Karunaratne Dilmini, Sibbald Matthew, Chandratilake Madawa
Centre for Medical Education, School of Medicine, University of Dundee, Dundee, UK.
McMaster Education Research, Innovation and Theory Program, McMaster University, Hamilton, Canada.
Med Educ. 2025 Jan;59(1):75-82. doi: 10.1111/medu.15479. Epub 2024 Aug 1.
Our study examined the influence of national cultural predispositions on training medical professionals and doctor-patient dynamics using a dialogical approach, guided by Hofstede's framework. This framework provided valuable insights into how cultural tendencies shape the learning and application of clinical reasoning skills in different cultural contexts. We found that dimensions such as power distance and individualism versus collectivism significantly influenced clinical reasoning, while other dimensions had more nuanced effects. Junior doctors in Southern nations, despite initially lagging behind, developed advanced clinical reasoning skills with experience, eventually matching their Northern counterparts. The study highlighted the link between cultural norms and educational practices, variations in family involvement during reasoning, adherence to clinical guidelines and doctors' emotional engagement in clinical care between Southern and Northern contexts. Additionally, we recognised that effective clinical reasoning extends beyond technical knowledge, involving an understanding and integration of cultural dynamics into patient care. This highlights the pressing need to prioritise this topic.
我们的研究采用对话方法，以霍夫斯泰德的框架为指导，考察了国家文化倾向对医学专业人员培训和医患互动的影响。该框架为文化倾向如何在不同文化背景下塑造临床推理技能的学习和应用提供了宝贵的见解。我们发现，权力距离和个人主义与集体主义等维度对临床推理有显著影响，而其他维度的影响则更为细微。南方国家的初级医生尽管最初落后，但随着经验的积累，他们发展出了先进的临床推理技能，最终与北方同行不相上下。该研究强调了文化规范与教育实践之间的联系，南方和北方背景下推理过程中家庭参与的差异、对临床指南的遵守情况以及医生在临床护理中的情感投入。此外，我们认识到有效的临床推理不仅仅局限于技术知识，还包括将文化动态理解并融入患者护理之中。这凸显了优先考虑这一主题的迫切需求。
