But I Don't Understand You: One Faculty's Observations of the Challenges Facing International Healthcare Students

'When I hear that international students are interested in my program, I experience both excitement and trepidation. From which countries have they traveled? What have they seen? What are their native languages? How well can they communicate in English? How long have they lived in the South? What are their religious backgrounds? Do they plan to remain here in the States, or return to their homeland?While the answers to these questions do not affect student admittance into the healthcare program, the answers do affect my teaching and the culture in the classroom. Some will argue that it shouldn't, that my teaching should be the same regardless of the origin of the student. My rebuttal to this argument is effect size: my classroom size (population) is small enough that each student affects the dynamic and culture of the learning environment. As an instructor in a relatively homogeneous area in the rural South, my classrooms typically consist of Caucasian males or females who were born and raised in the Bible-Belt region. Their siblings, parents, grandparents, and great-grandparents live nearby and attend the same Christian-based church every Sunday. This homogeneity makes teaching easy, if somewhat boring.Now let us introduce an "outsider." Someone who will challenge the status quo; who will introduce diversity and new ideas. Someone who has traveled a great distance to study abroad and experience new things. Someone with the courage to leave the "known" for the "unknown," abandoning family and friends in the search for life-changing experiences. Someone who is open to new ideas and perspectives. International students are to be admired for their tenacity and willingness to pursue unique learning experiences. But what if I don't understand them?According to the Institute of International Education, there were 974,926 international students studying in the United States in 2014-2015 (Institute, 2016). Of these, 33,399 majored in the health professions. Of the top 10 countries of origin, only one (Canada) could be considered similar in language and culture to the United States. Other countries within the top 10 included: China, India, South Korea, Saudi Arabia, Brazil, Chinese Taipei, Japan, Vietnam, and Mexico. These countries have varying primary languages and extremely diverse cultures. Not only is it challenging for international students to acclimate to coursework here in the United States, but it is a challenge for faculty to meet the individual needs of these students (Mantzourani, Courtier, Davies & Bean, 2015).COMMUNICATION CHALLENGESCommunication issues are, by far, the biggest hurdle for international students in a healthcare program. Not only is English the primary (and usually only) language spoken in the southeastern United States, but the local accents can make it difficult for any non-locals to understand. A classic example of this can be seen by the use of subtext during an episode of the highly controversial show, Here Comes Honey Boo-Boo, a reality television series which follows the life of a family in rural Georgia (Cavalcante, 2014). The use of subtext implies that even the English speaking public cannot understand the rural southeastern dialect. Now, imagine that English is your second language. Comprehension and communication becomes even more difficult as the English taught during their primary education years does not align with the English actually used by their teachers, fellow classmates, and patients.While English comprehension in the southeast is challenging, the anxiety created by the language barrier drastically increases when students are asked to participate in formal oral discussions (Bista, 2012). However, research has shown that informal conversations, such as those found with patients and peers in clinical practice, can greatly increase communication skills (Lee, 2016; Mesaroli et al, 2015). A study by Mesaroli et al (2015) found that international students believed their interactions with patients enhanced their overall communication skills and "improved their ability to use short, direct questions" (p. …