Mandela School of Medicine (NRMSM), University of KwaZulu-Natal, Durban, cannot teach in isiZulu, the mother tongue of almost 80% of the province's 10.2 million people, and the most common home language spoken in South Africa , do not communicate. Oral competence was assessed in an isiZulu history-taking station in the objective structured clinical examination.
INTRODUCTION
As such, I actively encouraged students to revisit and reinforce the first year isiZulu content to bridge the gap between the module and the use of the language in the clinical years. In an attempt to reinforce learning, I introduced assessment in isiZulu (discussed in more detail in Section 1.2.3) in the form of a simple history-gathering scenario in the second and third years of the MBChB programme.
BACKGROUND
Before 2011, isiZulu was not taught in the second and third years of the MBChB programme. Such assessments take place once per semester in the second and third years (see the program overview in Table 1 below).
PROBLEM STATEMENT
The ability of healthcare workers (HCWs) to speak isiZulu will benefit native isiZulu patients in the region and is likely to improve patient satisfaction, patient safety and health outcomes. Improved proficiency in isiZulu is also likely to have a positive impact on interprofessional relationships between doctors and other healthcare providers such as nurses.
AIMS AND OBJECTIVES
The latter is particularly important with reference to the use of chronic medications such as antiretroviral and anti-tuberculosis treatment and in the treatment of chronic non-communicable diseases such as hypertension. This study has been carried out on third-year students because they have reached a stage in the curriculum where they come into direct contact with isiZulu-speaking patients in the departments of the Clinical Methods course, which highlights the necessity to be able to . communicate effectively with their patients.
SUMMARY & STUDY OUTLINE
Chapter four describes the findings of the study, namely the demographics of the study population, and then the findings regarding the knowledge, attitude and practice of the group. Chapter five presents a discussion of the findings and further addresses second language acquisition and the competencies required for medical students.
INTRODUCTION
LANGUAGE & CULTURAL BARRIERS AND THEIR EFFECTS ON HEALTH
Levin's study of isiXhosa-speaking patients at a South African pediatric teaching hospital indicated that only 6% of medical interviews were conducted either partially or fully in the home language of the patient. The author found that "language and cultural barriers were cited by more parents as a major barrier to health care than structural and socioeconomic barriers" (Levin, 2006, p.1076).
RESEARCH IN COMMUNICATION AND ITS TEACHING
He emphasized that language was an integral part of the medical consultation and that learning isiZulu in the course of their daily work improved. Much of this work focuses on the importance of an understanding of the target culture relevant to the professional's relationship with the patient.
THEORETICAL CONSTRUCTS RELEVANT TO THE STUDY
Based on his 1981 study, Long argued that changes in language interactions were consistently necessary for SLA to be successful. Basically, this theory maintained that the development of skills in a language occurred through communication, where interactions in the language facilitate learning (Long, 1981). He further described how the use of the language in dialogue built up knowledge of language or linguistic competence in.
Cognitive theories view SL learning as a special case of more general learning mechanisms in the brain.
SUMMARY
Important prerequisites for patient-centeredness and social responsibility should include that medical students graduate with the necessary communicative and cultural competence in isiZulu. As described in Chapter 1, clinical communication teaching at NRMSM is based on the Calgary-Cambridge method (Silverman et al., 2005). The approach further involves teaching a patient-centred method which places the patient's ideas, beliefs and expectations prominently in the medical interview, thus making it a method easily adapted for use in the African context. of the South.
An account of the history of SLA theory, including reference to neurocognition, and methods used in L2 teaching has been provided to explain how they inform the recommendations to be made in Chapter 6 for incorporating isiZulu language teaching and learning into the 6-year MBChB program to achieve communicative competence in isiZulu for.
INTRODUCTION
RESEARCH DESIGN
The profile of the study population will be described in detail in the next chapter. The study population consisted of all third-year students who enrolled in the first-year isiZulu module in 2010, the year in which the NRMSM began the 6-year or “new” course. All students in the sample failed the isiZulu proficiency test at the start of their first year.
A list of the 86 students who registered for the module in 2010 was obtained from the isiZulu teacher and all students were invited to participate in the study.
DATA SOURCES
The study further explored the behavior in terms of the practice or use of isiZulu in the clinical situation with patients or staff. This served to assess their knowledge of isiZulu in the form of written language skills. The students' OSCE grade in the October 2012 examination was recorded and used as an indicator of knowledge in the form of communicative (oral) competence in isiZulu.
The grades of the group of students in the study sample were compared with the class average.
MEASURES TO ENSURE VALIDITY OF DATA
The students did not write the test in the pilot study, but read the content and found the instructions, which were given in English and isiZulu, clear. Both markers had previous experience of OSCE examination and were unaware of which students were included in the study. At the time of the study and now I am not directly involved in the teaching of isiZulu in the isiZulu module in the first year.
However, I assisted the isiZulu tutor, provided clinical content for scenarios and acted as an in-house moderator for the orals and for the first year module, as I am competent to speak the isiZulu required in the clinical setting having been a practicing clinician for many years.
DATA COLLECTION
Findings from the survey will influence T&L for isiZulu in terms of improvements to the course that can be implemented after the survey is completed. The results and the rich description in the study will thus, in contrast to being generalisable, be generative and suggest opportunities for further development of teaching and research within the profession-specific isiZulu for medical students.
DATA MANAGEMENT
The analysis of the Likert items in the questionnaire related to the specific objectives of the study. After individual analysis of the Likert items was conducted, Likert items were grouped and averaged to create Likert scales or mean attitude and practice scores for each student in the cohort. Communicative competence was assessed in the OSCE, and student grades were compared to class grades in a one-sample t-test.
Thus, language learning was assessed in two ways in the study - once against the students' own scores on the proficiency test and once against their peers in the OSCE.
SUMMARY OF RESEARCH
ETHICS
WORK PLAN
SUMMARY
INTRODUCTION
DESCRIPTIVE STATISTICS
Most students rated themselves as competent in English, with 98.4% (n=60) ticking all 3 indicators when asked to rate their competence in terms of three indicators: "Speaking/Reading and Writing". This suggests that the majority of the group considered themselves competent in Afrikaans from exposure at school level, as only 4.9% (n=3) gave Afrikaans as their home language, with a further 1.6% (n=1) giving English and Afrikaans as home languages.
ANALYTIC STATISTICS
Regarding improved student-patient communication (Mode 4, the average of the study group felt that such communication was improved by using isiZulu in the medical interview. Regarding using isiZulu to communicate with staff, very few (only 16.4%) students used isiZulu to communicate with staff on the wards Many positive comments related to improvements in communication, particularly in relation to communication with patients in the clinical setting.
At the same time, other teaching strategies are being introduced and explored in isiZulu teaching and learning.
SUMMARY
INTRODUCTION
DISCUSSION
It indicates that the knowledge acquired in the first three years of the course has been retained to some extent, as students took the test in 2012 without preparation. An interesting perception of respondent 82 was that investigating isiZulu in the OSCE was unfair because it put the minority class at a disadvantage. As mentioned, experts vary widely in their estimates of the duration of this process, but it is known to be a lengthy process.
The Language Plan for the university, which was approved in August 2006, is currently in Phase with the development of isiZulu in the institution which is primarily the responsibility of the College of Humanities.
SUMMARY
INTRODUCTION
OUTCOME OF STUDY
RECOMMENDATIONS
The current approach to teaching in the first year using elements of CLT and TBLT should be continued as it has shown favorable results. Pilot studies of the use of isiZulu videos are already underway in the College of Health Sciences (Diab, Matthews, & Gokool, 2013), and there are initiatives to develop computer-assisted language learning (CALL) programs (Gokool, 2011). Regular iziZulu formative assessment should be integrated into the curriculum, strategically spaced at intervals to ensure prior knowledge is reinforced and extended.
Bedside tutoring or tutoring in the clinic or outpatient setting (clinical tutor/buddy system).
SUMMARY
34;Commentary: Linking Cultural Competency Training to Improved Health Outcomes: Perspectives from the Field." Academic Medicine 85(4). 34;Communication Teaching and Assessment in Medical Education: An International Consensus Statement." Patient Education and Counseling 137: 191. 34; The Teaching and Learning of isiZulu as a Second Language for Professional Purposes at the University of KwaZulu-Natal: A Response to Professional Needs.” Alternation 17(1): 138.
34; The impact of language barriers on the health care of Latinos in the United States: A review of the literature and practice guidelines. J Midwifery Womens Health 47(2):80.
