Wilby Kyle J, Govaerts Marjan J B, Austin Zubin, Dolmans Diana H J M
College of Pharmacy, Qatar University, PO Box 2713, Doha, Qatar.
School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, Netherlands.
BMC Med Educ. 2017 Mar 21;17(1):61. doi: 10.1186/s12909-017-0899-y.
Research has shown that patients' and practitioners' cultural orientations affect communication behaviors and interpretations in cross-cultural patient-practitioner interactions. Little is known about the effect of cultural orientations on assessment of communication behaviors in cross-cultural educational settings. The purpose of this study is to explore cultural orientation as a potential source of assessor idiosyncrasy or between-assessor variability in assessment of communication skills. More specifically, we explored if and how (expert) assessors' valuing of communication behaviours aligned with their cultural orientations (power-distance, masculinity-femininity, uncertainty avoidance, and individualism-collectivism).
Twenty-five pharmacist-assessors watched 3 videotaped scenarios (patient-pharmacist interactions) and ranked each on a 5-point global rating scale. Videotaped scenarios demonstrated combinations of well-portrayed and borderline examples of instrumental and affective communication behaviours. We used stimulated recall and verbal protocol analysis to investigate assessors' interpretations and evaluations of communication behaviours. Uttered assessments of communication behaviours were coded as instrumental (task-oriented) or affective (socioemotional) and either positive or negative. Cultural orientations were measured using the Individual Cultural Values Scale. Correlations between cultural orientations and global scores, and frequencies of positive, negative, and total utterances of instrumental and affective behaviours were determined.
Correlations were found to be scenario specific. In videos with poor or good performance, no differences were found across cultural orientations. When borderline performance was demonstrated, high power-distance and masculinity were significantly associated with higher global ratings (r = .445, and .537 respectively, p < 0.05) as well as with fewer negative utterances regarding instrumental (task focused) behaviours (r = -.533 and - .529, respectively). Higher masculinity scores were furthermore associated with positive utterances of affective (socioemotional) behaviours (r = .441).
Our findings thus confirm cultural orientation as a source of assessor idiosyncrasy and meaningful variations in interpretation of communication behaviours. Interestingly, expert assessors generally agreed on scenarios of good or poor performances but borderline performance was influenced by cultural orientation. Contrary to current practices of assessor and assessment instrument standardization, findings support the use of multiple assessors for patient-practitioner interactions and development of qualitative assessment tools to capture these varying, yet valid, interpretations of performance.
研究表明，患者和从业者的文化取向会影响跨文化医患互动中的沟通行为及理解。关于文化取向对跨文化教育环境中沟通行为评估的影响，我们知之甚少。本研究旨在探讨文化取向是否是评估者特质或评估者间差异的潜在来源，进而影响沟通技能的评估。具体而言，我们探究了（专家）评估者对沟通行为的重视程度是否以及如何与他们的文化取向（权力距离、男性化-女性化、不确定性规避和个人主义-集体主义）相一致。
25名药剂师评估者观看了3个录像场景（医患互动），并在5分制的整体评分量表上对每个场景进行评分。录像场景展示了工具性和情感性沟通行为的典型和临界示例的组合。我们使用激发回忆和口头报告分析来调查评估者对沟通行为的理解和评价。对沟通行为的口头评价被编码为工具性（任务导向）或情感性（社会情感），以及积极或消极。文化取向使用个体文化价值观量表进行测量。确定了文化取向与整体评分之间的相关性，以及工具性和情感性行为的积极、消极和总表述频率。
发现相关性因场景而异。在表现差或好的视频中，不同文化取向之间没有差异。当展示临界表现时，高权力距离和男性化与更高的整体评分显著相关（分别为r = 0.445和0.537，p < 0.05），并且与关于工具性（任务导向）行为的负面表述较少相关（分别为r = -0.533和-0.529）。此外，较高的男性化得分与情感性（社会情感）行为的积极表述相关（r = 0.441）。
因此，我们的研究结果证实文化取向是评估者特质的一个来源，并且在沟通行为的解释上存在有意义的差异。有趣的是，专家评估者通常对表现好或差的场景达成一致，但临界表现受文化取向影响。与当前评估者和评估工具标准化的做法相反，研究结果支持在医患互动中使用多个评估者，并开发定性评估工具来捕捉这些不同但有效的表现解释。
