The theory of activity theory
The practice of activity theory
Formulating research questions
Selecting a methodology
We selected the three medical schools based on suggestions of nine medical education experts with ample international experience, who named medical schools that met our criterion of a school in a non-Western setting where PBL had been a substantial teaching method for over five years. An East Asian and a Middle Eastern school were selected from these suggestions and found willing to participate. The Western European school was selected for pragmatic reasons, but met the criterion of using PBL as a substantial teaching method for over 5 years. The Western European and Middle Eastern school had used PBL since their foundation, while the East Asian school had implemented PBL as part of an overall curriculum reform aimed at moving from a teacher-centred to a student-centred curriculum. The reform resulted in a hybrid curriculum that was partly lecture-based and partly PBL
We employed purposive sampling to select interview participants. Male and female students, students from different PBL groups, and students born and raised in the local setting were included. We also included a number of students who had lived and attended school in another country for some time, which we expected to yield richer comparative and multi-voiced information. We included approximately equal numbers of students from the first and the third year to detect differences or transformation. We included tutors from the first and third year with different disciplinary backgrounds. Key staff involved in PBL, such as deans, directors of medical education departments and PBL coordinators, were selected through snowball sampling. Recruitment continued until saturation was achieved. We randomly selected tutorials in the first and third year for our non-participatory observations. In total, 88 interviews and 32 observations were conducted across the cases: 9, 10 and 9 first-year students, 10, 9 and 9 third-year students, 6, 6, and 5 tutors, and 5, 5, and 5 key persons were interviewed in the Middle Eastern, East Asian and Western European case, respectively. Five, 6 and 8 first-year tutorials, and 5, 6 and 2 third-year tutorials, respectively, were observed
Externalization: how students shaped PBL across three cultural contexts
Differences in students’ cultural backgrounds were found to shape group discussions and self-directed learning processes in PBL differently across the three cases. In the Middle Eastern context in particular, students expressed uncertainty and a focus on tradition, which influenced PBL group discussions as students felt anxious to speak up and ask questions. Also, they developed uncertainty-reducing strategies for the self-directed learning element of PBL. In the Middle Eastern and East Asian contexts a strong focus on group relations and face was identified, which impacted on the group discussions as students needed time to establish group relations before feeling comfortable to participate. They were very conscious of maintaining their own and others’ face in front of the group, which influenced discussion dynamics. Acting based on hierarchical relations was another factor of influence in both non-Western contexts in particular. Students preferred to let the tutor speak up, as a source of knowledge and a higher status person, and self-directed learning occurred only to the extent that professors did not cover knowledge, as a higher source of knowledge compared with students’ self-study. In the three contexts, students expressed a strong drive for achievement and competition, though this was least expressed in the Western European context. In the three contexts alike, however, this resulted in decreasing attention to group discussions and self-directed learning if other curriculum aspects were more important for exams and grading, increasing attention if students’ participation substantially counted for grading, and a potential reluctance to share information. Although cultural factors were the study’s main focus, many institutional, organizational, curricular, economic and historical factors were found to mediate the activity of PBL. The shape of PBL in relation to cultural factors was therefore not as straightforward as the above description may suggest. The assessment system, the scope of PBL implementation in the curriculum, the nature of students’ secondary school education, the language of instruction, personality differences between students, and differences between tutors were of major influence on how group discussions and self-directed learning in PBL were shaped
Internalization: how PBL shaped students across three cultural contexts
Besides influencing PBL processes, these cultural and other contextual factors also mediated how students were shaped by PBL. Different degrees between the three contexts were found in the development of students’ discussion skills and self-directed learning skills. The hybrid PBL implementation in the East Asian case, for example, implied that students gained a substantial part of their knowledge through lectures, which inhibited the development of self-directed learning skills. Communication skills, however, were encouraged in the East Asian case by students’ focus on achievement and competition coupled with the fact that students were graded for their participation in the PBL sessions. In the Middle Eastern case, students expressed a high level of initial anxiety about PBL, due to cultural factors and the traditional nature of their secondary school education, but they experienced a substantial development of self-directed learning and communication skills because the full scope of the PBL implementation virtually left them no choice. In the Western European case, students expressed lower levels of initial anxiety and few problems with building self-directed learning and communication skills in PBL, due to supportive secondary schooling and cultural factors, but consequently this development was less substantial compared with the gap that Middle Eastern students bridged. Despite these differences, however, PBL was found to gradually shape students across the contexts in a similar direction. Students across the cases were found to build up confidence and comfortableness to participate in group discussions by speaking up, asking questions to peers and tutors, criticizing knowledge and challenging the statements of others. Also, they were found to develop motivation for self-directed learning, an understanding of its purpose, and skills related to searching and finding information, and constructing knowledge
In sum, we found that a complex interaction between PBL, students, their cultural backgrounds and other contextual factors determined differences and similarities in the way PBL processes and students were shaped across three cultural contexts. We concluded that, although cultural factors might pose more challenges to applying PBL in non-Western settings, PBL seemed feasible in different cultural contexts. By definition, however, across these contexts PBL processes and outcomes differ according to locally specific, continuously changing activity system dynamics
Reflections on using activity theory to study cultural complexity
Activity theory seems a useful framework for (cross-)cultural research that matches current views on culture as a dynamic process situated in a social context.
The structure of the activity system can serve as an organizing principle to grasp cultural complexity in a way that values this complexity, rather than to dismiss it as ‘noise’.
Activity theory’s focus on contradictions is a strength as well as a potential limitation, because (cultural) processes that result from congruence might be ignored.
Activity theory is not a shortcut to capture (cultural) complexity: it is a challenge for researchers to determine boundaries for the activity they investigate and to analyze and interpret the dynamics of the activity system.