Received: 27 July 2018 Revised: 11 October 2018
DOI: 10.1111/lnc3.12312
ARTICLE
Research directions in medical English as a
lingua franca (MELF)
M. Gregory Tweedie1
1
Werklund School of Education,
University of Calgary, Calgary, Alberta,
Canada
2
Nursing Foundations, University of
Calgary Qatar, Doha, Qatar
Correspondence
M. Gregory Tweedie, Werklund School of
Education, University of Calgary, Calgary,
AB, Canada.
Email: gregory.tweedie@ucalgary.ca
Lang Linguist Compass. 2019;13:e12312.
https://doi.org/10.1111/lnc3.12312
Accepted: 12 February 2019
| Robert C. Johnson2
Abstract
This article asserts that medical English as a lingua
franca (MELF) represents an important direction for
future research in ELF. The flow of health care workers
across international borders and the role of English as
the dominant language of international communica-
tion and medicine position MELF interactions as
increasingly common in medical contexts worldwide.
Research is called for with respect to the relationship
of MELF to ELF, and specifically whether ELF linguis-
tic features and pragmatic strategies are incorporated in
medical contexts, where communicative immediacy
and precision figure centrally. Since criticisms of ELF
research include its relatively narrow contexts for study
(to date mostly European and on a lesser scale East
Asian) and its limited domains (higher education and
business), MELF presents an opportunity to expand
the research scope of ELF considerably. While suggest-
ing that migrant destinations like the states of the Gulf
Cooperation Council represent especially relevant sites
for researching MELF, the article argues that a defini-
tion of ELF that includes native speaker interactions
allows for the possibility of MELF research where
English is considered a dominant native language. Con-
cerns over the effect of miscommunication on patient
safety are well researched in health care disciplines,
and so a fuller understanding of MELF may assist in
the delivery of safe and effective patient care within
the linguistic complexity characterizing health care.
wileyonlinelibrary.com/journal/lnc3 © 2019 John Wiley & Sons Ltd 1 of 12
2 of 12 TWEEDIE AND JOHNSON

1 | INTRODUCTION

Our interest in health care communication where English is a lingua franca (ELF) springs from
three sources. First, as language teachers, we are involved in the design and delivery of both cur-
riculum and instruction in English for specific purposes to health care professionals. Second, as
researchers in applied linguistics, we take an interest in the context for which we prepare our
learners: a multilingual, culturally diverse environment in which English functions as a language
of medical communication for speakers of many other first languages (L1s). Finally, in common
with probably everyone reading this article, as end users (patients) of health care services, we nat-
urally want to receive the best possible quality care and treatment for ourselves and our families.
Health care researchers and practitioners are making it clear that communication difficulties
are a pressing problem. In an integrative review, nursing researchers Foronda, MacWilliams,
and McArthur (2016) for example, present a blunt assessment: “Ineffective communication in
healthcare results in delayed treatment, misdiagnosis, medication errors, patient injury, or death”
(p. 36). One particular aspect of ineffective communication, language barriers, intersects directly
with our professional expertise as language teachers/researchers. Language barriers are presented
in the medical literature in equally unsettling terms: including as hindrances to quality care (Flo-
res, 2005) and increased risk of adverse medical events (Johnstone & Kanitsaki, 2006).
This article considers research focusing on health care delivery where English is a lingua
franca, through the lenses of the professional and personal interests described above. We will
argue for the expansion of research in an area presently overlooked by both health care and
ELF research: Communication among health care professionals in settings where English is a
lingua franca. Though we recognize that investigating ELF communication among health care
professionals is inherently multidisciplinary in nature, our research focuses on the field of lan-
guage education for nursing. We assert that extending ELF research across many health care
disciplines, including our own, will benefit medical professionals in various fields—and ulti-
mately their patients.

2 | B A C K G R O U N D : NU R S E M I G R A T I O N AN D EN G L I S H AS A
LING UA F RANCA

The cross‐border flow of nurses and other medical professionals, bringing with them differing
L1s, typically intersects with the position of English as the dominant language for international
communication (McArthur, 2002) and medicine (Maher, 1987). This intersection may occur as
medical professionals find employment in countries where English holds a preponderant posi-
tion as a native language such as the USA, or it may occur in nations where English functions
as a prominent additional language but retains a “norm dependent” stance, such as Saudi Ara-
bia (Mahboob & Elyas, 2014, p. 135), where native speaker linguistic norms are deferred to. The
migration of health care workers sets the stage for English users from differing L1s to interact
(Qatar, for example; see Tweedie & Johnson, 2018a). In medical environments, where English
is used as a vehicular language for speakers of multiple L1s, the resultant interactions are antic-
ipated to be consistent with the features of ELF.

3 | D E F I N IN G ( M E D IC A L ) EN G L I S H A S A L I N G U A FR A N C A

For an increasing number of people around the world for whom English is not an L1, interac-
tions with speakers of other differing first languages will take place in English. Whether by a
TWEEDIE AND JOHNSON 3 of 12

Korean tourist asking for directions in Germany, or a business transaction between Angolan
and Chinese entrepreneurs, the role of English as the “default mode” for global communication
(McArthur, 2002, p. 13) continues to expand to the extent it is likely that the majority of total
interactions in English on any given day around the globe are between people for whom English
is not a first language, but a mutually understood lingua franca.
The term lingua franca originally described a contact language used in the Eastern Mediter-
ranean region (MacKenzie, 2014), and according to Mauranen (2018), the label is still “normally
used to mean a contact language, that is, a vehicular language between speakers who do not
share a first language” (p. 7). The cross‐border interactions accompanying globalization have
spawned previously unimaginable magnitudes of language contact, and the historically unprec-
edented global spread of English has placed it as a functioning lingua franca among a multitude
of diverse contacting languages.
Although there is no definitive consensus on an exact definition of ELF, Seidlhofer's is widely
referenced: “any use of English among speakers of different first languages for whom English is
the communicative medium of choice, and often the only option” (Seidlhofer, 2011, p. 7). ELF is
used interchangeably with terms like international, global, or world language (Seidlhofer, 2004,
p. 210). However, as MacKenzie, 2014, p. 2 quips: “Of course ELF is an applied linguists' term;
most users probably just think they are speaking English.”
Disagreement exists as to whether native English speakers (NS) can be included in an ELF
interaction; some argue that ELF is by definition exclusively for speakers of differing L1s (e.g.,
Firth, 1996; House, 1999). However, as a binary division of English users into “native”/ “nonna-
tive” speakers (NS/NNS) is problematic from a number of perspectives (e.g., see Davies, 2003;
Rajagopalan, 1997), and because of the reality that the widespread use of English worldwide often
involves diverse participants, researchers like Mauranen (2018) take a broader view of ELF: “a
contact language between speakers or speaker groups when at least one of them uses it as a second
language” (p. 8; emphasis ours). Given the remarkable global reach of English, ELF is “prominent
in international politics and diplomacy, international law, business, the media, and in tertiary
education and scientific research” (MacKenzie, 2014, p. 2). While sometimes derided as BSE
(“bad simple English”; Reithofer, 2010, p. 144), we follow Widdowson in taking a more positive
view: ELF users enlarge the language's potential for international communication; given relative
freedom from the strict constraints of syntax or morphology, they “express themselves more freely
without having to conform to norms which represent the sociocultural identity of other people”
(Widdowson, 2004, p. 361). Because English is in contact with many of the world's languages
(Schreier & Hundt, 2013), the features of ELF vary widely as speakers likely codeswitch, borrow,
or transfer from whatever L1 being drawn upon. Despite the variation, Mauranen (2012) hypoth-
esizes a stabilization of ELF, as speakers accommodate to mutual usage forms. For readers unfa-
miliar with ELF, it is important to note that these features are not considered “errors” from an ELF
perspective. The goal of English Language Teaching, from an ELF perspective, is not to attain
“native speaker” levels of proficiency, but to encourage ways of speaking among other “nonnative
speakers,” which would lead to successful communication.
Important research streams in ELF include teacher and learner attitudes toward its use (e.g.,
Bayyurt, 2006; Llurda, 2009; Sifakis & Sougari, 2005), analysis of ELF corpora (Kirkpatrick,
2010; Mauranen, 2012; Seidlhofer, 2012), and linguistic features of ELF interactions (e.g., Cogo
& Dewey, 2012; Pitzl, 2012). Researchers have identified a number of features of ELF relative to
Standard English, including structural simplification, approximation, lexical simplification, and
a preference for enhancing explicitness (e.g., Björkman, 2013; Cogo & Dewey, 2006; Dewey,
2007; Gilner, 2016; Seidlhofer, 2004). Noteworthy in studies of communicative processes is the
4 of 12 TWEEDIE AND JOHNSON

fact that misunderstandings among interlocutors seem to be relatively rare (e.g., Björkman,
2013; Meierkord, 2004). Pitzl's (2005) study of ELF interactions in the context of business defines
understanding as “an interactive and jointly constructed process which is dynamic and cooper-
ative” (p. 52), and this joint construction has been identified as a feature of ELF in general (e.g.,
Firth, 1996; Seidlhofer, 2001). However, as will be discussed later, ELF misunderstandings have
not yet been subject to the scrutiny of high stakes communicative situations, given the relatively
limited contexts of ELF studies to date.
Lexico‐grammatical elements of ELF are said to differ from Standard English usage, and a
number of lists have been proposed which categorize some of these features (e.g., Ranta, 2013).
Examples of identified distinctive elements include omission of the third person ‐s
(e.g., she like pizza), article omission, regularization of countable/uncountable noun forms (e.g.
equipments and furnitures), regularization of verb forms like using teached for taught, and prefer-
ence for the progressive ‐ing form. However, researchers have noted that ELF nonstandard usage
of features such as the above do not differ from Standard English to the degree that might be
expected (Breiteneder, 2005; Dorn, 2011; Meierkord, 2004). The authors' research interests center
on how ELF communicative processes such as lexical/structural simplification, approximation, or
enhanced explicitness are brought to bear in ELF health care interactions. The reality that mis-
communications may lead to serious threats to patient safety has been well documented (Foronda,
MacWilliams, & McArthur, 2016), and the challenges to accurate health care communication in
English have been described across a range of contexts such as emergency departments (Slade
et al., 2015), clinical handovers (Eggins, Slade, & Geddes, 2015), pediatric hospitals (Cohen,
2005), and between health care professionals in Intensive Care Units (Gurses & Carayon, 2007).
Studies specifically on language barriers have revealed difficulties in practitioner–patient interac-
tion, reduced treatment adherence, and limited access to care, among other challenges (e.g., Gra-
ham, Gilchrist, & Rector, 2011; Ian, Nakamura‐Florez, & Lee, 2016). Ideally, patients would
receive care in a language with which they are most comfortable, and when not possible, through
the use of quality interpreting services (CHIS, 2002). However, most studies take place where
English is spoken as a native language (ENL) and/or a dominant L1, but to date little research
exists from contexts where English functions as a foreign language or an official language along-
side other more predominant L1s (Bosher & Stocker, 2015). If little is known about English lan-
guage medical communication outside of ENL contexts, ELF settings represent an even rarer
research site. Most data on ELF interactions have been focused on the domains of higher educa-
tion and business (Jenkins, Cogo, & Dewey, 2011), and even that research has been conducted
largely in European contexts and to a lesser extent East Asia. Notably, the recently published
and comprehensive Routledge Handbook of English as a Lingua Franca (Jenkins, Baker, & Dewey,
2018) does not include a discussion of MELF among its 47 chapters.
Tweedie and Johnson (2018b) use the term medical English as a lingua franca (MELF) to
describe health settings where ELF interactions are predominant. As noted above, such environ-
ments are facilitated by migration of health care professionals across international borders and
the role and status of English in medicine and international communication. As the next section
will explain, (M)ELF interactions are even more prevalent in particular regions where large
migrant populations communicate in English.

4 | M I G R A N T DE S T I N A T I O N S AN D ( M ) E L F

Major migrant destinations provide intriguing insights into the development of ELF use, and
especially so in states of the Gulf Cooperation Council (GCC; International Relations and
TWEEDIE AND JOHNSON 5 of 12

Security Network, 2009),1 where historical‐economic conditions have created language contact
environments intensifying the role of ELF. Yet, to date, ELF has been the subject of little
research in the region (Alharbi, 2018).
Rapid economic development in GCC countries like the United Arab Emirates (UAE) and
Qatar has led to the influx of large numbers of temporary migrant workers, particularly from
South Asia. While exact population numbers are difficult to obtain (Heard‐Bay, 2005), in part
due to political sensitivities regarding expatriate labor (Willoughby, 2006), estimates put the
number of temporary workers at 85% of Qatar's population (Paschyn, 2012), and 88% of the
UAE's (Boyle, 2012). In most parts of the GCC, the number of locals are exceeded by that
of expatriate workers (Ali, 2009). English is a second or third language2 for many of the
region's expatriates and is typically utilized as an “acrolectal lingua franca”3 (Boyle, 2012,
p. 312). Boyle draws upon social network theory to argue that conditions in temporary
migrant communities like the UAE provide accelerated language change environments, as
weakened social ties of migrant residency loosen linguistic norms typically more entrenched
at home.
Our own professional context as teachers and researchers lends itself to a special interest in
how ELF in the GCC intersects with nursing specifically. Nurses typically deliver the bulk of
patient care in health care settings (Almalki, FitzGerald, & Clark, 2011) and are the members
of health care delivery teams “most likely to intercept errors and prevent harm to patients”
(Hughes & Clancy, 2009, p. 1). Given their important role in health care delivery, the world-
wide phenomenon of nurse migration (Kingma, 2006), which includes aggressive recruitment
across international borders, is prevalent in the GCC as well. Expatriate nurses in the region
far outnumber nationals, accounting for more than 70% of the total nurses in Saudi Arabia,
for example (Almalki et al., 2011), and 97% in the UAE (El‐Haddad, 2006). The region's use
of English as a vehicular language for communication among nurses with other L1s has been
observed in the literature (Aldossary, While, & Barriball, 2008), with some researchers identi-
fying the importance of nurse–patient language concordance for the delivery of quality nurs-
ing care (e.g., Almalki et al., 2011), and concerns over patient safety as a result of the
multicultural workforce (Almutairi, Gardner, & McCarthy, 2013). A lead pharmacist at a
UAE hospital linked medication errors to English proficiency levels in the expatriate work-
force (Bladd, 2008).
In a previous study, the authors (Tweedie & Johnson, 2018a) utilized Smith and Nelson's
(1985) intelligibility framework to analyze a role play exchange between nurses of different
L1s negotiating a hospital patient handover simulation. Analysis of the exchange by nursing
instructors revealed areas of L2 intelligibility that posed a threat to patient safety: through med-
ication word misrecognition (both dosages and frequency) and from lexical and syntactic impre-
cision. Results from a subsequent listening comprehension measure, completed by nursing
students from a variety of L1s, were also unsettling: Though listeners misunderstood the
exchange at key points affecting patient care and safety, the majority felt “confident” or “very
confident” they had accurately understood. From a patient's point of view, it is disquieting that
miscommunications might take place which affect safety; it is perhaps even more unsettling to
think nurses may not even realize they are misunderstanding one another.
The potential to put lives at risk due to unintelligibility in ELF, in areas like health care, avi-
ation or engineering, stands alongside a key criticism offered by Mackenzie (2014), who finds
existing descriptions of ELF exchanges too “angelic” (p. 140). This echoes Firth's (2009) claim
that the relatively rare miscommunications observed in ELF studies can in part be explained
by the narrow range of contexts in which they took place: “focused on either students' casual
6 of 12 TWEEDIE AND JOHNSON

conversations or business encounters ‐ in almost all cases within a Western European setting”
(p. 149). Mackenzie argues that where researchers from other disciplines, such as Second Lan-
guage Acquisition, identify errors or deficiencies, the prevailing mood in ELF is likely to inter-
pret these as “signs of ‘creativity’ and/or savvy, contextually appropriate innovations” (p. 141).
Such innovations are well and good for comprehension in the imagined communities ELF the-
orizing often portrays, or to describe conversations among tourists and taxi drivers, or respond
to questions in academic presentations. Interlocutors in these contexts have the luxuries of time
and relatively low stakes communicative situations in which to utilize the ELF pragmatic strat-
egies (such as those described by Kirkpatrick, 2010, 2011) to achieve convergence in comprehen-
sion. However, most hospital patients and airline passengers, given the choice, would likely
value timely, precise communication over “innovation” for the ELF interactions in which they
are a very present stakeholder.

5 | E L F AN D N U R S I N G E D U C A T I O N

We have thus far noted the particular situation where a specific type of ELF (MELF) intersects
with the conditions of a prominent migrant destination (the states of the GCC), and have noted
that MELF requires an exceptional level of communicative precision. It follows that the realities
of an ELF environment should be reflected in the type of language support offered for medical
education in the region. However, we have not found this to be so.
One study referred to a transnational branch campus in a GCC country where analysis of a
health care assessment scenario revealed language misunderstandings that could impact patient
safety, yet an institutional needs analysis had determined that aural skills were not a factor in
student success (Tweedie and Johnson, 2018a). We viewed publicly available language support
course curriculum documents at multiple GCC state nursing education institutions and found
that only one hinted at language instruction which evidenced cognizance of the M/ELF envi-
ronment. One institution's English language support course description, among other learning
outcomes, intended to enhance nursing students' “ability to communicate effectively in multi‐
cultural encounters within an English‐speaking community.” While this institution's curricular
recognition of the linguistic environment is indeed a positive sign, such awareness is at present
not reflected elsewhere in the region's nursing education.
Tweedie and Johnson (2018a) suggest some strategies for language development curriculum
in MELF contexts: foregrounding the role of listening in curriculum overall, a focus on transfor-
mative listening tasks (cf. Rost, 2002) that are interactional in nature; attention to strategies
enhancing communicative effectiveness such as error repair, self‐correction, question asking,
repetition, etc. rather than emphasizing strict accuracy in form; and instructional prioritization
of nursing‐specific lexis. We concur with Jenkins (2007) regarding international communication
contexts: “the ability to accommodate to interlocutors with other first languages than one's own
… is a far more important skill than the ability to imitate the English of a native speaker” (p.
238), and recommend that health care education in such settings reflect this priority. However,
the realization of such a priority faces an uphill climb. A preference for imported inner circle (cf.
Kachru, 1985)4 curricula, teaching materials, and pronunciation models persists in the GCC,
and dialects of English other than (perceived) inner circle varieties typically encounter resis-
tance (Al‐Asmari & Khan, 2014). In the authors' experience, students and teachers alike are ret-
icent to affirm the value of effective communication over strict attention to native speaker
norms.
TWEEDIE AND JOHNSON 7 of 12

6 | MELF RESEARCH DIRECTIONS

A number of research directions present themselves with respect to MELF.

First, little is known about linguistic features specific to MELF. We surmise, based on expe-
rience as language teachers/researchers, that MELF will share many features with ELF's
“emerging patterns of lexical and grammatical forms” (Jenkins et al., 2011, p. 289). As noted
above, Seidlhofer (2004) and others suggest a number of these, including removal of the third
person present tense ‐s, dropping definite/indefinite articles, nonstandard question forms, etc.,
and the authors' own observations of MELF exchanges indicate general alignment with these
researchers' preliminary lists of ELF features. However, we wonder whether there are other
ELF features, which might exhibit similarities and/or differences from medical English; a ques-
tion such as this requires a large MELF corpus to investigate. Such a corpus would also help
with other areas of study, such as identification of high‐frequency, high‐importance medical lex-
ical items, potential linguistic variation based on L1, variance based on context (emergency
ward, patient handovers), and so on.
Another research direction is with respect to patient safety. Jenkins' (2000) well‐known
“Lingua Franca Core” proposes items for pronunciation teaching deemed essential for intelli-
gibility across ELF interactions, suggesting, for example, that distinctions such as the /θ/ and
/ð/ sounds are unnecessary. MELF, with its inherent need for precise communication, pro-
vides the opportunity to consider how ELF tendencies toward simplification are enacted.
Does, for example, a /d/ or /t/ sounding of the inital /θ/ in theophylline (whose side effects
include seizures) result in communication errors that could harm patient safety? We expect
that in most cases, intelligibility will be reached, either because, as Jenkins asserts, the /θ/
phoneme is not necessary for comprehension, or via ELF meaning‐making strategies such
as repetition, clarification, error repair, and the like (Kwan & Dunworth, 2016). As Ranta
(2018, p. 245) points out, ELF speakers tend to “orient cognitively to contents over form …
it is quite acceptable to rely on whatever seems to work in interaction”. How is this “what-
ever works” communicative strategy enacted where precision in expression is required? The
high stakes nature of the communicative context begs for research into its salient features.
Strategies like a “let it pass” approach (waiting until an unclear meaning becomes clear) as
identified by Firth (1996) are more difficult to enact in high stakes ELF contexts like
aviation and health care.
Finally, while we highlight the GCC states as of particular interest given the place of ELF in
migrant destinations, MELF interactions can be researched in other contexts. The rise of med-
ical tourism (Bookman & Bookman, 2007) may heighten MELF communication: A Thai sur-
geon in a Bangkok hospital may well use English to communicate an upcoming surgical
procedure to her Japanese patient, for example. Further, it is not difficult to imagine MELF
exchanges as commonplace in immigrant destination countries like Canada, where fully 25%
of physicians and 8% of nurses are internationally trained (Covell, Neiterman, & Bourgeault,
2016). In this regard, we return to the discussion of whether an ELF interaction, by definition,
may include native speakers. Mauranen's definition of ELF as a contact language requires that
only one of the interlocutors use it as an L2 (Mauranen, 2018, p. 8). Mauranen's delineation
therefore raises the possibility that the actual number of MELF health care interactions has
been considerably underestimated. The international cross‐border flow of health care workers
(Lu & Corbett, 2012) has facilitated the use of English as a contact language, consistent with
the larger trend of ELF “deterritorialisation” (Wang, 2018, p. 151, cf. Seidlhofer, 2011). This pre-
sents intriguing implications for health care education in countries traditionally seen as ENL,
8 of 12 TWEEDIE AND JOHNSON

where investigations have largely focused on NNS medical staff interaction with NS patients.
Might we imagine curriculum at medical training institutions in the USA, for example, includ-
ing skills for (M)ELF interaction?

7 | CONCLUSION

This article has asserted that MELF represents an important direction for future research in the
discipline of English as a lingua franca. A proposed starting point for inquiry is the relationship
of MELF to ELF, and whether ELF linguistic features and pragmatic strategies are evident in
medical contexts where communicative immediacy and precision are critical elements. While
suggesting that the GCC states constitute a particularly apposite context for investigating MELF,
we have argued that a definition of ELF, which includes NS interaction, coupled with the flow
of health care workers across international borders, opens wide the possibility of studying
MELF in regions where English is considered a dominant native language.
MacKenzie (2014) exclaims “Enough already!” when arguing that present accounts of ELF
interaction are overly “angelic” (p. 140). In this regard, data drawn from MELF interactions
present an appealing addition to existing ELF sources. Given the often urgent and precise
expression required in health care delivery, MELF research offers an opportunity to examine
whether ELF processes for achieving mutual understanding hold true. However, along with
increased understanding of ELF as a theoretical construct comes a more practical motivation
for MELF research: The delivery of safe and effective patient care in the midst of the linguistic
complexity that characterizes health care worldwide.

E N D N O T ES
1
The Gulf Cooperation Council, founded in 1981, is composed of Bahrain, Kuwait, Oman, Qatar, and Saudi
Arabia and the United Arab Emirates (International Relations and Security Network, 2009).
2
We follow Ranta (2018, p. 252) in using “second or third language” here as shorthand for someone who uses
English as an additional language, “regardless of how many other languages (besides his/her mother tongue(s))
the person knows or the order in which s/he has acquired them.”
3
An acrolectal variety exhibits the least linguistic difference from the original language, in contrast to a basilectal
variety (Swann, Deumert, Lillis, & Mesthrie, 2004).
4
Kachru (1985, pp. 16–17) used the terms inner, outer, and expanding circles to describe varieties of English
around the globe. Inner circle varieties are defined as “norm‐providing” in that “native speakers” are seen to
be models for other varieties, contrasting with expanding circle varieties which are “norm‐dependent.” Between
these two are outer circle varieties, which may see clashes between the establishment of local linguistic norms
and inner circle usage. Despite widespread use of English in the GCC, many English users still look to British or
American English speakers as linguistic models.

ORCID
M. Gregory Tweedie https://orcid.org/0000-0003-0497-4577

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A UT H O R B I O G R A P H I E S
M. Gregory Tweedie is an Associate Professor at the Werklund School of Education at the
University of Calgary, Canada, where he teaches in the areas of language and literacy edu-
cation. His research in the areas of language education has been published in TESOL Jour-
nal, Studies in Higher Education, TESOL Quarterly and other international journals. Greg's
research interests include dialects in education, varieties of English, and English as a lingua
franca.

Robert C. Johnson is the Curriculum and Assessment Lead in the Foundations Program of
the University of Calgary in Qatar. He also teaches statistics, academic writing, and educa-
tion courses in the Bachelor of Nursing Program and applied statistics in the Master of Nurs-
ing program at the institution. He is the recipient of the 2013 Jacqueline Ross TOEFL
Dissertation Award and has published in Assessing Writing, TESOL Quarterly and other
international journals. His research interests include assessment, validity, argument‐based
test validation, and communication in English as a Lingua Franca for health care.

How to cite this article: Tweedie MG, Johnson RC. Research directions in medical
English as a lingua franca (MELF). Lang Linguist Compass. 2019;13:e12312. https://doi.
org/10.1111/lnc3.12312