Adult learning principles apply cross-culturally — adults everywhere want to participate in their own learning — but there's a caveat: Definitions of participation do vary.

Here's an example. The first time I spoke to a broadly multicultural audience was at the International Conference on Teaching Statistics in Marrakech. (Yes, I took the Marrakech Express to get there.) Participants came from six different continents.

My talk followed a paper quite literally read by a German physician. Since my presentation used paper dolls to teach a concept called Bayes' Theorem, I had the audience clear out the middle of the room and we laid the dolls on the floor where everyone could see them. I also had volunteers act as students who then worked with the dolls in learning to use the theorem. Audience members helped by pointing things out to the “students” and suggesting how best to proceed. In contrast to the German's presentation, where people sat and listened as he spoke, almost everyone was active during mine.

And when I finished, I got the same polite applause as the German who'd preceded me. There was another German, however, who approached me afterwards, red-faced and agitated. He almost sputtered as he told me, “Yours was a typically American presentation, and I can only watch CNN for 10 minutes before it makes me crazy.”

Avoid the CNN Craze

What he meant was that while he'd expected me to read my paper (as he listened and contemplated what he heard), I had people doing things that didn't give him the chance to “reflect-in-action” that he'd anticipated. The CNN network's format is a series of quick, superficial clips that also preclude the opportunity to think about what one is seeing and hearing.

The message was clear. This man (and I'm certain there were others in the audience) was limited in his ability to learn from me because I frustrated his ability to participate in his own learning. This is not good use of either his time as a learner or mine as a teacher. And so I ran headlong into the question of how to deal with culturally-based learning patterns.

Do Your Research

There are, of course, two solutions: First, one can learn what various folks are used to, and then do those things. This communicates the message, “I value what you do as much as what I do.” Indeed, I will use this approach in September when I teach in Colombia. Because my Spanish is of the un poquito variety, and everyone in the audience speaks English, I'll lecture in English. My slides will nevertheless be in Spanish because that's what the audience is used to. That will obviate the need for them to translate what they're seeing as well as what they're hearing.

Acknowledge Differences

Or you can acknowledge that your teaching style is different from what your audience is used to, allowing them to adjust their expectations and so avoid feelings of frustration.

He almost sputtered, saying, “Yours was a typically American presentation.” And so I ran headlong into the question of how to deal with culturally-based learning patterns.

I used this approach in Germany the year after the Marrakech presentation. During my introduction, I told the audience that my instruction was likely different from what they were used to, and so I was most curious to hear what they thought about what I had to say and how I said it.

While they were initially hesitant to participate, with encouragement the audience members did join in. And judging by their comments afterwards, they were comfortable with the highly active format I used.

My final piece of advice: Avoid watching CNN if, like thoughtful members of your audience, you enjoy taking the time to think about what you're seeing and hearing.

Henry B. Slotnick, PhD, PhD, visiting professor, University of Wisconsin Medical School in Madison, conducts research on how physicians learn. He has been recognized by the Alliance for CME with several awards for his contributions to CME. Send your questions or ideas to