PBL의 국제화 : 문화에 따라서 어떻게 자기주도적 학습이 영향을 받는가

Rethinking the globalisation of problem-based learning: how culture challenges self-directed learning

Janneke M Frambach,1 Erik W Driessen,1 Li-Chong Chan2 & Cees P M van der Vleuten1

Introduction

교육법이 문화와 이념을 반영한다는 것은 일반적으로 잘 알려진 것이다. 전 세계로 교육법이 지속적으로 퍼져나간다는 면에서 문장의 문화적 함의를 이해하는 것은 대단히 시급한 문제가 되었다. PBL은 특히 전 세계적으로 널리 퍼진 방법이다. 이 교육법은, 특히 의학교육에서, 빠르게 의학 정보가 늘어나는 이 시기에 반드시 필요한 자기주도적 평생학습을 유도하여, 지역사회가 필요로 하는 것과 의과대학을 졸업한 사람이 갖춘 것 사이의 간극을 줄여준다는 지지를 받고 있다. 여러 문화권 사이에 '공통의 가치'가 있을 것이라는 주장에 대한 반박은 거의 무시되곤 한다. 세계화는 교육법의 표준화를 가져왔고, 서로의 문화적 차이에 대해서는 큰 관심을 주지 않았다. 의학교육 외적 영역의 연구에서 문화의 차이가 학습의 차이를 가져오고, 교육법의 선호에도 차이를 가져온다는 것이 보여진 바 있다. 따라서 '전세계적으로 적용가능한'교육방법임을 가정한 교육방법은 다른 문화권에서는 맞지 않을 수도 있다. 

It is generally acknowledged that education methods reflect cultural and ideological values.1–3 Addressing the cross-cultural implications of this notion is increasingly urgent in view of the continuing dissemination of education methods around the globe. The globalisation of student-centred methods, including problem-based learning (PBL), is particularly widespread.4,5 These methods are advocated, particularly in medical education, for their ability to foster self-directed lifelong learning, which is considered indispensible in light of the rapid growth in medical information and the discrepancies between medical graduates’ competencies and communities’ needs.6,7 Counterarguments that the assumption of shared values across cultures may be false seem to be largely ignored.8 Driven by ideological or other motives, the globalisation movement promotes the standardisation of education methods and practices across cultures, apparently with little regard for cultural differences.9,10 Research outside medical education has revealed differences between cultures in students’ learning and preferences for educational approaches.11–13 Consequently, the cultural origin of a supposedly ‘international’ educational approach may compromise its suitability for other cultural contexts.3

서양 문화의, 학생 중심적, 문제 중심적 방법은 진정으로 '만국 공통의' 것은 아니다. 또한 이 방법이 비-서양문화권에서도 통하느냐에 대한 물음이 항상 있어왔다. Gwee와 Khoo는 PBL의 교육원칙을 따르기에 아시아 문화권은 어려울 수 있다고 언급하며, 이 간극을 좁힐 수 있는 방법에 대해 언급한 바 있다. 여러 문화권에 걸친 PBL의 적용가능성에 대한 연구를 보면, 학생과 교수들의 긍정적 반응도 있지만, 서양에서 이뤄지는 것과 차이가 있는 점도 언급되고 있다.

Rooted in Western culture, student-centred, problem-based methods may not be of a truly international nature3,14 and their compatibility with non-Western cultures has been questioned.15 Gwee5 and Khoo16 pointed to Asian cultural attitudes that might be difficult to reconcile with the educational principles of PBL, but also noted attitudes that might mitigate this discrepancy. The few empirical studies into the cross-cultural applicability of PBL reported positive views among students and staff,6,7,17,18 but also noted problems and assumed differences with Western practice.17–19 

대부분 이런 연구는 PBL의 implementation phase에 국한되어 있거나, 아시아에서 한 기관/국가/지역에서 적용된 직후에 이뤄진 경우가 많다. PBL의 여러 문화권에 대한 적용가능성 연구는 더 많은 문화권과 PBL을 구성하는 여러 단계에 대해서 시행될 필요가 있다. 의학교육에서 문화간 차이의 역할을 제대로 이해하기 위해서는 ‘comparative studies of educational values and practices in different cultures and countries’가 필요하다. 

Most of these studies were limited to the implementation phase of PBL or shortly thereafter and to single institutions, countries or regions, mainly in Asia. Researchers of the cross-cultural applicability of PBL might cast their nets wider to include more cultures and look beyond the implementation stage of PBL. A sound understanding of the role of cross-cultural differences in medical education calls for ‘comparative studies of educational values and practices in different cultures and countries’.8 

이러한 관점에 따라 우리는 PBL을 도입한 세 학교에서 cross-cultural research를 진행하고자 한다. 우리는 첫 번째 연구에서 학생들이 PBL tutorial동안 학생들의 의사소통 행동양상이 cross-cultural problem의 원인이 될 수 있음을 지적한 바 있다.

In response to this call, we are conducting a cross-cultural research project on PBL, after its implementation, in three medical schools in, respectively, East Asia, the Middle East and Western Europe. Our first study showed that students’ communicative behaviour during PBL tutorials is a potential source of cross-cultural problems as a result of a significant impact of hierarchical relations, group relations, concern with loss of face, a focus on achievement and competition, and feelings of uncertainty (J.M. Frambach, E.W. Driessen, P. Beh & C.P.M. van der Vleuten, unpublished manuscript, 2012).

이번 연구는 PBL의 주요 교육적 원칙인 '자기주도학습'에 어떻게 문화적 요소가 작용하는가를 보고자 한다. 이 원칙이 '서구에서의 민주주의, 개인주의, 평등주의'에 기반했다는 주장이 있다. 아래와 같이 정의된다.

The present study investigates whether and how cultural factors affect one of PBL’s main educational principles: self-directed learning (SDL).20 It has been argued that this principle relies strongly on ‘Western ideals of democracy, individualism and egalitarianism’.21 It is defined here as:

‘…the preparedness of a student to engage in learning activities defined by himself rather than by a teacher. “Preparedness” must be understood as having both a motivational aspect and involving skilled behaviour. Thus, an accomplished self-directed learner experiences an intrinsic need to acquire knowledge, not dominated by requirements set by his teachers. In addition, he has mastered the appropriate information seeking skills, that is: he knows where and how to find information resources that would fulfil his need.’22

문화는 "shared motives, values, beliefs and identities of members of collectives"로 정의된다. 우리는 교육환경 및 학습자의 과거 경험과 같은 다른 맥락적 요소들도 고려하였다. social cultural approach를 사용하였으며, socio-cultural theorist는 인간이란 지속적으로 환경에 의해 변화하며, 그것을 내재화한다고 주장한다. 반대로 인간들은 그들에게 내재한 생각과 가치를 '외면화'함으로서 환경을 변화시킨다. 우리는 PBL의 여러 문화간 적용가능성을 알아보기 위해서 다음과 같은 질문을 던졌다.

Culture is defined as the shared motives, values, beliefs and identities of members of collectives.13 We also examine other contextual factors that may be of influence, such as the education setting and students’ past experiences.21 We use a socio-cultural approach23,24 to obtain a comprehensive picture of how cultural, societal and other contextual factors affect students’ development as self-directed learners, because a socio-cultural perspective is assumed to encompass the cultural and contextual environment.1,25 Socio-cultural theorists state that humans are continuously influenced and shaped by their environment as they ‘internalise’ its norms and characteristics.26,27 Conversely, humans influence and transform their environment by ‘externalising’ their inner ideas and values.27 We expected to gain insight into the cross-cultural applicability of PBL by exploring the following research questions: 

• How do students across different cultural contexts internalise the principle of SDL? (How does it shape them?) 
• How do students externalise their cultural background to the process of SDL? (How do they shape it?)

Methods

Setting

A qualitative, comparative case study was conducted in two non-Western and one Western medical school. Nine medical education experts with ample international experience suggested medical schools that met our criterion of a school in a non-Western setting in which PBL has been a substantial teaching method for over 5 years. A medical school in Hong Kong and a medical school in the Middle East were selected and found willing to participate. As the latter school wished to remain anonymous, we refer to its regional rather than its national location. The Western medical school, in the Netherlands, was selected on pragmatic grounds because three of the authors are affiliated to it and it met the criterion for the use of PBL. Ethics approval was granted by the ethics review boards of the Hong Kong and Middle Eastern medical schools. At the Dutch medical school, formal ethics approval is not required for education research.

Data analysis

Using the thematic approach of template analysis,28 a succession of coding templates, consisting of hierarchically structured themes, were applied to the data (Fig. 1). atlas.ti Version 6.2 (Scientific Software Development GmbH, Berlin, Germany) was used for the coding. All steps and decisions were documented in an audit trail. The first two coding steps were conducted independently by the first two authors. They developed an initial template after coding a subsample of the interview transcripts using preliminary themes. While analysing half of the transcripts, they developed a final template, which was iteratively applied to the same transcripts. Agreement on the occurrence and interpretation of themes was reached through discussion.

Based on an initial interpretation of the results and on comparisons between the schools and between Year 1 and 3 students across and within the schools, a focused template was developed. While analysing the remaining interview transcripts, field notes and observation sheets, summaries of the collected documents and the research journal with this template, we also looked for disconfirming evidence. A final interpretation led to the creation of a comprehensive picture representing how students’ cultural backgrounds and the process of SDL shape one another.

Results

중동의 불확실성, 그리고 전통

Uncertainty and tradition in the Middle East

Middle Eastern students expressed more feelings of uncertainty as a cultural factor compared with Dutch and Hong Kong students. Their uncertainty and difficulties in adapting to SDL were related to sharp contrasts between PBL and their prior educational experiences. Rather than feeling motivated, many students felt lost and unable to find appropriate information to address their learning objectives. Uncertainty was related to experiences of traditional, teacher-centred secondary education, but also to a culturally determined focus on tradition. Middle Eastern respondents referred to their society’s respect for the ‘old ways’ and wariness regarding innovations. As they became used to PBL, however, their attitudes changed significantly. Students came to support the principle of SDL and information seeking became less problematic, although students still felt PBL was not easy and wanted more guidance:

홍콩의 융합과 위계

Hybridism and hierarchy in Hong Kong

From the outset, finding information was less difficult for Hong Kong students. As topics of tutorials were also covered in lectures in the hybrid curriculum, identifying learning needs and developing information-seeking skills were less relevant to Hong Kong students. They showed little awareness that PBL was intended to foster SDL. 

Whereas the lectures covered the basic sciences, the Hong Kong tutorials focused more on clinical reasoning skills. By contrast, the Dutch and Middle Eastern students had to rely on tutorials for most of their knowledge. The Hong Kong students often felt the tutorials repeated the content of lectures, which some appreciated as providing a useful opportunity for revision and a chance to apply their knowledge to a clinical case, but others considered a waste of valuable study time:

여러 문화간 성취와 평가

Achievement and assessment across cultures

Middle Eastern and Hong Kong students characterised themselves and their respective societies as competitive and described themselves as striving for success and to be the best. They felt pressured to pass examinations and rank among the top students:

Dutch students were also examination-focused, although their responses during interviews suggested a lower level of culture-related focus on achievement and success compared with the other two cohorts. The general feeling among the three groups of students was that they valued PBL only for its contribution to their examination preparation. This depended on examination content. 

In Hong Kong, examination content was mainly determined by lectures. 

In the Middle Eastern and Dutch schools, it depended more on PBL tutorials. 

However, particularly in the Middle Eastern school, the inclusion of additional topics caused students to concentrate on these predetermined additional topics and their lecture notes more than on identifying and addressing their individual learning needs. Even if they supported and understood the principle of SDL, achievement and assessment took priority, directing their attention and efforts away from SDL to examination content:

Discussion

This study of cross-cultural differences in PBL education practice explored how students in three different cultural contexts internalised the PBL principle of SDL and externalised their cultural background to the PBL process. 

학생들은 문화적 요소를 외면화 하였고, 이는 PBL의 목표인 SDL과 상충하였다.

Students externalised cultural factors that conflicted with cultural values residing in the PBL goal of SDL.

• Feelings of uncertainty about the independence required in SDL, 
• a focus on tradition that impeded the uptake of a new approach to learning, 
• a dependence on hierarchical sources rather than oneself or one’s peers, and 
• pressure to achieve rather than an intrinsic motivation to learn posed challenges to non-Western students in particular. 

이는 앞선 연구와 유사한 결론이다. 불확실성/전통/위계/성취에 대한 강조는 서구보다 비서구에서 더 두드러진다.

This is consistent with previous reports that similar factors interfered with non-Western students’ development of critical discussion behaviours in PBL (Frambach et al, unpublished manuscript, 2012). Uncertainty, tradition, hierarchy and achievement have often been identified as more prominent in non-Western than in Western cultures.29–31 This suggests a certain incongruity between PBL and non-Western cultures, which complicates the straightforward transfer of PBL to such cultural contexts.

그러나 문화적 요소가 모든 것을 설명하는 것은 아니다. 전통/교수자중심 secondary education/융합 교육과정/PBL에서 다뤄지지 않은 시험내용 등이 학생들이 자기주도적학습을 하는 것을 더 어렵게 만든다.

However, cultural factors clearly do not explain all of the discrepancies in findings between the respective contexts. 

Several contextual factors, such as a traditional, teacher-centred secondary education, a hybrid curriculum and examination content not covered during PBL sessions further complicated students’ development of SDL skills. 

• For example, the secondary school education system in Hong Kong is very much based on knowledge acquisition and rote learning to pass examinations. Because teachers and recommended textbooks serve as the main sources of information, there is little opportunity for SDL. Therefore, it is not surprising that current Hong Kong medical students remain dependent on teachers and lectures for their learning. 
• However, this may change in the future in response to education reform taking place in Hong Kong high schools, which emphasises SDL by students as a major educational goal.

앞선 연구결과와 마찬가지로 여기서도 자기주도적학습을 비롯한 다른 PBL기술들이 PBL이 적용되는 맥락에 따라 달라진다는 것을 확인할 수 있었다. 자기주도적학습이 PBL이 도입된다고 자동적으로 일어나는 것은 아니다. 그렇게 할 수 있게 만드는 환경을 만드는 것이 중요하다. 실제로 1학년 학생을 적절한 안내 없이 PBL만 시키면 오히려 '생존'을 위하여 튜터, 사전에 정해진 학습목표, 단순암기식 학습에만 집중하게 된다. 이러한 결과는 본 연구에서 드러난 바와 같이 서로 다른 문화권임에도 (정도의 차이는 있지만) 유사한 행동방식/니즈/선호를 언급한 것과도 관련이 있다.

Our findings support earlier comments that the development of SDL and other PBL skills depends heavily on the context in which PBL is applied.21 Research suggests that SDL does not occur automatically when PBL is implemented. Carefully considered and focused efforts are needed to shape a propitious context.32,33 In fact, exposing Year 1 students to the independent learning environment of PBL without providing them with adequate guidance may, rather than promoting the development of SDL skills, cause them to become severely dependent on tutors, predetermined learning objectives and on rote learning in order to ‘survive’.32,33 This is supported by our findings that students across three different cultures, albeit to different degrees, mentioned similar behaviours, needs and preferences with regard to...

• alleviating uncertainty, 
• consulting senior students, 
• asking for tutor guidance and 
• focusing on examination content.

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Med Educ. 2012 Aug;46(8):738-47. doi: 10.1111/j.1365-2923.2012.04290.x.

Rethinking the globalisation of problem-based learning: how culture challenges self-directed learning.

Frambach JM1, Driessen EW, Chan LC, van der Vleuten CP.

Author information

Abstract

CONTEXT:

Medical schools worldwide are increasingly switching to student-centred methods such as problem-based learning (PBL) to foster lifelong self-directed learning (SDL). The cross-cultural applicability of these methods has been questioned because of their Western origins and because education contexts and learning approaches differ across cultures.

OBJECTIVES:

This study evaluated PBL's cross-cultural applicability by investigating how it is applied in three medical schools in regions with different cultures in, respectively, East Asia, the Middle East and Western Europe. Specifically, it investigated how students' cultural backgrounds impact on SDL in PBL and how this impact affects students.

METHODS:

A qualitative, cross-cultural, comparative case study was conducted in three medical schools. Data were collected through 88 semi-structured, in-depth interviews with Year 1 and 3 students, tutors and key persons involved in PBL, 32 observations of Year 1 and 3 PBL tutorials, document analysis, and contextual information. The data were thematically analysed using the template analysis method. Comparisons were made among the three medical schools and between Year 1 and 3 students across and within the schools.

RESULTS:

The cultural factors of uncertainty and tradition posed a challenge to Middle Eastern students' SDL. Hierarchy posed a challenge to Asianstudents and achievement impacted on both sets of non-Western students. These factors were less applicable to European students, although the latter did experience some challenges. Several contextual factors inhibited or enhanced SDL across the cases. As students grew used to PBL, SDL skills increased across the cases, albeit to different degrees.

CONCLUSIONS:

Although cultural factors can pose a challenge to the application of PBL in non-Western settings, it appears that PBL can be applied in different cultural contexts. However, its globalisation does not postulate uniform processes and outcomes, and culturally sensitive alternatives might be developed.

© Blackwell Publishing Ltd 2012.

Comment in

• The cultural flavours of problem-based learning. [Med Educ. 2013]
• The culturally sculpted self in self-directed learning. [Med Educ. 2012]

PMID:

 

22803751

 

[PubMed - indexed for MEDLINE]