title: How clinical reasoning is taught and learned: Cultural perspectives from the University of Melbourne and Universitas Indonesia.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia. findyartini@yahoo.com.
authors.forename: Ardi
authors.initials: A
authors.lastname: Findyartini
authors.affiliation: Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
authors.forename: Lesleyanne
authors.initials: L
authors.lastname: Hawthorne
authors.affiliation: Melbourne Medical School, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Geoff
authors.initials: G
authors.lastname: McColl
authors.affiliation: Melbourne Medical School, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia.
authors.forename: Neville
authors.initials: N
authors.lastname: Chiavaroli
mesh_terms: D000293:Adolescent; D000328:Adult; D001290:Attitude; D001315:Australia; D002983:Clinical Competence; D000066491:Clinical Decision-Making; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D007214:Indonesia; D007858:Learning; D008297:Male; D013337:Students, Medical / Q000523:psychology*; D013663:Teaching; D055815:Young Adult
keywords: Clinical reasoning; Comparative case study; Cultures of learning; Undergraduate medical education