| The increasing communications in healthcare contexts are becoming more and moreimportant. It is both of significance and urgency to develop medical people’s interculturalcommunication competence in healthcare contexts (ICCHC) and reform Medical Englishteaching so as to meet the varying needs in medical situations. This study aims toinvestigate how Chinese medical staff communicates with foreign patients and what kindof competence they should develop to achieve desirable treatment effect and on this basis,an intercultural communication competence in healthcare context (ICCHC) model has beenbuilt tentatively. Being exploratory in nature, the study also suggests how to reform themedical English teaching.The study of ICCHC is conducted in three stages: building the ICCHC model,validating the ICCHC model, and modifying the ICCHC model. Firstly, based on athorough literature review on intercultural communication competence and thecommunication in healthcare context, the author defined the ICCHC as the ability toeffectively and appropriately communicate with people from diverse cultural backgrounds,which requires medical linguistic competence, pragmatic competence in healthcarecontexts and intercultural competence in healthcare contexts. Then, an empirical study iscarried out for the purpose of validating the model in reality. The study has used qualitativeand quantitative research method to establish as complete a picture as possible of ICHCand probes its components based on the analysis of the data collected.Finally, based on the discussion of the data, the researcher further validates andrevises the model, the general framework has been proved as complete on the whole, andthe subcategory of the components was refined. The medical linguistic competenceincludes medical linguistic knowledge and skill; the pragmatic competence in healthcarecontext includes social linguistic competence in healthcare context, medical discoursecompetence and strategy competence in healthcare context; intercultural competence inhealthcare context includes cognitive, understanding competence of medical culture andempathy. The researcher also puts forward the suggestions for medical English teachingreform and points the direction for further researches.The thesis is composed of six chapters. They are presented as follows. Chapter One begins with an introduction of the current situation of medical treatmentsof foreigners in China, and then the medical English researches and the situation ofmedical English teaching are presented. Therefore it is important and urgent to developintercultural communication competence in healthcare context(ICCHC) model so as tomeet the growing needs in medical situations in China.Due to the unfamiliarity of the cultural background between doctors and patients,their communication often reduces the certainty and expectations, and may lead to doubt,misunderstanding, and even conflicts between Chinese doctor and foreign patients. Therelationship between culture, communication and healthcare has become a very complexissue which requires knowledge from various academic disciplines such as health science,sociology, psychology, bioethics, and linguistics. This complexity occurs most frequentlyin intercultural discourse where patients, their families and healthcare workers havedifferent cultural attitudes and behaviors. So it’s necessary to take into consideration thespecific health needs of these people, and improve doctor’s ability to communicatecompetently in healthcare contexts with patients from other cultures whose values,behaviors, and communications may vary from those of the doctors.Medical English education in China’s colleges and universities is supposed to trainmedical students to meet the needs of their future career. Based on a brief review of theMedical English teaching and research, it has been found that Medical English researchmethod and scope is rather simple and narrow and that Medical English teaching fails togets its due attention in many colleges and universities. The current situations of MedicalEnglish teaching, from the curriculum, the teaching methodology, the quality of textbooksto the classroom organization, all need to be further improved.Chapter Two consists of three parts. The first two parts are the literature review andthe third part is the construction of the ICCHC model.The terms “communicative competence” and “intercultural communicationcompetence” are defined first. The notion of ICC is derived from “communicativecompetence”. Based on the recognition of the cultural limitations of “communicativecompetence”, the concept of “intercultural communication competence” is put forward tocomplement the concept of “communicative competence”. Spitzberg (1997) defines ICCvery broadly as an ability to communicate appropriately and effectively in a given context. Lustig and Koester(1996) views competent intercultural communication as interaction thatis perceived as effective in fulfilling certain rewarding objectives appropriate to the contextin which the interaction occurs. Chen and Starosta(1998) defines ICC as the ability toexecute communication behaviors effectively and appropriately. Although researchersdefine ICC in various ways, the author thinks that appropriateness and effectiveness arecentral to the definition of ICC competence.Then, studies on ICC model both at home and overseas are reviewed. With the focuson its components, Byram(1997) proposes a comprehensive framework that includes threecomponents of knowledge, skills and attitudes. Kim(1992) defines the components interms of one’s “adaptive capacity”, which is comprised of cognitive (“sense-making”),affective (including emotional and aesthetic tendencies, motivational and attitudinalpredispositions), and operational/behavioral (flexible and resourceful) dimensions.Spitzberg(1997) proposes that motivation (to communicate competently), knowledge (ofhow to communicate competently), and skills (behavioral enactment of knowledge) are thekey components of ICC. According to Chen and Starosta(1998), ICC is a concept which iscomprised of cognitive, affective, and behavioral ability of interactants in the process ofintercultural communication. In China, Wen Qiufang(1999) holds that ICC includescommunicative competence and intercultural competence. In this thesis, Wen’s model isadopted.The features on intercultural communication in healthcare contexts are also discussed.The communication in healthcare context is different from the daily communication. It’scharacterized by medical words and expressions in the discourse, the special conversationsequence, the imbalance of the doctor-patient communication, etc. As doctors and patientshave different health beliefs, it influences the belief systems of what constitutes illness,disease, health, the presentation of symptoms by patients, the decisions of physicians, andthe patient’s receptivity to recommendations. It also influences the expectations thatpatients and doctors have of each other. Thus, culture profoundly influences diagnosis,treatment, and responsiveness. However, the studies on communication between Chinesemedical staffs and foreign patients are rare, and worse still, there is little discussions onintercultural communication competence in healthcare context(ICCHC). Based on the ICC model of Wen Qiufang, the researcher tentatively constructs theICCHC model. The model defines ICCHC as the ability to effectively and appropriatelyperform communication behaviors in healthcare context in a culturally diverseenvironment. It comprises medical linguistic competence, pragmatic competence inhealthcare context and intercultural competence in healthcare context.Chapter Three reports an empirical study. The empirical research mainly focuses onthe four questions:(1) Does the medical linguistic competence contributes to the ICCHC?(2) Does the pragmatic competence in healthcare context contributes to the ICCHC?(3)Does the intercultural competence in healthcare context contributes to the ICCHC?(4)what’s the relationship of the three components?The study is based on a combination of data collection methods (observations,recordings of naturally occurring medical consultations and staff meetings, interviews andquestionnaires). Communication between Chinese medical staff and foreign patients duringmedical consultations are recorded. Through the analysis of the conversation transcripts inreal healthcare situations, the researcher investigates the reasons of barriers and success ofthe communication, and tries to validate ICCHC model. Semi-structured interviews areconducted with four experienced participants of intercultural communication in healthcare(ICHC). Through the interview, the difficulties of ICHC and the experts’ idea on thedefinition and components of ICCHC are analyzed. The questionnaire on ICCHC isdistributed to two groups, the Chinese doctors and nurses who are in charge of foreignpatients’ treatment and the Medical English teachers in universities. The components of theICCHC are further discussed through the statistical analysis of the questionnaire data.Chapter Four reports the data analysis of the recordings of naturally occurring medicalconsultations. The researcher first records the conversation between Chinese doctors,nurses and their foreign patients. And then transcribes the recording material. Theresearcher categorizes and analyzes their linguistic descriptions, the reasons, difficulties,barriers and conflicts of unsuccessful ICHC and explores in three aspects.Firstly, it discusses that the medical English pronunciation, words and grammar maycause the difficulties, barriers and conflicts of unsuccessful ICHC.Then, it focuses on the pragmatic aspects of the form of address, euphemism, politeusage of words and discourse structure in healthcare context, and found that it may also result in the communication breakdown.Finally, it discusses that the culture aspects of hospitalization procedure, medicationhabits, privacy, medical decision-making in diverse medical cultures may also cause thecommunication problems.Based on the above analysis, it’s evident that medical linguistic competence(including medical linguistic knowledge and skill); pragmatic competence in healthcarecontext (including social linguistic competence in healthcare context, medical discoursecompetence and strategy competence in healthcare context); intercultural competence inhealthcare context (including cognitive and understanding competence of medical culture,empathy competence) contribute to the successful ICHC.Chapter Five mainly deals with the analysis of questionnaire data and interview data.The interview data is discussed first. The interview attempts to integrate the views onChinese doctor, nurse, medical English teacher and foreign patients about the ICCHCmodel and its components, and how the participants solve the problems in ICHC, Thisstudy supports the general ICCHC framework proposed in Chapter2and finds thatmedical linguistic competence is the basis for ICHC and pragmatic competence andintercultural competence in healthcare context is an important factor for ICHC.Then to further examine the components of ICCHC, the questionnaire data iscollected from two groups of people, the doctors and nurses who define ICCHC from“situational needs” and the medical English teachers who define ICCHC from students’“study needs”. In order to examine whether the ICCHC model can be used to guide themedical English teaching or not, the researcher also uses Mann-Whitney U test to examinethe difference of the two group’s judgments on the importance of the items in thequestionnaire. The Mann-Whitney U test result shows that there are no differences betweenthe two groups of people. Finally the researcher uses factor analysis to test the importanceresult of the items of the whole questionnaire and finalized the components of ICCHC. Thefactor analysis result shows that ICCHC is composed of medical linguistic competence(including medical linguistic knowledge and skill), pragmatic competence in healthcarecontext (including social linguistic competence in healthcare context, medical discoursecompetence and strategy competence in healthcare context), intercultural competence in healthcare context (including cognitive and understanding competence of medical culture,empathy competence).Chapter Six summarizes the research findings and presents a complete model ofICCHC. And based on the model, the author explores the pedagogical implication of theresearch findings. With the model as guidance, in the Medical English teaching reform, thefocus of Medical English teaching should fall on developing students’ interculturalcommunication competence in healthcare context in order to meet the development of thesociety and the needs of student’s future career. Also the limitations of the research arelisted, the future researches should be carried out to enlarge the quantity of the participants.This study is a new attempt, the author endeavors to construct the ICCHC model anddiscusses the components of ICCHC, but some problems may still exist and need furtherexploration. |
PDF Full Text Request