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Es udios de
lingüís ica inglesa aplicada
VOCAL-MEDICAL: ON-LINE LANGUAGE LEARNING AND
CULTURAL PREPARATION FOR EMERGENCY SERVICES
K is in B ogan
Ins i u e o Technology a T alee, I eland
k is in.b og[email p o ec ed]
Je Ad iaenssens
Thomas Mo e Uni e si y College, Belgium
je .ad iaenssens@ homasmo e.be
Helen Kelly
Royal College o Su geons, I eland
helen.kelly@ csi.ie
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The VOCAL-Medical P ojec (Voca ionally O ien ed Cul u e and
Language – Medical) is a wo yea Leona do da Vinci T ans e o Inno a ion
p ojec , unded by he EU Commission, and pa o he Li elong Lea ning
P og amme. I ollows on om wo ea lie EU p ojec s, namely VOCAL (www.
ocalp ojec .eu) and he awa d winning P oblem-SOLVE. The VOCAL-Medical
p ojec pa ne ship b ings oge he 14 pa ne coun ies and 9 languages. The end
p oduc will be an on-line aining ool o eme gency s a who deal wi h pa ien s
who do no unde s and he local language. The e will be also an app o mobile
phones (sma phones) and able s (wi h HTML5 unc ionali ies) which can be
used by he consul an in an eme gency medical si ua ion.
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This p ojec is di ec ed a p o essionals in he medical sec o who need o
communica e wi h pa ien s who a e non-na ionals in eme gency si ua ions whe e
good communica ion skills can li e ally mean he di e ence be ween li e and dea h.
I esponds o a g owing need in he medical sec o o o e come he language and
in e cul u al ba ie s which a e occu ing wi h e e g ea e equency as a esul
o demog aphic changes and inc eased mobili y.
The p ojec aims o b idge he gap be ween di e en heal hca e sys ems
and di e en cul u al beha iou s inhe en in he doc o -pa ien ela ionship. This
has bene i s o heal hca e sys ems, o he p o essionals who wo k in hem and
o pa ien s.
Key wo ds: Mul ilingual, mul icul u al, in e cul u al and language
ba ie s, quali a i e communica ion in he medical sec o .
El P oyec o VOCAL-Medical (Voca ionally O ien ed Cul u e and
Language – Medical / Cul u a e Idioma Medico O ien ado a la Fo mación
P o esional/Vocacional) es un p oyec o de dos años del Leona do da Vinci T ans e
o Inno a ion (T ans e encia de la Inno ación), inanciado po la Comisión
Eu opea, den o del P og ama de Ap endizaje Pe manen e. (Li elong Lea ning
P og amme). Es una con inuación de dos an e io es p oyec os de la UE: VOCAL
(www. ocalp ojec .eu) y el ganado de p emios P oblem-SOLVE.
Palab as cla e: Mul ilingüe, mul icul u al, in e cul u al y ba e as
lingüís icas, comunicación cuali a i a en el sec o sani a io.
1. In oduc ion
The VOCAL-Medical p ojec (Voca ionally O ien ed Cul u e and Language
– Medical) is a wo yea Leona do da Vinci T ans e o Inno a ion p ojec
and pa o he EU Commission’s Li elong Lea ning P og amme. I is a
ollow-on p ojec o Vocal (www. ocalp ojec .eu), an ea lie EU p ojec
ha an om 2007 un il 2009 and ha was based on he P oblem SOLVE
EU unded p ojec ha was awa ded he EU Language Label 2006.
The VOCAL p ojec pa ne ship consis s o 10 Eu opean
coun ies, a combina ion o 14 pa ne s and 9 languages. The lead p ojec
pa ne , he Ins i u e o Technology, T alee (ITT) co-o dina es his pan-
Eu opean collabo a ion. Quali y issues a e deal wi h by a pa ne in he
UK and echnical ma e s a e he emi o Danma Compu e s in Poland.
The lead medical expe is he Belgium pa ne Thomas Mo e Kempen,
who is suppo ed by o he medical colleagues in he ITT, RCSI (Royal
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College o Su geons in I eland) in Dublin and he Eme gency Se ices
in Slo akia. O he p ojec pa ne s a e om Bulga ia, Ge many ( wo
pa ne s), Li huania, Poland ( wo pa ne s), Slo akia (a uni e si y pa ne ),
Slo enia and Tu key. Apa om being medical expe s, pa ne s a e also
mobili y coo dina o s, language lec u e s and expe s in mul imedia o
ICC (In e cul u al Communica ion). The dual ocus o his on-line p ojec
is on he one hand a medical con ex led by he Belgium pa ne and an
in e cul u al compe ence led by one o he Ge man pa ne s, Assis GmbH.
The end p oduc is a mul i-lingual, mul i-cul u al on-line applica ion
o s a in eme gency ca e ha will suppo hei communica ion skills and
can also be used in eal ime eme gency si ua ions. The a ge g oup is
eme gency s a in he medical sec o .
2. Ra ionale – Resea ch Summa y
Eme gency ca e depa men s and ambulance se ices a e as -paced wo k
en i onmen s cha ac e ized by a b oad a ie y o pa hology and pa ien s.
Mo eo e , eme gency ca e o en equi es ins an aneous decisions abou li e
and dea h (Ad iaenssens e al, 2011; Kilcoyne & Dowling, 2007). In mos
cases, eme gency consul a ions a e unplanned esul ing in inc eased s ess,
anxie y and e en agg ession in pa ien s and ela i es. As a consequence,
good communica ion is p imo dial in his se ing o ga he essen ial medical
in o ma ion, p o ide clea in o ma ion o he pa ien s and hei ela i es
and o educe le els o dis ess.
A s udy by Philips e al (2010) e ealed ha non-na i e speake s and
immig an s o en seek hei i s medical help in eme gency ca e (Philips
e al, 2010). As a consequence language p oblems a e e y common in
hese heal h ca e se ices. Gene al p ac i ione s (on du y) a e howe e also
con on ed equen ly wi h o eign pa ien s as hey a e in many heal h ca e
sys ems he i s con ac poin in case o (semi)u gen medical p oblems
(Shi, 2012).
In addi ion o language ba ie s, also in e cul u al di e ences play
an impo an ole in he adequa e deli e y o (semi) u gen ca e (Wach le
e al, 2005). Religious aspec s, gende a i udes and heal h belie s we e
ound o al e communica ion be ween heal h ca e p o ide s and pa ien in
ER (Taylo e al, 2013).
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Se e al s udies in he las decades emphasize he need o b idge he
language gap and in e cul u al ba ie s in eme gency ca e (Meischke e al,
2013; Flo es, 2006; Ca asquillio e al, 1999). Resea ch shows signi ican
e ec s on ‘ ime o dispa ch’ ( o example, delay in s a -up o esusci a ion),
accu acy o he le el o medical ca e deli e y, misin e p e a ion o
symp oms and diagnos ic mis akes, and o e all sa is ac ion o non-na i e
speaking pa ien s in ER (B ach e al, 2005; Quan, 2010).
E ec i e communica ion be ween pa ien s and heal h ca e
p o essionals who a e cul u ally and linguis ically di e en implies
u ilisa ion o s a egies o p o ide compe en heal h ca e (Lee, 2003).
A b oad a ie y o hese s a egies is desc ibed by B ach and F ase
(2000), e.g. c ea ion o in e cul u al awa eness, aining in in e cul u al
and language compe encies, p o ision o in e p e e se ices, speci ic
ec ui men and e en ion policy o mino i y s a , and he in ol emen o
amily and communi y membe s in heal h ca e decision making. Besides
hese s a egies, he de elopmen o (ICT) ools o suppo and acili a e
p o ide -pa ien / amily communica ion can also be help ul in b idging he
language and cul u al gap in u gen medical ca e.
3. Aims and Objec i es
The aim o he VOCAL-Medical p ojec is he ans e o inno a ion
om he Leona do da Vinci TOI p ojec VOCAL (2007-2009) and o he
ele an EU p ojec s o he LLP 2007-2013 in ela ion o language lea ning
in oca ional con ex s o a new oca ional namely he heme o his p ojec
which ela es o he heal hca e sec o . I a ge s p o essionals in he clinical
se ings b oadly speaking who need o communica e wi h pa ien s who
a e non-na ionals in eme gency si ua ions whe e good communica ion
skills a e o en he key o quali y and e ec i e heal hca e. As such his
p ojec aims o espond o an inc easing need o o e come language and
in e cul u al ba ie s ac oss heal hca e sec o s globally as a esul o
demog aphic changes and inc eased mobili y.
Inc easingly, clinical p o ide s and heal hca e s a engage on a
p o essional basis wi h colleagues and pa ien s om di e en cul u es and
many o whom ac oss Eu ope and elsewhe e use English as a lingua anca.
L2 (o non-na i e speake s) p o ide s ace communica i e and cul u al
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challenges when dealing wi h pa ien s om he local cul u e and om
o he cul u es. The use o he lingua anca English does no mean ha he
cul u al alues and belie s b ough by he pa icipan s o he in e ac ion
a e no longe ele an no do hey become neu alized. Na i e speake s o
English (L1 speake s) also ace challenges when dealing wi h colleagues
and pa ien s who a e om di e en cul u al backg ounds. Fu he mo e,
di e en cul u al belie s and alues a e b ough by speake s o many
a ie ies o English o he in e ac ion, e.g., US-English, Indian English,
and can impac on pe cep ions o oles, powe , au ho i y, which a e hen
coded in e bal, non e bal and pa a e bal communica ion. This p ojec
he e o e d aws addi ionally on in e cul u al communica ion heo y and
applies i o he clinical con ex as a means o imp o ing he e ec i eness
o all heal hca e p o essionals wo king in mul icul u al challenging
en i onmen s.
This p ojec aims o p o ide language and cul u e aining ma e ials
con ex ualised o he medical sec o , h ough coope a ion be ween
educa ional ins i u ions and p o essionals wo king in his sec o . I s a ge
audience is speci ically: in hospi al eme gency se ices; ambulance se ice
and as escue eams; GP’s on s andby/call du y (especially in u ban
a eas); doc o s/specialis s wi hin he hospi al examining and diagnosing
eme gency pa ien s.
I s objec i e in o de o ul il hese aims is o c ea e and es he
con en o a web-based/mobile applica ion designed o he abo e pu poses.
4. P ojec Me hodology
One o he s eng hs o his p ojec is he ac ha i is ocused on
s akeholde s and speci ically in eg a es hei inpu . The con en o he
p ojec (online modules) has been w i en acco ding o he eedback
ecei ed by all pa ne s’ needs analysis. As a esul , he ma e ials gene a ed
by he pa ne s a e based on eal and iden i iable needs inco po a ing he
demands o he a ge sec o .
The s uc u e and concep o he p e ious p ojec VOCAL was
ans e ed by he cu en p ojec pa ne s o he medical sec o . The e we e
ou phases in he design p ocess:

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a) Elici ing and colla ing ele an linguis ic and cul u al inpu om
s a wo king in he medical sec o
A he e y s a o he p ojec su eys we e w i en by he Belgium
pa ne as he medical expe in his p ojec . This pa ne also moni o ed
and analysed he su eys. The implemen ed su eys we e “Needs Analysis
ques ionnai es” aimed a he a ge g oup, o example, s a wo king in he
heal hca e and medical sec o s in gene al bu also o include pa amedics,
eme gency medical echnicians and ambulance d i e s, in o de o elici
in o ma ion use ul o medical s a in o de o imp o e communica ion
wi h hei pa ien s. In addi ion he “local” knowledge o pa ne s in each
coun y was u ilised by hei esea ch in o local cul u al and linguis ic
opics ha we e ele an o he medical sec o .
b) Designing o p o o ype ma e ials in he o eign language
The o e all aim o he p ojec was o design a ool o suppo communica ions
in eme gency si ua ions. The aining ma e ial was designed based on he
esul s o he medical su eys o he Belgium pa ne and wi h he inpu
by one o he Ge man pa ne s who is an expe in ICC (In e cul u al
Communica ion). These pa ne s c ea ed a p o o ype o he ma e ial in
English, which was in i s inal e sion ans e ed by all o he p ojec
pa ne s in o hei own a ge languages. The p o o ype includes key wo ds
and ph ases in o de o assis he use wi h he linguis ic knowledge. Gene al
and cul u al in o ma ion, i ual ou s ollowed by exe cises (T ue/False;
D ag & D op and mul iple choice) and a inal es o indi idual eedback
a e c ea ing he con en o he online aining ma e ial.
c) P o o ype ma e ials o eedback
Submission o hese ma e ials was an impo an ea u e o he Quali y
Manage . The P ojec Co-o dina o and all pa ne s we e eques ed o gi e
cons an eedback abou he con en o he modules; led by he Belgium
medical expe and he Ge man ICC expe . Cons an consul a ion wi h he
echnical eam ensu ed ha pa ne s we e no c ea ing modules in Mic oso
Wo d ha we e no able o ans e in o an online o ma a a la e s age.
d) Final consul a ion and es ing phase o he p o o ype empla e wi h
he a ge g oup
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As al eady men ioned be o e, one o he dis inc ea u es o his p ojec
was he emphasis o he a ge g oup. This was combined wi h a dual
ocus on quali y; he mo e es ing was done, he be e he end esul o
he p oduc . Wi h his in mind he las phase o he p ojec concen a ed on
es ing he online modules. Each pa ne was asked o dis ibu e eedback
su eys (online and ha d copies) o he a ge g oup in hei coun y. The
es esul s o hese a ge g oups we e hen o wa ded o he echnical
eam who implemen ed he changes in he online modules. Liaison wi h
he echnical eam was on-going and a bug- acking sys em was used o
main ain an up- o-da e eco d o ac i e/ ixed echnical issues and bugs.
This phase was bo h ensu ing quali y assu ance and he dissemina ion o
he p ojec o he a ious a ge g oups and po en ial end-use s in each
coun y.
5. S uc u e o he Online Topics o he T aining Ma e ials
The on-line VOCAL-Medical ma e ials a e no jus bilingual (i.e. designed
in he a ge language o each pa ne coun y and also a ailable in English)
bu also mul ilingual (any a ge language can be combined wi h ano he
depending on he needs o he use ).
The e a e i e aining on-line modules a ailable:
1) In oduc ions and pa ien his o ies,
2) Alle gies and use o medica ion,
3) E en s ela ing o he cu en complain ,
4) Family and social si ua ion and ambulance si ua ions,
5) In e cul u al awa eness.
Each o he selec ed opics o he “ aining ma e ials” is p esen ed
acco ding o he same s uc u e: The in oduc ion page p o ides Gene al
Backg ound abou he selec ed opic. The nex ea u e is Key wo ds and
key ph ases in he a ge language accompanied by audio in he language
o he hos coun y and a w i en ansla ion. Nex is he co e ea u e o he
online modules which a e h ee anima ed i ual ou s o ypical scena ios
wi h ex iles o dialogues. This ex can be made in isible so ha he use
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can concen a e on hei lis ening skills. A mix o exe cises (e.g. mul iple
choice, d ag/d op; ue/ alse) is ollowed by each i ual ou . Ins an
eedback (indi idual sco es) o keep he use mo i a ed has been added.
The use will also be in o med which o hei answe s in he quizzes a e
co ec o no . Recommenda ions on medical issues a e gi en in he ad ice
sec ion which ocuses e y much on c oss-cul u al issues and on p ac ical
ad ice om he conduc ed su eys by he Belgium pa ne a he s a o he
p ojec . The second las sec ion is called Heal h sys em: coun y-speci ic
in o ma ion abou heal h ca e issues in each coun y a e summa ised he e
wi h ele an web links. A inal es will p o ide u he oppo uni y o he
use o sel -assessmen .
Apa om he i e on-line aining modules he e is he Vocal-
Medical mobile applica ion. This is a web-based mul ilingual esou ce
o sma phone, able o PC and gi es he eme gency medical s a
membe he oppo uni y o communica e and eco d he medical his o y
o non-na i e speaking pa ien s p esen ing a he eme gency se ices.
The applica ion is a ailable a h p://m. ocal-medical.eu. I consis s o
ou modules co e ing di e en medical opics. The da a collec ed can be
p in ed o elec onically s o ed in he medical eco d. The ollowing opics
a e ea u ed: In oduc ions, pas medical his o y, alle gies, medica ion,
las o al in ake, e en s leading o he cu en complain , amily and social
his o y and in he ambulance. P e ious pa ien ’s su eys can also be p in ed
and s o ed as he use has o log in a he s a . This ea u e o he p ojec is
also mul ilingual. The medical s a membe can selec a di e en language
in compa ison o he pa ien s.
6. Didac ic App oach
VOCAL inco po a es au hen ic con empo a y si ua ions in a medical
en i onmen and is ask-based in i s lea ning app oach The p ojec c ea es
an au onomous lea ning en i onmen , combines use iendly echnology
and na iga ional componen s wi h open access. Na i e speake s a e
in ol ed in he p epa a ion o all o he con en , i ual ou s, ques ions
and quizzes. The a ailabili y o high equency ocabula y as a lea ning
me hod, audio iles and an in-buil eedback sys em a e used h oughou he
sec ions. Di e en lea ning s yles a e add essed by p o iding bilingual ex
iles o eading, isual ma e ial accompany he anima ed i ual ou s and
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audio iles a e p o ided o lis ening. The in e ac i e na u e o he ma e ial
ensu es ha s uden s a e sel -mo i a ed and i o e s he oppo uni y o
au onomous lea ning. An impo an conside a ion o his design is he
knowledge ha clinicians and heal hca e s a ha e limi s on hei ime
o aining and wo k in a a ie y o p o essional en i onmen s. The
usabili y and app op ia eness o hese ools o aining pu poses among
his pa icula p o essional g oup has pa ly d i en he open na u e o hese
ools. The in e cul u al aining componen is lexible and can be used and
eused in a lexible manne by use s and bo h he App and he websi e
a e s andalone sel -access ools which his p ojec sees as an impo an
conside a ion o his p o essional g oup.
7. Conclusion
T ansna ional mobili y is g owing bo h be ween EU membe s a es and
o he pa s o he wo ld and addi ionally in conside a ion o he cu en
e ugee c isis a ec ing he EU, he associa ed challenges on EU heal h
se ices as highligh ed in his discussion a e likely o come unde mo e
ocus in he coming mon hs and yea s. Heal h se ices a e he e o e
inc easingly con on ed wi h people wi h an inadequa e command o he
na ional language. The e is now qui e a body o esea ch on he impac o
language ba ie s in he heal h se ices which d aws a en ion o p oblems
including misdiagnosis, medica ion mismanagemen , delay and ine ec i e
se ice deli e y as well as e hical conside a ions, which esul om poo
communica ion.
Gi en he legal basis o he igh s o ci izens o membe s a es
o ecei e heal h ca e, as well as na ional legisla ion (such as he Race
Rela ions Ac in he UK), he e is inc easing conce n abou ai , e ec i e
and e icien access o medical se ices as well as abou he po en ial and
ac ual cos s o in e p e ing and ansla ing se ices. The impac o language
ba ie s is el especially by hose who a e in he i s line o con ac wi h
pa ien s, pa icula ly eme gency se ices and gene al p ac i ione s (on
du y). Inadequa e communica ion and language p oblems inc ease he isk
o diagnos ic o he apeu ic ailu es.
Resea ch has e ealed ha quali y o ca e is di ec ly ela ed o
heal h p o essional language abili y and cul u al compe ence: language