I recently had an interesting experience with prejudice against reflective learning. One of our medical students who is Dene from an isolated community had failed a key national oral exam twice, not because he doesn't know his medicine but because of his personal presentation. If he fails the exam again his medical career is over.
I interviewed him to see if I could figure out what was going on. The young man is a concrete/reflective learner; after each question, he pauses and looks away, then writes in his notebook, then he responds. The medical faculty that was with me said his answers were well organized and correct.
98% of medical students are or learn to be concrete/active. They are expected to respond immediately to questions while looking the questioner in the eye. Whether this style makes the best physician is debatable, but it is an expectation of medical culture that is deeply ingrained. The examiners are from Ontario, and I have no input into that exam process.
We talked to him about preparing common illness scripts and practicing answering with those to speed up his response time. I also talked to him privately about using his anger and frustration to change the system once he graduates. He currently refuses to discuss his ancestry with the examiners.
Culture is a huge issue in medicine. One of our faculty described it as moving the Titanic to try to change it. I find it interesting that all of our Aboriginal medical graduates have gone on to government or university jobs and not back to their communities. I know they are needed and rewarded in those positions but I also wonder how difficult it would be to return after being enculturated in medicine.
