Rethinking the globalisation of problem-based learning: how culture challenges self-directed learning Janneke M Frambach, 1 Erik W Driessen, 1 Li-Chong Chan 2 & Cees P M van der Vleuten 1 CONTEXT Medical schools worldwide are increasingly switching to student-centred methods such as problem-based learning (PBL) to foster lifelong self-directed learning (SDL). The cross-cultural applicability of these meth- ods has been questioned because of their Western origins and because education contexts and learning approaches differ across cultures. OBJECTIVES This study evaluated PBL’s cross- cultural applicability by investigating how it is applied in three medical schools in regions with different cultures in, respectively, East Asia, the Middle East and Western Europe. Specifically, it investigated how students’ cultural back- grounds impact on SDL in PBL and how this impact affects students. METHODS A qualitative, cross-cultural, com- parative case study was conducted in three medical schools. Data were collected through 88 semi-structured, in-depth interviews with Year 1 and 3 students, tutors and key persons involved in PBL, 32 observations of Year 1 and 3 PBL tutorials, document analysis, and contex- tual information. The data were thematically analysed using the template analysis method. Comparisons were made among the three medical schools and between Year 1 and 3 students across and within the schools. RESULTS The cultural factors of uncertainty and tradition posed a challenge to Middle East- ern students’ SDL. Hierarchy posed a challenge to Asian students and achievement impacted on both sets of non-Western students. These factors were less applicable to European students, although the latter did experience some challenges. Several contextual factors inhibited or enhanced SDL across the cases. As students grew used to PBL, SDL skills increased across the cases, albeit to different degrees. CONCLUSIONS Although cultural factors can pose a challenge to the application of PBL in non-Western settings, it appears that PBL can be applied in different cultural contexts. How- ever, its globalisation does not postulate uni- form processes and outcomes, and culturally sensitive alternatives might be developed. international issues Medical Education 2012: 46: 738–747 doi:10.1111/j.1365-2923.2012.04290.x Discuss ideas arising from this article at www.mededuc.com ‘discuss’ 1 Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands 2 Department of Pathology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China Correspondence: Janneke M Frambach, Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands. Tel: 00 31 43 388 5775; Fax: 00 31 43 388 5779; E-mail: j.frambach@maastrichtuniversity.nl 738 ª Blackwell Publishing Ltd 2012. MEDICAL EDUCATION 2012; 46: 738–747