Anesthesia in Thailand and Canada: A comparative case study of two residency training programs.

摘要

Medicine is characterized by a tension between its universalistic principles and its local sociocultural interpretations. Recent international developments in medicine have stressed the former while neglecting the latter. To examine these issues, an anesthesia residency training program in Thailand was compared with a similar one in Canada. The purpose of this comparative case study was to understand how culture influences medical education and to differentiate the universal from the socio-cultural aspects of medicine.Differences in the two sites' educational and medical practice profiles were linked to their respective demographic, socio-economic, historical and geopolitical contexts. Universal aspects of anesthesia education included the definition of anesthesia as a medical specialty, the characteristics of good anesthesiologists and anesthetic care, and the stresses associated with being an anesthesia teacher. However, culture was found to exert a strong influence on the balance between knowledge and clinical practice, the teacher-learner relationship, pedagogy, and the relationships between the individual and the team. These differences were examined using the critical theorist, interpretivist and postpositivist paradigms. Within the interpretivist paradigm, Hofstede's framework of national culture was applied to the findings. This study showed that medicine is not only a universal science---it is also a product of its historical and socio-cultural soil. It is critical to understand both the universal and socio-cultural aspects of medicine as a basis for effective and equitable international and cross-cultural medical collaboration.This study used a multiple (comparative) case study approach, incorporating mixed methods within a dialectic stance paradigmatic framework. This stance engages in a multiplicity of worldviews in order to understand the full complexity of the research phenomena. One anesthesia residency training program in Thailand was compared with a similar one in Canada, with respect to demography, curriculum, teaching, evaluation and clinical practice as well as values in anesthesia education, through document analysis, observational studies, interviews and surveys. Specifically, each program's values regarding the characteristics of a good anesthesia teacher, learner and clinician were examined. In the analysis, qualitative and quantitative data were integrated and interpreted in light of the national and cultural contexts of each residency training program.