[lg policy] Linguist List Issue: English in Medical Education

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Message1: English in Medical Education
Date:28-Oct-2013
From:Catherine Richards crichards.golini at gmail.com
LINGUIST List issue http://linguistlist.org/issues/25/25-956.html 


Announced at http://linguistlist.org/issues/23/23-3425.html 

In "English in Medical Education: An intercultural approach to teaching language and values" Peih-ying Lu and John Corbett take a fresh and very contemporary look at the topic of language education in medicine. The importance of cross-cultural competence in both language and medical training is examined in detail while the methodological shift towards "task-based" language learning and "problem based" medical training is highlighted. Chapters are varied in theme and are both practical and theoretical, offering both the ELT/ESP practitioner and the medical trainer food for thought. Topics include an exploration of intercultural communicative competence training and critical cultural awareness in education, a focus on the language of medical communication and professional-patient exchanges, a practical look at the analysis of language and the use of corpora, the use of literature and visual arts in medical education, in addition to task design and course design.

SUMMARY
Chapter 1: Introduction -- English in Medical Education
In this chapter the authors offer an overview of the book and present  the current scope of English of Medical Purposes (EMP), explaining why they believe a change of direction is warranted. A brief summary of some current, popular EMP textbooks not only highlights the many approaches taken to language education in medicine and the varying emphasis on the four language skills but also that different textbooks target many different kinds of students, both native and non-native speakers, pre-clinical and practising professionals, and high and low-level English language competence. In spite of the differences, what most of these textbooks have in common is that they make little or no reference to intercultural communicative competence -- also known as cultural or cross-cultural competence in the field of medicine -- and this "curious absence" (Lu and Corbett; 2013, p4) is a neglect that, in the authors' view, needs addressing. The principal purpose of the book is thus outlined:!
  to argue the case for addressing issues of intercultural competence in medical education while finding practical ways of addressing medicine's concerns in the intercultural language classroom.

Chapter 2: Intercultural Communicative Competence in Medical Settings
In this chapter the authors take a closer look at the intercultural communicative competence of language education and the cross-cultural communicative competence of medical education, emphasising the similarities between the competences and presenting an overview of the literature from both fields.  The development of the notion of language competence is summarised, from its initial popularisation by Chomsky in the 1950s through to its re-labelling by sociolinguist Hymes (1971) as "cultural competence". Both descriptions were concerned with native speaker norms. Bryam and his contemporaries are then cited as broadening the field of description to develop "intercultural communicative competence" which described the knowledge and skills expected of native speakers within and across different language communities. Bryam's five ''savoirs'' (1997) are outlined in some detail. The savoirs were reformulated by Risager (2007) to render them more useful as a resource for the speaker!
  than the instrument of assessment they were sometimes criticised to be. The Council of Europe Framework (CEFR, 2001:2), incorporating Bryam's savoirs, and its American version, the American Standards, are described. Both sets of curricular guidelines are intended to help learners and teachers develop knowledge and sensitivity to cultural and linguistic diversity. The CEFR also emphasises foreign language acquisition (i.e. the languages of fellow European member states) as a means to acquire a deeper understanding of other cultures.  A similar set of guidelines comes from the domain of medical training: the TACCT inventory. An inventory designed to assess the level of intercultural competence training in medical schools in the US, the TACCT inventory is, say the authors, ''an elaborate extension of Byram's 'savoirs' and Risager's 'resources', or a version of the CEFR or American Standards that has been devised for medical educators.'' (p29). Specific reference to the medica!
 l profession notwithstanding, Lu and Corbett see great similarities in
 these cultural competence tables, including their limitations: they acknowledge the dangers of abstracting from and simplifying what is essentially a very complex set of learned responses and to the fact that these competence tables speak about what students should learn or what skills they should have acquired but not about how they can acquire them. They deal with the 'how' in the following chapter.

Chapter 3: Task Design in Language and Medical Education
The authors now turn to teaching and learning practices with a particular emphasis on task-based learning (TBL). TBL is an approach that Lu and Corbett consider well-suited to the aim of developing intercultural communicative competence and is an approach that has many similarities to the long-established practice of using problem-based learning (PBL) in the medical classroom. A brief overview of TBL is presented before moving on to a comparison of the language learning approach with PBL. There are some important theoretical differences -- not least that medical trainers don't expect their students to acquire medical skills simply from carrying out meaningful pedagogical tasks -- but both approaches share the common belief that students will learn complex skills and content more effectively when engaging in problem-solving activities with a defined objective. The shortcomings of each approach are touched upon, including the fact that neither approach is, in its bare form, mu!
 ch concerned with intercultural communication. But, argue Lu and Corbett, they both have great potential to be, and the rest of the chapter focuses on how TBL and PBL can be used to address intercultural issues in the classroom.

Chapter 4: Exploring Medical Language
Having considered, broadly, task design in the language and medical classroom, the authors turn their attention in this and the subsequent chapter to the nature of medical language. 

Acknowledging the enormity of the field -- a single chapter can't do more than scratch the surface -- Lu and Corbett nonetheless are keen to underline the importance of sensitising the medical student to the distinction between professional and so-called 'everyday' discourse -- that is, discourse with and between non-professionals. As far as language analysis and investigation are concerned, the authors focus on digital resources as the data source, arguing that both medicine and language instruction have been transformed by the development of information technology over the last few decades. The proliferation of medical and healthcare advice sites, databases and forums means that patients can access information that hitherto had been the preserve of the professional. The professional, too, has a wealth of reference material available at the touch of a button. The analysis of language has also been transformed, not only by the availability of corpora online -- including the !
 existence of the web as a corpus -- but by the availability of increasingly sophisticated tools to analyse these vast collections by the linguist, the teacher and the learner alike. The authors present a brief overview of healthcare portals before looking in more detail at corpora and what can be learned from them, from the broader perspective of sociolinguistic concerns through to an analysis of collocations and frequency and key words analyses.  Digital data is presented as a rich source of language that can be used by course and material developer, teacher and learner to provide insights into significant cultural concerns, attitudes and values.  What it does not do, the authors caution, is replace the teacher herself or the insights to be had from an analysis of face-to-face interactions, the topic of the subsequent chapter.

Chapter 5: Medical Talk
This chapter aims to review the literature from diverse fields -- sociolinguistics, ethnology, applied linguistics and medical education -- relating to face-to-face healthcare interaction. It is indeed a dense chapter that looks at professional-patient communication, the use of translators, professional communication and the reporting of case histories, non-professional discourse, e.g. patients' talking about illness ,framing spoken discourse and additionally the problems associated with switching between technical and everyday language.

The objective is to illustrate how all participants in any interaction navigate difference and diverse cultural boundaries, be they differences in geographical, linguistic, ethnic or racial background -- or indeed differences in social class and professional status. Conversation analysis (CA), a tool for the best part of half a century in language studies is also, perhaps for obvious reasons, the preferred method for much analysis of professional-patient interaction. The authors present various ways of using conversation analysis to help train professionals for a myriad of interaction types from communicating with patients from different backgrounds or through an interpreter through to communicating with senior professionals during training. What the use of recordings of conversations and observations of clinical interactions brings is the opportunity for trainees to develop and demonstrate knowledge, attitude and skills in safety; they provide a rehearsal for some of the ti!
 me-constraints and stresses of real-life medical interactions.

Chapter 6: Critical Awareness in Medical Education
Having considered certain characteristics of medical language the authors move on to consider the role of critical cultural awareness in language education for medical students.  How to define critical cultural awareness is discussed before they give an overview of the contribution of the sociology of medicine and medical anthropology in the development of so-called ''western'' medicine. The theoretical is balanced by some practical ideas for the language classroom using case studies and other activities in the final section. Byram's ''savoirs' are referred to again -- they are the 'fil rouge' running through the book -- and we learn that critical cultural awareness is the least defined and most controversial of the savoirs. This is a tricky area to navigate for readers unfamiliar with the subject of critical cultural awareness or indeed unfamiliar with the disciplines of anthropology or the sociology of medicine, though it is an interesting chapter and full of thought-provo!
 king ideas. Lu and Corbett discuss the different perspectives on illness and disease taken by some sociologists and consider issues of power and authority in medical encounters with reference  to compliance and trust. The authors also suggest practical activities that encourage medical students to consider roles in medical encounters and the concept of the 'good' patient. Then, drawing upon anthropology, the authors consider the healing/curing distinction, where curing relates specifically to the clinical treatment of a disease and healing suggests dealing with the wider experience of illness as seen by the patient. The authors suggest that while sharp distinctions between conventional/biomedical medicine (curing) and alternative approaches (healing) are unhelpful, it nonetheless remains a useful tool for developing critical cultural awareness in medical education. Medical 'pluralism' in Japan is discussed -- where so-called conventional and alternative approaches successfu!
 lly co-exist -- as is the idea of medical metaphor and the experience 
of birth in different cultures. This is a dense and varied chapter but one which succeeds in persuading the reader that students of medicine can be presented with topics and texts that deal with common practices and procedures in which all manner of attitudes, values and beliefs can be evidenced.

Chapter 7: Literature and Language in Medical Education
In dealing with literature separately from the visual arts (the subject of a subsequent chapter), Lu and Corbett explain that while the language teacher may be quite familiar with the use of literature in the classroom they might be considerably less familiar with the techniques for interpreting and discussing the visual arts -- which also includes film and television. Literature finds a ready place in the classroom concerned with intercultural communicative competence as it allows student to witness an alternative perspective, to be presented with different values systems and, Lu and Corbett say, ''it invites both an emotional response and a reflection on that emotional response." (p143).

Examples of suitable texts and sources of suitable texts are given but the authors acknowledge that materials on their own may not be sufficient to maximise the benefit of using literature in the classroom -- in short, there's no substitute for skill and experience. Half of the chapter is dedicated to practical advice dealing with the selection of suitable texts, how to design effective tasks using literary texts, best practice when dealing with reading literature and suggested ways to monitor students' responses and their skills development -- an important aspect of the teaching process but one often neglected.

Chapter 8: The Visual Arts in Medical Education
This chapter expands on the concept of visual arts by discussing not only painting but also television drama and film. Much of the chapter is practical in nature and includes an interesting case study -- the story behind the cover painting 'A Loving Skin-graft' by Shi-Qiao Li. The use of painting has a long tradition in language instruction, as visual art lends itself well to the practise of targeted language. Corbett (2003: 139-165) goes a step further by adding aspects of visual literacy, an approach which treats all visual images as culturally constructed messages and one, say the authors, that encourages the development of one of Bryam's 'savoirs': 'knowing how to interpret and relate information'. The section on the moving image -- that is, film and television -- is both practical and advisory in nature. Ideas for teaching using film or tv are discussed and a list of questions are included that can serve as a framework for addressing the range of medical issues that fil!
 m and television portray. Caution is advised however when it comes to the use of popular medical dramas -- a type of television show popular the world over.  Citing Czarny et al. (2010) , the authors remind readers that medical ethics and ethical dilemmas are not synonymous and that simply exposing students to challenging film or television material may not lead to the kind of learning the teacher intends, or indeed any kind of learning.  Popular TV dramas and film are less concerned with portrayals of professionalism than with deviation from the norm.

Chapter 9: Course Design for Intercultural Language Education in Medical Setting
The final chapter takes a broader look at the design of a language course that incorporates some of the principles discussed in the previous chapters.  It is almost a stand-alone chapter that gives excellent advice on what to consider when designing from scratch or adapting an existing course.  The chapter discusses a number of points including principles of English for specific purposes, environment analysis, content and sequencing and monitoring, assessment and evaluation. Suggestions range from the more general -- environment analysis is clearly context-dependent and general in nature -- through to the detailed: a list of suggested units in a medical English course, organized around themes/topics, as well as a more detailed table of the various goals of one sample unit.

The chapter, like others, also includes 'Activity' box-outs which encourage the reader to reflect on his or her situation. 

EVALUATION
The authors have written a highly readable, thought-provoking book in response to a rapidly developing educational field.  They successfully highlight the parallels between inter-cultural communicative competence and cultural competence in medical education and suggest valid ways of exploring medical language and medical talk by using contemporary digital resources.

The chapter on corpora is well-presented and certainly useful for the teacher looking to begin exploring this area. They also present useful ways of exploiting visual arts and literature in the classroom and a step-by-step overview of course design which any medical or healthcare English ESP course designer should find useful.

The book is aimed at a large group that at one extreme includes seasoned language specialists without any medical background and at the other medical practitioners with little experience or knowledge of language analysis or presentation. This could be its downfall, but the volume is well-balanced between the theoretical and the practical and is supported by current and well-respected research drawn from a range of fields. Lu and Corbett do not shy away from acknowledging controversy or shortcomings -- their warning that much television medical drama may not be as useful as other learning resources is welcome.

There are many books concerned with intercultural communication and education currently in print that, in reality, contain little that might be said to be practical or teacher-friendly.  Lu and Corbett don't forget the classroom, the student or the teacher, and they offer a good range of task ideas and activity box-outs that are usually reflective and appropriate for group work or training sessions.  Sometimes, however, the brief overview such a book demands results in a rather sketchy summary. The chapter on task based learning is overly simplified though in their defence Lu and Corbett acknowledge this, suggesting the brief overview is enough to ''suggest its attraction to intercultural language educators'' (p37).   Likewise chapter 5 attempts to cover a vast number of complex areas under the heading 'Medical Talk' and is the least cohesive in the book. 

These small concerns aside, the book is nonetheless a fascinating volume and will certainly be of great interest to English teachers working in the medical and healthcare field.

REFERENCES
Bryam, M. (1997) 'Teaching and Assessing Intercultural Communicative Competence'. Clevedon: Multilingual Matters.

Corbett, J. (2003)  'An Intercultural Approach to English Language Teaching.' Clevedon: Multilingual Matters.

Czarny, M.J., Faden, R.R. and Sugarman, J. (2010) Bioethics and professionalism in popular television medical dramas. 'Journal of Medical Ethics' 36 (4), 203-206.

Hymes, D.H. (1971) 'On Communicative Competence'. Philadelphia: University of Pennsylvania Press.

Risager, K. (2007) 'Language and Culture Pedagogy'. Clevedon: Multilingual Matters. 

Catherine Richards is a PhD student at the University of Swansea in Wales.  She is investigating the nature of healthcare vocabulary -- specifically the vocabulary of radiography. 


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