Medical Teacher
ISSN: 0142-159X (Print) 1466-187X (Online) Journal homepage: http://www.tandfonline.com/loi/imte20
Twelve tips for promoting learning during
presentations in cross cultural settings
Takuya Saiki, Linda Snell & Farhan Bhanji
To cite this article: Takuya Saiki, Linda Snell & Farhan Bhanji (2017): Twelve tips for
promoting learning during presentations in cross cultural settings, Medical Teacher, DOI:
10.1080/0142159X.2017.1288860
To link to this article: http://dx.doi.org/10.1080/0142159X.2017.1288860
Published online: 13 Feb 2017.
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Date: 03 March 2017, At: 01:56
MEDICAL TEACHER, 2017
http://dx.doi.org/10.1080/0142159X.2017.1288860
TWELVE TIPS
Twelve tips for promoting learning during presentations in cross cultural
settings
Takuya Saikia,b, Linda Snella,b and Farhan Bhanjia,b
a
Medical Education Development Centre, Gifu University, Gifu, Japan; bCentre for Medical Education, McGill University, Montreal,
Quebec, Canada
ABSTRACT
Educators frequently learn together in cross cultural settings such as at international conferences. Cultural differences should
influence how educational programs are designed and delivered to effectively support learning; cultural sensitivity and the
competence to deal with such differences are important skills for health professions educators. Teaching without this
approach may lead to lost learning opportunities. This article provides twelve tips for educators to consider when planning
and delivering formal presentations (e.g. lectures and workshops) in cross cultural settings. The tips were constructed based
on a literature review, the authors’ experience, and interviews with international educators who frequently deliver and
receive education in cross cultural settings. The tips are divided into three phases: (1) preparation for the session to optimize
learners’ experience (2) interaction when delivering the session and (3) reflection on the experience.
Case scenario: You have been invited to give a formal
presentation (e.g. lecture, workshop, or symposium) in another
country, in a language that is not the first language of the
audience. What should you think about when preparing this
session, particularly related to presenting to an audience with a
different culture and first language?
Internationalization is an important force in twenty-first
century higher education, including that of health professionals. Factors leading to the internationalization of medical education include the globalization of health care
delivery, the perceived need among education leaders to
exchange views related to developments in medical education and the need for a common vocabulary (Harden 2006).
Globalization should not simply be considered as a way
towards standardization (or convergence) across countries
but as a means of divergence to respect and preserve cultural diversity; this requires intercultural communicative
competence (Byram 2012).
Many health professions educators provide formal teaching activities such as lectures or workshops for an audience
from different cultures, and will need to interact with these
participants effectively in a culturally appropriate manner.
Medical education conferences are becoming increasingly
international—for instance the annual conference of the
Association for Medical Education in Europe (AMEE) draws
3400 participants from nearly 100 countries, speaking a
multitude of first languages (AMEE 2015). As well, many
medical educators are invited to give formal presentations
in countries to an audience whose first language (and culture) is not that of the speaker. While for the most part
English has become the language of communication within
many international groups of scholars, allowing communication to occur without the added burden of real time
CONTACT Takuya Saiki
[email protected]
translation, there remains a challenge to effective communication and common understanding when presenting to
diverse audiences (Maher 1986). Cognitive psychology
would postulate that, even when people change the language they speak, their perceptions, and way of thinking
are still based in their own cultural context and cannot be
fully converted from one language to another (Nisbet
2003). Without understanding these issues, teachers are
unlikely to optimize learning for the participants.
Understanding cultural differences may broaden international medical teachers’ views on the effective delivery of
lectures and workshops, yet few educators use more than
personal experience and anecdotes in preparing and delivering these sessions. Valuable resources on delivering lectures and workshop development have been published in
the medical education literature (Steinert 1992; Steinert &
Snell 1999), yet specific attention has not been paid to
teaching in cross cultural settings. We define cross cultural
to mean “relating to or involving two or more different
cultures” (Dictionary and ThesaurusjMerriam-Webster online
dictionary 2016). Resources on teaching cultural safety in
clinical care have similarly not addressed teaching health
professions colleagues in a culturally appropriate manner
(Razack et al. 2011). The aim of this article is to provide
guidance to teachers who provide lectures, workshops or
other presentations in international, cross cultural settings.
The twelve tips presented here (see Table 1) are based on
the authors’ experiences (including dramatic “failures”
when not considering these culturally important issues)
along with interviews of diverse stakeholders in cross cultural education. These stakeholders included both experts
who deliver education sessions as well as learners who
have experienced the sessions.
Medical Education Development Centre, Gifu University, Gifu, Japan
ß 2017 Informa UK Limited, trading as Taylor & Francis Group
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T. SAIKI ET AL.
Table 1. Tips for promoting learning during cross cultural presentations.
Phase
Preparation phase
Interaction phase
Reflection phase
Tip
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
Perform a “cultural” needs-assessment as part of your general needs assessment
Create comprehensive materials
Use teaching materials as advanced organizers for learning
Ensure technological compatibility between your electronic devices and the host’s system before the session
Provide an outline with the relevant “ground rules” for the session
Use translation effectively
Contextualize your presentation
Respect the local culture and always maintain a professional demeanor
Be flexible and willing to adapt during the session
Leave time after the session to speak to participants
Debrief the session with the host and where possible, some audience members
Enjoy the experience and the opportunity to immerse in another culture
Tips
Preparation phase
Tip 1
Perform a “cultural” needs-assessment as part of your
general needs assessment
When you have an opportunity to teach in a different cultural setting it is helpful to speak to the host to understand
some of the local educational customs. This would be in
addition to the usual needs assessment on the purpose of
the session, the background knowledge, skills, and attitudes
of the participants, the content to address, and the breadth
and depth of the material to be covered. Understanding
the local context from the host, and the differences from
your own, may help you to contextualize the session in
order to optimize learning from the session. Determining
the goals for the session, whether it is a “research oriented”
presentation or more of a “general overview” will help
determine the content and instructional design. Learning a
few simple phrases in the local language (e.g. hello, nice to
meet you, thank you) can demonstrate respect towards
your audience and help as an “ice breaker”. A simple internet search can provide you with a basic understanding of
the history and culture of the country you are going to and
can help you gain the most from the experience outside of
the presentation as well as during the teaching.
Recognizing the inherent hierarchies and power distances
(Hofstede & Hofstede 1997) in some cultures may help you
navigate discussions with your local hosts in order to work
collaboratively to develop sessions. “Visiting experts” are
rarely questioned in some cultures so it will take a conscious effort to gain the input from your local hosts.
Tip 2
Create comprehensive materials
The usual approach to “keep slides clean” and with limited
information may not hold true when teaching individuals
who are working in their second (or third … ) language.
Using complete phrases and avoiding abbreviations and
acronyms may aid participants’ understanding. Cognitive
psychology recognizes that working memory is limited in
capacity. It can however be enhanced by using both spoken language (the phonological/articulatory loop) and what
we see (the visuo-spatial sketchpad) working together
(Bruning et al. 2010) i.e. what you say and what you write
should be closely matched, so using “text rich” PowerPoint
slides (or other supplemental information) is valuable.
Translation of slides, or at least key concepts, can be
quite useful to the audience and should be built into the
planning timeline. The degree of translation needs to be
balanced against the potential for “busier” or more cluttered slides that may be harder to read. Even if translated
slides are not projected, printed versions can be distributed
to the audience. The amount of translated material will
depend on the linguistic proficiency of the audience and
should be part of the needs assessment with the host.
Even in circumstances where minimal translation is
required, it may be important to consider the different
ways things are stated (e.g. “registrar/resident”), the lack of
a specific terms in audience members’ native language (e.g.
“educational scholarship”) and the danger of using colloquial language (e.g. “toddler”) (Cantillon et al. 2009).
Simplifying language (e.g. avoiding the use of idioms, using
most common words rather than specialists’ hyponyms
(e.g. “red” rather than “crimson”), using simple rather than
phrasal verbs) will help audiences to understand the key
messages (Nation & Meara 2013). Usually the host faculty
can help you to detect such issues if you can provide materials ahead of time.
Tip 3
Use teaching materials as advanced organizers for
learning
While face-to-face interaction during your session will likely
be the highest yield learning activity, the ability to bring
everyone to a more common baseline understanding
through the dissemination of key literature or other
key documents should not be underestimated. By
“dissemination of information” we refer to the targeted distribution to the intended audience who will be participating in the session (Brown & Manogue 2001), allowing
learning to occur before you arrive. As well, for those who
cannot attend your session, these materials may stimulate
their personal learning.
Tip 4
Ensure technological compatibility between your
electronic devices and the host’s system before the
session
Your personal computer/laptop may not function with the
local projector or microphone, so having a back-up presentation on a memory drive or cloud system is very important. As well, local computers or projectors may not
MEDICAL TEACHER
recognize or function with your version of PowerPoint or
other presentation program. Video clips are the most likely
part of the presentation to fail; contingency plans need to
be made for the session if they do not work. Sending your
presentation to the host ahead of time allows them to test
the projection compatibility beforehand.
Interaction phase
Tip 5
Provide an outline with the relevant “ground rules”
for the session
Modern medical education is largely based on educational
approaches such as constructivism and collaborative learning. Yet there is variable penetration of these theories into
the educational design of teaching and learning from culture to culture. If your goal is to deliver a learner-centered
session with a large degree of interaction, discuss potential
interactive strategies with your host to assess audience
“readiness” and consider how best to optimize your educational goals. For instance, in some cultures it may be taken
for granted that participants could interrupt the speaker
when they have questions, while in others it would be considered particularly “rude” or unacceptable. Coupled with
perceived power differences between teachers and learners,
it may make it hard for participants or teachers to ask the
relevant and challenging questions that may further group
learning. Working with a local host may help you develop
creative solutions to facilitate your goals e.g. the use of
breakout or buzz groups (especially if you let individuals
work in their own language), requesting written questions
and providing cards or an electronic means for gathering
them, or “signposting” times for questions may help facilitate interactive discussion that may not be otherwise
possible.
Tip 6
Use translations effectively
Understanding the linguistic proficiency of the audience
using the host(s) perspective can help define when using
simultaneous translation is appropriate. Most sessions do
not have a budget for professional simultaneous translation
so using your host or one of their colleagues may be an
alternative. Literal translations of speech for each slide or
activity may be cumbersome and disrupt the flow of the
session so should only be used in “extreme” situations
where the language gap between presenter and audience
is very large. A more rational approach may be to summarize key concepts periodically and pause for clarifying
questions—in the native language if necessary. Recognizing
that language proficiency skills will be differ among reading, writing, oral comprehension and speech, the ability to
stay in one’s own language when asking questions may be
empowering to some participants, who can understand the
presentation but do not proficiently speak the language
(particularly in front of a large group of colleagues).
Sending your slides and workshop material ahead of time
will help the host or translator become familiar with your
3
content/terminology and provide a more accurate and concise interpretation of your ideas.
Tip 7
Contextualize your presentation
It is difficult to notice how our own assumptions affect
how we interact with the world, including how we teach.
Some of the greatest challenges to our assumptions come
from preparing and delivering educational programs and
working with people from different backgrounds or cultures. Understanding the local context can be particularly
helpful to customize your presentations so that they are
relevant to the local audience. Many lectures and workshops challenge participants not only to listen but also to
take what they have learned and apply it in their local context. Providing concrete examples of how this might be
accomplished using the local environment, understanding
the resources and culture of education practice can be particularly useful. As an extreme example, promoting the use
of a pure PBL curriculum in the context of a resource limited, 700 student per year medical school class with a faculty to student ratio less than one quarter of your own
may not be well received as a change initiative. Similarly
promoting debriefing strategies for simulation based education that work in western society (where smaller power
distances and individualist orientation allow identification
of “errors” and open discussion in a facilitated debriefing)
may not be as easily incorporated in far east cultures where
collectivism predominates (where the “disgraces” of other
team members, particularly respected senior colleagues
may not allow the same type of facilitated team debriefing
to occur).
Additionally, care should be applied when using humor
or jokes in cross cultural presentations. Context is very
important in humor—some seemingly harmless jokes may
have very negative connotations in another culture and
have the unintended consequence of offending the hosts.
Text rich jokes may be difficult to read and comprehend in
a short time interval, leading to frustration in the participant. Generally we would recommend omitting jokes from
presentations in this context, or at least checking these
jokes with the local host to ensure they are appropriate.
Tip 8
Respect the local culture and always maintain a
professional demeanor
Presenting to colleagues in a new culture is a wonderful
experience that should be enjoyed. Anticipating some of
the challenges may help avoid minor frustrations. For
example you may feel as if your audience is not listening
or paying attention. In some cultures people close their
eyes to help them concentrate—it does not mean they are
inattentive or asleep! A little patience may go a long way—
slow down and make sure your intended message is understood. Focusing on “key points” may serve you more than
trying to cover large amounts of material: you may need to
sacrifice content for clarity. Non-verbal communication is
critical: make sure your facial expressions, gestures and
body language aligns with the positive message you wish
4
T. SAIKI ET AL.
to convey, not that of someone who is rushed or
frustrated.
Tip 9
Be flexible and willing to adapt during the session
Recognize that even with the best of intentions and preparation, you still need to be flexible during the session and
you may need to expand your creativity and teaching skills
beyond what you use in your daily teaching activities.
Focus on how you can encourage participation and
interaction. For example, in Japan an audience member
speaking out in a large lecture or raising a hand would be
quite difficult, but participation through an anonymous
audience response system is more acceptable. Rather than
asking individual audience members to speak, consider
using breakout or buzz groups where the spokesperson
reports back a group consensus rather than individual
ideas.
Reflection phase
Tip 12
Enjoy the experience and the opportunity to immerse
in another culture
The opportunity to present and dialog with colleagues of
another culture can be enriching and allow for personal
and professional growth. Understanding the history of education and cultural norms can help you gain insight into
the educational context. Rather than simply focusing on
“what’s better” or “what’s different” between cultures, a
more reflective approach can use the educational and cultural differences to create culturally relevant presentations.
Immersion in a new culture (or deeper immersion into
one you already know) is a privilege. The professional and
personal relationships that you build are truly remarkable
and can accelerate your understanding of the culture you
are visiting. Take the time to enjoy the environment, to see
something that is new to you, to try a new food, to speak
to someone and find out what it means to be from the
country you are visiting. Allow yourself to reflect on the
customs and traditions and to determine what you might
want to bring into your own life when you return home.
Tip 10
Conclusions
Leave time after the session to speak to participants
These practical twelve tips provide a model for educators
to plan and deliver teaching sessions in cross-cultural settings. These tips will enhance educators’ presentation skills,
develop their intercultural competence, and lead to
improved learning and cross-cultural exchange.
Plan ahead with your host to determine the amount of
time you should allow for questions at the end of your
session. It may also be helpful to have “informal” time
after the session available for discussion and interaction
with the audience members. This may allow the opportunity for individuals with weaker language skills, or those
who may be shy or modest for personal or cultural reasons, to ask their questions and discuss key issues. It may
be hard for non-native English speaking audience members to ask questions in a large group. The informal (and
often social) post-session discussions can help facilitate
their questions and encourage dialog about the presentation. It is often at this time where you learn more about
the local context (and the contrasts with your own) as
well as to learn about the culture and history from a
local’s perspective.
Tip 11
Debrief the session with the host and, where possible,
some audience members
Reflecting on the strengths and weaknesses of the session
will allow you to improve future sessions. Using the external (and perhaps more objective) lens of the host can be
valuable if there is a trusting, safe relationship where (s)he
can provide constructive feedback. This debriefing activity
needs to be bidirectional allowing for feedback from yourself to the hosts so that they can support future sessions
when you may not be present. Select members of the audience can also provide feedback, either informally or
through a program evaluation or survey. These discussions
and the survey results can help focus your attention on the
elements which you felt to be most relevant (e.g. did your
session design allow audience members to participate
meaningfully?)
Disclosure statement
The authors report no conflicts of interests. The authors
alone are responsible for all of the content of the article.
Notes on contributors
Takuya Saiki, MD MPHE PhD is an associate professor of
the Medical Education Development Center, Gifu University.
Farhan Bhanji, MD MSc(Ed) FRCPC is a professor of Center
for Medical Education and Department of Pediatrics at
McGill University. He is the Associate Director of
Assessment and a CanMEDS Clinician Educator at the Royal
College of Physicians and Surgeons of Canada.
Linda Snell, MD MHPE FRCPC MACP is a professor of
Medicine and core faculty member at the Center for
Medical Education at McGill University, and senior Clinician
Educator at the Royal College of Physicians and Surgeons
of Canada.
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