Intercultural Clinical Communication

Pasted from Unilearn:

Dear colleagues,

Staff in our unit have recently completed an interactive DVD-ROM on intercultural clinical communication. For those of you who work in this area, you'll know how scarce multimedia resources on intercultural clinical communication are!

' "I'm feeling a bit crook": Understanding and managing clinical communication' is designed for pre-clinical and clinical international medicine and health science students. There are four sections:

- voxpops of international students talking about cultural differences and challenges in Australian clinical settings, with reflection tasks as triggers for discussion;

- four videos of international students interviewing simulated patients (social history, alcohol history, paediatric asthma management, physiotherapy subjective chronic pain assessment). The videos include reflection tasks and language activities.

- a library section of resources including newspaper articles

- a sound file glossary of Australian colloquialisms and slang heard in clinical settings (with explanations and example of use in context).

Single copies are $66 and can be ordered through the University of Melbourne's e-showcase

For more information please email me

Kind regards,


Dr Robyn Woodward-Kron
International Student Support Program
Faculty International Unit, Faculty of Medicine, Dentistry and Health Sciences NEW CONTACT DETAILS
179 Grattan St,

The University of Melbourne
Victoria 3010 Australia
T: 03 93476489 (pls. note temporary number)
F: 03 9347 7854

Re: Non-standard English

Pasted from Unilearn:

Dear Robyn,

I was interested to hear about your project, particularly the idea of the glossary of non-standard Australian English. I think the project opens up a number of interesting questions, particularly regarding the positioning of standard and non-standard English(es) within the curriculum in tertiary education.

Before moving to Melbourne, I worked at the School of Applied Linguistics and Language Studies, at the University of Dundee in Scotland, where we ran a series of workshops on teaching Scottish English to international (and national) medical and dentistry students. The aim of these was to raise awareness of Scots English used by patients in the local area, as this was an issue that presented itself time and time again. Students, educated in a ‘standard’ English, often speaking their own variety, were not equipped to deal with the reality of Scottish English in the workplace. If you are interested, you can see a conference paper on this project here: ... ingourlang

The project raised a few eyebrows, to say the least. We were questioned by some as to why we were teaching Scottish English to international students. Would this help them get a better IELTS grade? Would this help them write better essays? What about their own spoken English? Might it suffer in any way? In short, were we actively deteriorating the English language standards of our students?

The point is that, raising awareness and knowledge of non-standard English(es) in tertiary education, and, in particular, promoting them as non-deficit models, should not be equated with encouraging students to produce non-standard English. There seems to be a great deal of confusion over ‘receptive’ and ‘productive’ skills, and a (growing) fear that deliberate/ explicit exposure to the non-standard within the curriculum, coupled with the encouragement of a positive attitude towards it, will eventually lead to production of the non-standard. The biggest fear is that it will find its way into their written academic assignments. The concept of code-switching becomes almost alien, and disappears into a hotpot of discourse over the deterioration of English language standards in education.

It is not only doctors and nurses that need to be able to negotiate cultures and Englishes. It is something that all graduates are faced with. Universities, as part of their aim to value and promote diversity, need to seriously consider the place of non-standard English within the curriculum. If graduates are to be prepared to communicate between and within Englishes and cultures, both locally and internationally, then awareness of the features of non-standard English(es) is almost essential. Arguably, this goes beyond the ‘standard’ and ‘non-standard’ Englishes of the countries in which English is spoken as a first language, particularly in multicultural contexts such as Australia. Here, I am thinking of Melbourne in particular, where we come up against a variety of Englishes on a daily basis, particularly in the western suburbs.

* Does anyone have any other examples of courses or programmes at their universities in which non-standard Englishes are explicitly presented and dealt with in a systematic way? Do any of these Englishes belong to ESL countries (Singaporean English, Indian English)?
* Is it possible to promote intercultural communication skills within the curriculum without dealing with the role of non-standard English(es)?

Many thanks


Scott Mc Donald,
Lecturer in Language and Learning
School of Learning Support Services
Portfolio of Language and Learning
Victoria University, Melbourne, Australia

Ph: + 61 3 9919-4774
Fax: + 61 3 9910 4766

Dr Chad Habel Centre for Learning and Professional Development University of Adelaide

Intercultural Clinical Communication

From Unilearn:

Hi Scott,

I teach a credit bearing course in English as a second language and it includes a fair amount of instruction in spoken Australian English. Can I offer tweo comments.

I am not sure how you define non-standard English. However, if you mean colloquial lexical items I am not a fan at teaching them. Personally, I don't believe that teaching students many of the sorts of cliches that are common on certain "Aussie English" websites (e.g., is an efficient use of time and energy. I would bet that many of the words and expressions that are described as "Aussie slang" are generally of low frequency (e.g., "chunder"), often idiosyncratic, or even no longer in use at all! I wonder if anyone has done any research on the frequency of these sort of words. Perhaps a corpus based approach to teaching these words, would be useful (rather than one based on starting with words beginning with "A" and ending with those beginning with "Z). I have however, pointed out to students that Australian English sometimes tends to shorten words and add a vowel (e.g., mozzie, barbie, ambo, rego). Students have appreciated this and this sort of instruction enables them to take some conrol of their own learning. They can begin to see the pattern, and I don't need to teach each word.

One aspect of non-standard English that I do teach is variations in word order in spoken English (e.g., fronting). Students appreciate this. I don't think students necessarily have to produce this sort of ungrammatical speech, but they should have a passive understanding of it.



Dr Chad Habel Centre for Learning and Professional Development University of Adelaide

Intercultural Clinical Communication

Dear Mark

Thanks for that - I'm very interested in this issue also as I am due to give a session on Australian Idioms and Slang to a group of International students next week. I completely agree that simply defining terms - especially terms which are not very common - is not the best way to go. I plan on identifying patterns such as the abbreviations you mention or the use of rhyming slang to try and give the students some tools for working things out themselves. I think this sort of thing could be quite fun without playing to the stage Aussie stereotype.

I have a couple of quick questions that I hope you have the time to answer - what do you mean by "fronting"? Do you mean variations to the usual subject-verb-object sentence structure? (Being a bit new to formal grammar I may be displaying my ignorance.) Are there any resources you've found particularly useful for teaching non-standard English? (The "Slang Dictionary" types seem ubiquitous and of limited use...) For my part I've found the National Museum of Australia's "Aussie English for the Beginner" website very useful for starters: ... _beginner/

On this site is a link to Bruce Moore's "Vocabulary of Australian English" which is quite interesting as it goes a bit further than simply providing definitions. Any suggestions from AALL staff on how to deal with this issue will be much appreciated.


Dr Chad Habel Centre for Learning and Professional Development University of Adelaide

Intercultural Clinical Communication

From Unilearn:

Hi Chad,


There are variations of what one might call fronting. Basically it
involves putting the topic of the sentence at the front of the sentence.
Typically it results in sentences like the following:

That bloke with the funny glasses, I saw him yesterday.
Your family, do they live in a big house?

Other variations in word order:

Other types of word order variations involve putting the topic at the
end of the sentence.....maybe even in a long sentence.

This results in a complex sentence which seems formally ungrammatical. I
am not sure myself how best to call the opposite of fronting. Some have
referred to it as "tails". See below for examples:

You have to wonder if it's ever going to stop this rain.
It's just not fair is it what the government has brought in this new tax


I have found the following two books useful for teaching.

"Exploring Grammar in Context", Carter, Hughes and McCarthy, 2000, CUP
(includes exercises for students)
"Grammar and Context", Hewings and Hewings, 2005, Routledge (reference

I am no expert in this sort of stuff either, but I have found that
teaching the above material is helpful for most students.


Dr Chad Habel Centre for Learning and Professional Development University of Adelaide

Intercultural Clinical Communication

Hi Mark,

Thanks for your email. I agree that teaching Aussie slang may not be efficient in certain circumstances, but it may help international students integrate more fully into their local environments.

When I talk about non-standard English(es), I’m thinking about other varieties of English that exist in society, that have not been standardised.

I’m questioning whether, given that certain segments of our wider society are not necessarily on the road to standard English (for cultural reasons, for example), the so-called native-speakers of English themselves might benefit from an increased awareness and knowledge of other non-dominant varieties of English?

Take, for example, ESB medical students intending to work in Aboriginal communities. I wonder whether an awareness of Aboriginal Englishes, coupled with intercultural awareness, would assist the communication process. By Aboriginal Englishes, I mean Englishes that reflect and maintain aboriginal cultures and identities.

Does anyone know of any such projects that are aimed at ESB students?



Intercultural Clinical Communication

This is a very good point - with reference to Scott's earlier post, I remember facing quite a challenge in reading and lecturing on Trainspotting! But it was lots of fun and the role of code-switching was very interesting.

I think these issues broaden out into general communication skills as well. For instance, we've had complaints from local students about the heavy accents of teachers from an international background. However, we've also had complaints from international students about Australian teachers who speak too fast, mumble, don't enunciate properly etc. They seem to assume that because they speak the "dominant" form of English their communication is beyond reproach. Perhaps the first step is getting everyone (teachers as well as students) to recognise the wide varieties of communication style and language use...


Dr Chad Habel Centre for Learning and Professional Development University of Adelaide

Intercultural Clinical Communication

From Virginia Hussin --

"I agree that the use of colloquial language is highly variable and idiosyncratic. When I was teaching credit bearing courses for overseas qualified nurses and teachers, I would ask the students to collect colloquial terms that they heard on their placements and bring them back to the classroom for discussion. As you can imagine, the lists of words and phrases collected in hospitals and schools were quite different but this approach semed to work very well because the language was curent.

In the last few years, I've been teaching supplementary English classes for EAL Nursing, Physiotherapy and Pharmacy students. I've found that students always want to know about colloquial terms they might come across, so I've come up with a few different lists but I'm aware that these lists have use-by dates.

For example, in sessions for the Nursing students, we've discussed words and phrases that they might hear when interviewing patients (taking and nursing history) e.g. words for family members: hubbie, life partner, ankle-biters, in-laws; words for parts of the body: guts, belly-button, ticker, balls; words for bodily functions: to have a wee, be clogged up, time of the month, have a doze, throw up; words for mental and physical states: to fly off the handle, mad as a snake, in a flap, shook up, on edge, down in the dumps, done in/buggered, feel like death warmed up, pissed/under the influence and words for wellness states: off-colour, on the mend, out of sorts, a bit off, to have time off, to have a set back, to have a bug. Of course there are also common words used by hospital staff are parts of the body e.g. peri for perineum and choly for cholecystectomy, not to mention acronyms such as D&C for Dilation and Curretage.

I have to run these phrases past my health professionaI friends occasionally to check thier currency and I also give the students examples to show that terms used, very much depend on age, gender, class and culture.


Intercultural Clinical Communication

Posted on behalf of Kate Chanock:

"good grief, Virginia, I feel queasy just reading about it! But you remind me of my daughter's horror when she caught herself, partway through her first nursing placement in a nursing home, telling a patient she was going to "just pop you on the toot" (sit you on the loo). She seems to have an ear for the dialect...