From leadership research to district action: Beyond Individualism and Independence: Exploring Collectivism and Interdependence as Paradigms of Healthcare and Health Professions Education

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: review-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Purpose: Healthcare is delivered by teams, yet individualism continues to be foregrounded in training and assessments. In contrast to individualism is collectivism, a sociocultural phenomenological lens that considers the degree to which people are integrated into groups. Along with collectivism is interdependence, which characterizes how two or more people or things are interconnected with each other. The purpose of this review was to examine the current body of work on collectivism and interdependence to examine their potential within healthcare and health professions education (HPE). Method: This narrative review included English-language publications from peer-reviewed journals between 1990 and 2024, and excluded non-English articles, perspective pieces, commentaries, and studies that were unrelated to healthcare or HPE. The initial search in January 2024 included MEDLINE, Embase, PsycINFO and ERIC databases and was updated in November 2024 with forward and backward reference mining. Results: In total, 3,415 articles were identified, of which 63 were included in the review. We used reflexive thematic analysis to consolidate the literature. Our analysis developed four interconnected themes: 1) reshaping the culture of healthcare and the learning climate of HPE, 2) accounting for individual contributions to the team, 3) the many facets of leadership, and 4) belongingness as an essential step towards collective well-being. Together, these themes expose tensions between individualistic educational structures and the team-based realities of clinical work, and highlight pathways toward relational, trust-based learning environments. Conclusion: Healthcare and HPE can be effectively examined through the paradigms of collectivism and interdependence, which transcend and challenge the current models of individualism and independence. Collectivism and interdependence offer conceptual and practical tools to reorient HPE toward relational accountability, shared leadership, and compassionate belonging. By embracing these guiding principles, healthcare workers and educators can better prepare for the collaborative, team-based nature of healthcare, and create protective and transformative learning environments.

Study methods

We conducted a narrative review (NR) to identify and synthesize literature about collectivism and interdependence to examine how these paradigms exist within the context of healthcare and HPE. NR was deemed an appropriate methodology because no work has previously examined in-depth the combination of collectivism and interdependence within the context of healthcare or HPE [15]. NR also offered the flexibility to select literature that could be consolidated, thereby building on relevant previous work without duplicating efforts [16]. Furthermore, our objective was not to systematically analyze or appraise the quality of currently available literature [17], but rather provide an overview of the current knowledge of collectivism and interdependence as it relates to healthcare and HPE. We followed the steps of NR methodology outlined in the literature as best practices [181920].

Limitations

This NR is limited by the underrepresentation of the Global South in the literature [76], which is important because these are geographic areas where the cultural phenomena of collectivism or interdependence are likely to be more prevalent [1177]. This likely signals that while searching for English-language literature, important publications in other languages may have been missed. Although full-text review and extraction was conducted by multiple authors (EA and SS), the initial title and abstract screening phase of the literature search was conducted by a single author (EA), which leaves open the possibility of bias in selection. As noted in our reflexivity statement, however, the authors are of a diverse cultural background, and we attempted to mitigate this through genuinely open-format discussion amongst authors when resolving disputes on borderline papers.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Eusang Ahn; Stefanie S. Sebok-Syer; Jerry M. Maniate; Kaitlin Endres; Warren J. Cheung. Beyond Individualism and Independence: Exploring Collectivism and Interdependence as Paradigms of Healthcare and Health Professions Education. Perspectives on Medical Education (2025-12-04). https://doi.org/10.5334/pme.2000

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.