Dr. Marisa Cordella
Current research projects
Intercultural oral examinations in medicine: Understanding the communicative skills of international medical graduates (IMGs) in Australian objective structured clinical examinations (OSCEs)
Investigators
Associate Professtor Neil Spike, Dr Marisa Cordella, Ms Kara Gilbert, Professor Barry McGrath, Professor Gordon Whyte, Dr Johannes Wenzel, Professor Val Wass and Dr Simon Musgrave
Summary of the project
This study aims to analyse the communication skills of IMGs in selected communicative OSCE scenarios designed to replicate Australian Medical Council (AMC) examination standards. Video-recordings of OSCE performances and stimulated recall interviews will constitute the corpus of this study. Following a Discourse Analysis approach, the data will be analysed on both dimensions of intra-professional and practitioner-client interactions to investigate the discourse difficulties experienced by IMGs. The findings are expected to inform not only socio-cultural and language reconstruction in the assessment and training of IMGs for Australian contexts but also the development of intercultural communication skills training across undergraduate and postgraduate programs.
Aims of project
In Australian medical education contexts, there are increasing numbers of international students from non-English speaking backgrounds enrolling in Australian medical degree programs, more and more international medical graduates occupying positions in Australian public hospital systems, and numerous Australian medical schools beginning to adapt their curricula in off-shore programs (Hawthorne, Minas & Singh, 2004; Whyte (unpublished); Spike, 2006). Consequently, more research is required to understand the discourse tensions generated in intercultural contexts of professional practice in order to improve the participation and performance of both medical students and qualified practitioners from different ethnic, cultural and/or linguistic backgrounds in Australian and contemporary global settings.
IMGs provide a useful focus for investigating the communication and socio-cultural problems of intercultural medical interactions. In numerous studies, researchers have reported on the difficulties of their integration in the Australian healthcare system with most implicating more than mere English language in the generation of their communication problems (McGrath, 2004; Han & Humphreys, 2005; Spike, 2006). In addition, there is growing recognition of the need for overseas trained ethnic minorities to acquire skills in institutionally located intra-professional medical discourse as much as the discourse pertaining to the culturally located patient-practitioner dyad (Roberts et al., 2000; Gilbert, forthcoming). In fact, researchers have acknowledged the discourse hybridity inherent in professional interactions that serve to confound the complexity of medical communicative competence (Atkinson, 1995; Roberts et al., 2000, Cordella 2004a, 2004b, 2006).
In the OSCEs that constitute the structured clinical assessment for Australian Medical Council (AMC) accreditation, candidates must integrate medical knowledge, clinical skills and professional attitudes to demonstrate clinical competency for Australian medical practice. Yet an OSCE comprises a mix of discourses - personal experience, professional and institutional – that a candidate must also manage in conjunction with the unpredictable interactional demands of the oral examination (Roberts et al., 2000). Therefore, the OSCE provides a useful site for, firstly, investigating the multidimensional complexity of medical communication for medical students and practitioners and, secondly, for identifying the discourse tensions experienced by IMGs in Australian clinical examinations.
Discourse analysis is an approach towards investigating communication that focuses on components of speech to reveal how “personal and social premises are tacitly encoded in, and validated and reinforced by, the way sentences, utterances or turns are formed and interconnected as parts of wholes” (Fitch, 2005: 253). Discourse analysis of OSCEs permits, therefore, an investigation of both the micro and the macro reality of communication to reveal not only the management of social relations in talk but also the institutional, professional and socio-cultural norms and values that modulate the social production of that talk (cf. Cicourel, 1999; Roberts et al., 2000; Roberts et al., 2003; Wodak, 1996).
This study aims to analyse the communication skills of IMGs in selected communicative OSCE scenarios designed to replicate AMC examination standards. As well as addressing the urgent needs to better accommodate socio-cultural and language reforms in the assessment and training of IMGs for Australian contexts (Spike, 2006), the findings are expected to also inform the development of intercultural communication skills training across undergraduate, postgraduate and IMG programs that will accommodate both intra-professional and practitioner-client interactions. It is envisaged, therefore, that such programs will promote the more effective participation of medical practitioners in Australian and affiliated international contexts.
Cultural and linguistic aspects of mediated and interpreted medical discourse
Investigators
Dr Julie Bradshaw, Dr Marisa Cordella, Dr Simon Musgrave, Helen Tebble and Dr Louisa Willoughby
Overview of the research project
As speakers of community languages age their language skills may diminish, while their medical needs increase. Nearly 30% of Italian speakers in Victoria are now over 65, and many need to make use of interpreter services or family support to communicate in medical contexts. Members of the Italian-speaking community report that the key problem facing them is how to provide support for their aging members. The proposed study will investigate the linguistic and cross-cultural experiences of elderly Italian-speaking patients in doctor-patient consultations where an interpreter is called on to provide linguistic mediation.
Doctors, patients, interpreters and family members are likely to bring to the interaction different cultural expectations about participant roles and the nature of information needed. Many elderly Italian speakers are likely to speak a regional dialect rather than Standard Italian, which may create problems for interpreting: professional interpreters who are familiar with medical discourse may not be equally familiar with the dialect, while family members who can communicate satisfactorily in the domestic sphere in the dialect or standard Italian are likely to have problems with medical terminology. The project aims to document the participants’ attempts to communicate, any sources of trouble, and their resolution. Medical consultations will be recorded and transcribed, and the discourse will be analyzed from several perspectives. In addition, post-consultation interviews will be conducted with all participants.
Connecting younger second language learners and older bilinguals
Investigators
Prof Colette Browning, Prof Michael Clyne, Dr Marisa Cordella, Dr Dr Doris Schupbach , Susanna Scarparo, Dr Susan Feldman, Ms. Brigid Maher and Dr Tina Weller.
Overview of the research project
This study involves volunteer students from each language currently enrolled in advanced Spanish, German or Italian. They will be paired with a healthy older volunteer Spanish, German or Italian speaker to conduct a number of conversations.
This project is informed by decades of research by Monash staff and students around multilingualism in Australia. It demonstrates our rich language resources and the importance of older people as catalysts for language maintenance within their own communities. Preliminary studies at primary and secondary level have described the success of the utilisation of community resources to develop students’ language skills. This parallels the Home Tutor Scheme in English as a Second Language. The new project also takes on board recent gerontological research, showing that the health and well-being of older people benefits from contact with younger people. This project will explore this in a context where migrants often become more attached to their original language and culture as they age.