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      How clinical reasoning is taught and learned: Cultural perspectives from the University of Melbourne and Universitas Indonesia

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          Abstract

          Background

          The majority of schools in the Asia-Pacific region have adopted medical curricula based on western pedagogy. However to date there has been minimal exploration of the influence of the culture of learning on the teaching and learning process. This paper explores this issue in relation to clinical reasoning.

          Method

          A comparative case study was conducted in 2 medical schools in Australia (University of Melbourne) and Asia (Universitas Indonesia). It involved assessment of medical students’ attitudes to clinical reasoning through administration of the Diagnostic Thinking Inventory (DTI), followed by qualitative interviews which explored related cultural issues. A total of 11 student focus group discussions (45 students) and 24 individual medical teacher interviews were conducted, followed by thematic analysis.

          Results

          Students from Universitas Indonesia were found to score lower on the Flexibility in Thinking subscale of the DTI. Qualitative data analysis based on Hofstede’s theoretical constructs concerning the culture of learning also highlighted clear differences in relation to attitudes to authority and uncertainty avoidance, with potential impacts on attitudes to teaching and learning of clinical reasoning in undergraduate medical education.

          Conclusions

          Different attitudes to teaching and learning clinical reasoning reflecting western and Asian cultures of learning were identified in this study. The potential impact of cultural differences should be understood when planning how clinical reasoning can be best taught and learned in the changing global contexts of medical education, especially when the western medical education approach is implemented in Asian contexts.

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          Most cited references51

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          Cultures and Organizations: Software of the Mind, Third Edition

          The revolutionary study of how the place where we grew up shapes the way we think, feel, and act-- with new dimensions and perspectives Based on research conducted in more than seventy countries over a forty-year span, Cultures and Organizations examines what drives people apart—when cooperation is so clearly in everyone’s interest. With major new contributions from Michael Minkov’s analysis of data from the World Values Survey, as well as an account of the evolution of cultures by Gert Jan Hofstede, this revised and expanded edition: Reveals the “moral circles” from which national societies are built and the unexamined rules by which people think, feel, and act Explores how national cultures differ in the areas of inequality, assertiveness versus modesty, and tolerance for ambiguity Explains how organizational cultures differ from national cultures—and how they can be managed Analyzes stereotyping, differences in language, cultural roots of the 2008 economic crisis, and other intercultural dynamics
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            Case study research: Design and methods

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              Research in clinical reasoning: past history and current trends.

              Research in clinical reasoning has been conducted for over 30 years. Throughout this time there have been a number of identifiable trends in methodology and theory. This paper identifies three broad research traditions, ordered chronologically, are: (a) attempts to understand reasoning as a general skill--the "clinical reasoning" process; (b) research based on probes of memory--reasoning related to the amount of knowledge and memory; and (c) research related to different kinds of mental representations--semantic qualifiers, scripts, schemas and exemplars. Several broad themes emerge from this review. First, there is little evidence that reasoning can be characterised in terms of general process variables. Secondly, it is evident that expertise is associated, not with a single basic representation but with multiple coordinated representations in memory, from causal mechanisms to prior examples. Different representations may be utilised in different circumstances, but little is known about the characteristics of a particular situation that led to a change in strategy. It becomes evident that expertise lies in the availability of multiple representations of knowledge. Perhaps the most critical aspect of learning is not the acquisition of a particular strategy or skill, nor is it the availability of a particular kind of knowledge. Rather, the critical element may be deliberate practice with multiple examples which, on the hand, facilitates the availability of concepts and conceptual knowledge (i.e. transfer) and, on the other hand, adds to a storehouse of already solved problems.
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                Author and article information

                Contributors
                findyartini@yahoo.com , ardi.findyartini@ui.ac.id
                l.hawthorne@unimelb.edu.au
                gjmccoll@unimelb.edu.au
                n.chiavaroli@unimelb.edu.au
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                21 July 2016
                21 July 2016
                2016
                : 16
                : 185
                Affiliations
                [ ]Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
                [ ]Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
                [ ]Melbourne Medical School, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
                Article
                709
                10.1186/s12909-016-0709-y
                4957336
                27443145
                d222273f-366c-4ca1-8919-956cc6160cf3
                © Findyartini et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 16 May 2015
                : 12 July 2016
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

                Education
                clinical reasoning,undergraduate medical education,cultures of learning,comparative case study

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