A cross-cultural study of students' approaches to professional dilemmas: sticks or ripples.
BACKGROUND
Medical educators internationally are faced with the challenge of teaching and assessing professionalism in their students. Some studies have drawn attention to contextual factors that influence students' responses to professional dilemmas. Although culture is a significant contextual factor, no research has examined student responses to professional dilemmas across different cultures.


METHODS
Semi-structured interviews inquiring into reactions towards, and reasoning about, five video clips depicting students facing professional dilemmas were conducted with 24 final-year medical students in Taiwan. The interviews were transcribed and analysed according to the theoretical framework used in prior Canadian studies using the same videos and interview questions.


RESULTS
The framework from previous Canadian research, including the components of principles, affect and implications, was generally applicable to the decision making of Taiwanese students, with some distinctions. Taiwanese students cited a few more avowed principles. Taiwanese students emphasised an additional unavowed principle that pertained to following the advice of more senior trainees. In addition to implications for patients, team members or themselves, Taiwanese students considered the impact of their responses on multiple relationships, including those with patients' families and alumni residents. Cultural norms were also cited by Taiwanese students.


CONCLUSIONS
Medical educators must acknowledge students' reasoning in professionally challenging situations and guide students to balance considerations of principles, implications, affects and cultural norms. The prominence of Confucian relationalism in this study, exhibited by students' considerations of the rippling effects of their behaviours on all their social relationships, calls for further cross-cultural studies on medical professionalism to move the field beyond a Western individualist focus.
Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. mjho@ntu.edu.tw
Ming-Jung
MJ
Ho
Chi-Wei
CW
Lin
Yu-Ting
YT
Chiu
Lorelei
L
Lingard
Shiphra
S
Ginsburg
D002983:Clinical Competence; D015331:Cohort Studies; D003431:Cross-Cultural Comparison; D004504:Education, Medical, Undergraduate / Q000379:methods*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011340:Problem Solving; D013337:Students, Medical / Q000523:psychology*; D013624:Taiwan; D014743:Videotape Recording