PBL의 세계화에 대해 다시 생각하다: 어떻게 문화가 자기주도학습에 영향을 주는가 (Med Educ, 2012)

PBL의 세계화에 대해 다시 생각하다: 어떻게 문화가 자기주도학습에 영햐을 주는가 (Med Educ, 2012)

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

교육법은 문화와 사상을 반영한다. 끊임없이 교육법이 전 세계적으로 퍼져나가고 공유되는 현 시점에서 이러한 인식에 대한 여러 문화간 함의를 살펴보는 것이 중요하다.

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 dis- semination of education methods around the globe.

문화간 공유하는 가치가 존재한다는 가정이 틀릴지도 모른다는 것에 대한 반대주장은 상당히 무시되어왔다. 세계화는 교육법의 표준화를 가져왔고, 문화적 차이에 대한 고려 없이 여러 문화권에서 활용되고 있다. 의학교육 외 분야에서의 연구를 통해 학생의 학습과 교육적 접근에 대한 선호에 문화간 차이가 있다는 것이 밝혀졌다. 그 결과 '국제적' 교육법에 대한 문화적 근원이 존재할 것이라는 가정은 다른 문화권에서는 적절하지 않을 수도 있다.

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 originof a supposedly ‘international’ educational approach may compromise its suitability for other cultural contexts.3

서양 문화에 기반을 둔, 학생 중심의 문제 중심의 방법은 진정으로 국제적이지 않을 수 있고, 여러 비-서구권 문화에서 적합성에 문제가 제기된 바 있다. Gwee와 Khoo는 아시아 문화권에서의 태도는 PBL의 교육 원칙과 잘 맞지 않을 수 있으나, 이 차이를 좁힐 수 있는 태도에 대해서도 언급하기도 했다. PBL이 여러 문화권에 걸쳐서 적용가능한가에 대한 실제 연구는 학생과 교수 등을 통한 연구에서 긍정적으로 보여진 적도 있지만, 서양에서 진행되는 PBL과의 차이 혹은 거기서 발생하는 문제도 지적된 적 있다. 대부분의 이러한 연구는 PBL의 도입시기 혹은 도입 직후에 국한되었거나, 단일기관, 단일지역에서 수행되었다.

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 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.

본 연구에서는 어떻게 문화적 요인이 SDL이라는 PBL의 주 교육원칙에 영향을 주는가에 대해 알아보고자 한다. 이러한 원칙은 '민주주의, 개인주의, 평등주의라는 서양의 사상'에 크게 기반하고 있다.

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 egalitarian- ism’.21 It is defined here as: 

학생이 교수에 의해 정의된 것이 아니라 스스로 학습활동을 정의하고 참여하는 것에 대한 준비도. '준비도'라는 것은 동기부여 뿐 아니라 적절한 행동기술을 포함한다. 따라서 SDL을 하는 학습자는 지식 습득에 대한 내적 요구가 있으며, 이 요구는 선생님에 의해서 정해진 것이 아니다. 추가적으로 이 학생은 적절한 정보탐색기술을 익혀야 하며, 이는 스스로의 요구를 충족시키기 위한 정보원이 어딘지를 알고 찾는 것이다.

‘…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 experi- ences 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

문화라는 것은 공유된 동기, 가치, 신념을 의미하며 그 문화의 구성원을 집단으로 묶어준다.

Culture is defined as the shared motives, values, beliefs and identities of members of collectives.13 

사회문화이론가들은 인간은 환경의 규범과 특징을 내면화하면서 지속적으로 환경에 의해 형성되어가며, 반대로 스스로 가진 생각과 가치를 환경에 외면화하면서 그 환경에 영향을 주고 바꾼다.

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

자료수집

The semi- structured interviews lasted 1 hour on average and were audio-recorded and transcribed verbatim. Oral and written informed consent was obtained. The participants received a symbolic gift. Purposive sampling ensured the inclusion of male and female students, students from different PBL groups and from the first and third years of training. 

The researchers were briefly introduced at the start of the tutorials and did not participate in sessions. Documents about the implementation and application of PBL were obtained from the key persons. The researchers kept journals in which they recorded additional contextual information. They also reported personal perspectives to create awareness of potential researcher bias. To enhance the trustworthiness of the data, a member check was conducted by asking a sample of the participants to indicate agreement with and comment on a report of preliminary results. The comments were integrated with the data.

Using the thematic approach of template analysis,28 a succession of coding templates, consisting of hierar- chically structured themes, were applied to the data (Fig. 1).

28 King N. Using templates in the thematic analysis of text. In: Cassel C, Symon G, eds. Essential Guide to Qualitative Methods in Organizational Research. London: Sage Publications 2004;256–70.

중동국가에서의 불확실성과 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:

Having experienced information searching and self- study in secondary school, Dutch students had less difficulty in adapting to SDL. In addition, Dutch culture places less value on tradition. Although the Dutch students were less uncertain, they required time to develop information-seeking skills and they generally preferred tutors who provided clear guidance. A particular problem for them concerned determination of the depth and breadth of the knowledge to be attained. Dutch, Hong Kong and, particularly, Middle Eastern students tried to cope with uncertainty and independence by asking senior students for advice and materials. Although it reduced insecurity, this strategy discouraged them from depending upon themselves for their learning:

혼합과 위계의 홍콩

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:

Some Hong Kong students were anxious about multiple interpretations that might come up during tutorial discussions because these created uncertainty about the ‘truth’ and they were hesitant about trusting their peers’ statements. This reflected their experience of a teacher-centred secondary education, as well as the culture of a hierarchical society in which knowledge and authoritative statements about the ‘truth’ are expected to come from professors or experts who represent persons of higher status. Students were not used to having to rely entirely on themselves for their learning. They also attached greater value to tutorials that were facilitated by expert clinicians rather than by non-experts. Although Dutch students also preferred facilitation by expert tutors, they were comfortable relying on their peers. The impact of hierarchy was also evident in the Middle Eastern school and manifested in students’ experiencing of anxiety about the requirement to search independently for the ‘truth’. However, by Year 3, student anxiety in the Middle East school had abated, whereas student anxiety in Hong Kong showed little difference between the years:

성취와 평가에 대한 문화간 차이

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 exam- ination content:

Discussion

보통 불확실성, 전통, 위계, 성취에 대한 강조는 비-서구권에서 서구권보다 더 두드러지는 특징이다. PBL과 비-서구 문화권 사이에서 발생하는 불일치는 여기서 발생하는 것일 수 있으며, PBL을 곧바로 이들 문화권에 적용하는 것을 어렵게 한다.

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 요인이 모든 것을 설명해주지는 않았고 다른 것도 있다.

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. 

예를 들면...홍콩 고등학교 교육은 SDL기회가 거의 없음. 학생들은 선생님-의존적이 됨.

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.

SDL과 PBL기술이 그것이 적용되는 context에 크게 영향을 받는다는 이전 연구를 뒷받침한다. PBL이 도입되었다고 SDL이 자연적으로 발생하지는 않는다. 촉진적 환경을 만들어주기 위해서는 정교하게 계획되고 집중적 노력이 필요하다. 실제로 1학년 학생을 적절한 가이드 없이 PBL의 독립적 학습환경에 넣어두면 살아남기 위해서 오히려 튜터, 사전에 정해진 학습목표, 단순 암기에 지나치게 의존하게 된다. 우리 연구에서도 세 문화권 학생은 서로 정도의 차이는 없었지만 비슷한 행동패턴을 보였는데, 불확실성을 줄이려고 한다거나, 선배에게 상담을 한다거나, 튜터에게 가이드를 요청한다거나, 시험 내용에 초점을 맞추는 것 등이 공통적이었다.

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 sim- ilar behaviours, needs and preferences with regard to alleviating uncertainty, consulting senior students, asking for tutor guidance and focusing on examination content.

가능한 대안 중 하나는 SDL을 PBL을 위한 도구로 활용하고, PBL의 목표로 인식하게 하는 것이다. 점진적으로 SDL에 노출시켜 주는 것이, 즉 1학년에는 가이드와 지원 체계를 강력하게 하는 것이, 궁극적으로 SDL 기술을 더 발전시킬 것이다. 특히 중고등학교 교육이 교사 중심이고 hybrid 접근법이 없는 경우에, 그리고 불확실성, 전통, 위계, 성취가 강조되는 문화권에서 중요하다.

A possible solution might be to strike a balance between using SDL as a means to PBL and perceiving it as an end of PBL.33 Gradual exposure to SDL, with relatively strong guidance and support in the first year, might ultimately yield the development of more SDL skills.33 Our findings suggest that this is particularly relevant in contexts in which secondary education is teacher-centred, no hybrid approach is followed, and the cultural factors of uncertainty, tradition, hierarchy and achievement are valued highly.

그럼에도 불구하고 세 문화권 학생들 모두 1학년에서 3학년으로 올라감에 따라 SDL의 원칙을 내면화하는 것으로 보였다. 

Despite the challenges, however, students across the three cultures increasingly internalised the principle of SDL as they moved from Year 1 to Year 3. 

• The Middle Eastern students made substantial progress from initial uncertainty to preparedness to determine their own learning activities and find relevant infor- mation. 
• Because of their pre-university experiences in SDL, the progress of the Dutch students was less marked, but still noticeable. 
• Hong Kong students seemed to quickly adapt to the PBL learning environment and to develop clinical reasoning skills, but were less stimulated to develop SDL skills in terms of determining learning objectives and con- sulting different information sources. 

이러한 결과는 학생들이 PBL 과정에 익숙해짐에 따라서 SDL 기술이 발전한다는 기존의 연구와도 일관된 것이다. 따라서 PBL이 비록 여러 문화권에서 곧바로 적용하기는 어려울지라도, 적용될 수 없다는 결론을 내리는 것 또한 옳지 않다.

These findings would appear to be consistent with those of studies reporting that SDL skills develop naturally as stu- dents become used to the PBL process and curricu- lum.33,34 Thus, although PBL may not be cross- culturally applicable in a straightforward way, it would be wrong to conclude that it cannot be applied across cultural contexts as practice continues to prove.

근본적인 질문은 PBL이 애초에 국제적으로 적용되어야 했었냐는 것이다. 의학교육이 전 세계적으로 개혁이 필요한 것은 사실이지만, 한 해법이 모든 곳에 적용되어야 하는냐는 논란의 여지가 있다. 현재는 서구에서 유래한 학생중심 교육법이 '국제적' 기준으로 대표되고 있다. 그러나 이 연구에서 이러한 방법들의 문화권간 적용 가능성에 의문을 가질 수 있음을 보여준다. 학생 중심의 문제 중심의 방법을 적용하면서 문화적 도전에 맞닥뜨리느니, 오히려 그 맥락에 가장 잘 맞는 대안을 찾거나 만드는 것이 나을 수도 있다. 현재의 '국제 기준'에 대한 움직임을 감안하면 이는 쉽지 않다. 그러나 아시아 지역의 영향력이 높아지고, 다른 지역도 발달함에 따라 미래의 의학교육의 지형도 바뀔 것이다.

A more fundamental question is whether PBL should be globalised in the first place. It is true that medical education worldwide is in need of reform, but whether one solution should be applied to all contexts is debatable. Currently, student-centred methods originating in Western culture seem to represent an ‘international’ standard. Yet, as this study confirms, the cross-cultural applicability of these methods may be questionable. Rather than taking on the cultural and contextual challenge of adopting student-centred, problem-based methods, it might be wiser for medical educationalists to rise to the challenge of exploring or creating alternatives that best fit their particular context. Given the current movement towards the development of ‘international standards’, this is a major challenge indeed. However, the rising influence of the Asian region and rapid developments in other parts of the world may imply changes in the future landscape of medical education.

11 Tweed RG, Lehman DR. Learning considered within a cultural context: Confucian and Socratic approaches. Am Psychol 2002;57 (2):89–99. 

12 Li J. Mind or virtue: Western and Chinese beliefs about learning. Curr Dir Psychol Sci 2005;14 (4):190–4. 

13 Joy S, Kolb DA. Are there cultural differences in learning style? Int J Intercult Relat 2009;33 (1):69–85.

8 Hodges BD, Segouin C. Medical education: it’s time for a transatlantic dialogue. Med Educ 2008;42 (1):2–3. 

9 Karle H, Christensen L, Gordon D, Nystrup J. Neo- colonialism versus sound globalisation policy in medi- cal education. Med Educ 2008;42 (10):956–8. 

10 Hodges BD, Maniate JM, Martimianakis MA, Alsuwai- dan M, Segouin C. Cracks and crevices: globalisation discourse and medical education. Med Teach 2009;31 (10):910–7.

31 Al Kadri HM, Al-Moamary MS, Magzoub ME, Roberts C, van der Vleuten CPM. Students’ perceptions of the impact of assessment on approaches to learning: a comparison between two medical schools with similar curricula. Int J Med Educ 2011;2:22–52.

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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

• 1Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. j.frambach@maastrichtuniversity.nl

Abstract

CONTEXT:

Medical schools worldwide are increasingly switching to student-centred methods such as problem-based learning (PBL) to foster lifelongself-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 Asian students 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]