Understanding Medical Students' Self-Directed Learning in the Clinical Setting: A Cross-Cultural Qualitative Interview Study in the U.S. and Taiwan

Abstract

Self-directed learning (SDL) in the clinical environment is an important Western construct that may be difficult to translate into other cultural settings. In recent decades, most Asian countries have adopted a Western model of medical education reform that emphasizes an individualistic, student-centered model of education. However, the applicability of this model in Asian medical education setting has not yet been examined. In addition, while SDL has been well-studied in classroom settings, barriers to and facilitators of SDL in the clinical setting are not well studied. To compare and contrast Western and Asian students' conceptualization and experiences of SDL in the clinical setting, we carried out a cross-cultural qualitative study with medical students at Harvard Medical School (HMS) and National Taiwan University College of Medicine (NTUCM). Students who recently finished core clerkships were recruited for this study. A total of 30 semi-structured interviews were conducted with 15 HMS students and 15 NTUCM students, and all the affiliated hospitals where students had core clerkships were represented. Data was analyzed using the Framework Method of content analysis. Building on existing theoretical frameworks of SDL, our findings identified the essential themes across three dimensions of SDL and six major steps in the SDL process in the contexts of both the U.S. and Taiwan. Medical students described using cognitive, social-emotional, and peer learning strategies to enhance their SDL. They characterized the learning environments that fostered SDL as those in which faculty and residents demonstrated an educational orientation, promoted psychological safety, invited student engagement and reduced the sense of urgency. While there were many similarities across the two groups, several consistent differences emerged: HMS students tended to focus more on individual performance and put considerable effort into impression management, whereas NTUCM students were strongly oriented to collaboratively learning with their peers but avoided standing out when learning in a group. For specific contextual considerations, lowering the anxiety caused by evaluation and encouraging peer learning may promote SDL in the U.S. As for medical schools in Taiwan, moderating students in group learning will help facilitate SDL.