Abstract
There is a growing need for research on culture, cultural differences and cultural effects of globalization in medical education, but these are complex phenomena to investigate. Socio-cultural activity theory seems a useful framework to study cultural complexity, because it matches current views on culture as a dynamic process situated in a social context, and has been valued in diverse fields for yielding rich understandings of complex issues and key factors involved. This paper explains how activity theory can be used in (cross-)cultural medical education research. We discuss activity theory’s theoretical background and principles, and we show how these can be applied to the cultural research practice by discussing the steps involved in a cross-cultural study that we conducted, from formulating research questions to drawing conclusions. We describe how the activity system, the unit of analysis in activity theory, can serve as an organizing principle to grasp cultural complexity. We end with reflections on the theoretical and practical use of activity theory for cultural research and note that it is not a shortcut to capture cultural complexity: it is a challenge for researchers to determine the boundaries of their study and to analyze and interpret the dynamics of the activity system.
Highlights
Medical educationalists increasingly address importance to the role of culture and cultural differences in medical education: an awareness that is fuelled by increasing flows of knowledge, students, teachers, and educational materials, methods and programmes across national, regional and continental borders [1, 2]
We end with reflections on the theoretical and practical use of activity theory for cultural research and note that it is not a shortcut to capture cultural complexity: it is a challenge for researchers to determine the boundaries of their study and to analyze and interpret the dynamics of the activity system
We found that a complex interaction between problem-based learning (PBL), students, their cultural backgrounds and other contextual factors determined differences and similarities in the way PBL processes and students were shaped across three cultural contexts
Summary
Following the cultural focus of our research questions, we structured the results according to the cultural themes we identified that contradicted with and shaped the self-directed learning and group discussion processes of PBL differently across the three cases through students’ externalization. In the Western European case, students expressed lower levels of initial anxiety and few problems with building self-directed learning and communication skills in PBL, due to supportive secondary schooling and cultural factors, but this development was less substantial compared with the gap that Middle Eastern students bridged Despite these differences, PBL was found to gradually shape students across the contexts in a similar direction. They were found to develop motivation for self-directed learning, an understanding of its purpose, and skills related to searching and finding information, and constructing knowledge
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