Estonian language proficiency of medical personnel in Estonia Mart Rannut, Elvira Küün (Tallinn University)

Current research is a scientific project commissioned and financed by the Estonian Ministry of Education and Research (RU/7009) called “Estonian and Other Language Skills of Estonian Medical Workers” (2009–2010). In the present research by language background of health professionals the following aspects are meant: * language of receiving general education, * language of receiving special education, * language spoken at home, * frequency of Estonian language use at work.

Main languages in which doctors have acquired secondary education turned out to be Estonian and Russian. Russian dominated among health professionals in Eastern Estonia. Other languages mentioned were in one case Estonian and Russian, Finnish, Russian and English. In case of nurses the main languages also turned out to be Estonian and Russian. Upon analysing the quantitative data, the statistical data management package SPSS 13.0 has been used. Upon analysing the research data, the correlation and rehabilitation analyses have been used.

Using Estonian language in everyday work The majority of doctors and nurses have to deal in their everyday work with both oral communication and written work, including computer work. Written communication was specified by different aspects: work with computers (an employee is supposed to have at least language level A). During oral communication many doctors from Eastern Estonia said that Estonian-speaking patients visited them quite rarely, which means that the main language used for oral communication at work in that area is Russian.

Preparing written texts, including documents, in Estonian One of the questions in the questionnaire distributed among health professionals was measuring the language level through the ability to produce a written text. For being able to produce a written text a person should have language level C. It became clear from the questionnaire that doctors and nurses prepare the written texts themselves or use ready-made forms or computer programmes for that, which make their work easier. The ability to produce texts was not related to any specific area, which became evident from the correlation that was rather small.

Comments 32.1% of family physicians in Eastern Estonia and altogether 38.5% of medical specialists prepare the documents themselves. In this case they are supposed to have an advanced level of knowledge of Estonian. But this where the discrepancy occurs: if such a large number of family physicians and specialist doctors presumably know Estonian on an advanced level, how is it possible that quite a lot of respondents asked the interviewers to translate for them the entire questionnaire?

Misunderstandings in communication 1. A doctor and a nurse do not understand a patient 2. A doctor and a nurse can’t explain anything to a patient 3. A patient doesn’t understand and can’t speak Estonian 4. A doctor and a nurse don’t understand and can’t speak Estonian 5. A doctor and a nurse don’t understand and can’t speak Russian

Knowledge of national language National language skills were measured in several different ways, the results of which were compared between themselves: · Subjective self-evaluation of one’s language skills · Subjective opinion of the language skills of one’s co-workers · Objective criteria. The latter were represented in the form of specific translation tasks, and also some test questions, on the basis of which the language skills of the respondents could be assessed.

Subjective assessment of national language skills Sub database – doctors and nurses with Russian background In order to analyse the national language skills a separate database A was created. It included health professionals who have at least one language attribute (education, speciality, language spoken at home) as Russian. Those health professionals located in Ida-Viru County who speak Russian at home but who have received education and their specialties in Estonian should be deducted from the total amount.

Level of oral and written language skills of the doctors The doctors’ own definition of themselves „I make occasional mistakes“ may be placed under language level C, or the advanced level (26.25% of doctors). In addition to that, this group also includes 25.65% of respondents who considered their Estonian language skills so good that stated that they could cope with their work easily using this language. Those respondents who understand the language but make mistakes belong to the group of independent language users, or the group of users with language level B. The amount of doctors with this level of Estonian language skills made up 28.1% of doctors. Respondents who need help during communication, in order to overcome the language barrier, have language level A (beginners). Among the respondents, there were 16.85% of those with A level, while 3.15% of respondents admitted that they didn’t know Estonian at all, i.e. their language level is 0.

As for the nurses, their written language skills were also quite poor in Eastern Estonia. A large number of nurses admitted that they can understand Estonian but make many mistakes when they write in the Estonian language. The writing skills among doctors seem to be a little better.

Among the total number of respondents there are many doctors and nurses with Russian background who don’t speak Estonian at work on a daily basis. Mainly those doctors and nurses come from Ida-Viru County, while there have also been occasional cases in Northern Estonia. In Southern Estonia and Western Estonia doctors and nurses speak Estonian at work on a daily basis.

The level of doctors’ as well as nurses’ proficiency in Estonian is strongly correlated to the different regions of Estonia. The correlation of the proficiency in professional oral Estonian depending on the region is r = 0.735, p = (doctors) and r = 0.761, p = (nurses). The correlation of the proficiency in professional written Estonian depending on the region is r = 0.707, p = (doctors) and r = p = (nurses). Nurses from East-Estonia, just like doctors, have difficulties with professional communication in Estonian; 5.4% of general nurses and 5.9% of specialised nurses do not speak Estonian.

Evaluation to Estonian language proficiency by health professionals with Russian background I can easily express myself I understand, do some mistakes by speaking I need help by communication I can`t speak Estonian I can easily express myself I do occasional mistakes

Objective measurement of the doctors' and nurses' language skills 1)Picture test The picture test included common names for various body parts (5), which had to be recognised and connected with the corresponding location in the picture of a human being. The problem here was that appendix was sometimes confused with the intestines, but this is not clear from the picture. Respondents had to recognise the following terms: pimesool (appendix), pahkluu (ankle), näpp (finger), otsmik (forehead) and kaenlaalune (armpit), and to mark these in the provided drawing.

2) Translation test The translation test included 5 non-medical complaints and the respondents had to translate these Estonian expressions regarding one's health into the foreign language selected by the respondent. Objective language proficiency was evaluated according to the number of correct answers each person gave to researchers. Without exception, the group of research subjects chose Russian as the foreign language. Based on the translation test, proficiency in Estonian can be considered to be at the lowest level (1 correct answer out of 5) in case of 2.7% general nurses and 11.8% specialised nurses in East- Estonia. 14.3% of general nurses in West-Estonia also belong to this language-level group.

If we compare the subjective level of language proficiency to the objective level, i.e. in this case oral and written language skills based on the picture and translation tests, it becomes apparent that doctors and nurses have been rather critical about their own abilities. In their own opinion, 25.65% of doctors and 16.7% of nurses have C-level language skills. At the same time, based on the test results, 63.15% of doctors and 57.45% of nurses can be placed in the C-level language proficiency category (all five answers given in the assignments were correct).

3.15% of doctors and 3.15% of nurses felt they had no language skills, i.e. those whose language level could be graded 0. However based on the test results, the 0-level included 14.35% of the doctors and 14.15% of nurses; this shows a reverse trend at the lowest language-skill level – the doctors and nurses overestimated their language skills. The situation in the intermediate levels was the following: 16.85% of doctors and 18.85% of nurses needed help in communicating; in other words, their language skills were at the beginner's level.

Misunderstandings in communication with doctors and nurses What the doctor did not understand? The doctor did not understand: Estonian, the patient's complaint, the medical chart, the patient's wishes during procedures, Russian, terminology. The problem was solved using the following methods: the patient chose another doctor, the patient chose another language that the doctor understood, the doctor used the help of the nurse, the help of other patients was used, the situation was not solved (1% of cases, Tallinn).

Patient satisfaction regarding doctors' and nurses' language skills The patients' assessments of doctors' and nurses' language skills were relatively uniform by region. In all the regions, the majority of patients-respondents were totally satisfied or rather satisfied. In North-Estonia, the number of totally satisfied patients was smaller, and the number of unsatisfied patients larger than in other regions.

In conclusion In general, it seems that the Estonian-language skills of most doctors is at the intermediate level, while on the contrary, the nurses' language skills are either above average or very modest. For instance, some doctors asked their nurses for help with the translation test and drawing. However, generally doctors were relatively familiar with simpler terms denoting common medical conditions; it was the answers to these questions that provided the most objective picture of the the doctors' and nurses' language skills.

The greatest difference between doctors in South- and West- Estonia and their colleagues in Estonia’s segregated regions was that those in South- and West-Estonia had a good level of Estonian-language proficiency and also used English and Finnish in their work. The patients also generally assessed their language proficiency to be at a very good level. In North-Estonia, some misunderstandings developed for English-speaking patients due to language differences during visits to the doctor.

This study may become an important document for planning further language courses for medical workers in the different regions of Estonia, while helping to raise awareness about doctors' and nurses' actual language training needs. Elvira Küün e-post: