International and transnational models for delivering medical education: The future for medical education

Internationalisation is one of the most important forces in higher education today, presenting a powerful challenge and an opportunity for medical school. As part of a programme to support clinical communication skills development I spent time with Year 1 medical students observing doctor?patient interactions in a small local clinic on the outskirts of a large regional city in Malaysia. These were Malaysian students of the Malaysian-based medical school of an Australian university. The students were observing a consultation between a middle-aged Malaysian doctor and an elderly female Malay patient dressed in the traditional clothes of that region. The doctor I observed was quietly spoken, gentle, caring and seemed to put the patient at her ease. He took time to listen to the patient and reassure her about her concerns. As is the custom in Malaysia when addressing an older person not known to you, he addressed the patient as `auntie?. I was impressed with the rapport he created and care he took with the patient ? a kind and caring doctor. Driving back to the campus, I listened with increasing dismay to the students in the back seat discussing the consultation. They talked disparagingly of this doctor?s paternalistic, doctor-centred approach. They noted that he failed to adequately elicit the patient?s perspective on her medical condition or to engage her in discussion and decisions on the treatment options. They were concerned at his use of closed questions and apparent failure to provide opportunities for the patient to assert herself. I wondered whether we had been watching the same consultation, and how we had arrived at such different interpretations of the doctor?s behaviour.