Beyond Individualism and Independence: Exploring Collectivism and Interdependence as Paradigms of Healthcare and Health Professions Education

Eusang Ahn; Stefanie S. Sebok-Syer; Jerry M. Maniate; Kaitlin Endres; Warren J. Cheung

doi:10.5334/pme.2000

Figures & Tables

Article selection process for narrative review of the literature on the implications of collectivism and interdependence, 1990–2024.

Table 1

Summary of articles (n = 63) included in narrative review, 1990–2024.

TITLE	AUTHOR	YEAR	TYPE	SOURCE	DISCIPLINE(S)	TOPIC(S)
A Dependent Structure of Interdependence: Structure and Agency in Relational Perspective	Crossley	2022	Article	Sociology	Sociology, Social psychology	Interdependence, Culture
A Scoping Review of Approaches for Measuring ‘Interdependent’ Collaborative Performances	Sebok-Syer, Shaw, Asghar et al	2021	Article	Medical Education	Health professions education	Interdependence, Assessment, Culture, Teamwork
A Theory of Collective Competence: Challenging the Neo-liberal Individualisation of Performance at Work	Boreham	2004	Article	British Journal of Educational Studies	Education, Teamwork	Collectivism, Assessment, Culture, Interdependence, Teamwork
Academic-Practice Partnerships: The Interdependence Between Leadership and Followership	Everett	2016	Article	Nursing Science Quarterly	Health professions education	Leadership, Followership, Teamwork, Interdependence
Awakening Compassion at Work: The Quiet Power That Elevates People and Organizations	Worline, Durron	2017	Book	Berrett-Koehler Publishers	Psychology	Compassion, Culture, Teamwork
Burnout, Mistreatment and Stress (in A Practical Guide for Medical Teachers)	Balaam, Harris	2021	Book	Elsevier Health Sciences	Health professions education	Compassion, Well-being
Can 40 Seconds of Compassion Reduce Patient Anxiety?	Fogarty, Curbow, Wingard et al	1999	Article	Journal of Clinical Oncology	Psychology, Economics	Compassion
Caring For Others Without Losing Yourself: An Adaptation of the Mindful Self-Compassion Program for Healthcare Communities	Neff, Knox, Gregory	2020	Article	Journal of Clinical Psychology	Psychology, Healthcare	Compassion, Well-being
Choosing Service Over Self-Interest	Block	1996	Book	Berrett-Koehler Publishers	Leadership, Management	Leadership, Interdependence, Collectivism, Culture
Collective Competence: Moving from Individual to Collaborative Expertise	Langlois	2020	Article	Perspectives on Medical Education	Health professions education	Teamwork, Collectivism, Assessment, Culture
Compassion and Efficiency Not Mutually Exclusive in Health Care	Brown	2019	Article	Canadian Medical Association Journal	Psychology, Economics	Compassion
Compassionomics: The Science and Practice of Caring	Lains, Johnson, Johnson	2024	Article	American Journal of Ophthalmology	Psychology, Economics	Compassion
Conceptualization of Jeong and Dynamics of Hwabyung	Chung, Cho	2006	Article	Psychiatry Investigation	Psychology	Collectivism, Culture
Considering the Interdependence of Clinical Performance: Implications for Assessment and Entrustment	Sebok-Syer, Chahine, Watling et al	2018	Article	Medical Education	Health professions education	Assessment, Interdependence, Teamwork
Coproducing Health Professions Education: A Prerequisite to Coproducing Health Care Services?	Englander, Holmboe, Batalden et al	2020	Article	Academic Medicine	Health professions education	Teamwork, Leadership, Culture
Cross-cultural Management	Abdelazim	2022	Article	Human Resource and Leadership Journal	Business, Management	Culture, Collectivism
Cultural Consequences: Comparing Values, Behaviours, Institutions, and Organizations across Nations	Hofstede	2001	Book	Sage Publications	Social psychology	Collectivism, Culture
Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care	Betancourt, Green, Carillo et al	2003	Article	Public Health Reports	Sociology, Healthcare	Culture, Injustice
Dimensionalizing Cultures: The Hofstede Model in Context	Hofstede	2011	Article	Online Readings in Psychology and Culture	Social psychology	Collectivism, Culture
Distant and Hidden Figures: Foregrounding Patients in the Development, Content and Implementation of Entrustable Professional Activities	Sebok-Syer, Gingerich, Holmboe et al	2021	Article	Academic Medicine	Health professions education	Assessment, Interdependence
Effective Followership: A Standardized Algorithm to Resolve Clinical Conflicts and Improve Teamwork	Sculli, Fore, Sine et al	2015	Article	Journal of Healthcare Risk Management	Health professions education, Management	Followership, Teamwork, Leadership
Elucidating System-level Interdependence in Electronic Health Record data: What Are the Ramifications for Trainee Assessment?	Sebok-Syer, Pack, Shepherd et al	2020	Article	Medical Education	Health professions education	Assessment, Interdependence
Embracing the Collective Through Medical Education	Bleakley	2020	Article	Advances in Health Sciences Education	Health professions education	Collectivism, Culture
Embracing the Tension Between Vulnerability and Credibility: ‘Intellectual Candour’ in Health Professions Education	Molloy, Bearman	2019	Article	Medical Education	Health professions education	Culture
Emic Understandings of Attentiveness and its Related Concepts Among Japanese	Fukushima	2016	Article	East Asian Pragmatics	Psychology	Collectivism, Culture
Epistemic Solidarity in Medicine and Healthcare	Pot	2022	Article	Medicine, Health Care and Philosophy	Philosophy, Bioethics	Solidarity, Injustice
Equity, Diversity, and… Exclusion? A National Mixed Methods Study of “Belonging” in Canadian Undergraduate Medical Education	Sivananthajothy, Adel, Afhami et al	2023	Article	Advanced in Health Sciences Education	Health professions education	Well-being, Professional Identity, Collectivism, Injustice
Fitting in While Standing Out: Professional Identity Formation, Imposter Syndrome, and Burnout in Early-career Faculty Physicians	Vaa Stelling, Andersen, Suarez et al	2023	Article	Academic Medicine	Health professions education	Professional Identity, Well-being, Culture
Followership Theory: A Review and Research Agenda	Uhl-Bien, Riggio, Lowe et al	2014	Article	Leadership Quarterly	Leadership, Management	Leadership, Followership
Improving Knowledge and Behavior to Leadership and Followership Among the Interprofessional Team	Tschannen, Dron, Tedesco	2018	Article	International Journal of Medical Education	Health professions education	Teamwork, Followership, Leadership
Individualism-collectivism in Hofstede and GLOBE	Brewer, Venaik	2011	Article	Journal of International Business Studies	Management	Culture, Collectivism
Interdependence Theory (in APA Handbook of Personality and Social Psychology)	Van Lange, Balliet	2015	Book	American Psychological Association	Social psychology	Interdependence, Culture
Leadership and Followership Dynamics in Interprofessional Health Care Teams: Attending Physician Perspectives	Barry, Teunissen, Varpio et al	2024	Article	Academic Medicine	Health professions education, Military	Leadership, Followership, Teamwork
Leadership and Followership in Military Interprofessional Health Care Teams	Barry, Bader-Larsen, Meyer et al	2021	Article	Military Medicine	Leadership, Management	Leadership, Followership
Leadership and the New Science: Learning About Organization from an Orderly University	Wheatley	1992	Book	Berrett-Koehler Publishers	Leadership, Quantum physics	Interdependence, Leadership
Leadership for Change in the Education of Health Professionals	Neufeld	1995	Book	Network Publications	Leadership	Culture, Leadership, Teamwork
Learning the Value of Africa’s Collectivism for an Individualistic Europe	Modesti, Becucci	2019	Article	Internal and Emergency Medicine	Psychology	Culture, collectivism
Leveraging Electronic Health Record Data and Measuring Interdependence in the Era of Precision Education and Assessment	Sebok-Syer, Small, Lingard et al	2024	Article	Academic Medicine	Health professions education	Assessment, Interdependence
Maslow’s Hierarchy of Needs: Does it Apply in a Collectivist Culture?	Gambrel, Cianci	2003	Article	Journal of Applied Management and Entrepreneurship	Management	Collectivism, Culture
Medical “Heroes” and the COVID-19 Pandemic	Lipworth	2020	Article	Journal of Bioethical Inquiry	Bioethics	Leadership, Professional Identity
Paradoxical Truths and Persistent Myths: Reframing the Team Competence Conversation	Lingard	2016	Article	Journal of Continuing Education in the Health Professions	Health professions education	Teamwork, Assessment
Professionalism and the Socialization of Medical Students	Hafferty	2008	Book	Cambridge University Press	Health professions education	Professional Identity, Collectivism
Reluctant Heroes: New Doctors Negotiating Their Identities Dialogically on Social Media	Dornan, Armour, Bennett et al	2023	Article	Medical Education	Health professions education	Leadership, Professional Identity
Riding The Waves of Culture: Understanding Cultural Diversity in Global Business	Trompenaars, Hampden-Turner	1998	Book	McGraw Hill	Management, Social psychology	Culture, Collectivism
Shared Minds: The New Technologies of Collaboration	Schrage	1990	Book	Random House	Teamwork, Management	Leadership, Teamwork, Collectivism
Situated Learning Theory in Health Professions Education Research: A Scoping Review	O’Brien, Battista	2020	Article	Advances in Health Sciences Education	Health professions education	Professional Identity, Collectivism
Situated Learning: Legitimate Peripheral Participation	Lave, Wenger	1994	Book	Cambridge University Press	Education, Psychology	Collectivism, Professional Identity
Solidarity in Biomedicine and Beyond	Prainsack, Buyx	2017	Book	Cambridge University Press	Bioethics, Philosophy	Solidarity, Policy, Injustice
Solidarity in Public Health Ethics and Practice: Its Conceptions, Uses and Implications	Bellefleur, Keeling	2015	Article	National Collaborating Centre for Healthy Public Policy (Canada)	Health policy, Bioethics	Solidarity, Policy, Injustice
Solidarity in the Moral Imagination of Bioethics	Jennings, Dawson	2015	Article	Hastings Center Report	Bioethics, Philosophy	Solidarity
Supportive and Collaborative Interdependence: Distinguishing Residents’ Contributions Within Health Care Teams	Sebok-Syer, Lingard, Panza et al	2023	Article	Medical Education	Health professions education	Assessment, Interdependence, Teamwork
The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change	Covey	2020	Book	Simon & Schuster	Leadership, Management	Culture, Interdependence
The Dangerous Pursuit of Independence	Regehr	2016	Abstract	The Centre for Health Education Scholarship, University of British Columbia	Health professions education	Interdependence, Collectivism, Culture
The Power of Followership: How to Create Leaders People Want to Follow, and Followers Who Lead Themselves	Kelley	1992	Book	Doubleday/Currency	Leadership, Management	Leadership, Teamwork, Followership
The Roseto Effect: A 50-year Comparison of Mortality Rates	Egolf, Lasker, Wolf et al	1992	Article	American Journal of Public Health	Epidemiology	Collectivism, Culture, Policy
The Wisdom of Teams: Creating the High-Performance Organization	Katzenbach, Smith	2006	Book	Harper Business Essentials	Management, Business	Teamwork, Leadership, Culture
The Wolf You Feed: Challenging Intraprofessional Workplace-based Education Norms	Stalmeijer, Varpio	2021	Article	Medical Education	Health professions education	Interdependence, Culture
Toward an Integrative View of Identity (in Handbook of Identity Theory and Research)	Vignoles, Schwartz, Luyckx	2011	Book	Springer	Psychology	Professional Identity, Collectivism
Toward Authentic Clinical Evaluation: Pitfalls in the Pursuit of Competency	Ginsburg, McIlroy, Oulanova et al	2010	Article	Academic Medicine	Health professions education	Assessment, Culture
Understanding Ubuntu and its Contribution to Social Work Education in Africa and Other Regions of the World	Mugumbate, Mpedziswa, Twikirize et al	2024	Article	Social Work Education	Education, Psychology	Collectivism, Culture
Unusually Low Incidence of Death From Myocardial Infarction: Study of an Italian American Community in Pennsylvania	Stout, Morrow, Brandt et al	1964	Article	The Journal of the American Medical Association	Epidemiology	Collectivism, Culture
What Does Solidarity Do for Bioethics?	Kolers	2021	Article	Journal of Medical Ethics	Bioethics, Philosophy	Solidarity
When I Say… Epistemic Injustice	Pervical, Martin, Maggio et al	2024	Article	Medical Education	Health professions education	Injustice, Solidarity

Table 2

Key themes identified through reflexive thematic analysis.

THEME	KEY INSIGHTS	REPRESENTATIVE CONCEPTS & FINDINGS
1. Reshaping the culture of healthcare and the learning climate of HPE	Culture is shaped by interactions, competitive vs collaborative dynamics, and the potential of solidarity.	Competitive medical school environments hinder teamwork. Siloed healthcare structures limit ‘collective responsibility.’ Communities of practice and interprofessional learning empower collective education. Solidarity (including epistemic solidarity) offers a collectivist counter to liberal individualism, fostering equity, reciprocity, and inclusive knowledge-sharing.
2. Accounting for individual contributions to the team	Performance and competence are relational, not individualistic. Teams thrive on interdependence and collective competence.	High-performing teams exceed expectations when members invest in each other’s growth. ‘Collective competence’ reframes assessment as distributed, contextual, and relational. Trainees inseparable from supervisors, systems, and patients → interdependence. Calls for assessment methods/language that capture team-based performance.
3. The many facets of leadership	Leadership is distributed, relational, and co-produced; followership and shared leadership are vital but constrained by hierarchy.	Shift away from the ‘heroic’ individual leader toward partnership and co-production. Followership is a necessary form of leadership. Shared leadership recognized but under-rewarded in hierarchical healthcare systems. Implications for redefining leadership in both healthcare and HPE.
4. Belongingness as an essential step towards collective well-being	Belonging and compassion underpin professional identity, well-being, and resilience.	Lack of belonging linked to imposter syndrome, burnout, depression (esp. underrepresented groups). Compassion (mindfulness, kindness, shared humanity) reduces stress and is cost-effective (‘compassionomics’). Professional identity shifts from ‘self’ → ‘self-in-relation’ → ‘self-in-profession.’ Socialization into the collective involves transformation of self, beyond skills/knowledge.

Beyond Individualism and Independence: Exploring Collectivism and Interdependence as Paradigms of Healthcare and Health Professions Education

Figures & Tables

Figure 1

Table 1

Table 2

Paradigm

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