Foreign Medical Graduates: Providing Critical, and Quality, Care

For many, the term “talent gap” conjures up an image of rows of empty seats in IT, engineering, and manufacturing. But the talent gap is also felt in healthcare. With the high cost of medical school, and the attractive salaries of physicians that specialize, the U.S. is simply not producing enough physicians to meet demand, especially in primary care.

This shortfall is expected to rise. The Association of American Medical Colleges found that the demand for doctors will continue to outpace supply, leading to a projected shortfall of between 46,100 and 90,400 doctors by 2025, many in primary care. These shortages are compounded by the fact that large numbers of physician ‘baby boomers’ will be retiring in the next few years.

Foreign Medical Graduates (FMG’s) are filling this crucial gap. Today, they comprise nearly 30 percent of all primary care doctors in the United States and provide quality medical care that equals or exceeds that of doctors who graduated from medical schools in the U.S.

Several leading hospitals are embracing the diversity of their medical staff while ensuring seamless communication between FMG’s and their patients. Knowing that pronunciation proficiency is an essential part of communication, these hospitals are providing English pronunciation training for their providers. The results have been transformational: better patient-centered communication due to greater understandability of their physicians, increased physician confidence and engagement, and higher Press Ganey HCAHP patient survey scores.

With a fully empowered physician workforce, these hospitals are filling the talent gap while delivering excellent medical care and the quality experiences their patients demand.

Accent Reduction: Giving Up or Taking On?

Accent Reduction: Giving Up or Taking On?

“Cultural competencies” has become a high priority for people in talent and learning development. From Fortune 500 companies to NATO, it’s widely understood that embracing diverse, multicultural norms helps organizations excel.

Where does accent modification (aka, accent reduction) fit in? Is it something that helps people become more culturally competent, or is it something that devalues diversity? To answer this, let’s first take a look at what it means to be fluent in a language…any language.

In order for two people to converse with one another, there needs to be a mutual understanding of what words mean (aka, vocabulary), how words are used (grammar), and how words are spoken (pronunciation). Vocabulary. Grammar. Pronunciation. None of these are intrinsically right or wrong. They’re simply sets of shared meaning between two or more speakers. Having a common basis of vocabulary, grammar, and pronunciation ensures that everyone who speaks is heard.

Accent reduction is a process where individuals learn how to pronounce the sounds of a language that do not exist in their first language. It enables people to express their thoughts, feelings, ideas, and professional expertise so that the speaker and listener can readily understand one another. It lets them meet a shared objective. When this happens, consulting with clients, leading teams, and collaborating with colleagues happen with greater ease and impact. People do not need to sound the same. On the contrary, this would diminish the rich cultural diversity of our global workforce. But we all need to be heard and easily understood.

With the completion of any given Accents International training program, participants still have an accent. What they don’t have is the experience of being frequently asked to repeat themselves; or worse, dismissed because their listeners aren’t able to understand their message. By acquiring a solid foundation in English pronunciation, non-native English speakers become culturally competent while maintaining their unique cultural identities.

Practice Makes Permanent

Practice Makes Permanent

I have some wonderful news…we’re made to learn. In fact, learning is the most natural thing for humans to do. Whether it’s learning to solve a math problem or learning to speak a foreign language, learning is to humans like flying is to birds.

After many years of studying the learning process, the most concise and easy to understand explanation I’ve found is described in How Your Brain Learns and Remembers, by Diana Hestwood and Linda Russell.

In layperson’s terms:

  • Brains are made up of, among other things, neurons
  • When we start to learn how to do something new, neurons begin to grow long tendrilly looking fibers called dendrites
  • When two dendrites grow close to one another, they create a contact point at a small juncture called a synapse
  • Dendrites send messages (in this case, how to do the new activity) by way of electrical signals that travel across the synapse. Learning has begun!
  • When you practice something, synapses become wider and it gets easier and easier for messages to travel from one dendrite to another and, de facto, from one neuron to another
  • Also with practice, the dendrites grow thicker. The thicker the dendrites, the faster signals travels to the dendrites’ host neurons.
  • With enough practice, the dendrites build a double connection. These double connections ensure the messages (the newly acquired skill) move from short term-memory to long-term acquisition
  • Voila! You’ve solidly learned how to do something new.

Of all the things we humans are capable of learning, speaking another language is right up there on the “Yep…got that one handled” list. Even for adults. (This is, of course, providing we’re immersed in that language.) The accent of that language, however, isn’t typically acquired without some degree of effort. As anyone who’s studied a foreign language in college can attest to, learning the accent of a second language takes, you guessed it, practice.

How much practice? With the right methodology and learning material, it only takes about fifteen mins/day, five days/week, over the course of approximately twelve weeks for new pronunciation techniques to become second nature. In other words, practice makes permanent! For people who’d like to communicate seamlessly in another language, our innate ability to learn makes excelling at the task not only possible, but almost a sure thing.

To Be Or Not To Bee, That Is The Question

Just a couple of weeks ago ABC News came out with an updated list, state-by-state, of America’s most misspelled words. Our faculty had great fun clicking on each other’s respective home state and seeing how our kinfolk ranked. It was pretty comical. Even more so was the ensuing banter over which words we were surprised to find misspelled, and which misspelled words seemed perfectly natural.

It didn’t take us long to bring the conversation back to a more serious note. After all, spelling and pronunciation are inextricably linked and, when English isn’t someone’s first language, both can be painfully difficult. Our clients could be the first to describe the seemingly illogical nature of English spelling and, by default, pronunciation.

Why are spelling and pronunciation so doggone difficult? Allow me to be direct: It’s not you, nor your colleagues, nor anyone who speaks English, be it their mother tongue or as a second language. Plain and simple, it’s the language.

Many languages are phonetic, where each letter is pronounced in only one way. English is not. One letter can be pronounced in a truly inordinate number of ways. In fact, there isn’t a letter in the English alphabet that can be pronounced in less than two distinct ways. (This includes silent versions. Think ‘p’ in the word ‘receipt’, ‘b’ in the word ‘numb’, and ‘l’ in the word ‘salmon’.) Now let’s narrow it down from the entire alphabet to just vowels. Take the letter ‘o’. There’s ‘o’ as in ‘cot’, ‘coffee’, ‘cool’, ‘cook’, ‘come’, ‘co-op’, ‘cope’, ‘cow’, ‘coil’, and on and on and on. Is it any wonder why folks in Colorado have difficulty spelling the word ‘tomorrow’? Heck, both the words ‘Colorado’ and ‘tomorrow’ are spelled with an ‘o’ that’s pronounced in three different ways.

As we can see, relying on pronunciation as a guide for correct spelling, and spelling for effective pronunciation, is arguably not the best strategy. For pronunciation, when it’s the case of a specific word or two, try howtopronounce.com. For spelling, good ol’ Webster’s Dictionary may still be the best game in town.

Don’t Let Me Be Misunderstood

“Don’t Let Me Be Misunderstood”
– hit song by The Animals

We’ve long known that chimpanzees communicate with ‘words’ –specific sounds to signify specific objects. What’s new, however, is the discovery that chimps have accents that depend on where they live and with whom they socialize. Published earlier this month in the journal Current Biology, the article “Chimps Learn New Language When They Change Locale” describes how a group of nine chimps literally changed their tune when they moved from a Dutch zoo to a zoo in Edinburgh, Scotland.

Prior to the move, the Dutch chimps used a high-pitched series of grunts to signify an apple, one of the chimps’ favorite foods. After joining the Scottish chimps, the newcomers lowered their pitch to match that of their new friends. “It’s the first time we’ve seen another primate species — not humans — change the structure of the call that they give for a specific object by socially learning it,” explained University of York psychologist Katie Slocombe. In essence, “the Dutch visitors changed their call for apples to conform to the pitch pattern used by their Scottish hosts.”

Pitch is a key component of any accent, be it a chimpanzee accent or a human one. In English, there are several instances where changing the pitch of a word altogether changes its meaning. For example, compare the pitch pattern of ‘a greenhouse’ with that of ‘a green house.’ A ‘greenhouse’ has an up-down pitch pattern. A ‘green house’ has an even pitch pattern. (Meaning, the pitch is the same for both ‘green’ and ‘house.’)
Acquiring new pronunciation patterns, whether it occurs naturally or a through an accent modification program, allows us to be easily understood. This may arguably be every person’s, and possibly every chimpanzee’s, greatest desire.

A Language Divided by an Ocean

Great Britain and America: “Two Countries Separated by a Common Language”
-Oscar Wilde

Last month I spoke at the 2012 NATO eLearning Conference where delegates from member nations discussed ‘best practices’ for online learning. My presentation, “Delivering Training to Multinational Audiences” sparked an important question, germane to both online and onsite training: “What do you do when the same word has different meanings depending on what side of the Atlantic you’re on?” For example, the word “boot” in British English describes what Americans would call the trunk of a car, the word “hire” means “to rent” in British English and “to employ” in American English, and while “to luck out” is a wonderful thing in America (where it means to have great luck) it’s an awful thing in Britain (where it means to run out of luck.) To get an appreciation for just how many words and phrases fall into this category (thousands upon thousands), whole books and anthologies have been written on the topic (see Divided by a Common Language: A Guide to British and American English by Davies Christopher and Mighty Fine Words and Smashing Expressions: Making Sense of Transatlantic English, by Orin Hargraves).

This challenge isn’t limited to just British-to-American discourse or, for that matter, South African-to-American, Irish-to-American, Australian-to-American and, believe it or not, American-to-American communication. Hence, per the latter, the publication of D.A.R.E –the Dictionary of American Regional English, to help those of us living and working in the U.S. who might otherwise be lost in translation. DARE is a multi-volume reference work that documents words, phrases, and pronunciations that vary from one place to another across the United States. It even includes a map of “regionalisms.”

Which leads us back to the original question…With so many people speaking correct, yet significantly different, English, how can we develop courseware so that learning is as easy and effective as possible? We like to recommend using what ARI has coined, “The Hover Solution.” It works like this… Comb through the material and cross reference each word, and especially all idiomatic phrases, to see if there are dialectical or regional differences. When you find them, indicate these words/phrases by either bolding or underlining them. Then allow the learner to hover over the marked word with his/her cursor until the “translation” appears on the screen. It’s an easy fix to a problem that causes communication disconnects day in and day out, all around the globe.

To learn more about creating instructional material for a diverse workforce, please contact us at info@lessaccent.com. To share your own “best practices,” please comment below. Communication is key, and we’re all in this together!

Cool Linguistic Trick to Boost Your Investment Earnings

Who would’ve thought that learning a second language could help in making better business decisions?  According to Boaz Keysar and his team of scientists at the University of Chicago, new research shows that bilingualism, literally, pays off.  Through a series of experiments, Keysar’s team conducted a cross-cultural comparison, recreating six experiments on three continents in five different languages (English, Korean, French, Spanish and Japanese).  In each experiment, test subjects were asked to choose between two options.  The options measured the degree to which a person was risk-averse to loss.  In one test, subjects demonstrated they were risk averse to loss (makes sense…who wants to lose?) and in the other test, they showed they were, surprisingly, risk averse to gain.  Interestingly, people were risk averse to gain when they were presented with scenarios presented in their first language, and risk averse to loss when the same scenarios were given in their second language.  Intuitively, we’d expect the exact opposite.   Why the flip-flop?  According to Boaz and his team, speaking in a second language requires more emotional distance than speaking in a native tongue.  Test subjects were able to think bias-free.

As if this isn’t enough, there are additional perks to bilingualism; one of them being that bilingualism confers protection against the onset of Alzheimer’s disease.   According to the National Institute of Health, bilingual patients are diagnosed with Alzheimer’s 4.3 years later and report the onset of symptoms 5.1 years later than monolingual patients. On the other side of the age spectrum, bilingualism also seems to help young children master higher levels of self-control and better understand abstract rules than their monolingual peers.

Greater chances for financial gain, delayed symptoms of Alzheimer’s, and kids with greater self-control…a veritable Three-For-One.  Not bad!

For those who’d like to learn another language, and who happen to work in a multinational organization, I’d like to suggest a good starting place.  Begin by learning to say “thank you” in each language spoken in your workplace. The benefits far outweigh the time commitment needed to do so.  There’s simply nothing like hearing someone say “thank you” in your own language.  It helps create a personal relationship that facilitates more open communication.  (For a complete list of how to say ‘thank you’ in foreign languages, see: www.omniglot.com/language/phrases/thankyou.htm.)  Mastering this simple phrase demonstrates you’ve made the effort to learn something about your colleague/client.  It shows you’re taking responsibility for part of the communication process.  A priceless message.

Why Learning a New Accent Isn’t Always Lemon Squeesy*!

We’re halfway into the 2012 Summer Olympics and the U.S. athletes have certainly done America proud. Take Michael Phelps, honoring the U.S. with his 18th gold medal, Gabby Douglas standing proud and bemedaled on the award stand, and 17-year-old boxer Claressa Shields beaming with golden grace.

But let’s have a look at one skill the U.S. athletes have yet to master…the Cockney accent. In an attempt to pay homage to their London hosts, several Olympians displayed their affection with a resolute, yet miserably hopeless, attempt to adopt their hosts’ native accent. If you want to laugh along with Team USA, check out their admirable, albeit unsuccessful, attempts. As much as I’m rooting for soccer player Heather O’Reilly, a gold in Cockney Accent certainly isn’t in the making.

In the athlete’s defense, the phrases chosen for the task are hardly “textbook”. They’re a wonderful slice of Cockney idioms, phrases that typically rhyme with the word the person wants to say; for example, ‘telephone’ becomes the phrase ‘dog and bone.’  The athletes, then, have to contend with a double whammy: getting their tongues around Cockney vowels and consonants, and their heads around the meaning of the phrases. The following idiom, and one that stumped Olympian after Olympian, makes the case: “Would you like some John Cleese with your uncle Fred, or just a little bit of talk and mutter?” actually means, “Would you like some cheese with your bread or just a bit of butter?”

Like accent learners of any language, the 2012 Olympians’ attempts demonstrate the difficulty of trying to acquire a new accent simply by using a “repeat after me” methodology. It doesn’t work, and especially not for adult learners. Given the neural wiring of our brains, adults need specific instructions. We need to be taught where to place our tongue, teeth, jaw, and lips to pronounce new sounds with which we may not be familiar. We need to be shown what it looks like and feels like…in effect, to “see” and “feel” a sound. Can it be done? Absolutely!

There are thousands of non-native English speakers who have successfully completed American accent training…and each one of them deserves a medal!

*More examples of Cockney slang.

Tearing Down the Bamboo Ceiling

I had a wake-up call last week while attending the Conference Board’s 2012 Corporate Diversity and Inclusion Conference in Chicago.  The two day event included informative sessions led by nearly every contingent of the American workforce.  Except one.  The Asian voice was missing.  I couldn’t figure out why, and I couldn’t let the question go.

As I started looking for answers, I began to think there was probably some connection with the fact that, sadly, Asians make up roughly 20% of the workforce but hold less than 2% of executive jobs at Fortune 500 companies.  And, according to the Alliance for Board Diversity Census, Asians hold just 2.1% of all Board seats in Fortune 500 companies.

This phenomenon, known as The Bamboo Ceiling, is part of a national dialogue being discussed in Fortune Magazine, Crain’s New York, The Atlantic, and numerous other publications.  The consensus seems to be that the numbers above are partly due to a cultural discomfort with, essentially, “tooting one’s own horn.”   While the absence of “voicing” one’s accomplishments may be typical in the Asian workplace, it’s the complete antithesis of what’s expected of rising stars in corporate America.

As consultant Jane Chang of Global Novations put it,

“Asian-Americans don’t grow up promoting ourselves; our parents do that for us. Most of us are uncomfortable with the idea of marketing and pitching our work, let alone building a network or having internal champions, common strategies for career advancement. We’ve been brought up with the ethics of keep your head down, work hard, and you will make money….We are not accustomed to speaking up. Thus, we are seen as lacking leadership skills – we can’t lead if we don’t offer our opinions.”

Jane Hyun, author of the book, Breaking the Bamboo Ceiling: Career Strategies for Asians” sums it up nicely by comparing two common idioms.  The first is the Chinese expression, ‘The loudest duck gets shot’; the second is the American saying, ‘The squeaky wheel gets the grease.’

Accent challenges compound this problem.  It makes sense.  Being constantly asked to repeat oneself is hardly incentive for demonstrating leadership skills like being outgoing and engaging in healthy conflict.

There are, however, helpful tools for acquiring the skills needed to “speak up” in ways that leadership takes note of and rewards.  One, of course, is participating in an accent neutralization professional development program.  The other is participating in a local Toast Masters (or similar such) organization.  Many corporations have in-house chapters and some are designed specifically for non-native English speakers.  A little bit of constructive coaching goes a very long way.

ARI’s objective is to help non-native English speakers “speak up” with clarity and confidence.  The only way to reap the benefits of an inclusive environment is to tear down the bamboo, and every other, ceiling.  How else can we see those rising stars shine?

Dictators Promote Understanding

It’s been almost seven years since I received our first inquiry from the American Association of Medical Transcriptionists (AAMT).  These are the folks who listen to dictations by physicians and nurses (who, I came to learn, are fondly referred to as ‘dictators’).  They then transcribe the audio dictations to written format.

The AAMT had a problem and they wanted to know if the Accent Reduction Institute could help.  With nearly 35% of our U.S. practicing physicians being non-native English speakers, understanding some of the dictations could be quite a challenge.  A medical transcriptionist (MT) could hit ‘rewind’ repeatedly, but without an actual process for deciphering unfamiliar speech patterns, they’d be stuck.  The MT’s compared it to the well known analogy of rocking in a rocking chair.  It gives you something to do, but you don’t get anywhere.

Thus, accent comprehension was born.

Last week I provided our process for understanding accented speech to an organization whose workforce comes from all around the globe.  Afterwards, one of the attendees sent me the following note.

My name is Kathleen and my father was a second generation American of Polish descent, his parents only spoke Polish and he only went up to the 6th grade.  He could not pronounce the “th” in Kathleen – he always called me Katleen. Now I understand why.  It is worth it just to have that understanding.  I have to confess that when people would use the term “dumb Polak” I thought they were referring to my father because he did not know how to pronounce my name.

I gasped when I read this.  Very painful.  The prejudicial slur is intolerable; the misunderstanding it created is heartbreaking.  BTW, my grandmother is also of Polish descent, and the immigrant experience in America is both a personal and professional one for me.  Perhaps this is one reason why helping people find their voice has been my lifelong passion.

When the AAMT made that first call nearly seven years ago, I’m not sure they meant to have such a far reaching impact on people’s personal lives.  To this day, I’m grateful for that call.