Medical Education in the Global Arena: The Impact of Cross-cultural Learning

A North American Obstetrician speaks through Skype to a classroom in Mbarara, Uganda while simultaneously lecturing inperson to a Boston, USA classroom on the topic of postpartum hemorrhage. The medical students and residents in Mbarara are quietly listening and diligently taking notes. The American-based students do not take notes but occasionally raise their hands to interject and ask questions. The same lecture seems to be received differently from two groups of students and the Boston-based lecturer wonders if these different forms of engagement impact the lessons taught. Are both groups gaining the same level of knowledge from the lecture despite these differences  Why are these differences occurring  Perhaps due to the barriers of distance and Internet, or do cultural differences have implications for the learning.

Types of Pedagogy

Traditional medical graduate education combines passive didactic learning in a classroom setting and participatory learning. As advances in the science of teaching have been made, education in the preclinical years has evolved from a purely classroom-based venue to the participatory and group-based learning of Problem-Based Learning (PBL). PBL fosters understanding, knowledge retention, and social and group work. Postgraduate medical education traditionally relies on an apprenticeship model of students learning during active participation in medical care. 

Whether in the classroom or by the bedside, teaching requires interaction between student and teacher; these are often influenced by social norms and relationships that guide behavior. Western post-graduate medical training for example, relies heavily on the Osler-derived model of participatory, service-oriented and work-based learning. A set of both implicit and explicit social relationships between ‘master’ and ‘apprentice’ or teacher and learner are required for this model to work. Learners are required to speak up, participate, engage and interact with the teacher. One observational study of clinical medical education identified seven important pedagogical strategies for learning: 1- questions and answers, 2- lecturing, 3- piloting, 4- prompting, 5- supplementing, 6- demonstrating, and 7- intervening.