English as an international language of medicine

Communicative competency is the initial goal of doctors who are obliged to work in a foreign language. The field of teaching and learning English for medical purposes belongs to the pedagogical branch of applied linguistics. Consider the problems of the overseas doctor who has to communicate with patients and colleagues in English. Such doctors may well have studied in English-medium schools or medical faculties. They have mastered a code of academic English and are at home with textbooks and journals in English. However, they often have difficulty in asking a patient about the duration of a headache. English in Medicine: A Course in Communication Skills†† English in Medicine: A Course in Communication Skills. By Eric Glendinning & Beverly Holmstrom. Cambridge University Press, Cambridge. 1987. Pp. 153. £4.75. ISBN: 0 521 311659 (Cassette £7.50+VAT; ISBN: 0521 323320). seeks to develop the English language skills required by foreign medical personnel for successful communication in their work or study. The course is based on the linguistic analysis of recorded data of doctor-patient and doctor-doctor communication. In keeping with current models of medical discourse analysis (Maher 1981 a, b) the text notes, for instance, how a native speaker instructs, explains and reassures while conducting an examination. The text employs an ethnographic approach to the channels and styles of communication including attention to the use of authentic documents. For example, the realization that referral letter writing has now been largely replaced by forms is an advance on previous language textbooks. The field of English language teaching and learning is not confined to overseas doctors in Britain or the USA. In medical schools around the world English is taught as part of the medical education curriculum. Medical students are fortunate if language teachers are aware of and respond to that important area of language teaching which (1) focuses on the specific English language needs of the medical learner, (2) focuses on themes and topics specific to the medical fields and (3) focuses on a restricted range of skills which may be required by the medical learner, e.g. for writing a medical paper, preparing a talk for a medical meeting, etc (Maher 1986a). The book by Glendinning & Holmstrom is one instance of the burgeoning field of language skills preparation. It is important to emphasize, also, that the language teacher need not be a medical specialist in order to teach students, doctors or nurses. As in the case of the above book, problem-solving activities allow doctors to use their professional knowledge while exercising English skills. The doctor or student provides the required specialist input while the teacher concentrates on ensuring that the communication is effective and accurate. This approach, of course, hangs on whether the teacher's orientation is sufficiently learner-centred to allow such new ways of learning. That English is of growing importance in modern medical communication is indicated to some degree by the widespread teaching of English in medical schools around the world. But what empirical evidence is there to support this view and to continue to justify English teaching in medical curricula? These questions can be dealt with in two ways. We can point to the spread of English in some medical education systems first by referring to longitudinal data on languages of instruction as supplied by medical schools of individual countries and second by longitudinal analysis of the language of articles listed in Index Medicus (Maher 1986b). The reality of three important sociolinguistic concepts (language spread, language maintenance and language decline) is well illustrated in the shifting situations of the world's medical schools. English has supplanted Arabic in Egyptian medical education and replaced Turkish, French and German in Afghanistan by 1970 (where Dari and Pushtu are other languages of instruction). The Afghan situation since the Soviet occupation in 1978 has, reportedly, moved the instructional language now towards Russian. English now co-exists with Burmese in Burma where before 1970 it was English medium instruction only. In some countries, such as Sri Lanka, vernacular languages have arisen (Sinhalese and Tamil) along with existing English instruction. Colonial languages have declined in some systems: French and Portuguese in India, Dutch in Indonesia. There is clearly a desire to maintain regional languages as vehicles of medical instruction. A Maltese language examination is obligatory in the matriculation examination although English is the official language of instruction at the Faculty of Medicine and Surgery. In Eire, all Irish-born students are required to have a working knowledge of Irish Gaelic. More significant than official declarations on what language is employed in medical education, however, is the high degree of English-mixing with other languages at the level of teaching material use. This is the case with Japan and it is obviously true of other countries also. In the Korean entry to the World Health Organization Directory of Medical Schools there is the footnote: ‘English is used in medical textbooks’. Turning to the field of biomedical communication, a recent study (Maher 1986b) has described global trends in language preference. A computer-based investigation of Index Medicus showing the language of journal articles over a 17-year period (1966–1983) indicates that the number of articles published in English has increased steadily (19%) over this period. In 1980, the total (189 616) included 20% published in countries other than the USA and the UK. About 8% were published in three countries: Japan, Germany and France. This increase in the volume of English language articles was not matched by a similar increase in the number of German-language articles, which had fallen 5% during the same period. In terms of the volume of medical publications by national grouping, whilst the USA accounts for a substantial 32.2% of all articles written in English internationally the geographical spread of publications in that language is significant. In India, Singapore and Pakistan, for instance, where English is used as a functional first language in the professional medical domain and in commonwealth countries such as Australia and Canada there is a steady production of English-language writing in medical journals. But if we compare, for example, the number of articles in Japanese journals with that of English-speaking Canada, Australia and New Zealand, we find surprisingly that Japan, where English is a foreign language, produced more medical articles in English in 1980 than all of these English-speaking nations combined. A new situation has arisen, therefore, with regard to the expansion as well as the ‘ownership’ of English. This language is expanding as an instrument of international communication and education in medicine. Also, English cannot be said to be the personal property of any single nation, not even of the circle of English-speaking ones. It is the possession of any individual or nation who chooses to use it. From the data available, English would appear to be used widely or used as the official language in countries where English is not the mother tongue, in the sense that domestic, internationally distributed journals of medicine are often published in English. English as a foreign language is taught as a compulsory subject in many medical schools around the world but with possibly less urgency than the sociolinguistic realities of modern international medicine demand. Fluency in reading skills is the minimum requirement not only for the comprehension of international journals but also for local in-house publications in countries where English is not the mother tongue. Also, the ability to write accurately in English will be a growing need (especially for postgraduate students around the world) but recognition of these linguistic needs must be made in the early stages of medical education. These pedagogical possibilities, combined with the advances now being made in our understanding of doctor-patient interaction and medical discourse in general emphasize the importance of applied linguistics to medicine.