|Year : 2022 | Volume
| Issue : 2 | Page : 70-78
Assessment of language proficiency and enhancement among 1st phase MBBS undergraduates
Dharma Rao Vanamali1, Himavathy Kodandarao Gara2, Abhay Dadaji Hatekar3, Jeneeta Baa4, Surekha Pardeshi5, Naruttam Sonowal6, Sarita Panigrahy7, Sachin Mulkutkar5, Mamata Sar4
1 Department of General Medicine, GVP IHC MT, Visakhapatnam, Andhra Pradesh, India
2 Department of Physiology, GVP IHC MT, Visakhapatnam, Andhra Pradesh, India
3 Department of Physiology, Government Medical College, Gondia, Maharashtra, India
4 Department of Anatomy, Veer Surendra Sai Institute of Medical Sciences and Research, Burla, Odisha, India
5 Department of Physiology, Grant Government Medical College, Mumbai, Maharashtra, India
6 Department of General Medicine, Jorhat Medical College and Hospital, Jorhat, Assam, India
7 Department of Pharmacology, GVP IHC MT, Visakhapatnam, Andhra Pradesh, India
|Date of Submission||14-Mar-2022|
|Date of Acceptance||16-Aug-2022|
|Date of Web Publication||23-Nov-2022|
Dr. Dharma Rao Vanamali
D. No. 6-209/13, SF-304, VGR Towers, Siddhardha Nagar, Last Bus Stop, BITS College Road, P.M. Palem, Visakhapatnam, Andhra Pradesh 530041
Source of Support: None, Conflict of Interest: None
Keywords: 1st phase MBBS undergraduates, communication skills, language barrier, language proficiency
|How to cite this article:|
Vanamali DR, Gara HK, Hatekar AD, Baa J, Pardeshi S, Sonowal N, Panigrahy S, Mulkutkar S, Sar M. Assessment of language proficiency and enhancement among 1st phase MBBS undergraduates. Assam J Intern Med 2022;12:70-8
|How to cite this URL:|
Vanamali DR, Gara HK, Hatekar AD, Baa J, Pardeshi S, Sonowal N, Panigrahy S, Mulkutkar S, Sar M. Assessment of language proficiency and enhancement among 1st phase MBBS undergraduates. Assam J Intern Med [serial online] 2022 [cited 2022 Nov 29];12:70-8. Available from: http://www.ajimedicine.com/text.asp?2022/12/2/70/361827
| Introduction|| |
As per the guidelines of Medical Council of India (MCI), Competency-Based Medical Education (CBME) aims to attain academic quality and medical education comparable to global standards. The goal is to achieve a competent Indian Medical Graduate (IMG) endorsed with qualities of commitment, excellent clinician, life-long learner, leadership, communicator and accountability to patients, community, and profession. As a thoughtful solution to provide technical, communication, and language skills, the Curriculum Implementation Support Program for CBME has introduced Foundation Course of 1-month duration after admission since academic year 2019–20. Also, Attitudes, Ethics, and Communication (AETCOM) module has been longitudinally aligned across the medical curriculum for enhancement of cognitive domain, skill acquisition, and modulation of affective domain to inculcate empathy and professionalism at a very early stage.,,, Many countries such as the UK, the Netherlands, the USA, and Canada have recognized the importance of mapping cultural competency in medical curriculum to facilitate effective interaction with culturally diverse patients and to downscale disparities in health care.,
For an individual, language is the key to express emotions, share feelings, and gain knowledge and experience and transmit them to future generations. Also, it augments exchange of information and facilitates teamwork above individual benefits. Attributed to cultural diversity in India and multi-lingual background, some students may find it difficult to cope with the transition from vernacular language to English as the medium of instruction. Limited language proficiency (LLP) and cultural differences may reflect as ineffective communication, altered coping behaviors, and various workplace mal-adaptations. These can, in turn, influence their harmonization, conformation, and knowledge acquisition in the same institution.
Medical undergraduates form a distinct group in which teamwork, communication, and humanistic attitude are essential for professionalism and comprehensive patient care. Challenges faced by 1st phase MBBS undergraduates include voluminous curriculum delivered in short period, large classes, psychological factors, and LLP of English and/or local language. Language benefits a student in terms of communication, negotiation, and developing learning style and effective reward systems. Hence, the primary outcome of the study was to gain a representative picture of existence of language barrier for English and the local/state language among 1st phase MBBS undergraduates. The secondary outcomes were (a) to assess the influence of language barrier on their attitude, communication, and learning practices and (b) to obtain students’ perception and feedback about Language and Communication training sessions included in Foundation Course.
| Materials and Methods|| |
This was a multi-centric, cross-sectional, survey-based study conducted across five medical colleges in India, i.e., (a) Gayatri Vidya Parishad Institute of Healthcare and Medical Technology (GVPIHC & MT), Visakhapatnam, Andhra Pradesh, (b) Veer Surendra Sai Institute of Medical Sciences and Research (VSSIMSAR), Burla, Odisha, (c) Government Medical College (GMC), Gondia, Maharashtra, (d) Grant Government Medical College (GGMC), Mumbai, Maharashtra, and (e) Jorhat Medical College and Hospital (JMCH), Jorhat, Assam. It was conducted after obtaining approval from the Institutional Ethical Committee of each respective medical college. The principal investigator of each college communicated and coordinated with the coordinating investigator for the smooth compliance of the study.
The study population comprised 1st phase MBBS undergraduates of batch 2019–20. The exclusion criteria were (a) who got transferred to other colleges, (b) who did not undergo complete sessions of training program, and (c) refusal to participate. The participation of the study participants was voluntary. After acquainting them with the purpose of the study, informed written consent was obtained and confidentiality was assured. No incentive or rewards were offered for participation in this study. The study was conducted in two phases for students after admission: (a) at the beginning of Foundation Course before initiation of language training classes and (b) at the end of training sessions. The description and purpose of the study were communicated to participants in small groups before giving the questionnaire with an intention to enhance the return rate.
In phase 1, the participants were asked to fill the survey questionnaire before they underwent sessions in language and communication classes scheduled in the Foundation Course of duration of 1 month. The questionnaires were administered in English language. The following data were conglomerated regarding (a) sociodemographic characteristics: age, gender, place of birth, marital status, residence, (b) details of schooling: medium of instruction and languages learnt, (c) medical history, and (d) survey questionnaire regarding perceived proficiency of English and the local language of the place where medical college is situated. The questions were either semi-structured or multiple-choice type. Any doubts, if present, were assisted.
The survey questionnaire was designed to obtain the perceptions and experiences pertaining to English and the local language. The questions were adapted from the Language and Social Background questionnaire and previous studies on language barriers., The data collection was holistic in nature probing various aspects of language and communication, which included the following: (a) language background, (b) self-rated language proficiency level, (c) perception regarding role of English in Medical curriculum, and (d) emotional and cognitive responses toward LLP in Medical college. The language background consisted information on mother tongue and languages that could be read, written, spoken and understood. The self-perceived proficiency level was rated for reading, writing, speaking, and understanding English and state (local) language (where the medical college is situated) on a scale from “0” to “5,” where “0” indicated no proficiency and “5” indicated high proficiency. The responses for items on perception of regarding English language in medical curriculum and emotional and cognitive response toward LLP were scored on a 5-point Likert scale from “1” to “5,” where “1” indicated “strongly agree” and “5” indicated “strongly disagree.”
Phase 2 consisted of a period of 1 week after the end of Foundation Course. The participants were given survey questions regarding the language and communication skills sessions and how much language enhancement was perceived. They were asked to rate the level of agreement about different aspects of training sessions on a 5-point Likert scale from “strongly agree” to “strongly disagree.” They were also asked to rate the training programs for parameters of “interest,” “quality,” “satisfaction,” and “usefulness” based on a 5-point Likert scale from “1” to “5,” where “1” indicated “lowest” and “5” indicated “highest.” They were also requested to opine and suggest about language and communication skill sessions.
The collected data were organized into Microsoft Excel sheet, and Statistical Package for Social Sciences (SPSS) software version 26 was utilized for statistical analyses. Descriptive statistics was utilized to describe and synthesize frequencies (N), percentages (%), means and standard deviation (SD) and were represented as frequency distribution tables and histogram. For language proficiency, rating “0” was no proficiency, “1” and “2” were grouped as poor, “3” as average, and “4” and “5” as high proficiency. The medical students with LLP of state language were dichotomized as group “A” who knew the state language and group “B” who did not know the state language. Perceptions about LLP between these two groups were analyzed using non-parametric Mann–Whitney U-test to determine statistical difference. The level of significance was set at P <0.05 for all statistical analyses.
| Results|| |
For the present study, a total of 691 1st phase MBBS undergraduates participated from five medical colleges, of which majority were males [n = 379 (54.85%)] [Table 1]. Their mean age was 18.78 ± 1.1 years ranging from 17 to 23 years. Majority of students [n = 563 (81.48%)] were staying in hostels. Ninety (13.02%) students did not know the respective language of the state where their medical college was situated as it was neither their mother tongue nor learnt in school/community.
|Table 1: Sociodemographic characteristics of the study participants (n = 691)|
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The proficiency for English, the respective state language, and both were confirmed by 170 (24.31%), 318 (46.02%), and 50 (9.18%) medical undergraduates, respectively [Figure 1]. For English proficiency, highest proportion [34.02% (n = 49)] was seen in GGMC, Mumbai and least in GMC, Gondia [15.67% (n = 21)]. For State language proficiency, highest proportion [60.2% (n = 59)] was seen in JMCH, Jorhat and least in GGMC, Mumbai [24.3% (n = 35)].
|Figure 1: Distribution of self-perceived language proficiency among medical undergraduates across different medical colleges in India|
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LLP for English was confirmed by 75.4% of the students (n = 521), although it was one of the languages taught in schools [Table 2]. Among them, maximum agreed for high proficiency for reading (84.26%), followed by writing (82.15%). Least proficiency (43.95%) was confirmed for speaking English. About 53.98% of the students (n = 373) agreed for LLP in state language. Among them, maximum agreed for high proficiency for understanding (84.26%), followed by speaking (82.15%). Lack of proficiency for either reading or writing state language was observed among 1/5th of the students approximately. Majority [n = 489 (69.98%)] could understand concepts when taught in English. But 121 (18.22%) students admitted their difficulty [Table 3]. Difficulty in comprehension of English during communication with teachers and peers was expressed by 263 (38.95%) students.
|Table 2: Self-rating of different language skills among study participants with limited language proficiency|
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|Table 3: Perception regarding role of English language in medical curriculum (n = 691)|
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Among 521 students, 50% (n = 264) were hesitant to communicate with teacher or peer in English [Figure 2]. Approximately 62.38% of students (n = 325) perceived obstruction to flow of words and interrupted conversation in English. Owing to limited proficiency in English, embarrassment and fear of teasing were expressed by 219 (42.03%) and 210 (40.31%) students, respectively. Almost 50% of the students disagreed for being isolated from peers/discussions [n = 291 (55.85%)] and self-blaming [n = 241 (46.26%)]. Two-thirds of the students [n = 381] wanted to learn English for effective communication. Nearly, one-fourth of the students [n = 134] were affected because of limited proficiency in English.
|Figure 2: Perception among medical students about limited English proficiency (n = 521)|
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More than 50% of the students [n = 373 (53.97%)] had LLP in respective state languages, of which 90 students had no acquaintance with state language either at home or school. The analyses of perceptions among these two groups are displayed in [Table 4]. When compared with students who knew the state language, hesitancy for communication and difficulty in understanding as well as comprehension were statistically significantly present among those who did not know the state language. Also, embarrassment, fear of teasing or bullying, being emotionally affected, isolation from peers and discussions, and motivation to learn state language were statistically significantly perceived more among students who did not know the state language when compared with those who knew.
|Table 4: Perception of medical students with limited language proficiency in state language(n = 373)|
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Regarding language training classes [Table 5], the majority agreed for clear definition of objectives [n = 647 (93.63%)] and fulfillment of training sessions [n = 556 (80.46%)]. The majority agreed for good sequential organization [n = 658 (95.22%)], encouragement of participation and interaction [n = 663 (95.94%)], relevant topics [n = 596 (86.25%)], and allotment of sufficient time [n = 441 (63.82)]. Post-training improvement in English and state language were expressed by 495 (71.63%) and 521 (75.4%), respectively. The rating (4 and 5) for training classes [Figure 3] was highest for usefulness [n = 574 (83.06%)], followed by quality [n = 537 (77.71%)] and interest [n = 526 (76.12%)]. The suggestions given by medical undergraduates are depicted in [Table 6].
|Table 5: Level of agreement regarding language and communication skill sessions conducted during Foundation Course (n = 691)|
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|Figure 3: Rating of different aspects of language training classes given by medical undergraduates|
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|Table 6: Suggestions given by medical undergraduates for language training in medical curriculum (n = 691)|
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| Discussion|| |
MCI vision 2015 aims for a holistic doctor who should be competent, humanistic, communicative, and professional. The objective of the research was to identify lacunae in language and communication skills among 1st phase MBBS undergraduates which is a potential blind spot in medical curriculum.
In the present study, around 25% of the medical undergraduates agreed for proficiency in English. Among students with limited English proficiency, almost 80% of the students were proficient in reading and writing, whereas around 40% of the students felt proficient in speaking English. Medical curriculum in India exists in realm of English. Medical textbooks and classroom instructions are in English and its proficiency is sine qua non for student’s academic progress. As English has its value for lingua franca, diverse cultural and linguistic background can influence the spoken and written English including accent, pronunciation, vocabulary, and grammar. Students with limited English proficiency may experience communication breakdowns with medical faculty and may comply less with instructions resulting in compromised learning.
In the present study, around 50% of the students had LLP in the respective state languages. Among them, 60% of the students agreed for high proficiency in understanding and speaking state language, whereas least proficiency was observed for writing (almost 40%). Better speaking and understanding can be attributed to language use with family, friends, and community. Better comprehension of local dialect is beneficial for effective communication with patients or their relatives.
The three-language formula is prevalent in many states and union territories till matriculation to support multi-lingual education at the national level which has resulted in trans-lingual classrooms instructions. In the present study, around one-fifth of students perceived difficulty in understanding concepts when taught in English, and double of them had compromised communicative skills with teacher or friends in English. Attributed to limited English proficiency, many faced challenge in language comprehension or felt embarrassed. In a survey on teachers in English-medium state schools in Andhra Pradesh, Chimirala et al., had conflicting observation of 69% of teachers using state languages other than English to explain concepts or difficult words so as to hold attention of students in classrooms. Durairajan et al., in their review of 19 studies of using state language inclusive approaches in Indian English classrooms at the secondary level, concluded that state language-mediated learning boosted empowerment and self-esteem among learners., Thus, many students may read and listen in English, think and understand in their mother tongue, and reproduce back in English. This forward and backward translation may create latency in their communication and reproducibility.
In the present study, around 13% of the students confirmed about unfamiliarity with state language of their respective medical colleges as it was neither their mother tongue nor learnt in schools/community. The figure almost coincides with the All-India Quota of 15% which is reserved in National Eligibility cum Entrance Exam Test (NEET) as per Medical Counseling Committee. These students might face impediments to comprehend and relate a local language and might get excluded or marginalized from active discussions. Thus, they represent liability which necessitates pedagogy of self-awareness and introspection to facilitate adaptation to new environment and better educational outcomes.
In the present study, students who were unfamiliar with state language had statistically significant perception of difficult language comprehension, hesitation, embarrassment, fear, and isolation than those students who knew state language. A language barrier may trigger strong emotions of anger, fear, shame, guilt, homesickness, and lower self-esteem. Such students are at the risk of becoming myopic owing to implicit biases and preconceived notions and may face additional danger of misinterpretation of dialogs from faculties and students.
In the present study, around 70% were motivated to learn language to improve communication competency. Majority of students expressed benefits about language training classes. Majority gave highest rating for usefulness followed by quality and interest. Post-sessions language enhancement was perceived by around 70% of the students. Successful training program facilitates learning, cognition, and constructive process. Students preferred experiential approaches such as videos, role play, and interactive sessions for vocabulary amelioration. Rees et al. in their study had similar observation among medical students at University of Nottingham who preferred role-play and interviews with real patients over lectures to improve communication skills. Interactions, itself being a source of learning, are beneficial to comprehend and adroit language.
In the present study, few students requested for voluntary participation as the needs of each student and requirement of language enhancement may vary. Numerous students requested for increased engagement with the local language training in terms of more and frequent sessions to comprehend medical terminologies and colloquialism. Time can be a determining factor for inclusion of such training programs into medical curriculum. Longitudinal implementation with periodic reinforcements distributed over a span of 4-year medical curriculum shall be more beneficial than single concise training program.,
India, being a socio-linguistically heterogenous country, endures a flexible amalgamation of traits of multilingualism under different roofs. Language dexterity depends on population diversity, regional language dominance, and economy of that particular state. Breaking linguistic isolation and acquiring proficiency in languages (English and the local language) shall substantiate better comprehension of the subject, effective communication, and multiplicity of relationships with teachers, peers, and patients. A professional translator is a rare bird in multi-lingual Indian clinical settings. “Today’s IMG” is “Tomorrow’s Physician” who should be cultural and linguistically competent in knowledge and praxis to provide compassionate and equitable patient care. Limited English proficiency may affect their educational outcome as language of instruction is English, whereas limited proficiency in regional dialect may affect communication skills with patients. Hence, students should be screened first for their LLP. The frequency and duration of language classes (English and regional dialect) should be computed based on students’ quest to enhance their communication skills.
There is a dearth of substantial data on language barrier faced by medical undergraduates during their medical curriculum. This study is of first of its kind to capture a representative picture of language barrier. As five medical colleges across India were centers for conduction of the study, bias for a particular language and its dominance was ruled out. The study has few limitations. Data were collected by survey which could be affected by recall and social desirability bias. Proficiency of language and perceptions regarding language barrier were self-rated by participants.
| Conclusion|| |
Financial support and sponsorship
Principal investigators at institute level.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]