On the odd position of medical students trained in English, treating patients in something else entirely
There’s a specific kind of two-language problem that shows up in medical schools across Italy, Poland, Hungary, and a handful of other countries: international students recruited into English-taught medicine programmes, trained entirely in English, examined in English, then sent onto hospital wards to treat patients who speak Italian, Polish, or Hungarian and often nothing else.
It’s the inverse of most language-learning problems. Usually the goal is competence in the target language for its own sake. Here, English is the instructional language, but it’s structurally useless at the bedside. A student can present a differential diagnosis fluently in English and still be unable to ask a frightened seventy-year-old patient, in their own language, where exactly the pain started.
Universities running these programmes generally bolt on local-language classes, but the level required is a genuinely odd target: not tourist Italian, not academic Italian, but the specific register of a clinical interview: gentle, precise, able to extract a reliable history from someone in distress, in a language the student may have started from zero. That’s a much narrower and harder skill than general conversational fluency, and it rarely gets the teaching time it needs relative to the medical curriculum itself.
What’s interesting from a language-teaching angle is that the actual skill gap isn’t vocabulary. Most of these students can learn ‘where does it hurt’ and body-part nouns quickly enough. What’s harder is everything that sits around the clinical question: hedging appropriately so a patient doesn’t panic, reading non-verbal distress signals that don’t translate directly, knowing which register shift moves a nervous elderly patient from guarded to forthcoming. That’s the same territory as C1+ business fluency, oddly, just transplanted to a context where getting it wrong has sharper consequences than a stalled negotiation.
There’s also a reverse pressure worth naming: these students often arrive already highly fluent in academic English from years of pre-med study, which can create a false sense that the language problem is solved. It isn’t. Academic English and bedside communication are close to different skill sets entirely, one built for precision and citation, the other for reassurance and extracting a coherent story from someone who’s frightened, in pain, or elderly and confused. Fluency in one doesn’t transfer automatically to the other, and the gap tends to surface for the first time in a live clinical setting, which is a genuinely bad place to discover it.
None of this is really an argument against English-taught medical programmes; they exist for good structural reasons, and the model works well enough that it keeps expanding. It’s more an observation about where the actual difficulty sits, and it’s rarely where the curriculum assumes it does.
Sources
Cicillini, S. (2021). Studying in an English-Medium Instruction Medical Degree Program in Italy: Students’ Perspective. European Scientific Journal, Special Edition ESC 2020, 50–65, on the growth and structure of English-taught medical degrees in Italy.
Developing an effective and comprehensive communication curriculum for undergraduate medical education in Poland: the review and recommendations (2022). BMC Medical Education, on the specific challenge of adapting clinical communication training to local language and cultural context.