# Evaluation of Japanese instructor experiences in the first overseas BLS course certified by the Japanese association for acute medicine in Cambodia: a mixed-methods analysis using text mining

## TL;DR

Japanese instructors taught a BLS course in Cambodia, facing communication and resource challenges but gaining valuable cross-cultural teaching experience.

## Contribution

New insights into cross-cultural BLS education challenges and adaptive strategies in LMICs using mixed-methods and text mining.

## Key findings

- Instructors reported high satisfaction but significant communication difficulties during the BLS course in Cambodia.
- Text mining revealed communication challenges, AED instruction issues, and resource constraints as key themes.
- Adaptive teaching strategies and peer learning helped instructors overcome challenges and grow professionally.

## Abstract

Emergency medical education in low- and middle-income countries (LMICs) faces significant challenges, including limited resources and cultural-linguistic barriers. Understanding instructor experiences in international settings is crucial for effective capacity building.

This study examined Japanese instructors’ experiences teaching the first overseas Basic Life Support (BLS) course certified by the Japanese Association for Acute Medicine in Cambodia, exploring teaching challenges and adaptations in cross-cultural contexts.

Six JAAM BLS-certified instructors participated in this exploratory mixed-methods pilot study conducted in Siem Reap, Cambodia, in March 2024. Instructors completed Visual Analogue Scale (VAS) assessments measuring accomplishment, communication clarity, instructional confidence, and cultural sensitivity, alongside open-ended questionnaires. Qualitative data underwent text mining analysis, including word frequency calculation, co-occurrence network construction, and manual sentiment classification.

Visual Analogue Scale scores revealed high satisfaction (sense of fulfillment: 9.1 ± 0.80; willingness to teach again: 9.2 ± 0.68) but significant communication difficulties (3.5 ± 1.52). Text mining identified three primary themes: communication challenges via interpreters, AED instruction difficulties due to English-only labeling, and practical adaptation under resource constraints. Despite challenges, instructors reported positive emotional growth through reflective practice and adaptive teaching strategies. Peer learning among participants emerged spontaneously during practical sessions.

While language barriers and equipment shortages affected instructional clarity in cross-cultural BLS education, instructors demonstrated adaptive expertise and professional growth through reflective learning. Findings suggest that visual communication enhancement, simplified terminology, culturally adapted materials, and effective interpreter collaboration are essential for sustainable international BLS programs in LMICs.