Objective. To compare the effectiveness of photovoice with traditional reflection as a methodology to identify student learning during an international advanced pharmacy practice experience (APPE). Methods. Over seven years, seven cohorts of two to three pharmacy students completed an APPE in which they participated in a medical mission trip to Guatemala. Cohorts were assigned to use either photovoice or traditional reflection techniques to identify and document their learning. After returning from the mission trip, a focus group was conducted with each cohort of students. Students' comments were audio-recorded and the audio recording was transcribed and the text was qualitatively analyzed. In addition, all students completed the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals (IAPCC-SV) before and after travel. Results. All 18 students who participated in the mission trips, (nine in each group) agreed to participate in the study. Several themes were identified when the transcripts of the focus group sessions were reviewed. Students in both groups emphasized learning about the enhancement of pharmacy skills, cultural appreciation, and self-examination in their reflections. However, students in the photovoice group emphasized three additional areas that were not emphasized by students in the traditional reflection group: emotional impact, critical reflection on privilege, and ethical distribution of health resources. Students' post-intervention mean scores on the IAPCC-SV increased more for the photovoice group (8.5 points) than the reflection group (6.8); however, this difference was not significant. Conclusion. Students who used photovoice focused more on the connection between their learning and emotional or moral experiences than did students who used traditional reflection techniques. Photovoice may represent a promising methodology for deeper reflection into affective learning domains because of students' connection between visual images and their lived experiences.