MED-NET Conferences 1998, Lille & 1999, Maastricht
Anthology of presentations 4.5.

Courses in Medical English

R. Snipes (Giessen, Germany)

Does Medical English have a legitimate place in medical education in a united Europe?
The answer to this question is obviously YES.
But....
Does teaching medical English undermine the objectives of SOCRATES-ERASMUS exchange policies? The answer to this question is - perhaps not so obvious – NO.

Without a doubt the common language within a united Europe has become English and it is obviously the scientific language of choice for communication both verbal as well as written. How then can educators in medicine ignore the necessity to include courses in medical English in their medical curricula? It is as essential as the mandatory courses in the various disciplines of medicine. This is necessary for all medical students regardless of whether she or he aspires to do clinic work for an extended stay in an English-speaking country.

For those medical students who desire to perform a portion of their studies in a European partner country under the auspices of the Socrates programme,. the necessity still exits for the candidates to acquire a working command of the host language, in order to work with patients and communicate in their native language. The two goals are not mutually exclusive.

Accepting the assumption that courses in medical English are not only desirable but also necessary for medical students, what form of medical English should be offered to the medical student? Medical English courses do exist that are directed primarily at faculty and research associates aiming to better their knowledge of scientific English such as that used to publish papers in scientific journals. Some other courses take the form of practising oral presentations for international meetings. This type is also directed more to faculty and researchers. The type of medical English course most urgently needed by the clinically oriented medical student is one that aims at teaching the future physician how to communicate in English with his or her patients.

Thus, the primary aims and expectations of a course in Medical English for non-English- speaking medical students are:

1. To train medical students for encounters with patients ( in English-speaking countries) and as a result:
2. To prepare medical student for future professional exchanges as physicians in the medical society of a united Europe (English being the common language of communication amongst colleagues).

A) HOW B) WHO C)WHAT

Three questions arise immediately when confronted with this new subject in a curriculum.

A) How can such a course be accomplished?

Firstly, in the form of an elective to students in the final years of their clinical studies, the idea being that they bring their medical knowledge with them, which they acquired in their own native language. The course should be limited to maximally 25 participants, meeting twice a week.

With this in mind the answer to the second question becomes more transparent:

B) Who can offer this course?

Ideally a medical person whose native language is English. This may not be so easy to accomplish on a permanent basis.

However, it is definitely not a prerequisite for a teacher of medical English to be a physician or a native English speaker! Assuming that the students bring with them their own medical knowledge then a primarily non-medical person can cope very well with such a course. Again such a person who is primarily English-speaking has a much broader basis upon which to build the course but this is not absolutely essential. Persons whose native language is other than English but who are trained in English (English-teachers, doctoral candidates in the department of English, for example) are all potential candidates and can guide such a course.

In order of preference: who can offer this course:

1. Medical personnel / English-speaking
2. Non-medical personnel / English-speaking
3. Medical personnel / Non-English-speaking
4. Non-medical personnel / Non-English-speaking

The answer to the third question:

C) What the course should include has no single answer

This can be left to the initiative of the teaching personnel and the wishes and expectations of the group. The outline below is one such possibility presently being used at the University Medical School in Giessen, Germany to groups of medical students and clinicians. The syllabus has developed over the past10 years, being modified and supplemented by suggestions and criticisms from students who have gained experience in clinics throughout the world, mostly English-speaking.

The protocol for such a course can be divided into the following categories:

1. Medical Abbreviations
2. Medical Pronunciation
3. Medical Vocabulary
4. Signs and Symptoms
5. Doctor-Patient Encounters
6. Greetings
7. Taking a history of present complaint and pain history
8. Taking a complete medical history
9. Making a review of systems
10. Verbal communication during a physical examination
11. Explaining techniques
12. Explaining diseases

Items 1-4 can best be handled by assigning homework. At each session, selected abbreviations and vocabulary can be reviewed in the form of verbal quizzes assuming that all participants have done their lessons. A booklet has been complied where abbreviations and vocabulary are presented, the vocabulary in form from lists with accompanying sentence so that students can learn their meaning in context. Vocabulary can be divided into layman’s terms and medical terms. The former consists of words that the patient uses in explaining her or his symptoms. For example, nauseous: the pregnant woman complained of feeling sick to her stomach, especially mornings. She feels nauseous.

Medical terms are those terms that a student learns in the course of medical studies which are not necessarily familiar to the patient. For example, icterus. Here the objective is to teach the student the common name, namely, jaundice. Pronunciation can be very effectively practised using a tape of selected medical terms, having the students repeat the words out loud and together. This may appear somewhat strange at first and remind the students of primary classes, but it is very effective in helping the students with their pronunciation and help with the melody of the language. In many cases the pronunciation of medical terms is quite different in English: for example, endoscopy

In English it is pronounced EN DOS / KO PE with emphasis on the DOS. In German it is pronounced ENDO / SKO / PE with equal emphasis on the all syllables. Signs and Symptoms is primarily an exercise in teaching diagnostic thinking. A typical sign and/or symptom is coupled to a group of diseases or complaints:

For example: the patient is presented with bright red blood in stools. What conditions have to be considered?
haemorrhoids, anal fissure, lower GI cancer, colonic diverticulum, ulcerative colitis, dysentery, ischemic colitis
By carrying out exercises 1-4 at the beginning of each session ( taking about 1/2 hour) the class tends to warm up and become more talkative.

What can follow for the remainder of the session is one of the items under Doctor-Patient Encounters. This represents a chronological sequence of a real doctor-patient encounter but of course cannot all be done in one session. Thus, greetings are practised in one session, including such cultural and socio-psychological aspects as shaking hands, addressing the patients by name etc.

The taking of medical histories is presented in a very complete fashion including the domains Patient Profile (personal statistics of the patient) Past Medical History including childhood diseases, Family History, Social History and Chemical History. The use of videos is very helpful in these exercises, from which the students gain not only the Anglo-Saxon way of doing a history but also the proper language.

With Review of Systems the student is taught how to ask about the major systems of the body in a short interview with the patient regardless of her or his present complaint. For example, to inquire about the GI system it is most common to ask the patient: how has your appetite been lately ( upper GI) and do you have regular bowel movements? (lower GI). If the patient indicates some difficulties or changes then a second set of more specific questions follows, for example, what is the consistency of the stools?, have you noticed any blood in the stools? What colour is it? And where is it located? on top or mixed into the faeces?.

It is not the intention of the course to teach the medical students medical practices. Thus, in the next topic of verbal communication during physical examinations it is the task of the course leader to practise with the students the best mode of instructing the patient in a friendly manner what is expected of her or him during the physical examination.

The explanation of techniques and diseases has been instituted into the course upon recommendation of students returning from their clinical stays abroad having often been asked by patients to explain an anticipated treatment or test. They are often asked rather than the attending physician because the latter lacked the time or the patients were too intimidated to ask the doctor himself. For both explanations it is important that students learn to example techniques in a language that the patients can understand avoiding technical terms and unnecessary details. The patient is mostly interested whether it is painful and how long it will last.

Again here, filmed interviews in the hospital or staged video sessions can be most helpful. Lacking this material it is also recommended to use a Key Words method. The leader of the group can read a short synopsis of a technique or disease. During this reading the students should underline the major and most important words. Immediately thereafter each student should attempt to give a verbal explanation using the key words she or he underlined during the reading.

To obtain coherency during the course a course booklet was compiled and written and given out to the students at the beginning of the course. It consists of all the five items above and offers the student the possibility of working outside of the course time and has proven to be very informative during their stays abroad.

ISBN Number 90.805758.1.X

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