Academic Exchange Quarterly Summer 2012 ISSN 1096-1453 Volume 16, Issue 2

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Enhancing Communication Skill in Diverse Learners


Andrea Morgan-Eason, LaGuardia Community College, NY


Morgan-Eason, MS, is an Assistant Professor of Nursing in the Health Science Department



The diversity of healthcare students is increasing, mirroring the changing faces of the population of the United States. Educating culturally diverse students has become a major challenge for schools preparing healthcare professionals. Faculty in higher education has been called upon to explore teaching strategies that will not only enhance the studentís learning, but prepare him/her for the working environment. This paper will focus on four teaching strategies that can be used in a community college setting to enhance the studentsí communication skills.



The demographics of the United Statesí population reflect an increasing segment of racially and ethnically diverse persons. According to the United States Census Bureau, both the non-Hispanic White and Asian population has grown considerably over the past ten years due to higher levels of immigration. Presently, there are 50.5 million Hispanics in the United States and many more undocumented, with the Asian population steadily growing (U.S. Census Bureau, 2010).


The changing demographics of the U.S. underscore the need for a diverse health professional workforce to ensure high quality healthcare. In order to accomplish this, health care leadership has identified a need for more culturally competent healthcare services. The Pew Health Professions Workforce has also made a recommendation to ensure that the health profession workforce reflects the diversity of the nationís population (Amaro, Abriam-Yago, & Yoder, 2006).


Although the U.S. has attempted to institute useful measures to increase diversity among students accepted into health professional programs, these measures are directed towards admission, curriculum development, faculty recruitment and support services. Faculty is still being challenged to educate, retain and graduate ethnically diverse students. There is a need for faculty to re-examine courses, teaching strategies for areas where diverse students need a more useful approach to maximize their learning needs and prepare them for the workforce. One of the areas of greatest concern is studentsí communication skills. Studies have shown that there is a need to recognize the language difficulties of diverse students, with adequate everyday communication, because it can be inadequate for health professionals (Parkhurst, 2010, Gilchrist & Rector, 2007). Offering a course in oral communication that integrates professional communication skills into discipline-specific content while using alternative teaching strategies, results in the acquisition of professional communication skills. More importantly of results in higher graduation rate (Parkhurst, 2010, Gilchrist & Rector, 2007, Evans, Tindale, Cable & Mead, 2009).



As the number of ethnically diverse students is increasing, there is a need for faculty to meet the learning needs of these students. The diverse students may possess language difficulties that can affect their academic achievement. Some of the challenges the students who are enrolled in healthcare professional programs may encounter include: deciphering multiple-choice questions, managing the time constraints of multiple choice tests, interpreting concepts related to the majority of American culture and mastering medical and non-medical terminology in English (Parkhurst, 2010, Gilchrist & Rector, 2007). Many of them also may have unique communication educational needs. Many health care courses, in general, concentrate on communication, both verbal and written, that is required of the health professionals (2007). This requires faculty to revisit their teaching strategies and create innovative ways to enhance the diverse studentsí language abilities and improve on their communication skills, with their patients and families.


Conceptual Framework

The Cummins Model can be useful in assessing student language issues and assisting faculty in creating appropriate teaching methods to improve the studentsí language abilities and communication skills (Amaro, Abriam-Yago & Yoder, 2006).The Cummins Model has two continua in which language proficiency can be conceptualized. The first continuum distinguishes between context-embedded (offering contextual clues to assist in the understanding of language, such as facial expression and feedback from the listener) and context-reduced (offering few clues). The second continuum distinguishes between cognitively undemanding (to use on subconscious activities, such as everyday routines) and cognitively demanding (requiring a conscious focus on understanding language and concepts) (Abriam-Yago, Yoder & Kataoka-Yahiro, 1999).


In preparing innovative teaching methods for the diverse learners, the model shows how a faculty member can move a topic that is cognitively demanding and context-reduced, an area where most healthcare programs courses fall under, to a context-embedded situation by reviewing and revisiting his/her teaching methods (1999). For example, in teaching students about a disease process, instead of utilizing a textbook, have the student read a journal article about the disease and have a class discussion. Journal articles may have figures, tables and illustrations as well as questions to be answered after the reading that can be of more interest to the students and less of a challenge to master and understand (Gilchrist & Rector, 2007).


Teaching Strategies

Developing effective teaching strategies for diverse students is an ongoing process and differs from student to student. There are numerous generalized teaching strategies; such as ones that involve students in the learning process and others to encourage students to actively participate; but there are few specific teaching strategies that address the ethnically diverse students (Flinn, 2004). The following teaching strategies have been identified as useful in the classroom setting with culturally diverse students: open discussion, small group tasks, lesson models, peer tutoring, case studies, focus groups, role modeling, seminars, hands-on activities, writing groups and multimedia games (Gilchrist & Rector, 2007, Brown, Kirkpatrick, Mangum & Avery, 2008, Reams & Bashford, 2011). Faculty, in order to begin to facilitate the education of diverse students, first must recognize the cultural and language issues and adapt alternative teaching strategies to assist them (Gilchrist & Rector, 2007).


Application of Adapted Teaching Strategies

Role Playing

Role play has been used in healthcare programs for varying reasons. For example, in both the nursing and medical professions, role play has been used to improve communication skills, cultural competence and application of ethics (Joyner & Young, 2006, Chaturvedi & Chandra, 2010). Role play adds variety and enhances learning in the classroom as students prepare for their clinical practice (Joyner & Young, Gilchrist & Rector, 2007). Utilizing role play requires an understanding of the learning objectives, in order to ensure that the lesson will be learned. For example, when role play is used to practice skills and techniques, faculty should design the role play with emphasis on overcoming problems. In addressing changes in understanding, feelings and attitudes, the role play needs to emphasize problem solving and relationship building instead (Joyner & Young).


At LaGuardia Community College, the nursing program students are from varying cultures, role play has been used in numerous ways. Prior to the studentsí first clinical rotation, therapeutic communication is taught through role play. Each student has the opportunity to practice in the role of the nurse, in order to learn how to facilitate communication that can assist in assessing the patientsí needs. During role playing, the students are able to practice both verbal and non-verbal communication techniques (Rosenberg & Gallo-Silver, 2011).


Role play can assist those students who have English as a Second Language. Students who have difficulty with language proficiency can easily be intimidated and shy. Role playing with the manikins it gives them an environment to feel comfortable to practice pronunciation and enunciation of medical terminology (Gilchrist & Rector, 2007). The faculty in the lab does provide guidance when needed in the proper pronunciation and correct usage of medical terminology. This is a teaching strategy students do seem to enjoy, because they are actively engaged. Students have commented on how role play does provide the hands-on experience which gives them more confidence in their communication skills before going in the clinical area for the actual experience (Rosenberg & Gallo-Silver, 2011).



Story-telling is an approach to teaching and learning that develops from the past experience of teachers, clinicians and students (Koening, & Zorn, 2002). In the healthcare profession, storytelling can be used to teach the students about social issues, the meaning of illness, assessment, intervention and best practices (Overcash, 2010). It can enhance listening skills, improve studentsí communication and interviewing skills, and can provide the student with the ability to engage with other people (Anderson, Ford, & Thrope, 2011; Quaintance, Arnold, & Thompson, 2010; Scott & Debrew, 2009).


Storytelling can be used to describe certain disease processes. The faculty, when teaching about a specific disease process, starts by sharing their own personal experiences of caring for a patient who had that particular disease; this in turn allows the students to share their own personal stories. By sharing stories both students and faculty are able to find a common bond that enhances the studentsí participation in class, creates a comfortable learning environment, improves the learnerís ability to understand and offers a personal dimension that the students can remember (Overcash, 2010).


Storytelling can be used in the clinical area during post conference. During post-conferences students are encouraged to share the stories of their experiences.The telling of stories allows for free talk, clarification, question and answer periods, all which involve increasing and enhancing the studentsí listening and communication skills (Stein, Billings & Kowalski, 2009). Students are also encouraged to write their stories in their journals, which provide opportunities for learning, reflection, critical thinking and assist in improving their writing skills and medical terminology (Christiansen, 2011). The progress in all areas is noted after reading their entries over the semester.


Assigning Readings

Students are more willing to seek and apply information to support their practice, if the reading assignments focus on a variety of presentation styles, activities and information sources. Familiarizing the students with the assigned readings and teaching them how to read and comprehend the assigned texts; can encourage students to intellectually engage with and learn from text, and improve their critical thinking skills (Kassiola, 2007).


Reading assignments are critical in healthcare programs. According to Beeson and Aucoin (2005) reading assignments remain one of the most widely used strategies for teaching nursing students. Students need to not only hear the subject being taught, but also has to be able to read and apply what has been read. Reading assignments can assist students with their vocabulary, communication skills and medical terminology (Gilchrist & Rector, 2007).


In assigning reading to culturally diverse students the recommended first step is to introduce the students to the textbook and teach the students how to read the textbook. This process is helpful to the students and can result in students using the textbooks more frequently. Another way of encouraging students to read the assigned readings is for the faculty to review the assigned reading and utilize the textbooks in class. This form of role modeling can motivate students to use the textbooks and read more efficiently. Anecdotally, over the past five years, when this process was used in the classroom the students seemed engaged in learning, fostered communication and improved their critical thinking skills.



The importance of information technology is growing in healthcare practice, and future healthcare workers need to be knowledgeable and skilled in this area. One of the biggest challenges in healthcare programs is to find ways to prepare the diverse students for dramatic technological changes, requiring the integration of information technology in the curriculum (Hegarty, Condon, Walsh & Sweeney, 2009). Educators have found ways not only to integrating technology in their curriculum, but using technology to assists students with their clinical performance, communication skills and problem solving (Hegarty, Condon, Walsh & Sweeney, Kingsley, 2007).


Technology-advanced simulation training in health profession education allows educators to provide experiences for students early in their programs of study and leads them to be more prepared to address situations that may occur in clinical settings (Haas, Seckman & Rea, 2010). It is also associated with large effects on outcomes for knowledge, skills and behaviors (Haas, Seckman & Rea). The skills of critical thinking, problem- solving and clinical decision-making are essential for health care workers to function effectively and the use of technology can facilitate these processes (Hegarty, Condon, Walsh & Sweeney, 2009).


The Simulation laboratory provides students with hands-on patient experiences that they will encounter in the clinical area. The simulation laboratory provides case scenarios in which students have to actively communicate with the simulated patient, are challenged to accurately assess the patient and treat accordingly, and encourages the students to think critically and problem solve. This environment creates an opportunities for students to be assisted with their written and oral communication skills.



The healthcare system is in need of healthcare professionals that have the language ability and cultural knowledge to meet the healthcare needs of ethnic and language minority immigrants. Therefore the recruitment, admission, retention and graduation of diverse students are essential to meets the demands of these multicultural communities. Developing effective adaptive teaching strategies, such as role play, storytelling, assigned reading and technology are innovative teaching methods that can maximize the diverse studentsí educational needs and greatly improve their communication skills for transition into the workforce.


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