Language issues: An important professional practice dimension for Australian International Medical Graduates

Abstract

Issues associated with speech and language have been noted in the international literature as an important aspect of the process of integration for Australian International Medical Graduates (IMGs). This paper makes a contribution through the presentation of a sub-set of findings on the factors associated with speech and language practices for IMGs, taken from a qualitative study which examined the IMGs’ experience of integration into the Australian healthcare system. A purposive sample of 30 IMGs were interviewed via telephone. Participants were asked to share their experience with communicating in English with patients and other health professionals in the context of the Australian healthcare system. The taped interviews were transcribed verbatim and then coded and thematically analysed. The findings indicate that the months following the point of entry into a medical position are a critical time for the majority of IMGs in terms of difficulties with communicating in English. A range of suggestions to improve speech and language skills for IMGs is provided. The findings emphasize the importance of speech and language skills and the serious implications of this issue for the clinical practice of IMGs.

Dismantling the Curriculum in Higher Education

“…The landscape against which the HE curriculum is forged is increasingly dominated by processes for financialisation and marketisation (McGettigan, 2015), with a specific focus on a university education for value (McGrath et al, 2015;Tremblay et al, 2015). This has underscored a recalibration of the governance, regulation and funding of HE, in terms of its institutional forms, and its products or services.…”

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

“…Current figures suggest that one‐third of the Australian medical workforce are international medical graduates (IMGs) who trained overseas, often in countries in which English is not the dominant language and where approaches to care may be very different from the patient‐centred model of care practised in Australia, which emphasises patient autonomy and shared decision making . Patient‐centred care is reflected in local medical education, but IMGs may be unfamiliar with not only the Australian medical system and approaches to care within it, but also with the communicative demands of working with such approaches in English . 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.…”

“…[3][4][5] Patientcentred care is reflected in local medical education, 6,7 but IMGs may be unfamiliar with not only the Australian medical system and approaches to care within it, but also with the communicative demands of working with such approaches in English. 5,8,9 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' 9 of communication, or those pragmatic features associated with interpersonal communication. As these vary considerably across languages and cultures, 10 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.…”

“…9,11,12 However, cultural and communication training and support for IMGs is not only expensive and difficult to access, but can also vary considerably in quality. 8,13 A recent move away from the conceptualising of English language training for IMGs as purely remedial 5,14 and an increased focus on the pragmatic aspects of communication 9 have meant that it often falls to medical and clinical educators to tackle the specific communication issues that arise in the course of learning how to practise in a second language. However, although native-speaking clinicians may be tacitly aware of many of these more subtle linguistic features, they can find it difficult to explicitly identify and explain them, let alone to teach them.…”

Talking their way to success: communicative competence for international medical graduates in transition

“…Successful professional and personal interactions rely on all parties sharing the same expectations regarding culturally appropriate ways of communicating in a particular context . IMGs, therefore, often have to adapt to ‘rebuild’ their communicative competence before they can effectively draw on their (adapted) communication skills to thrive in their new work, cultural and interactional environments. This transitional phase is often characterised by unintentional communication difficulties, such as appearing uncaring in interactions with patients or uncooperative when working in a team; difficulties that can easily (albeit falsely) be attributed to personal traits rather than issues related to linguistic competence …”