This review calls attention to the existence of manifold discourses about globalization and culture in non-Western medical education contexts. In refocusing global medical education processes to avoid Western cultural imperialism, it will also be necessary to avoid the pitfalls of other globalization discourses. Moving beyond existing discourses, researchers and educators should work towards equitable, context-sensitive and locally-driven approaches to global medical education.

ContextThe definition of medical professionalism poses a challenge to global medical educators. This is especially pronounced in settings where professionalism frameworks developed in the west are transferred into different cultures. Building upon our previous study across Western contexts, we examine Taiwanese and Sri Lankan medical students’ conceptualisations of professionalism in terms of what professionalism comprises (i.e. dimensions) and how it is linguistically framed (i.e. discourses).MethodsA qualitative group interview study was undertaken comprising 26 group interviews with 135 participants from one Taiwanese (n = 64; Years 4–7) and one Sri Lankan medical school (n = 71; Years 2–5). Through thematic framework analysis we examined the data for explicit dimensions of professionalism. Through discourse analysis we identified how participants constructed professionalism linguistically (discourses).ResultsThirteen common dimensions across Taiwanese and Sri Lankan talk were identified, with the dimensions (contextual, integration and internalised self) being identified only in Sri Lankan data. Professionalism as knowledge and patient‐centredness were dominant dimensions in Taiwan; in Sri Lanka, attributes of the individual and rules were dominant dimensions. Participants in both countries used four types of discourses previously identified in the literature. Individual and interpersonal discourses were dominant in Taiwanese talk; the collective discourse was dominant in Sri Lankan talk. Findings were compared with our previous data collected in Western contexts.ConclusionsDespite some overlap in the dimensions and discourses identified across both this and Western studies, Taiwanese and Sri Lankan students’ dominant dimensions and discourses were distinct. We therefore encourage global medical educators to look beyond a one‐size‐fits‐all approach to professionalism, and to recognise the significance of context and culture in conceptualisations of professionalism.

In an era of globalization, cultural competence is necessary for the provision of quality healthcare. Although this topic has been well explored in non-Western cultures within Western contexts, the authors explore how Taiwanese medical students trained in Western medicine address intercultural professionalism dilemmas related to tensions between Western medicine and Taiwanese culture. A narrative interview method was employed with 64 Taiwanese medical students to collect narratives of professionalism dilemmas. Noting the prominence of culture in students' narratives, we explored this theme further using secondary analysis, identifying tensions between Western medicine and Taiwanese culture and categorizing students' intercultural professionalism dilemmas according to Friedman and Berthoin Antal's 'intercultural competence' framework: involving combinations of advocacy (i.e., championing one's own culture) and inquiry (i.e., exploring one's own and others' cultures). One or more intercultural dilemmas were identified in nearly half of students' professionalism dilemma narratives. Qualitative themes included: family relations, local policy, end-of-life care, traditional medicine, gender relations and Taiwanese language. Of the 62 narratives with sufficient detail for further analysis, the majority demonstrated the 'suboptimal' low advocacy/low inquiry approach (i.e., withdrawal or inaction), while very few demonstrated the 'ideal' high advocacy/high inquiry approach (i.e., generating mutual understanding, so 'intercultural competence'). Though nearly half of students' professionalism narratives concerned intercultural dilemmas, most narratives represented disengagement from intercultural dilemmas, highlighting a possible need for more attention on intercultural competence training in Taiwan. The advocacy/inquiry framework may help educators to address similar disconnects between Western medicine and non-Western cultures in other contexts.

Canada, like all other federations, must function despite the complex nature of fiscal relations between the country‘s multiple levels of government. The Conservative government, under Prime Minister Stephen Harper, has acknowledged that a fiscal imbalance exists in the Canadian federation. Through a number of recent measures, the government has strived to reconcile the country by trying to achieve a state of fiscal equilibrium. This paper will explain how Canada came to be in a state of imbalance, what that means, and how it relates to Alain Noël‘s three conditions for fiscal balance. In particular, this paper will focus on the perceived imbalances or disadvantageous financial situations in large Canadian cities like Toronto and in the provinces of Ontario and Saskatchewan. Though many opposition members refused to believe that a fiscal imbalance was applicable to the Canadian situation [...]