Transformative Education
for Health Professionals

Culture and pedagogy – not one size fits all

Culture and pedagogynot one size fits all

Dr Neel Sharma

Advances in health professions education are currently fast paced. Decades back this avenue was fairly stand still. Yet there has now been huge interest in the field across the domains of teaching, learning and assessment. Significant areas of recommendation are focus of the WHO in order to help standardise processes on a global scale. These include faculty development, curricula design, use of simulation, accreditation aspects and interprofessional education to name but a few.

Often medical education reform as we currently see it today is based on Western innovation which generally snowballs globally. However, we know that typically the evidence for and against certain innovations is based generally on consensus with very few studies demonstrating long term gains. I also wonder whether more focus should turn towards the effects of culture on pedagogy.

Economic shifts are currently notable with the well documented decline of Europe and rise of Asia. In Singapore for example several merger schools exist including the LKC School of Medicine (comprising Imperial and NTU) and Duke NUS. In China, the Ottawa Shanghai Joint School of Medicine has been established. And in the Middle East there exists the Weill Cornell Medical College in Qatar and the Harvard Medical School Center for Global Heath Delivery in Dubai. As a result, there has been a shift of educators from West to East.  

From a cultural perspective, the literature highlights the important concepts of individualism and collectivism (Wursten H et al, 2013). The former is typically a Western based approach focusing on students speaking out, large group discussion, ease of confrontation in learning being made more open, and impartial teacher input. The collectivist culture which is typically Eastern, highlights students only speaking out when called upon to do so, small group interaction and a desire for no loss of face (Wursten H et al, 2013).

Power distance on teaching has also been documented (Wursten H et al, 2013). In certain parts of Asia, there is a premium on order, with teacher initiated discussions and minimal criticism. The overall effectiveness of learning is felt to be due to a function of teacher excellence. In the West power distance is much lower, with student initiation, student centred communication, and two-way communication encouraged. Uncertainty avoidance in the East is higher with a need for structured teaching and an expectation of teachers to have all the solutions.

Taking this further educational practices in Finland and South Korea for example have been highlighted.

In Finland, there is documented student centred education, two-way engagement, student initiative, and an interest in intellectual disagreement with the teacher. In South Korea, education is teacher centred, teacher initiated, with the assumption of disloyalty on the basis of intellectual disagreement. (Wursten H et al, 2013).

Schumacher et al highlighted that in order to develop the master learner one should focus on the aspect of autonomy for example where teachers encourage learners’ plans to prevail even if they contrast to that of the teacher (2013).

Furthermore, Rudolph et al in their paper on debriefing highlight the advantages of debriefing with good judgement and the encouragement of a two way interaction between teacher and learner (2006)

It is important to note that these aspects may not be best suited in non-Western settings. Not only is there an educator shift globally there has also been for decades a shift of students from East to West. Therefore, we must be mindful of these occurrences and ensure that medical education approaches take these factors into account. Only then can true rigour be achieved. 

References

Wursten H, Jacobs C. The impact of culture on education. ITIM international. 2013. http://geerthofstede.com/tl_files/images/site/social/Culture%20and%20edu...

Schumacher D et al. Developing the master learner: applying learner theory to the learner, the teacher and the learning environment. Acad Med 2013: 88: 1635-1645

Rudolph JW et al. There’s no such thing as non judgemental debriefing: a theory and method for debriefing with good judgement. Simulation in healthcare 2006:1: 49-55

Dr Neel Sharma is a gastroenterology trainee with a keen interest in medical education. He is currently based in Singapore and serves as a Visiting Scholar Faculty member at the Harvard Macy Institute, Boston, USA. 

 

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