International Medical Graduates and Problems of Interculturality
Simon Musgrave Marisa Cordella, Monash University
In this paper, we focus on a situation where interculturality takes an unusual form. Rather than a situation where the intercultural problem is one of creating a space in which different worldviews can be accommodated and validated, we look at one in which the "other" enters with the desire and indeed the obligation to minimise their "otherness" - this is the position of the International Medical Graduate (IMG).
IMGs play an increasingly important role in the health system of many first-world countries (Spike 2006), and their communicative competence and strategies for improving it are the subject of a rapidly-expanding literature (Rider and Keefer 2006, Roberts et al. 2003, Schildmann et al. 2006). The problem of interculturality for these individuals is that they must communicate as effectively as possible with patients across two separate cultural divides. Firstly, there is the divide between the culture of the medical profession and the general culture, a divide which all medical workers have to be able to bridge. Secondly, there is the divide between the native culture of the IMG and the general culture of the place in which they find themselves working. This negotiation of multiple intercultural divides takes place in the context of the ethical obligation on the medical practitioner to assist the patient to the best of their ability. The Hippocratic injunction to do no harm can, in this context, be interpreted to include the injunction "Minimise distress", and this in turn can demand strategies which minimise threat to the patient as a result of any perception of the IMG as 'the other'.
We base our discussion on data on IMGs collected during Objective Structured Clinical Examinations, a tool used extensively in medical curricula to assess health practitioners' clinical and communication skills (Brazeau and Crosson 2002, Chabeli 2001, Roberts et al. 2003, Ross et al. 1988) We demonstrate that IMGs use a series of linguistic strategies to engage their patients communicatively and we interpret these strategies in terms both of the dichotomy between 'empathy' and 'sympathy' (Bennett 1998), and in terms of intercultural pragmatics.
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