem\u003eTraining and Development\u003c/em\u003e, which marked the official birth of Kirkpatrick Four-level Evaluation Model (Kirkpatrick, 2009). Table 1 shows the definition of each level in Kirkpatrick\u0026rsquo;s Four-Level Evaluation Model.\u003c/p\u003e\n\u003cp\u003eTable 1 Kirkpatrick\u0026rsquo;s Four-level Evaluation Model (Kirkpatrick \u0026amp; Kirkpatrick, 2005)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eFour levels\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003cp\u003eDefinition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eLevel 1: Reaction level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003cp\u003eEvaluates trainees\u0026rsquo; attitudes toward training.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eLevel 2: Learning level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003cp\u003eEvaluates to what degree learning has occurred. (knowledge, skills, attitudes)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eLevel 3: Behavior level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003cp\u003eEvaluates to what extent behavior has changed as a result of the project.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eLevel 4: Results level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 401px;\"\u003e\n \u003cp\u003eEvaluates to what extent results have occurred because of the training.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe Reaction level evaluates trainees\u0026rsquo; attitudes towards training programs after the training program has completed. The training evaluation on the reaction level is always carried out as soon as the training ends. A satisfaction questionnaire is often used. Universities, professional organizations, and consultants who conduct these kinds of projects should be very interested in participants\u0026rsquo; reactions, in order to show participants that the trainers value their reactions, as well as to measure their reactions and obtain suggestions for improvement.\u003c/p\u003e\n\u003cp\u003eThe Learning level evaluates to what extent learning has occurred. Three aspects are included on the learning level: First, understanding the concepts, principles, and techniques being taught; second, developing and improving skills; and third, changing attitudes. Common and effective assessment mechanisms at this level include competency pen and paper tests, performance tests, surveys from trainees and their supervisors, interviews, and combinations of these.\u003c/p\u003e\n\u003cp\u003eThe Behavior level evaluates to what extent on-the-job behavior has changed as a result of the project. Evaluating behavior is very important, because if training projects do not have any influence on trainees\u0026rsquo; behaviors, the training has no meaning. The most often used mechanism for this level of assessment is interviews conducted at key time intervals after the training program has completed and participants have started or returned to their jobs. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Results level evaluates to what extent results have occurred because of the training. Results could be shown in many ways and in many areas, including less turnover of foreign assignment positions, improved quantity or quality of work, reduction of waste, reduction in wasted time, increased sales, reduction in costs, increase in profits, and return on investment (ROI) (Kirkpatrick \u0026amp; Kirkpatrick, 2005; Duke, 2017).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEach level in Kirkpatrick\u0026rsquo;s Four-level Evaluation Model is interrelated. It is unrealistic to expect a change in behavior if appropriate learning has not occurred and it is unrealistic to expect learning to occur if steps have not been taken to create a positive learning atmosphere. As for the third and the fourth level, they are always challenging for any project organization committee and should not be conducted before completing level one and two evaluations (Smidt, Balandin, Sigafoos \u0026amp; Reed, 2009).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe following three empirical studies will illustrate how Kirkpatrick\u0026rsquo;s evaluation model is used. The first one is a leadership training program; the second one is a employment training program; the third one is a educational technology program.\u003c/p\u003e\n\u003cp\u003eWang (2012) used Kirkpatrick Four-level Evaluation Model to evaluate a leadership training project for supervisors in GAP, one clothing retailer. On the reaction level, they used a survey with a five-point Likert Scale to evaluate trainees\u0026rsquo; satisfaction towards the training project. Questions covered expectations, relevance, activities, and so on. On the learning level, they used pen-and-paper tests to evaluate trainees\u0026rsquo; command of basic concepts of leadership. On the behavior level, two different versions of surveys using a 6-point Likert Scale were handed out to trainees and their subordinates respectively to evaluate the trainees\u0026rsquo; performance on work. On the results level, through follow-up investigations, evaluators found a positive correlation between revenue and evaluation score both after one and two years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLiu, Liu and Fang (2021) evaluated the employment training effectiveness for persons with disabilities using Kirkpatrick\u0026rsquo;s Four-level Evaluation Model. Based on the results of open-ended interviews with people with disabilities, support personnel, and employers, they select universal themes from three aspects: reaction layer, learning layer, and outcome layer. The employment training evaluation questionnaire with 28 questions is developed. Due to the particularity of the research subjects, evaluation on the behavior level is excluded in the questionnaire.\u003c/p\u003e\n\u003cp\u003eChu and Lu (2013) evaluated the effectiveness of educational technology training for university teachers based on Kirkpatrick\u0026rsquo;s model. They collected data from the \u0026ldquo;Survey on Satisfaction with Educational Technology Training for College Teachers\u0026rdquo; to understand the training effectiveness of participating teachers at the reaction level; In order to evaluate the level of knowledge and skills acquired by participating teachers through training, they compared the differences in educational technology abilities between participating and non participating teachers using an independent sample t-test based on the scores of the \u0026ldquo;College Teacher Educational Technology Ability Survey Questionnaire\u0026rdquo;. To examine the changes in teaching behavior of participating teachers after training, they collect information on teachers\u0026rsquo; classroom teaching behavior using \u0026ldquo;Teacher Classroom Teaching Behavior Observation Scale\u0026rdquo;. To evaluate the training effectiveness of the results level, the researchers observed and recorded the reactions of students in the classroom from both participating and non participating teachers, and conducted a self-evaluation survey on the learning situation of students from participating teachers.\u003c/p\u003e\n\u003cp\u003eThese three studies give us insights into what kinds of methods can be used on each level of Kirkpatrick\u0026rsquo;s Four-level Evaluation Model. On the reaction level, training feedback questionnaires are always adopted. On the learning level, pen-and-paper tests are always used. On the behavior level, self-assessment and others\u0026rsquo; assessment of work performance are often adopted as evaluation methods. On the results level, the effectiveness of training projects is always based on statistical analysis of, for example, revenue, quantity of publication, and so on.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.4 Research Gaps in intercultural training evaluation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs for intercultural training evaluation studies discussed before, few of them are empirical, and these empirical studies do not focus the evaluation process itself. Their focus is specifically on the design process of intercultural training programs and they only refer to intercultural training evaluation at the end of the study. In addition, these studies only focused on the results of quantitative methods and did not give full description of the results of qualitative methods, so it was still unclear that on what aspects trainees\u0026rsquo; intercultural competence improved, and there is no long-term follow-up evaluation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs we can see in some training evaluation studies in other fields, Kirkpatrick\u0026rsquo;s Four-level Evaluation Model is used to give a more comprehensive evaluation, but this evaluation model has not been used in the field of intercultural communication.\u0026nbsp;This study intends to apply this classic training evaluation model to the field of intercultural training based on an intercultural training for TCM professionals who will be dispatched abroad to explore the feasibility of this evaluation model in intercultural training evaluation. Thus, based on the theoretical framework\u0026nbsp;one overarching research question and four sub-\u0026nbsp;questions are raised:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo what extent did this program successfully accomplish its desired goals and reach its desired outcomes?\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eOn the reaction level, from the trainee\u0026rsquo;s perspective, is the training project well designed and implemented? What are the strengths and weaknesses?\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOn the learning level, in what ways did the project influence the trainees\u0026rsquo; intercultural competence? \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOn the behavior level, in what ways have trainees\u0026rsquo; on-the-job behavior changed?\u003c/li\u003e\n \u003cli\u003eOn the results level, to what extent have results occurred because of the training？\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"III. Methodology","content":"\u003cp\u003eThis study uses Kirkpatrick\u0026rsquo;s four-level evaluation model to take a long-term follow-up survey for an intercultural training project for TCM professionals. Participants, the TCM project, and the evaluation process will be introduced in this part.\u003c/p\u003e \u003cp\u003e3.1 Participants\u003c/p\u003e \u003cp\u003eTrainees joining the intercultural training project were recruited as participants of the study. They were acupuncturist, orthopedist, cardiologist massage therapist, or neurologist, who would be dispatched to abroad in the near future. A total of twenty-two TCM professionals consisting of thirteen males and eight females participated in the study and they all provided their written consent forms.\u003c/p\u003e \u003cp\u003e3.2 The TCM Training Project Overview\u003c/p\u003e \u003cp\u003eThis intercultural training project was designed for TCM professionals who would be dispatched to work abroad. The project aimed to improve TCM professionals\u0026rsquo; intercultural competence, especially their ability to adapt to life in another culture and to successfully carry out their professional responsibilities. The training program focused on the following aspects: (1) understanding the target culture, (2) developing intercultural communication skills, (3) improving English competencies of TCM professionals, and (4) promoting TCM culture overseas. The program adopted various training methods, such as simulation games, critical incidents, role plays, intercultural dialogues, and case studies to achieve the training goals.\u003c/p\u003e \u003cp\u003eThe team of trainers included three leading educators, seven mentors, and twelve foreign guest speakers, from other countries, including The Czech Republic, Thailand, the USA, Russia, and so on. Twenty-two TCM professionals participated in the intercultural training program. The intercultural training project ran from March 17, 2018 to June 2, 2018, every Saturday from 9am to 12 am, then from 1pm to 4pm. The 12-week training project covered the following topics (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTopics Covered in Intercultural Training Project for TCM Professionals\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTime\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTopics\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarch 17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNature of intercultural communication and TCM going global\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarch 24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCultural identity and professional image management\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarch 31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCultural differences: value dimensions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApril 7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraditional Chinese values and TCM culture\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApril 14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntercultural dialogue (1): verbal communication\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApril 21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntercultural dialogue (2): nonverbal communication\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eApril 28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntercultural relationship (1): living abroad\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMay 5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntercultural relationship (2): working abroad\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMay 12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConflicts management strategies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMay 19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCultural adaptation and coping strategies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMay 26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeveloping intercultural competence\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJune 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup presentation and wrapping up\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eEach week\u0026rsquo;s learning activities included four modules: themed lectures, intercultural learning activities, English for TCM Professionals, and a \u0026lsquo;face-to face\u0026rsquo; encounter with someone from another culture. Each themed lecture focused on an intercultural communication (IC) related topic. Trainers presented, discussed, and applied IC theories to the medical context and seek to develop trainees\u0026rsquo; IC competencies in real life. For the intercultural learning activities, the trainers adopted various intercultural training methods to improve trainees\u0026rsquo; intercultural competence in different contexts. Such training methods include but are not limited to simulation games, critical incidents, role plays, intercultural dialogues, and case studies. The third section, English for TCM professionals, gave opportunities for trainees to practice their English during the training, especially listening and speaking. The training focused on practical skills, such as common conversation topics in the TCM context, public speaking skills, communicating at conferences, and writing emails and letters in English. During the final section, \u0026lsquo;Face-to-Face\u0026rsquo; with cultures, guest speakers were invited to participate in face-to-face interaction with the trainees. Such guest speakers included returnees from overseas posts, international students, and faculty from target cultures. Returnees from their overseas posts shared their first-hand experience with the trainees, so that they were better prepared for their own cross-cultural transitions. International students and faculty would give an insider\u0026rsquo;s point of view regarding their home culture and discuss any topics selected by the trainees.\u003c/p\u003e \u003cp\u003e3.3 The Evaluation Process\u003c/p\u003e \u003cp\u003eThe evaluation process is in line with Kirkpatrick\u0026rsquo;s Four-level Evaluation Model (Kirkpatrick \u0026amp; Kirkpatrick, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2005\u003c/span\u003e). The specific evaluation content and evaluation methods on each level are as follows in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEvaluation content and methods on Kirkpatrick\u0026rsquo;s Four-level Evaluation Model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFour levels\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEvaluation Content\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEvaluation Content\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 1: Reaction level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrainees\u0026rsquo; satisfaction towards the training programme\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Satisfaction questionnaire online\u003c/p\u003e \u003cp\u003e2. face to face interview of trainee immediately after the training\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 2: Learning level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe development of intercultural communication competence shown in class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. face to face interviews of trainee immediately after the training\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 3: Behavior level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe development of intercultural communication shown in the workplace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. In-depth interviews interviews of dispatched trainees online\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 4: Results level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe development of intercultural communication shown on the organizational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1. Face to face interview of dean of Shanghai University of TCM\u003c/p\u003e \u003cp\u003e2. Online interview of the dean of one of the dispatched hospitals in Morocco\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eLevel 1: Reaction level evaluates trainees\u0026rsquo; attitudes toward training. Specifically, in this project, it evaluates whether the TCM professionals are satisfied with the training project or not. The methods include a satisfaction questionnaire (see Appendix 1) and face to face interviews (see Appendix 2). Both the satisfaction questionnaire and face to face interviews are carried out immediately after the training is finished. During the face to face interview, trainees are asked to give their overall evaluation of the training project.\u003c/p\u003e \u003cp\u003eLevel 2: Learning level evaluates to what degree learning has occurred (knowledge, skills, attitudes). Specifically, in this project, it evaluates the development of intercultural communication competence changes of TCM professionals shown in class. The evaluation method on this level is face to face interviews (see Appendix 2). The face to face interviews are carried out immediately after the training is finished. During the face to face interview, trainees are asked to reflect their intercultural competence changes during the training project.\u003c/p\u003e \u003cp\u003eLevel 3: Behavior level evaluates to what extent behavior has changed as a result of the project. Specifically, in this project, it evaluates to what degree trainees\u0026rsquo; intercultural communication competence has changed in the working environment twenty days after they have been dispatched abroad. Online interviews were carried out through \u003cem\u003eWechat\u003c/em\u003e twenty days after the TCM professionals are dispatched to Morocco (see appendix 3).\u003c/p\u003e \u003cp\u003eLevel 4: Results level evaluates to what extent results have occurred because of the training, that is to say, if there is any influence at the organizational level. Specifically, in this project, it evaluates to what extent the development of intercultural communication shown on the organizational level. In the case of this particular intercultural training program for TCM professionals, the \u0026ldquo;organizations\u0026rdquo; in question are (a) the institution that dispatches TCM professionals and (b) its overseas cooperative organizations where these professionals will be dispatched. Therefore, the dean of Shanghai University of TCM, and the dean of one of the dispatched hospitals in Morocco were interviewed respectively (see appendix 4).\u003c/p\u003e"},{"header":"IV. Data Analysis","content":"\u003cp\u003eThis part mainly talks about the data analysis based on each level of Kirkpatrick\u0026rsquo;s Four-level Evaluation Model, specifically, reaction level, learning level, behavior level and results level.\u003c/p\u003e\n\u003cp\u003e4.1 Results on Level 1: Reaction Level\u003c/p\u003e\n\u003cp\u003eEvaluation at the Reaction level evaluates trainees\u0026rsquo; attitudes toward the training project. Two methods were utilized\u0026mdash;a satisfaction survey and face-to-face interviews. The satisfaction surveys were sent to trainees through \u003cem\u003eWechat\u0026nbsp;\u003c/em\u003eat the end of the training project. The survey used a five-point Likert Scale, ranging from strongly disagree to strongly agree, and covered many aspects of the training project, including trainers, materials used, facilities, schedule, relevance to their work, and so on. One open-ended question, \u0026ldquo;What suggestions do you have for this training?\u0026rdquo; was also included at the end of the survey.Trainees filled out the survey, and the results are shown in the Table 4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 The Results of Satisfaction Survey\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Table 4, all items received a score above 4.0, with especially high scores for the two items: \u0026ldquo;The trainers have strong communication skills\u0026rdquo; and \u0026ldquo;The trainers are well prepared\u0026rdquo;, which indicates that trainees were quite satisfied with the training project and the training team. However, one item, \u0026ldquo;The schedule is suitable\u0026rdquo; received a comparatively low average score. It seems that the schedule of the training project is not appropriate.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo obtain more detailed information, the trainees were interviewed face-to-face. All the interview questions were open-ended\u0026nbsp;(semi structured interview).\u0026nbsp;In total,\u0026nbsp;twenty-two\u0026nbsp;were interviewed separately. As for the overall evaluation of the training project, many trainees said that this training project was very systematic, practical, and engaging. Nearly all of them stated that they appreciated the combination of didactic teaching and experiential teaching. They also said that trainers are very active, innovative, and well-organized. As for their favorite activities, most trainees chose the case studies. They said it was easier for them to understand and very practical. Many trainees also liked the panel discussions and games, because these activities gave them opportunities to talk with each other and share ideas. Some people liked the video clips, because this amplified art was very typical and interesting. As for the evaluation of \u0026ldquo;culture face-to-face\u0026rdquo;, all the trainees said they liked this part very much, as it gave them a chance to communicate with foreigners and know the status quo of TCM in their countries and their medical system.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt the same time, trainees also gave some suggestions. The most often stated suggestion is that trainees would like more interaction with guest speakers, which will help them to understand what the guest speakers said, because the trainees\u0026rsquo; English ability is not that good. In addition, they said that it would be better if the foreign guest speakers have medical backgrounds, for example, inviting foreign students in medical school as guest speakers, and it would be better if guest speakers come from countries where TCM professionals have been or where they are going. They also hope that guest speakers can talk about their own culture shock in China related to the medical system. And trainees hope to know more information about local people\u0026rsquo;s attitudes towards TCM and medical help, ideally from those countries where trainees will be going.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc8198465\"\u003e4.2 Results on Level 2: Learning Level\u003c/p\u003e\n\u003cp\u003eLevel 2, learning level evaluates to what extent learning has occurred because of the training. This study evaluates in what ways the training project changes trainees\u0026rsquo; intercultural competence. Trainees were interviewed at the end of the training project and each interview lasted for about fifteen minutes. The trainees reflected on their own development of intercultural competence throughout the course of the intercultural training project. Finally, the answers are analyzed through thematic analysis based on Deardorff\u0026rsquo;s Pyramid Model of Intercultural Competence (2008). Two dimensions and seven components emerge as shown in Table 5. For each component, two interview extracts are provided hereafter.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5 Results on Level 2: Learning Level\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003eDimensions emerged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eComponents emerged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eManifestations in Interview\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eKnowledge and Comprehension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(1) Cultural self-awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eRealize cultural differences in past intercultural encounters\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(2) Deep understanding and knowledge of culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eLearn about intercultural theories such as high context and low context, cultural taboos, values and so on;\u003c/p\u003e\n \u003cp\u003ehave a deeper understanding than before.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(3) Culture-specific information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eLearn about different medical systems and the status quo of TCM in foreign countries\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(4) Sociolinguistic awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eBecome more aware of nonverbal communication.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRequisite attitudes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(5) Respect (valuing other cultures, cultural diversity)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eRespect cultural diversity and cultural difference;\u003c/p\u003e\n \u003cp\u003eTry to see from the perspective of other cultures.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(6) Openness (to intercultural learning and to people from other cultures, withholding judgment)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eBe nonjudgmental;\u003c/p\u003e\n \u003cp\u003eBe open to cultural difference.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(7) Curiosity and discovery (tolerating ambiguity and uncertainty)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eBecome more confident and more willing to speak to foreigners.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e(1) Cultural Self-awareness\u003c/p\u003e\n\u003cp\u003eCultural self-awareness means understanding one\u0026rsquo;s own cultural patterns. Only then can we begin exploring the gap between our values, beliefs, and behaviors and those of others. Many trainees discussed changes related to cultural self-awareness through the training project. They said that they did not realize cultural differences in their past intercultural encounters until they had this training project. See the following interview extracts: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Respondent 6, acupuncturist] \u0026ldquo;Every time I learn a lot in class. Many things are new to me. When I worked abroad, I did not realize what I had been through came from cultural difference. Now through all the cases the teachers presented, I have a feeling of dawning...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e[Respondent 8 acupuncturist] \u0026ldquo;For example, I once worked in Malta. At that time, we were sent to Malta without any training. In Malta, when we talked about something, we always sent emails. For some emails, I felt that they did not talk anything important, so I just had a look at it. After this training, I realize that the emails that I did not pay much attention to did need my reply. As taught in our class, for many details, maybe we think they are not important, but people in some culture need specific information. For many emails, I just looked at it and even did not rely it, but maybe they thought that was a very important point...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(2) Deep Understanding and Knowledge of Culture\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDeep understanding and knowledge of culture means understanding contexts, role and impact of culture and others\u0026rsquo; world views. During their interviews, many trainees mentioned that their understanding and knowledge of culture had improved. They said they had learned intercultural communication theories such as high context and low context, cultural taboos, values and so on and had deeper understanding what they have been through before. Here are some interview extracts.\u003c/p\u003e\n\u003cp\u003e[Respondent 2, orthopedist] \u0026ldquo;If I had had the training before I went abroad, it would have saved me a lot of trouble. In turn, having the training after experiencing working abroad, I am more aware of the importance of the knowledge and concepts taught in class and know how to analyze my experiences rationally. I know where I did wrong and how to avoid similar mistakes in the future. I felt very desperate at that time, but if I had had the training project before, I would have been more mentally prepared...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e[Respondent 9, cardiologist] \u0026ldquo;Before taking this training, I saw everything from only the Chinese perspective. Now I know that every country has their own understanding about ethnicity, religion and culture. We may have different understandings about the same thing...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(3) Culture-specific Information\u003c/p\u003e\n\u003cp\u003eCulture-specific information refers to information about a given culture and guidelines for interaction with members of that culture. In their interviews, trainees said that their culture-specific information improved. In particular, they learned about foreign medical systems and the status quo of TCM in certain countries and nearly all aspects of life abroad during the \u0026ldquo;culture face-to-face\u0026rdquo; part. Here are some interview extracts: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Respondent 7, acupuncturist] \u0026ldquo;I did not have many chances to interact with so many foreigners before. From this training, I know their understanding of traditional Chinese medicine, the status and background of traditional Chinese medicine in their countries.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e[Respondent 10, acupuncturist] \u0026ldquo;In culture face to face part, we learn much about their local medical situations, insurance policies, medical payment, and doctor\u0026rsquo;s appointment process and so on. It is very helpful...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(4) Sociolinguistic Awareness\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSociolinguistics is the effect of the society on the language. From interview, trainees also show their sociolinguistic awareness development. Many trainees referred to that nonverbal communication was very important for TCM and they were more aware of it because of the training. Here are two examples.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Respondent 5, acupuncturist] \u0026ldquo;I remember that during the last session one of our trainers talked about nonverbal communication which is very important when we work abroad. Traditional Chinese medicine uses four ways of diagnosis, looking, listening, questioning, feeling the pulse, so knowing some nonverbal communication is very necessary. That is very practical...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e[Respondent 12, massage therapist] \u0026ldquo;I learned some gestures. Like this, in some culture, it means OK, but in some cultures, it means asshole. I become more aware of what I say and what I do...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(5) Respect (valuing other cultures, cultural diversity)\u003c/p\u003e\n\u003cp\u003eRespect means valuing other cultures and cultural diversity. Many trainees mentioned in the interviews that they needed to respect cultural diversity and cultural difference and see from the perspectives of other cultures. Here are some interview extracts: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Respondent 1, acupuncturist] \u0026ldquo;I think intercultural communication is like yin and yang in traditional Chinese Medicine, like black and white. It does not mean we need to become gray when we interact with each other. Both yin and yang are important for their dynamic interaction\u0026hellip;\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e[Respondent 9, cardiologist] \u0026ldquo;I did not realize the culture difference before. After taking this training, I think that the interaction between different cultures is similar to the interaction between doctors and patients. When we talk with patients, we also need to see from their perspective. If I have a chance to go abroad, I also need to see from their perspective...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(6) Openness (to intercultural learning and to people from other cultures, withholding judgment)\u003c/p\u003e\n\u003cp\u003eOpenness means withholding judgment and being open to intercultural learning and to people from other cultures. Many trainees noted that we needed to understand cultural difference and be open to different cultures. Here are two examples. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Respondent 7, acupuncturist] \u0026ldquo;I think high context and low context are very interesting. It is similar to our individual characters. Some people are very straightforward. They say what they think. Some people are very introverted. Maybe they just say half of what they think. You do not know what they are thinking and you can only guess. It is similar to intercultural communication. You need to get along with different people. There is no right or wrong. You need to adjust to their communication styles...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e[Respondent 10, acupuncturist] \u0026ldquo;Cultural differences exist among countries as well as among individuals. We need to tolerate differences and seek common ground while respecting difference. Resolving cultural difference does not mean that we want you follow our culture or we totally give up our culture. We need to seek balance to better communicate with each other...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e(7) Curiosity and Discovery (tolerating ambiguity and uncertainty)\u003c/p\u003e\n\u003cp\u003eCuriosity and discovery mean tolerating ambiguity and uncertainty. Some trainees said that they became more confident and more willing to speak to foreigners, which demonstrates an underlying attitude of curiosity and discovery. Here is one example: \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Respondent 7, acupuncturist] \u0026ldquo;... I think I got improvement at least on one point. I have many foreign outpatients every day. Before taking this training, I was a little afraid when they came. Now I am more confident and I am not afraid anymore. I am more confident when talking with them. Now when foreigners come, I am very happy, because I have a chance to communicate with them...\u0026rdquo;\u003c/p\u003e\n\u003cp id=\"_Toc8198466\"\u003e4.3 Results on Level 3: Behavior Level\u003c/p\u003e\n\u003cp\u003eThe Behavior level evaluates to what extent trainees\u0026rsquo; behavior has changed as a result of the training. In-depth interviews were carried out through Wechat twenty days after trainees were dispatched to Morocco. The in-depth interviews includes the following four questions as shown in Appendix 3. Finally, the answers are analyzed through thematic analysis based on Deardorff\u0026rsquo;s Pyramid Model of Intercultural Competence (2008). Three dimensions and six components emerge as shown in Table 6. For each component, two interview extracts are provided hereafter.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 6 Results on Level 3: Behavior Level\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"568\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003eDimensions emerged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003eComponents emerged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003eManifestations in Interview\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eKnowledge and Comprehension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(1) Cultural self-awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003ecommunicate in a way that local people could accept and understand;\u003c/p\u003e\n \u003cp\u003eimprove national confidence.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(2) Culture-specific information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003ecommunicate in a way that local people could accept and understand\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRequisite attitudes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(3) Respect (valuing other cultures, cultural diversity)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003ebe more tolerant of cultural differences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(4) Openness (to intercultural learning and to people from other cultures, withholding judgment)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003ebe more tolerant of cultural differences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(5) Curiosity and discovery (tolerating ambiguity and uncertainty)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003einterested in how to better understand the local culture and the mentality of the recipients\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 118px;\"\u003e\n \u003cp\u003eSkills\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 244px;\"\u003e\n \u003cp\u003e(6) Relate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 206px;\"\u003e\n \u003cp\u003ecommunicate in a way that local people could accept and understand\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1. When asked whether this training helped them work abroad, most of them said that the training program helped her to be more tolerant of cultural differences, which showed their respect and openness. Here are some interview extracts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Extract 1]\u0026rdquo;\u0026hellip;The local people sometimes will thank you in the way of \u0026ldquo;kissing the back of your hand\u0026rdquo;, which makes me feel uncomfortable and seemed far too formal, but I still tell myself, \u0026lsquo;This is ceremonious gratitude. Accept it and thank their great kindness\u0026rsquo;...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e[Extract 2]\u0026rdquo;...I think in both work and life, I have more tolerance because of the training program. In other words, I am more willing to tolerate and more willing to believe the\u0026rdquo;kindness\u0026rdquo; behind \u0026ldquo;difference\u0026rdquo;. It is easier for me to be happy...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e2. When asked whether this training gave them any new insights on spreading TCM culture, most of them said that we needed to respect each other and communicate in a way that local people could accept and understand, which displayed her cultural self-awareness, culture-specific information, her skills of relating. Here is one interview extract.\u003c/p\u003e\n\u003cp\u003e[Extract 1]\u0026rdquo;...During the process of sharing TCM culture, we need to relate to local culture and communicate in the way that local culture can accept. For example, in Islam, there is the concept of the only true God, so we do not have to force others to understand Chinese Medicine on the basis of accepting our traditional materialist philosophy. We can blur or leave out some concepts about \u0026ldquo;ism\u0026rdquo; under the circumstances of respecting cultural difference...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e3. When asked what difficulties they face now in their overseas work. They have referred to two difficulties. One is the language and the other is how to better understand the local culture and the mentality of the recipients, which also showed curiosity and discovery (tolerating ambiguity and uncertainty). Here is the interview extract.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Extract 1] \u0026ldquo;...The biggest difficult is language. My language ability is very poor. Luckily, this time we have a professional translator to help us, so we can get much help, but we still do not know enough about Islam and the mentality of African recipient nationals...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e4. Finally, when asked for their suggestions for future intercultural training for TCM professionals, most of them said that intercultural training should put more efforts on improving TCM professionals\u0026rsquo; intercultural competence, in particular, tolerance of cultural differences. At the same time, they said that TCM professionals should try to improve their professional skills and national confidence, which showed cultural self-awareness. Here is the interview extract.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e[Extract 1] \u0026ldquo;...Working abroad, especially for TCM doctors who have a strong cultural background, on one hand, we need to improve our cultural tolerance, on the other hand, our professional skills and national confidence are also very important. With the development of our country, our discourse power in the world is increasing. As individual, we also need to improve our professional skills and our confidence, but we should not be complacent. We should neither be too humble nor too pushy...\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eAccording to the difficulties the trainees face now and their suggestions, for later intercultural training, trainers need to continue combining language training into intercultural training. Trainers also need to provide more information about local culture and local people\u0026rsquo;s mentality towards TCM and medical help. At the same time, trainers need to try to cultivate trainees\u0026rsquo; national confidence and attitudes of respect, openness, curiosity, discovery towards different cultures.\u0026nbsp;\u003c/p\u003e\n\u003cp id=\"_Toc8198467\"\u003e4.4 Results on Level 4: Results Level\u003c/p\u003e\n\u003cp\u003eLevel 4 evaluates the impact of the training program at an organizational level. To evaluate the impact on the institution that dispatches TCM professionals and the impact on overseas cooperative organizations (hospitals, schools, clinics, associations), the dean of Shanghai University of TCM\u0026nbsp;was interviewed face to face and the dean of one of the dispatched hospitals in Morocco was interviewed\u0026nbsp;online. The interviewing questions are in the Appendix 4.\u003c/p\u003e\n\u003cp\u003eWhen the dean of SUTCM was interviewed, he said that he had talked with cooperative organization abroad, and they thought very highly of these dispatched doctors. When the dean of one of the dispatched hospitals in Morocco was interviewed online, he said that the feedback of local patients were very positive and more and more local patents were willing to try TCM. Besides, he said that the dispatched doctors were cooperating with the local doctors well and some of them established friendship. He also said he would be very willing to cooperate with SUTCM in the future to learn more about TCM.\u003c/p\u003e"},{"header":"V. Results","content":"\u003cp\u003eIn summary, the answer to the overarching research question and four sub-questions put forward before are as follows.\u003c/p\u003e \u003cp\u003eTo what extent did this program successfully accomplish its desired goals and reach its desired outcomes?\u003c/p\u003e \u003cp\u003e(1) On the reaction level, from the trainee\u0026rsquo;s perspective, is the project well designed and implemented? What are the strengths and weaknesses?\u003c/p\u003e \u003cp\u003eOn the reaction level, based on the results of questionnaire and interview, trainees are quite satisfied with the training project. Nearly all the trainees stated that they liked the combination of didactic training with experiential training, which was very systematical, practical and engaging. Trainees like case studies, panel discussions, games, and video clips most, as they said these activities helped them to understand the intercultural theories and concepts and gave them chances to communicate with each other. As for the \u0026ldquo;culture face-to-face\u0026rdquo; part, they said this part gave them a chance to communicate with foreigners and learn about different medical systems and the status quo of TCM abroad.\u003c/p\u003e \u003cp\u003eThe most often stated suggestion is that trainees would like more interaction with guest speakers, which will help them to understand what the guest speakers said, because the trainees\u0026rsquo; English ability is not that good.\u003c/p\u003e \u003cp\u003e(2) On the learning level, in what ways did the project influence the trainees' intercultural competence?\u003c/p\u003e \u003cp\u003eBased on face-to-face interviews, both the trainees\u0026rsquo; intercultural competence improved. The trainees\u0026rsquo; intercultural competence improved on two dimensions\u0026mdash;knowledge and comprehension dimension and requisite attitudes dimension. Four components were related to knowledge and comprehension dimension, including cultural self-awareness, deep understanding and knowledge of culture, culture-specific information, and sociolinguistic awareness. Three components were related to requisite attitudes dimension, including respect, openness, and curiosity / discovery.\u003c/p\u003e \u003cp\u003e(3) On the behavior level, in what ways have trainees\u0026rsquo; on-the-job behavior changed?\u003c/p\u003e \u003cp\u003eOn the behavior level, based on the follow-up interview (twenty days after the training project), it is found that trainees\u0026rsquo; intercultural competence also improved in their work. The follow-up interview with the TCM professionals sent to Morocco show that trainees\u0026rsquo; intercultural competence improved on three dimensions\u0026mdash;knowledge and comprehension, requisite attitudes, and skills. Two components were related to knowledge dimension, including cultural self-awareness and culture-specific information. Three components were related to requisite attitudes dimension, including respect, openness, and curiosity / discovery. One component was related to skills dimension, that is relate.\u003c/p\u003e \u003cp\u003e(4) On the results level, in what way can we evaluate this intercultural training project?\u003c/p\u003e \u003cp\u003eThe Results level evaluates the impact at the organizational level, which includes two bodies, the institution that dispatches TCM professionals and the overseas organizations it cooperates with. The dean of Shanghai University of TCM and the dean of one of the dispatched hospitals in Morocco were interviewed respectively. Both of them spoke highly of the performance of trainees.\u003c/p\u003e \u003cp\u003eThe dean of SUTCM said that he had talked with cooperative organization abroad, and they thought very highly of these dispatched doctors. The dean of one of the dispatched hospitals in Morocco said that more and more local patents were willing to try TCM and he would be willing to cooperate with SUTCM in the future to learn more about TCM.\u003c/p\u003e"},{"header":"VI. Discussion","content":"\u003cp\u003eThe findings match the application of Kirkpatrick\u0026rsquo;s Four-level Evaluation Model in other fields, so this theoretical framework can be used in the field of intercultural communication. As put forward by Kirkpatrick, the training evaluation on the reaction level is always carried out as soon as the training ends (Kirkpatrick \u0026amp; Kirkpatrick, 2005; Duke, 2017). In this study, a satisfaction questionnaire is used, which matches the methods in empirical studies in other fields using Kirkpatrick\u0026rsquo;s model(Wang, 2012; Liu, Liu, \u0026amp; Fang; 2021, Chu \u0026amp; Lu, 2013). Furthermore, this study adds face-to face interview to provide more detailed information about trainees\u0026rsquo; opinions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs put forward by Kirkpatrick, common and effective assessment mechanisms at this level include competency pen and paper tests, performance tests, surveys from trainees and their supervisors, interviews, and combinations of these (Kirkpatrick \u0026amp; Kirkpatrick, 2005; Duke, 2017). Some empirical studies choose scale or pen-and-paper tests on this level(Wang, 2012; Liu, Liu, \u0026amp; Fang; 2021, Chu \u0026amp; Lu, 2013). Due to the specialty of intercultural competence, this study didn\u0026rsquo;t choose pen-to-paper test, and due to the limitation of number of trainees, this study didn\u0026rsquo;t choose training scale. This study uses face-to-face interview as soon as the training ends. Trainees are asked to reflect their intercultural competence. The detailed dialogue was recorded to provide readers with more information.\u003c/p\u003e\n\u003cp\u003eAs put forward by Kirkpatrick, the most often used methods for this level of assessment is interviews conducted at key time intervals after the training program has completed and participants have started or returned to their jobs (Kirkpatrick \u0026amp; Kirkpatrick, 2005; Duke, 2017).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome empirical studies choose scale or observation on this level (Wang, 2012; Liu, Liu, \u0026amp; Fang; 2021, Chu \u0026amp; Lu, 2013). Due to the limitation of distance, this study didn\u0026rsquo;t choose observation, and due to the limitation of number of trainees, this study didn\u0026rsquo;t choose training scale. This study uses online interview twenty days after trainees were dispatched to Morocco. The detailed dialogue was recorded to provide readers with more information.\u003c/p\u003e\n\u003cp\u003eAs put forward by Kirkpatrick, results could be shown in many ways and in many areas, including less turnover of foreign assignment positions, improved quantity or quality of work, reduction of waste, reduction in wasted time, increased sales, reduction in costs, increase in profits, and return on investment. Wang (2012) did a research to find out the relationship between revenue and evaluation score both after one and two years through follow-up investigation evaluators found a positive correlation. Liu, Liu, \u0026amp; Fang (2021) used evaluation scale to complete evaluation on this level. Chu \u0026amp; Lu (2013) observed and recorded the reactions of students in the classroom from both participating and non-participating teachers, and conducted a self-evaluation survey on the learning situation of students from participating teachers. Due to the limitation of number of trainees, this study didn\u0026rsquo;t choose training scale. And due to the limitation of time, it is hard to find out the correlation between training effectiveness and revenue. In this study, the dean of Shanghai University of TCM was interviewed face-to-face and the dean of one of the dispatched hospitals in Morocco was interviewed online.\u003c/p\u003e"},{"header":"VII. Conclusion \u0026 Limitation","content":"\u003cp\u003eThis study carries out a long-term follow-up evaluation of an intercultural training project for TCM professionals using Kirkpatrick\u0026rsquo;s Four-level Evaluation Model. The study mainly uses qualitative method, including face to face interview and online interview, then uses theme analysis to analyze trainees\u0026rsquo; intercultural competence. Results show that Kirkpatrick\u0026rsquo;s Four-level Evaluation Model is applicable in evaluating intercultural training project.\u003c/p\u003e \u003cp\u003eOn the reaction level trainees are quite satisfied with the training project; on the learning level their intercultural competence improve mainly on two dimensions: knowledge(cultural self-awareness, deep understanding and knowledge of culture, culture-specific information, sociolinguistic awareness) and attitudes (respect, openness, curiosity and discovery); on the behavior level their intercultural competence improve on three dimensions: knowledge (cultural self-awareness, culture-specific information), attitudes (respect, openness, curiosity and discovery ) and skills (relate); on the results level the feedback from home and abroad organizations are also pretty good. Besides, this study put forward useful suggestions for improving future intercultural training programs for TCM professionals based on the results at the end of the paper. The significance of the study is two-fold. Theoretically, this study explores the feasibility and effectiveness of Kirkpatrick\u0026rsquo;s Four-level Evaluation Model (Kirkpatrick \u0026amp; Kirkpatrick, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2005\u003c/span\u003e) in the field of intercultural communication evaluation. Practically, evaluation results of this intercultural training provide useful information for trainers, which will help them to better design and carry out intercultural training programs for TCM professionals in the future. Thus, trainees will gain more in the future intercultural training programs and perform better in their overseas work, which is also beneficial for TCM culture \u0026ldquo;going out\u0026rdquo;.\u003c/p\u003e \u003cp\u003eNevertheless, there is one limitation in this study. Due to geographical and economic limitations, some evaluation on the third and fourth level could only be carried out online through \u003cem\u003eWeChat\u003c/em\u003e, which may constrain the information provided by the interviewees.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was reviewed and approved by Henan Polytechnic University Human Participants Ethics Committee and the Reference No. is SKJYB2023-20. We ensured that the study complied with the Declaration of Helsinki, and obtained written informed consent from all participants.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;Not applicable\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical trial number\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;Not applicable\u0026rdquo;\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe data presented in this study are available on request from the corresponding author. The data are not publicly available due to ethical considerations.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;The authors declare that they have no competing interests\u0026rdquo;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003ethe Fundamental Research Funds for the Universities of Henan Province (Grant No. SKJYB2023-20).\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003e\u0026ldquo;KM designed the research, analyzed and interpreted the participate data regarding Intercultural training evaluation. QS improved the research method and edited the manuscript. All authors read and approved the final manuscript.\u0026ldquo;\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe would like to extend our gratitude to Prof. Zhang Hongling who provided insightful advice to our manuscript. We also appreciate all participants who agreed to participate in this study. We are finally thankful to the editor and reviewers for their hard work in processing our manuscript. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBhawuk DPS, Brislin R. The measurement of intercultural sensitivity using the concepts of individualism and collectivism. International Journal of Intercultural Relations. 1992; 16: 413-436. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBennett JM. Transformative training: Designing projects for culture learning. In: Moodian MA, editors. Contemporary leadership and intercultural competence: Understanding and utilizing cultural diversity to build successful organizations. Thousand Oaks, CA: Sage；2008.p.95-110\u003c/li\u003e\n \u003cli\u003eChu YM, Lu H. Evaluation of the effectiveness of educational technology training for university teachers based on Kirkpatrick\u0026rsquo;s model. Modern Educational Technology.\u0026nbsp;2013; 23:34-37.\u003c/li\u003e\n \u003cli\u003eDeardorff DK. 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The Kirkpatrick model: A useful tool for evaluating training outcomes. Journal of Intellectual and Developmental Disability. 2009; 34:266-274.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSpitzberg BH, Cupach WR. Handbook of interpersonal competence research. New York: Springer-Verlag; 1989.\u003c/li\u003e\n \u003cli\u003eUpcraft ML, Schuh J H. Assessment in Student Affairs: A Guide for Practitioners; 1996.\u003c/li\u003e\n \u003cli\u003eWang K. Case analysis of Kirkpatrick\u0026rsquo;s four levels and its application strategies. 2013. https://kns.cnki.net/kcms2/article/abstract?v=mtmIrHeyR2uBn-y4Yl7v3LOptlfFR-totdgkMIczEb82GN-oFn4WxuKFawfIIlFmGBa_TXNEMZCxMjgNiPn43P4S6CD8r-h6_5mUqvbxE4edn2IVHVoU3dpaoMSBH9qxKQnvAN9CQzCpKwf1iKf_dkv\u003cbr\u003eNDIDkq1GYosSHLDWE_Mkts9nQArHT2hSahjj3TfVfFJHD5hMHrjI=\u0026amp;uniplatform=NZKPT\u0026amp;language=CHS\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Kirkpatrick’s Four-level Evaluation Model, Deardorff Pyramid Model of Intercultural Competence, Intercultural Training Evaluation, Intercultural Competence, Traditional Chinese Medicine (TCM)","lastPublishedDoi":"10.21203/rs.3.rs-6277862/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6277862/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eMany scholars have investigated and theorized about various aspects of intercultural training program design, relatively few have focused their efforts on the evaluation of these programs\u0026rsquo; effectiveness. This study intends to explore how Traditional Chinese Medicine (TCM) Professionals develop their intercultural competence in an intercultural training program by using Kirkpatrick\u0026rsquo;s Four-level Evaluation Model. This study mainly adopts a qualitative method, including face to face interview and online interview to take a long-term follow-up survey, so it can give full details of trainees\u0026rsquo; development of intercultural competence. Results show that on the reaction level of Kirkpatrick\u0026rsquo;s Four-level Evaluation Model, trainees are quite satisfied with the training project; on the learning level, their intercultural competence improve mainly on two dimensions: knowledge and attitudes; on the behavior level, their intercultural competence improve on three dimensions: knowledge, attitudes and skills; on the results level, the feedback from home and abroad organizations are also pretty positive. In conclusion, Kirkpatrick\u0026rsquo;s Four-level Evaluation Model is feasible and effective in the field of intercultural communication evaluation.\u003c/p\u003e","manuscriptTitle":"Type of the Study: Empirical Study Evaluating Intercultural Competence: A Case Study of an Intercultural Training Program for Traditional Chinese Medicine (TCM) Professionals","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 11:02:42","doi":"10.21203/rs.3.rs-6277862/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5f7c5944-b111-444a-b14c-fc976937ab15","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-10T15:08:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 11:02:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6277862","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6277862","identity":"rs-6277862","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}