Learning to speak like a doctor: A linguistic ethnographic study of communication patterns in a Saudi clinical skills and simulation centre

Medical students in many non-English speaking countries are required to study their discipline through English as a Medium of Instruction (EMI). However, their prior language preparation is through English for Medical Purposes (EMP) courses, which often focus narrowly on vocabulary and grammar. Although doctors frequently describe students as having “problems in English”, the specific nature of those problems, particularly in spoken clinical interaction, remains unclear. This thesis addresses this gap by identifying the communicative demands of EMI clinical training and proposing pedagogical solutions. The study adopts a linguistic ethnographic approach, integrating ethnographic observation with detailed analysis of language in interaction. Fieldwork was conducted at the Clinical Skills and Simulation Centre in a Saudi medical college, where students practise history-taking, perform physical examinations, and engage in simulated clinics. Data collection included classroom and mock exam observations, audio recordings of interaction, field notes, and interviews with students and doctors. Grounded theory was used to generate themes, while Narrative analysis, Conversation Analysis and Interactional Sociolinguistics were applied to the micro-analysis of spoken interaction, presenting the findings in a narrative ethnographic form. The analysis identifies four recurring patterns of clinical practice: teaching and learning, Narration, Verbalisation, and Repetition. These patterns require students to manage interaction, shift registers, perform under authority, and produce extended and accurate talk. Based on these findings, the thesis proposes three interrelated communicative competences—Interaction, Speaking, and Accuracy—as central to clinical performance. These are examined through the lens of Intercultural Communicative Competence (ICC) and translated into key clinical abilities. The thesis makes three key contributions: it provides a detailed linguistic ethnographic account of clinical communication in a Saudi simulation context; theorises a grounded model of communicative competence for clinical training; and proposes a task-based framework that aligns EMP teaching with the communicative demands of EMI clinical training.