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Taiwanese medical students’ narratives of intercultural professionalism dilemmas: exploring tensions between Western medicine and Taiwanese culture

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Abstract

In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas. Noting the prominence of culture in students’ narratives, we explored this theme further using secondary analysis, identifying tensions between Western medicine and Taiwanese culture and categorizing students’ intercultural professionalism dilemmas according to Friedman and Berthoin Antal’s ‘intercultural competence’ framework: involving combinations of advocacy (i.e., championing one’s own culture) and inquiry (i.e., exploring one’s own and others’ cultures). One or more intercultural dilemmas were identified in nearly half of students’ professionalism dilemma narratives. Qualitative themes included: family relations, local policy, end-of-life care, traditional medicine, gender relations and Taiwanese language. Of the 62 narratives with sufficient detail for further analysis, the majority demonstrated the ‘suboptimal’ low advocacy/low inquiry approach (i.e., withdrawal or inaction), while very few demonstrated the ‘ideal’ high advocacy/high inquiry approach (i.e., generating mutual understanding, so ‘intercultural competence’). Though nearly half of students’ professionalism narratives concerned intercultural dilemmas, most narratives represented disengagement from intercultural dilemmas, highlighting a possible need for more attention on intercultural competence training in Taiwan. The advocacy/inquiry framework may help educators to address similar disconnects between Western medicine and non-Western cultures in other contexts.

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Acknowledgements

The authors wish to thank Yuting Chiu for assistance in data analysis and Christopher Merchant and Andrew Chen for their useful comments on previous drafts.

Funding

This work was funded by the Association for Medical Education in Europe and the Ministry of Science and Technology, Taiwan.

Authors’ contribution

MJH, CER, MC, and LVM developed the study and contributed to data collection. All authors participated in the analysis and interpretation of data. KG wrote the first draft of this article, while CER revised the article significantly after thorough peer-review feedback. The final version was edited and approved for publication by all authors and agree to be accountable for all aspects of the work.

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    Authors and Affiliations

    1. Department of Medical Education & Bioethics, National Taiwan University College of Medicine, Taipei, Taiwan

      Ming-Jung Ho & Katherine Gosselin

    2. Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka

      Madawa Chandratilake

    3. Chang Gung Medical Education Research Center (CG-MERC), Chang Gung Memorial Hospital, Linkou, Chang Gung Medical Foundation, 5. Fu-Hsing St., Kuei Shan Dist., Taoyuan City, 333, Taiwan, ROC

      Lynn V. Monrouxe

    4. Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia

      Charlotte E. Rees

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    1. Ming-Jung Ho
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    Correspondence to Lynn V. Monrouxe.

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    This study was approved by the institutional review board of the hospital affiliated with the Taiwanese university where the study was conducted.

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    Ming-Jung Ho and Katherine Gosselin contributed equally to this work.

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    Ho, MJ., Gosselin, K., Chandratilake, M. et al. Taiwanese medical students’ narratives of intercultural professionalism dilemmas: exploring tensions between Western medicine and Taiwanese culture. Adv in Health Sci Educ 22, 429–445 (2017). https://doi.org/10.1007/s10459-016-9738-x

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    • DOI: https://doi.org/10.1007/s10459-016-9738-x

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