Challenges Experienced by Korean Medical Students and Tutors During Problem-Based Learning: A Cultural Perspective

Main Article Content

Hyunjung Ju
Ikseon Choi
Byoung Doo Rhee
Jong Tae-Lee


How people learn is influenced by the cultural contexts in which their learning occurs. This qualitative case study explored challenges Korean medical students and tutors experienced during their PBL sessions from a cultural perspective using Hofstede’s cultural dimensions. Twelve preclinical medical students and nine tutors from a large Korean medical school participated in interviews. The interview data were analyzed using the constant comparative method and classified according to Hofstede’s cultural dimensions. Twenty-two themes emerged within the following overarching categories: large power distance (6 themes), high uncertainty avoidance (6), individualism (3), collectivism (4), and masculinity/short-term orientation (3). This article discusses culturally responsive solutions with regard to each cultural dimension, which would help overcome these challenges and enhance the experiences of students and tutors with PBL.

Article Details



Aarnio, M., Lindblom-Ylanne, S., Nieminen, J., & Pyorala, E. (2013). Dealing with conflicts on knowledge in tutorial groups. Advances in Health Sciences Education, 18(2), 215–230.

Albanese, M. A., & Mitchell, S. (1993). Problem based learn- ing: A review of literature on its outcomes and implementation issues. Academic Medicine, 68(1), 52–81.

Anderson, K., Peterson, R., Tonkin, A., & Cleary, E. (2008). The assessment of student reasoning in the context of a clinically oriented PBL program. Medical Teacher, 30(8), 787–794.

Andrews, P. (2010). The importance of acknowledging the cultural dimension in mathematics teaching and learning research. Acta Didactica Napocensia, 3(2), 3–16.

Anfara, Jr., V. A., Brown, K. M., & Mangione, T. L. (2002). Qualitative analysis on stage: Making the research process more public. Educational Researcher, 31(7), 28–38.

Azer, S. A. (2001). Problem-based learning: Challenges, barriers and outcome issues. Saudi Medical Journal, 22(5), 389–397.

Azer, S. A. (2004). Becoming a student in PBL course: Twelve tips for successful group discussion. Medical Teacher, 26(1), 12–15.

Azer, S. A. (2005). Challenges facing PBL tutors: 12 tips for successful group facilitation. Medical Teacher, 27(8), 676– 681.

Barrows, H. S. (1985). How to design a problem-based curriculum for the preclinical years. New York, NY: Springer.

Barrows, H. S. (1994). Practice-based learning: Problem-based learning applied to medical education. Springfield: Southern Illinois University.

Barrows, H. S. (1996). Problem-based learning in medicine and beyond: A brief overview. New Directions for Teaching and Learning, 1996(68), 3–12.

Barrows, H. S., & Tamblyn, R. M. (1980). Problem-based learning: An approach to medical education. New York: Springer.

Boeije, H. (2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity, 36(4), 391–409.

Brukner, H., Altkorn, D. L., Cook, S., Quinn, M. T., & Mcnabb, W. L. (1999). Giving effective feedback to medical students: A workshop for faculty and house staff. Medical Teacher, 21(2), 161–165.

Carson, J. G., & Nelson, G. L. (1996). Chinese students’ perceptions of ESL peer response group interaction. Jour- nal of Second Language Writing, 5, 1–19.

Chang, B. H., Lee, Y. C., Kim, B. W., Kang, D. S., Kwak, Y. S., Kang, E., . . . Kim, H. J. (2001). The implementation of problem-based learning in Kyungpook National Univer- sity School of Medicine and its evaluation. Korean Journal of Medical Education, 13(1), 91–105.

Charlesworth, Z. M. (2008). Learning styles across cultures: Suggestions for educators. Education and Training, 50(2), 115–127.

Charmaz, K (2006). Constructing grounded theory: A practical guide through qualitative analysis. Thousand Oaks, CA: Sage. Chuang, S.-F. (2012). The relationship between cultural values and learning preference: The impact of accultura- tion experiences upon East Asians. International Journal of Training and Development, 16(1), 1–22.

Clark, T. (1990). International marketing and national character: A review and proposal for an integrative theory. Journal of Marketing, 54(4), 66–79.

Creswell, J. W. (2007). Qualitative inquiry and research design: Choosing among five traditions (2nd ed.). Thousand Oaks, CA: Sage.

Cronjé, J. C. (2011). Using Hofstede’s cultural dimensions to interpret cross-cultural blended teaching and learning. Computers & Education, 56(3), 596–603.

de Grave, W. S., Dolmans, D. H. J. M., & van der Vleuten, C. P. M. (2001). Student perceptions about the occurrence of critical incidents in tutorial groups. Medical Teacher, 23(1), 49– 54.

de Grave, W., Schmidt, H. G., & Boshuizen, H. P. A. (2001). Effects of problem-based discussion on studying a subsequent text: A randomized trial among first year medical students. Instructional Science, 29(1), 33–44.

Ende, J. (1983). Feedback in clinical medical education. JAMA: The Journal of the American Medical Association, 250(6), 777–781.

Frambach, J. M., Driessen, E. W., Chan, L.-C., & van der Vleuten, C. P. M. (2012). Rethinking the globalisation of problem-based learning: How culture challenges self-directed learning. Medical Education, 46(8), 738–747.

Glaser, B. G., & Strauss, A. L. (1967). The constant comparative method of qualitative analysis. In B. G. Glaser & A. L. Strauss, The discovery of grounded theory: Strategies for qualitative research (pp. 101–115). Hawthorne, NY: Aldine Publishing Company.

Glew, R. H. (2003). Problem-based learning: The problem with problem-based medical education. Biochemistry and Molecular Biology Education, 31(1), 52–56.

Gwee, M. C. (2008). Globalization of problem-based learning (PBL): Cross-cultural implications. Kaohsiung Journal of Medical Science, 24(3), S14–S22.

Hall, M., de Jong, M., & Steehouder, M. (2004). Cultural differences and usability evaluation: Individualistic and collectivistic participants compared. Technical Communi- cation, 51(4), 489–503.

Hewson, M., & Little, M. (1998). Giving feedback in medical education: Verification of recommended techniques. Journal of General Internal Medicine, 13(2), 111–116.

Hmelo-Silver, C. E., & Barrows, H. S. (2008). Facilitating collaborative knowledge building. Cognition and Instruction, 26, 48–94.

Hofer, B. K. (2004). Epistemological understanding as a metacognitive process: Thinking aloud during online searching, Educational Psychologist, 39(1), 43–55,

Hofstede, G. (1986). Cultural differences in teaching and learning. International Journal of Intercultural Relations, 10(3), 301–320. 90015-5

Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, Institutions, and organizations across nations (2nd ed.). Thousand Oaks, CA: Sage.

Hofstede, G., Hofstede, G. J., & Minkov, M. (2010). Cultures and organizations: Software of the mind: Intercultural cooperation and its importance for survival (3rd ed.). New York: McGraw-Hill.

Houlden, R. L., Collier, C. P., Frid, P. J., John, S. L., & Pross, H. (2001). Problems identified by tutors in a hybrid problem-based learning curriculum. Academic Medicine, 76(1), 81.

Hung, W. (2006). The 3C3R model: A conceptual framework for designing problems in PBL. The Interdisciplinary Journal of Problem-based Learning, 1(1), 55–77.

Hung, W. (2011). Theory to reality: A few issues in implementing problem-based learning. Educational Technology Research and Development, 59(4), 529–552.

Hung, W., Bailey, J. H., & Jonassen, D. H. (2003). Exploring the tensions of problem-based learning: Insights from research. New Directions for Teaching and Learning, 2003(95), 13–23.

Hussain, R. M. R., Mamat, W. H. W., Salleh, N., Saat, R. M., & Harland, T. (2007). Problem-based learning in Asian universities. Studies in Higher Education, 32(6), 761–772.

Jehng, J., Johnson, S. D., & Anderson, R. C. (1993). Schooling and students’ epistemological beliefs about learning. Con- temporary Educational Psychology, 18(1), 23–25.

Johnson, D., Johnson, R., & Smith, K. (2007). The state of cooperative learning in postsecondary and professional settings. Educational Psychology Review, 19(1), 15–29.

Kaufman, D. M., & Holmes, D. (1996). Tutoring in problem-based learning: Perceptions of teachers and students. Medical Education, 30(5), 371–377.

Khoo, H. E. (2003). Implementation of problem-based learning in Asian medical schools and students’ perceptions of their experience. Medical Education, 37(5), 401–409.

Kim, J., Son, H., Choi, Y., Hong, K., Ahn, B., Uhm, D., Chin, Y., . . . Seo, J. (2004). A qualitative evaluation of problem-based learning curriculum by students’ perceptions. Korean Journal of Medical Education, 16(2), 179–193.

Kindler, P., Grant, C., Kulla, S., Poole, G., & Godolphin, W. (2009). Difficult incidents and tutor interventions in problem-based learning tutorials. Medical Education, 43(9), 866–873.

Kitchener, K. S. (1983). Cognition, metacognition, and epistemic cognition: A three-level model of cognitive processing. Human Development, 26(4), 222–232.

Lim, W. (2012). Dysfunctional problem-based learning curricula: Resolving the problem. BMC Medical Education, 12(89), 1–7.

Merriam, S. B. (1998). Qualitative research and case study applications in education (2nd ed.). San Francisco: Jossey-Bass.

Moust, J. H. C., van Berkel, H. J. M., & Schmidt, H. G. (2005). Signs of erosion: Reflections on three decades of problem-based learning at Maastricht University. Higher Education, 50(4), 665–683.

Nendaz, M. R., & Tekian, A. (1999). Assessment in problem-based learning medical schools: A literature review. Teaching & Learning in Medicine, 11(4), 232–243.

Neville, A. J. (2009). Problem-based learning and medical education forty years on: A review of its effects on knowledge and clinical performance. Medical Principles and Practice, 18(1), 1–9.

Nieminen, J., Sauri, P., & Lonka, K. (2006). On the relationship between group functioning and study success in problem-based learning. Medical Education, 40(1), 64–71.

Park, C. S. (2002). Crosscultural differences in learning styles of secondary English learners. Bilingual Research Journal, 26(2), 213–229.

Parrish, P., & Linder-VanBerschot, J. A. (2010). Cultural dimensions of learning: Addressing the challenges of multicultural instruction. International Review of Research in Open and Distance Learning, 11(2), 1–19.

Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage Publications. Phuong-Mai, N., Terlouw, C., & Pilot, A. (2005). Cooperative learning vs Confucian heritage culture’s collectivism: Confrontation to reveal some cultural conflicts and mis-match. Asia Europe Journal, 3(3), 403–419.

Ragin, C. (1987). The comparative method: Moving beyond qualitative and quantitative strategies. Berkeley: University of California Press.

Savery, J. R., (2006). Overview of problem-based learning: Definitions and distinctions. Interdisciplinary Journal of Problem-Based Learning, 1(1), 9–20.

Savery, J. R., & Duffy, T. M. (1995). Problem based learning: An instructional model and its constructivist framework. Educational Technology, 35(5), 31–38.

Schoenfeld, A. H. (1998). Toward a theory of teaching-in-context. Issues in Education, 4(1), 1–94.

Schommer, M. (1990). Effects of beliefs about the nature of knowledge on comprehension. Journal of Educational Psychology, 82, 498–504.

Schommer, M. (1994). An emerging conceptualization of epistemological beliefs and their role in learning. In R. Garner & P. Alexander (Eds.), Beliefs about text and about text instruction (pp. 25–40). Hillsdale, NJ: Erlbaum.

Schwartz, S. (1994). Beyond individualism/collectivism: New cultural dimensions of values. In U. Kim, H. Trian- dis, Ç. Kagitçibasi, S. Choi, & G. Yoon (Eds.), Individualism and collectivism: Theory, method and applications (pp. 85–115). Newbury Park, CA: Sage.

Servant, V.(2013).The many roads to problem-based learning: A cross-disciplinary overview of PBL in Asian Institutions. In K. Mohd-Yusof, M. Arsat, M. T. Borhan, E. de Graaff, A. Kolmos, & F. A. Phang (Eds.), PBL across cultures (pp. 395–404). Aalborg, Denmark: Aalborg University Press.

Skinner, V., Braunack-Mayer, A., & Winning, T. (2015). The purpose and value for students of PBL groups for learning. Interdisciplinary Journal of Problem-Based Learning, 9(1), 19–32.

Soares, A. M., Farhangmehr, M., & Shoham, A. (2007). Hofstede’s dimensions of culture in international marketing studies. Journal of Business Research, 60(3), 277–284.

Springer, L., Stanne, M.E., & Donovan, S. S. (1999). Effects of small-group learning on undergraduates in science, mathematics, engineering, and technology: A meta-analysis. Review of Educational Research, 69(1), 21–51.

Strauss, A., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. London: Sage. Strijbos, J. W. (2000). A classification model for group-based learning. European Journal of Open, Distance and E-Learning. Retrieved from

Tsou, K., Cho, S., Lin, C., Sy, L. B., Yang, L., Chou, T., & Chiang, H. (2009). Short-term outcomes of a near-full PBL curriculum in a new Taiwan medical school. Kaohsiung Journal of Medical Sciences, 25(5), 282–293.

Valle, R., Petra, L., Martínez-González, A., Rojas-Ramirez, J., Morales-Lopez, S., & Piña-Garza, B. (1999). Assessment of student performance in problem-based learning tutorial sessions. Medical Education, 33(11), 818–822.

van Rijn, H., Bahk, Y., Stappers, P., & Lee, K. (2006). Three factors for context mapping in East Asia: Trust, control and nunchi. CoDesign, 2(3), 157–177.

Ward, J. D., & Lee, C. L. (2002). A review of problem-based learning. Journal of Family and Consumer Science Education, 20(1), 16–26.

Yin, R. K. (2008). Case study research: Design and methods (4th ed.). Thousand Oaks, CA: Sage.

Yoo, B., Donthu, N., & Lenartowicz, T. (2011). Measuring Hofstede’s five dimensions of cultural values at the individual level: Development and validation of CVSCALE. Journal of International Consumer Marketing, 23(3/4), 193–210.

Zhang, J. (2007). A cultural look at information and communication technologies in Eastern education. Educational Technology Research and Development, 55(3). 301–314.

Zhang, J. (2010). Technology-supported learning innovation in cultural contexts. Educational Technology Research and Development, 58(2), 229–243.