Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language

Background Miscommunication in the healthcare sector can be life-threatening. The rising number of migrant patients and foreign-trained staff means that communication errors between a healthcare practitioner and patient when one or both are speaking a second language are increasingly likely. However, there is limited research that addresses this issue systematically. This protocol outlines a hospital-based study examining interactions between healthcare practitioners and their patients who either share or do not share a first language. Of particular interest are the nature and efficacy of communication in language-discordant conversations, and the degree to which risk is communicated. Our aim is to understand language barriers and miscommunication that may occur in healthcare settings between patients and healthcare practitioners, especially where at least one of the speakers is using a second (weaker) language. Methods/Design Eighty individual interactions between patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their first language will be video recorded in a range of in- and out-patient departments at three hospitals in the Metro South area of Brisbane, Australia. All participants will complete a language background questionnaire. Patients will also complete a short survey rating the effectiveness of the interaction. Recordings will be transcribed and submitted to both quantitative and qualitative analyses to determine elements of the language used that might be particularly problematic and the extent to which language concordance and discordance impacts on the quality of the patient-practitioner consultation. Discussion Understanding the role that language plays in creating barriers to healthcare is critical for healthcare systems that are experiencing an increasing range of culturally and linguistically diverse populations both amongst patients and practitioners. The data resulting from this study will inform policy and practical solutions for communication training, provide an agenda for future research, and extend theory in health communication.

Book Review: "Language learning beyond the classroom"

Language learning beyond the classroom is part of a growing body of literature focused on teaching and learning in contexts that are informal and unstructured. Areas include so-called shadow education and informal pedagogies. Shadow education refers to the privatised tutoring supplementing school curricular that is a pervasive feature of education in parts of Asia (Bray & Lykins, 2012) and increasingly evident in Australia. Informal pedagogies refers to teaching in informal contexts and was the focus of a Special Interest Group (SIG) at the recent American Educational Research Association (AERA) annual conference in Chicago. Presentations in the SIG included designing tools for supporting learning in science classes after school and in sites such as zoos...

Developing and testing readability measurements for second language learners

This research constructed a readability measurement for French speakers who view English as a second language. It identified the true cognates, which are the similar words from these two languages, as an indicator of the difficulty of an English text for French people. A multilingual lexical resource is used to detect true cognates in text, and Statistical Language Modelling to predict the predict the readability level. The proposed enhanced statistical language model is making a step in the right direction by improving the accuracy of readability predictions for French speakers by up to 10% compared to state of the art approaches. The outcome of this study could accelerate the learning process for French speakers who are studying English. More importantly, this study also benefits the readability estimation research community, presenting an approach and evaluation at sentence level as well as innovating with the use of cognates as a new text feature.

Identifying the learning development of students who are refugees

Students who are refugees need understanding and support to settle successfully into mainstream Australian classrooms. Teachers not aware of students’ prior learning and the process of second language acquisition may have difficulty providing the most appropriate learning environments to meet these students’ needs. This study found that, with no coordination of information on students’ learning backgrounds nor of their learning needs and development, students were in danger of being identified as at-risk of having a learning disability, with little support to substantiate such claims.

Pragmatics, perceptions and strategies in Chinese college English learning

This study investigated Chinese College English students. perceptions of pragmatics, their pragmatic competence in selected speech acts, strategies they employed in acquiring pragmatic knowledge, as well as their general approach to learning English as a foreign language. The research was triggered by a national curriculum initiative that prioritizes the need for College English students to enhance their ability to use English effectively in different social interactions (Chinese College English Education and Supervisory Committee, 2007). The traditional "grammar-translation" and "examination-oriented" method is believed to have reduced Chinese College English students to what is dubbed "mute" and "deaf" language learners (Zhang, 2008; Zhao, 2009). Many students lack pragmatic knowledge on how to interpret discourse by relating utterances to their meanings, understanding the intention of language users, and how language is used in specific settings (Bachman & Palmer, 1996, 2010). There is an increasing body of literature on awareness-raising of the importance of pragmatic knowledge and strategies for classroom instruction. However, to date, researchers have tended to focus largely on the teaching of pragmatics, rather than on how students acquire pragmatic competence (Bardovi-Harlig & Dornyei, 1998; Du, 2004; Hou, 2007; Ruan, 2007; Schauer, 2009). It is this gap in the research that this study fills, with a focus on different types of pragmatic knowledge, learner perceptions of such knowledge, and learning strategies that College English students employ in the process of learning English in general, and pragmatics in particular. Three strands of theories of second language acquisition (Ellis, 1985, 1994): pragmatics (Levinson, 1983; Mey, 2001; Yule, 1996), intercultural communications (Kramsch, 1998; Samovar & Porter, 1997; Samovar, Porter & McDaniel, 2009) and English as a lingua franca (ELF) (Canagarajah, 2006; Firth, 1996; Pennycook, 2010) were employed to establish a conceptual framework for data collection and analyses. Key constructs derived from the three related theories helped to form a typology for a detailed examination and theorization of the empirical evidence gathered from different sources. Four research instruments: a questionnaire (N=237), Discourse Completion Tasks (DCTs) (N=55), focus group interviews (N=18), and a textbook tasks analysis were employed to collect data for this systematic inquiry. Data collected by different instruments were analyzed and compared by way of a triangulation to enhance its validity and reliability. Major findings derived from different sources highlighted that, although College English students were grammatically advanced language learners, they displayed limited pragmatic knowledge and a highly restricted repertoire of language learning strategies. The majority of the respondents, however, believed that pragmatic knowledge was as important as linguistic knowledge in the process of developing communicative competence for interaction in different contexts. It was argued that a combination of a less than sufficient English proficiency, limited knowledge of pragmatics, inadequate language materials and tasks, and a small stock of language learning strategies, were a major hindrance to effective learning and communication, resulting in pragmatic failures in many intercultural communication situations. As the first systematic study of how Chinese College English students learned pragmatics, the research provided a solid empirical base for developing a tentative model for the learning of pragmatics in a College English classroom in China and similar educational contexts. The model was strengthened by a unique combination of theories of pragmatics, intercultural communication and ELF. Findings from this research provided insights into how Chinese College English students perceived pragmatics in the English as foreign language (EFL) curriculum, the processes of learning, as well as strategies they utilized in developing linguistic and pragmatic knowledge and competence.

What counts as English in the internationalised Australian university: Implications for teaching and learning

English is currently ascendant as the language of globalisation, evident in its mediation of interactions and transactions worldwide. For many international students, completion of a degree in English means significant credentialing and increased job prospects. Australian universities are the third largest English-speaking destination for overseas students behind the United States and the United Kingdom. International students comprise one-fifth of the total Australian university population, with 80% coming from Asian countries (ABS, 2010). In this competitive higher education market, English has been identified as a valued ‘good’. Indeed, universities have been critiqued for relentlessly reproducing the “hegemony and homogeneity of English” (Marginson, 2006, p. 37) in order to sustain their advantage in the education market. For international students, English is the gatekeeper to enrolment, the medium of instruction and the mediator of academic success. For these reasons, English is not benign, yet it remains largely taken-for-granted in the mainstream university context. This paper problematises the naturalness of English and reports on a study of an Australian Master of Education course in which English was a focus. The study investigated representations of English as they were articulated across a chain of texts including the university strategic plan, course assessment criteria, student assignments, lecturer feedback, and interviews. Critical Discourse Analysis (CDA) and Foucault’s work on discourse enabled understandings of how a particular English is formed through an apparatus of specifications, exclusionary thresholds, strategies for maintenance (and disruption), and privileged concepts and speaking positions. The findings indicate that English has hegemonic status within the Australian university, with material consequences for students whose proficiency falls outside the thresholds of accepted English practice. Central to the constitution of what counts as English is the relationship of equivalence between standard written English and successful academic writing. International students’ representations of English indicate a discourse that impacts on identities and practices and preoccupies them considerably as they negotiate language and task demands. For the lecturer, there is strategic manoeuvring within the institutional regulative regime to support students’ English language needs using adapted assessment practices, explicit teaching of academic genres and scaffolded classroom interaction. The paper concludes with the implications for university teaching and learning.

What is language and how is it learnt?

This chapter describes the nature of human language and introduces theories of language acquisition.

Languages of Communication : Indigenous language and/or English?

My interest in producing this paper on Indigenous languages was borne out of conversations with and learnings from community members in the Torres Straits and those connected to the ‘Dream Circle’. Nakata (2003, p. 12) laments the situation whereby ‘teachers are transitionary and take their hard-earned knowledge with them when they leave’. I am thus responding to the call to add to the conversation in a productive albeit culturally loaded way. To re-iterate, I am neither Indigenous nor am I experienced in teaching and learning in these contexts. As problematic as these two points are, I am in many ways typical of the raft of inexperienced white Australian teachers assigned to positions in school contexts where Indigenous students are enrolled or in mainstream contexts with substantial populations of Indigenous students. By penning this article, it is neither my intention to contribute to the silencing of Indigenous educators or Indigenous communities. My intention is to articulate my teacherly reflections as they apply to the topic under discussion. The remainder of this paper is presented in three sections. The next section provides a brief overview of the number of Indigenous people and Indigenous languages in Australia and the role of English as a language of communication. The section which follows draws on theorisations from second/additional language acquisition to overview three different schools of thought about the consequences of English in the lives of Indigenous Australians. The paper concludes by considering the tensions for inexperienced white Australian teachers caught up in the fray.

Listening skill requires a further look into second/foreign language learning

Current English-as-a-second and foreign-language (ESL/EFL) research has encouraged to treat each communicative macroskill separately due to space constraint, but the interrelationship among these skills (listening, speaking, reading, and writing) is not paid due attention. This study attempts to examine first the existing relationship among the four dominant skills, second the potential impact of reading background on the overall language proficiency, and finally the relationship between listening and overall language proficiency as listening is considered an overlooked/passive skill in the pedagogy of the second/foreign language classroom. However, the literature in language learning has revealed that listening skill has salient importance in both first and second language learning. The purpose of this study is to investigate the role of each of four skills in EFL learning and their existing interrelationships in an EFL setting. The outcome of 701 Iranian applicants undertaking International English Language Testing System (IELTS) in Tehran demonstrates that all communicative macroskills have varied correlations from moderate (reading and writing) to high (listening and reading). The findings also show that the applicants’ reading history assisted them in better performing at high stakes tests, and what is more, listening skill was strongly correlated with the overall language proficiency.

Cross-cultural language learning and web design complexity

Accepting the fact that culture and language are interrelated in second language learning (SLL), the web sites should be designed to integrate with the cultural aspects. Yet many SLL web sites fail to integrate with the cultural aspects and/or focus on language acquisition only. This study identified three issues: (1) anthropologists’ cultural models mostly adopted in cross-cultural web user interface have been superficially used; (2) web designers deal with culture as a fixed one which needs to be modeled into interface design elements, so (3) there is a need for a communication framework between educators and design practitioners, which can be utilized in web design processes. This paper discusses what anthropology can contribute to language learning, mediated through web design processes and suggests a cultural user experience framework for web-based SLL by presenting an exemplary matrix. To evaluate the effectiveness of the framework, the key stakeholders (learners, teachers, and designers) participated in a case scenario-based evaluation. The result shows a high possibility that the framework can enhance the effective communication and collaboration for the cultural integration.

Case study of collaborative learning in two contexts : what do English language learners gain?

This chapter describes the use of collaborative learning as an approach to enhance English language learning by students from non-English speaking backgrounds. Communicative Language Teaching (CLT) principles were applied to two case studies, one comprising of undergraduate English as Foreign Language Learners in Turkey and the other involved English as Second Language learners in Australia. Social constructivism inspired communicative language teaching using collaborative learning activities such as team work, interactive peer-based learning, and iterative stages of learning matrix were incorporated to enhance students' learning outcomes. Data collected after the CLT intervention was made up of field notes, reflective logs and focus group interviews which revealed complementarities, as well as subtle differences between the two cases. The findings were summarized as learning dispositions; speaking fluency and confidence; learning diagnostics and completion deficiencies; task engagement, flow theory and higher order thinking skills; in addition to self efficacy and development of student identity. CLT has the potential to provide a more inclusive and dynamic education for diverse learners through vital outcomes and benefits which resonate with the real world.

Traveller’s Tales : The Expatriate English Language Teacher in the New Global Culture

Most of the research into ELT has focused on its linguistic and methodological aspects, which are based on Western scientific traditions. The contributions and experiences of English language teachers themselves, especially their work in overseas contexts, have frequently been overlooked. This volume aims to document the complexity of ELT as ‘work’ in new global economic and cultural conditions, and to explore how this complexity is realised in the everyday experiences of ELT teachers. The development of ELT from the colonial experience to its current status as a global commodity is explored; ELT is then situated in the discourses of globalisation, specifically within Appadurai’s theorisation of global flows of people, images, ideas, technology and money, or scapes. Within this framework, narratives are constructed from the experiences of Native-speaking English teachers. These reveal much about the personal, pedagogical and cultural dimensions of ELT work in non-Centre countries, and will contribute to a greater understanding of the intercultural dimensions of ELT for all those who work in it, and in related educational fields.

Teaching English as an additional language in senior high school : critical discourses in critical times

This paper presents a Critical Discourse Analysis (CDA) of four policy documents currently offering ‘sets of possibilities’ for the teaching of English as an additional or second language (hereafter EAL/ESL) in senior classrooms in Queensland, Australia. The aim is to identify the ways in which each document re-presents the notion of critical literacy. Leximancer software, and Fairclough’s textually-oriented discourse analysis method (2001, 2003) are used to interrogate the relevant sections of the documents for the ways in which they re-present (sic) and construct the discourses around critical language study. This paper presents the description, interpretation and explanation of the discourses in these documents which constitute part of a larger project in which teacher interviews and classroom teaching are also investigated for the ways in which ‘the critical’ is constructed and contested in knowledge and practice.