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Table 1 Four cultural dimensions, derived from Hofstede (2011)

From: Exploring cultural and linguistic influences on clinical communication skills: a qualitative study of International Medical Graduates

Dimension Definition Countries
Power distance Relates to the unequal distribution of power in a society and the degree to which less powerful members accept this. People in societies exhibiting a large degree of power distance accept a hierarchical order in which everybody has a place and which needs no further justification. In medicine doctors are seen as ‘God-like’ and the consultations are controlled by the doctor. In low power distance societies patients treat doctors as equals. Higher power distance scores are seen in Eastern European, Latin, Asian and African countries.
Lower scores are seen in Germanic and English-speaking Western countries
Uncertainty avoidance Reflects the extent to which members of a society attempt to cope with anxiety by minimising uncertainty. Uncertainty avoiding cultures feel threatened by unknown or unstructured situations. They try to prevent such situations from arising by having strict laws, rules and behaviour codes. In medicine it has been shown that strong uncertainty avoiding societies place less emphasis on building rapport with patients.23 Uncertainty avoiding scores are higher in Latin countries, Japan, countries in East and Central Europe and those that are German speaking.
Lower scores are seen in English speaking, Nordic and Chinese culture countries
Individualism vs. Collectivism This the degree to which people in society are integrated into groups. A culture is deemed ‘Individualist’ if the members of the group are supposed to care for themselves and their immediate family only; the ties between individuals are loose. ‘Collectivist’ culture refers to societies in which people from birth onwards are integrated into strong, cohesive in-groups, which throughout a person’s lifetime continue to protect them in exchange for unquestioning loyalty. Individualism is seen in the UK and other developed and Western countries.
Collectivism prevails in less developed and Eastern countries, with Japan taking a middle position on this dimension
Masculinity vs. Femininity This looks at differences between male and female values along a scale from “assertiveness and competition” to “caring and modest”. In masculine cultures the differences between gender roles are more dramatic such that men should be seen as assertive and ambitious, whilst women may not have these qualities. In feminine cultures greater emphasis is placed by both men and women on relationships and quality of life. Masculine cultures see open displays of competition between students who make themselves visible in class and over-rate their own performance High masculinity scores are seen in the UK, Japan, German speaking countries and Mexico.
Low scores are seen in Nordic countries and in the Netherlands and moderately low in some Latin and Asian countries like France, Spain and Thailand