English for the Workplace: Doing Patient-Centred Care in Medical Communication

Abstract

(Kachru, 1992), including countries such as India, Pakistan and Sri Lanka, where a different variety of English is spoken (AMC, 2009(AMC, , 2011(AMC, , 2012a(AMC, , 2012b.In addition to the challenges of working in an unfamiliar medical system, these doctors can also face considerable difficulties in daily communications with patients, families, and colleagues (Hall, Keely, Dojeiji, Byszewski, & Marks, 2004;McDonnell & Usherwood, 2008;Tipton, 2005). In addition to the more obvious language difficulties with vocabulary, grammar, pronunciation, and an understanding of accents and colloquialisms, they can also struggle with the less salient but vitally important interpersonal features of language use, such as how to build rapport and show empathy (Hall et al., 2004;McDonnell & Usherwood, 2008;Pilotto, Duncan, & Anderson-Wurf, 2007). Moreover, many may not be familiar with the demands of the patientcentred models of care expected in developed medical environments in Canada and Australia, but less common in developing countries where medical facilities are very stretched (Dahm, 2011b;Khalil & Bhopal, 2009).In this article we focus on the communication challenges facing doctors who trained in medical environments very different from those found in Canada and Australia using a language other than English, in order to inform communications training designed specifically for doctors from language backgrounds other than English, and to illustrate how a close analysis of professional discourse can be transferred to ESL classes preparing for work environments beyond the medical world. We draw on clinical role-plays performed by practicing locally trained native English-speaking (NES) doctors and nonnative English-speaking (NNES) IMGs to identify the communication features of the kind of patient-centred approach to medical communication that will be expected of them. Although specific features and approaches to communication in Canada and Australia likely differ in some minor respects, our aims are to highlight features that are relevant in both cultures and to illustrate how discourse data can be used to identify culturally appropriate ways of communicating in a medical setting in order to provide an accurate evidence base from which culturally appropriate medical communication courses for IMGs may be developed.

Action‐Oriented Hope: An Agent of Change for Internationally Educated Professionals

“…Many of the prevailing themes that appear in literature regarding IEHPs pursuing licensure emphasize the importance of supporting immigrants to enhance interpersonal skills, language, and communication abilities (Austin & Dean, 2004; Dahm & Yates, 2013; Fernandez‐Pena & Day, 2006; Hatami & Weber, 2013), as well as technical skills within the health care system (Austin & Dean, 2004). Financial barriers are also a prominently noted theme (Austin & Dean, 2004; Fernandez‐Pena & Day, 2006), as is the need for programming to include peer learning and mentorship to enhance understanding and integration into the new culture (Austin & Dean, 2004; Kennedy & Chen, 2012).…”

Enhancing international medical graduates’ communication: the contribution of applied linguistics

“…Thus, clinical educator 1 felt that IMG E sounded ‘dismissive’, and clinical educator 3 identified a difficulty in her use of the backchannel cue ‘Okay’ and felt that this made her sound uninterested in what the patient had to say. From an applied linguistics perspective, IMG E can be seen as failing to fully realise the role of minimal backchannel cues in signalling that the listener is open and genuinely interested in listening or the importance of using cues of this kind as important indicators of approachability . Listeners interject cues such as ‘okay’ into the speaker's narrative to show they are paying close attention and to signal an interpersonal engagement with the narrative .…”

“…Moreover, in addition to more readily identifiable difficulties with English grammar, vocabulary, pronunciation or comprehension, IMGs may also have difficulty in identifying and correctly using what have been termed the more ‘subtle features’ of communication, or those pragmatic features associated with interpersonal communication. As these vary considerably across languages and cultures, they pose particular challenges to doctors who have trained in another language and can impact negatively on their ability to meet the expectations of colleagues and patients, particularly in situations that demand a nuanced approach to verbal and non‐verbal interpersonal communication, such as in the establishment of rapport, and the projection of willingness to listen or the display of empathy through words and actions …”

“…In order to illuminate issues that arise when speakers from one cultural background interact with speakers from another, we will draw on the concepts of socio‐pragmatic and pragmalinguistic knowledge . To explore aspects of medical discourse, we will draw on concepts of interpersonal approachability features and framing …”

Learning how to speak: Pronunciation, pragmatics and practicalities in the classroom and beyond

“…The data are drawn from a study in which native and non-native English-speaking doctors were invited to a specially set up simulation facility to role-play two medical scenarios common in hospital emergency departments (for further details of the study, see Dahm & Yates 2013). While all the participants were experienced, only the native speakers were currently practising, as the non-native speakers had not yet passed the clinical examinations required for registration in Australia.…”