Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Vic., Australia.
School of Clinical Sciences at Monash Health, Monash University, Melbourne, Vic., Australia.
Med Educ. 2021 Aug;55(8):903-911. doi: 10.1111/medu.14464. Epub 2021 Feb 18.
'Culture' is a word frequently invoked within medical education literature to explain challenges faced by learners in practice. While social settings and practices are widely acknowledged as critical influences on medical education, there is vast variability in how the term 'culture' is employed. This may lead to confusion, resulting in assumptions and oversights.
This critical literature review aims to characterise how the term 'culture' is explicitly and implicitly conceptualised in medical education research.
Four leading English language journals in the medical education field were searched in a twelve-month period for research papers or reviews that mentioned culture in title or abstract in a substantive way. A content analysis was undertaken of extracted definitions. In addition, metaphor analysis was used to identify conceptual metaphors, which were subsequently clustered thematically.
Our search yielded 26 papers, 8 of which contained definitions, mostly from the organisational literature. We interpreted nine conceptual metaphors related to how the term culture was employed (terroir, divider, dominant force, toxic force, obstacle, microclimate, object, brand and holdall) in four categories (unchanging, powerful, can adapt around, can be used).
This critical review reveals that medical education as a field: 1) draws most explicitly from the organisational literature; 2) invokes culture in multiple means but in ways that privilege either acontextual human agency or all-powerful social forces; and 3) regards culture as a negative or neutral force but rarely a positive one. There is a notable absence around conceptualisations of 'culture' that allow educator, student and administrator agency but at the same time acknowledge the deep forces that various social settings and practices exert. Other literatures investigating learning cultures and cultural reflexivity focus on this nexus and may provide possible means to advance considerations of culture within medical education research.
“文化”是医学教育文献中经常提到的一个词，用于解释学习者在实践中面临的挑战。尽管社会背景和实践被广泛认为是医学教育的关键影响因素，但“文化”一词的使用方式存在很大的差异。这可能导致混淆，从而产生假设和忽视。
本批判性文献综述旨在描述医学教育研究中“文化”一词的明确和隐含概念化方式。
在 12 个月的时间内，对医学教育领域的四家主要英语语言期刊进行了搜索，以查找标题或摘要中实质性地提及文化的研究论文或综述。对提取的定义进行了内容分析。此外，还使用隐喻分析来识别概念隐喻，随后对这些隐喻进行主题聚类。
我们的搜索结果得到了 26 篇论文，其中 8 篇包含定义，这些定义主要来自组织文献。我们解释了与“文化”一词的使用方式相关的九个概念隐喻（风土、分界线、主导力量、有毒力量、障碍、小气候、物体、品牌和行李袋），并将其分为四类（不变、强大、可适应、可利用）。
本批判性综述表明，医学教育领域：1）主要从组织文献中借鉴；2）以多种方式调用文化，但优先考虑无背景的人类能动性或全能的社会力量；3）将文化视为消极或中性的力量，而很少是积极的力量。在允许教育者、学生和管理者能动性的同时，承认各种社会背景和实践所产生的强大力量的“文化”概念化方面存在明显的缺失。其他调查学习文化和文化反思的文献则关注这一交点，并可能为在医学教育研究中考虑文化提供可能的方法。
