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.

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:  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.

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?

Talent Management and the Meta-Message

For those of us who work closely with Talent Managers and Directors of Learning and Development, we need little convincing of the business case for communication training. It makes perfect sense that effective communication is directly proportional to innovation and “mind-share”. In other words, the better we communicate the greater the productivity. And innovation, mind-share, and productivity are the signatures, let’s even call them trademarks, of a free market economy.

While not exclusive to the U.S., Americans can take pride in the “free movement of labor” aspect of its workforce. People are free to move up the ladder not because of social class or familial ties, but because of the unique skill set they bring to an organization and its teams. Talent Managers, Diversity Officers, HR specialists, and Learning and Development folks can especially take pride in their role of ensuring the multicultural talent of our diverse workforce has a level playing field.

Why? Because they’re the ones that promote effective communication programs. These give key talent opportunities to share their expertise with ease and confidence, to get buy-in to new ideas, and to lead others in more effective directions. When this happens, key talent can position and reposition themselves where they, and their organizations, can best maximize their contributions. And even better, what happens when our contributions are noted and valued? We move away from thinking about what’s best for me toward thinking about what’s best for the organization. Everybody wins.

This blog post isn’t an attempt to validate the views of economist Adam Smith or his famous, “The Wealth of Nations”. It’s to recognize the hard, and integral, work that people in charge of communication training bring to their organizations. With specific regard to accent modification, they know that behind every, “What? What did you say?” is an unspoken message conveyed between the listener and his/her speaker. Linguists call this ‘the meta-message’. The meta-message has to do with more than just the meaning of words. It has to do with an implicit, though often unintended, statement about the relationship between the two people speaking. Some people think of this as ‘the message behind the message’. With the example, “What? What did you say?”, the meta-message is clear: You, Mr./Ms. speaker, we have a problem because I can’t understand you.

Accent modification is a relatively new kind of professional development training. At the start of the last decade, there were only a handful of us who left academia to bring it to the private sector. During the early years, the corporate leadership who brought us in were downright brave. They had to defend their budget expenditures on a training program that hadn’t yet amassed the number of participants needed to validate, in any meaningful way, an ROI. (We believe the number needs to be above 1,000 participants who’ve either advanced their careers or had a noticeable impact on their organizations.) It was risky, but corporate leadership took a chance on accent modification; they took a chance on us.

I’d like to make a simple statement to the leadership at corporations, universities, and government agencies who betted on us. I hope both the message and the meta-message are one in the same:

Thank you!

Metaphors: Better than Facts

“Metaphors are much more tenacious than facts.”
~ Paul de Man

Believe it or not, despite our varying degrees of poetic ability, we all try our hand with the poet’s most time honored literary device, metaphor. Metaphor is a technique used to transfer the qualities of one word to another. It seems complicated, but really it’s not. For example, does the following sound familiar? “She has a heart of gold.” Or, “her eyes were shining stars.” Of course, the woman’s heart isn’t really made of gold; nor are her eyes actual celestial bodies. But you get the idea that she’s a kind person with bright and alluring eyes. “Eyes” are, in fact, one of our most favorite ‘metaphorical’ words. Here are a few global perspectives (get the pun?):

“When soldiers have been baptized in the fire of a battle-field, they have all one rank in my eyes.” Leopold Bonaparte (French)

“The hardest thing to see is what is in front of your eyes.” Johan Wolfgang von Goethe (German)

“When I look into the future, it’s so bright it burns my eyes.” Oprah Winfrey (English)

A surprising amount of the English language is rooted in metaphorical associations. Anger is linked to fire, as in “inflammatory remarks” or “consumed by rage.” Love is linked to war, as in “love is a battlefield” or “she fled from his advances“. Another common contrast is “up” versus “down,” where “up” is “good” and “down” is “bad.” It’s usually good when we “grow up”, “stand up”, “rise up”, “team up”, “show up”, and “1-up”, but not so good when we “stand down”, “throw down”, “show down”, “burn down”, or “fall down”. We throw our hands in the air when profits “go up”, but our faces drop when profits “go down”.

One way English speakers can help smooth out communication in multicultural contexts is by using literal ways of talking rather than metaphorical, or non-literal, ways. For non native English speakers, phrasal verbs are often the most difficult to understand. A phrasal verb is when we take a word like “make” and add an adjective like “up”. This creates the phrase “to make up”. The reason verb phrases are confusing is because they often have more than one meaning. In this case, “to make up” can mean to fabricate, to re-do, or to reconcile. How about the phrase “to make out”? Can you think of at least three meanings?

Mastering a second language can be a challenge. There’s a lot that goes into it: grammar, vocabulary, reading, writing, and pronunciation. Here’s a tip English speakers can use to make the process easier for others: use as much direct, literal speech as possible. This can take some mindfulness and practice. Americans, including me, love indirect speech. In fact, we use non-literal phrases around the clock, night and day, and 24/7! But if we can get into the habit of using words like “arrive” instead of “show up”, and “give” instead of “hand out”, it’s more likely our message will be understood with ease and confidence. How do we know it’s time to use more poetic license? Listen for when the other person starts using idiomatic expressions and non-literal phrases. When you recognize them… follow their lead!

Global Trends: Focusing the Lens of Communication Training

If I were ‘fluent’ in a foreign language, most people would take it to mean that I’d mastered the grammar, vocabulary, reading, writing, and pronunciation rules of that language. I’d like to suggest another aspect of language proficiency that isn’t typically included, one that deals with the relationship between language and culture.

Linguists call this often neglected, but absolutely essential, part of speech, ‘phatic’ communication. This is the area of discourse that has nothing to do with requesting information (interrogatives), or telling someone what to do (imperatives), or giving new information (declaratives). ‘Phatic’ communication falls into a more elusive category… the realm of using language to build, maintain, and negotiate relationships. Expressions like “thank you,” “I’m sorry,” “you’re welcome,” and “please” are all examples of ‘phatic’ communication.

In our multicultural workforce, sometimes the intent of our message gets lost in translation. For example, when we use idiomatic expressions that mean, “you’re welcome,” we may lose the sense of gratitude. “You’re welcome” sounds sincere and appreciative. Can’t you just feel the sincerity in the phrase? Yet other phatic expressions – “don’t worry about it,” “not a problem,” “no big deal,” “just trying to be helpful,” “it was nothing” -hardly do justice to a good ol’ fashioned “you’re welcome.”

The American workforce, with its international supply chain, is becoming more and more diverse. Corporate training now reflects an unprecedented focus on communication training programs. And language skills are now rightly viewed as being either “enablers” or “disablers.” Language can facilitate collaboration and innovation, or isolation and stagnation.

We know that the top Fortune 100 companies are also the organizations with the strongest diversity and inclusion programs. My goal is to help companies leverage the connection between language and culture to increase productivity, mind-share, and the bottom line.

One way we do this is to provide communication training programs that get people thinking about word choice. When we speak, what do we convey in addition to basic information? What is the message behind the message? Is it ‘you’re welcome’ or ‘no problem’? To a non-native English speaker, the phrases may suggest two very different sentiments. Practice English, whether it’s your first language or second, using ‘phatic’ speech that conveys the very best of your intentions. Use language to create bridges of communication.

Language Acquisition: A Case for the Hard Wired Brain

Have you ever wondered how languages are made? Who invents all the rules anyway? Are we really ‘hard wired’ for language acquisition or is it something we learn if given the right set of circumstances? Or both?

It’s rare that we get to see the birth of a whole new language…one that develops completely naturally, without any help from role models or teachers. But that’s exactly what happened in Nicaragua in the early 1980’s, and it gives us great insight into the ‘nature’ vs. ‘nurture’ question of language acquisition.

Prior to the early ’80’s, most deaf children in Nicaragua had little or no contact with other deaf children or adults. Their means of communication were limited to a set of ad hoc gestures that ‘made sense’ to family members. But when the government opened its first school for the deaf in Managua, all that changed. Two hundred children had the opportunity, for the first time, to convey their thoughts, feelings, and ideas as fully as any hearing child in Nicaragua, or around the world. But first they had to create the means to do so…

According to Ann Stenhgas of the Language Acquisition Development and Research Laboratory in New York City:

“…as (the children) interacted, they began to change the gestures and home signs they were using. Their vocabulary grew quickly over those first few years, just like when a little child learns to talk. Their signs became more systematized, more regular, and less gestural. The structure of signed sentences became much more complicated. By the time this generation became adults, at the end of the 1980s, their signs were rapid and fluent. The language had grown to resemble other languages around the world. It could now express ideas as complex as any other language.”

It joined the family of more than 6,300 human languages and is called Nicaragua Sign Language, or NSL.

Languages share an essential, bottom-line characteristic: they’re governed by as strict set of intricate rules. But who ‘makes up’ these rules? I think the answer comes from the children of Nicaragua. Communities of people who need to interact in similar ways not only create language, they can do so in less than a decade. Wow!

Sometimes our accent reduction learners are amazed by the number of pronunciation rules that govern the American accent. At the beginning, it may seem overwhelming. But I’m on the side of “we’re hard wired for language acquisition” – all aspects of it. Language learning is part of our universal, human experience. And just as a decade is more like a nanosecond with respect to inventing an entire language, 15 hours of instruction (our standard English pronunciation training program) is a blink of the eye.

It’s not an easy task to learn a new language, but I think we can all be inspired by the creators of NSL. For those who are mastering a second language, rest assured that we’re programmed for success.

Watch the story on YouTube about how Nicaragua Sign Language came into being

Communicating Joy: An ROI to Accent Modification Training

The Accent Reduction Institute’s mission statement is a little deceiving. It states, Eliminating Language Barriers While Helping People Maintain Their Unique Cultural Identity. While this certainly isn’t untrue, it doesn’t tell the whole story. Our “M.O.” is actually bigger than it may appear: bring joy to our clients, joy to their organizations, joy to their clients, and joy to our faculty and curriculum writers. That’s our goal. Our objective. Our end all, be all. To borrow from the French…creating joy is our raison d’etre.

Why all the fuss about something as touchy-feely as “joy”? Wouldn’t it be more reasonable to expect an American accent training company‘s objective to be more along the lines of…helping people be more productive? Or giving people the tools they need to better communicate their professional expertise to colleagues and clients? Or enabling our international workforce to raise the bottom line of their companies? Of course! But these objectives are the logical consequences of what we do (accent modification), not why we do it.

Our mission statement speaks to our more fundamental goal of helping people fully participate in their own lives. Most of our program participants sought training because they were frustrated by the constant question, “What? What did you say? Can you repeat that? I don’t understand what you’re saying.” By the time they found us, they’d already shut down a part of themselves.

If you had two proposals in front of you, one from a company whose employees held back from full participation and one whose employees were eager to jump in and joyously innovate, problem solve, and assist…which company would you choose? Perhaps the companies that hire us may even say that Joy is their ultimate ROI as well…after their personnel complete pronunciation training these companies get, and retain, customers who appreciate working with them.

I recently asked our Director of Curriculum and Training, Barb Niemann, about the highlight of her year. Barb’s answer? “Our participants can now speak English without a language barrier. They’re happy. Their managers are happy. Their clients are happy. I’m thrilled.”

Cultural Competency: Creating Collaboration

ARI faculty provide communication training for a wide variety of organizations: those in corporate America, academia, the US Department of Defense, non-profit community agencies, etc. And, without exception, there’s an emphasis on a new area of proficiency that reflects the diversity of our current task/workforces: cultural competency.

What in the world is that? What does it mean to be culturally competent? In pursuit of an answer, I’ve found that while the specifics change from organization to organization, the phrase always includes a common objective: understanding the culture of those with whom we work and serve in order to create partnership and collaboration.

There are all kinds of ways to become culturally competent:

  • We can learn business protocols, dining etiquette, and greeting and leave-taking customs.
  • We can learn about religious perspectives and historical experiences that shape views of family, community, and team building.
  • We can also learn how language reflects people’s views of culture and their place in it. If language is the vehicle that conveys information, culture is the lens we use to interpret it.

Being culturally competent means knowing how to speak in ways that go beyond simply exchanging information; it means using language to build successful relationships. How can we demonstrate cultural competency in our diverse workplaces? A good starting point is to hit ‘delete’ on that one phrase we habitually use when we don’t understand someone’s accent: “What? What did you say?” While ill-will is certainly not intended, often this phrase does more harm than good. The message behind the message, the meta-message, is, “I don’t understand because you have a problem speaking.” Not helpful for establishing goodwill and camaraderie. Instead of “what did you say”, try, “I’m sorry. I didn’t understand. Could you please repeat that for me?” The meta-message is altogether different.

Accent Trainers: No Longer Just for Hollywood Professionals

Hollywood? Broadway? Ann Arbor, MI? Where do you find a real Accent trainer? It used to be, only five short years ago, that an accent expert was someone who trained actors and actresses how to speak with a foreign accent for a specific role. Think Tom Hanks in Forest Gump, Kevin Kline in French Kiss, or Jeff Bridges in Crazy Heart. And of course, who could possibly forget the scene in The Pink Panther where the accent trainer was trying to teach Steve Martin how to say ‘hamburger’ with an American accent?

But these days, when someone uses the terms “accent trainer” or “accent coach,” an altogether different set of expertise comes to mind…at least for those of us in the world of corporate, multicultural diversity training. The terms no longer conjure up visions of a movie star being prepped for his or her role in an upcoming blockbuster. Nowadays, the image is often one of foreign-born business professionals wanting to learn English pronunciation in order to convey–not a set of scripted lines–but technical and professional expertise in the real world of team building and good client service. In conference rooms and training offices around the globe, an accent trainer refers to someone creating inclusiveness in our business environments by eliminating language barriers in our diverse, global workforce.

What do an accent trainer in Hollywood and, say, Ann Arbor, MI have in common? If we scratch below the surface, a whole lot! While those working in the film industry tend to think of this line of work as ‘adding an accent’, people, quite mistakenly, think of corporate accent trainers as ‘taking away’ a person’s accent. Not so. At least not at the Accent Reduction Institute. As I’ve talked about in previous blogs, ‘accent reduction’ is a deceiving misnomer for our line of work. Both kinds of accent trainers mentioned above enable people to pronounce sounds that exist in a target language that don’t occur in his/her first language. A highly proficient accent trainer –a true expert- will teach people how to go from one accent to another.

At the Accent Reduction Institute, we call this code-switching, and it’s an integral part of our curriculum. Why? Because it’s always about giving people a choice of how, where, and when they’d like to express and convey their ideas and expertise. Accent trainers in the film industry and accent trainers for the business world may have two different objectives. But we share one common denominator: we teach people how to speak with clarity, confidence, authenticity, and ease.