Like many Western countries, Germany is facing a shortage of skilled labor, particularly in the health care sector. To address this shortfall, health care professionals are being recruited from various regions worldwide. The Triple Win program requires nurses wishing to work in Germany to achieve a specified level of German proficiency before they arrive in Germany and then build on their language skills to ultimately achieve Level C1 of the Common European Framework of Reference for Languages (CEFR) once they start working in Germany.
Originally from the United States, I have lived in Germany for over four decades. I originally studied to be a German teacher and switched to translation and translation training with a focus on medical translation after putting down permanent roots here. Facing a lull in my translation business earlier this year, I decided to tackle a project that had been on my “to do” list for a long time: develop a course for non-German health care professionals working in Germany. I offered my services to the local continuing education center (Volkshochschule) and was immediately hired to teach a group of nurses and nursing trainees from seven different countries (Afghanistan, Kazakhstan, Nigeria, North Macedonia, Morocco, Tunisia, and Ukraine).
I was relieved to learn that there was no need to reinvent the wheel; excellent teaching materials were available for this target group and specifically for preparing learners for the “TELC” exam for nurses (B1/B2). I signed up for various publishers’ platforms for teachers and received invitations to attend webinars about their German as a Foreign Language (DaF, DaZ) textbooks for teaching health professionals. One webinar offered by the Hueber publishing company was entitled “Kompetent im Klinikalltag – Mit Szenarien erfolgreich unterrichten” (“Using ‘scenarios’ to teach learners competence in their everyday hospital setting”). In this case, the target learners were medical doctors rather than nurses.
The webinar was moderated by Dorothee Thommes, one of the authors of the textbook Menschen im Beruf Medizin. She interviewed Prof. Marion Grein, an expert in the area of German as a vocational language. Grein reported that until around the year 2000, the German taught to non-Germans was of a general nature, with teaching taking place primarily at schools and universities and institutions such as the Goethe-Institut, despite the fact some 21% of the learners required German for vocational purposes. By 2010, this share had risen to nearly 58%, which led to the development of teaching materials and curricula designed specifically for vocationally oriented language activities (“berufsorientierte Sprachhandlungen”).
Grein reported that by 2015, a “paradigm shift” had taken place, with “vocational language” (“Berufssprache”) now firmly established between “general language” (“Allgemeinsprache”) and “language for special purposes” (“Fachsprache”). “Berufssprache” entails similar “scenarios” across different vocations, including preparing a job applications and interviewing for a job, making appointments, phone calls, making complaints, etc., as well as similar text types, such as reports, tables, and forms.
At the same time, “Berufssprache” is embedded in a particular professional and cultural context that is best taught in courses focusing on a particular vocational group, in this case, health care. It involves culturally influenced patterns of actions, a literal translation of the nice German term “kulturell geprägte Handlungsmuster.”
Grein discussed the diversity of health concepts across cultures, noting that in the “Western world,” the World Health Organization (WHO) definition of health is typically accepted. This definition describes health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” thereby presenting a “positive” state of health. She emphasized that this concept is not universal, citing alternative views such as the perception of illness as a form of divine punishment (punitive medicine) and “balance medicine,” a holistic approach that underscores the interconnectedness of body, mind, and spirit, as notable deviations from the WHO definition.
Awareness of patients’ perception of illness is therefore an essential part of communication that goes beyond pure linguistic exchange. Grein described four models of physician-patient communication:
Paternalistic: Physician dictates treatment (“authoritarian”)
Patient-as-partner: Physician and patient discuss treatment approach
Interpretive: Physician suggests treatment, patient considers and decides
Informative: Physician informs, patient decides
In terms of language, the particular “scenario” thus determines the structure of the physician-patient conversation. Grein advocated the use of “role plays” as the most effective method for practicing these scenarios. This approach offers several advantages including its authenticity and practical applicability. Role plays also allow for the integration of multiple language skills, such as speaking, listening comprehension, reading, and writing. Additionally, a significant learning outcome of this practice is the increased confidence in real-life situations, which is developed through these “dry run” exercises.
In textbooks, “scenarios” are often presented at the end of the lesson with the aim of bringing together all of the sub-elements covered, such as grammatical items, pronunciation, and collocations. Typically, these scenarios include a “story line” and encompass three action steps involving three distinctive communication situations (e.g., a phone call, formal conversation, and an email) and three different roles. This structured approach aims to provide a comprehensive and practical application of the lesson’s content, reinforcing the students’ understanding and proficiency in various communicative contexts.
Following this theoretical introduction to “Berufssprache,” Grein turned to the specific textbook, Menschen im Beruf Medizin, calling on co-author Dorothee Thommes to elaborate on aspects of the textbook. Grein mentioned that the team of Thommes, a highly experienced DaF educator, and her co-author Alfred Schmidt, a German medical doctor, was the ideal combination for this task. The two authors had already developed the “TELC” language test for medical doctors in 2013, which led to the first edition of the book in 2016. For this edition, the team developed 139 listening comprehension exercises alone, with Schmidt’s experience as a cabaret performer contributing to the entertainment factor of the dialogues in the exercises.
Interestingly, one of the webinar participants commented on the unpopularity of role plays among the course participants, asking Grein for her perspective on this. Grein confirmed that in contrast to rote learning, which is what many language course participants have experienced in the past (and certainly medical/nursing students!), role plays force participants to leave their comfort zone and are unpredictable. Be this as it may, Grein sees role plays as the only option for simulating and practicing for real-life clinical situations. One option could be to avoid the term “role play”…
In Germany, the role plays also serve to prepare the candidates for various equivalency examinations for recognizing the credentials of health care professionals. The simulations should therefore include both the specialized vocabulary and the cultural framework. For instance, a physician coming from a “punitive” system will have little experience taking a patient history that involves eliciting information on previous illnesses, etc. Another topic with widely varying culture-dependent perspectives is pain. Depending on the source culture, the concept of “empathy” may have to be specifically explained and practiced, for example.
Grein presented the structure of the textbook Menschen im Beruf Medizin, focusing on its culturally specific topics and language use. She highlighted that in Germany, nurses and doctors commonly use the pronoun “we” when asking patients about their condition. For example, they might ask, “Have we had a bowel movement in the past 24 hours?” This usage reflects a particular cultural approach to patient interaction in the German medical context.
This also means educating non-German health care professionals about register, for example, of anatomical terms and disease names. In German, many anatomical terms have vernacular equivalents, such as “Blinddarm” for “appendix” and “Lungenentzündung” for “pneumonia.” While understanding Greek or Latin terms may suffice for comprehending professional publications, it is insufficient for effective communication with patients. Hence, familiarity with both the technical and common terms is essential for clear and empathetic patient interactions.
Regarding “cultural competence,” Grein referred to an article entitled “Cultural Competence in Nursing Muslim Patients,” which, although focused on the UK nursing context, holds significant relevance for Germany. Germany has a longstanding Muslim minority population originating from the 1960s Gastarbeiter (“guest worker”) program and has recently seen an influx of migrants from Afghanistan, Bosnia, Kosovo, and the Middle East. This demographic context underscores the importance of cultural competence in health care, particularly in understanding and addressing the unique needs of Muslim patients. Here the term “culture-sensitive medicine” is particularly important. The textbook includes various exercises that encourage self-reflection. Scenarios may encompass details such as family visits to patients and religious perspectives and values. For instance, they might explore who in the family is responsible for the patient’s care.
I found this webinar highly informative and appreciated the insights provided by the textbook author. I was particularly impressed to learn that Thommes had spent three weeks shadowing doctors working in German hospitals in preparation for writing the book. In my course for nurses, I use the textbook Linie 1 Pflege by Klett, which effectively prepares participants for the “TELC” examination for nurses. The textbook also includes authentic role plays and listening exercises, which contribute significantly to the learners’ practical language skills.
As to my German course for nurses: We concluded our 20th and final session this week and it has been an extremely enriching experience. The students have been highly motivated and quick learners. Moreover, their passion for their work is truly inspiring. This dedication is a promising sign for the future of German health care.
Karen Leube, a native of Pennsylvania, is a freelance translator and translator trainer based in Aachen, Germany. She served on the faculty of the universities of Heidelberg and Mainz (FTSK), where she offered courses on biomedical technology and general medical translation in cooperation with local hospitals and research institutions. Since establishing her freelance business in 2004, she has taught numerous continuing education courses for translators and interpreters. Twelve of her book translations have been published to date, including Thomas Häusler’s Gesund durch Viren (Viruses vs. Superbugs).
Karen founded and coordinated ATA’s GLD Members in Europe group from 2009 to 2019 and served as the GLD’s Assistant Administrator for two years prior to assuming the position as Administrator in 2022.