Cureus | A Focus on the Qualitative Aspects of Cultural Prototypes and Differences In Simulation Debriefing

A Focus on the Qualitative Aspects of Cultural Prototypes and Differences In Simulation Debriefing


Abstract

Introduction: Cultural influences have a significant effect on learning styles (1) and on interactions amongst clinicians (1-2).The infusion of cultural elements into the debriefing process helps simulation-based education be tailored to individual learners’ needs (3). Hofstede’s culture analysis permits a quantitative comparison of cultural elements. (4).  

Research Question: we aim to explore the connection between Hofstede’s Power Distance Index (PDI) and behavior patterns during simulation debriefing relative to cultural origin. Specifically:
1) identify debriefing prototypes by mapping cultural, societal and regional elements of interaction
2) elucidate how interactions between instructors and participants are linked to their cultural backgrounds

Methods: Six hypotheses were formulated based on culture-relevant debriefing topics: (H1) Talking time, (H2) Interaction patterns, (H3) Style of interaction, (H4) Initiation of discussion, (H5) Content of the debriefing and, (H6) Difficulty discussing non-technical aspects. An interview-guiding questionnaire was designed consisting of demographic, quantitative and qualitative questions.

Results and Discussion: 68 interviews were conducted in 26 countries with PDIs ranging from 11 (minimal hierarchy) to 99 (significant hierarchy); 65% were from low PDI countries (PDI<50).

Quantitative Analysis: Correlation analysis was conducted based on Kendall’s tau. As hypothesized: (H1) participant talking time during debriefings was significantly less in countries with high PDI (-.234, p .022); (H2) the higher the PDI the less participants interact amongst themselves (-.306, p .004); (H3) leading questions dominated the discussion (.283 p .005) in high PDI countries; (H4) interactions were initiated by debriefers in high PDI countries (.238, p .022); (H5) the debriefing content in high PDI countries conveyed more technical rather than non-technical knowledge (-.374 p .000); (H6) speaking up (.354 p .002), closed loop communication (.507 p .000), system challenges (.381 p .001) and situational awareness (.247 p .028) were significantly more difficult to discuss in high PDI settings.

Qualitative Analysis: Participants were asked 1) to explain why certain non-technical skills were more difficult to discuss and 2) what other culture-relevant debriefing aspects they would like to elaborate on. Responses ranged from a few words to paragraphs and were analyzed qualitatively using content thematic analysis. Meaning unites were defined and categorized and two domains were identified; “Hierarchy Rules (n)” and “Culture Rules (v)” . Within these domains, various themes and subthemes emerged. Multiple relationships and subtle nuances were revealed amongst these themes/subthemes and the original domains such as professional hierarchy and expectations of knowledge and gender imbalance; communication barriers and willingness to volunteer lack of knowledge and, fear of judgment from peers and colleagues. 

Poster
non-peer-reviewed

A Focus on the Qualitative Aspects of Cultural Prototypes and Differences In Simulation Debriefing


Author Information

Zavi Lakissian Corresponding Author

Pediatrics and Adolescent Medicine, American University of Beirut Medical Center

Rana Sharara-Chami

Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center

Francis Ulmer

Department of Pediatrics, Insel University Hospital Berne

Martin Stocker

Department of Pediatrics, Kantonsspital Luzern

Ella Scott

Pediatrics, Sidra Medical and Research Center

Peter Dieckmann

Center for Human Resources, Copenhagen Academy for Medical Education and Simulation (Cames)


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