How clinical reasoning is taught and learned: Cultural perspectives from the University of Melbourne and Universitas Indonesia.

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. METHOD: 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.

Workforce Integration of Philippine-Educated Nurses who Migrate to Canada through the Live-in Caregiver Program.

Nurses who migrate through the Canadian Live-in Caregiver Program face significant barriers to their subsequent workforce integration as registered nurses in Canada. This study applies the concept of global care chains and uses single case study methodology to explore the experiences of 15 Philippine-educated nurses who migrated to Ontario, Canada, through the Live-in Caregiver Program. The focus is the various challenges they encountered with nursing workforce integration and how they negotiated their contradictory class status. Due to their initial legal status in Canada and working conditions as migrant workers, they were challenged by credential assessment, the registration examination, access to bridging programs, high financial costs, and ambivalent employer support. The results of the study are pertinent for nursing policymakers and educators aiming to facilitate the integration of internationally educated nurses in Canada.

Les infirmières qui migrent par l'intermédiaire du programme canadien des aides familiaux résidants font face à des obstacles importants après leur intégration à la population active en tant qu'infirmières au Canada. Cette étude applique le concept de chaînes mondiales des soins et utilise une méthodologie fondée sur l'étude de cas unique pour explorer le vécu de 15 infirmières formées aux Philippines et qui ont migré en Ontario, au Canada, par l'intermédiaire du programme des aides familiaux résidants. L'étude se penche notamment sur les divers défis qu'elles ont dû relever dans le cadre de leur intégration en milieu de travail infirmier ainsi que sur la façon dont elles ont composé avec leur niveau de classe contradictoire. En raison de leur statut juridique au Canada et de leurs conditions de travail en tant que travailleuses migrantes, elles ont dû surmonter les obstacles que représentaient l'évaluation de leurs titres de compétences, l'examen d'accréditation, l'accès aux programmes de transition, les coûts financiers élevés et le soutien ambivalent d'employeurs. Les résultats de l'étude offrent de l'information pertinente aux décideurs et aux éducateurs qui œuvrent pour la profession infirmière et pour l'intégration des infirmières formées à l'étranger au Canada.

International medical students and migration: the missing dimension in Australian workforce planning?

OBJECTIVE: To investigate the potential contribution of international medical students at Australian universities to the Australian medical workforce. DESIGN, SETTING AND PARTICIPANTS: A prospective survey in 2006-2007 of 619 international medical students in their final 2 years of undergraduate- and graduate-entry medical courses across eight Australian universities, followed by a 2009 survey of 88 international medical graduates of the University of Melbourne (most of whom were respondents of the earlier survey), assessing the correlation between students' intended place of internship and their actual place of internship. MAIN OUTCOME MEASURES: The survey respondents' preferred internship location; the proportion of respondents who intended to remain in practice in Australia long term; and correlation between respondents' intended internship locations and actual placements in their first postgraduate year. RESULTS: Of the 619 international medical students surveyed in 2006, 358 (58%) responded. Most planned to undertake Australian internships and seek permanent-resident status, although a third were undecided about their long-term plans. Nationality was a highly significant variable. Most preferred city rather than regional or rural training locations and expressed interest in migrating to Australia. The 2009 survey of the University of Melbourne's 2008 medical graduates showed a high correlation between students' plans in their last two years of study and outcomes in their first postgraduate year, with 73% accepting Victorian internships for 2009. CONCLUSION: International medical students studying at Australian universities represent a substantial and highly acceptable medical workforce resource for Australia. Their requirement for internships needs to be considered in, and should influence, infrastructure planning.

Communication skills and undergraduate psychiatry: a description of an innovative approach to prepare Australian medical students for their clinical psychiatry attachment.

OBJECTIVE: To address the increasing diversity in the linguistic and ethnic backgrounds of medical students at the University of Melbourne, a program was developed to prepare students for the particular challenges in cultural literacy and idiomatic English language proficiency, especially when exploring sensitive areas of patients' personal history. The authors outline the University of Melbourne program and present two case studies. RESULTS: Post hoc confidential survey of students' appraisals of the program is presented. CONCLUSION: The survey found a high level of acceptance and approval among most students.

A case study in the globalization of medical education: assisting overseas-born students at the University of Melbourne.

Over the past decade there has been a remarkable increase in ethnic diversity among Australian medical students. This phenomenon has been driven by two forces: the disproportionate school-level academic success achieved by first-generation migrant and refugee-origin youth, and the rapid globalization of Australia's tertiary education system, in a context where reduced government funding has accelerated the development of 'academic capitalism' (Slaughter & Leslie, 1997 ). This paper briefly examines each trend, prior to exploring select pedagogical implications of these changes for the University of Melbourne, the destination of choice by 2001 for 30% of all international students electing to study medicine in Australia. Two key questions are addressed: (1) What are the potential problems in delivering Western-style medical education to culturally and linguistically disparate groups?; (2) What model of international student support has been developed by the Faculty of Medicine, Dentistry and Health Sciences at the University of Melbourne? The paper suggests the model may have potential relevance for other universities, in the context of the accelerating globalization of medical education.