International nursing students with English as a second language (ESL) sometimes find they are unable to fully engage in their university studies and clinical placements as a result of communication difficulties (for example, see Chiang & Crickmore, 2009; Donnelly, McKiel, & Hwang, 2009; Guhde, 2003; Gunn-Lewis & Smith, 1999; Shakya & Horsfall, 2000; Starr, 2009). The factors contributing to their communication problems include: The range of language registers (from colloquial to specialist language), the physical environment (usually a noisy clinical placement or group-based tutorial/laboratory space), and communicative pressure (quickly, accurately, and under pressure; Müller, 2011). Communication problems can have serious consequences in a medical context. An example of this is mishearing a medication order given verbally over the phone and subsequently administering the wrong medication to a patient.
Vocabulary is a major underlying contributor to the problem
It has been noticed that a major issue contributing to communication problems is a lack of medical vocabulary knowledge (Seibold, Rolls, & Campbell, 2007; Shakya & Horsfall, 2000), but also an inability to rapidly relate spoken to written forms (Blackman & Hall, 2009; Donnelly et al., 2009). It is common to find that international nursing students have difficulty with lowfrequency vocabulary in both speech and writing. As a result, they may not be able to easily recognise a spoken word, repeat it correctly, nor match it to the written form. Moreover, students tend to display a general lack of familiarity with medical vocabulary (understandably, since it is lowfrequency specialist language), difficulty with the phonological requirements of medical terms, and a frequent inability to identify affixes and roots in medical words. This lack of familiarity with medical vocabulary may have negative consequences for students' further study. Research indicates that, for reading activities, English language learners need to be familiar with 98% of the words used in order to have full comprehension (Schmitt, 2008, pp. 329 and 330). In real terms, that means if 1 in 50 words is unknown, comprehension is hindered. Furthermore, in order to have good comprehension in speech, a similarly low threshold of 95% vocabulary knowledge is needed (Schmitt, 2008, pp. 331 and 332). In a medical context, low-frequency words are most likely to be unknown and yet crucial to comprehension. Anecdotal evidence from one-to-one diagnostic interviews with struggling international students studying nursing at Flinders University is useful here. The students often state that their lack of vocabulary hinders their ability to understand lectures and clinical facilitators. However, once they are able to manage the vocabulary, they can better interact with the curriculum.
Current vocabulary support and its use by students
Specialist language support varies among schools and universities; some offer little support whereas other places like the Australian Catholic University offer a transition course (see Chiang & Crickmore, 2009) and Flinders University offer tailored programmes to help students with nursing English. However, it is common expectation that students will acquire medical terminology through exposure from daily educational activities. Schmitt's (2008) review of vocabulary learning, however, reveals that the strategy of exposure alone results in a low uptake of new words and a low rate of retention. Reading glossaries in textbooks is another method expected of students, but these are written lists which do not help with pronunciation for international students.
Audio options are available for students, such as online mp3s or CD packages that accompany some medical textbooks, and it has been found that audio input accompanied by written text improves both listening and reading ability (Liu, Moore, Graham, & Lee, 2002). …