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Med Educ. 2008 Mar;42(3):279-85. doi: 10.1111/j.1365-2923.2007.02993.x.

Influence of national culture on the adoption of integrated and problem-based curricula in Europe.

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Department of Educational Development and Research and Medical Education Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.



There is an evident misbalance in the frequency of medical schools with problem-based learning (PBL) curricula in northern versus southern Europe. This study explores the hypothesis that national culture influences the flexibility of (medical) schools in terms of their propensity to adopt integrated and PBL curricula.


National culture was defined by a country's scores on indexes for 4 dimensions of culture as described by Hofstede, defined as: power distance; individualism/collectivism; masculinity/femininity, and uncertainty avoidance. Non-integrated medical curricula were defined as those that included courses in 2 of the 3 basic sciences (anatomy, biochemistry and physiology) in the first 2 years; otherwise, by exclusion, curricula were assumed to be integrated. The medical curricula of 134 of the 263 schools in the 17 European countries included in Hofstede's study were examined.


Correlations were calculated between the percentage of integrated medical curricula in a country and that country's scores on indexes for each of the 4 dimensions of culture. Significant negative correlations were found between the percentage of integrated curricula and scores on the power distance index (correlation coefficient [CC]: - 0.692; P = 0.002) and the uncertainty avoidance index (CC: - 0.704; P = 0.002). No significant correlations were found between the percentage of integrated curricula and scores on the indexes for individualism/collectivism and masculinity/femininity.


A (medical) school which is considering adopting an integrated or PBL curriculum and which is based in a country with a high score on Hofstede's power distance index and/or uncertainty avoidance index must a priori design strategies to reduce or overcome the obstructive effects of these dimensions of culture on the school's organisation.

[Indexed for MEDLINE]

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