University of Tampere researches the language skills of doctors coming from abroad in a collaboration of medical practitioners and linguists. They want to find out what effect language skills have on the fact that 60 percent of foreign doctors fail the certification to qualify for a license to practice medicine.
Ever since the news started to spread of doctors who speak Finnish poorly, there have been plans to make stricter language skill requirements for foreign doctors. In March a working group in the Ministry of Social Affairs and Health proposed a professional language exam to doctors coming from outside the EU/EEA countries. A language test is also being planned for doctors who move from one EU/EEA country to another.
– We thought that it would be good to have research-based information so that this thing would not only rest on the ideas of the working group, says Kari Mattila, Professor in General Practice at the University of Tampere.
Maija Tervola who is a post-graduate student of the Finnish language is now researching the language skill levels of foreign doctors on Kari Mattila’s initiative.
The School of Medicine at the University of Tampere is the only place in Finland which organizes the certification tests of foreign doctors. This activity is being controlled by Valvira, the National Supervisory Authority for Welfare and Health.
In the years it has had the organizing responsibility, the University has assembled a large data of the three-part competence test that includes a written theoretical test, a written exam on the Finnish public healthcare system and a clinical aptitude test. The exam has proved to be so difficult that only 40 percent manage to pass it.
– We wanted to have Maija (Tervola) start looking with us at how language affects how the test is evaluated and how well people do in the test. What is the language like the doctors use in the test and what are the factors that explain it? This is the research project we are about to start, Kari Mattila says.
Better skills are demanded of teachers than MDs
The numbers of foreign doctors are growing. At the beginning of 2010 there were 1,125 doctors working in Finland who did not have Finnish or Swedish as their native language.
Maija Tervola, who has started the research on doctors’ language skills, reflects on the fact that class teachers in comprehensive school have a much higher language skill requirement than doctors. She thinks that it is well justified that in many academic professions, such as that of comprehensive school teachers, the required level of language skills is the highest level in the test for the National Certificate of Language Proficiency. Therefore it is surprising that only intermediate level is enough for doctors, the same level that is required of a person who wants to apply for citizenship.
The language proficiency test is demanded only of doctors who come from outside the EU/EEA region. Problems are caused by doctors arriving from inside the EU who are not required to submit any proof of their language skills. The shortage of doctors may have given rise to hiring doctors who do not have sufficient language skills to do their jobs.
The patient in the role of an interpreter
Tervola is planning to test the language skills of foreign doctors with a separate test but she has started the research by looking at the answers the doctors have given in their competence test. She is also planning to look at the videos of the clinical aptitude test that is a part of the competence test.
Tervola says that pronunciation and intonation are one critical point whose significance is often played down.
– In a customer service situation it cannot be demanded of the patient or client that they would do the work and processing along the lines of “this is probably what the doctor said”. When it is an intimate and significant situation, understanding should be made as easy as possible. The same problem can be seen in reverse: the patient should not be required to make his/her own speech more understandable when s/he is describing his/her symptoms.
In Tervola’s view pronunciation and intonation may count for even a half of the interpretation of the message.
On the basis of the written responses in the competence test, Tervola has concluded that the doctors know vocabulary and phrases quite well but that mistakes make understanding difficult. It is because of these that the patient must make interpretations.
– The message can basically be understandable even if there are a few words that have been pronounced so and so. However, is this enough in a doctor’s job in the long run? It is rather doubtful, Tervola thinks.
There are answers in the competence test where the letters “a” and “ä” have been mixed and the case endings are missing.
– The written answers cannot be directly used to infer how a person does in oral communication. Still, case endings and the dots in ‘ä’ and the like usually succeed better in written than in spoken language when people have the time to think. On the other hand, many mistakes that are evident in written language cannot be heard in speech at all. A person can e.g. write ‘kesi’ or ‘kasi’ but pronounce the word correctly ‘käsi’.
Finnish doctors also have problems with language
As a lot of attention is paid to the foreigners’ poor language skills, people might forget that the communication skills of Finnish doctors need to be improved too.
– Finnish doctors are not famous for the fact that they always know how to say the right words. A doctor can look at an x-ray and say in the presence of the patient that this looks bad. These are issues of communication that are not only foreigners’ problems, Tervola remarks.
Should Finnish doctors have language skill requirements?
– I have been wondering whether I should take Finnish doctors as a point of comparison. Tervola specifies that she has come to the conclusion that Finnish doctors can be used as a point of comparison in terms of correct language use but not in terms of communication.
Text: Heikki Laurinolli
Translation: Laura Tohka
This story was originally published in Finnish in Aikalainen 9/2012 and it can be found at