Current strategic policy at the University of Copenhagen (UCPH) aims to internationally promote education, create partnerships and collaborate in high level scientific study [1]. One specific area of internationalization is the inclusion of non-Danish students in traditionally Danish degree programs. For example, in 2013 the Faculty of Health at UCPH enrolled 116 international students, both full time students and Erasmus exchange students [2, 3]. To meet the needs of this more diverse student body, courses traditionally taught in Danish were taught in English.

At present, the majority of English medium instruction (EMI) clinical courses at the School of Medical Sciences (MedSchool) are taught through traditional lectures and elective clinical training sessions. Since 2006, UCPH has also offered a limited number of clinical courses in hospital departments taught in English. In contrast to classroom based EMI medical courses, these clinical training courses offer local and international students the opportunity to study and work together in a hospital setting with local patients and offer the Danish students to interact with the international students.

While enrolment of international students in courses at UCPH’s MedSchool has resulted in challenges related to both linguistic and cultural diversity for the students, it has also affected the teaching staff, and lecturers are adjusting to this change. Whereas some of the clinical doctors have been positive to teaching in English, there has also been some resistance to internationalization of courses and the use of English as the language of instruction and teaching. To investigate possible causes and determine whether any of these are related to linguistic proficiency, we asked Danish doctors in this clinical setting to consider how comfortable they are working and teaching in English.

The study shows that teaching and communication in English compared to Danish is assessed to be about 30 % more difficult, and that approximately 10 % of doctors find it very difficult to teach and communicate orally in English.

English is the primary foreign language in Denmark and is taught for at least 7 years during primary school. Some of the medical text books at the MedSchool are in English, but English has not previously been used as the language of instruction. Specialist doctors are to some degree trained to acquire medical knowledge in English, but an academic career demands ability also to communicate in English, as 90 % of the medical scientific literature is disseminated in English. The participating departments are common clinical departments where approximately half of doctors are specialists and half are younger doctors at different stages of specialized training. Some doctors have been on the wards for many years and others have just joined the team. Two of the departments have had a few English speaking students for several years, while teaching in English had only just been introduced at the third department at the time of the study. With 30–52 new students per semester at each department, it is necessary to draw on the skills of all doctors at the departments, as confirmed by the fact that over 80 % of the respondents, regardless of level of medical responsibility, stated that they work with students in the clinical setting. The daily classroom lessons are shared between lecturers/professors, but may also be led by senior trainees/residents, as training in teaching is an essential part of the specialist medical training program, a common trend at university hospitals [4–6]. The introduction of EMI courses was a pragmatic decision. The doctors received no formal supervision or offer of English language training. Those who had difficulties communicating in English could to some extent avoid formal teaching, but they were still faced with meetings held in English and interaction with students on the ward.

The questionnaire used in this study was not validated and relies on the physicians’ self-assessment, and generally self-assessment has been found to correlate poorly with performance in some contexts [5]. Doctors generally rate themselves highly as teachers [4], and often assume they have teaching qualifications without courses in medical pedagogy [6, 7]. It is also recognized that teachers often overestimate their linguistic abilities, their teaching and their communicative skills [8]. However, as we asked about the clinician’s assessment of the ease of teaching and instructing in English compared to in Danish, we assume that any overestimation may be equivalent in the two situations. The survey was performed during morning meetings and the respondents were expected to be representative for the staff. We have no comparable data from other departments, but find no reason to believe that the doctors in our departments differ substantially from other clinicians in a hospital setting.

This study reports the doctors’ self-assessed perceptions of strong receptive English language skills, i.e., listening and reading comprehension. Several of the doctors stated that they have fair competences in writing medical English, but while many found it difficult, they often also found writing medical Danish challenging. However, overall, the respondents in this study found oral production in teaching in English to be the most challenging, indicating that receptive language skills not were sufficient to ensure productive competences. This supports previous research, which suggests that the teachers find themselves less confident when teaching in English compared to their own Scandinavian language [9, 10]. In addition, previous studies have reported that doctors’ EMI teaching was more formal and contained less small-talk compared to teaching in Danish [9–11].

The self-assessed need for further English skills varied. Those who found their linguistic abilities sufficient ranged from one mother-tongue English speaker, to others who had lived in English speaking counties either as children or had studied abroad. In addition, there were some who may have felt their English knowledge was sufficient, because they were on their way toward careers as general practitioners.

Introducing education in a foreign language is associated with many challenges [10, 11], and in a clinical setting the challenges are not only linguistic, but also involve attitudes and opinions, and demand structural changes in the organization, and are time consuming. Danish Universities demand internationalization and acknowledge that linguistic competences for both medical students and teachers need to improve. UCPH has established a center for support, the Centre for Internationalisation and Parallel Language Use (CIP), which develops courses for improving the English skills for university staff [12–14]. A study from CIP [14] reported, that the attitudes of the academic staff towards increased use of English as the educational language at the University of Copenhagen, depended on the teaching load in English. While the MedSchool is increasingly offering courses held in English, it is doubtful if such initiatives can ameliorate the linguistic shortcomings in a clinical department, as a clinical course also involves communication with patients and other groups of employees, who may find English communication even more difficult. We find that teaching English-speaking students is a challenge to a clinical department, and our results question whether internationalization through teaching in English in clinical departments is the best possible model.