Medical student and patient language congruence: Impact on clinical learning and communication

Language congruence between practitioner and patient is a key influence on clinical communication. It influences not only the quality of communication in terms of information transferral but also the capacity of practitioners to establish rapport and maintain culturally-appropriate interactions. This article reports on a qualitative interview study using thematic analysis conducted with final-year medical students of Monash University's Jeffrey Cheah School of Medicine and Health Sciences in Malaysia. It investigated their perceptions of how the different languages used in communicating with patients influenced clinical interactions, as well as the nature of their learning within the clinical environment. Within the clinical learning settings investigated, many of the students and patients were multi-lingual, and both the students and patients varied considerably in their proficiency in the national language, Bahasa Malaysia, as well as in English. The study found that students perceived that the language used for consultation influenced clinical communication in a variety of ways, including the capacity to establish rapport, the approach to questioning, the amount and type of information elicited from patients and the ability of the students to express ideas and information with sensitivity. In turn, these factors had an impact on clinical learning, influencing, for example, patient expectations and behaviour. In some cases, particularly where there was a lack of alignment between perceived shared ethnicity and language congruence, it even had an impact on medical student “access” to patients. The paper explores some implications of these factors for clinical learning.