How culture affects validity: understanding Japanese residents' sense-making of evaluating clinical teachers

M. Kikukawa*, R.E. Stalmeijer, T. Matsuguchi, M. Oike, E. Sei, L.W.T. Schuwirth, A.J.J.A. Scherpbier

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives Traditionally, evaluation is considered a measurement process that can be performed independently of the cultural context. However, more recently the importance of considering raters' sense-making, that is, the process by which raters assign meaning to their collective experiences, is being recognised. Thus far, the majority of the discussion on this topic has originated from Western perspectives. Little is known about the potential influence of an Asian culture on raters' sense-making. This study explored residents' sense-making associated with evaluating their clinical teachers within an Asian setting to better understand contextual dependency of validity. Design A qualitative study using constructivist grounded theory. Setting The Japanese Ministry of Health, Labour and Welfare has implemented a system to monitor the quality of clinical teaching within its 2-year postgraduate training programme. An evaluation instrument was developed specifically for the Japanese setting through which residents can evaluate their clinical teachers. Participants 30 residents from 10 Japanese teaching hospitals with experience in evaluating their clinical teachers were sampled purposively and theoretically. Methods We conducted in-depth semistructured individual interviews. Sensitising concepts derived from Confucianism and principles of response process informed open, axial and selective coding. Results Two themes and four subthemes were constructed. Japanese residents emphasised the awareness of their relationship with their clinical teachers (1). This awareness was fuelled by their sense of hierarchy (1a) and being part of the collective society (1b). Residents described how the meaning of evaluation (2) was coloured by their perceived role as senior (2a) and their experienced responsibility for future generations (2b). Conclusions Japanese residents' sense-making while evaluating their clinical teachers appears to be situated and affected by Japanese cultural values. These findings contribute to a better understanding of a culture's influence on residents' sense-making of evaluation instruments and the validity argument of evaluation.
Original languageEnglish
Article numbere047602
Number of pages8
JournalBMJ Open
Issue number8
Publication statusPublished - 2021


  • medical education & training
  • human resource management
  • quality in healthcare

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