Training physicians to work in a second language
Journal cover Folia Scandinavica Posnaniensia, volume 36, year 2024
PDF

Keywords

second language physicians
second language communication in healthcare
metaphors in healthcare
language training for healthcare providers
migrant physicians
health communication

How to Cite

Szymańska, O. (2024). Training physicians to work in a second language. Folia Scandinavica Posnaniensia, 36, 4–22. https://doi.org/10.14746/fsp-2024.36.01

Abstract

This study highlights the importance of targeting practices that facilitate physician-patient communication in language courses for health professionals. The aim of this study is twofold. Firstly, it examines if and how physicians with a second language deploy metaphors to facilitate understanding. Secondly, it investigates how this practice can be enhanced through communicative training. The study comprises two separate parts, each with a different approach, method, and participants. Study 1 investigates the use of metaphors in authentic situations from outpatient clinics, where physicians consulted patients in L2 Norwegian. The data consists of transcripts of video recordings and an interview with one of the physicians. Study 2 examines the outcomes of an intervention during an intensive language course before the physicians’ arrival in Norway. The data in this study include oral and written production, as well as an interview with one of the participants. Study 1 revealed contexts in which migrant physicians deploy metaphors to facilitate their communication in L2 and types of the expressions they use. Study 2 showed that stimulating metaphor awareness might be beneficial for metaphor use in communication and comprehension in visual representation, which in turn can support  L2 communication in the physicians’ everyday practices.

https://doi.org/10.14746/fsp-2024.36.01
PDF

Funding

The study was founded by The Research Council of Norway (302219, 223265).

References

Alpers, L.-M. (2016). Distrust and patients in intercultural healthcare: A qualitative interview study. Nursing Ethics 25(3), 313–323. DOI: https://doi.org/10.1177/0969733016652449

Baquiran, C.L.C. & Nicoladis, E. (2020). A doctor’s foreign accent affects perceptions of competence. Health Communication 35(6), 726–730. DOI: https://doi.org/10.1080/10410236.2019.1584779

Berbyuk Lindström, N. (2008). Intercultural communication in health care - Non-Swedish physicians in Sweden. Doctoral thesis. University of Gothenburg.

Berbyuk Lindström, N., Allwood, J. & Khoram-Manesh, A. (2006). How do Non-Swedish Physicians Communicate with their Swedish Patients and Colleagues? In Ø. Dahl, I. Jensen & P. Nynas (eds.), Bridges of Understanding-Perspectives on intercultural communication (pp. 155–170). Unipub forlag, Oslo Academic Press.

Berbyuk Lindström, N. & Girardelli, D. (2023). Patient Bias in Sweden. An Exploratory Study on Discrimination Against Migrant Physicians. European Journal of Health Communication 4(2), 73–92. DOI: https://doi.org/10.47368/ejhc.2023.204

Berthelin, S.R. (2022). Strategier for bruk av metaforer fra andre språk. Nordand: Nordisk tidsskrift for andrespråkslæring 17(1), 33–47. DOI: https://doi.org/10.18261/nordand.17.1.3

Boers, F. & Littlemore, J. (2000). Cognitive style variables in participants’ explanations of conceptual metaphors. Metaphor and Symbol 15(3), 177–187. DOI: https://doi.org/10.1207/S15327868MS1503_4

Boers, F. & Demecheleer, M. (2001). Measuring the impact of cross-cultural differences inlearners’ comprehension of imageable idioms. ELT Journal Volume 55(3), 255–262. DOI: https://doi.org/10.1093/elt/55.3.255

Bronnec, M., Altenmüller, D-M., Fuchs, M., Lahmann, C., Schulze-Bonhage, A. & Bauer, P. (2023). “What is this strange sensation?” A qualitative exploration of metaphors used to verbalise hard-to-describe experiences by people with epilepsy. Epilepsy and Behaviour 138(17), 108963. DOI: https://doi.org/10.1016/j.yebeh.2022.108963

Cano-Ibanez, N., Zolfaghari, Y., Amezcua-Prieto, C. & Khan, K.S. (2021). Physician–Patient Language Discordance and Poor Health Outcomes: A Systematic Scoping Review. Frontiers in Public Health 9. DOI: https://doi.org/10.3389/fpubh.2021.629041

Casarett, D., Pickard, A., Fishman, J.M., Alexander, S.C., Arnold, R.M., Pollak, K.I. & Tulsky, J.A. (2010). Can metaphors and analogies improve communication with seriously ill patients? Journal of Palliative Medicine, 13(3), 255–260. DOI: https://doi.org/10.1089/jpm.2009.0221

Chandrashekar, P. & Jain, S.H. (2020). Addressing patient bias and discrimination against clinicians of diverse backgrounds. Academic Medicine 95(12), 33–43. DOI: https://doi.org/10.1097/ACM.0000000000003682

Cummins, J. (1981). The Role of Primary Language Development in Promoting Educational Success for Language Minority Students. In California State Department of Education, Schooling and Language Minority Students: A Theoretical Rationale, 3–49.

Deignan, A., Gabrys, D. & Solska, A. (1997). Teaching English metaphors using cross-linguistic awareness-raising activities. ELT Journal 51(4), 352–360. DOI: https://doi.org/10.1093/elt/51.4.352

Gelis, A., Cervello, S., Rey, R., et al. (2020). Peer role-play for training communication skills in medical students: A systematic review. Simul Healthcare 15(2), 106–111. DOI: https://doi.org/10.1097/SIH.0000000000000412

Golden, A. & Szymańska, O. (2022). Griper polske studenter poenget på norsk? Forståelse av metaforiske uttrykk blant norskstuderende i Polen. Nordand: Nordisk tidsskrift for andrespråksforskning 17(2), 65–79. DOI: https://doi.org/10.18261/nordand.17.2.1

Hauser D.J. & Schwarz, N. (2020). The War on Prevention II: Battle Metaphors Undermine Cancer Treatment and Prevention and Do Not Increase Vigilance. Health Communication 35(13), 1698–1704. DOI: https://doi.org/10.1080/10410236.2019.1663465

Hoang, H. (2014). Metaphor and Second Language Learning: The State of the Field. The Electronic Journal for English as a Second Language 18 (2), 1–27.

Hoang, H. & Boers, F. (2018). Gauging the association of EFL learners’ writing proficiency and their use of metaphorical language. System 74, 1–8. DOI: https://doi.org/10.1016/j.system.2018.02.004

Jain, P. & Krieger, J.L. (2011). Moving beyond the language barrier: the communication strategies used by international medical graduates in intercultural medical encounters. Patient Education and Counseling 84(1), 98–104. DOI: https://doi.org/10.1016/j.pec.2010.06.022

James, M.A. (2018). Teaching for Transfer of Second Language Learning. In H. Mohebbi & C. Coombe (eds.), Research Questions in Language Education and Applied Linguistics (pp. 157–161). Springer Texts in Education. Springer. DOI: https://doi.org/10.1007/978-3-030-79143-8_29

Jarvis, S. & Pavlenko, A. (2008). Crosslinguistic Influence in Language and Cognition. New York: Routledge. DOI: https://doi.org/10.4324/9780203935927

Johannesen, L.M. & Hellesø, R. (2019). Første- og andrespråklige sykepleiere har ulik journalføring. Sykepleien Forskning 14(76342). DOI: https://doi.org/10.4220/Sykepleienf.2019.76342

Kahlin, L. Tykkeson, I., Romanitan, M., et al. (2018). Methods for studying migrant doctors’ transition to a new language. In S. Hållsten & Z. Nikolaidou (eds.), Explorations in Ethnography, Language and Communication. Capturing linguistic and cultural diversities (pp. 101–126). Södertörn Discourse Studies.

Kauff, M., Anslinger, J., Christ, O., Niemann, M., Geierhos, M., & Huster, L. (2021). Ethnic and gender-based prejudice towards medical doctors? The relationship between physicians’ ethnicity, gender, and ratings on a physician rating website. The Journal of Social Psychology 1–9. DOI: https://doi.org/10.1080/00224545.2021.1927944

Kövecses, Z. (2020). Extended Conceptual Metaphor Theory. Cambridge: Cambridge University Press. DOI: https://doi.org/10.1017/9781108859127

Lakoff, G. & Johnson, M. (1980). Metaphors we live by. Chicago: University of Chicago Press.

Landau, M., Arndt, J. & Cameron, L.D. (2018). Do Metaphors in Health Messages Work? Exploring Emotional and Cognitive Factors. Journal of Experimental Social Psychology 74, 135–149. DOI: https://doi.org/10.1016/j.jesp.2017.09.006

Lazard A.J., Bamgbade B.A., Sontag J.M. & Brown C. (2016). Using Visual Metaphors in Health Messages: A Strategy to Increase Effectiveness for Mental Illness Communication. Journal of Health Communication 21(12), 1260–1268. DOI: https://doi.org/10.1080/10810730.2016.1245374

Littlemore, J. (2005). The effect of cognitive style on vocabulary learning strategy preferences. Iberica, 5–31.

Littlemore, J. (2019). Applying Cognitive Linguistics to Second Language Learning and Teaching. London: Palgrave Macmillan.

Littlemore, J. & Low, G. (2006). Metaphoric Competence, Second Language Learning, and Communicative Language Ability. Applied Linguistics 27(2), 268–294. DOI: https://doi.org/10.1093/applin/aml004

Littlemore, J. Krennmayr, T., Turner, S. & Turner, J. (2014). An Investigation into Metaphor Use at Different Levels of Second Language Writing. Applied Linguistics 35(2), 117–144. DOI: https://doi.org/10.1093/applin/amt004

Littlemore, J. & Turner, S. (2019). What can metaphor tell us about experiences of pregnancy loss and how are these experiences reflected in midwife practice? Frontiers in Health Communication 4(42), 1–17. DOI: https://doi.org/10.3389/fcomm.2019.00042

MacArthur, F. (2010). Metaphorical competence in EFL: Where are we and where should we be going? A view from the language classroom. AILA Review 23(1), 155–73. DOI: https://doi.org/10.1075/aila.23.09mac

Magaña, D. (2019). Cultural competence and metaphor in mental healthcare interactions: A linguistic perspective. Patient Education and Counseling 102(12), 2192–2198. DOI: https://doi.org/10.1016/j.pec.2019.06.010

Malkomsen, A., Røssberg, J.I., Dammen, T., Wilberg, T., Løvgren, A., Ulberg, R. & Evensen, J. (2022). How therapists in cognitive behavioral and psychodynamic therapy reflect upon the use of metaphors in therapy: a qualitative study. BMC Psychiatry 22(433). DOI: https://doi.org/10.1186/s12888-022-04083-y

Mannsåker, H. (2022): The role of metaphor and metonymy in the portrayal of what is currently called schizophrenia. Metaforik.de 32, 53–95. Retrieved from https://www.metaphorik.de/en/book/export/html/497 (accessed 29 March 2023).

Munday, I., Newton-John, T. & Kneebone, I. (2020). ‘Barbed wire wrapped around my feet’: Metaphor use in chronic pain. British Journal of Health Psychology 25(3), 814–830. DOI: https://doi.org/10.1111/bjhp.12432

Norwegian Medical association (2022). Legestatistikk. Retrieved from https://www.legeforeningen.no/om-oss/legestatistikk/#Medlemstall (accessed 29 March 2023). Den norske legeforening (leger og studenter).

Pavlenko, A. (2009). Conceptual representation in the bilingual lexicon and second language vocabulary learning. In A. Pavlenko (ed.), The bilingual mental lexicon: Interdisciplinary approaches (pp. 125–160). Multilingual Matters. DOI: https://doi.org/10.21832/9781847691262-008

Pitkänen, T., Tervola, M., Toivonen, M. & Kosunen, E. (2021). Kielellisen merkityksen välittymisen ongelmia maahanmuuttajalääkärien potilastenteissä. VIRITTÄJÄ 125(3), 377–403. Retrieved from https://urn.fi/URN:NBN:fi:tuni-202111088256 (accessed 10 September 2023). DOI: https://doi.org/10.23982/vir.95381

Rasmussen M.T., Brøgger, M.N., Matthiesen, S.S. & Møller J.E. (2022). “I Surrendered”: Metaphors in Residents’ Stories about Communication Challenges. Health Communication 4(1). DOI: https://doi.org/10.1080/10410236.2021.2023265

Saatci, G. & Aksu, M. (2020). A study on the detection of corona-virus perceptions of foreign students receiving tourism education at the undergraduate level through metaphor. Journal of Awareness 5(4), 617–630. DOI: https://doi.org/10.26809/joa.5.042

Semino, E. (2020). “Not Soldiers but Fire-fighters” – Metaphors and Covid-19. Health Communication 36(11), 1–9. DOI: https://doi.org/10.1080/10410236.2020.1844989

Skjeggestad, E., Gerwing, J. & Gulbrandsen, P. (2017). Language barriers and professional identity: A qualitative interview study of newly employed international medical doctors and Norwegian colleagues. Patient Education and Counseling 100 (8), 1466–1472. DOI: https://doi.org/10.1016/j.pec.2017.03.007

Solarek-Gliniewicz, M. (2024). Strategier for å etablere felles forståelse i medisinske konsultasjoner på andrespråk. En studie av samtaler mellom polske leger og norske pasienter. [Doctoral dissertation, University of Oslo].

Spina, M., Arndt, J., Landau, M.J. & Cameron, L.D. (2018). Enhancing Health Message Farming with Metaphor and Cultural Values: Impact in Latinas’ Cervical Cancer Screening. Annals of Behavioral Medicine 52(2), 106–115. DOI: https://doi.org/10.1093/abm/kax009

Türker, E. (2016). The role of L1 conceptual and linguistic knowledge and frequency in the acquisition of L2 metaphorical expressions. Second Language Research 32(1), 25–48. DOI: https://doi.org/10.1177/0267658315593336

Turner, S., Littlemore, J. & Taylor, J. (2022). Metaphors that shape parents’ perceptions of effective communication with healthcare practitioners following child death: a qualitative UK study. BMJ Open 12(1):e054991. DOI: https://doi.org/10.1136/bmjopen-2021-054991

Tykesson, I., Kahlin, L., & Romanitan, M.O. (2019). Utvecklingen av interaktionell kompetens hos läkare som lär sig svenska: Mönster i frågesekvenser i rollspel med patienter. Språk och stil 29, 41–72. DOI: https://doi.org/10.33063/diva-399803

Wilding, E., Bartl, S., Littlemore, J., Clark, M. & Brooke, J. (2023). A metaphor analysis of older adults’ lived experience of household isolation during COVID-19. Frontiers in Communication (7). DOI: https://doi.org/10.3389/fcomm.2022.1015562

WHO = World Health Organization. (2016). Health workforce requirements for universal health coverage and the sustainable development goals. Background paper No. 1 to the Global Strategy on Human Resources for Health. WHO Document Production Services. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/250330/9789241511407-eng.pdf (accessed 29 March 2023).

WHO = World Health Organization. (2020). Health topics: data and statistics. Retrieved from https://www.euro.who.int/en/health-topics/health-systems/health-workforce/data-and-statistics (accessed 29 March 2023).

Yu, H., Isahakyan, A. & van Merrienboer, J.J.G. (2023). Second language learning role-play: effects of patient and doctor roles on motivation and competence. Front. Med. DOI: https://doi.org/10.3389/fmed.2023.1163267