The students that were interviewed and observed as part of this action research project were all of a SE Asian background. All of them were of Chinese distraction. A total of 9 students were involved in this project. Interviews were in the form of focus groups. All of them spoke English but their proficiency varied. Clinical educators and university supervisors who had undertaken supervision of a student from a SE Asian NESB were also interviewed. Again, a focus group strategy for their perspectives on cross cultural supervision was part of this action research project.
From the action research cycles undertaken in this particular project, several themes emerged regarding cross cultural supervision. One important consideration is that this information is specific to the group involved in this project. Its applicability to other situations and other SE Asian students must be based upon the reality that there will always be variation and extremes.
Chang (1995) described the Western model of individuation along 3 parameters which all reinforce the individual's need for 'independence'. This is in contrast to the East Asian model of individuation in which Chang (1995) states, that much of this process is influenced by Confucianism which promotes 'approval' and 'group harmony'.
In terms of cross cultural supervision, this model creates an inherent conflict in the expectations of the Western supervisor and the East Asian Supervisee. First of all, the Western educator/supervisor expects the individual to take responsibility for their own actions, to be an independent learner and to be assertive in the learning experience. In contrast to this expectation is the East Asian's perspective. The supervisee will prefer to do things which gain approval of the supervisor. Actions and behaviours will be undertaken to ensure normative approval and harmony. Behaviours which are seen to be assertive, such as presenting your own ideas and opinions violate the precepts of maintaining harmony.
By being aware of cultural behaviour patterns, supervisors can modify the way in which they interact with their learners.
I was doing a placement in psycho-geriatrics. I was supposed to determine the patient's level of orientation by talking about current and past events - eg. Prime Ministers, facts about W.W.II. How am I supposed to know all about Australian culture and history? It puts you at a real disadvantage as you don't know how to communicate around a common issue with your patients because you come from a different culture.It would seem from the above comment that students of a NESB try to communicate within the appropriate cultural context but miss many of the cues that are culturally bound.
Helping students to become more familiar with cultural membership issues now becomes the big challenge for students, supervisors and teaching institutions alike. For many fieldwork programs, particularly in health, the experience is left towards the end of academic study - after the students have completed all their science and clinical subjects. Immersion into the health care sector, suddenly puts the student into a situation where there is a lot of cultural discrepancy.
The use of mentoring strategies or buddy systems is one potential strategy. By linking students of a different culture and NESB to local students early in their education, opportunities to learn more about local customs and conversational language would become possible.
This issue of master vs. novice and the cultural factors that influence this relationship are best described by the following contrasting quotations.
While it is not impossible for students of an East Asian cultural background to develop the skills necessary for success in a Western model of education, being sensitive to the discomfort the learner may be having in confronting the supervisor needs to occur. Explaining the basis for your requests to have the student self-evaluate is a good start. Ensuring that the learning environment is safe and having the student's trust is also imperative.
The student's problem solving abilities seem very poor, we teach Australian students to be very independent whereas this doesn't appear to be the case with the NESB students.
Student's commentOne's own ideas are not as important as what the actual facts are or what is accurate - rather than take the wrong course of action - it appears more appropriate to hear the information from an expert so that the course of action is correct.
In Singapore and Malaysia we have better English training and a reasonable command of English. We think in English but our choice of words is the most difficult and the source of most misunderstanding. Peers from Australia have a much wider word choice for each particular situation whereas mine is very limited. Peers have so many words to describe pain, for example... this creates the impression in your Supervisors that you are not very good. If I spoke in Mandarin I could describe pain in many more subtle ways.Among the SE Asian students, the fact that English is something they are taught throughout their formative years of education leads to the assumption that English is one of their first languages. Certainly, the supervisors that were interviewed during the project would question whether English was the first language of these individuals. The following quotation exemplifies this:
I asked the student what his/her first language was and they said English - but this obviously was not the case. A lot of English may be spoken at school but maybe not at home and not the same English.
I found I was having difficulty coming up with the correct words during problem solving sessions with my supervisor. This made me quite anxious. The supervisor was stereotyping me as having insufficient knowledge but the real issue was that it took longer for me to process information and come up with the correct words to express the thought.As supervisors, being sensitive to this wait time issue is critical. By ignoring this feature of communication with a person from a NESB, misunderstandings may develop. What is interpreted as a knowledge gap can in fact be purely a literacy and language issue.
I feel like I am always using the same words to reinforce behaviour. I notice how other Australian students and therapists show their appreciation and motivate patients - it seems so natural and well communicated. I am very conscious of what I am about to say and it sounds like I am saying the same thing over and over again - probably to the point where it sounds insincere. (Student)A common concern that was expressed by supervisors is that the students communicate in a very brusque manner. This brusqueness, however, likely stems from the concepts of wait time, the difficulties in word selection and sentence construction and the lack of cultural membership. What the brusqueness represents is the awareness of students needing to respond in an appropriate time frame with the patient. Sentence construction and word selection being difficult for students of a NESB means that the conversation must be kept simple. Because of this, sentences may be clipped and very short, staccato type statements may be expressed. With this limit in word choice and time, it is also impossible to 'wrap' the communication into a cultural context as well. As a result, the communication appears cold and clinical even though the student cares deeply about their patient.
This challenge was not unnoticed by some of the supervisors which is evidenced in the following comment.
It takes longer to develop rapport with patients, this relates to the communication difficulties - the students are spending so much time listening, thinking, translating etc..... It becomes difficult for the patients to develop rapport. The student, because they are anxious and busy thinking, often come across as very blunt - this further cuts off rapport.
What cultural issues create teaching and learning dilemmas between the Clinical supervisor/educator and student and how do we overcome these?
Hall, S. (1992). Discrimination in Government Policies and Practices S.80 Report No. 9. Developing Anti-Discriminatory Teaching Practices in a Primary School. Equal Opportunity Commission. Perth, Australia. p21.
|Please cite as: Ladyshewsky, R. (1996). Cross cultural clinical supervision/education: The SE Asian experience. In Abbott, J. and Willcoxson, L. (Eds), Teaching and Learning Within and Across Disciplines, p99-104. Proceedings of the 5th Annual Teaching Learning Forum, Murdoch University, February 1996. Perth: Murdoch University. http://lsn.curtin.edu.au/tlf/tlf1996/ladyshewsky2.html|