RESEARCH REPORT

A Cross-cultural Comparison of Anatomy Learning:Learning Styles and Strategies

Barry S. Mitchell,1* Qin Xu,1 Lixian Jin,1 Debra Patten,2 Ingrid Gouldsborough3

1Faculty of Health and Life Sciences, De Montfort University, The Gateway, Leicester, United Kingdom2School of Medicine and Health, University of Durham, Stockton-on-Tees, United Kingdom3Faculty of Life Sciences, University of Manchester, Manchester, United Kingdom

Cultural influences on anatomy teaching and learning have been investigated by applica-tion of a questionnaire to medical students in British and Chinese Medical Schools.Results from the responses from students of the two countries were analyzed. Bothgroups found it easier to understand anatomy in a clinical context, and in both countries,student learning was driven by assessment. Curriculum design differences may have con-tributed to the British view wherein students were less likely to feel time pressure andenjoyed studying anatomy more than their Chinese counterparts. Different teachingapproaches resulted in British students being more likely to recite definitions to learn,and the Chinese students found learning from cross-sectional images easy. Cultural differ-ences may account for the observation that British students were more inclined to askquestions in class, and the preference of Chinese students to study in small groups. Thefindings give evidence to show how ‘cultures of learning’ influence students’ approachesand indicate the importance of cultural influences as factors amongst international andhome learner groups. Anat Sci Ed 2:49–60, 2009. © 2009 American Association of Anatomists.

Key words: learning styles; cultures of learning; gross anatomy;Chinese students;medical students

INTRODUCTION

The learning of anatomy is fundamental for medical andnursing students and those studying for the allied health pro-fessions. In this context, it is important to understand stu-dents’ learning styles and strategies: this understanding is akey part of developing a more learner-centered approach andof seeking ways to improve student learning. Anatomy teach-ers need to know how students approach the learning of theirsubject, and whether and how different groups of learnersmay adopt different learning styles and strategies. With rele-vant knowledge of their students’ learning styles, teachersmay consider whether and how to adjust their methods ofteaching or assessment, and how learning materials shouldmatch the styles of learning of particular students. In particu-lar, for the focus of this paper, some groups of students fromdiverse educational and cultural backgrounds may adoptlearning styles and strategies that differ from those of their

peers. Because increasing numbers of those taking anatomycourses are international students, whilst others are from mi-nority ethnic groups, a cross-cultural perspective is increas-ingly important. It is also the case, as language and literatureteachers or anthropologists know, that by studying other cul-tures we are in a better position to reflect on and criticallyappreciate our own culture. This would surely apply to anexamination of cross-cultural ways of learning anatomy.

Concerning learning styles and strategies two assumptions wecannot afford to make are, first, that all students adopt the sameways of learning—on the contrary, anecdotal evidence and com-mon observation of students in clinical practice indicates thatthere is some variety, for example, in note-taking methods or inways of learning and memorizing anatomical terminology. Sec-ond, we cannot assume that students use the same learning stylesand strategies for all subjects; some students may well adopt dif-ferent selections from a repertoire of ways of learning to matchtheir perception or experience of learning in different disciplinesor learning specific topics. Possibly, there are particular learningstyles adopted by different students for anatomy which varyfrom how the same students learn other clinical subjects.

LEARNING STYLES AND STRATEGIESIN MEDICAL SCIENCES

Some research about students’ learning styles and strategies inmedical education has been published, especially concerning

*Correspondence to: Dr. B.S. Mitchell, Faculty of Health and LifeSciences, De Montfort University, Leicester LE1 9BH, UnitedKingdom. E-mail: bmitchell@dmu.ac.uk

Received 12 January 2009; Revised 20 February 2009; Accepted 25February 2009.

Published online 3 April 2009 in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ase.73

© 2009 American Association of Anatomists

Anatomical Sciences Education MARCH/APRIL 2009 Anat Sci Ed 2:49–60 (2009)

cross-cultural perspectives (see ‘‘Discussion’’). Other research-ers have compared one teaching method with another, e.g.group discussion versus lectures, to show student preferen-ces for (and greater knowledge retention in) more interac-tive styles (Costa et al., 2007), whilst others are concernedwith the validity of measures of learning styles using differ-ent instruments (Chapman and Calhoun, 2006; Cook andSmith, 2006; Klein et al., 2007). A more general discussionof cognitive styles and learning strategies may be found inthe work of Riding and Rayner (1998). It has been arguedthat teachers in medical settings may have their own pre-ferred teaching styles, whereas learners have their ownlearning styles, and that teachers should therefore varytheir methods and styles to take account of learners’ stylis-tic variation; however, some degree of mismatch betweenteachers’ and learners’ respective styles may stimulate flexi-bility in student learning, whereas a constant match mayinduce boredom among learners (Vaughn and Baker, 2001).Hence, a flexible balance, rather than an absolute match, isbelieved to be necessary. Mitchell et al. (2004) investigatedthe shared learning experiences of anatomy in multiprofes-sional courses and found that assessment results variedwidely among different health professional learners andsuggested that this might be related to factors such as thevalue placed upon anatomy by the profession-specifictutors present in practical classes. Within medical fields,there is evidence of some variation between ways of learn-ing in clinical practice amongst different professionalgroups, such as medical students, nurses, midwives andspeech and language therapists (Cortazzi et al., 2001).Whilst this shows some variation across student groups,other researchers have looked at learning style differencesbetween students, such as surgical trainees, and their medi-cal teachers (Stimpson and Plusa, 2004) and the effect oflearning style differences on undergraduate clinical exami-nation performance (Lynch et al., 1998; Martin et al.,2000), and on postregistration continuing medical educa-tion preferences (Robinson, 2002). However, it should notnecessarily be assumed that students’ learning style prefer-ences are fixed, there is some research comparing changesin approaches to learning during professional training fordental and medical students (Linderman et al., 2001).Indeed, educationally, one hopes for changes and develop-ments in learning styles as students become more advancedor mature, and master increasingly complex concepts andmaterial.

The present study focuses on British and Chinese medicalstudents’ choices of learning styles and strategies for learninganatomy, and the effect of cross cultural differences on thesechoices. Exploration of the culture of learning is as importantas identifying learning strategies and styles. Thus, two specificresearch questions arise: first, what learning styles and strat-egies do students report when they are learning anatomy and,second, in learning anatomy are there cross-cultural differen-ces in the selection and use of learning styles and strategies?These questions have a wider relevance for educators inter-ested in the teaching and learning of science and health dis-ciplines in general, and those who are interested in cross-cultural and comparative medical education. The implica-tion of the findings has an impact on how teachers canadapt their teaching to meet the needs of learners and onhow students from different cultures may share informa-tion on learning styles to broaden their vision and aware-ness of learning.

METHODS

The present study has employed quantitative methods of datacollection and statistical analysis. The questionnaire wasadministered to students in four medical schools, two in Brit-ain and two in China. The curriculum design and how itincluded anatomy varied at these different medical schools.At the University of Durham, anatomy was included in a sys-tems approach; at the University of Manchester, the approachwas to utilise a problem-based learning approach, with somedirect anatomy teaching in the dissecting room too. In bothChinese Universities (Medical School of Nanjing University;Shandong University School of Medicine), the anatomycourses were traditional, with dissection laboratory exercises.A questionnaire entitled ‘‘Methods and styles for learninganatomy by medical students’’ was designed in English thentranslated into Chinese. The translation was verified by staffin Chinese Studies at the University of Cambridge. Completedquestionnaires were applied during a class to maximizereturn. British and Chinese students were asked to reporttheir choices of commonly recognized learning styles/strat-egies and their opinions of using these in their anatomy learn-ing. The questionnaire responses were graded on a Likertscale.

The questionnaire had three sections. Section 1 containedtwo questions that identified the students’ current study leveland the level when anatomy was taught. Section 2 had 18statements on approaches to learning anatomy, with possibleresponses of never, sometimes, often, always and not consid-ered. Section 3 contained 12 statements on opinions aboutlearning anatomy in medical studies, with possible responsesof disagree, moderately disagree, moderately agree, agree andnot applicable (Appendix shows the questionnaire in English).

Administration of the Questionnaire

The English version of the questionnaire was administered tofirst and second year medical students in the two British uni-versities by the lecturers involved in Anatomy teaching. Theiranatomy teaching was spread over both the first and secondyear in the curriculum. The Chinese version of the question-naire was administered in the two Chinese universities by thelocal teachers to students during the year in which they stud-ied anatomy. One Chinese university had two differentintakes of students: a 5-year medical curriculum in which theanatomy teaching was delivered in the first year; and a 7-yearmedical curriculum in which the teaching was delivered inthe second year. The other Chinese university had only a 7-year curriculum with the anatomy teaching in the secondyear. The completed questionnaires were collated and proc-essed using Microsoft1 Office Excel (Microsoft Corp., Red-mond, WA).

Data Processing

A total of 250 valid questionnaires were returned from thetwo Chinese Medical Schools and 443 from the two BritishSchools. Questionnaires were distributed and completed fol-lowing a teaching session at which all students attended.Responses for Sections 2 and 3 were coded with numeric val-ues (see Table 1) for statistical analysis where the numericvalues were treated as independent Ordinal data. Invalidquestionnaires were excluded from analyses.

50 Mitchell et al.

Statistical Analyses

The difference between the British and Chinese responses foreach statement was assessed using a Mann–Whitney test. Thedifference between responses from Chinese and British medi-cal students was deemed statistically significant when P wasless than 0.05 and highly significant when P was less than0.01. Statistical analysis was carried out using StatisticalPackage for the Social Sciences (SPSS) software, version 15.0for Windows (SPSS, Inc., Chicago, IL).

RESULTS

Section 2—Learning Style

The results of statistical analysis for the statements 1–18 inthe questionnaire are shown in Table 2. The coding strategyfor data analysis is shown in Table 1 and the mapping ofchoices for each statement according to the countries (Fig. 1)shows the differences in the distribution of the responses. Thediameter of the circles reflects the strength of opinion.

In the statistical analysis of the statements 1–18, 11 indi-cated highly significant (P < 0.01) and 1 indicated significant(P < 0.05) differences between the British and Chinese stu-dents’ responses. For six statements, similarities of opinionwere indicated by P values (P � 0.05).

Highly significant

1. Chinese students are far more likely to use the approachof ‘tackle whole area first then . . . to easier and smallerpieces’ (P 5 0.000).

2. British students are significantly more likely to make anduse revision cards (P 5 0.000).

3. British students are significantly more likely to raise ques-tions in class (P 5 0.000).

4. British students are significantly more likely to raise ques-tions after class (P 5 0.000).

7. More British students prefer to use study aids than theirChinese counterparts (P 5 0.004).

9. British students are significantly more likely to use an‘‘image in mind’’ whilst studying anatomy (P 5 0.000).

10. British students are more likely to find it easiest to learnaccording to body regions (P 5 0.004).

11. British students are more likely to find it easiest to learnaccording to different systems (P 5 0.001).

12. British students are more likely to learn by reciting defi-nitions (P 5 0.001).

17. Chinese students are far more likely to find learning fromcross-sectional images easy (P 5 0.000).

18. British students are much more likely to use web-basedresources (P 5 0.000).

Significant

15. Chinese students are significantly more likely to preferhands-on dissection (P 5 0.021).

Non significant

5. Both groups often find it easier to understand anatomy ina clinical context (P 5 0.206).

6. Both groups often find it easier to remember anatomy ina clinical context (P 5 0.791).

8. In both countries, the students’ learning is often drivenby format of assessments (P 5 0.710).

13. Students from both countries often prefer using cadaversand/or prosection (P 5 0.759).

14. Students from both countries often prefer to learn bymemorizing facts (P 5 0.734).

16. No difference is found in preference of having a demonstratorcarrying out dissection in laboratory sessions (P5 0.397).

Section 3—Opinions About Anatomy Learning

The results of statistical analysis for the statements 19–30 inthe questionnaire are shown in Table 3. The coding strategyfor data analysis is shown in Table 1 and the mapping in Fig-ure 2 shows the differences in the distribution of theresponses between the countries. The diameter of the circlesreflects the strength of opinion. Statistical analysis of thestatements 19–30 shows that 8 out of the 12 statements indi-cated highly significant differences (P < 0.01) and 1 signifi-cant difference (P < 0.05) between the responses of the Brit-ish and Chinese students. For three statements, similarities ofopinion were indicated by the P value (P � 0.05).

Highly significant

20. British students enjoy learning anatomy more than theirChinese counterparts (P 5 0.000).

21. Chinese students found learning head and neck anatomyusing cadavers more difficult than their British counterparts(P 5 0.000).

22. Chinese students found learning anatomy of externalgenitalia using cadavers more difficult than their Britishcounterparts (P 5 0.000).

24. Students from both countries moderately disagree thatsufficient time is given in the curriculum, though thisview is significantly less strongly held by British students(P 5 0.003).

25. British students are significantly more likely to believelearning anatomy helps understanding of other subjects(P 5 0.003).

Table 1.

Numeric Coding for Sections 2 and 3 of the Questionnaire on Methods and Styles for Anatomy Learning

Section 2 Never Sometimes Often Always Not Considered

Coding 1 2 3 4 5

Section 3 Disagree Moderately Disagree Moderately Agree Agree Not Applicable

Coding 1 2 3 4 5

Anatomical Sciences Education MARCH/APRIL 2009 51

Table

2.

DescriptiveStatisticsandResultsofMann–W

hitneytests

forSection2(AnatomyLearningStyle)

Statement

Country

N25th

Centile

Median

75th

Centile

P

1Ipreferto

tackle

thewhole

areafirstandthenbreakthingsdownto

easierandsmallerpieces.

China

240

23

30.000

Britain

426

22

3

2Ilearn

itbymakingmyownstudyorrevisioncardswithpictures,diagramsandnotes.

China

245

11

20.000

Britain

429

22

3

3Ifeelconfidentaboutaskingmyteacherquestionsin

class.

China

246

12

20.000

Britain

432

23

4

4Ifeelconfidentaboutaskingmyteacherquestionsafterclass.

China

244

12

20.000

Britain

434

23

4

5Ifinditeasierto

understandwhenitis

putinto

aclinicalcontext.

China

242

33

40.206

Britain

428

33

4

6Ifinditeasierto

rememberwhenitis

putinto

aclinicalcontext.

China

246

33

40.791

Britain

427

33

4

7Ipreferto

useavariety

ofstudyaids,suchasplasticmodels,im

ages,bones,diagrams.

China

246

33

40.004

Britain

431

34

4

8Ifindthatmylearningis

drivenbytheform

atofassessment.

China

245

23

30.710

Britain

426

23

3

9Ihaveanim

agein

mymindoftheareaIam

studying.

China

246

22

30.000

Britain

425

23

4

10

Ifinditeasiestto

learn

accordingto

theregionsofthebody.

China

247

23

30.004

Britain

426

23

3

11

Ifinditeasiestto

learn

onaccordingto

differentsystems.

China

245

22

30.001

Britain

425

23

3

52 Mitchell et al.

Table

2.

(Continued)

Statement

Country

N25th

Centile

Median

75th

Centile

P

12

Ilearn

itbyrecitingthedefinitions.

China

241

12

20.001

Britain

428

12

3

13

Ipreferto

usecadave

rsand/orprosections.

China

247

23

40.759

Britain

424

23

4

14

Ilearn

itbymemorizingfacts.

China

245

23

30.734

Britain

426

23

3

15

Ipreferdoinghands-ondissectionin

thelaboratory.

China

245

23

40.021

Britain

424

23

3.5

16

Ipreferhavingademonstratordoingdissectionin

laboratory

sessions.

China

243

23

40.397

Britain

423

23

3

17

Ifindlearningfrom

cross-sectionalim

ageseasy.

China

244

22

30.000

Britain

425

12

3

18

Iuseweb-basedresourcesto

help

me.

China

248

11

20.000

Britain

427

22

3

Anatomical Sciences Education MARCH/APRIL 2009 53

26. Chinese students are significantly more likely to findhands-on dissection very useful (P 5 0.012).

28. Chinese students are significantly more likely to hold theview that learning anatomy takes up more time thanother subjects (P 5 0.000).

30. Chinese students are significantly more likely to learnanatomy in small groups (P 5 0.000).

Significant

19. Significant difference is found in the opinion between theBritish and Chinese students about whether their way oflearning is suited for anatomy study (P 5 0.023).

Non significant

23. There is no significant difference between British andChinese students in the likelihood of forgetting anatomi-cal knowledge after exams (P 5 0.961).

27. Students from both countries moderately agreed thatthey cannot learn anatomy from books and lectures alone(P 5 0.392).

29. There is no difference between students from both coun-tries agree in their preference for learning individually (P5 0.603).

DISCUSSION

Learning Style and Strategy: Conceptsand Definitions

The term ‘learning styles’ refers to cognitive differences in theways in which individuals learn. A learning style is a rela-tively permanent, characteristic approach in a wide range ofperceptions and learning behaviors to different tasks and sit-uations (Cassidy, 2004). Learning strategy is defined as the

methods individuals choose to use in their learning (Schmeck,1986). Typically, learning styles are investigated anddescribed with many models containing different sets ofterms, usually three or four basic categories which are usedto profile learners, e.g., Sternberg (1995) proposes a ‘theoryof mental self-government’ which uses the metaphor of gov-ernment as a source of terms and four categories. A style is away of thinking; people do not use one style only, but have a

Figure 1.

Anatomy learning styles of British and Chinese medical students. Distribution of responses to statements on approaches to learn anatomy (statements 1–18 in Sec-tion 2). For details, see Table 2. Choices are: (1) never, (2) sometimes, (3) often, (4) always, and (5) not considered.

Figure 2.

Opinions of British and Chinese medical students on anatomy learning. Distribu-tion of responses to statements on opinions about anatomy learning (statements19–30 in Section 3). For details, see Table 3. Choices are: (1) disagree, (2) mod-erately disagree, (3) moderately agree, (4) agree, and (5) not applicable.

54 Mitchell et al.

Table

3.

DescriptiveStatisticsandResultsofMann–W

hitneytests

forSection3(O

pinionin

AnatomyLearning)

Statement

Country

N25th

Centile

Median

75th

Centile

P

19

Mywayoflearningis

wellsuitedto

thestudyofanatomy.

China

240

22

30.023

Britain

435

23

3

20

Ienjoystudyinganatomy.

China

236

33

40.000

Britain

437

34

4

21

Ifinditdifficultto

studytheanatomyoftheheadandneckusingcadavericspecim

ens.

China

236

23

40.000

Britain

432

22

3

22

Ifinditdifficultto

studytheanatomyoftheexternalgenitalia

usingcadavericspecim

ens.

China

233

23

30.000

Britain

431

12

3

23

Icanlearn

anatomyformyexams,butafterw

ardsIseem

toforgetitvery

quickly.

China

235

23

40.961

Britain

430

23

4

24

There

issufficienttimegivento

anatomyin

thecurriculum.

China

239

12

30.003

Britain

430

12

3

25

Ifindthatstudyinganatomyhelpsmeto

understandothersubjects

better.

China

238

33

40.003

Britain

429

33

4

26

Ifindhands-ondissectionin

thelabvery

useful.

China

237

34

40.012

Britain

429

33

4

27

Icanlearn

anatomyfrom

booksandlecturesalone.

China

237

12

20.392

Britain

426

12

2

28

Ifindittakesupmore

timethanothersubjects.

China

236

33

40.000

Britain

422

23

4

29

Ipreferto

learn

itonmyown.

China

239

22

30.603

Britain

428

22

3

30

Ipreferto

learn

itwithotherstudents

insmallgroups.

China

238

33

40.000

Britain

429

23

4

Anatomical Sciences Education MARCH/APRIL 2009 55

profile of styles or preferences in ways of using their abilities.Styles can vary from one task to another, and may be social-ised in families, schools and cultural contexts but can changeover time. A full discussion of learning styles and learningstrategies may be found in Riding and Rayner (1998).

Learning Styles Across Cultures and Culturesof Learning

In the classroom, studies on cross-cultural learning haveshown there are variations in preferred learning styles from dif-ferent cultural groups, although some common learning stylesare shared by these learners (Oxford and Anderson, 1995;Oxford, 1996). Cortazzi and Jin (1996; 2002) have arguedthat the preference of learning styles can be rooted in learners’cultures of learning. To develop this concept, Jin and Cortazzi(1997; 1998) have used questionnaires, together with class-room observation, interviewing and photography, to investigatestudents’ expectations of teachers, what being a ‘good student’means, and students’ ideas about classroom interaction, e.g.whether and how they ask teachers questions. Cultures oflearning, as a term, encompasses more than learning styles andstrategies within a broader framework of cultural expectationsand socialisation into ways of learning and ways of using lan-guage in the classroom. Their results (Jin and Cortazzi, 1997;1998; Cortazzi and Jin, 1996; 2001; 2002) show statisticallysignificant differences in learners’ perceptions in China, Malay-sia, United Kingdom, Japan and Turkey. In the case of Chinesestudents, attitudes and conceptions of learning and classroominteraction can be traced to specific elements of the Confucianheritage but contemporary Chinese cultures of learning are alsoundergoing changes (Jin and Cortazzi, 2006). Further research(Jin and Cortazzi, 2008; Cortazzi et al., 2009) on investigatingstudents’ metaphors for ‘teacher’ and ‘learning’ in differentcountries shows that learners’ underlying conceptions of learn-ing, and their perceptions of the role of the teacher, have somecore common features, but with a very different emphasis andsome unique features, in China, United Kingdom and Lebanon.The authors suggest that different mental models exist whichaffect the learners’ expectations and interpretations of class-room practices which, they argue, indicate different mentalmodels of learning which affect the learners’ expectations andinterpretations of classroom practices.

Learning Styles and Cultures of Learningin Anatomy

In the present study, Chinese students appear far more likelyto use the approach of tackling a whole area of anatomy first,rather than studying smaller pieces. Why this more holisticapproach should be so is unclear, though perhaps it is toobtain an overview which aids understanding, in accordancewith Gestalt psychology. In contrast, the British studentsadopt a more deconstructionist position, rather than a didac-tic holistic view, perhaps reflecting a cultural difference inhow the body, mind and spirit are viewed. That both Britishand Chinese students tend to forget ‘learned facts’ afterexams is not surprising since rote learning has been acknowl-edged to represent superficial rather than deep learning(Lonka and Lindblom-Ylanne, 1996). Indeed, in this studystudents from both countries tend to use memory to learn thesubject, with British students significantly more likely torecite definitions as part of their learning strategy. In thestudy by Levinsohn (2007), in contrast to the present study,

the ability to rote learn factual material was noted as a char-acteristic of Chinese students, although Levinsohn’s studentswere not studying anatomy. Furthermore, Kember (1999) andearlier Entwistle and Ramsden (1983) have shown that Chi-nese students use repetition to gain deeper levels of under-standing. In the present study, the more holistic Chineseapproach observed may facilitate understanding of the rela-tionship between different anatomical parts. Perhaps the factthat Chinese students are more likely to learn from cross-sec-tional images supports this, and thus less reliant on the recita-tion needed by the British with their deconstructivist strategy,where a holistic perspective is less easy to appreciate. In con-trast from their original deconstructivist approach, the subse-quent reconstruction of a three-dimensional mental map ofthe body by the British students requires a significant degree ofintegration of information; it may be this deconstructivistapproach (rather than tackling the whole area first) may be aprerequisite for reassembling a holistic map. Significantly, stu-dents from both countries found understanding anatomy in aclinical context a helpful approach which may be an indictmentof rote learning, and a support for the view that learning inmedicine benefits from contextualisation, as experienced inmany contemporary curricula, in the UK at least. Whether theemphasis of the more traditional approach in the Chinese cur-ricula leads to a less enjoyable experience, as suggested by thestudy, is an intriguing affirmation for a more progressive peda-gogy. There are also certain shared styles that perhaps reflectthe discipline and the facilities available within the institution asmuch as cultural differences, such as the preference for usingcadavers and/or prosections (Smith and Matthias, 2007), andmemorizing facts. Memorization as a learning strategy is oftencriticized by educationalists, but this omits to acknowledge therole anatomy teaching plays in providing a grounding in the useof a universal terminology which is the currency of clinical med-icine.

Although such learning as an educational strategy is lessthan ideal, the service it performs for the learner is undeni-able from a professional perspective. The advantages and dis-advantages of learning from cadavers are more fully devel-oped by McLachlan and Patten (2006). The British preferencefor web-based material as a support for their learning maysimply be a reflection of the increasing general dependence ofBritish students on this medium, which itself reflects the suit-ability of ‘e-tivities’ for learning anatomy which is a highlyvisual discipline (Mitchell, 1998; Jastrow and Vollrath,2003). However, that the Chinese students find greater diffi-culty in learning the anatomy of the head and neck region isa question of degree since it is well acknowledged within theanatomy profession that British students also find this of allregions of the body the most challenging.

In the British culture of learning students are encouragedto ask questions during and after class. In China in-classquestions are not expected, where students are less challeng-ing of their academic staff whose position is unquestioned.This is reinforced by the study of Levinsohn (2007) whosefindings demonstrated similar regard for the authority of theirteachers by Chinese students. Indeed, in a Confucian HeritageCulture (Watkins and Biggs, 2001) the teacher is generallywell respected even as a guru figure for students. Moreover,Chinese students do not tend to ask as many questions asWestern students (Biggs, 1996). In the Chinese culture, ques-tioning may be seen as a challenge to the teacher (Ginsberg,1992). However, Chinese teachers assume the role of mentorfar more than Western teachers, and they interact with

56 Mitchell et al.

students after class in a more informal mode (Stevenson andStigler, 1994). The study of Watkins and Biggs (2001) hasshown that Western students tend to believe understandingresults from sudden insight, that academic success is primar-ily attributed to innate ability. Chinese students, on the otherhand, tend to attribute understanding, and hence academicsuccess, primarily to effort. This Chinese view results in seri-ous study, in which students pay strict attention in class andto other behaviors likely to gain positive learning outcomes(Dweck and Grant, 2001).

These cultural differences may explain the strong Chinesepreference for a small group autonomous learning approach(Jin and Cortazzi, 1997), as this is their main opportunity todiscuss and consolidate their learning. The length of timeallocated to British curricula (two years) may offer significantadvantages in allowing students time to process and consoli-date their learning, and perhaps should be considered by theChinese Schools. Equally, consideration of adoption of amore holistic approach in British curricula design may alsooffer benefits to aid student understanding. Whether thedetailed visual approach consistently required in the learningof Chinese literacy is an aid to formulation of a mental three-dimensional map of the human body in the Chinese medicalschools is an advantage yet to be proven. Though the evi-dence that Chinese students are significantly more likely tofind learning from cross sectional images easier indicates thatthis may be a likely explanation, although the Chinese curric-ula did not include a specific medical imaging module. Never-theless, in one of the British curricula of the present studyattempts to promote three-dimensional understanding havebeen further advanced (Patten, 2007), in which three-dimen-sional anatomy has been linked with living anatomy.

CONCLUSION

Teachers and learning material designers need to take intoaccount students’ different learning styles and strategies toenhance their learning, so that students become aware oftheir own repertoire of learning styles and strategies, not onlyto focus and enhance their learning in relation to particulartasks, but also to be aware of likely cultures of learning asfactors in student diversity, particularly for international stu-dent groups. Learning styles may be influenced by culture,and students from different cultures use different learningstrategies. The two questions raised in the study have beenaddressed, and further evidence provided that cultural influ-ences are significant factors in learning anatomy, and this issomething that merits further consideration. Account shouldbe taken of cultures of learning in the design of anatomicalteaching and learning material. Alternative approaches toanatomy teaching may be important to meet needs of anincreasing international population of students. The featuresof curriculum design in the two countries that offer benefitsto student learning should be considered by the two coun-tries: the holistic approach in Britain and spreading of teach-ing over two years in China.

NOTES ON CONTRIBUTORS

BARRY S. MITCHELL, Ph.D., is the Dean of the Faculty ofHealth and Life Sciences at De Montfort University, Leicester,United Kingdom. His research interest is directed towards

clinically oriented anatomical variations, medical educationand computer-based learning.

QIN XU, Ph.D., is a senior lecturer in the School of AlliedHealth Sciences, De Montfort University, Leicester, UnitedKingdom.

LIXIAN JIN, Ph.D., is a reader in Linguistics and HealthCommunication at De Montfort University, Leicester, UnitedKingdom. Her research focuses on cultures of learning andteaching and intercultural and interprofessional communica-tions.

DEBRA PATTEN, Ph.D., is a lecturer in Anatomy andMedical Education in the School of Medicine and Health,University of Durham, Stockton on Tees, United Kingdom.Her current research is on medical education, particularlyrelated to anatomy teaching, learning and assessment.

INGRID GOULDSBOROUGH, Ph.D., is a senior teachingfellow at the Faculty of Life Sciences, University of Manches-ter, Manchester, United Kingdom. She is involved in thedesign and delivery of anatomy teaching to medical, dentaland allied health sciences students.

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APPENDIX

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