How cultural factors affect medical students' interactions with clinical practice feedback: a qualitative study of ethnically diverse students at three transcontinental campuses.

Abstract

Transnational medical educational programs are now commonplace. Given the importance of individualised feedback, this study explored how cultural factors influence feedback experiences across three transnational campuses of one medical school. A total of 57 final-year medical students were interviewed from a sampling frame of 514 (269 male, 245 female). One-to-one semi-structured interviews were conducted and analysed using template analysis. Codes were iteratively refined into four themes, which were critically reviewed through the lenses of Hofstede's cultural dimensions and Figured Worlds. Four themes were identified: (1) early socialisation into feedback shaped by family and schooling; (2) hierarchical learning environments positioning students as passive recipients; (3) strategies to cope with negative feedback; and (4) gendered differences in the interpretation of feedback. National identity played only a minor role, while prior experiences and hierarchical structures were more influential. Female students more often described humiliation and emotional burden, whereas some male students framed negative feedback as a 'rite of passage.' Feedback experiences in transnational medical programs appear less determined by national culture than by early life experiences and hierarchical clinical environments. Hofstede's framework offered limited explanatory value, while Figured Worlds illuminated how identities are negotiated in feedback encounters. To enhance feedback cultures in transnational settings, faculty development should prioritise dialogic approaches, sensitivity to learners' prior experiences, and awareness of gendered impacts. Institutional change is needed to move beyond transmissive practices and foster learner-centred, inclusive feedback.