Abstract
In many Western countries such as Australia, international medical graduates (IMGs) play a crucial role in meeting health workforce needs. For doctors for whom English is an additional language and who have received their medical education in non-Western settings, a challenge is the patient-centred approach to communication, which is well established in Western medical education as the optimal approach for safe and effective healthcare. It acknowledges the patient as an active participant in the healthcare interaction, and the importance of the psychosocial dimension of patient well-being. While there is a vast literature on doctor-patient discourse in the qualitative health literature, there is little in the medical education domain that systematically examines the linguistic patterns of doctors who are learning or are less familiar with patient-centred paradigms of communication. This article examines how IMG doctors manage patient-centred interviewing. The data are 15 video-taped 8-minute roleplay consultations of IMGs and simulated patients. Systemic functional linguistics and genre theory provided the theoretical framework and tools to analyse how the doctors realised the tasks of patient-centred communication as informed by the medical education literature, with a particular focus on the tasks of gathering information, providing information and decision-making. The findings suggest that the discourse patterns of doctor-patient communication demonstrated by the IMG doctors were towards a model of patient-centred communication; that is, aspects of the communication resonated with the features of patient-centred communication. However, valued aspects such as seeking patient perspectives and eliciting and validating patient emotions were either not given discursive prominence or were largely absent. Medicalised language featured in the doctor talk to explore sensitive behaviours or topics. The findings provide insights for medical educators into how IMG doctors from non-Western educational contexts might interpret the communication demands of patient-centred care.
About the author
Robyn Woodward-Kron is Associate Professor in Healthcare Communication in the Department of Medical Education, University of Melbourne Australia. Robyn is a translational healthcare communication researcher with her work informing curriculum development in communication skills curricula in medical education. Her interdisciplinary research examines patient-centred care in health professional communication, inter- and intra-professional communication in both spoken and written contexts. Robyn publishes in medical journals including Academic Medicine, Social Science and Medicine, Medical Teacher, Clinical Teacher as well as applied linguistics journals including Language Testing and Assessment, and English for Specific Purposes.
Acknowledgments
The international medical graduates who participated in the 2011 workshops and gave permission for their roleplays to be used for research purposes. The Department of Health, Victoria, for the Developing Organisational Capacity Grant, 2010–2012. To colleagues, Drs Eleanor Flynn, Catriona Fraser, and John Pill; Ms Cathie Bow; University of Melbourne.
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