DataPDF Available
Identity text: an educational intervention to foster
cultural interaction
Zareen Zaidi
*, Danie¨ lle Verstegen
, Rahat Naqvi
, Tim Dornan
Page Morahan
Division of General Internal Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA;
Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences,
Maastricht University, Maastricht, The Netherlands;
Languages and Diversity, University of Calgary, Calgary,
AB, Canada;
FAIMER Institute, Philadelphia, PA, USA;
Department of Microbiology and Immunology, Drexel
University College of Medicine, Philadelphia, PA, USA
Background: Sociocultural theories state that learning results from people participating in contexts where
social interaction is facilitated. There is a need to create such facilitated pedagogical spaces where participants
can share their ways of knowing and doing. The aim of this exploratory study was to introduce pedagogical
space for sociocultural interaction using ‘Identity Text’.
Methods: Identity Texts are sociocultural artifacts produced by participants, which can be written, spoken,
visual, musical, or multimodal. In 2013, participants of an international medical education fellowship
program were asked to create their own Identity Texts to promote discussion about participants’ cultural
backgrounds. Thematic analysis was used to make the analysis relevant to studying the pedagogical utility of
the intervention.
Result: The Identity Text intervention created two spaces: a ‘reflective space’, which helped participants reflect
on sensitive topics such as institutional environments, roles in interdisciplinary teams, and gender discrimina-
tion, and a ‘narrative space’, which allowed participants to tell powerful stories that provided cultural insights
and challenged cultural hegemony; they described the conscious and subconscious transformation in identity
that evolved secondary to struggles with local power dynamics and social demands involving the impact of
family, peers, and country of origin.
Conclusion: While the impact of providing pedagogical space using Identity Text on cognitive engagement and
enhanced learning requires further research, the findings of this study suggest that it is a useful pedagogical
strategy to support cross-cultural education.
Keywords: educational cultural hegemony;pedagogical space;cross-cultural education;sociocultural theory;discourse analysis
*Correspondence to: Zareen Zaidi, Division of General Internal Medicine, Department of Medicine,
University of Florida, PO Box 100277, Gainesville, FL 32610-0277, USA, Email: Zareen.zaidi@medicine.
Received: 12 August 2016; Revised: 29 September 2016; Accepted: 7 October 2016; Published: 1 November 2016
In health professions education, new academic par-
tnerships between North American and European
institutions and health centers in developing countries
have emerged (1, 2). This globalization is ushering in
an increasingly interconnected world with complexities
for cross-cultural communication in both face-to-face
and online settings (3, 4). Exploring and understanding
cultural difference have been noted as critical for establish-
ing trust and determining long-term success of educational
programs (1, 2, 5, 6). It is of note that when trust is
undermined in multicultural learning environments, lear-
ners from minority backgrounds have reported increased
depression, anxiety, hypertension, cardiovascular, pul-
monary, and pain conditions (7!9).
Dogra and colleagues have recently published AMEE
Guide No. 103 for assisting faculty in designing, deliver-
ing, and assessing diversity curricula (10). They note that
‘course design is not value free or unbiased as it is
dependent on the perceptions held by educators’ and that
many educational approaches are ‘rooted in the historical
context of white domination of disadvantaged minorities
and are very race or ethnicity focused’. This conclusion
emphasizes research, which has shown that groups in
power may dictate assumptions about culture, leading to
‘common-sense understandings that serve for all’ (11).
Such ‘dominant discourse’, the way of speaking created by
those in power, thus becomes the accepted way of looking
at or speaking about the subject (12). The phenomenon of
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stifling of non-dominant discourses by a tacitly dominant
discourse is termed ‘cultural hegemony’ (13, 14). ‘Educa-
tional cultural hegemony’ occurs when teachers assume
that content and task are culture free, and unconsciously,
implicitly discourage introducing the student’s personal
cultural context. Markus and Conner have highlighted
numerous examples where educational methods have
been dominated by teachers from Western independent
cultures, inhibiting the engagement and learning by those
from interdependent cultures (6).
One of Dogra and colleagues’ key recommendations is:
‘provide a safe learning environment but be prepared to
challenge students to push themselves’ (10). Our earlier
research emphasizes this challenge. We found that health
professions educators from diverse cultures who were
participating in residential program sessions, followed by
online distance educational discussions, made surpris-
ingly few references to sociopolitical events or norms in
their home countries (15). When they did, their online
contributions were more likely to be greeted by silence or
superficial, short-lived discussions than in-depth explora-
tion of the issues raised.
Educational literature reveals the need for ‘pedagogical
space’ to promote a safe place for sense making of such
exchanges about culture and identity that can foster
learning (16, 17). Pedagogical spaces are not only
physical, but also narrative social spaces with historical
and cultural dimensions in which learners interact (18).
Sociocultural theorists and practitioners have described
learning in collaborative cultural contexts (19) as well as a
lack of facilitating interactional, narrative pedagogical
space (20). The gap we identify in the literature is the
lack of specific educational interventions to provide
safe pedagogical space that can promote cross-cultural
Creation of ‘Identity-Safe Classrooms’ where teachers
encourage discussions about learners’ identities has been
shown to improve student performance on standardized
testing (21). Cummins and Early have described Identity
Text as an educational strategy that promotes this
pedagogical space (22). Identity Text is an intervention,
orchestrated by the teacher or facilitator, to describe and
discuss learners’ creative work, which can showcase
the influence of cultural background on the individual
(23). Identity Text engages learners by asking them to
create ‘texts’ (e.g., creative writing and other multimodal
forms of cultural production) that express the identity
or influence of cultural background on the individual
in a new social setting (22). Identity Text thus offers a
method to challenge hegemonic societal trends by bring-
ing learners’ cultural backgrounds to the foreground, and
drawing attention to the multiple facets of life experiences
which shape interactions in learning environments (6, 23).
While Identity Text has been described in K-12 educa-
tional settings (22), in this study we explored the use of
the Identity Text intervention in a very different setting.
The objective of this research was to evaluate the use of
Identity Text as a structured educational intervention to
promote discovery and dialogue about participants’
cultural backgrounds. Specifically, this project set out to
describe the application of the intervention in an educa-
tional context that comprises an asynchronous online
platform and global health professions education faculty
development program.
Theoretical framework
Our aim is to introduce Identity Text as a pedagogical tool
for sociocultural interaction, which places this research
within the critical theory paradigm (24). Discourse theory
(25), which falls in the scope of critical theory, posits
that language is not only about what the person is saying
(informing others) but also what the person is doing
(actions) and being (identity). Language can exercise and
resist power (25). It is ‘never neutral’ (12) because it
incorporates tacit assumptions of what is normal and right
(25). Qualitative data analysis, from this standpoint, can
identify power relations and cultural assumptions (12, 26).
The US-based Foundation for Advancement of Interna-
tional Medical Education and Research (FAIMER)
has a 2-year global fellowship program for midcareer
health professions faculty from over 40 developing coun-
tries (5). The program goals are to strengthen knowledge
and skills in education, leadership, and project manage-
ment, and build a community of practice in health
professions education with the aim of improving the health
of communities (5). The program comprises an initial
3-week face-to-face immersion residential session in
Philadelphia, an 11-month e-learning period with online,
asynchronous discussions (conducted via listserv), a
second 2-week residential session, and a second and final
11-month e-learning period. Participants remain members
of the community of practice after graduation and con-
tinue to take an active role in online discussions.
During 2013!2014, the FAIMER Institute invited alumni
from the years 2001 to 2011 to convene a 2-week ‘FAIMER
Community Conversation’ on a topic of their choice. ZZ
(FAIMER Institute Fellow alumnus) convened a conver-
sation in December 2013 entitled ‘Identity Matters’ and
invited the coauthors as guest faculty. We used Identity
Text (27) as the educational intervention because it
fits with a learner-centered approach and stimulates
constructive, contextual, and collaborative learning. We
asked participants to actively connect the topic of identity
to their own daily life and history (constructive and
Zareen Zaidi et al.
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contextual) and reflect on the Identity Text of others
(constructive and collaborative) (28).
Data gathering process
ZZ asked FAIMER listserv participants to submit an
Identity Text describing how their identity as an educator
had evolved over time. The written cue (Appendix 1)
asked them to take into account how the people, tradi-
tions, politics, language, religion, race, ethnicity, gender
issues, and economy of their country had influenced
their identity as a person and educator. It asked partici-
pants to be creative in their submission, using any medium
of communication (e.g., art, poetry, slides, and videos).
ZZ then facilitated the online discussion about how
participants’ cultural backgrounds influenced their roles
as educators and leaders. As part of the collaborative
approach, the authors also contributed their own Identity
Texts and joined in the discussion. At the end of the 2
weeks, ZZ compiled the submitted Identity Texts into a
109-page text, which served as the data set for analysis.
Critical reflexivity
The authors have diverse backgrounds: ZZ is a FAIMER
Institute Fellow alumnus, who trained as an internist in
New York and emigrated from Pakistan to the USA. DV
is Dutch, lived in Asia and Italy, and works with learners
from all around the world at Maastricht University. RN
lived in France while obtaining her PhD, immigrated
to Canada from Pakistan, and focuses on language and
diversity education. PM is an American, founding co-
director of the FAIMER institute, and has worked to
promote gender and minority issues. TD works in the
UK, has lived in the Netherlands, is an expert in critical
research, and has worked with health professions educa-
tors from cross-cultural backgrounds. These authors took
part in a conscious explicit process of critical reflexivity,
discussing via Skype calls and emails how their back-
grounds might influence analysis of the texts. They
discussed their preconceptions and interpretations of the
data, using their diverse backgrounds as resources to
provide cultural insights. ZZ, DV, PM, and TD partici-
pated actively by submitting their own Identity Texts
online in order to make transparent their own subjectiv-
ities, to foster a safe pedagogical space and enhance
critical reflectivity.
Data analysis
This was a thematic analysis, which used Braun and
Clarke’s framework of latent thematic analysis to analyze
the Identity Texts (29). Bearing in mind the research
question and following the six phases described by Braun
and Clarke, two of the authors (ZZ and RN) indepen-
dently analyzed the data and identified themes, focusing
on patterns and richness of responses rather than the
number of responses, and assigned comments to themes.
ZZ then wrote a narrative of the results, proceeding from
identification of cultural themes to analysis of the content
of the themes to synthesis and explanation. A latent
thematic analysis goes beyond semantic content of data
and identifies underlying ideas and assumptions (29). To
study these broader meanings, we used a set of analytical
tools described by Gee, which are compatible with our
critical theoretical orientation, to identify typical stories
or figured worlds; these are narratives and images that
different social and cultural groups use to make sense of
the world (25). They function as simplified models of
how things work when they are ‘nor mal’ and ‘natural’ from
the perspective of a particular social and cultural group
that the participants invited listeners to assume (30). Gee’s
tools were also used to study how participants’ language
enacted distinctive ways of interacting, valuing, feeling,
and believing (31). All authors contributed to the evolving
narrative, and an audit trail was maintained.
Twenty-eight participants, including four of the authors,
contributed to the online discussions. Participants who
posted their Identity Texts came from 11 countries in
Africa (Ethiopia, Egypt, and South Africa), Asia (India,
Pakistan, Turkey, Bangladesh, China, and Philippines),
and Latin America (Brazil and Colombia). Three co-
authors from the US, Netherlands, and UK, and the first
author from Pakistan also contributed their Identity Texts.
Our analysis revealed that the Identity Text interven-
tion provided submissions about the impact of socio-
cultural factors on the formation of identity that could be
framed as two pedagogical spaces: a ‘reflection space’ and
a ‘narrative space’. Appendix 2 contains verbatim exam-
ples to illustrate what we mean by those terms. Below, we
present an analysis of the text in these two spaces.
A reflection space
Participants used the Identity Text framework to reflect
on tensions they faced in their life and careers. Several
frank and open discussions emerged on sensitive topics
such as institutional environments, roles in interdisciplin-
ary teams, and gender discrimination. Several partici-
pants commented that they were ‘happy to have this
opportunity’ which invited ‘introspection’, ‘encouraged
them to share their story’ and discuss topics that were
often in their subconsciousness or for which they had no
space to discuss in an educational setting.
Identity dissonance
One topic of reflection was on tensions between tradi-
tional academic and actual pedagogical responsibilities.
One participant described contrasting figured worlds
where ‘an identity has been built ... that promotion is
always and only possible through publication or research’.
Life as a university professor was compared metaphori-
cally to ‘soccer only targeted at scoring goal but not
Pedagogical space in cross-cultural education
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showing a beautiful game or the art of soccer (targeted
at publishing not the art of teaching)’ (Participant A,
A second topic of reflection was the tension caused by
power relations and the struggle with dominant percep-
tions about who holds authority in interdisciplinary
teams, which was highlighted by two participants who
were nurses. They described dissonance related to explicit
expectations and actual experience, and to theoretical
status and practical hierarchical work environments. One
nurse described how she was introduced as ‘Doctor’ as ‘a
quick way to gain respect from the people’: ‘when I said
or did something impressive then I wanted people to
know that even a nurse can think and advocate for their
health; and I did that thinking this was my contribution
to nursing’ (Participant B, Pakistan). The text refers to
unspoken assumptions about the role of a nurse and the
role of a doctor, that is, a doctor can go into a nurse’s
space but not the reverse.
Gender-related tensions
Participants also reflected on tensions faced around
gender-related societal expectations, which in some parts
of the world still determine career choices. A participant
from India highlighted the expected roles of women as
child bearers rather than doctors, although this expecta-
tion might not be openly acknowledged by society
(Participant C, India). Her response brought to light the
tensions faced by women in India as wives, mothers, and
women physicians. Participants from developed countries
also described gender-related stereotypes. As an example,
one participant shared that her mother had said: ‘When
you have a family, you will soon stop working again to
care for your children’ but ‘luckily, my current world
allows me to combine both’ (Participant D, Netherlands).
She wrote that she had ‘also refused to accept that women
should have different role in society’. This participant also
noted that she was one of eight women of the 130
researchers in her institute, and ‘how some of those eight
fought to be more male than male, others disappeared
into the background, and a third group overexposed their
femininity. None of them attractive choices’ (Participant
D, Netherlands). Another participant drew the group into
an academic figured world in the 1980s when she ‘was one
of less than 150 women chairs in either basic or clinical
science across the US’. She described pushing this into her
subconsciousness for many years and having gender bias
pointed out to her during a leadership fellowship pro-
gram, when ‘some faculty looked to the men Fellows
rather than the women Fellows when answering ques-
tions’. Understanding the ‘gender bias’ over the years and
‘reflection on this experience led me to assume my identity
in advancing women!’ (Participant E, USA).
In these examples, participants reflected on tensions in
careers, notably their perceptions about academic versus
pedagogical responsibilities, power relations in interdisci-
plinary teams, and gender biases. Through these reflec-
tions facilitated by the Identity Text strategy, participants
were not just ‘saying’; they were also ‘doing’. Through
their reflections, they were educating others about strug-
gles they faced in academic advancement in their parti-
cular cultural settings.
Role of middle-class culture
Participants described how middle-class culture in their
countries led them to choosing medicine as a career:
‘Society, peers, and family endorsed joining a prestigious
and well-paying course of medicine’ (Participant C, India).
Another participant stated that being told from an early
age that she ‘must’ become a doctor led her to become
a doctor. She too attributed this to her ‘middle-class
background’ (Participant F, India).
A narrative space
Role of social network on identity formation
Our analysis of the Identity Texts also revealed powerful
stories about how participants saw and understood the
world, a narrative space. Several participants wrote retro-
spectively in a storytelling fashion, building connections,
on the role family members played in shaping their careers.
One participant used the metaphor of dance to describe
the role of parents as mentors: ‘In my dance of life, from
my father I got the steps of inquiry, a love for reasoning,
and the heated side of my temperament that will stand me
in good stead for the tango or the Pasodoble. My mother’s
contribution is linked rather to the more subtle dances
like the rumba and the waltz’ (Participant G, South
Africa). The participant appeared to be making explicit
information that might otherwise be buried in the sub-
A participant contributed her story which traversed
three generations of musicians at the University of the
Philippines Conservatory of Music and that coming from
a well-known musician family ‘genetics has something to
do with the love of teaching’ (Participant H, Philippines).
She herself went onto a career in medicine but noted the
influence her mother had on her career:
listening to her colleagues, students and friends
recount their most memorable experiences with my
mother, I am once again awed by her courage, her
commitment and dedication to parenting and teach-
ing, her simplicity, her integrity and her passion for
excellence in everything she did. Thank you, Mom. I
hope that we inherited those good traits.
Participants discussed fortuitously meeting mentors
who shaped their careers. Incorporation of ‘love for dis-
section’ and anatomical pathology, passion for microbes,
interdisciplinary research, health professions education, and
leadership stemmed from mentorship, as one participant
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described: ‘We instinctively identify with particular in-
dividuals and tend to model our behavior and activities
on them, either unconsciously, or consciously and delib-
erately, aided by a process of reflection’ (Participant G,
South Africa).
Role of politics on identity formation
Participants used Identity Text to share stories that were
quite specific to their particular cultural environment.
As an example, the above participant also articulated a
figured world of South Africa emerging from apartheid,
explained the health professions context, and provided
an ‘insider view’ of the impact of political events. Her
story demonstrated historical cultural experiences related
to race, socioeconomic factors that have played a critical
role in shaping her worldviews, and provided a rich
resource to discuss coexistence with various cultural
the uprising of school children against the form of
education to which they were subjected was a
watershed moment in the transition to the democ-
racy finally achieved in 1994. So the political
landscape had a major influence to my growth and
development. (Participant I, South Africa)
White western view
A western faculty member described her struggle in a
cross-cultural teaching environment as, on one hand,
‘being quite comfortable in an outsider position’ and, on
the other hand, not being able to connect with women
from other cultures outside the work environment:
I was really eager to talk to the Moroccan and
Turkish mothers of my son’s class mates, but we had
little to discuss. They did not work and I had no
religion. We talked about our children, but that was
about it. I was quite disappointed with myself
for not being able to connect. (Participant D, The
She went on to draw us into the figured world of
a western faculty member in a cross-cultural learning
environment looking ‘for borders between two fields’
where ‘volunteering my white-western view instead of
waiting for your discussion points’ felt ‘like an elephant
in the china cabinet’ (Participant D, The Netherlands).
Another white participant from South Africa commen-
ted on how seemingly ‘fragile’ partnerships at academic
institutions administratively controlled by minority white
faculty continue to work and how she found ‘the dynamics
in the school, which had lecturers of all races, were
fascinating’. She also realized how isolated she had been
from the social and political realities of South Africa:
‘how my own thinking had also been stifled by the system
and how liberating it was to have access to a much wider
cultural spectrum’ (Participant I, South Africa).
A white faculty member from the USA commented
on how using ‘Identity Text’ reminded her of race-related
conversations she had taken part in and how such
conversations help unpack ‘unearned privileges’ like
being white and male (Participant E, USA).
Principal findings
Our research demonstrates that the Identity Text (23)
educational intervention can provide formal, legitimate
‘pedagogical space’ that facilitates cross-cultural educa-
tion in an online global faculty setting where many
participants have not personally met each other. Our
analysis of the submissions revealed two complementary
components of that legitimized space. The reflection space
enabled learners to reflect on deep cross-cultural issues
such as power dynamics, gender bias, and tensions
between being an academic and educator. The narrative
space fostered the exchange of thoughtful stories about
personal backgrounds and local situations. The reflection
and narrative space provided space to discuss issues such
as gender, politics, and white privilege, which are generally
not brought up in learning environments. Cultural hege-
mony in health professions education inadvertently en-
courages learners to leave their cultural backgrounds at the
classroom doorstep (32). Identity Text helps challenge
these hegemonic trends by providing a safe space to share
and learn about these important issues. These discussions
are critical in medical education because of two main
reasons: first, learners who are adept in multicultural
conversations report improved preparedness to take care
of diverse population which is associated with improved
access to health care for racial and ethnic minority
patients, greater patient choice and satisfaction, and better
educational experience for health professions students (33,
34). Second, there is now a vast body of literature that
challenges ‘color-blind’ policies at institutions (35) as by
ignoring racial identities individuals and institutions place
minority groups at a disadvantage at the recruitment,
retention, and promotion levels (36, 37). Creating forums
or hosting focus groups to hear the voices of individuals of
color, women, and lesbian, gay, bisexual, and transgender
(LGBT) prevent them from feeling isolated and devalued.
Supporting and nourishing minority meetings and groups
on campus or at an institution increases multicultural
interaction, provides a support system, and sends a strong
message about the organizational climate (36).
Relationship with other research
The results indicate that the Identity Text teaching method
encompasses many of the methods suggested by Dogra
and colleagues to foster diversity competence outcomes
such as the ability to ‘evaluate your own attitudes and
perceptions (including personal biases) of different groups
Pedagogical space in cross-cultural education
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within society’ and ‘reflect on the relevance of diversity in
health and delivery of services’ (10).
Educational researchers have noted a lack of facilitat-
ing interactional, narrative interventions (20). Identity
Text appears be a simple educational intervention that
provides and legitimatizes the pedagogical space that has
been noted to be important in promoting sense making
(16, 17). It also provides ‘narrative space’ for self and
telling one’s stories (38) and ‘reflection space’ to foster
reflection in an interactional way.
There are several ways in which this educational
intervention may be particularly useful with the increasing
number of cross-cultural educational settings and use
of distance learning. First, stories provide insights into
others’ culture and lead to better understanding and
cultural tolerance (16). Moreover, knowing each other’s
stories makes participants in a teaching/learning setting
feel they are part of a group, which can stimulate
engagement, build trust, and reduce dropout rates (39).
Second, it is also important to understand and develop
our story about our backgrounds and culture for success-
ful development of professional identity (20). Identity
Text, as indicated in some of the participants’ contribu-
tions in the results, created an opportunity to discuss
tensions and dissonance encountered during professional
development. Telling and re-telling personal stories en-
ables learners to understand the development of their
professional identity in the sociocultural context (20).
Third, reflection on how individuals position them-
selves in relation to dominant institutional or social
bodies can help learners from minority groups to shed
light on their evolving professional identities (40!42).
Another educational arena that may be a fertile ground
for use of Identity Text is bridging the gap between the
professional and personal worlds; this is coming increas-
ingly to the forefront in intergenerational differences in
health professions education (43). Finally, the use of
Identity Text may facilitate discussions about how cultur-
al context influences education, thus helping to promote
more effective implementation of educational theories
and research.
Strengths and limitations
We have demonstrated the feasibility of the Identity
Text teaching method in eliciting substantial reflection
and stories about educators’ professional development !
in the challenging context of an asynchronous online
setting, with global learners, many of whom have never
met personally.
This study has several limitations. First, participation
was voluntary; therefore, those who took part may
‘believe’ in the importance of promoting discussion about
the learner’s cultural background. We did not capture the
point of view of participants who may not believe or who
felt uncomfortable discussing their background in a public
forum; for example, this type of disclosure may not be
common in some cultures (6). Nevertheless, we had parti-
cipants from 14 countries in five continents. Second, because
this was an exploratory study to establish if Identity Text
was a feasible teaching method to elicit submissions and
dialogue about cultural issues in a challenging environ-
ment (online, global, and lack of personal connections),
we did not gather data regarding the ability of Identity
Text to result in cognitive engagement and learning, or
assess the amount and quality of reflection or narratives.
However, Dogra and colleagues have suggested possible
assessment methods, which can be incorporated into
Identity Text (10).
Learnings and implications for future practice
We propose the use of Identity Text as an educational
intervention that can result in engagement of learners
through identity affirmation and building a learning
community, which in turn would result in cognitive
engagement. We have also identified several strategies
for successful use of Identity Text. First, there is the need
for practice and experience in preparing thoughtful
Identity Texts. We provided one text and two PowerPoint
examples for the participants along with the written cue.
Second, we found active facilitation was necessary, both
to encourage provision of Identity Texts and to encourage
reflective reactions to those posted. The German Society
for Medical Education has recently proposed specific
competencies for faculty to demonstrate their social and
communicative ability, which include establishing a work-
ing climate conducive for learning and cooperation (44).
Although participants submitted Identity Texts, dialogue
around these submissions was limited; even with active
facilitation, there was variable back-and-forth discussion
among participants about the commonalities, differences,
or impact of sharing Identity Texts. Finally, educators
need to give careful thought to cultural considerations
about societal norms about personal disclosure (6).
Having faculty provide their own stories, and disclosing
their own experiences and biases may be needed to
provide a safe space for sharing.
As Dogra and colleagues have indicated (10), further
research is needed to measure the long-term impact
of teaching methods, such as using Identity Text, on
enhanced engagement, learning and building, and sustain-
ing a community of practice (19). Further research is also
needed to determine whether an intervention such as
Identity Text increases dialogue on sociocultural issues in
a professional development setting (15).
Part of this work was presented at the AMEE Conference
!Milan 2014.
IRB approval was obtained through Foundation Uni-
versity, Pakistan, on commencement of the study.
Zareen Zaidi et al.
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We would like to thank Stacey Friedman, Associate Director
of Evaluation and Planning at FAIMER, for her support and
Brownell Anderson for reviewing the article and providing valuable
Conflict of interest and funding
The authors report no conflict of interest. This work
was supported by the Gatorade Trust through funds
distributed by the Department of Medicine, University
of Florida, Gainesville, FL, USA and by the Medical
Education Travelling Fellowship awarded by ASME to
the first author.
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Appendix 1. The written cue.
Tell us about the evolution of your identity over time as an educator. Each one of you brings with you a wealth of
information about your country; the people, traditions, politics, language, religion, race, ethnicity, gender issues,
and economy of the area. Each of these factors has likely influenced you as a person and as an educator. Let’s talk
about how these factors affected the evolution of your identity. Attached are two PowerPoint presentations and a
write-up for inspiration, which may give you some ideas.
Feel free to use any form to communicate your thoughts, including PowerPoint, YouTube, Art, Poetry, Sketches or
Pictures (you are not limited to this list). If you can use your native language and translate, that would be great! Try
to tell your story, that is, use a narrative style.
Appendix 2. Excerpts from Identity Texts.
.I contemplate the emergence of my personal dance and I see it rooted in the exuberant, provocative, slightly
defiant Sophiatown jive, with a good dose of kwaito, a little bit of samba and quite a few steps that I cannot yet
predict. I trust in the emergence of the normative truth that how we teach and the way we are have an impact on
who our students will become and where they will go. My future is a ‘lucky packet’ and still holds many surprises,
but my subjective truth is that, as long as my feet keep moving and I am engaged in understanding learning and in
guided reflection, my personal insight, my teaching and the meaning of my life will blossom.
.To cut a long story short, I moved from one state to another, mostly in South and Central India, every six years.
It meant learning a new language, joining a new school, making new friends, and adapting to a new culture.
In each place, while I felt a part of the culture, I was considered an outsider. The funny part is I never stayed
in Bihar, so I never identified with it. Today, when someone asks me where I am from, I have a tough time
explaining. I feel like saying ‘pan-Indian’. I find it easier to explain to a foreigner that I am Indian, than to my
countrymen! And though I feel at home everywhere, I can’t say I am accepted as one of their own anywhere
within India. Yet, in all honesty, I cannot say that I have ever been denied any opportunities or rights because of
this ‘identity crisis’. I have blended in quite easily everywhere.
.Dance macabre. Who does not remember the angst accompanying that first cut through the skin in the dissection
hall. ‘Will I recognise the brachial plexus before I destroy it?’ Quickly followed by: ‘Oh my God, I completely
destroyed it’, and the embarrassing realisation days later that the brachial plexus is so big that it is impossible
to miss. But through all of this we had Dr. ND. She had the grace not to laugh in our faces, but gently guided us
to discover all the truths of the body; to develop a love for the gentle dissection of the thalamus; to envision the
relationships in the anterior mediastinum, always showing respect towards our cadaver, which so easily could
have been flippantly dismissed. I developed such a love for anatomy that I again turned tutor, and AD, my dear
friend to this day, still acknowledges my tutoring as the only reason he passed anatomy. Dr ND !a role model
and mentor to honour and remember.
.I have been a member of several ‘conversations on race’, ‘healing the wounds of racism’, etc. over the past
30"years. Much of this work has been ‘identity text’ !to listen and understand where individuals come from,
and understand my own identities. For example, in the US there are various ‘unearned privileges’ that tend to
come with birth or life stage, being: a man, white, heterosexual, able-bodied, Christian, English speaking, higher
socioeconomic status, between 20!60 years old. So on the one side, I am white, so I have unearned privilege; on
the other side, I am a woman, so I have less unearned privilege than a man.
.I was born in a middle class family in India and by default, it is the dream of every middle-class parent in India
that all their children should become either doctors or engineers. So, they would push and push their children
with extra classes, tuitions, medical entrance preparations from Grade 9 onwards etc. In keeping with this
tradition, I was told from my childhood that I ‘must’ become a doctor, which I took very seriously and achieved
it. So my identity a doctor was partly contributed to by my middle-class culture.
.We were in a strange and uniquely South African situation of being a medical school, which was only for people
of colour who came largely from very economically disadvantaged backgrounds. The dynamics in the school,
which had lecturers of all races, was fascinating and I realised very early on how isolated I had been from the
social and political realities of South Africa, how my own thinking had also been stifled by the system and
how liberating it was to have access to a much wider cultural spectrum. The potential for cultural hegemony was
obviously very high, the curriculum and accreditation processes and control over who could be admitted to the
school and who could teach, were largely held by the White minority authorities, but somehow there was a
partnership, sometimes fragile but overwhelmingly honest, between faculty and students.
Pedagogical space in cross-cultural education
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The aim of this Guide is to support teacher with the responsibility of designing, delivering and/or assessing diversity education. Although, the focus is on medical education, the guidance is relevant to all healthcare professionals. The Guide begins by providing an overview of the definitions used and the principles that underpin the teaching of diversity as advocated by Diversity and Medicine in Health (DIMAH). Following an outline of these principles we highlight the difference between equality and diversity education. The Guide then covers diversity education throughout the educational process from the philosophical stance of educators and how this influences the approaches used through to curriculum development, delivery and assessment. Appendices contain practical examples from across the UK, covering lesson plans and specific exercises to deliver teaching. Although, diversity education remains variable and fragmented there is now some momentum to ensure that the principles of good educational practice are applied to diversity education. The nature of this topic means that there are a range of different professions and medical disciplines involved which leads to a great necessity for greater collaboration and sharing of effective practice.
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Cross-cultural education is thought to develop critical consciousness of how unequal distributions of power and privilege affect people's health. Learners in different sociopolitical settings can join together in developing critical consciousness-awareness of power and privilege dynamics in society-by means of communication technology. The aim of this research was to define strengths and limitations of existing cross-cultural discussions in generating critical consciousness. The setting was the FAIMER international fellowship program for mid-career interdisciplinary health faculty, whose goal is to foster global advancement of health professions education. Fellows take part in participant-led, online, written, task-focused discussions on topics like professionalism, community health, and leadership. We reflexively identified text that brought sociopolitical topics into the online environment during the years 2011 and 2012 and used a discourse analysis toolset to make our content analysis relevant to critical consciousness. While references to participants' cultures and backgrounds were infrequent, narratives of political-, gender-, religion-, and other culture-related topics did emerge. When participants gave accounts of their experiences and exchanged cross-cultural stories, they were more likely to develop ad hoc networks to support one another in facing those issues than explore issues relating to the development of critical consciousness. We suggest that cross-cultural discussions need to be facilitated actively to transform learners' frames of reference, create critical consciousness, and develop cultural competence. Further research is needed into how to provide a safe environment for such learning and provide faculty development for the skills needed to facilitate these exchanges.
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Foundation for Advancement of International Medical Education and Research (FAIMER) faculty development programs have operated since 2001 and are designed to overcome many of the challenges inherent in global health collaborations, including alignment with local needs, avoiding persistent dependency, and development of trust. FAIMER fellowship programs, developed for midcareer faculty members in all health professions from around the world, share goals of strengthening knowledge and skills in education leadership, education methods, and project management and evaluation. Building community is another explicit goal that allows participants to support and learn from each other.The author recommends several practices for successful international collaborations based on 13 years of experience with FAIMER fellowships. These include using authentic education projects to maintain alignment with local needs and apply newly acquired knowledge and skills, teaching leadership across cultures with careful communication and adaptation of concepts to local environments, cultivating a strong field of health professions education to promote diffusion of ideas and advocate for policy change, intentionally promoting field development and leadership to reduce dependency, giving generously of time and resources, learning from others as much as teaching others, and recognizing that effective partnerships revolve around personal relationships to build trust. These strategies have enabled the FAIMER fellowship programs to stay aligned with local needs, reduce dependency, and maintain trust.