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South African medical students who are Cuban-trained and therefore Spanishspeaking, on their return to South Africa need to learn medical vocabulary, terminology, and appropriate interactional discourse in the two major languages of English and Afrikaans, in order to be able to practise professional medicine effectively and efficiently. Indeed, their language problems are further compounded by differences in medical equipment and in medical practices between Cuba and South Africa. To meet these particular students’ needs and provide a communication support tool, the concept of a paper-based pocket-size multi-lingual illustrated dictionary was introduced as an additional component in a blended learning approach, to complement online materials called MoM-SA. The dictionary, to which students are invited to add material, has word lists in English, Afrikaans and Spanish, and offers links to the online materials. Students can add terminology, translations into other African languages and images, so that the dictionary grows and reflects the everyday needs of the students, who, at the same time, become co-owners of the dictionary; thus, process has become content and, as a result, learner motivation has increased. Keywords: medical terminology, medical discourse, communication support tool, multilingual medical practice, ESP, MoM-SA Setting the Scene: Cuban-Trained South African Medical Students With eleven official languages, communication challenges in a multilingual South African (SA) professional healthcare context are manifold. Medical professionals are expected to communicate in different languages depending on the region where they operate. In the Western Cape province, for instance, they are expected to communicate in English, Afrikaans and isiXhosa, the three dominant languages in the region. Since medical students apply to a school which may not be in the area where they were raised, they are very often challenged with having to learn another language in which to function professionally. Moreover, it is by no means certain that they will have been schooled in both Afrikaans and English, as well as another African language. First year medical students at the University of Stellenbosch therefore sit language proficiency tests when they enter university and have to take part in an academic SiSAL Journal Vol. 4, No. 4, December 2013, 339-352 340 literacy course in either English or Afrikaans, whichever has proved to be their least strong language. Apart from this academic literacy course, the students also have to complete a communication course in their weakest language, between the two languages of isiXhosa and Afrikaans. However, an altogether different linguistic challenge came about in 1985, when South Africa and Cuba signed a cooperative health agreement as part of an intervention which seeks to address the shortage of qualified medical doctors in South Africa (Health Care in South Africa, 2013). Through the programme, on an annual basis, a group of medical students from South Africa, who have not passed the entry requirements to medical school, are allowed to spend the first six years of their training in Cuba. During this period the students receive twelve months of intensive Spanish language training, followed by five years of medical training (undertaken in Spanish in a preventionoriented health care system). Upon their return to South Africa, the students are admitted to different universities where they do their internships and complete their studies, undertaking the Cuban final qualifying exam which is ratified in South Africa. At Stellenbosch University, where the participants in this study were enrolled, the intensive orientation programme, which has been designed for them as a group, with their specific needs in mind, consists of 1) medical skills training appropriate to curative-oriented health care, 2) language courses with a focus on medical communication in English and Afrikaans (the two major languages for professional medical communication in the Western Cape region of South Africa) and 3) supervised clinical ward rotations in the university hospital. Since these medical students, whose home language is often not English or Afrikaans, but who may have been schooled in one of these languages, have undertaken all of their medical training in Spanish, they have learned the medical vocabulary as well as more general medical communication practices only in Spanish. Consequently, in order to be able to communicate and practise medicine effectively in South Africa, they need to (re-)learn the medical vocabulary and terminology, as well as related interactional discourse or scripts. Medics on the Move and Medics on the Move South Africa (MoM-SA) Since quality of doctor-patient and doctor-colleague communication can SiSAL Journal Vol. 4, No. 4, December 2013, 339-352 341 directly influence the quality of patient care (Hewett, Watson, Gallois, Ward, & Leggett, 2009; Watson, Hewett, & Gallois, 2012) and may even improve patient health outcomes (Stewart, 1995), communication training has, in recent years, received ample attention in patient-centred medicine. Even though it has become an integrated component of a western medical curriculum, language support guides (such as the Calgary-Cambridge guides; Silverman, Kurtz, & Draper, 2005) ‘typically mention the use of a second or foreign language as just one of many issues in cross-cultural communication without providing any solutions or prescriptions to address ensuing communication problems’ (Gasiorek & Van de Poel, 2012, p. 4). This need to address the issue of cross-cultural communication for medical professionals has led to the development of Medics on the Move (MoM). Medics on the Move started in 2006 as an EU co-funded project and has since developed into an online tool for six European languages at beginners (MoM-basic) and advanced level (MoM-advanced) with translation support for six other languages (www.medicsmove.eu). MoM is intended for (pre-)professionals to use autonomously as a communication tool in clinical settings, but it can also be used as a learning tool in training and teaching contexts. The online materials for beginners (MoM basic) are based on scenario texts which follow the doctor-patient consultation timeline interspersed with communicative situations with colleagues. The syllabus is functional and speechact-based and the scenario texts have different types of support: phonetic (audio and systematic pronunciation training), grammatical (rule-based with examples from medical contexts), lexical (wordlist and wordmaps bringing words together in semantic fields) and communication (a task-based approach, see below for more examples). Due to the communication challenges for the students in a South African medical professional setting and the fact that SA medical schools have integrated patient-centred communication in their medical training programmes, the Faculty of Medicine and Health Sciences at Stellenbosch University introduced a language-specific communication training programme for all students. Given the complex profile of the learners, the restricted number of teaching hours and the lack of targeted teaching and learning materials, the approach adopted in the developmental process was critical. The programme was conceived, in 2013, as a SiSAL Journal Vol. 4, No. 4, December 2013, 339-352 342 collaboration between the Language Centre and the Medics on the Move team, with input from local developers, pedagogues, material designers and medical consultants. It has adopted a blended learning approach (Graham, 2006) consisting of (limited) contact teaching (20h) and autonomous online learning (see, among others, Little 1991) and is tailored for a South African context for online and contact teaching and learning both in Afrikaans and English. In order to inform the programme, called MoM-SA, a needs analysis was carried out involving staff and students. Since the Cuban-trained students have special needs, they were studied separately. Needs Analysis as Part of MoM-SA Implementation In 2012, after having completed the medical training programme in Cuba and having participated in the medical orientation programme, a group of ten Cuban-trained SA students took part in a needs analysis (questionnaire and focus group) that was conducted with a view to increasing learning output (Van de Poel & Gasiorek, in press). Students reported reversed culture shock with respect to South African culture and clinical contexts (Szkudlarek, 2010), in terms of personal and medical experiences, as well as language skills. Students explained, among others, that they had to get used to the food cooked at home and they often felt estranged from their families and friends, but, specifically, they had difficulties with professional communication, and, more particularly, with understanding and using medical terminology in English and Afrikaans. The overall findings, with respect to medical communication, were that these preprofessionals suffer from the threat of losing face when trying to be the doctors they want to be. One of the major linguistic preconditions was that students had to make their own notes and vocabulary lists in order to cope with their own deficient medical language skills while on ward rotation. Moreover, the difficulties with terminology were compounded by differences in medical equipment and medical practices between Cuba (focused on primary healthcare, i.e. prevention) and South Africa (focused on secondary or curative care). Students were at a loss and claimed, “You find yourself in a ward and almost everything that you see you 1	  The South African MoM-team is lead by Kris Van de Poel and Tobie van Dyk. The project is undertaken with financial support from ICELDA and the research unit for Applied Language Studies at the University of Antwerp in Belgium. 2	  At Stellenbosch, about ten Cuban-trained students take part in the annual

Medics on the Move South Africa: Access to Medical Words