Oral communication skills of international medical graduates: Assessing empathy in discourse

Abstract

We examine a dataset consisting of 11 International Medical Graduates (IMGs) performing an Objective Structured Clinical Examination (OSCE). Our aim is to address questions about the linguistic realization of empathy in the clinical discourse of IMGs and the extent to which OSCE examiners are sensitive to relevant features of the discourse. We analyse three aspects of the dataset as manifestations of empathy: sequential organization to provide reassurance; responsiveness to the simulated patient's lexical choices for emotionally charged words; and the organization of turn-taking in the interaction. Our analysis suggests that in each of these areas it is possible to identify discourse strategies which realize empathy. These strategies are used by IMGs who are good communicators and not used by poor communicators. Our evidence suggests that of the features we examine, the most salient for the examiner is a greater than normal occurrence of transition pauses. We argue that it is only in the area of the organization of conversation that the problems displayed by some IMGs are due to differences in cultural background, and it is therefore significant that the feature we identify as salient comes from this area.Keywords: empathy; discourse analysis; reassurance; division of work; International Medical Graduate (IMG); OSCE BackgroundAustralia, like many other Western countries (Birrell 1996;Birrell and Hawthorne 2004), relies heavily on international medical graduates (IMGs) to provide medical care to its growing population (Han and Humphreys 2006). These IMGs bring to Australian medical institutions a considerable diversity in their background training, clinical skills, understanding of the health system and communication skills (McGrath 2004;Whelan 2006). IMGs' professional knowledge, lay-cultural knowledge, socio-cultural assumptions, institutional norms and values, and personal experiences are all in full display in medical events (Sarangi and Roberts 1999;Roberts and Sarangi 2002;Candlin and Candlin 2003;Roberts et al. 2003Roberts et al. , 2004. A lack of commonality in the participants' inferences and contextual cues may affect the interpretative schema and therefore the comprehension of speech (Gumperz 1971(Gumperz , 1982(Gumperz , 1999 between IMGs and their patients, potentially causing miscommunication in medical visits. Such communication difficulties can have a negative effect on patients' satisfaction in the consultation. 1 This paper addresses some of the communication difficulties that IMGs face during medical consultations by examining how diverse discourse features were used by IMGs to articulate an empathic stance during an OSCE (objective structured clinical examination) and the extent to which the assessor's rating seems to be sensitive to these discourse features. The data we consider here was taken from a training session for IMGs preparing for the actual Australian Medical Council examination. In this case a medical practitioner played the role of the patient. The OSCE scenario assess...

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