Approaching culture in medical education: Three perspectives

Abstract

The notion of culture is increasingly invoked in the medical education literature as a key influence on how educational strategies unfold, and culture change is frequently identified as a necessary precursor to progress. A meaningful perspective on what culture means is often missing from these discussions, however. Without a theoretically grounded notion of culture, calls for culture change are challenging to interpret and to act upon. In this cross-cutting edge paper, we explore how culture has been defined and theorised using three lenses: the organisational perspective; the identity perspective, and the practice perspective. We consider what each perspective might offer to medical education researchers. Each of these perspectives draws on a range of disciplinary influences, and none represents a singular theory of culture. Broadly, the organisational perspective directs our attention to the shared assumptions and values that bind individuals within an organisation. It tends to view culture through a strategic lens; culture may be either a barrier to or a facilitator of the changes that are inevitably required of an organisation if it is to maintain its relevance. The identity perspective, particularly the notion of figured worlds, alerts us to the power of communal narratives to shape how individuals see themselves within particular cultural worlds. The practice perspective emphasises what actually occurs in practice, avoiding symbolic ideas about culture and shared values and instead privileging activity and human-material networks or arrangements. These diverse perspectives share a common thread- they shift our research gaze beyond the individual, allowing us instead to see how those individuals form organisations, inhabit cultural worlds and constitute practices. They afford substance and direction for explorations of culture, and thus offer the promise of a more nuanced understanding of some of medical education's most challenging problems.