Top 3 cultural clashes for foreign medical graduates

I just completed working with an organization whose employees interact with every foreign medical graduate who wants to become licensed in the US, the majority of whom are non-native speakers of English. Our training focused on developing the cultural competence and communication skills to provide the best customer service.

Working with over 100 employees organization-wide identified 3 common areas of conflict they had with the soon-to-be doctors in America. The conflict and differences are consistently between the low context American workplace and the applicants from high context cultures, in the following areas:

1. Gender – Issues of gender were a common theme. Men who could not get what they wanted from female employees often asked to “speak to a man” or “speak to the manager” only to find the manager was a woman, too. Some men outright refused to work with a woman. Men often called to demand confidential information about or to try and undermine female family member applicants.

2. Status – Doctors in general and those from high context, hierarchical cultures in particular, believed themselves to be of higher status than the employee who was helping them. Status is viewed through family name, connections, or job title. Status conflicts also extended to gender, with men viewing themselves of greater status. Employees also felt that applicants with high concepts of their status were often rude and demanding in interactions.

3. Cheating –The concept of cheating varies by culture and one shouldn’t assume all people share the same definition. Cheating for this organization included providing false documentation or unacceptable practices during licensing exams. American culture has very strict definition of cheating and plagiarism, which is more fluid in other cultures. Specific definitions with concrete examples and consequences must be communicated.

A doctor’s personal cultural beliefs and values do not stop once she or he becomes licensed in the US. It is reasonable to assume these carry over into the health care workplace.  Of course not every foreign doctor from a high context culture fits this profile. However, healthcare organizations must acknowledge and address the need for cultural competency training for many of their foreign medical professionals.

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CAL Learning partners with Axiom Learning Solutions

CAL Learning is proud to announce our partnership with Axiom Learning Solutions as their intercultural and language training provider,  within their Learning Services.

We continue our commitment to serving the pharma/biotech, technology, healthcare, and other industries  in developing the language and culture skills of their foreign-born employees.

contact us for more information on accent reduction, language or intercultural training programs.

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5 ways to improve your English skills without a teacher

Many English language learners who have lived and worked in the US for a while say they’ve plateaued in their language skills.  They have achieved a certain level of fluency, but often feel limited in their vocabulary and ability to express nuance. They want to continue advancing, but don’t know how.

If you don’t have the time to take a class, there are lots of things you can do to improve your English skills on your own. Here are 5 easy things you can do to advance your English communication skills without a teacher or classroom.

1. Be proactive

Stay engaged in English. Read the news, watch TV, listen to the radio, talk to strangers. The best way to learn is to practice, so make language practice a priority every day. Many language learners spend much of their time speaking their native tongue with friends and family. Go outside of your language group, and put yourself in English speaking environments. When you are with English speakers, participate actively.

2. Follow blogs on topics of interest

Because you are familiar with the topic, the content will be easier. You will also expand your vocabulary in the subject area. Keep a written list of new vocabulary, useful phrases or idioms, and new grammar structures. Post responses on the blog to practice writing skills. Stay engaged in the discussion.

3. Read aloud

Reading aloud is an excellent exercise. It improves fluency, pacing, stress and intonation. Read the same paragraph repeatedly until it flows eloquently. Focus on proper pronunciation of difficult words and sounds.

4. Engage sales associates

Always talk to a few sales associates when you go in a store. It’s their job to help you. Ask as many questions as you can think of. Ask follow up questions.

5. Practice phone skills

Speak to telemarketers when they call.  It is better to practice with unimportant conversations than an important phone call at work. Talk to them at length and make them answer as many questions as you can think of.  You can also practice phone skills by calling customer service rather than using an online chat or email. It’s great practice for a difficult skill.

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why are some vowels held longer than others?

Voiced and Voiceless Consonant Pairs

Many consonants come in pairs of voiced and voiceless pronunciation. Some  examples include  d/t,  v/f,  and b/p.

The only difference between the two consonant is that one has a vibration of the vocal chords (voiced) and one does not (voiceless). Other than that,  the tongue, lips, or teeth placement and air flow for the two consonants are the same.

When a vowel is before a voiced consonant, the sound will be held longer.

When a vowel is before a voiceless consonant, the sound will be shorter.

w-i-i-i-de  building white  building
Voiced Voiceless
The wide building is the white building wide white
I need room in the neat room need neat
The robe is made of rope robe rope
The first prize is for the first price prize price
Save water that is safe water save safe
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pronouncing th and v in technical vocabulary

Technical topics and discussions have a prescribed vocabulary with high frequency of repetition. If you learn to clearly pronounce these key words with correct articulation, you will be much more easily understood.  Learning to correctly pronounce a few consonant and vowel sounds can affect a lot of words in your technical vocabulary.

Can you pronounce these common technical words?

Use a hand mirror while you practice. Do your lips, teeth, and tongue look like the ones in the picture?

Don’t forget to use correct stress,  in bold.


method, methodology, theory, theoretical, theorem, hypothesis, thesis, in-depth, ethnographic, ethnography,


vital, observation, observable, variable, qualitative, validity,  level, survey, predictive,

interval, covariance, intervention

Start reducing your accent today!

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Native English speakers/speak in short phrases They. Don’t. Talk. Word. For. Word.

Fluent English speakers/express their ideas/ in phrases and thought groups/and they do it/ without even thinking/. Many non-native speakers/ don’t speak in phrases/ and end up sounding choppy.

Do you speak in phrases or word by word?

Stress in Phrases

Each phrase has a primary stress point. It  is usually the stressed syllable in the last content word.  See examples.

Primary stress can be changed to show focus

  • The meeting was moved to next Wednesday at three fifteen
  • The meeting was moved to next Wednesday at three fifteen.

Linking in Phrases

When speaking, the words in each phrases run together through linking (moving the last sound of one word to the beginning of the next) and reduction (of function words). this makes each phrase sound smooth and fluent.

Phrasing is Key to Fluency

  1. Fluent English speakers talk in phrases and thought groups
  2. Speakers who don’t link words in phrases will sound choppy
  3. Speakers who group words in phrases incorrectly, may be incomprehensible

Speakersuse phrasing

tomake theirideas clear

andeasy tofollow

I’llha vaburger

medium rare

witha sideoffries

Themeeting wasmoved

Tonext Wednesday

atthree fifteen.


wason thetable

beforeI left

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Start Reducing Your Accent Today

Do people often ask you to repeat yourself?
Do you find it difficult to have conversation by phone?
Are you nervous that your accent prevents you from getting your message across, or holds you back at work?

How soon would you like to:

Speak with greater clarity and fluency

Feel self-confidence in speaking situations

Have greater opportunity for career advancement

A strong accent can hold you back from moving up to the next level regardless of potential.

You can reduce your accent and learn to speak more clearly with CAL Learning online accent reduction coaching

With no travel time and  course content focused on your needs, goals and interests, CAL Learning online accent reduction coaching helps busy professionals use their time wisely. Coaching emphasizes identifying and correcting repeated patterns of error, with the objective of maximum improvement and habit formation in a short period of time. You will see  significant improvement in the 5 areas covered in our  coaching program.

Contact us to learn more, or to schedule a FREE ASSESSMENT to identify your problematic areas in pronunciation.

About the Coach: Lauren Supraner is founder and president of CAL Learning, an intercultural communication consulting and training company. Lauren has over 25 years’ experience in business communication skills for non-native speakers of English, and intercultural communication training. She coaches foreign-born professionals in accent reduction, business English, and American culture, and has helped thousands of executives, managers, and technical professionals to reduce their accents and improve their skills in cross-cultural communication .

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Common English Word Stress Rules to Help Reduce Your Accent

Stress is extremely important in English. Stressing the wrong syllable or pronouncing all syllables with equal stress are a common problem for non-native speakers. So how can I tell which syllable to stress?

Although the rules for stress are very complicated and have many exceptions, there are a few common patterns that are easy to remember.

Every word has one stressed syllable which is pronounced louder, longer and higher.

Stress on 1st syllable:
Two-syllable nouns label, format, table, coffee, breakfast
Two-syllable adjectives lucky, grateful, handsome, boring, silly
Two-syllable adverbs often, sometimes, mostly, rarely, never
Compound nouns toothpaste, bookshelf, sunshine, headset
Stress on 2nd syllable:
Two-syllable verbs invent, reply, decide, persuade, divide
Phrasal verbs pass out, give up, turn off, give in

Sometimes, the same word can be either a noun or a verb. In general, nouns stress the first syllable, verbs, the second.

Nouns Verbs Nouns Verbs
CONvict conVICT REcall reCALL
CONduct conDUCT CHECKout check OUT
INsult inSULT PROduce proDUCE
RUNdown run DOWN SUSpect susPECT
MAKE up Make UP BREAK up Break UP

Notice the stress in the following noun/verb pairs.

  1. When someone insults me, I don’t take the insult very well.
  2. Someone should conduct an investigation into his conduct.
  3. I suspect the suspect will want to call a lawyer.
  4. I don’t recall the beef recall of the 1990’s.
  5. The final project will help us project a better image.
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5 Technical Presentation Tips for Non-native Speakers

A large percentage of STEM graduates in the US are foreign-born, and non-native speakers of English. When they enter the US workforce, they face communication obstacles that native speakers will not. Most STEM employees are often required to make presentations, whether to their team, at conferences, to customers, or to marketing departments. And although most companies offer presentation skills training workshops for their employees, almost none address the unique set of challenges non-native speakers may have.

If you are non-native speaker in the STEM fields, think about these as you plan your next presentation:

1. Phrasing

Phrasing is the way speakers break up their sentences into understandable chunks. Incorrect phrasing can make the speaker very difficult to understand. Phrasing is extremely important in technical presentations, because the information presented is so dense. Many non-native speakers don’t think about phrasing in their presentations, and very often end up sounding choppy. Which phrasing is more understandable?

  • The optical /module/ reaches input /and output rates /of 160 gigabits/per second/ between/ two processors /with 32 /integrated waveguides./
  • The optical module/ reaches input and output rates /of 160 gigabits per second/ between two processors /with 32 integrated waveguides/.

2. Syllabication

Unlike in conversational English, many words in the STEM fields are very long and can have 5 or more syllables. It is important to pronounce every syllable. Dropping syllables is a common problem for non-native speakers. Additionally, speakers from languages that don’t have consonant cluster (such as Japanese) may add an extra vowel syllable to break up a group of consonants. Don’t drop or add syllables!

3. Clear articulation of consonants and vowels

In English, the tongue, lips and jaw are much more active with a wider range of motion than in many other languages. Most non-native speakers need to retrain muscle memory to create clear and understandable sounds. Additionally, many English sounds require a vibration in the vocal chords. For example non-native speakers will mispronounce “lens”  with final s, because many languages don’t have final z.  The audience not only has to think about content, but deciphering mispronunciations as well. Technical presentations have very few speech reductions, and so most words must be clearly enunciated.

4.  Proper stress

Changes in word form create changes in word stress. Non-native speakers need to master the common patterns and rules for English stress. For example, the stress will always be on the syllable before these suffixes: -tical, -tic, -logy. So while we say pharmacy,  the stress changes in biopharmaceutical, pharmacokinetic, and pharmacology.

5. Plan ahead

Make a list of problematic and key words ahead of time and practice practice practice. You can ask a native speaker for the correct pronunciation. If you know you are saying problematic words and key phrases correctly, you will be more relaxed and confident in your presentation.

Bring CAL Learning’s Technical Presentation Skills for Non-native Speakers workshop onsite to your company.
Contact us and schedule before September 24, 2014 and get 15% off!

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10 ways to communicate better with LEP patients

Almost all healthcare facilities in the US serve some patients with limited English proficiency (LEP).  How you approach communication– how you speak and how you listen, has an enormous impact on the success or failure of the communication. Here are 10 things you can do to  improve communication with LEP patients.

Listen Better

  1. Listen with patience. It takes time to communicate with LEP patients. Be quiet and allow pauses. Don’t interrupt, speak over, or finish their sentences. Listen to learn, not refute.
  2. Listen for key words, main ideas. Summarize or repeat this info back to the patient to confirm or clarify.
  3. Listen to body language. A blank stare or tense body may mean be a sign that they don’t understand. Body language is not the same across cultures. Asian patients may smile when they do not understand or when they feel uncomfortable.
  4. Listen for language level and then adjust your speaking (speed, vocabulary, grammar, etc)  accordingly. To assess language level, start with simple, yes/no questions and build in complexity using open ended questions that require explanation.
  5. Listen without prejudice. Do not equate an accent, poor grammar, or lack of fluency with lack of intelligence. Beware of the impact of culture. LEP clients may say they understand when they don’t, to save face.

Speak Better

  1. Speak Simply. Use short sentences with simple grammar and vocabulary. Avoid technical language, jargon, and idioms.
  2. Speak with structure. Use signposts (first, second, after that, etc) to lead the listener through a process.
  3. Speak in small doses. Don’t give too much information at one time. Be concise. Don’t digress. Check comprehension with each new piece of information.
  4. Speak slower with greater enunciation. Emphasize stress and intonation  to help the listener identify important or key information.
  5. Speak with your body. Use facial and hand gestures to emphasize and clarify. Demonstrate.


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