Culture, Pedagogy and Assessment:
A View from the Bridge
STEWART MENNIN
Dedicated to the memory of
Miriam Friedman Ben-David
© 2010, Stewart Mennin
Ottawa 2010
© 2010, Stewart Mennin
Ottawa 2010
© 2010, Stewart Mennin
Ottawa 2010
© 2010, Stewart Mennin
Ottawa 2010
Miriam Friedman Ben-David
© 2010, Stewart Mennin
Ottawa 2010
© 2010, Stewart Mennin
Ottawa 2010
Paulo Freire – Pedagogy of the Oppressed
© 2010, Stewart Mennin
Ottawa 2010
Culture is a Collective Point of View
Mennin, 1997
© 2010, Stewart Mennin
Ottawa 2010
Culture, Pedagogy, & Assessment:
A View From the Bridge
 Culture
 East West, North South
 Med Ed Export - Import
 Reacculturation & Learning
 Relationship-centered
care/teaching
 Thank you
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© 2010, Stewart Mennin
Regina Petroni Mennin
Ruy Souza
Ottawa 2010
Definitions of Culture
 Horticulture, agriculture (18th-19th centuries)
 High culture –that which is excellent in art, manners
 Anthropology – non genetic phenomena
 Symbolic communication of experiences
 A period in civilization
 Shared attitude, values, goals, & practices
characteristic of a group or organization
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Language, art, customs, clothing, stories & myths, ritual,
objects
Cohesion, viscosity
© 2010, Stewart Mennin
Ottawa 2010
Context : What Surrounds US
Cole, 1996
11
Context: What Weaves Us Together
Cole, 1996
12
West - East
West
The Individual
© 2010, Stewart Mennin
East
The Group
Ottawa 2010
Cultural Competence
 Ability to interact
effectively with people of
different cultures
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© 2010, Stewart Mennin
Awareness of one’s own
culture & world view
Attitudes towards cultural
differences
Knowledge of different
cultural practices &
worldviews
Tolerance
Difference as a source of
learning
Ottawa 2010
Culture Is Us
A Challenge to the Culture of Health Care in the US
“…what is clear to me is
that we cannot fix the
problem by adding 32
million people to the
mix and not changing
the way we deliver
care."
President of the Premier Healthcare Alliance
Coalition of 2300 not-for-profit hospitals
© 2010, Stewart Mennin
Ottawa 2010
Collaborative Health Care:
Learning from Others
 32 million new patients
 Shortage of 40,000
physicians
 Learning from others
 Bangladesh
 Physician assistants
 Nurse practitioners
 Community health
workers - Latin America, Africa
 Early work experience
© 2010, Stewart Mennin
Ottawa 2010
Creativity is More With Less
 Access to information,
patients
 Learning as social
process
 Humanization
© 2010, Stewart Mennin
Ottawa 2010
Learning From Experience
Dewey defined
education as a
reconstruction &
reorganization of
experience, which
increases our ability
to direct the course
of subsequent
experience
© 2010, Stewart Mennin
Ottawa 2010
Exporting Western Medical Education to
Resource Challenged Countries: Risks & Issues
 Problem-based learning
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Culture of teacher’s
authority
Teacher skills
Tyranny of grades
Deep – Surface learning
 OSCE
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Standardized patients
 Skills labs
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© 2010, Stewart Mennin
Real patients
Ottawa 2010
Learning From Diversity (others)
 Increases capacity to
adapt & learn
 Awareness, attitudes,
knowledge, skills
 Difference is essential for
life
© 2010, Stewart Mennin
Ottawa 2010
Liberating Constraints, Culture, Pedagogy,
Assessment
21
Learning From the East & South
 HIV strategy
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Brazil
 Community health workers
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Latin America, Africa
 Humanization
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Brazil
 Permanent education for
health
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© 2010, Stewart Mennin
Brazil
Ottawa 2010
Permanent Education for Health:
More than CME (Brazil)
Workplace, practice & assessment
 1. What constitutes quality for us & for our patients?
 2. What problems do we have achieving the patterns
of quality? (includes data from patients, evaluation
projects, outcome analysis, group experiences, etc.)
 3. What is going on? How are things working?
Otero & Mennin, 2010
© 2010, Stewart Mennin
Ottawa 2010
Permanent Education for Health:
More than CME (Brazil)
 4. Whose problem is it? Who is involved & who must
be present (including colleagues from other
units/services (labs, imaging, etc.)?
 5. What do we need to know to understand the
problem? What explicative framework can we
construct?
 6. What are the necessary interventions (educational
and other) to move from we are now to where we
need to be?
Otero & Mennin, 2010
© 2010, Stewart Mennin
Ottawa 2010
Permanent Education & CME
 Permanent
EducationEducation
strategiesPermanent
Education for
 Mainly transmission
Health
CME
 CME
Identification of
Education needs
Health teams, work
problems/solutions
Individuals
Educational Strategies
Problematization,
collective reflection,
action, reflection
Individual, passive
Educational techniques
Interactive, team work
Mainly transmission
Targets
Health teams
Individuals
© 2010, Stewart Mennin
Ottawa 2010
Learning as Reacculturation (Brufee)
1. Teaching as assimilation
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They’re different
Stereotyping
2. Teaching as accommodation
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Deficit
Concepts
Learn techniques & methods
3. Teaching as educating –
Boundaries, context, participatory
© 2010, Stewart Mennin
Ottawa 2010
Deficit Learning/Teaching
© 2010, Stewart Mennin
Ottawa 2010
Co-shaping the Environment
© 2010, Stewart Mennin
Ottawa 2010
Learning As Reacculturation
 Nested cultures
 Multi-being
 Learning as adaptation
to situation –
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© 2010, Stewart Mennin
Phase IB Primary Care
Curriculum
Foreign medical students
Ottawa 2010
All Change Begins With Conversation
(exchange)
© 2010, Stewart Mennin
Ottawa 2010
© 2010, Stewart Mennin
Ottawa 2010
Relational Being
 Relationship in health
care, education, team
members, systems,
communities
 Boundedness
© 2010, Stewart Mennin
Ottawa 2010
Relationship-Centered
 Teacher – Centered
 Student- Centered
 Learning-Centered
 Relationship-Centered
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© 2010, Stewart Mennin
RC-Care
RC-Teaching
Ottawa 2010
Relationship-Centered Care
 Partnership
 Shared decision-making
 Self-awareness
 Attention to relational processes
 Non-linear human interactions
 Emergence of self-organizing patterns of meaning
 Values difference &diversity
 Authentic responsive participation
© 2010, Stewart Mennin
Ottawa 2010
Indian Hospital Roraima, Northern Brazil
© 2010, Stewart Mennin
Ottawa 2010
Relationship-Centered Teaching
 Participation as person
 Co-action
 Co-evolution
 Humanization
© 2010, Stewart Mennin
Ottawa 2010
Institutional Culture Change:
Indiana University School of Medicine
 Planned ≠ lived curriculum
Planned
 Emergent design
 Appreciative inquiry
 Complex responsive
Lived
processes of relating
Eric Johansson
© 2010, Stewart Mennin
Ottawa 2010
Details Indiana
 General change (non-specific),
step by step emergent
 3 years
 Recognize & disseminate
success – Identify root causes
 Complex responsive processes
of relating –Stacy
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Nonlinear change
Attention to patterns enacted in
the moment
Cottingham, Suchman, et al., 2008
J Gen Int Med 23(6):715-722
© 2010, Stewart Mennin
Ottawa 2010
Evaluation of Culture Change:
Indiana University School of Medicine
 Began at the beginning
 Multi-method –
Cottingham, Suchman, et al., 2008
J Gen Int Med 23(6):715-722
© 2010, Stewart Mennin
qualitative-quantitative
design
 Track & publicize
changes, emergent
events
 Town meetings of
discovery
 Focus on relationshipcentered events
Ottawa 2010
Assessment (Learning) Drives Learning
© 2010, Stewart Mennin
Ottawa 2010
Formative Assessment & Culture
 Culture, reflection,
feedback
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© 2010, Stewart Mennin
Elders
Gender
Power
Competition grades,
status, # 1
Ottawa 2010
Getting to Tolerance
42
Knowing
Skills
Immigration
Culture, cultural diversity
Citizenship
Intercultural education
Learning as communication
Legal framework
Attitudes
Getting to Tolerance
43
Knowing
Skills
Listen to & dialog
Habits of reflection
Dealing with misconceptions & conflict
Adapt to unexpected, accept risks
Tolerate ambiguity
Participate , question, choose
Attitudes
Getting to Tolerance
44
Knowing
Skills
Attitudes
Be aware of cultural constraints
Open to learn from diversity
Respect others’ ways of acting,
believing
Be flexible & empathic
Put yourself in the other’s shoes
What Can Be Learned From The Bridge?
 Culture is about
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© 2010, Stewart Mennin
tolerance of difference
Difference is a source of
learning
Pedagogy is about
freedom to understand
(do)
Assessment in authentic
context includes culture
Relationships in teaching
& care are primary
Ottawa 2010
Some Research Questions Culture,
Pedagogy, Assessment
 How can global standards can be implemented & still
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preserve local approaches & priorities?
How can we show that relationship-centered
teaching makes a difference?
Can, and if so how, can formative assessment &
feedback be adapted in diverse settings?
How can teachers recognize and participate in
students’ transitions between multiple cultures of
learning?
How are innovations from the South and East
adapted to other educational cultures?
© 2010, Stewart Mennin
Ottawa 2010
Morin, 2001
To articulate and organize, and thereby
recognize and understand, the problems of
the world, we need a reform in thinking. And
this reform is paradigmatic, not
programmatic. It is the fundamental
question for education because it concerns
our ability to organize knowledge.
Presentation available at
www.menninconsulting.com
© 2010, Stewart Mennin
Ottawa 2010