Virginia Allum is Head of Medical English at SLC (Specialist Language Courses) and also works as a freelance medical English writer. Author of several online Occupational English Test courses – SLC Reach OET B Medicine 2.0 (doctors) and SLC Reach OET B Nursing 2.0 (nurses) as well as general medical English preparation courses for healthcare professionals: SLC Medical Terminology, SLC English for Nurses: Getting the Essentials Right, SLC English for Doctors: Advanced Communication Skills and SLC English for Care. As a freelance writer she recently co-authored OET Preparation Nursing (CUP India) 2019, author and is a regular contributor of medical English articles for Infirmiers.com (online magazine for the IFSI -French Nursing Diploma).
You’re a nurse who also works as a materials writer for medical and nursing English. What first led you to medical English?
Like many people, I have meandered through a few different areas of study and associated jobs. Writing medical English materials was a natural progression through previous studies. After school, I started an Arts/Law degree in Sydney. This was a combination Law degree with an Arts degree in languages (Spanish, French and German). I soon realised that my main love was the study of languages. At the same time, I had been working in a care home to earn pocket money for a planned overseas trip. I also realised that I loved Nursing too. After dropping out of university and travelling for a while, I returned to Australia and trained as a nurse at Royal Prince Alfred Hospital in Sydney.
Working for a while in hospitals, I decided to set up a Home Nursing Service in Sydney which developed into a Palliative Care Nursing Service (by accident). I found that Palliative Care was the area of Nursing I loved (you may notice that I always add role plays or units about end-of-life care in my books and courses).
Moving on a few years and I started on a new direction – I became a Nurse Preceptor, teaching students of the ‘College Course’ in Nursing, as it was then called. Nursing was moving into the tertiary sector and this was the first step. I found that Teaching was another area I enjoyed, especially as it was in the workplace and very practical. By chance I read an advertisement for an intake of students for a Grad. Cert. TESOL course. With a love of language learning behind me, I thought this may be an interesting direction to go. After a few years teaching EFL, I was led (again, by chance) into teaching medical English. A Japanese Nurses’ Study Tour was about to walk into the doors of the college where I taught…’You were a nurse, weren’t you? Could you put something together for the tour? Always one to say ‘Yes’ before really considering the ramifications, I agreed. Unfortunately, the existing medical English books were outdated and the college’s materials which were kept in a bottom drawer and were not very useful.
I linked up with the Nursing department of the college to try to find out the needs of international Nursing students and found that much targeted language support was needed, but not available. A comment about this to a friend (Patricia McGarr) led us to the writing of the ‘Cambridge English for Nursing’ books, as (again, by chance) Cambridge University Press were looking for authors for a new series (‘Cambridge English for..’) and need someone to write the Nursing title.
This was the beginning of a new direction for me. I had the advantage of a nursing background to add to EFL training. I found it satisfying to be able to produce materials which were meaningful and near authentic. In fact, many of the dialogues I write come from previous experience. Most are a conglomeration of different interactions I have had with patients, their relatives and other healthcare professionals.
It’s a long way from those first materials found in the bottom drawer which contained useful expressions such as ‘Doctor, my elbow hurts.’
Has awareness of language and communication in nursing changed (in Australia and the UK) since you first qualified? (In what ways? Etc)
Definitely. There have been many changes in communication between healthcare professional colleagues and between healthcare professionals and patients. When I completely my hospital-based training in Sydney in 1982, nurses were ‘on the outer’ regarding communication with other healthcare professionals, particularly doctors. We were still viewed as ‘handmaids’ to doctors, not entitled to view opinions or be part of medical discussions. In my opinion, the change to a Bachelor in Nursing changed this. Nurses became better educated and confident in providing specialist input to patient care. Many bedside nursing tasks are now undertaken by health support workers (Healthcare Assistants in the UK), leaving higher level Nursing tasks to Registered Nurses. From a medical English perspective, this means that communication between colleagues can require an increasingly technical vocabulary.
Communication with patients requires the ability to translate technical language regarding procedures and medication into an everyday health language. An example of this is wound care. When I finished my training in 1982, we had around three types of dressings we could choose from; dry dressings (a piece of gauze), saline dressings (gauze soaked in saline), Eusol dressings (a kind of chlorine solution). Documentation of dressing changes was scant (I remember a ‘Communications book’) and care plans or care pathways were unheard of. There has been a huge change in the level of Health Literacy in patients, so that they have greater expectations of interactions with healthcare professionals. Previous comments such as ‘Don’t worry, it will all work out fine’ don’t wash any more. Patients and their carers expect accurate information which they can understand. Patients may have researched their health status online – accurately or inaccurately. These are new interactions which healthcare professionals now have with patients, either tactfully correcting inaccurate information or being able to build on a basic understanding.
As well, there is a greater understanding of the effect of poor communication. Patients whose anxiety is ignored or minimised often become more anxious which can delay recovery. Tactless interactions when delivering bad news can be traumatic for patients. Lack of understanding of different cultural expectations in hospital or when communicating can also cause distress. I have seen great strides in confronting these sorts of communication issues since my early days as a nurse. I still remember a consultant talking to a patient from New Caledonia who had been transferred to our hospital in Sydney for major brain surgery. The patient only spoke French. The consultant was convinced that his minimal French was sufficient to explain the procedure of a craniotomy and burr holes. The horror of his explanation remains with me (‘I’ll make a hole in your tête and then we’ll…’).
You are also Head of Medical English at Specialist Language Courses, the UKs leading digital provider of medical English training. In your view, is digital training the future for EMP?
Providing medical English training to healthcare professionals has one major difficulty – unpredictable shifts. Healthcare professionals who are already working, but hoping to move to an English-speaking country often have limited opportunities to attend face-to-face classes. I believe that digital learning offers a solution to this. Webinars can supplement the digital content of an online course, allowing for a feeling of personal contact and pronunciation correction. Pages of online courses can be downloaded, if students want to practise writing answers and activities can be done again and again, until the student masters them. As a materials writer, the digital environment is great for a field which changes quite frequently. I often find that I read an article about a new treatment or drug just after producing material on the same topic. In the digital world, I can update immediately. I am lucky to be working with SLC, as the company produces a very good quality product – plenty of pictures to help students understand complex technical jargon and a great team who edits and exercises quality control. It’s very satisfying to see the CPD accreditation on SLC courses which suggests that digital learning works well in the healthcare environment.
You’ve also been closely involved with the occupational English Test and have co-authored a very recent test preparation book, ‘OET Preparation Nursing’ which was published by Cambridge Press India. What makes this book different?
Although there have been quite a few OET preparation books published recently, Cambridge University Press India wanted to produce a book which initially appealed to the Indian market, but was not India-centric. Indian nurses, as well as nurses from other countries in the region (Nepal, Myanmar, the Philippines) have attempted the OET in order to work in Australia and New Zealand. Recent changes in the UK have seen a growth in non-EU nurses applying to work there. Nurses from South-east Asia, predominantly India and the Philippines have turned their attention to the UK as a work destination. Whilst nursing practice is similar in India, for example, the opportunities for interaction with patients is not the same. Time constraints mean that nurses working in India do not have the opportunity to develop a rapport with patients or spend time explaining procedures, so they are understood by patients. There can be hesitance about asking for clarification or admitting that something has not been understood. These differences in cultural interaction between India and Australia or the UK need to be appreciated for a candidate to be successful in the OET, hence the need for a book which is published in India with these issues in mind. As with all OET materials, the idea behind them is not to stop learning about healthcare interaction as soon as the test is passed – an awareness of the importance of effective communication in the workplace is paramount and can go a long way to helping a healthcare professional settle into a new workplace environment.
Medical English has evolved greatly- from lists of vocabulary and short phrases to learning about communication in a medical environment which includes intercultural communication and the ability to switch between technical and everyday health language. For this reason, whilst the OET Preparation book is published in India, it will have a wider appeal for all candidates who should use OET as an opportunity to examine their own methods of interaction with colleagues and patients and perhaps develop alternative modes of communication.
Many of the teachers and trainers who are involved in medical and nursing English are teachers and language specialists but do not have a medical background. Is there any advice that you, with your background in nursing, can give them?
Whilst a background in Medicine or Nursing is not entirely essential to teach medical English, there are obvious advantages in a healthcare background when teaching workplace-based courses. Having said that, a person with a background in Medicine or Nursing will probably not know everything about Medicine or Nursing. Every teacher has to do some research, before teaching a new module. Compare with a History teacher who specialises in the History of the 18th century and is suddenly faced with teaching the History of Ancient Greece.
There are numerous health sites which explain healthcare-related topics. Find one which is easy for you to follow. Have a passing relationship with medical terminology – remember that by learning some of the commonly occurring prefixes and suffixes, you’ll have half a hope of guessing the whole word.
Keep in mind that most, if not all, verbal interactions follow the same structure as any other interaction, e.g. asking for information, providing information, allaying anxiety. Use your students’ experience in their own language to compare interactions. Are they similar or different?
Academic medical English follows the same path as regular academic English. Some texts may be challenging for you to understand, but can be used in teaching to identify medical terms. Abstracts are quite useful for this. Make use of your students as a resource to discuss health-related topics.
They won’t expect you to be experts in Medicine – you are the language expert. Sometimes, it’s handy to have a ‘friend in the business’ who can be asked questions like ‘Which word would you use to explain this?’ Use EALTHY as your ‘go to’ resource. There are plenty of members who can answer specific questions.
With regard to OET texts, remember that they are less likely to contain a large amount of medical terms and any that are used should be explained. So, as a teacher, you are purely training students to understand what a patient says (e.g. during a snippet of a consultation), what a healthcare professional says to a colleague or patient (in a short text of 100-150 words) or an opinion or attitude a healthcare professional expresses during an interview or short presentation.