Robyn Woodward-Kron

Negotiating meanings and scaffolding learning: writing support for non‐English speaking background postgraduate students

Language and learning advisers and non‐English speaking background (NESB) postgraduate students negotiate complex territory when working together to improve students’ texts. However, the individual writing consultation is sometimes conceptualised one‐dimensionally by faculty as a form of editing. The writing consultation with NESB postgraduate students has also received only sporadic attention in the higher education literature. This paper provides a contextual, discourse analytical account of one writing consultation between a faculty‐based language adviser and a Master of Public Health NESB student. The findings show that the consultation was a dynamic exchange druing which a range of meanings were negotiated. The findings also show that the adviser scaffolded the student’s academic writing and learning in a number of ways. More research is needed in different teaching contexts and at various stages of students’ writing in order to provide a greater understanding of the writing support consultation to inform guidelines for providing individual language support to NESB postgraduate students.

Clinical teaching and learning: from theory and research to application

Learning in the clinical setting is the cornerstone of medical school education, but there are strong imperatives to optimise the ways in which students acquire clinical expertise. Deliberate practice is characterised by attention, concentration, effort and repetition of skills; it is an important tool for developing and maintaining professional expertise. Research has led to a greater understanding of how medical students develop core clinical skills, especially in the areas of diagnostic reasoning, communication and physical examination. Advances in information technology and instructional design are helping to strengthen the links between formal educational activities and opportunistic learning in the clinical setting.

The medical educator, the discourse analyst, and the phonetician: a collaborative feedback methodology for clinical communication.

Frameworks for clinical communication assist educators in making explicit the principles of good communication and providing feedback to medical trainees. However, existing frameworks rarely take into account the roles of culture and language in communication, which can be important for international medical graduates (IMGs) whose first language is not English. This article describes the collaboration by a medical educator, a discourse analyst, and a phonetician to develop a communication and language feedback methodology to assist IMG trainees at a Victorian hospital in Australia with developing their doctor–patient communication skills. The Communication and Language Feedback (CaLF) methodology incorporates a written tool and video recording of role-plays of doctor–patient interactions in a classroom setting or in an objective structured clinical examination (OSCE) practice session with a simulated patient. IMG trainees receive verbal feedback from their hospital-based medical clinical educator, the simulated patient, and linguists. The CaLF tool was informed by a model of language in context, observation of IMG communication training, and process evaluation by IMG participants during January to August 2009. The authors provided participants with a feedback package containing their practice video (which included verbal feedback) and the completed CaLF tool. The CaLF methodology provides a tool for medical educators and language practitioners to work collaboratively with IMGs to enhance communication and language skills. The ongoing interdisciplinary collaboration also provides much-needed applied research opportunities in intercultural health communication, an area the authors believe cannot be adequately addressed from the perspective of one discipline alone.

How we developed Doctors Speak Up: an evidence-based language and communication skills open access resource for International Medical Graduates

Abstract Background: Some International Medical Graduates (IMGs) need to develop language and communication skills for patient-centred care but have limited opportunities to do so. Aim: To develop an evidence-based, language and communication skills web resource for IMG doctors and supervisors, focussing on culturally challenging patient interviews. Methods: Forty-eight IMGs participated in four practice OSCEs. We video-recorded the interactions and applied discourse analytic methods to investigate salient language and communication features. Results: The findings from the OSCE workshops showed that many participants demonstrated aspects of patient-centred interviewing but were hindered by limited interactional competence to elicit information and negotiate behaviours as well as a limited repertoire of English grammar, vocabulary, and phonological phrasing for effective interaction. These findings guided the choice of content and pedagogy for the development of the web-based resource Doctors Speak Up. Conclusion: Evaluation and uptake of the Doctors Speak Up website confirm the demand for a resource combining targeted communication skills and language instruction. Over 19 500 users visited the website between March 2012 and November 2013.

A review of approaches to improve participation of culturally and linguistically diverse populations in clinical trials

The under-representation of culturally and linguistically diverse participants in clinical trials is an ongoing concern for medical researchers and the community. The aim of this review is to examine the complex issue of recruiting culturally and linguistically diverse (CALD) older people to medical research and to examine responses to these issues. The review focuses on (1) trends in the existing literature on barriers to and strategies for recruiting CALD and older people to clinical research, (2) issues with informed consent for CALD populations, and (3) the efficacy of innovative approaches, including approaches incorporating multimedia in research and consent processes. The literature indicates that predominant barriers to greater involvement of CALD patients in clinical trials are communication, including literacy and health literacy considerations; English language competence; and cultural factors in the research setting such as mistrust of consent processes, as well as considerable practical and logistical barriers, including mobility considerations. Some evidence exists that incorporating multimedia resources into the informed consent process can improve patient understanding and is preferred by patients, yet these findings are inconclusive. A multi-methodological approach, including the use of culturally and linguistically sensitive multimedia tools, may help address the issue of low inclusion of CALD groups in clinical research. Researcher education needs to be taken into account to address preconceptions about CALD resistance to research participation and to raise awareness of cultural concerns in regard to research participation.

Learning outcomes for communication skills across the health professions: a systematic literature review and qualitative synthesis

Objective The aim of this study was to identify and analyse communication skills learning outcomes via a systematic review and present results in a synthesised list. Summarised results inform educators and researchers in communication skills teaching and learning across health professions. Design Systematic review and qualitative synthesis. Methods A systematic search of five databases (MEDLINE, PsycINFO, ERIC, CINAHL plus and Scopus), from first records until August 2016, identified published learning outcomes for communication skills in health professions education. Extracted data were analysed through an iterative process of qualitative synthesis. This process was guided by principles of person centredness and an a priori decision guide. Results 168 papers met the eligibility criteria; 1669 individual learning outcomes were extracted and refined using qualitative synthesis. A final refined set of 205 learning outcomes were constructed and are presented in 4 domains that include: (1) knowledge (eg, describe the importance of communication in healthcare), (2) content skills (eg, explore a healthcare seekers motivation for seeking healthcare),( 3) process skills (eg, respond promptly to a communication partners questions) and (4) perceptual skills (eg, reflect on own ways of expressing emotion). Conclusions This study provides a list of 205 communication skills learning outcomes that provide a foundation for further research and educational design in communication education across the health professions. Areas for future investigation include greater patient involvement in communication skills education design and further identification of learning outcomes that target knowledge and perceptual skills. This work may also prompt educators to be cognisant of the quality and scope of the learning outcomes they design and their application as goals for learning.

Training for staff who support students

Front‐line administrative, academic and clinical teaching staff often find themselves providing pastoral and learning support to students, but they are often not trained for this role, and this aspect of their work is under‐acknowledged.

Educating the patient for health care communication in the age of the world wide web: a qualitative study.

Purpose Communication skills teaching in medical education has yet to acknowledge the impact of the Internet on physician–patient communication. The authors present a conceptual model showing the variables influencing how and to what extent physicians and patients discuss Internet-sourced health information as part of the consultation with the purpose of educating the patient. Method A study exploring the role physicians play in patient education mediated through health information available on the Internet provided the foundation for the conceptual model. Twenty-one physicians participated in semistructured interviews between 2011 and 2013. Participants were from Australia and Switzerland, whose citizens demonstrate different degrees of Internet usage and who differ culturally and ethnically. The authors analyzed the interviews thematically and iteratively. The themes as well as their interrelationships informed the components of the conceptual model. Results The intrinsic elements of the conceptual model are the physician, the patient, and Internet based health information. The extrinsic variables of setting, time, and communication activities as well as the quality, availability, and usability of the Internet-based health information influenced the degree to which physicians engaged with, and were engaged by, their patients about Internet-based health information. Conclusions The empirically informed model provides a means of understanding the environment, enablers, and constraints of discussing Internet-based health information, as well as the benefits for patients’ understanding of their health. It also provides medical educators with a conceptual tool to engage and support physicians in their activities of communicating health information to patients.

Health professionals’ views on health literacy issues for culturally and linguistically diverse women in maternity care: barriers, enablers and the need for an integrated approach

Objective To identify health literacy issues when providing maternity care to culturally and linguistically diverse (CALD) women, and the strategies needed for health professionals to collaboratively address these issues. Methods A qualitative case study design was undertaken at one large metropolitan Australian hospital serving a highly CALD population. Semistructured interviews were conducted with a range of maternity healthcare staff. The data were analysed thematically. The study is informed by a framework of cultural competence education interventions for health professionals and a health literacy framework. Results Eighteen clinicians participated in the interviews (seven midwives, five obstetricians, five physiotherapists, one social worker, and one occupational therapist). Emergent themes of health literacy-related issues were: patient-based factors (communication and cultural barriers, access issues); provider-based factors (time constraints, interpreter issues); and enablers (cultural awareness among staff, technology). Conclusions There are significant health literacy and systemic issues affecting the hospitals provision of maternity care for CALD women. These findings, mapped onto the four domains of cultural competence education interventions will inform a technology-delivered health literacy intervention for CALD maternity patients. This approach may be applied to other culturally diverse healthcare settings to foster patient health literacy. What is known about the topic? There are health inequities for pregnant women of culturally and linguistically diverse (CALD) backgrounds. Low health literacy compounded by language and cultural factors contribute to these inequities and access to interpreters in pregnancy care remains an ongoing issue. Pregnancy smart phone applications are a popular source of health information for pregnant women yet these apps are not tailored for CALD women nor are they part of a regulated industry. What does this paper add? This paper provides clinician and language service staff perspectives on key health literacy issues that are both patient-based and provider-based. This research confirms that the complex interplay of social and practical factors contributes to and perpetuates low health literacy, creating barriers to health access; it also highlights several enablers for increasing CALD health literacy and access. These include greater health practitioner awareness and accommodation of CALD womens needs and the provision of culturally and linguistically appropriate eHealth resources. What are the implications for practitioners? eHealth resources are emerging as valuable enabling tools to address the health literacy and information needs of pregnant women. However, these resources need to be used adjunctively with health practitioner communication. Both resource developers and health practitioners need to understand issues affecting CALD patients and their needs. Developers need to consider how the resource addresses these needs. Training of health professionals about culture-specific issues may help to enhance communication with, and therefore health literacy among, individual cultural groups. Further, formalised language and interpreting training of bi- or multilingual health professionals is advised to ensure that they are able to interpret to a professional standard when called on to do so.

Member roles and identities in online support groups: Perspectives from corpus and systemic functional linguistics

Online support groups (OSGs) are common sources of both health information and social support. To augment existing qualitative understandings of member roles and identities in OSGs, this article presents a corpus-based investigation of shifts in member lexicogrammatical and discourse-semantic choices in a bipolar disorder OSG. In total, 8.4 million words in 57,000 posts were transformed into a structured, grammatically annotated corpus and investigated using systemic functional linguistics (SFL) as a theoretical framework, focusing on interpersonal and experiential meanings. The findings of mood and transitivity analyses show marked differences between new and veteran members’ language choices over the course of membership in the OSG: particularly, in how veteran members provide advice, and in how new and veteran members ascribe and attribute bipolar disorder to both the self and others. Discussion addresses the affordances and limitations of corpus linguistics and SFL as strategies for providing quantitative support for key claims of earlier research in this field.