Communication issues in GP training : a multi-cultural and linguistic approach

1. Communication issues in GP training : a multi-cultural and linguistic approach Hazel Townsend PG Cert Med Ed

2. Referral of GP trainees to Trainee Support Service • TSS November 2011 to present (contract due to end 31 October 2015) • 60 referrals from GPVTS throughout North East • 32 of these due to “communication” issues or CSA exam failure with communication concerns as an element in the feedback • A noticable proportion of these trainees were IMG’s • Why? • And what have we done to make changes?

3. A few referrals were related to accent/comprehension • TEFL • 1:1 fashioning techniques according to trainee need • Task-based Language Learning • Confidence-building

4. Native English speaker speaking English Thinks in English Speaks in English Understands subtleties of English language conversations Since messages are usually clearly understood, action implications are also clear Non-native English speaker speaking English Thinks in other language, often must interpret incoming and outgoing messages Often limited vocabulary Often lacks sensitivity to subtleties of English language conversations Since messages are not always clearly understood, action implications can also be unclear

5. many referrals mentioned assertiveness • Assertive Communication with Cultural Influences workshop • 7/38/55 • multi-modals • Thomas-Killman conflict management style • assertive behaviours as opposed to passive (or aggressive) behaviours • cultural background • Far East, Middle East, West Africa, Eastern European • Hofstede's 6 Cultural Dimensions in relation to how we communicate. IBM worldwide 1967 - 1973 = 70 countries

6. Thomas-Killman Model • Shark - dominance - I win at any cost • Owl - collaboration - win/win • Teddy bear - smoothing - like me at any cost • Fox - compromising - you give up a little, I give up a little • Turtle - maintenance - I am not here, I have nothing to say

7. Assertive Behaviours • Barriers to assertive behaviour • The passive communicatior • The aggressive communicator • The ASSERTIVE communicator • BEING ASSERTIVE • Eye contact • Body posture • Gestures • Voice • Timing • Content

8. Multi-modals example 1 • https://www.youtube.com/watch?v=TdU2l0i2Wh0

9. Multi-modals example 2 • https://www.youtube.com/watch?v=XqiRRIRhZoM

10. Hofstede's 6 Cultural Dimensions • Power Distance Index : the degree to which the less powerful members of a society accept and expect that power is distributed unequally. Societies showing a greater Power Distance accept that everybody knows their place and no further justification is needed. Lower Power Distance societies strive for equality in the distribution of power

11. Hofstede's 6 Cultural Dimensions • Individualism vs Collectivism : individualism = individuals take care of only themselves and their immediate families whereas collectivism = individuals expect familiy members or extended family/in group to look after them in exchange for unquestioning loyalty

12. Hofstede's 6 Cultural Dimensions • Masculinity vs Femininity : masculine society = achievement, heroism, assertiveness and material wealth. Feminine society = cooperation, modesty, caring for the weak, quality of life

13. Hofstede's 6 Cultural Dimensions • Uncertainty Avoidance Index : should we control the future or just let it happen? Strong UAI societies = rigid codes of belief and behaviour. Weak UAI societies = more relaxed attitude

14. Hofstede's 6 Cultural Dimensions • Long Term Orientation vs Short Term Normative Orientation : relating to how a society prioritizes it's links to it's past over dealing with the challenges of the present and the future. Low scoring societies = maintain time-honoured traditions and norms, viewing societal change with suspicion High scoring societies = a more pragmatic approach; prepare for the future

15. Hofstede's 6 Cultural Dimensions • Indulgence vs Restraint : indulgent society = gratification of basic and natural human drives related to enjoying life and having fun. Restrained society = suppresses gratification of needs and regulates it by means of strict social norms

16. doctor knows best • concept of Face • http://geert-hofstede.com/united-kingdom.html

17. Context • The way you use language can be very powerful • Different contexts = use language differently • Institutional English • Medical English • Common understanding/use of jargon • What • When • Where • To whom • Why • How

18. Competencies needed • Linguistic competency – grammar, phonology, lexis, syntax etc • Pragmatic competency – ability to use language appropriately in different social/institutional situations • Strategic competency – how else to get your message across? • Discourse competency – when to speak, when to be silent, when to join in etc • Fluency

19. Research • much research on the subject of how communication difficulties affect patient safety • some related to not understanding grammar,tenses and pronouns • many related to what constitutes jargon? • most related to communication discordance/schema

20. Current research • Doctor-patient dialogue now a LEGAL obligation • informed consent • Warwick University Centre for Applied Linguistice, Warwick Med School, NHS CCC for Rugby & Coventry and South Warwickshire • Written communication between hospital-based specialists, GP's and patients in the UK • University of Nottingham, Leicestershire and Rutland Hospice and Loughborough University • Video-basesd communication research and training, empathy and pain management in supportive and palliative care

21. my own research • thank you for listening