Challenges and opportunities in cultivating medical students’ competencies: Participatory action research from a hierarchical cultural setting

Abstract

Backgrounds Research concerning student-centered learning (SCL) recommends a comprehensive assessment of medical students’ competencies including their personal and professional characters. Accordingly, nurturing future doctors should be in a continuous mentorship program. However, in a hierarchical culture, communication is one-way with limited feedback and reflection. We aimed to explore challenges and opportunities for SCL implementation in medical schools in this cultural setting necessary for a globally interdependent world. Methods Two cycles of participatory action research (PAR) were conducted, involving medical students and teachers in Indonesia. A national conference on SCL principles was conducted between the cycles, also the SCL modules were developed for each institution and feedback was shared. Twelve focus group discussions were conducted (before and after the module development), with 37 medical teachers and 48 medical students from 7 faculties of medicine across Indonesia at various levels accreditation. Following verbatim transcriptions, a thematic analysis was conducted. Results and Discussions In cycle 1 PAR, some challenges in implementing SCL were identified: lack of constructive feedback, overloaded content, summative-based assessment, hierarchical culture environment, and teachers’ dilemma of committed time between patient-care and education. In cycle 2, several opportunities to approach the SCL were proposed: a faculty development program on mentorship, students’ reflection guides and training, a more longitudinal assessment system, also a more supportive government policy on the human resources system. Conclusions The main challenge of fostering student-centered learning revealed in this study was a teacher-centered learning tendency in the medical curriculum. The weighting towards summative assessment and the national educational policy drive the curriculum like a ‘domino effect’, away from the expected student-centered learning principles. However, using a participative method, students and teachers could identify opportunities and articulate their educational needs, i.e., a partnership-mentorship program, as a significant step toward student-centered learning in this cultural context.

Discovering social learning ecosystems during clinical clerkship from United States medical students’ feedback encounters: a content analysis

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“…Moreover, written commentary can have less impact on competency judgments than quantitative metrics [ 5 ]. Environmental factors that negatively impact clinical teaching and feedback practices are not unique to Western countries; they have also been observed in Asia, where hierarchical and collectivist culture may also play a role [ 6 , 7 ].…”

Deeper look into feedback practice in an Indonesian context: exploration of factors in undergraduate clinical settings

“…An ability to apply suitable coping mechanisms was crucial to derive the greatest benefit from the feedback provided [ 16 ]. The high-power distance between teachers and students further complicated the matter by causing hesitancy and fear to discuss or clarify the messages they receive [ 17 , 18 ]. This caused delays for teachers to recognize issues that occur with the acceptance of feedback.…”

“…A safe environment became crucial for effective feedback interactions to occur. Within a safe environment, students can be open in conducting reflection, discussing their learning needs with the teacher, and agreeing the steps they need to take to improve their performance [ 5 , 17 ]. Teachers’ understanding of challenges faced by students in clinical settings helps students to feel accepted and builds a sense of belonging.…”

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“…To address the issue of low lecturer performance, we require a leader who can serve as an example for lecturers to improve their performance. Such a leader should have the ability to influence and drive the implementation of education, ultimately achieving educational goals effectively and efficiently (Findyartini et al, 2023).…”