Medically Speaking: Rules for Curriculum Design
Lynda Katz Wilner, Corporate Communication Trainer, ESL RULES, LLC, lkwilner@successfully-speaking.com;
Marjorie Feinstein-Whittaker, Corporate Communication Trainer, ESL RULES, LLC, wg@prospeech.com
In today’s healthcare settings there is a varied assortment of cultures represented by the healthcare provider and patient population. Limited English proficiency on both sides is often a challenge seen in hospitals throughout the United States. This, compounded by differing communication and cultural styles and accents, sets the stage for potential misunderstandings and frustration for both parties.
There is an increasing need to develop curriculums for students entering healthcare fields. The challenge is in designing a course that will not only address medical vocabulary and language but, most important, teach students effective communication skills to successfully interact with patients, family members, and colleagues. Healthcare professionals, including physicians, nurses, allied health professionals, technicians, transport personnel, and unit clerks, all require optimal communication skills to successfully meet the demands of their occupation. A wide range of languages, verbal and nonverbal communication styles, accents, and cultural backgrounds influence the exchange of information and ideas. Miscommunication in healthcare situations can lead to a disruption of trust and rapport and lack of patient satisfaction, and may even have life-threatening consequences.
An ideal curriculum must include the strategies for effective communication, and should provide the student with a repertoire of tools to avoid or repair communication breakdown (Wilner, 2002; Wilner & Feinstein-Whittaker, 2007). In addition, it is essential to include an exploration of aspects of various cultures and how their beliefs and customs relate to illnesses, treatment, family roles, and communication styles (Lipson & Dibble, 2005; Salimbene, 2005).
MASTERING THE RULES FOR OPTIMAL COMMUNICATION
Some essential elements for this type of course are as follows (Wilner & Feinstein-Whittaker, 2007):
Rule #1: Compound Nouns
Our medical vocabulary is filled with compound nouns. Think about how we check a patient’s vital signs and blood pressure and family members meet in the waiting room. The rule for pronouncing compound nouns is to stress the first word of a compound noun with higher pitch, louder volume, and a longer vowel.
Rule #2: Proper Nouns
We introduce ourselves as Dr. Shah or Ms. Caroline; we refer to hospitals, such as Johns Hopkins or Mass General; and we give directions, such as North Avenue or Wolfe Street, near Camden Yards, inBaltimore, Maryland. The rule for pronouncing proper nouns is to stress the last word, except with the word street.
Rule #3: Acronyms and Initializations
In American English, we use a multitude of “abbreviations” or shortcuts for frequently used words. We may receive our MD or RN degree; a patient may suffer a CVA (cerebro-vascular accident) or an MI (myocardial infarction), or we check the patient’s CBC (complete blood count). The rule for acronyms and initializations is to stress the last letter of the abbreviation or initialization. Acronyms are said as a whole word; e.g., GERD (gastro-esophageal reflux disease).
Rule #4: Numbers
Stating numbers can be confusing, if we don’t abide by the correct stress pattern. When counting, stress the first syllable in “teen” numbers such as thirteen, fourteen, and fifteen. When counting, stress the first part of “ten” numbers such as thirty, forty. However, when discussing quantity, time, currency, and dates, stress the second part of the “teen” numbers; e.g., fifteen milligrams vs. fifty milligrams. In this context, primary stress shifts to the noun.
If one adheres to this rule, an appointment at 8:50 or 8:15 won’t be misinterpreted and 30 mg won’t be confused with 13 mg. These errors can lead to catastrophic consequences. The rule for numbers is to stress the appropriate syllable when counting and/or describing time, currency, dates, and measurements.
Rule #5: Syllable Stress
The predominance of multisyllabic words in medical terminology is often the nemesis of the English language learner working in medical fields. Syllable stress is usually more critical than sound production for intelligibility. If the student learns a general rule to decipher these words, the student’s competency and confidence increase significantly. First, the student should be taught to divide a word into syllables. Then, he or she must learn to stress the syllable preceding suffixes. Of course, exceptions will exist. This will allow the student to accurately state that the patient has undergone a colonoscopy or tracheotomy, and express an interest in anesthesiology or psychiatry.
CLARITY OF SPEECH
Pronunciation of specific sounds should also be included so the student doesn’t confuse “bleeding” and “breathing,” for example, and disrupt the message in critical situations. Because class sizes are usually large, the teacher must identify a few challenging sounds that are experienced by many members of the group. Typical high-priority sounds might include voiced and voiceless -th, -v, -l, -r, -er, and the -ng endings. Practice in using target sounds within the context of medical words is essential to ensure carryover in daily conversation (Wilner, 2002; Wilner & Feinstein-Whittaker, 2007).
GENERAL COMMUNICATION RULES
Healthcare providers must learn to be excellent communicators, which includes both listening and speaking. The following are some tips for both of these modalities:
Active Listening
Maintain eye contact
- Give nonverbal fe
edback - Lean forward
- Restate or paraphrase
- Ask questions for clarification
- Listen to emotional meaning
- Refrain from interrupting
- Do not finish other people’s sentences
Communication Repair Strategies
- Remain calm
- Maintain eye contact
- Repeat it one time
- Speak with adequate volume for the situation
- Rephrase your sentence
- Explain it another way
- Provide examples
- Use visual cues, such as gestures or pointing
- Spell or write down the difficult word aloud
- Emphasize the important word
CONCLUSION
A student who took the Communication Skills for Allied Health Careers course at Baltimore County Community College made the following comments about her competency level at the completion of the program. (Other comments can be accessed at http://www.successfully-speaking.com/testimonials-ccbc.php.)
I work for a Nursing Home Care Agency here in Baltimore. A few weeks back I was asked to go work for an elderly gentleman whose family had given specific instructions that ‘they do not want anybody with an accent.’ Unfortunately, there was nobody else available and I was requested to work with him. I applied the techniques I learned from [this class]. For example, I pronounced words very clearly, I talked very slowly and loudly, and I maintained eye contact. I tried to apply all what I learned from the speech class, and I did not have any problem with the gentleman. He understood everything I told him and I even went back to work with him again. I managed to handle my patient very well because of the techniques I acquired from (this class). I will continue to apply all the communication techniques plus tips on how to handle patients from different cultural backgrounds and I know it will improve my quality of work in the nursing field.
LM, international student from Nigeria
REFERENCES
Lipson, J. G., & Dibble, S. L. (2005). Culture and clinical care. San Francisco, CA: UCSF Nursing Press.
Salimbene, S. (2005). What language does your patient hurt in? A practical guide to culturally competent patient care. Amherst, MA: Diversity Resources.
Wilner, L. K., & Feinstein-Whittaker, M. (2007). Medically Speaking RULES. Owings Mills , MD: Successfully Speaking. www.successfully-speaking.com
Wilner, L. K. (2002). Medically Speaking: Accent modification for the medical profession. Owings Mills, MD: Successfully Speaking. www.successfully-speaking.com
Lynda Katz Wilner and Marjorie Feinstein-Whittaker are corporate communication trainers and certified speech and language pathologists in the Baltimore and Boston areas, respectively. Lynda is also adjunct faculty at the Community College of Baltimore County and teaches communication skills to international preclinical nursing students. Marjorie is a member of the Performance Improvement Team at the Workforce Development Center at Bunker Hill Community College in Boston, MA. Their company, ESL RULES, LLC, conducts workshops and develops training materials for nonnative English speakers. They are both members of TESOL and have presented these innovative approaches of accent modification at state and international conventions. They will be presenting “English for Medical Professionals - Assessments and Activities” at TESOL 2010 in Boston and will have a booth in the exhibit hall. To learn more about them, visit http://www.eslrules.com.
