Culture in medical education: comparing a Thai and a Canadian residency programme

CONTEXT: Globalisation initiatives in medical education are premised on a universal model of medical education. This study was conducted to challenge this premise by empirically examining the impact of culture on the practice of medical education in anaesthesia residency training programmes in Thailand and Canada. METHODS: Using a mixed-methods comparative case study research approach, one Thai and one Canadian anaesthesia residency training programme were examined with respect to curriculum, educational practices and teacher beliefs. Data sources included observations of academic and clinical teaching, programme document analysis, surveys and faculty interviews. Recruitment resulted in a 76% survey response rate and 13 interview participants at the Thai site and a 61% survey response rate and 16 interview participants at the Canadian site. Multiple linear regression analysis was used to compare survey responses between the two programmes. The qualitative analysis consisted of primary coding, clustering into pattern codes, and identifying themes and sub-themes. The integration of quantitative and qualitative data for each case was followed by a cross-case analysis. RESULTS: The two programmes were similarly organised and had similar curricular content. However, important differences emerged in curricular emphasis, educational practices, and teacher beliefs and values. Thai faculty staff emphasised knowledge and scholarship, described the faculty-resident relationship as 'familial' and focused on 'teaching methods'. Canadian faculty members emphasised clinical abilities, described the faculty-resident relationship as 'collegial' and focused on 'learning environments'. These findings were related to broader cultural differences that influenced how the curriculum was interpreted and enacted at each site. CONCLUSIONS: This study shows that although the scientific and knowledge base of medical education is universal, its enactment may be influenced by culture and context. Globalisation initiatives in medical education must be tempered by recognition of these considerations.