Medical Education 1987, 21, 283-284
Editorial
English as an international language of medicine
Communicative competency is the initial goal of
doctors who are obliged to work in a foreign
language. The field of teaching and learning
English for medical purposes belongs to the
pedagogical branch of applied linguistics. Con-
sider the problems of the overseas doctor who
has to communicate with patients and colleagues
in English. Such doctors may well have studied
in English-medium schools or medical faculties.
They have mastered a code of academic English
and are at home with textbooks and journals in
English. Howcver, they often have difficulty in
asking a patient about the duration o f a headache.
English in Medicine: A Course in Communication
Skillst seeks to develop the English language
skills required by foreign medical personnel for
successful communication in their work or
study. The course is based on the linguistic
analysis of recorded data of doctor-patient and
doctor-doctor communication. In keeping with
current models of medical discourse analysis
(Maher 1981a, b) the text notes, for instance,
how a native speaker instructs, explains and
reassures while conducting an examination. The
text employs an ethnographic approach to the
channels and styles of communication including
attention to the use of authentic documents. For
example, the realization that referral letter writ-
ing has now been largely replaced by forms is an
advance on previous language textbooks.
The field of English language teaching and
learning is not confined to overseas doctors in
Britain or the USA. In medical schools around
the world English is taught as part ofthe medical
education curriculum. Medical students are for-
tunate if language teachers are aware of and res-
pond to that important area of language teaching
which ( I ) focuses on the specific English
language needs of the medical learner, (2) focuses
on themes and topics specific to the medical fields
tEnglish in Medicine: A Course in Com-
munication Skills. By ERICGLENDINNING & BEVERLY
HOLMSTROM.Cambridge University Press, Soviet occupation in 1978 has, reportedly,
Cambridge. 1987. Pp. 1 5 3 . 24.75. ISBN: o 521 311659
(Cassette €7.5o+VAT; ISBN: o 5 2 1 3 2 3 3 2 0 ) .
and (3) focuses on a restricted range of skills
which may be required by the medical learner,
e.g. for writing a medical paper, preparing a talk
for a medical meeting, etc (Maher 1986a). The
book by Glendinning & Holmstrom is one ins-
tance of the burgeoning field of language skills
preparation. It is important to emphasize, also,
that the language teacher need not be a medical
specialist in order to teach students, doctors o r
nurses. As in the case of the above book, pro-
blem-solving activities allow doctors to use their
professional knowledge while exercising English
skills. The doctor or student provides the
required specialist input while the teacher con-
centrates on ensuring that the communication is
effective and accurate. This approach, of course,
hangs on whether the teacher’s orientation is
sufficiently learner-centred to allow such new
ways of learning.
That English is of growing importance in
modern medical communication is indicated to
some degree by the widespread teaching of
English in medical schools around the world.
But what empirical evidence is there to support
this view and to continue tojustify English teach-
ing in medical curricula? These questions can be
dealt with in two ways. We can point to the
spread of English in some medical education sys-
tems first by referring to longitudinal data on
languages of instruction as supplied by medical
schools of individual countries and second by
longitudinal analysis of the language of articles
listed in Index Medicus (Maher 1986b).
The reality of three important sociolinguistic
concepts (language spread, language mainten-
ance and language decline) is well illustrated in
the shifting situations of the world’s medical
schools. English has supplanted Arabic in Egyp-
tian medical education and replaced Turkish,
French and German in Afghanistan by 1970
(where Dari and Pushtu are other languages of
instruction). The Afghan situation since the
moved the instructional language now towards
Russian. English now co-exists with Burmese in

284 Editorial
Burma where before I970 it was English
medium instruction only. In some countries,
such as Sri Lanka, vernacular languages have
arisen (Sinhalese and Tamil) along with existing
English instruction. Colonial languages have
declined in some systems: French and Portuguese
in India, Dutch in Indonesia. There is clearly a
desire to maintain regional languages as vehicles
of medical instruction. A Maltese language
examination is obligatory in the matriculation
examination although English is the official
language of instruction at the Faculty of
Medicine and Surgcry. In Eire, all Irish-born
students are required to have a working
knowledge of Irish Gaelic. More significant than
official declarations o n what language is
employed in medical education, however, is the
high degree of English-mixing with other
languages at the level of teaching material use.
This is the case with Japan and it is obviously true
ofother countries also. In the Korean entry to the
World Health Organization Directory of Medical
Sclzools there is the footnote: 'English is used in
medical textbooks'.
Turning to the field of biomedical com-
munication, a recent study (Maher 1986b) has
dcscribed global trends in language preference. A
computer-based investigation of I n d e x M e d i c u s
showing the language of journal articles over a
17-year period (19661983) indicates that the
number of articles published in English has
increased steadily (19"/0) over this period. In
1980, the total (189 616) included 20% published
in countries other than the USA and the U K .
About 8% were published in three countries:
Japan, Germany and France. This increase in the
volumc of English language articles was not
matched by a similar increase in the number of
German-language articles, which had fallen 5 %
during the same period. In tcrms of the volume
of medical publications by national grouping,
whilst the USA accounts for a substantial 32.2%
of all articles written in English internationally
the geographical spread o f publications in that
language is significant. In India, Singapore and
Pakistan, for instance, where English is used as a
functional first language in the professional
medical domain and in commonwealth countries
such as Australia and Canada there is a steady
production of English-language writing in medi-
cal journals. But i f w e compare, for example, the
numbcr of articles in Japanese journals with that
of English-speaking Canada, Australia arid N e w
13652923, 1987, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2923.1987.tb00363.x by Cochrane Mexico, Wiley Online Library on [29/06/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Zealand, we find surprisingly that Japan, where
English is a foreign language, produced more
medical articles in English in 1980 than all of
these English-speaking nations combined.
A new situation has arisen, therefore, with
regard to the expansion as well as the 'ownership'
of English. This language is expanding as an
instrument of international communication and
education in medicine. Also, English cannot be
said to be the personal property o f any single
nation, not even of the circle ofEnglish-speaking
ones. It is the possession o f any individual or
nation w h o chooses to use it. From the data
available, English would appear to be used
widely or used as the official language in coun-
tries where English is not the mother tongue, in
the sense that domestic, internationally dis-
tributed journals of medicine are often published
in English.
English as a foreign language is taught as a
compulsory subject in many medical schools
around the world but with possibly less urgency
than the sociolinguistic realities of modern inter-
national medicine demand. Fluency in reading
skills is the minimum requirement not only for
the comprehension of international journals but
also for local in-house publications in countries
where English is not the mother tongue. Also,
the ability to write accurately in English will be a
growing need (especially for postgraduate stu-
dents around the world) but recognition of these
linguistic needs must be made in the early stages
of medical education.
These pedagogical possibilities, combined
with the advances now being made in our under-
standing o f doctor-patient interaction and medi-
cal discourse in general emphasize the
importance of applied linguistics to medicine.
J. MAHER
Institrife-for A p p l i e d
Lariqrra'ye S t u d i e s ,
Utliuersity of E d i r i b t q h
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