Abstract
Objective
To assess the level of comprehension of the courses taught in English at the annual European school on Physical and Rehabilitation Medicine (PRM) (European School Marseille).
Materials and methods
The English level of 37 students, mainly from European countries, was tested using three written questionnaires: an initial test of English grammar, a questionnaire about comprehension at the end of a basic PRM class taught in English by a French specialist and a final multiple-choice test (MCT) on the contents of the course.
Results
We found a difference between the level of English given by the residents and the level shown by the initial test. The overall level of English comprehension of the group was good, an average of 8.2/10 (S.D.: 2.1) on a Visual Analogue Scale. The mean MCT score on the contents of the course was good, an average of 6.1/10 (S.D.: 2.2). For residents with lower levels of English, the level of comprehension for courses taught in English by the French specialist was greater than the level of comprehension for courses taught by native English speakers ( p = 0.033).
Conclusion
The level of comprehension of most European PRM residents for courses taught in English by French PRM specialists and by English-speaking specialists is good. The level of comprehension is, of course, influenced by the English level of European residents. It thus appears worthwhile to organize programmes taught in English for European PRM residents. Nonetheless, it is important to assess the language skills of the residents and to use specific tools to help the small number of trainees whose English level is to low.
Résumé
Objectif
Analyser le niveau de compréhension en langue anglaise des cours réalisés durant une école européenne concernant la médecine physique et de réadaptation (MPR) (European School Marseille).
Matériel et méthode
Le niveau d’anglais de 37 étudiants venant principalement de pays européens a été testé à l’aide de trois questionnaires : un test sur la grammaire, un test sur le niveau de compréhension de l’anglais réalisé à la fin d’un cours de niveau basique pour des étudiants internes en MPR, réalisé en anglais, par un enseignant français et des questions à choix multiples (QCM) sur le contenu du cours.
Résultats
On retrouvait une différence entre le niveau d’anglais donné par l’étudiant et le niveau d’anglais retrouvé aux tests. Le niveau de compréhension en anglais du groupe était globalement bon, mesuré en moyenne à 8,2/10 (ET : 2,1) sur une échelle visuelle analogique. La note moyenne aux QCM sur le contenu du cours était bonne 6,1/10 (ET : 2,2). Pour les étudiants ayant le moins bon niveau en anglais, l’orateur français était mieux compris que l’orateur anglais ( p = 0,033).
Conclusion
Le niveau de compréhension par des internes MPR Européens du cours réalisé par un enseignant français et par un enseignant anglophone en anglais est dans l’ensemble bon. Il est donc légitime d’organiser un enseignement en langue anglaise pour un groupe d’internes de MPR européens. Le niveau de compréhension est influencé par le niveau d’anglais des étudiants. C’est dire l’intérêt d’une évaluation préalable ou d’une aide spécifique pour la petite fraction d’étudiants dont la connaissance de l’anglais est insuffisante.
1
English version
1.1
Introduction
The English language has become essential in the medical field at the international level. Participating in international conferences requires being able to understand and speak English in order to exchange ideas about the medical field in general and the medical specialty in particular. According to a 2006 study by the Educational Testing Service (ETS), France ranked seventh out of 24 countries in terms of the average level of English as tested by the Test Of English for International Communication (TOEIC), behind Portugal and Romania . In 2007, France ranked 16th among European Union countries in terms of Test of English as a Foreign Language (TOEFL) scores .
The impact of English level on medical studies, medical practice and medical training has already been extensively studied. Most of the studies concern the doctor–patient relationship when the patient’s language is not English. Timmins review of the literature highlighted the impact of language barriers on the care of Hispanic patients in the USA. According to this review, the access to health care and the quality of care were altered for this population due to the language barrier.
Other studies have focused on the impact of student English levels on the ranking of medical students. One study conducted in Saudi Arabia found no correlation between these two parameters , while two other studies showed that a good level in English was correlated with the potential of being a good medical student . In Australia, after the difficulties of medical students who were not native English speakers were highlighted, programmes were developed to remedy these difficulties . In addition, tools have been developed to track down problems with written English in Australian medical schools .
A study of student nurses in Ontario (Canada), found a higher exam failure rate when English wasn’t the mother tongue of the student . In Ontario medical schools, specific training programmes have been developed to improve the communication between doctors and French-speaking patients . Every French-speaking doctor had additional courses in French, with the rest of the curriculum being delivered in English. The article underlines the importance of the dimension of the language–culture link, which can influence patient care. Fernandez et al. have also highlighted the importance of cultural differences. They have shown that the results of Asians and Africans on clinical exams with a standard patient in California were lower, although their English tests results were excellent. One of the hypotheses offered to explain this discrepancy was cultural differences and the interpretation of the patient’s non-verbal communication.
After completing their medical studies, doctors must continue their education throughout their careers. This continuing education requirement means they must access the literature in English. Here again, problems abound. Letelier et al. tested the level of comprehension of an article written in English and Spanish with a population of Spanish-speaking doctors. A questionnaire was given to the participants, with questions about the article. The worst scores were recorded for the article written in English, with a response time greater for reading in English compared to reading in Spanish. Most low scores were for reading in English.
In 2008, Fung reported the importance of having access to articles in languages other than English in order to continue spreading medical information. Several ideas were considered:
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author-provided abstracts in other languages;
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free translation according to the Wiki model (e.g., Wikipedia);
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an international writer/translator council;
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the publication of a second-language version of scientific journals.
Certain journals (e.g., British Medical Journal ) have already begun implementing the last suggestion.
More and more training courses for medical students and doctors are organized and given in English. To our knowledge, only one study has examined the impact of the English language on teaching . This study looked at the case of a western ethics course, given in English by a professor who was a native English speaker, for an audience of medical students in Saudi Arabia. This study showed that the understanding of western ethical principals was good for the students whose native language was not English.
As part of the European Summer University programmes, a school about Physical and Rehabilitation Medicine (PRM) is held every year in Marseille, the European School Marseille . The courses are all given in English by lecturers from all over Europe and North America to students from Europe and the World (Northern Africa, Middle East and the Americas). We conducted this study with the objective of analyzing the level of English comprehension in the courses given during this school by a lecturer, Anglophone or not. Our goal was to identify the problems for understanding course content linked to language barriers.
1.2
Materials and methods
1.2.1
Population
This study was conducted in 2008 at the European School Marseille during a school that is officially recognized as part of the European Summer University programme. This school is intended for medical students, mostly residents in PRM. The participants come from all around the world: from Europe, Mediterranean countries, the Americas and the Middle East. The subjects examined during this school include posture and movement analysis, rehabilitation, and the neurophysiology of motor disabilities. The school lasts 10 days, with roughly 70 lecturers from Europe and the USA.
The school had 37 students in 2008: 32 PRM residents, two PRM doctors and three second-year Master’s students, including one physiotherapist. Many countries were represented:
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France (five students);
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Italy (eight students);
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Greece (five students);
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Romania (three students);
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Portugal (three students);
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Spain (two students);
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England (two students);
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Brazil (two students);
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Austria (one student);
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Croatia (one student);
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Ireland (one student);
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Latvia (one student);
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Switzerland (one student);
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Syria (one student);
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the USA (one student).
1.2.2
English level test
The first day of the school, an English level test was given. This test had three parts: general information about experience with English, an assessment via the Common European Framework (CEF) and a multiple-choice test (MCT) of English grammar and conjugation.
The first part asked various questions about the highest school level obtained in English, the English certificates obtained, the level of English (according to the student) and the number of trips to English-speaking countries and the length of stay.
The second part asked the students to evaluate themselves on the global scale of the CEF ( Appendix 1 ). This common framework, developed by the Council of Europe, provides a frame of reference for language competency. It allows the level of English to be defined on a six-level scale: A1 and A2 – basic level; B1 and B2 – independent level; C1 and C2 – expert level.
The last part asked 32 multiple-choice questions (MCQ) in order to test the students’ level of English in the terms of grammar and conjugation.
1.2.3
Comprehension test
We used a questionnaire with a Visual Analogue Scale (VAS) ( Appendix 2 ) to test student comprehension. This questionnaire permitted us to analyze the level of comprehension of the English language, the level of comprehensibility of the lecturer, the level of comprehension of the questions asked and the usefulness of the PowerPoint slides for understanding course content. There were three questions on the questionnaire that were designed to find out if the students would have liked to ask questions and whether or not the language barrier prevented them from asking their questions.
For one of the courses, a series of five MCQ were asked to evaluate how well the students understood the course content. These MCQ were based on the slides used in the PowerPoint presentation for the course and could have one or more responses. All the responses could be found in the slide presentation.
1.2.4
Procedure
The English level test was given to all the students on the first day of the school. Four different courses were selected to evaluate the students’ level of comprehension of the English language. Four lecturers were chosen: two native French speakers and two native English speakers, one from the USA and one from the UK. Two basic courses and two advanced courses were selected for the study. The basic courses included a course on pathological gait given by one of the French-speaking lecturers (denoted “basic French course”) and a course on the fundamentals of electromyography in peripheral neurological lesions given by the lecturer from the USA (denoted “basic English course”). The advanced courses included a course on vestibular compensations given by the other French-speaking lecturer (denoted “advanced French course”) and a course on trans-cranial magnetic stimulation given by the lecturer from the UK (denoted “advanced English course”).
The comprehension tests were given at the end of the courses. The students were not warned at the beginning of the course that they would be tested after the course. The five-question MCT was given only after the basic course on pathological gait given by the French lecturer. We chose to use the MCT test only after the basic French course in order to avoid making the procedure any more awkward by increasing the number of questionnaires.
1.2.5
Statistical tests
We used descriptive statistics to describe the student population and to summarize the various aspects of the students’ English level. We also used descriptive statistics to summarize the results for the general population in terms of the comprehension for each course.
Next, we compared the students’ comprehension of the basic French course to that of the basic English course and then the comprehension of the advanced French course to that of the advanced English course.
Finally, we separated the student population into two groups (A and B) based on the responses to the English level test. We then compared the comprehension of the group with the higher level to the group with the lower level for each course. Mann-Whitney tests, as well as a one-factor ANOVA, were used. The significance threshold was p < 0.05.
2
Results
2.1.1
Population description
Table 1 shows the results of the English level test for all 37 students. Two students were native English speakers. Eight students responded that they had a University level in English. No students had taken the TOEFL, but seven students had obtained English language certificates of some sort.
| Population | Group A | Group B | |
|---|---|---|---|
| Number of students | 37 | 17 | 20 |
| Basic English level (CEF) | 6 | 0 | 6 |
| Independent English level (CEF) | 23 | 10 | 13 |
| Expert English level (CEF) | 8 | 7 | 1 |
| English language certificate holder (number of students) | 7 | 6 | 1 |
| Average length of trips to English-speaking countries (in months) | 7.6 (19.8) | 17.5 (27.7) | 0.15 (0.7) |
| Average number of errors on the MCT on English grammar and conjugation | 8.9 (5.9) | 3.2 (2.1) | 13.8 (2.9) |
When we asked the students to assess their level of English, zero students responded “basic”, 10 responded “elementary”, 13 responded “intermediate”, eight responded “advanced” and five responded “expert”, with one student not responding to this question. Twelve students had made a trip to an English-speaking country, with the average length of stay being 26.5 months (standard deviation [S.D.]: 30.4) and the average time elapsed since the trip being 5.9 years (S.D.: 2.9).
However, when we asked the students to indicate their level on the global scale of the CEF, their responses broke down in the following manner:
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basic level: A1 – two students and A2 – four students;
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independent level: B1 – 12 students and B2 – 11 students;
expert level: C1 – four students and C2 – four students.
Thus, we had six students (16.2%) who evaluated their level as basic, 23 students (62.2%) who evaluated their level as independent and eight students (21.6%) who evaluated their level as expert. For comparison, when we asked the students to evaluate their level without the CEF descriptions, 27% declared themselves as “basic”, 36% as “independent” and 36% as “expert”. The average number of errors on the MCT evaluating grammar and conjugation was 8.9 (S.D.: 5.9) per student.
2.1.2
Comprehension level
Thirty-five students attended the basic French course. The average level of English comprehension was 8.2/10 (S.D.: 2.1) and the average level of comprehensibility of the lecturer was 8.8/10 (S.D.: 1.5). The average value for the usefulness of the PowerPoint presentation was evaluated at 8.8/10 (S.D.: 1.9). There were no questions asked and 11 out of 35 students (31.4%) stated that they didn’t ask questions due to language barriers. It is important to note that this course was given on the second day of the school. The average grade on the MCT for course content comprehension was 6.1/10 (S.D.: 2.2).
Twenty-seven students attended the basic English course. The average level of English comprehension was 8.5/10 (S.D.: 1.9) and the average level of comprehensibility of the lecturer was 8.7/10 (S.D.: 1.8). The average value for the usefulness of the PowerPoint presentation was evaluated at 7.4/10 (S.D.: 3.1). The average level of comprehension of the questions asked was 8.6/10 (S.D.: 2.0) and two out of 27 students (7.4%) stated that they didn’t ask questions due to language barriers. It is important to note that this course was given on the last day of the school.
Twenty-nine students attended the advanced French course. The average level of English comprehension was 8.2/10 (S.D.: 2.0) and the average level of comprehensibility of the lecturer was 8.3/10 (S.D.: 1.7). The average value for the usefulness of the PowerPoint presentation was evaluated at 8.3/10 (S.D.: 1.9). The average level of comprehension of the questions asked was 8.1/10 (S.D.: 2.3) and six out of 29 students (20.7%) stated that they didn’t ask questions due to language barriers. It is important to note that this course was given on the day before the last day of the school.
Thirty-four students attended the advanced English course. The average level of English comprehension was 7.5/10 (S.D.: 2.1) and the average level of comprehensibility of the lecturer was 8.0/10 (S.D.: 1.9). The average value for the usefulness of the PowerPoint presentation was evaluated at 8.6/10 (S.D.: 2.1). The average level of comprehension of the questions asked was 6.8/10 (S.D.: 2.6) and 11 out of 34 students (32.4%) stated that they didn’t ask questions due to language barriers. It is important to note that this course was given on the second day of the school.
Table 2 synthesizes the results given above. There are no statistically significant differences when comparing the four courses in terms of the level of English comprehension ( p = 0.157), the level of comprehensibility of the lecturer ( p = 0.174) or the usefulness of the PowerPoint presentation for understanding the course content ( p = 0.224). There is, however, a statistically significant difference concerning the comprehension of the questions asked; the questions were better understood in the basic English course than in the advanced English course ( p = 0.013).
| Basic French course | Advanced English course | Advanced French course | Basic English course | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Population | Group A | Group B | Population | Group A | Group B | Population | Group A | Group B | Population | Group A | Group B | |
| Number of students in each course | 35 | 16 | 19 | 34 | 16 | 18 | 29 | 14 | 15 | 27 | 14 | 13 |
| English comprehension VAS/10 (standard deviation) | 8.2 (2.1) | 9.3 b (0.8) | 7.3 b (2.3) | 7.5 (2.1) | 9.1 b (0.8) | 6.2 b (2.1) | 8.2 (2.0) | 9.2 b (1.1) | 7.2 b (2.2) | 8.5 (1.9) | 9.3 b (1.0) | 7.7 b (2.2) |
| Lecturer comprehensibility VAS/10 (standard deviation) | 8.8 (1.5) | 9.2 (0.9) | 8.5 a (1.9) | 8.0 (1.9) | 9.1 b (1.1) | 7.1 b (1.9) | 8.3 (1.7) | 8.8 (1.3) | 7.8 a (2.0) | 8.7 (1.8) | 9.5 b (0.8) | 7.8 b (2.2) |
| Question comprehension VAS/10 (standard deviation) | No questions | No questions | No questions | 6.8 a (2.6) | 8.5 b (1.9) | 5.4 a,b (2.3) | 8.1 (2.3) | 9.6 b (0.7) | 6.8 b (2.5) | 8.6 a (2.0) | 9.2 (1.4) | 8.1 a (2.4) |
| Language barrier for asking questions Number (%) of students | 11 (31.4%) | 0 (0%) | 11 (57.9) | 11 (32.4%) | 0 (0%) | 11 (61.1%) | 6 (20.7%) | 0 (0%) | 6 (40%) | 2 (7.4%) | 0 (0%) | 2 (15.4%) |
| Usefulness of the PowerPoint presentation for comprehension VAS/10 (standard deviation) | 8.8 (1.9) | 8.2 (2.7) | 9.2 (0.9) | 8.6 (2.1) | 8.4 (2.7) | 8.8 (1.4) | 8.3 (1.9) | 7.9 (2.2) | 8.6 (1.5) | 7.4 (3.1) | 7.0 (3.7) | 7.9 (2.4) |
| Correct responses on the MCT for basic course content Grade/10 (standard deviation) | 6.1 (2.2) | 7.2 b (1.8) | 5.1 b (2.1) | No MCT | No MCT | No MCT | No MCT | No MCT | No MCT | No MCT | No MCT | No MCT |
a Significant statistical difference between the two courses for the same group (population, group A or group B).
b Significant statistical difference between group A and group B for the same course.
2.1.3
Comparison of the groups according to level
As shown in Table 1 , the student population was separated into two groups based on the results of the MCT on English grammar and conjugation. We used the average number of errors on this test to assign students to one group or the other. All the students with a number of errors less than 8.9 were assigned to the group with a higher level of English (group A) and those with a number of errors greater than 8.9 were assigned to the group with a lower level of English (group B).
There were 17 students in group A. The countries represented in this group were:
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Portugal (three students);
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England (two students);
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Spain (two students);
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Greece (two students);
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Brazil (two students);
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Ireland (one student);
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Austria (one student);
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Switzerland (one student);
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Romania (one student);
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Italy (one student);
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the USA (one student).
The average number of errors was 3.2 out of 32 questions (S.D.: 2.1).
There were 20 students in group B. The countries represented in this group were:
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France (five students);
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Italy (seven students);
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Greece (three students);
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Romania (two students);
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Syria (one student);
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Croatia (one student);
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Latvia (one student).
The average number of errors was 13.8 out of 32 questions (S.D.: 2.9).
We compared the two groups for all courses ( Table 2 ). Sixteen students from group A and 19 students from group B attended the basic French course. The average level of English comprehension was 9.3/10 (S.D.: 0.8) for group A compared to 7.3/10 (S.D.: 2.3) for group B. The difference between the two groups is statistically significant ( p < 0.001). The average level of comprehensibility of the lecturer was 9.2/10 (S.D.: 0.9) for group A compared to 8.5/10 (S.D.: 1.9) for group B. This difference is not statistically significant ( p = 0.132). The average value for the usefulness of the PowerPoint presentation was evaluated at 8.2/10 (S.D.: 2.7) by group A and at 9.2/10 (S.D.: 0.9) by group B. This difference is not statistically significant ( p = 0.740). In group B, 11 out of 19 students (57.9%) stated that they didn’t ask questions due to language barriers compared to none in group A. Finally, group A had an average grade of 7.2/10 (S.D.: 1.8) on the MCT on course content compared to 5.1/10 (S.D.: 2.1) for group B. This difference is statistically significant ( p < 0.005).
Fourteen students from group A and 13 students from group B attended the basic English course. The average level of English comprehension was 9.3/10 (S.D.: 1.0) for group A compared to 7.7/10 (S.D.: 2.2) for group B. The difference between the two groups is statistically significant ( p = 0.011). The average level of comprehensibility of the lecturer was 9.5/10 (S.D.: 0.8) for group A compared to 7.8/10 (S.D.: 2.2) for group B. This difference is statistically significant ( p = 0.006). The average value for the usefulness of the PowerPoint presentation was evaluated at 7.0/10 (S.D.: 3.7) by group A and at 7.9/10 (S.D.: 2.4) by group B. This difference is not statistically significant ( p = 0.442). The average level of comprehension of the questions asked was 9.2/10 (S.D.: 1.4) for group A and 8.1/10 (S.D.: 2.4) for group B. This difference is not statistically significant ( p = 0.104). In group B, two out of 13 students (15.4%) stated that they didn’t ask questions due to language barriers compared to none in group A.
Fourteen students from group A and 15 students from group B attended the advanced French course. The average level of English comprehension was 9.2/10 (S.D.: 1.1) for group A compared to 7.2/10 (S.D.: 2.2) for group B. The difference between the two groups is statistically significant ( p = 0.006). The average level of comprehensibility of the lecturer was 8.8/10 (S.D.: 1.3) for group A compared to 7.8/10 (S.D.: 2.0) for group B. This difference is not statistically significant ( p = 0.106). The average value for the usefulness of the PowerPoint presentation was evaluated at 7.9/10 (S.D.: 2.2) by group A and at 8.6/10 (S.D.: 1.5) by group B. This difference is not statistically significant ( p = 0.383). The average level of comprehension of the questions asked was 9.6/10 (S.D.: 0.7) for group A and 6.8/10 (S.D.: 2.5) for group B. This difference is statistically significant ( p < 0.001). In group B, six out of 15 students (40%) stated that they didn’t ask questions due to language barriers compared to none in group A.
Sixteen students from group A and 18 students from group B attended the advanced English course. The average level of English comprehension was 9.1/10 (S.D.: 0.8) for group A compared to 6.2/10 (S.D.: 2.1) for group B. The difference between the two groups is statistically significant ( p < 0.001). The average level of comprehensibility of the lecturer was 9.1/10 (S.D.: 1.1) for group A compared to 7.1/10 (S.D.: 1.9) for group B. This difference is statistically significant ( p = 0.001). The average value for the usefulness of the PowerPoint presentation was evaluated at 8.4/10 (S.D.: 2.7) by group A and at 8.8/10 (S.D.: 1.4) by group B. This difference is not statistically significant ( p = 0.691). The average level of comprehension of the questions asked was 8.5/10 (S.D.: 1.9) for group A and 5.4/10 (S.D.: 2.3) for group B. This difference is statistically significant ( p < 0.001). In group B, 11 out of 18 students (61.1%) stated that they didn’t ask questions due to language barriers compared to none in group A.
For each level group (A and B), we looked for differences between the various courses (e.g., between basic and advanced, between French-speaking lecturer and English-speaking lecturer) for each aspect of comprehension. For group A, there was not significant difference when comparing the four courses in terms of English comprehension ( p = 0.512), comprehensibility of the lecturer ( p = 0.278), comprehension of the questions asked ( p = 0.172) or the usefulness of the PowerPoint presentation for understanding the course content ( p = 0.599). For group B, there was no significant difference when comparing the four courses in terms of English comprehension ( p = 0.258) or the comprehensibility of the lecturer ( p = 0.059). However, when comparing the comprehensibility of the lecturer for group B between the basic French course and the advanced English course, there is a significant difference, with a lower level of lecturer comprehensibility for the advanced English course ( p = 0.033). The usefulness of the PowerPoint presentation for understanding the course content is not significantly different among the various courses ( p = 0.378). Nonetheless, there is a significant difference in terms of comprehension of the questions asked: the questions were better understood in the basic English course than in the advanced English course ( p = 0.011).
2.2
Discussion
The objective of this study was to analyze the level of comprehension of the English language in courses given in English during the European PRM school, with the overall goal of identifying the problems linked to language barriers in the course content comprehension. This study demonstrated that the level of comprehension in the courses is globally good when the focus is the entire student population. It thus seems legitimate to organize courses in English for European PRM residents. However, we did notice a difference depending on the level of course difficulty (e.g., basic versus advanced) and the lecturer’s native language (e.g., native French speakers versus native English speakers). For example, the questions asked during the course were less well understood in the advanced course given in English than in basic course given the same language. This calls attention to a potential student interaction problem when the course is given in English, which could limit the participation of students who express themselves less well in English. One important factor that is highlighted by our results is that a native French speaker giving a course in English can be perfectly well understood by European students.
When the student population was divided into two groups according to the students’ level of English, the group with the lower level had more difficulty understanding the course content and understanding the lecturer (when he/she is a native English speaker as opposed to a native French speaker), as well as more problems participating in class, with a lower level of comprehension of the questions asked and less ability to ask questions due to language barriers. Once again, native French speakers appear to be better understood than their English-speaking counterparts. When tested on course content, the group with the lower level performed less well than the group with the higher level. This result is important because it shows that poor comprehension of a course due to language barriers can have consequences on the comprehension of course content when English is used, and thus on knowledge transmission.
As seen above, the level of course comprehension was always lower in the group of students with lower levels of English. The S.D. for the lower level group are always higher than for the group with higher English levels. This suggests that the levels in the lower level group are probably more heterogeneous. The lower level group also had difficulties in asking question due to language barriers, although this effect tended to diminish over time. According to our results, the fear of asking questions drops sharply between the course on the second day and the course on the last day. Thus, length of time seems to be an important factor for English courses since the longer the programme (in the case of our school, two weeks), the more comprehension improves. The fact that the group learns to know itself during the course can act on this parameter.
The only parameter that remains constant, regardless of the public concerned, is the importance of the PowerPoint presentation for comprehension. Thus, we think that it is important for the slides to contain the most information possible (without reducing their readability) in order to improve the level of comprehension when giving a presentation in English.
The results of this study fully confirm the data in the literature. Our study is one of the rare studies that examine and evaluate the impact of language on the comprehension difficulties in a lecture course. Our results show that language barriers can have an impact on comprehension in this type of course. The difficulties connected to the language barrier have already been documented in terms of patient–doctor interaction , showing a significant impact on patient care. Several works about medical studies have illustrated the impact of the language barrier on learning in the medical field and on exam results (which can be less successful) . In some cases, programmes have been designed to improve the learning of students who are not native English speakers . The same language barrier issues have also been found for reading articles written in English ; certain people need to have the articles translated in other languages to overcome this barrier .
We found only two studies of medical students (students in Saudi Arabia) that showed that the level of English didn’t have any impact on the student’s level in medical courses . One of these studies showed that, in a course on ethics, the language barrier didn’t exist, finding a good level of comprehension in lecture courses given in English . We found little data on the comprehension of a course in the student’s native language. Most studies concern the evaluation of new pedagogical methods designed to improve student learning. The level of comprehension of course content is never total since comprehension can be influenced by the student’s level and previous training, which can differ from one European country to another. Some studies have even shown that gender can influence the student’s learning capacity and success rates on exams in medicine .
The student population in this study is heterogeneous in terms of English levels. Countries considered to have a good level of English based on such tests as the TOEFL are represented, as well as other countries considered to have a lower level . We find it noteworthy that all the French students in the school were assigned to group B, which had a lower level of English. Thus, it can be considered that these students were confronted by comprehension difficulties. Obviously, self-evaluation is not enough since we observed that, on the English level tests, certain students with a poor level of English and a poor level of comprehension declared themselves to have an expert level. Still, this could be due to a poor comprehension of the level descriptions, which were written in English in the questionnaire.
The MCT on English grammar and conjugation was the most effective and reliable for creating the two groups. We would like to underline the advantages of testing the students’ English level at the beginning of a course given in English in order to better adapt the course to the level of the group and thus improve the comprehension. We also noticed that students in the group with the higher level of English were mostly the students that had stayed in an English-speaking country or had obtained an English language certificate. The international medical community should encourage residents to pursue these kinds of activities.
2.2.1
Study limitations
One of the difficulties encountered in this study was student absences. The number of students wasn’t always the same in each course, creating groups of different sizes. Another source of errors in this study may be the comprehension of the questionnaire, or the incorrect interpretation of the questions, for students who have poor English comprehension skills. If the questionnaires had been written the students’ native language, comprehension might have been better, with a lower risk of error. However, that would have been complicated to implement due to the high number of countries represented.
We chose to analyze the results for the two students living in England and the two native English speakers with the results for the whole group. We could have analyzed their results separately. If we eliminate the results for these four students, the averages are not significantly modified. The responses to the five-question MCT on the basic French course content are not higher for these four students than for the rest of group A.
The MCT used to test the level of English was not part of a standardized test (e.g., the TOEFL or the TOEIC). For time reasons, it was not possible to distribute a questionnaire that was too long. This MCT allowed us to efficiently separate the students into two groups.
Our choice to not warn the students about the comprehension test or the course content test is open to question. We wanted to surprise the students so that they would not prepare for these tests. However, if the students had been warned about these tests, we would probably have avoided the problem of absenteeism. To reduce the different biases described above, it would be interesting to continue this study over several years.
Though there have been no studies on this subject, it would be interesting to discover the global English level of European PRM students, with the evaluation being done in the student’s own country. However, analyzing the evaluations of the level of English of students in the European School Marseille over several years would also be interesting. The English level tests could be used to verify the group’s level of English in order to propose appropriate tools to students to improve the level of course comprehension (e.g., written documentation, glossaries, texts related to the course, PowerPoint presentation available on the Web). It doesn’t seem to be desirable to select the students who speak the best English based on these tests because that would make the school available to a limited number of PRM students (i.e., those who have the best levels in English).
2.3
Conclusion
The comprehension level of European PRM residents in a course given in English by a native French speaker and a native English speaker was, overall, good. It thus seems to be legitimate to organize courses in English for European PRM residents. This study showed that the level of comprehension can vary within a group during a course given in English to non-native speakers of English. The group can have a very good level of comprehension overall, with a small group of students that understand less well and thus are not able to interact during the course, which can lead to failure on course content tests. The level of comprehension is influenced by the students’ English level, which underlines the importance of a preliminary evaluation or specific aid for the small fraction of students whose English proficiency is insufficient.
Acknowledgements
Thanks to all the participants, both students and lecturers, of the European School Marseille 2008 ( Fig. 1 ), without whom this study could never have been done.
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