Transcript presentation - My Surgery Website

Communication issues in GP training : a
multi-cultural and linguistic approach
Hazel Townsend
PG Cert Med Ed
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?
A few referrals were related to accent/comprehension
TEFL
1:1 fashioning techniques according to trainee need
Task-based Language Learning
Confidence-building
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Non-native English
speaker speaking English
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
www.cddft.nhs.uk
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
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
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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
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Thomas-Killman Model
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Barriers to assertive behaviour
The passive communicatior
The aggressive communicator
The ASSERTIVE communicator
BEING ASSERTIVE
Eye contact
Body posture
Gestures
Voice
Timing
Content
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Assertive Behaviours
Multi-modals example 1
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• https://www.youtube.com/watch?v=TdU2l0i2Wh0
Multi-modals example 2
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• https://www.youtube.com/watch?v=XqiRRIRhZoM
• 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
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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
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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
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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
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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
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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
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Hofstede's 6 Cultural Dimensions
• http://geert-hofstede.com/united-kingdom.html
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• doctor knows best
• concept of Face
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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
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Context
• 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
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Competencies needed
• 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
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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
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Current research
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• my own research
• thank you for listening