Challenges of communication skills transfer of medical students in the cultural context of Indonesia

Abstract

Medical schools worldwide are promoting a student-centered and patient-centered care curriculum by using problem-based learning (PBL) strategy, emphasizing group dynamics and discussions. This approach facilitates student engagement, par-ticipation, and partnership interaction. However, in the context of the wide power-distance or the existence of socio-hierar-chical gaps in Indonesia, two-way dialogue is limited. Few studies describe the one-way paternalistic communication styles between physician-patient, teacher-student, and parents-children, which can lead to less effective learning and healthcare environments. In this study, we investigated if students in an Indonesian medical school, who have been learning and prac-ticing a partnership style of communication in a PBL curriculum for three years, are using the same style of communication with their junior peers outside the classroom. We examined the communication style between senior and new medical stu-dents, using surveys, observations, and focus group discussions, during a three-day orientation at the beginning of medical education. The results indicated that senior students used a one-sided communication style with their juniors, whereas new students expressed the need for egalitarian interaction with seniors. A classic dilemma of nature versus nurture was found and discussed. To change the traditional values, robust, constructive, and systematic formative training is key.