Puheen ymmärtäminen ja ymmärrettävyys suomea toisena kielenä käyttävien lääkäreiden kielitaidon ilmentäjänä

This dissertation examines the linguistic challenges of doctors using Finnish as a second language in patient work. The subjects of the study are doctors who have completed their qualifications outside the EU/EEA and whose legalisation process in Finland is ongoing. The research focuses on speech comprehension and speech comprehensibility, because these aspects of language skill play a key role in diagnosing and treating patients and have also proven to be particularly challenging for doctors.

A doctor needs to understand exactly what a patient is telling them about their condition, and the patient to understand the treatment instructions they receive. Therefore, this study focuses on the transactional function of speech, i.e. the function of conveying meaning. This examination of how meaning is conveyed in discussions between doctors and patients provides us with information that can be used in defining the level of language skills that is adequate for patient work. In addition, the study provides new knowledge about the processes involved in comprehending speech in a second language.

In theoretical and methodological terms, the study combines the approaches of psycholinguistic research and interaction research, meaning that comprehension is approached both as an interaction and as a processing event in an individual’s mind. Not all comprehension problems are outwardly visible during a discussion, and therefore, a study of comprehension requires other methods alongside traditional interaction research methods.

The research consists of four sub-studies that utilised different types of data. The first and second sub-studies used discussion material collected during the clinical skills test, a part of the Finnish legalisation process for doctors educated outside the EU/EEA that involves the assessment of a patient appointment. The data consists of videos of 30 doctors’ appointments, with a total of 87 patients, and the associated written documentation. The discussions and related documentation were compared to identify the points in which understanding between the doctor and the patient broke down. The data for the third sub-study was produced in an experimental setting involving L2 Finnish-speaking doctors (N=11) as test subjects. They were shown a video of discussions between a Finnish doctor and their patients and asked to report on their understanding of the content of the discussion. A semantic analysis of the reports identified the types of linguistic and contextual factors that were present when comprehension problems arose. The data for the fourth sub-study was produced in conjunction with training that prepared doctors for their legalization examinations. It includes reflection texts and focus group discussions in which the participants reflected on the linguistic challenges of a doctor’s work. The reflection data was analysed using thematic analysis.

The results indicate that problems in comprehending speech and producing comprehensible speech are common among doctors who use Finnish as a second language at B1–B2 levels. The doctor misunderstands or fails to understand a large number of details in the patient’s speech, and may also be unaware of this lack of understanding. Variation in speech among patients and the unpredictable range of topics in doctor-patient discussions proved particularly challenging. The language used by patients differs from the professional language of doctors, and the differences are not limited to vocabulary but also extend to areas such as spoken information structures. The study suggests that it is necessary to support the language awareness of L2 doctors, for example, in relation to the linguistic variation that is encountered in patient work or to the link between language and professional processes such as diagnostics.

With respect to the speech comprehension process, the study reveals that comprehension can fail at any level of language processing, from word recognition to semantic interpretation and contextualisation. This is explained by factors such as processing load, which makes others’ speech difficult to predict and slows the processing. The study also showed how professional knowledge is tapped into the processing of patients’ speech and how, on the other hand, deductions based on professional knowledge can be misleading.

The results of the study will be used to enhance the language training for doctors using Finnish as a second language, but they can also be applied more generally in L2 teaching. It is important for L2 teachers to be familiar with the processes of speech comprehension and the factors influencing the comprehension of speech so that they can guide language learners to identify potential comprehension problems and to address them by asking clarifying questions. The study can also help colleagues working with L2 Finnish-speaking doctors to conceptualise the listening comprehension skills of a B2-level speaker in practice.