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Medical education in a multilingual and multicultural world

1993; Wiley; Volume: 27; Issue: 1 Linguagem: Inglês

10.1111/j.1365-2923.1993.tb00221.x

1365-2923

John C. Maher,

Interpreting and Communication in Healthcare

Medical education takes place within an increasingly multilingual and multicultural world. Medical schools world-wide officially employ 55 languages as media of instruction. There are some 5000 languages in use globally. Some of the 55 are languages of wider communication (known to linguists as LWCs), such as French in the Cameroon or English in Singapore, whilst others are lesser known languages (LKLs), such as Dari and Pushtu in Afghanistan or Mongolian in Inner Mongolia. Institutional or governmental policy aside, if all the languages and dialects known and used regularly by teachers and students were included the number would be much larger. We live in a multicultural world in which bilingualism and the possession of plural cultures and languages by any one individual or community is not only not strange but in fact normal. Unfortunately, the metaphor of the Tower of Babel as a human catastrophe instead of an emblem of rich diversity and opportunity has provided a useful tool in the marginalization of indigenous or ‘other’ languages in the modern nation state. Standardization and homogeneity of purpose and design have long regulated medical education. Factors determining languages of influence and choice in medical communication include the extent of research and publications available in a particular language, the migration of researchers to and from language communities and the ‘size’ and distribution of a particular language around the world. The standard languages now used in medical schools undoubtedly provide an important and essential medium of education. Given the influence of factors such as central educational policy, social prestige and regional location, a psychiatry manual, for instance, would probably not be written in Breton and certainly not in Yorkshire dialect. In many countries, standard languages become the lingua franca whilst they may not be the national language. In Saudi Arabia or Kuwait, English is not a national language but it is the official language of medical instruction (despite the fact that many Kuwaiti medical personnel were trained through Russian or East European languages). On the contrary, all the medical colleges in linguistically homogeneous Cuba employ Spanish — a language of ‘power’. ‘Nation’ need not coincide educationally with a single internal standard language or monolingual policy. Thus, in the USA, the three medical schools of Puerto Rico teach through Spanish. Castilian Spanish is taught in Spain but Catalan is retained for the medical schools of Barcelona. In many cases, medical schools may be ‘language specific’— one college, one language. Thus in Belgium, there are five medical schools which teach in Flemish (Dutch) and five in French; likewise in Switzerland, German is used in Basel, Bern and Zurich and French in Geneva and Lausanne. In multilingual countries with substantial indigenous populations frequently only one language of instruction is permitted. Thus, France has Breton, German, Occitan, Sardinian, Corsican and other languages but only French is recognized. In many instances, however, internal bilingualism is enshrined in medical school policy. Thus in the Cameroon both English and French are employed, in Madagascar Italian and English, and in Sri Lanka English while Sinhala and Tamil are used for practical work. Language switching in less formal learning situations is typical among students from mixed language backgrounds. Medical students of formerly multilingual nation conglomerates (Soviet Union, Yugoslavia) now appear to be shifting allegiances to other languages. Whereas Russian was a compulsory and influential subject in some East European medical schools, experiments are now in progress involving the selective use of English as a medium for medical training in some countries, in particular Poland. We wait for the outcome of decision-making regarding the status of Russian as the medium of instruction of scores of medical schools in the former Soviet republics. What must not be compromised, however, is the maintenance of language diversity and tolerance of language minorities within newly independent states. Nationalism only succeeds in crushing ‘other’ languages. Policy-making needs to consider education for a multilingual world not only because demographic movements such as immigration entail the movement of languages and with it public responsibilities but also because language is the educational resource of each individual. Non-Roman scripts frighten a monolingual British or North American student and ‘foreign’ languages are ranked in an order of reluctant acceptability: French probably comes first, German is useful but unattractive, Spanish is for a package tour holiday. However, the current reality in Britain is that to be English or Scottish or Welsh it is not necessary to have English as one's first language. For example, in the mid-1980s, the proportion of bilingual pupils in five Local Education Authorities was: 30% (Haringay), 18.8% (Waltham Forest), 17.8% (Bradford), 14.4% (Coventry). How many schoolchildren are hindered from entering medical schools because educational evaluation and screening are strictly oriented towards one language variety only? Medical students rarely come from one language community. In a study of the ethnolinguistic backgrounds of students in a medical school in Australia, Tiller & Jones (1984) reported that students spoke 41 languages, 21% of the sample being fluent in one or more of 30 languages. Such reports are useful in refuting the stereotype of the monolingual ‘Anglo-Saxon’ student. The fact that none of the students surveyed was familiar with any Melanesian, Micronesian or Polynesian language is, however, a cause for concern. Likewise, no students were fluent in any of the 150 Aboriginal languages of Australia. When students of multilingual backgrounds do embark upon medical studies what use is made of their intimate linguistic and cultural knowledge for learning purposes in a medical context? Studies indicate that personality and motivation play a larger part in success in medical school performance than intellectual ability (Walton 1987) and students' linguistic and cultural specificities undoubtedly play a part in motivation. When an individual's cultural habitus is ignored or even ridiculed the person may feel isolated, angry, powerless and lacking in confidence. As secondary education in many countries around the world moves forward with multilingual/multicultural curricula, medical education also needs to be responsive to an emerging globalization of medicine. The Edinburgh Declaration (World Federation for Medical Education 1988) highlighted concern about the proper provision in medical schools of knowledge, attitudes, and skills for dealing with contemporary society. A comprehensive investigation of the role of language in medical schools is urgently required. What languages are needed in the community? What languages and cultural backgrounds do medical students bring to the learning situation? (The World Health Organization regional initiative in the Middle East, the ‘Arabization of Medicine’ programme, is part of a balanced effort to bring greater linguistic and cultural sensitivity to bear on medical education, at the same time avoiding irrational ethnocentrism.) Ought there to be positive discrimination for some medical places based upon the ethnolinguistic needs of the community? In what ways can the scientific mores of medicine interact with the cultural diversities of individual learners? Do the underlying principles of a medical school's curriculum reflect the seriousness of its commitment to language and languages? Medical students are not a ‘problem’ because they come from a ‘minority’ or have accented speech or require language training. A more sophisticated view is to view their monolingual peers as linguistically disadvantaged. What planning is needed to develop medical care in a multicultural and multilingual society and how can medical education fulfil its proper role in this? As requirements for a working knowledge of foreign languages become diluted in some medical schools, particularly in English-speaking countries, there is the danger of cultural arrogance and isolationism. However, knowledge of other languages is still a part of training in many of the world's medical schools and the results are beginning to show. Already the medical profession of Japan, for instance, writes and publishes a larger volume of literature in English than the combined total of all their colleagues in Canada, Australia and New Zealand (Maher 1986). The global movement of doctors is essential for the cross-fertilization of medical ideas. A knowledge of foreign languages may also assist (though not necessarily) in the development of social tolerance and understanding of new ideas. Certainly, medical students directly involved in language study or working within a class-room which recognizes and encourages linguistic and cultural diversity will be obliged to rethink assumptions about their approach to communication and interpersonal interaction. New medical education must take the lead.