Purpose/Hypothesis : Internationalization in physical therapy clinical education is an area of mutual interest among faculty at Bergen University College (Norway), Duke University (United States) and Sheffield Hallam University (United Kingdom). Students from these three universities participated in international clinical education placements in cooperation with Haukeland University Hospital (HUS) and Haraldsplass Deaconess Hospital (HDS) located in Bergen, Norway. The purpose of this project was to develop a sustainable model for peer-learning in international physical therapy clinical education.Number of Subjects : Fourteen third year students, two post-professional interns, four clinical instructors, and two clinical managers.Materials/Methods : Students were selected through an application and interview process to participate in peer-learning placements during clinical education. Because non-Scandinavian speaking students face a special challenge in communication and documentation, students from the United States and the United Kingdom were paired with a Norwegian student and clinical instructor. Peer-learners were assigned to clinical placements in two different hospitals. This international peer-learning model was evaluated through 1) interviews with students and clinical instructors, individually and in groups; 2) observation of students and clinical instructors during patient encounters; and 3) assessment of studentsÕ patient journals, reports and reflective writing assignments. Data were analyzed using qualitative content analysis.Results : Four main themes emerged from data gather during interviews and observation of students and clinical instructors. 1) Learning: Students challenge and complement each other while learning of differences in cultural treatment traditions. Professional development of the clinical instructor is enhanced. 2) Tutorials: Feedback on efficacy of the peer-learning process and individual tutorials is important. 3) Challenges in communication: Translation, differences in professional language and inability to read documentation in patient charts 4) Interactions with patients: Clarification of roles, peer-teaching and English speaking patients enhance the learning process.Conclusions : International cooperation among physical therapy faculty, students and clinical educators promotes cross-cultural communication and professional development. To challenge and assess students, clinical teaching should be organized both individually and in pairs. Similarly, students advance their learning when evaluating and treating patients together and as a single provider.Clinical Relevance : International exchange opportunities involving peer-learning in clinical education can be planned, organized and implemented through international collaborations that promote cultural understanding among students, clinical instructors, academic faculty and patients who are all citizens in an increasingly global society.