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.