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, par-
ticipation, and partnership interaction. However, in the context of the wide power-distance or the existence of socio-hierar-
chical 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 prac-
ticing 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 stu-
dents, 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.
Keywords: intercultural communication skills, student-centered learning, patient-centered care, problem-based learning,
partnership communication style