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.

Frambach et al.-Quiet or questioning? Students' discussion behaviors in student-centered education across cultures 2 Quiet or questioning? Students' discussion behaviors in student-centered education across cultures A tool used in student-centered education is discussion among students in small learning groups. The Western origin of student-centered education,coupled with cross-cultural differences in communication styles,may detract from its crosscultural applicability. This study investigates how in student-centered education, students' cultural backgrounds are expressed in discussions and shape students' discussion behaviors and skills. A comparativecase study was conducted, using problem-based learning as a student-centered model, in three medical schools located in East Asia, Western Europe and the Middle East. Four cultural factors were found to potentially cause students, especially those in the non-Western schools, to refrain from speaking up, asking questions, and challenging others in discussions. Six contextual factors mediated the influence of the cultural factors. The findings were incorporated in a conceptual model. The conclusion seems justified that student-centered education is feasible in different cultural contexts, but across these contexts, processes and outcomes are likely to differ.

Medical CCPs are challenging though seem feasible. Partnerships with more solid integration of academic operations appear robust in terms of ownership and provide, besides financial, also academic advantages to both institutions. However, more research is needed on the long-term effects on quality of graduates and impact on the host health care system.

Acknowledgments:The author would like to thank the following AAMC personnel for reviewing earlier drafts of this Last Page: Karen Mitchell and Cynthia Searcy. Author contact: mkroopnick@aamc.org In the spring of 2015, potential physicians will take the MCAT 2015 exam, the newest version of the MCAT exam. The MR5 Committee (the advisory committee for the MCAT 2015 exam) redesigned the exam to test the academic competencies * that tomorrow's physicians will need to know to succeed in medical school. The design is based on survey responses from over 2,700 medical school and baccalaureate faculty members and feedback from expert panelists and participants in over 90 outreach events. The MCAT 2015 exam will, like the current exam (the MCAT 1991 exam, introduced in 1991), test concepts in the natural sciences, as well as skills in critical analysis and reasoning. Unlike the MCAT 1991 exam, the MCAT 2015 exam will also cover concepts from the behavioral and social sciences. The table below highlights the features the MCAT 2015 exam shares with the MCAT 1991 exam, as well as its new features.

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Numerous, mainly Anglo-Saxon, higher education institutions have agreements with foreign providers to deliver their curricula abroad. This trend is gradually making inroads into the medical domain, where foreign institutions undertake to offer their students learning experiences similar to those of the home institution. Not an easy feat, as the national health care contexts differ greatly between institutions. In a bid to export the curriculum, institutions risk compromising their financial resilience and reputation. This article presents an instrumental case study of a home institution’s perspective on the establishment of a cross-border student-centered curriculum partnership. It provides the reader with a practical discourse on dimensions that need to be bridged between home and host contexts, and on new working processes that need to be integrated within the home institution’s existing organizational structure. We describe the advantages and disadvantages based on our experiences with a centralized organizational approach, and advocate for a gradual move toward decentral interfaculty communities of practice.

There is a growing need for research on culture, cultural differences and cultural effects of globalization in medical education, but these are complex phenomena to investigate. Socio-cultural activity theory seems a useful framework to study cultural complexity, because it matches current views on culture as a dynamic process situated in a social context, and has been valued in diverse fields for yielding rich understandings of complex issues and key factors involved. This paper explains how activity theory can be used in (cross-)cultural medical education research. We discuss activity theory’s theoretical background and principles, and we show how these can be applied to the cultural research practice by discussing the steps involved in a cross-cultural study that we conducted, from formulating research questions to drawing conclusions. We describe how the activity system, the unit of analysis in activity theory, can serve as an organizing principle to grasp cultural complexity. We end with reflections on the theoretical and practical use of activity theory for cultural research and note that it is not a shortcut to capture cultural complexity: it is a challenge for researchers to determine the boundaries of their study and to analyze and interpret the dynamics of the activity system.

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