Challenges of Communication Skills Transfer of Medical Students in the Cultural Context of Indonesia

Medical schools worldwide are promoting a student-centered and patient-centered care curriculum by using problem-based learning (PBL) strategy, emphasizing group dynamics and discussions. This approach facilitates student engagement, participation, and partnership interaction. However, in the context of the wide power-distance or the existence of socio-hierarchical gaps in Indonesia, two-way dialogue is limited. Few studies describe the one-way paternalistic communication styles between physician-patient, teacher-student, and parents-children, which can lead to less effective learning and healthcare environments. In this study, we investigated if students in an Indonesian medical school, who have been learning and practicing a partnership style of communication in a PBL curriculum for three years, are using the same style of communication with their junior peers outside the classroom. We examined the communication style between senior and new medical students, using surveys, observations, and focus group discussions, during a three-day orientation at the beginning of medical education. The results indicated that senior students used a one-sided communication style with their juniors, whereas new students expressed the need for egalitarian interaction with seniors. A classic dilemma of nature versus nurture was found and discussed. To change the traditional values, robust, constructive, and systematic formative training is key.