A bird flying in the sky.

6 Things I’ve Learned about Cross-Cultural Staff Development

Tomorrow I’m going to a small town on the Indian border to lead a three day training. I’ll be teaching from the Ministry of Health’s handbook on counseling skills to use with patients with substance use disorders.

Staff development has been the most interesting and rewarding part of my assignment here.

The Bhutanese educational system is new. Prior to the 1950’s education only occurred in the monasteries. The teaching style is still heavily influenced by the Indian teachers who staffed the schools since, for a long time, no Bhutanese were qualified.

The teaching style relies on memorization of texts. Not only is critical and independent thinking not a priority, it is often discouraged. Questioning your teacher is also a no-no. Western teachers in the rural areas tell me that it’s common for students to print articles from the internet, sign their names at the bottom, and receive full marks.

For the staff I teach, this is the type of learning they are used to.

It’s taken about 3 months for the staff and me to adjust to each other.

In the beginning, I gave the training they asked for. Lectures and powerpoint. There was a lot of head nodding (some in agreement, some in boredom), and there was a lot of “Yes, Madame. Thup thup thup.”

*Thup means OK.

I felt so happy!

And then I noticed that there was no change in the treatment. I asked the Bhutanese counselor. Why weren’t they doing x, y, and z?

He shrugged and laughed a little. “Oh yes, all the volunteers tell us to do that.”

So I started making the training far more interactive even though I could tell they were a little freaked out. Role plays, demonstrations, discussions, case examples, brainstorming, etc. We did it all.

A couple of weeks later the head nurse pulled me aside and said, “Sister Jodi, the staff has been talking. We don’t like powerpoints and lectures. It’s too boring. We like active learning. Can you do that more?”


And here I am about to train 20 nurses from the rural districts. Nurses who don’t know me and who definitely aren’t used to my teaching style (which is basically the opposite of what they are used to).

Today I reviewed my plans with a couple of the staff here. I got some good feedback and advice. Though one of them did say, “Oh Madame, they will be very shocked!”

So, here are a couple of things I’ve learned about staff development in a cross-cultural and multi-lingual setting

One. Language is everything.

You can never assume that something can be said in another language. This is true for vocabulary (e.g. emotion words) and sentence construct. Turns out there’s no difference between an open and a closed question in dzongkha. You have to explain the purpose of the skill and what sort of patient reaction to expect. Then let the trainees discuss how they will say it in their own language.

Two. Offer behavioral and verbal reinforcement.

Westerners (low context culture) rely heavily on verbal reinforcement. “Good job!” “I can tell you really thought about that.” “You’re doing well.” This isn’t always true in cultures where emphasis is on duty and obedience. Things really turned around in my training when I started giving out candy.

Three. Powerpoints (or handouts) do have their place.

If the learners do not speak English as a first language, let them read AND listen.

Four. Give them something to be right about.

Trainees will approach the work feeling that there is a “right” answer. They are more likely to participate if they feel they have the right answer. Give them something to be right about and gradually increase the amount of independent thinking you ask for.

Five. Be up-front about your teaching style and expectations.

Let them know there will be participatory activities and what that will look like. This might be new for them. Also, be clear that answering the phone and side-talking aren’t OK. In Bhutan at least, these are common behaviors and aren’t considered rude. I’ve learned not to take these things personally, and I’ve also learned that I’m not able to be effective when this is happening.

Six. Be clear about your intentions.

I’m happy if the participants come away with 1) more empathy for patients, 2) flexibility in their approaches and a willingness to try new things, and 3) paying attention and responding to the patients’ responses to interventions.

Next week I’ll post about how this all went down. Wish me luck!


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