Skip to main content
SpringerLink
Log in

On International (Medical) Doctors’ Professional Identity in a Multilingual Environment

  • Chapter
  • First Online:
Multilingual Healthcare

Part of the book series: FOM-Edition ((INTSE))

  • 684 Accesses

Abstract

In Germany and in German-speaking Switzerland, due to a shortage of medical doctors, many physicians have been recruited from abroad. While studies on trained doctors with a migration background exist with regard to English-speaking countries, international medical doctors and psychologists using German as their professional medium are underresearched. Based on 17 interviews, the present study explores how these international doctors experience readjustment in their professional identities when working in a foreign healthcare environment. A focus is on the challenges they face in their daily work and how they employ multilingual language competencies in interaction with national and international patients. The study aims to determine stages of international doctors’ development processes towards a multilingual and interculturally competent professionalism in terms of language, institutional practice and sociopragmatic aspects of healthcare in their host country.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    The term ‘allophone’ is used in Switzerland to denote migrants who speak an L1 other than the majority of the society, a language differing from official languages spoken at work and in institutions, cf. e.g. NEK-CNE (2017).

  2. 2.

    For more detailed linguistic analyses, relevant parts will be selected and re-transcribed according to HIAT standard (cf. Rehbein 2001; Redder 2001; Rehbein et al. 2004) in a separate study. In addition to the interviews, in Switzerland 8 doctor-patient interactions (DPI) were audio recorded and transcribed using HIAT standards and the Exmaralda transcription tool (cf. Rehbein 2001; Redder 2001; Rehbein et al. 2004). Due to restrictions of the current paper’s scope, we will concentrate on our interview data here. The current paper uses representation of data excerpts in utterance list form.

  3. 3.

    In Switzerland, a total of 13 medical doctors and psychologists who regularly use an L2 or Lingua Franca at work were interviewed and 8 audio recordings of DPI from interviewees were collected. For this study, only the interviews with seven participants were taken into consideration on the grounds that they were L2 German speakers.

  4. 4.

    The Swiss data were collected in 2017 as part of Bachelor thesis work at ZHAW School of Applied Linguistics. We gratefully acknowledge the work contributed by E. Beauverd, N. Rojas, A.-L. Veljkovic, S. Boulaouche, N. Pochetti, L. Ciriello, G. Santabaya. The work done by Beauverd et al. received the 2017 Rieter Award for Best Bachelor Thesis.

  5. 5.

    (.) denotes a small pause under 1 s.

References

  • Albl-Mikasa, M., & Hohenstein, C. (2017). A cognitive and pragmatic discourse approach to community interpreting: The influence of interpreters’ knowledge of doctor-patient encounter structures on interpreter-mediated medical interactions. In D. Perrin & U. Kleinberger (Eds.), Doing applied linguistics—Enabling transdisciplinary communication (pp. 130–138). Berlin: De Gruyter.

    Google Scholar 

  • Albl-Mikasa, M., & Hohenstein, C. (forthcoming). Community interpreting as a socially and cognitively situated activity: Speech action patterns and underlying knowledge structures in interpreter-mediated medical interactions. Extended version of the paper “Interpreting in medical settings: speech actions and interactional flow”, given at Critical Link 8, Edinburgh, 29 June 2016. To be published in C. Wilson (Ed.), Critical LinkS—A New Generation: Future-proofing interpreting & translating. Publication of selected papers from Critical Link 8 (provisional title).

    Google Scholar 

  • Andrews, M., Squire, C., & Tamboukou, M. (Eds.). (2008). Doing narrative research. London: Sage. Online-Ausg. Los Angeles, [Calif.].

    Google Scholar 

  • Angelelli, C. (2007 [1,2004]). Medical Interpreting and Cross-cultural Communication. Cambridge, New York, Melbourne: Cambridge University Press.

    Google Scholar 

  • Beauverd, E., Rojas, N., & Veljkovic, A.-L. (2017). Arzt-Patienten-Kommunikation im mehrsprachigen Kontext in der Schweiz. Schwierigkeiten beim Verwenden einer L2 oder Lingua Franca in der Arzt-Patienten-Kommunikation. Awarded with the Rieter Prize for best Bachelor-Thesis 2017, ZHAW, Dept. Angewandte Linguistik, Winterthur.

    Google Scholar 

  • Berbyuk Lindström, N. (2008). Intercultural communication in health care. Non-Swedish physicians in Sweden. Dissertation, University of Gothenburg.

    Google Scholar 

  • Beyer, R. C. M. (2017). The performance of immigrants in the German labor market. SOEPpapers on Multidisciplinary Panel Data Research, DIW Berlin, Berlin.

    Google Scholar 

  • Boulaouche, S., & Pochetti, N. (2017). Sprache, Gesundheit und Medizin: Umgang mit Mehrsprachigkeit und Interkulturalität in der Arzt-Patienten-Kommunikation. Bachelor-Thesis, ZHAW, Dept. Angewandte Linguistik, Winterthur.

    Google Scholar 

  • British Medical Association. (2017). Influences on choice of medical career. London: British Medical Association House. https://www.bma.org.uk/collective-voice/policy-and-research/education-training-and-workforce/influences-on-choice-of-medical-career. Accessed 31 May 2019.

  • Buchan, J., Wismar, M., Glinos, I. A., & Bremner, J. (2014). Health professional mobility in changing Europe (Vol. II). Copenhagen: European Observary on Health Systems and Policies.

    Google Scholar 

  • Buckman, R. (1984). Breaking bad news: Why is it still so difficult? British Medical Journal,288, 1597–1599.

    Article  Google Scholar 

  • Bührig, K. (2009). Interpreting in hospitals. Starting points for cultural actions in institutionalized communication. In K. Bührig, J. House, & J. D. ten Thije (Eds.), Translational action and intercultural communication (pp. 155–178). Manchester: St. Jerome Publishing.

    Google Scholar 

  • Bührig, K., & Meyer, B. (2015). Ärztliche Gespräche mit MigrantInnen. Chapter 16. In A. Busch & T. Spranz-Fogasy (Eds.), Handbuch Sprache in der Medizin (pp. 300–316). Berlin, Boston: de Gruyter.

    Google Scholar 

  • Bundesärztekammer. (2016). Entwicklung der berufstätigen ausländischen Ärzte. Ärztestatistik 2016. http://www.bundesaerztekammer.de/ueber-uns/aerztestatistik/aerztestatistik-2016/auslaendische-aerztinnen-und-aerzte/. Accessed 13 Nov 2018.

  • Cardoso, I., Batista, P., & Graça, A. (2014). Professional identity in analysis: A systematic review of literature. The Open Sports Science Journal, 7(2), 83–97.

    Google Scholar 

  • Cast, A. D., & Burke, P. J. (2002). A theory of self-esteem. Social Forces,80(3), 1041–1068.

    Article  Google Scholar 

  • Ciriello, L., & Santabaya, G. (2017). Therapeutenseitige Handlungen in einem mehrsprachigen Kontext. „Äh ich habe Sie glaube ich nicht richtig verstanden“. Bachelor-Thesis, ZHAW, Dept. Angewandte Linguistik, Winterthur.

    Google Scholar 

  • Cordella, M., & Musgrave, S. (2009). Oral communication skills of international medical graduates: Assessing empathy in discourse. Communication and Medicine,6(2), 129–142.

    Google Scholar 

  • Cruess, R. L., Cruess, S. R., Boudreau, J. D., Snell, L., & Steinert, Y. (2015). A schematic representation of the professional identity formation and socialization of medical students and residents: A guide for medical educators. Academic Medicine,90(6), 718–725.

    Article  Google Scholar 

  • Dahm, M. R., & Cartmill, J. (2016). Talking their way to success: Communicative competence for international medical graduates in transition. Medical Education,50(10), 992–993.

    Article  Google Scholar 

  • Dahm, M. R., & Yates, L. (2013). English for the workplace: Doing patient-centred care in medical communication. Tesl Canada Journal/Revue Tesl du Canada 21, 30(7), 21–44.

    Google Scholar 

  • Dorgan, K. A., Lang, F., Floyd, M., & Kemp, E. (2009). International medical graduate-patient communication: A qualitative analysis of perceived barriers. Academic Medicine,84(11), 1567–1575.

    Article  Google Scholar 

  • Fienemann, J. (2006). Erzählen in zwei Sprachen: Diskursanalytische Untersuchungen von Erzählungen auf Deutsch und Französisch. Vol. 18: Mehrsprachigkeit. Münster: Waxmann.

    Google Scholar 

  • Fioramonte, A. (2014). A study of pragmatic competence: International medical graduates’ and patients’ negotiation of the treatment phase of medical encounters. Graduate Theses and Dissertations. http://scholarcommons.usf.edu/etd/5478. Accessed 31 May 2019.

  • Foster, K., & Roberts, C. (2016). The heroic and the villainous: A qualitative study characterizing the role models that shaped senior doctors’ professional identity. BMC Medical Education,16(206), 1–11. https://doi.org/10.1186/s12909-016-0731-0.

    Article  Google Scholar 

  • Gombert, J. E. (1992). Metalinguistic development. Chicago: University of Chicago Press.

    Google Scholar 

  • Hartog, J. (2006). Beyond ‘misunderstandings’ and ‘cultural stereotypes’. In K. Bührig & J. D. ten Thije (Eds.), Beyond misunderstandings. Linguistic analyses of intercultural communication (pp. 174–187). Amsterdam: John Benjamins.

    Google Scholar 

  • Hohenstein, C. (2006). Erklärendes Handeln im Wissenschaftlichen Vortrag. Ein Vergleich des Deutschen mit dem Japanischen. München: iudicium.

    Google Scholar 

  • House, J. (2003). Misunderstanding in intercultural university encounters. In J. House, G. Kasper, & S. Ross (Eds.), Misunderstanding in social life, discourse approaches to problematic talk (pp. 22–56). London: Longman.

    Google Scholar 

  • House, J., & Lévy-Tödter, M. (2010). Linguistic competence and professional identity in English medium instruction. In B. Meyer & B. Apfelbaum (Eds.), Multilingualism at work. From policies to practices in public, medical and business settings (pp. 13–45). Amsterdam: John Benjamins.

    Chapter  Google Scholar 

  • Ibarra, H. (1999). Provisional selves: Experimenting with image and identity in professional adaptation. Administrative Science Quarterly,44, 764–791.

    Article  Google Scholar 

  • Jain, P., & Krieger, J. L. (2011). Moving beyond the language barrier: The communication strategies used by international medical graduates in intercultural medical encounters. Patient Education and Counseling,84, 98–104.

    Article  Google Scholar 

  • Johnen, T., & Meyer, B. (2007). Between connectivity and modality: Reported speech in interpreter-mediated doctor-patient communication. In J. Rehbein, C. Hohenstein, & L. Pietsch (Eds.) Connectivity in grammar and discourse. Vol. 5: Hamburg Studies on Multilingualism (pp. 395–418). Amsterdam: John Benjamins.

    Google Scholar 

  • Kegan, R. (1982). The evolving self: Problem and process in human development. Cambridge: Harvard University Press.

    Book  Google Scholar 

  • Kegan, R. (1994). In over our heads: The mental demands of modern life. Cambridge: Harvard University Press.

    Google Scholar 

  • Klingler, C., & Marckmann, G. (2016). Difficulties experienced by migrant physicians working in German hospitals: A qualitative interview study. Human Resources for Health, 14(57). https://doi.org/10.1186/s12960-016-0153-4.

  • Lévy-Tödter, M. (2019). Globale Gesundheitsversorgung: Ethische Aspekte der Ärztemigration. In W. Leal Filho (Ed.), Aktuelle Ansätze zur Umsetzung der UN-Nachhaltigkeitsziele. Buchreihe: Theorie und Praxis der Nachhaltigkeit (pp. 63–77). Berlin: Springer Spektrum.

    Google Scholar 

  • Löning, P., & Rehbein, J. (eds.) (1993). Arzt-Patienten-Kommunikation. Analysen zu interdisziplinären Problemen des medizinischen Diskurses. Berlin/New York: de Gruyter.

    Google Scholar 

  • Loprieno, A. (2015). Ausbildung Humanmedizin: Systemische Analyse und Empfehlungen—Schlussbericht. Studie im Auftrag des Staatssekretariats für Bildung, Forschung und Innovation SBFI. Bern: SBFI.

    Google Scholar 

  • Meyer, B., Kliche, O., & Pawlack, B. (2010). Family interpreters in hospitals: good reasons for bad practice? In R. Antonini (Ed.), Child Language Brokering – Special Issue of Mediazioni, Rivista Online Di Studi Interdisciplinare Su Lingue e Culture. In MediAzioni 10, 297–324.

    Google Scholar 

  • Michalski, K., Farhan, N., Motschall, E., Vach, W., & Boeker, M. (2017). Dealing with foreign cultural paradigms: A systematic review on intercultural challenges of international medical graduates. PLoS ONE,12(7), e0181330.

    Article  Google Scholar 

  • Monrouxe, L. V., Rees, C. E., & Hu, W. (2011). Differences in medical students’ explicit discourses of professionalism: Acting, representing, becoming. Medical Education,45, 585–602.

    Article  Google Scholar 

  • NEK-CNE. (2017). Allophone migrants and the healthcare system. Ethical issues of community interpreting. Position statement n°27. Bern: National Advisory Commission on Biomedical Ethics NCE.

    Google Scholar 

  • Niemi, P. M. (1997). Medical students’ professional identity: Self-reflection during the preclinical years. Medical Education,31, 408–415.

    Article  Google Scholar 

  • Passi, V., Doug, M., Peile, E., Thistlethwaite, J., & Johnson, N. (2010). Developing medical professionalism in future doctors: A systematic review. International Journal of Medical Education,1, 19–29.

    Article  Google Scholar 

  • Pratt, M. G., Rockmann, K. W., & Kaufmann, J. B. (2006). Constructing professional identity: The role of work and identity learning cycles in the customization of identity among medical residents. Academy of Management Journal,49(2), 235–262.

    Article  Google Scholar 

  • Redder, A. (2001). Aufbau und Gestaltung von Transkriptionssystemen. Kap. 100, XV. Methoden II: Transkription/Methods II: Transcription. In Brinker et al. (Ed.), HSK Text- und Gesprächslinguistik, 2. Halbband: Gesprächslinguistik. Reihe Handbücher Sprach- und Kommunikationswissenschaften (E-book edition 2008) (pp. 1038–1059). Berlin: De Gruyter.

    Google Scholar 

  • Redder, A. (2008). Functional pragmatics. Ch. 7. In G. Antos & E. Ventola (Eds.), Handbook of interpersonal communication. Vol. 2: Handbook of Applied Linguistics (pp. 133–178). Berlin: De Gruyter.

    Google Scholar 

  • Redder, A. (2010). Grammatik und sprachliches Handeln in der Funktionalen Pragmatik—Grundlagen und Vermittlungsziele. In Japanische Gesellschaft für Germanistik (Ed.), Grammatik und sprachliches Handeln. Akten des 36. Linguisten-Seminars, Hayama 2008 (pp. 9–24). München: iudicium.

    Google Scholar 

  • Redder, A. (2013). Produktivität der Diskontinuitat. Verbalkomplex und komplexe Verben in der Bildungssprache. In K.-M. Köpcke & A. Ziegler (Eds.), Schulgrammatik und Sprachunterricht im Wandel (pp. 307–328). Berlin: De Gruyter.

    Google Scholar 

  • Rehbein, J. (1985a). Medizinische Beratung türkischer Eltern. In J. Rehbein (Ed.), Interkulturelle Kommunikation (pp. 349–419). Tübingen: Narr.

    Google Scholar 

  • Rehbein, J. (1985b). Ein ungleiches Paar—Verfahren des Sprachmittelns in der medizinischen Beratung. In J. Rehbein (Ed.), Interkulturelle Kommunikation (pp. 420–448). Tübingen: Narr.

    Google Scholar 

  • Rehbein, J. (1986). Sprachnoterzählungen. In E. W. B. Hess-Lüttich (Ed.), Integration und Identität. Soziokulturelle und psychopädagogische Probleme im Sprachunterricht mit Ausländern (pp. 63–86). Tübingen: Narr.

    Google Scholar 

  • Rehbein, J. (2001). Das Konzept der Diskursanalyse. In K. Brinker, G. Antos, W. Heinemann, & S. F. Sager (Hrsg.) Text- und Gesprächslinguistik. 2. Halbband. HSK (pp. 927–945). Berlin: de Gruyter.

    Google Scholar 

  • Rehbein, J. (2006). The cultural apparatus. Thoughts on the relationship between language, culture and society. In K. Bührig & J. D. ten Thije (Eds.), Beyond misunderstanding. The linguistic reconstruction of intercultural discourse (pp. 43–96). Amsterdam: Benjamins.

    Google Scholar 

  • Rehbein, J. (2012). Intercultural communication. In C. A. Chapelle (Ed.), The encyclopedia of applied linguistics (pp. 2758–2765). Malden: Wiley.

    Google Scholar 

  • Rehbein, J., Schmidt, T., Meyer, B., Watzke, F., & Herkenrath, A. (2004). Handbuch für das computergestützte Transkribieren nach HIAT. Arbeiten zur Mehrsprachigkeit Folge B, 56(2004). Hamburg: Universität Hamburg (Sonderforschungsbereich 538 Mehrsprachigkeit).

    Google Scholar 

  • Roberts, L. M. (2005). Changing faces: professional image construction in diverse organizational settings. Academy of Management Review, 30(4), 685–711.

    Google Scholar 

  • Roehr-Brackin, K. (2018). Metalinguistic awareness and second language acquisition. New York: Routledge.

    Book  Google Scholar 

  • Schein, E. H. (1978). Career dynamics: Matching individual and organizational needs. Reading: Addison-Wesley.

    Google Scholar 

  • Schön, D. A. (1999). The reflective practitioner: How professionals think in action. Reprint. Aldershot: Ashgate.

    Google Scholar 

  • Schrewe, B., Bates, J., Pratt, D., Ruitenberg, C. W., & McKellin, W. H. (2017). The big d(eal): Professional identity through discursive constructions of ‘patient’. Medical Education,51, 656–668.

    Article  Google Scholar 

  • Shuval, J. T. (2000). The reconstruction of professional identity among immigrants physicians in three societies. Journal of Immigrant Health,2(4), 191–202.

    Article  Google Scholar 

  • Spranz-Fogasy, T., Becker, M., Menz, F., & Nowak, P. (2014). Literatur zur Medizinischen Kommunikation. Bibliografie Medizinische Kommunikation. Mannheim: Institut für Deutsche Sprache.

    Google Scholar 

  • Ten Thije, J. D. (2006). Notions of perspective and perspectivising in intercultural research. In K. Bührig & J. D. ten Thije (Eds.) Beyond misunderstanding. The linguistic reconstruction of intercultural discourse (pp. 97–151). Amsterdam: Benjamins.

    Google Scholar 

  • van de Mieroop, D. (2015). Social identity theory and the discursive analysis of collective identities in narratives. In A. De Fina & A. Georgakopoulou (Eds.), The handbook of narrative analysis (pp. 408–428). Chichester: Wiley.

    Chapter  Google Scholar 

  • van de Poel, K., & Brunfaut, T. (2010). Medical communication in L1 and L2 contexts: Comparative modification analysis. Intercultural Pragmatics,7(1), 103–129.

    Article  Google Scholar 

  • Villalobos, B. T., Bridges, A. J., Anastasia, E. A., Ojeda, C. A., Hernandez Rodriguez, J., & Gomez, D. (2016). Effects of language concordance and interpreter use on therapeutic alliance in Spanish-speaking integrated behavioral health care patients. Psychological Services, 13(1), 49–59.

    Google Scholar 

  • Visintin, S., Tijdens, K., & van Klaveren, M. (2015). Skill mismatch among migrant workers: Evidence from a large multi-country dataset. Journal of Migration, 4(14). https://doi.org/10.1186/s40176-015-0040-0.

  • Wald, H. S., Anthony, D., Hutchinson, T. A., Liben, S., Smilovitch, M., & Donato, A. A. (2015). Professional Identity Formation in Medical Education for Humanistic, Resilient Physicians: Pedagogic Strategies for Bridging Theory to Practice. Academic Medicine, 90(6), 753–760.

    Google Scholar 

  • WBF and EDI. (2016). Gesamtsicht Aus- und Weiterbildung Medizin im System der Gesundheitsversorgung. Gemeinsamer Bericht WBF/EDI. Bern: Schweizerische Eidgenossenschaft, Eidgenössisches Departement für Wirtschaft, Bildung und Forschung WBF, Eidgenössisches Departement des Innern EDI. https://www.bag.admin.ch/bag/de/home/themen/berufe-im-gesundheitswesen/medizinalberufe/medizinische-grundversorgung/strategie-gegen-aerztemangel.html. Accessed 29 Aug 2018.

  • Wenger, E. (1998). Communities of practice: Learning, meaning, and identity. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Wengraf, T. (2001). Qualitative research interviewing: Biographic narrative and semi-structured methods. London: SAGE.

    Book  Google Scholar 

  • WHO. (2010). WHO Global code of practice on the international recruitment of health personnel. Geneva: World Health Organisation.

    Google Scholar 

  • Wong, A., & Trollope-Kumar, K. (2014). Reflections: An inquiry into medical students’ professional identity formation. Medical Education,48, 489–501.

    Article  Google Scholar 

  • Yates, L., & Dahm, M. R. (2016). Doing patient-centred consultations: Some challenges for IMGs. In S. J. White & J. Cartmill (Eds.), Communication in surgical practice (pp. 35–67). Sheffield: Equinox.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. ZHAW Angewandte Linguistik, Winterthur, Switzerland

    Christiane Hohenstein

  2. FOM Hochschule, Hochschulzentrum Hamburg, Hamburg, Germany

    Magdalène Lévy-Tödter

Authors
  1. Christiane Hohenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Magdalène Lévy-Tödter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christiane Hohenstein .

Editor information

Editors and Affiliations

  1. LCC – Department Angewandte Linguistik, ZHAW Zürcher Hochschule für Angewandte Wissenschaften, Winterthur, Switzerland

    Christiane Hohenstein

  2. FOM Hochschule für Oekonomie & Management, Hamburg, Germany

    Magdalène Lévy-Tödter

Appendix 1

Appendix 1

Tables 10.5a und 10.5b Corpus data.

Table 10.5a German corpus. (Authors’ own representation)
Full size table
Table 10.5b Swiss corpus. (Authors’ own representation)
Full size table

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Fachmedien Wiesbaden GmbH, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hohenstein, C., Lévy-Tödter, M. (2020). On International (Medical) Doctors’ Professional Identity in a Multilingual Environment. In: Hohenstein, C., Lévy-Tödter, M. (eds) Multilingual Healthcare. FOM-Edition(). Springer Gabler, Wiesbaden. https://doi.org/10.1007/978-3-658-27120-6_10

Download citation

Publish with us

Policies and ethics

Search

Navigation