1. The Impact of Culture on Learning and Performance Dr Vijay Nayar Dr Yomi McEwen 23 rd January, 2013 11th National Multi-specialty Conference

2. Why is this important?

3. Consider against a backdrop of increasingly diverse cultures within…… Population (patients) Workforce Trainees

8. Oxford dictionary definition of culture …… the ideas, customs, and social behaviour of a particular people or society:e.g Afro-Caribbean culture:people from many different cultures …..the attitudes and behaviour characteristic of a particular social group: e.g the emerging drug culture

9. Hofstede’s definition of culture “the collective programming of the mind that distinguishes the members of one group or category of people from another” (Hofstede, 2001) Members of a society function according to culturally determined implicit models in the minds of their members

10. Five dimensions of Culture: Based on attitude surveys of IBM employees in over 50 countries Empirically identified 5 dimensions along which culture can be distinguished: –Power distance –Individualism vs. Collectivism –Uncertainty avoidance, –Masculinity vs. Femininity –Long-term vs. Short-term orientation Hofstede (1980, 2001)

11. Power distance In some cultures – quite large power distance teacher to student, led by teacher, not contradicted or criticised In others - increasingly more self directed, encouraging to challenge knowledge  Potential implications – no experience of challenging or debate therefore unable to unpack the knowledge, difficulty with SDL

12. Individualism vs. Collectivism Refers to the degree to which individuals are expected to look after themselves or remain integrated with their family or colleague groups

13. Individualism vs. Collectivism Individualistic Think of themselves as an individual with a focus on ‘I’ Individual excellence is nourished and celebrated Collectivist Learn to intuitively think of themselves as part of a group focusing on ‘we’ Unquestioning loyalty is expected and assumed

14. Influence of Culture on Learning and Performance Overseas Trainees confronted by: –new culture –different educational system –different learning and teaching styles

15. PREPARATIONENCOUNTERADJUSTMENTSTABILISATION Transition Cycle (Nicholson, 1987) Anticipation prior to change Settling, Person- Role fit Personal change, role development and building relationships Making sense of new role, emotions

16. PREPARATIONENCOUNTERADJUSTMENTSTABILISATION Positive Cycle Developing realistic expectations Sustained trust, commitment and effectiveness with role and people Personal change, role development and building relationships Confidence in coping, enjoyment

17. PREPARATIONENCOUNTERADJUSTMENTSTABILISATION Negative Cycle Unrealistic expectation Unpreparedness Fearfulness Reluctance Failure Not fitting in Grieving Mismatch  Shock  Rejection  Regret

18. “Reality shock” Mismatch between expectations and reality Dealing with unmet expectations  Induction – not only policies and procedures but also “cultural induction”  Support

19. Adjustment stage Early success in the new role is important Performance feedback needs to be swift and reliable Favourable feedback Correct performance problems as they occur (Peters and Waterman, 1982) Supervisory style and support are primary determinants of success at this stage A mentor can facilitate adjustment

20. Psychological Factors Serve as resources or barriers Career Transition Inventory (CTI) developed by Heppner (1998): 5 key psychological factors identified –Readiness –Confidence –Personal Control –Support –Independence

21. Resilience “The capacity to rebound or bounce back from adversity, conflict, failure, or even positive events, progress, and increased responsibility” (Luthans, 2002) A learnable capacity that can be developed in the most ordinary of people (Masten, 2001) Resilient individuals view adversity and setbacks as opportunities for learning, growth, and development, find solutions(Luthans and Youssef, 2007)

22. Resilience is a valuable resource in career transition

23. Potential implications Exams are focussed on evidence of knowledge and recall vs knowledge applied to practice – requiring demonstration of critical reasoning Need to maintain ‘face’, do not like ‘I don’t know’ – see it as a threat Difficulty managing uncertainty

24. Implications for Educators Be aware of the cultural context of learning and performance Understand the different approaches learners have to learning Appreciate the extent to which difficulties that arise are due to cultural factors Be aware of your own cultural assumptions and biases

25. Useful interventions Induction and preparatory work Discuss their approaches to learning Supervision and Support Mentorship Feedback on performance-good and bad Address performance problems as they occur Encourage resilience

26. Cultural Induction Cultural differences Fear of failure Fear of criticism Self Directed Learning Reflective practice Managing uncertainty

27. Cultural Induction Communication skills Interpersonal skills Subtleties and nuances of language Doctor-Patient relationship GMC GMP, confidentiality etc Leadership and Team working

28. ‘Culture is not an excuse for poor performance but may put it into context’ Thank you for your attention