A total of eight themes were identified based on three factors namely ‘English language use during medical training and practice’, ‘university culture and environment’, and ‘individual EL proficiency. The summary of the factors and themes are illustrated in
Factor 1: English Language Usage in Medical Training and Practice
Theme 1 - English Language as a Learning Tool
In medical programmes, learning activities include lectures, problem-based learning sessions (PBLs), clinical skills and simulation sessions (CSSC), hospital and bedside teaching. It is evident that students perceived EL as a learning tool in these activities as they cited that learning activities are in English.
“If we're in class, sure, English only speaking, if we're at Clinical Skills & Simulation Centre sure, English only speaking.” FGS3 (L215-216)
Furthermore, students also perceived EL to be an important learning tool as medical learning resources are mainly in English.
“Reference or the books that we use are mostly used in English. So, English is very important actually in our studies of our medical programme”. FGS5 (L70-71)
Theme 2 - English Language as a Professional Language
English language is perceived to be equally important as a professional language. Medical students communicate in English with patients, peers and lecturers and participate in external events such as community support, conferences and extra curricular activities (ECAs). Students shared that speaking in English makes them appear more professional, particularly when representing the university in external events.
“It's also something to do with the image because like if we do if we are representing IMU and going to a different public university in Malaysia for example. So if we since we are carrying the name of IMU, if we converse in English, I would say that it will bring a better image to IMU”. FGS2 (461-465)
Theme 3 - English Language as a Communication Tool
Medical students communicate with peers formally and informally in learning setting and during social interactions. Furthermore, in IMPs where students are from multilingual backgrounds and nationalities , English language is also the main communication tool.
“We have people from various cultural backgrounds and different countries, even we have international students here. So, it's logical if we speak in English and we converse with each other in English since that that will make the international students feel more comfortable as they will be able to understand what we're talking.” FGS2 (L45-51)
Factor 2: The Influence of University Culture and Environment EL Mastery
Theme 1 - University Support in English Language Mastery
As students in IMPs are multilingual with varied cultural backgrounds and nationalities, it was necessary to explore university support in mastering the English language. Students felt that university learning environment with English as a medium of instruction and ECAs have helped in strengthening their command of English. There was visible improvement in English language proficiency for peers who had initially struggled with English language after the first semester of the medical programme.
“But what I noticed from them is that after the six months of our semester one their English skills like improve tremendously. And when we asked the person about it, what they said was that it was the talking with all the peers was the one that helped them.” FGS2 (L136-138)
To support improvement in EL communication skills, students mentioned that lecturers equally encouraged them to communicate in English.
“Our lecturer actually encouraged him to speak English more.” FGS3 (L577-578)
Theme 2 - Self-initiative and Peer Support in English Language Mastery
As IMPs enrol students from multilingual and varied socio-cultural backgrounds, some students may face difficulties learning and communicating in an English medium environment.
“At first I was quite struggling to adapt with English speaking environment.” FGS2 (L187)
Students from multilingual and multicultural backgrounds with lesser opportunities to communicate socially in English expressed that the English speaking environment came as a shock, as some of them did not have experience of speaking with different ethnicities or nationalities. Therefore, in order to improve their English proficiency and cope with learning, students mentioned that they have taken initiatives on their own and approached peers for support.
“If they really don't know the language, they will come to us and ask us what does it mean… We have to translate it to them, either using their own language, or we use really simple terms to explain it.” FGS1 (L790-791, L795-796)
Besides that, students watched and listened to English reading and entertainment materials, online learning tools and registered for English classes outside the university.
“I tried to improve myself with a lot of things like, I watch English movies, I listened to English songs. And of course, I tried to gain the courage to speak in English with my friends.” FGS2 (L188-189)
Factor 3 – Individual English Language Proficiency
Theme 1 – English Language for Academic Progression
Students feel that limitations in English language impacted their learning as they needed more time and effort to comprehend the resources.
“They might actually be speed lagging behind learning like learning the syllabus, I mean, they have to be/ they have to put like extra effort to learn the same thing that we learned/ we have to learn because maybe it's not in the language that they are comfortable in.” FGS1 (653-657)
Furthermore, assessments such as assignments, presentations, reports and OSCEs are carried out in English. Hence, having poor command of English has an impact on their assessments when examiners are not clear about what is presented.
“If you are not so proficient in the language, you will have difficulty trying to structure your points according to paragraphs and making the flow look nice. And because of the inability to do that, then the lecturer, the person marking the paper might feel like, this person is all over the place, he doesn't really know what he's writing about.” FGS3 (L604-607)
Lack of English proficiency impedes students’ day to day learning. Those who are weak in the language are afraid to ask their lecturers when unsure of the content taught or participate less in Problem Based Learning (PBL) discussions.
“It's hard when you are among with your peers because you need to let them to understand and also the facilitator to understand. Some they don't know certain my language.” FGS5 (L239-252)
Theme 2 – English Language for Patient Communication
Students also perceived that proficiency in English language has an impact on patient communication. Lack of English proficiency may cause the interactions to sound rude, awkward and lead to misunderstanding and errors in instructions given to patients. For sensitive issues such as sexual history, medical students explained that proficiency in English is needed when exploring details without causing patients’ uneasiness. Most importantly, they felt proficiency helped gain patient’s confidence when discussing such matters.
“I think communication with patients, that will also be a problem because some people I heard my friends say, they directly translate it from Mandarin to English. And then sometimes, it might sound wrong, it might sound rude in English.” FGS1 (L688-691)
Theme 3 - English Language for Personal and Professional Development
During their studies, students are involved in medical research, meet with visiting professors from other universities, attend conferences and receive training at health clinics and write case reports. These encounters, which are mainly in English, contribute to the personal and professional development of a future doctor. Students explained that English language accuracy is required to review literature, conduct and communicate research, resulting in opportunities to interact professionally in academia or healthcare at both the workplace or collaborating with international colleagues.
“…eventually when you go out into the working world, when you do literature reviews, when you review other people's research, when you do your own research, eventually you're going to have to reach that level of like academic, that sort of academic standard that is required of the community when they do research projects, and you do literature reviews.” FGS3 (L660-666)
“For me usage of English might not be very important in a community level, but for professional level like from colleagues to colleagues, we still need to use English or professionalism and to discuss anything about medical, I think it's very important to speak in English.” FGS2 (L469-473)