The English for Healthcare Virtual Symposium, in common with its big sister the English for Healthcare Conference, aims to encourage an exchange of ideas to stimulate discussion and to provide a platform for the presentation of new approaches to the teaching and learning of language and communication in medicine.
We welcome proposals that relate to classroom practice and proposals that are research-based and help to develop our understanding of how language is used for the practice of medicine and healthcare. The event attracts language teachers and communication skills trainers working with health professionals, both in training and in the workplace, and practitioners from the medical translation and interpreting field.
Areas/Themes include but are not limited to:
Content-Based and CLIL
English Medium Instruction
Medical Academic English
Language skills in EMP (Reading, Speaking, etc.)
Assessment (e.g., Occupational English Test)
Technology in the English for medical purposes classroom
Task-based and problem-based learning in English for medical purposes
Role plays / Simulation in the English for medical purposes
Corpora in English for medical purposes
Discourse analysis in English for medical purposes
Professional practice and discourse
Communication skills training for healthcare
Interpreting /translation for healthcare
Medical Humanities in the English for medical purposes
TYPES OF SESSIONS
Please note that sessions are shorter than in the face-to-face English for Healthcare Conference, scheduled to be held in September 2022.
Workshop: a practical, interactive, how-to session – 45 minutes plus 10 minutes questions.
Practice-Oriented Presentation: focused on classroom practice – 15 minutes, plus10 minutes questions.
Research based Presentation: focused on completed research – 15 minutes, plus 10minutes questions.
Dynamic E-Poster: Dynamic e-Poster presenters have 10 minutes to present and an additional two minutes for questions.
DEADLINE FOR RECEIPT OF ABSTRACTS: 28 March 2021
300 words maximum (no references)
Do not use any special fonts, such as bold print or caps (italics fine)
Do not add tables, photos, or diagrams to your abstract
Do not indent your paragraphs, leave one space between paragraphs instead
Your abstract should clearly summarise the content of your session/poster
Please indicate what type of session your submission is for.
Virginia Allum, EALTHY’s clinical nursing advisor and Head of Medical English for Specialist Language Courses, is a busy woman. As well as writing courses, training teachers and providing expertise and support for EALTHY and SLC, she is an item writer for the Occupational English test (OET). Remarkably, she also works part time as a Registered Nurse, bringing her unique blend of experience, humour, and knowledge to patients across the Western Isles off the coast of Scotland. Yesterday she received the first dose of the Pfizer vaccine. This is her story.
I feel very privileged to have received a Covid-19 vaccination today at NHS Western Isles where I work. The procedure had all the hallmarks of a pandemic response. We arrived with our masks on, sat in chairs spaced the correct distance apart and received information about the vaccine (the Covid-19 mRNA Vaccine BNT162b2 or ‘Pfizer’ vaccine). Important questions were asked to ensure all precautions were taken and then it was on to the ‘vaccination room’. Consent given, I had my injection, or ‘jag’, as it is known here on the Isle of Lewis (I haven’t been able to find out why it isn’t ‘jab’…in any case, I was used to the term ‘shot’ in Australia).
I returned to my chair in the waiting room where I was observed for 10 minutes and then sent home to rest. I hope to receive the second dose in 12 weeks.
It started me thinking about all the vaccinations I have received in the past, vaccinations which protected me from some very nasty diseases. Some of you will know that I was born in Australia and so started my vaccination history there.
Triple Antigen and Polio
In 1953, the Diphtheria-tetanus-whole-cell pertussis vaccine (DTPw) was introduced. This was a 3-dose infant-based schedule which I was to receive 5 years later. In Australia, mass production of the inactivated polio vaccine began in July, 1956, two years before my birth, so I was amongst the early youngsters vaccinated against poliomyelitis. The oral Sabin vaccine (live attenuated oral polio vaccine) was not registered until 1964 after trials in Tasmania. Australia and the Western Pacific Region was to be declared polio-free in 2000.
Travel overseas: The International Certificate of Vaccination (the ‘Yellow Card’)
This record was developed by the WHO and one which my parents had to have completed before we travelled from Australia to the UK (by boat, via South Africa) so my father could work there. I was vaccinated against smallpox (and still have the scar on my upper arm), cholera and yellow fever. My first vaccinations were given to me by my grandfather (a GP) who refused to give me the boosters as he didn’t want to be remembered as ‘Grandpa who gives needles’. A different GP was sought for the boosters!
Liver with Hepatitis B infection highlighted inside human body and close-up view of Hepatitis B Viruses, medical concept, 3D illustration
In 1982, a serum derived hepatitis B vaccine was registered for use in adults and in 1985, for neonates. In 1986, vaccination using 3 doses was recommended for at-risk adults, e.g. Aboriginal and Torres Strait Islanders, immigrants and refugees from high risk countries, healthcare workers, IV drug users, recipients of factor VIII or IX blood products and household and sexual contacts of hepatitis B carriers. Between 1987 and 1988 two recombinant hepatitis B vaccines were registered in place of the serum derived vaccine. I was given the 2-dose vaccination against Hepatitis B in 1987.
In June, 2006 a 4-valent human papillomavirus vaccine was registered for use in females aged 9–26 years as a 3-dose schedule. I was not in the age group to receive this vaccine, but my daughter was proud to receive the vaccine which had been developed by the University of Queensland in Australia by Professors Ian Frazer and Jian Zhou.
And now, today I have received a new type of vaccination.
‘Pfizer is collaborating with German biotech company BioNTech to focus on a technology called an mRNA vaccine. Unlike conventional vaccines, which are produced using weakened forms of the virus, RNA vaccines can be constructed quickly using only the pathogen’s genetic code. Many standard vaccines work by injecting a dead or weakened form of the pathogen into the body in preparations that are designed not to make you sick but rather to build immunity. The key to building this immunity is that the portion of the pathogen called the antigen trains the immune system to recognise and respond to the infectious agent.5 RNA vaccines work by introducing into the body a messenger RNA (mRNA) sequence that contains the genetic instructions for the vaccinated person’s own cells to produce the vaccine antigens and generate an immune response.’
How far have we come from the 18th century when Edward Jenner inoculated a 13 year-old-boy in 1796 with cowpox to demonstrate immunity to smallpox. Two years later the first smallpox vaccine was developed.
The virus that the Covid-19 vaccine is fighting is tiny; the coronavirus is 0.1- 0.5 nanometres. (a red blood cell is 7-8 nanometres). To my mind, this makes the development of a vaccine against such a tiny ‘monster’ a miracle!
It has become a bit of a cliché in OET circles that students and teachers alike face a lack of high-quality preparation materials; a new title by a well-respected author in the field is therefore bound to cause excitement. OET Speaking and Writing Skills Builder (Nursing and Medicine) by Ros Wrightis aimed at both self-study and classroom settings and with its focus on the development of techniques required for the speaking and writing OET sub-tests (nursing and medicine), will be welcomed by both independent learners and classroom teachers. It is the companion title to OET Reading & Listening Skills Builder (All Professions), which I have reviewed separately, and this review looks both at the print and the Digibook editions of the book. Like the Reading and Listening book, OET Speaking and Writing Skills Builder was written with input from two medical advisers, who are credited on the front covers.
As companion texts, it is perhaps surprising that the organisation of the Writing and Speaking book differs from that found in the Reading & Listening text. In OET Speaking & Writing Skills Builder, there areeight rather than ten topic-focused units, such as respiratory (covered in Units 1 & 4), endocrinology and psychiatry. There is no cross over with the Reading and Listening book in terms of unit topics, meaning autonomous learners and students on a long-stay exam preparation course using the books side by side may find themselves dealing with two distinct topics at the same time. However, this does mean that they also gain exposure to a greater range of topics.
Each unit opens with an OET Speaking section, which looks at the skills required to meet the clinical communication aspects of the Speaking sub-test and patient-centred care in the workplace. There is then a Medical Focus section linked to the unit’s topic, sections dealing with Grammatical Expression and Lexis and finally OET Writing. This final section makes significant use of the SBAR framework and also helps students to make principled choices when selecting which information to include in an OET letter.The grammar and lexis areas are largely well chosen, covering the language which many OET candidate struggle with such as articles, softening questions and asking for consent; four sections on dependent prepositions out of eight for Lexis does feel a little imbalanced, notwithstanding the issues many learners face with this language point. Additionally, given the C1 level of OET, the tense review sections seem pitched a little low.
The book is rich in additional resources, audio scripts and answer keys, including some very useful case notes, sample letters and speaking role play cards and a grammar reference, making the book ideal for self-study. I particularly liked the sample letters with their detailed annotations highlighting good practice and the additional further commentaries although I was surprised to see one sample letter of 221 words described as being of an appropriate length given that OET asks test takers write a letter of between 180 to 200 words.
The print edition is attractively laid out in full colour and the pages breathe well thanks to plenty of white space. Additional bite-size hints about exam strategies are presented in the frequent blue Test Tip boxes and are a strength. Learning objectives for each of the five sections are given at the beginning of each unit; the addition of some kind of review activity or reflective task at the end of each unit or cycle of three units would have been a welcome addition.
All of the book’s contents can be accessed through Express Publishing’s own online platform and Digibooks app. Pleasingly, the code for this online version is provided at no extra charge, bound in with the hard copy edition, and for student accounts is valid for 15 months from the activation date; teachers on the other hand can re-activate the apps for free. CD recordings of the audio tracks are available separately for a small charge of just under 8 Euros. A stand-alone digibook edition is available, with a 15% reduction on the price of the printed edition.
The user experience for students is mixed. Students who are studying on their own will welcome the opportunity to access the whole book, including the audio recordings, on a PC or a mobile device at no extra charge and the flexibility this offers is clearly welcome. The digibook edition has flexible navigation, with each activity on its own page. These are accessed linearly using back and forward arrows or via a drop-down menu which makes it easy to jump to a specific exercise anywhere in the book. However, as these pages are labelled with the exercise number only (e.g. Exercise 6.2), it is not self-evident how each activity relates to the five parts of the unit (Speaking, Medical Focus, Grammatical Expression, Lexis and OET Writing). Also, the first number does not correspond to the unit number, making quick navigation difficult. Hopefully, this is an issue that the digibook team can address easily in the future. The serif font used looks dated and the non-responsive nature of the page frame means there is often a lot of empty white space in shorter exercises, giving a rather dated user experience. On a mobile phone, this lack of non-responsive design meant that I had to place my device on its side to fit the page on screen: holding the phone normally meant constant scrolling left to right. Answers requiring me to type in a word were also problematic: many mobiles default to capitals for the first word in a new field, but the system automatically marks as wrong a correctly spelled word with an erroneous first capital letter.
Teachers using the digibook to project via a projector or an interactive board/panel will welcome the opportunity to project these unit segments and this will work equally well in face-to-face, online or in hybrid classes. However, the publisher seems to have overcomplicated its LMS, with a hierarchy of users (student, teacher, school manager, school master and parent), each with its own lengthy user manual. I have not been able to trial this with a group of students, butthere are options for progress reporting, homework and assignment setting and even attendance checking.
OET Speaking & Writing Skills Builder (Nursing and Medicine) is a welcome addition to the slowly growing choice of materials available to teachers and students who are studying independently. Its focus on speaking and writing skills development meets the needs of candidates who are not familiar with the requirements of the relevant OET sub-tests and while the middle sections are sometimes pitched low, they are described as optional. As I wrote for my review of the companion Reading and Listening book, many students preparing for OET fall into the trap of thinking that exam practice alone is the key to exam success and this book provides something different and for that itdeserves praise and success.
Published 2020, Express Publishing.
160 pages; 31,79 Euros for print book and digital access currently reduced to 25,43 Euros (or 25,43 Euros currently reduced to 20,34 Euros for the digibook only); Audio CDs 7,95 Euros
Until recently, candidates preparing for the Occupational English Test, plus the teachers supporting them, have faced a relative lack of high-quality published preparation materials. OET Reading & Listening Skills Builder, written by Tom Fassnidge, will therefore be a welcome addition to the growing array of OET materials, as will its companion title, OET Writing & Speaking Skills Builder (Nursing and Medicine).
Tom is an experienced OET teacher and materials writer who has worked for one of the UK’s leading OET Premium
Providers; this new title provides candidates with the techniques required for the reading and listening (all professions) sub-tests and is suitable for either self-study or classroom use.
OET Reading & Listening is divided into ten units which are organised by topic. Besides the usual clinical areas (lifestyle issues and infectious diseases), the topics also include wider issues such as training and best practice plus technology and social issues. Each unit includes a reading and listening focus plus a language/skills
focus. Beginning in Unit One with an overview of the types of texts and questions found in the reading and listening sub-tests, the reading and listening focus sections then look at each part of the reading and listening sub-tests in turn and repeat this structure throughout the remaining nine units. The language/skills focus cover the many sub-skills required for success in OET, including gist, detail and purpose and useful language such as collocations, modals, and semi-modals plus a very useful section on identifying and avoiding distractors. In total, the book provides the
equivalent of more than two complete OET Reading and Listening sub-tests. Of note is the author’s comment in the introduction that the texts and exercises are designed to be “a little easier than the real test” to help students to focus on the development of the techniques required for OET success. This reflects nicely the book’s title, although it is perhaps a little disappointing that there are no complete practice tests at the C1 level provided at the back of the book for students to gauge their level on completion of the book.
Like the Speaking & Writing volume, the hard copy edition of OET Reading & Listening Skills Builder includes additional resources, audio scripts and answer keys, making the book ideal for self-study. Furthermore, all of the book’s contents can also be accessed through Express Publishing’s own online platform and the Digibooks app. Unusually, the code for this online version is provided at no extra charge, bound in with the hard copy edition, and for student accounts is valid for 15 months from the activation date; teachers on the other hand can re-activate the apps
for free. CD recordings of the audio tracks are available separately for a small charge of just under 8 Euros.
Unfortunately, the digibook edition of OET Reading & Listening Skills wasn’t ready at the time of writing this review but the publisher states that the online/app edition will be highly interactive. The teachers’ guide for Express Publishing’s online platform is very comprehensive and perhaps almost overwhelming in its detail, while the platform itself allows students who are part of an taught group to check what has been assigned to them as homework, complete it online, have their answers automatically corrected and see their progress. Individual learners are also well catered for, being able to complete all of the book’s activities (including listening ones) online and receive instant feedback.
The book is attractively laid out in full colour, with plenty of white space on the page for the contents to breathe. Frequent blue Test Tip boxes, presented as speech bubbles, provide additional bite-size hints about exam strategies and are a strength. It was good to see learning objectives for Reading, Listening and Language and Skills presented at
the beginning of each unit; the addition of some kind of review activity or reflective task at the end of each unit or cycle of three units would have been a welcome addition.
I am very happy to recommend this and its companion Speaking and Writing volume to teachers and students who are studying independently. The focus on skills development will be particularly welcome to teachers and students who value a focus on developing their skills. Many students preparing for OET fall into the trap of thinking that exam
practice alone is the key to exam success and this book is brave in providing something quite different and for that it deserves praise and success.
Published 2020, Express Publishing.
158 pages; 31,79 Euros for print book and digital access (or 15% discount for digibook
only), currently reduced to 25,43 Euros; Audio CDs 7,95 Euros
Spoonerisms or malapropisms, commonly referred to as slips of the tongue, are a perfectly natural aspect of communication. They’re also the source of much amusement. Who doesn’t enjoy hearing lexically confused celebrities – Justin Bieber once claimed he was ‘detrimental to his own career’ – though I reserve most of my delight for the communicative cockups of politicians. Trump and Bush Jnr are well known for their weird wordery, but here’s a goody from Tony Abbott, former PM of Australia: ‘No one, however smart, however well-educated, however experienced … is the suppository of all wisdom.’ I feel a joke forming – no. Can’t. Too rude.
Remember former US Vice-President Dan Quale? He famously came out with ’I stand by all the misstatements that I’ve made’ while Richard J Daley, former mayor of Chicago, uttered some gems during his term in office, once calling a tandem bicycle a ‘tantrum bicycle’ and referring to Alcoholics Anonymous as ‘Alcoholics Unanimous’.
These days, we’re certainly more aware of slip-ups, errors and abuses because so much is being written, not only in emails but on social media, in forums, blogs and newspaper comments sections. We also seem far more tolerant of spelling mistakes and grammar oddities (assuming we’ve spotted them in the first place). If you doubt this, correct someone in the Comments section of a newspaper and see what happens. The so-called grammar police – who really seem more concerned with punctuation and spelling than structure and form – get short shrift when they pop up to correct a misplaced apostrophe.
Meaning is an altogether more slippery beast
But meaning is an altogether more slippery beast. When communication takes place, and language competency is not called into question – that is to say, both participants are judged to be proficient in whatever language they’re using – each participant assumes that lexical choices are deliberate and appropriate. You rarely see vocabulary being corrected. If you tell me you’ve eaten four doughnuts, I’m not going to be too impressed, but I’ll believe you. I may well seek confirmation – four? FOUR? – but I won’t wonder if you really meant one or that you intended to say sandwich. If you tell me you’re a plumber, I won’t wonder if you meant fitness instructor. It gets trickier, though, when faced with less concrete, stodgy facts. ‘How are you feeling today’ or ‘Does this make me look fat?’ doesn’t always lead to an unequivocal response. I’m likely still confident that you’ve chosen the word you wanted, but I may not always be sure of the accuracy of the message or its veracity. Aside from bare faced lies, there are white lies, half-truths, evasive responses and vaguery. You could write a book on these aspects of communication – plenty of people have. I’ll talk a bit about it in my next blog post.
But what happens when a mother tongue is not shared, or language competency is not evenly matched? With their multicultural populations, this is a typical scenario in many urban medical encounters in countries like the UK, the US Canada and Australia. Even without the challenges of accent and pronunciation, grammar issues and health literacy issues, miscommunication because of vocabulary is a common source of frustration, confusion and, sometimes, medical error. Unlike the rarefied atmosphere of the classroom, where students are safe to make mistakes, and where there’s time to investigate the collocations, connotation, range of meaning, register and appropriacy of a single word, a real-time medical interaction permits no such analysis.
Meaning in medical encounters
When we speak about communication issues in medical encounters, we’re often referring to those interactions where the patient doesn’t understand or fully understand what their doctor is saying. Over the last decade or so, many papers have investigated just how little medical terminology patients understand, and the impact of not understanding on the patient’s health and well-being. (See for example Chapman, K., Abraham, C., Jenkins, V., & Fallowfield, L. (2003)). Studies like these continue to appear in disciplines other than applied linguistics and for a variety of languages and areas of medicine.
Some linguists and healthcare communication researchers have shifted their focus away from what patients don’t understand and on to what they do understand and how they use the medical terms that they know. (Fage-Butler & Jensen (2016) and Koch-Weser, de Jong & Rudd, (2009; 2010) are well worth reading.) These studies reveal a considerably more complex picture than the standard understand/do not understand dichotomy. The so-called ‘expert patient’ – often a patient living with a chronic condition – has been described as having a kind of ‘vertical knowledge’ which suggests that they can use ( a lot of complex) medical terminology relevant to their condition. In light of these findings, assessing what the patient understands or doesn’t understand should be an essential part of the consultation. As Fage Butler and Jensen (ibid) write:
Appropriate pitching of terms can avoid the potentially damaging eﬀects of poor communication brought about by inappropriate (too complex or too simple) use of terms. This is not an easy task. It takes time for a health-care professional to establish what terminological level is appropriate, which can be problematic in an already time-pressed consultation.
The authors also make clear that we need to be cautious in assuming that patients and medical professionals are using medical terminology in the same way. This is a hugely important point. Meaning divergence, as this is called, can often pass unnoticed with both participants assuming a common, shared meaning where in fact none exists. For example, in oncology, talk of disease progression may pass without comment, but the patient may not have understood that this is not something to be pleased about. Another example of this – and it’s one I like to trot out because it a great example – is the term ‘chronic’. How many international health professionals know that it can be used in certain varieties of English to mean ‘bad’? If I tell my doctor my pain is chronic because it’s intense, the doctor is likely to understand that I’ve had it for some time and the remark may pass without comment. Dahm (2012) found that people (and that includes medical professionals) are more aware of meaning divergence when they’ve had personal experience of it. She also found that the very concept of meaning divergence can be difficult to grasp for some people. For some, it can mean that the severity of my condition, the intensity of my pain or the impact on my life is not being fully understood or appreciated by you.
The role of experience in how we understand words
Experience also plays a role in how we all use and understand words. Patients may use terms differently to medical professionals because as patients we emphasise the experience of the condition or symptom, and, just as personal experience of a condition varies from one person to another, so do the meanings attached to the words we use. In the same way, medical professionals will understand different aspects of the same word depending on their experience and area of expertise. A psychiatrist will have quite a different understanding of the term ‘schizophrenia’ than a GP. The patient with schizophrenia, in turn, possesses a different understanding to both psychiatrist and GP. This is a fascinating area. (Professor John Skelton, EALTHY President, alerted me to this a few years ago, though he expressed it far more elegantly than I have just done.)
So, as teachers of medical English what can we take from this? Well, the obvious thing is that Meaning is a Minefield (there’s a good summary of just how complex it is to talk about meaning here: https://plato.stanford.edu/entries/word-meaning/ ) and our students should be made aware that simple translations won’t necessarily cut it. Words have very intricate relationships with other words and with the context in which they’re used. Developing our students’ awareness of this seems crucial. And as human beings, our relationships with each other and how we communicate are equally as intricate. We teachers can never hope to give our healthcare students all the knowledge they need to be competent communicators when they leave our classrooms, but we can help them acquire the skills they need to become effective communicators. These skills will develop as their professional skills and experience grow. Medical professionals using English in the workplace, more than anything else in my view, need the linguistic means to negotiate meaning with their patients and their colleagues, and to negotiate meaning with skill, with sensitivity and with the awareness that each and every interaction is unique.
I’ll leave you with a few medical malaprops that had me in stitches. Literally. Not. (😉 )
She had postmortem (postpartum) depression
Heart populations and high pretension (palpitations and hypertension)
A case of headlights (head lice)
Sick as hell anemia (sickle cell anemia)
The blood vessels were ecstatic (ectatic)
The patient was treated for Paris Fevers (paresthesias)
It was a non-respectable (unresectable) tumor
Nerve testing was done using a pink prick (pinprick) test
I had smiling mighty Jesus (spinal meningitis)
As we move further into the Coronavirus pandemic, I started wondering how the world’s populations felt at a similar stage of the 1918 Influenza pandemic. An article titled ‘”Destroyer and Teacher”: Managing the Masses During the 1918-1919 Influenza Pandemic’ (1) highlighted some interested social behaviours.
I recommend reading the entire article especially the epilogue which may have you shaking your head sadly, especially George Soper’s comment in his 1919 article, The Lessons of the Pandemic (2), that : “.. . This may all seem very discouraging but it need not depress anybody. .. To rightly measure a difficulty is often the first step toward overcoming it.”
In her article, Nancy Tomes gives a summary of the responses to the 1889-1890 Russian Influenza Pandemic and the 1918-19 Spanish Influenza Pandemic. As you read through the events of the timeline, you’ll no doubt have some ‘light bulb’ moments as you identify some examples of current behaviour patterns which are occurring.
1889-1890 Russian Influenza
flu thought to be caused by ‘microorganisms floating in the air’
contagiousness of influenza (the ‘grip’) not appreciated: Public Health (PH) authorities downplayed the importance of the virus coming to the US from Russia and left its treatment to private physicians
medical advice generally to stay home and recover and keep infected people from others. No advice on how to avoid contagion
bacteria causing cholera, syphilis, typhoid and TB discovered; public health movement expands
flu identified as a ‘germ disease’, named ‘x-germ’.
flu described as a respiratory disease which could be transmitted through coughing, sneezing and spitting.
advice for minimising spread: quarantine, isolation, disinfection, ventilation and personal hygiene
other ideas still current – spread of flu on library books and postage stamps
expanding mass media – newspaper reading at an all-time high
By the 1918s, some of the issues facing current PH authorities and economists were starting to become evident:
flu was seen as a ‘crowd disease’. More people packed into crowded cities.
increase in mass gatherings, e.g. troop ships and theatres. During the 1918 pandemic, a ban on mass gatherings for people of all ages was instituted.
By 1918, it was noted that the US relied on large cities for their expanding economy. Businessmen resisted quarantine measures like the shutting of factories. So, the question is raised about contagion control versus a stable economy (Familiar?)
Comments suggesting people were affected more by fear than influenza started to appear in newspapers. Words such as ‘fear’ and ‘panic’ were found in newspaper articles (Familiar?)
the public appeared confused by the PH message: unsure about terms such as ‘essential versus non-essential services’
“The pandemic revealed how economically important public amusements had become to local economies.”: in addition, it was clear that city dwellers relied on theatre, cinema and concerts for their social life.
There were so many parallels in the article with our current situation that I was keen to read the author’s conclusion and/or forecast about any future pandemics, remembering that the article was published in 2010. I think it is worth adding the entire epilogue. Areas in bold are mine and refer to points which may not have played out as the author suggests or which I think the author foretells with unfortunate accuracy.
“Even now, nearly 100 years later, the image of the influenza pandemic as “destroyer and teacher” remains a compelling one. For all the greater knowledge we now possess about its genetic makeup and natural history, the influenza virus still retains the capacity to remind us how difficult disease prevention and control remain in modern societies. Do we have any better chance of controlling a “crowd disease” such as influenza in the early 21st century, compared to 1919?
In some important ways, the answer is probably yes. To begin with, we have a new line of defense that was missing in 1918–1919, in the form of antivirals such as Tamiflu® and the capacity to produce effective flu vaccines. These measures play an essential role in the modern approach to influenza pandemics. Yet they have their limitations: stockpiles of Tamiflu can be quickly used up by physicians seeking to calm panicky patients, and the manufacture of flu vaccine depends on a complicated and in some ways antiquated system of production. Thus, the discovery of flu wonder drugs and vaccines has by no means diminished the need for nonpharmaceutical interventions. As the Centers for Disease Control and Prevention guidelines for pandemic control make evident, they have an essential role to play in slowing down influenza’s spread long enough for these measures to be perfected and distributed.62
It may also be easier for people to understand the rationale for social-distancing measures now than it was in 1918. First, the proliferation of fictional and journalistic portrayals of killer epidemics has created a popular apprehension of pandemics in general and influenza in particular that did not exist in 1918. Inventive film makers and novelists have spun dramatic scenarios, some entirely hypothetical, some loosely based on real diseases, about the dangers of rapidly spreading plagues. Books and films, among them Michael Crichton’s Andromeda Strain, Stephen King’s The Stand, Richard Preston’s The Hot Zone, Terry Giliam’sTwelve Monkeys, and Francis Lawrence’s I Am Legend, to name only a few, have taught successive generations of movie and TV watchers to fear the microbe. Real-life pandemics, including HIV/AIDS and SARS, have taught their own lessons about the difficulties of disease prevention in modern mass societies. Along with climate change, pandemic disease has become part of an apocalyptic set of worries far beyond what E. O. Jordan’s generation could have imagined.63
Yet despite our renewed fear of the germ, the implementation of social-distancing measures still faces many challenges today. Public-gathering bans, school closures, and transportation restrictions are difficult to enforce for the same reasons they encountered resistance in 1918–1919. Nor are we any more likely than our World War I forbears to be able to sustain an exacting hygiene of nose/mouth/hand prevention. Consider, for example, the many studies that show the difficulties of getting health-care professionals to practice proper hand-washing protocols, a problem that has helped make hospital-based infections such as methicillin-resistant staphylococcus aureas so common. Like the mayor who let his face mask dangle and the TB expert who coughed into his hand, even people who should know better forget to be careful. Health-care professionals still have to be reminded to wash their hands frequently.64 Studies have also found that men tend to be more careless about hygiene protocols than women, suggesting that the man/boy problem has yet to be solved.65
Perhaps fortunately for us, the resources of late modern industrial culture will conceivably make it easier for us to tolerate staying sequestered at home at least on a short-term basis. Compared to troop ships and railroads, air travel is easier to regulate from a public health perspective, especially since the terrorist precautions enacted in 2001. With the expansion of the modern welfare state, local and state governments can order employees to stay at home and assure them they will be paid. Businesses serving health-conscious customers may be slightly more willing to conform to public health directives. Our capacities to stockpile food and entertain ourselves at home with cable television, computer games, and the Internet (so long as the electricity holds out) have grown enormously since 1918. We have become far more familiar with sneezing into tissues and wearing face masks while mowing the lawn or using aerosol sprays.
Still, should pandemic influenza return in its guise as “destroyer and teacher” we would no doubt have many humbling lessons to learn. Nearly 100 years after the great pandemic, we have no program of national health insurance. Enormous racial and class disparities in health status and access to health care persist. Despite a far greater degree of scientific sophistication, we have been unable to stop the spread of HIV/AIDs, which has generated its own bitter lessons. We still have many reasons to study the great influenza pandemic. To conclude with George Soper’s still-relevant observation from 1919: “This may all seem very discouraging but it need not depress anybody. .. To rightly measure a difficulty is often the first step toward overcoming it.”16
Soper GA. The Lessons of the Pandemic. Science. 1919;49(1274):501-506. doi:10.1126/science.49.1274.501
Tomes N. “Destroyer and teacher”: Managing the masses during the 1918-1919 influenza pandemic. Public Health Rep. 2010;125 Suppl 3(Suppl 3):48-62. doi:10.1177/00333549101250S308
I suffer from selective word sensitivity syndrome, otherwise known as lexiphonia. Sufferers of the condition experience strong negative emotions for certain words – emotions that range from dislike right through to hatred. When I hear or read a word that I am sensitive to, I grimace as if in pain, I mutter something like ‘oh for (insert expletive) sake’ and, when particularly moved, I yell.
Before I get myself into trouble, you can close the medical dictionary. Lexiphonia, as far as I know, doesn’t exist. ( And if anyone reading this can tell me otherwise, I’d be glad to hear from you). This is a condition that you can’t have as it hasn’t been invented yet. Can conditions be invented? Hmm. More on that later.
Euphemism is a trigger for this non-condition of mine and that’s unfortunate, because there’s a lot of it about. ‘Euphemisms’ said Quentin Crisp (1985) ‘are unpleasant truths wearing diplomatic cologne’ while Holder I(2008) in How Not to Say What You Mean: a Dictionary of Euphemisms refers to euphemism as ‘the language of evasion, hypocrisy, prudery and deceit’. (For an interesting article about the many uses of euphemism see Richard Nordquist’s piece.)
And yet, where would many people be without euphemism, when death is the topic? In our house, the news that someone has died is delivered plainly and simply: ‘X died this morning’ though I suspect our frankness in matters of death makes us unusual. For many people, such directness is less acceptable than ‘X passed/passed on/passed over/passed away this morning’. I believe that the latter is the form most used in the UK, while I hear all versions used by north Americans. I understand that these euphemisms function to soften and to protect and thus have an important communicative role. They’re perceived to be kinder than their more literal equivalents.
But are euphemisms for death appropriate in journalism? Should TV news readers use euphemism to report a death? Or medical professionals, when communicating with fellow medical professionals? I subscribe to an online publication written for GPs – family doctors. Once a week it pops into my inbox with interesting articles on common conditions (bona fide ones), and news of interest. Covid-19 related news has unsurprisingly featured a lot over the last couple of months. Imagine my surprise when I read the news of GP and healthcare worker deaths being reported with the euphemism ‘passed away’. This was not an announcement to the surgery receptionists but journalism in a professional publication. In my opinion, euphemism has no place in such a context.
In the very same article, I read the following sentence: ‘GPs killed by Covid-19!’ Ok –I’ll come clean: there was no exclamation mark. I added that, to complement the tabloid-vibe the headline was giving off. Can you be killed by a virus? Killed by a knife-wielding patient, ok. But killed by Covid-19? I don’t think so. While the euphemism was inappropriate, the choice of verb just seems wrong.
Tabloid headlines are designed to shock, to lure you in (and often seem to have little relation to the story that follows.) There seems to have been a fair amount of tabloid-style reporting during this pandemic, even from sources considered reputable. The Covid-19 virus has, at times, been imbued with characteristics not associated with other pathogens and the language used, along with images, have been the primary contributors to this. There are currently corpora of the language of Covid-19 being put together and investigated – I look forward to reading the results.
As language teachers and linguists, we spend more time than most considering words – so I’ll leave with one more puzzle to ponder. Is a vaccine invented or developed? I was taught, and thus have always taught, the latter. It appears that in the 21st century however, vaccines can now also be invented, and if you don’t believe me, do a quick internet search. What are your thoughts?
As Covid-19 takes hold on our lives, we rely on medical professionals who continue working in a challenging environment ignoring by necessity that many health systems globally were already facing nurse shortages, an ageing workplace and a shrinking health budget. By examining previous crises such as the 1918 Influenza pandemic and the 2014-15 Ebola epidemic, the importance of personal and organisational resilience emerges as an essential arm in the fight against the relentless Covid-19 opponent.
In her article, ‘What the COVID-19 pandemic tells us about the need to develop resilience in the nursing workforce’, Deborah Duncan presents us with a list of how tos . They are interesting not least because of their simplicity. They are actions which are achievable by all of us. They are actions we should be practising each day, virus or no virus. I was drawn to the final suggestion, that of journal writing and self-reflection. As nurses we are tasked with writing a personal reflection journal which becomes part of our re-validation evidence every three years – evidence that we think about the consequences of our interactions with patients and colleagues and reflect on the effect they have on us. It appears that this is also an essential ingredient in the development of personal resilience.
Duncan’s summary of actions which promote personal resilience is worth reading and not exclusively by healthcare professionals. It is a tool kit for us all during the current pandemic and beyond.
Develop personal resilience.
Practice of healthy coping strategies (Hudgins 2016)
Encouraging hopefulness (Hart et. al. 2014)
Using positive language and supporting self-efficacy (Hudgins 2016)
Supporting positive emotions (Bonanno 2004)
Development of a mentoring relationship (Jackson et al 2007)
Developing strong social support (Tsai et al 2012, Kalahar-Levering 2019)
Journal writing and self‐reflection to enhance emotional insight (Giordano 1997)
I work two days a week at the University of Birmingham these days (generally, I mean, not just because of covid), so I am spending those two days working from home. I can tell you that the back garden is looking lovely, the quince blossom has come and gone, the next door neighbour had a parcel delivered this morning, and the fields where we go walking are full of the sound, and sometimes the sight, of larks.
Other than that, our Med School is wrestling with the issue of how we graduate students we’re confident are safe without actually giving them the full range of exams we normally do, what with the University being shut at present … How are others dealing with this issue? I’m Head of Education Quality for our MBChB Programme, so have to be interested in this.
One of the things we’re doing is giving an online viva exam – in fact, a case-based discussion – to the bottom students of our final year. I’m involved in giving practice sessions for these, so have three students lined up for today and tomorrow. And I’m discussing how we manage clinical exams (ie, exams with touching) for our Physician Associate students in August. And I’m doing character references for the General Medical Council for students.
My big question for all of us is this: will the current crisis utterly and completely change the face of education? Or will it all somehow just disappear, and we’ll go back to what we were doing this time last year? (And for those of us in universities, structured and financed to deliver face-to-face teaching, will we be able to charge our students the present level of fees if we move to a more distance-oriented programme? And will they accept this? Will we so arrange things that each student gets as many contact hours, but more of them one-to-one or in small groups, delivered online?)
Within EALTHY, I’m working with our much-admired Head, Catherine, as co-editor of a special issue of the journal ESP Today.
Other than that, I’m working on a paper on language and philosophy for a colleague in the Netherlands, who works closely with a former PhD student. We’ve recently published a paper on an aspect of this (Great fun! Don’t miss it! Read all about the beetle! … at Veen, Skelton, de la Croix). I did an online tutorial with them on Monday with about twenty students, mostly Dutch but with representatives from UK, Sweden and the US as well. Good fun! Actually, yes, it was – much as I dislike Zoom, Skype and so on.
Also, I noticed during lockdown that the piece I did for our friends in Castelló has recently been published. It’s part of Discourses at the edge of life. If anyone wants a copy of “Montaigne, the essay and the end of life”, let me know. It’s so flipping long – between you and me, it goes on forever – it will last you well past the current crisis.
I live in Stratford (Shakespeare’s birthplace), hence the walks in the open countryside. A walk of about a mile, and then I can go and listen to the birds, and fail to identify most of them, and admire the improbably clear skies.
A new title for candidates aiming to pass OET Nursing, the Cambridge Guide to OET Nursingassumes that candidates have reached the appropriate level of language competence and does not attempt to introduce or revise lexis or structure. Rather, the title prepares candidates for the exam by presenting what the publishers refer to as ‘extensive task-based learning and practice’ for the four parts of the exam along with strategy and tips.
The Reading and Listening chapters are broken down into the three sections of each paper, with plenty of opportunity to get to grips with the skills necessary to succeed. This is particularly important as each section demands different skills and do not all pose the same level of difficulty. Part C in both sections can be particularly challenging for candidates – distinguishing between opinion and fact is no easy matter, even for native speakers.
The chapters dedicated to the Speaking and Writing part of the test follow the same format: an explanation of the sub-test ( which includes the criteria and level descriptors) is followed by a detailed preparation chapter, withplenty of explanations of the skills required to achieve a good pass,along with relevant practice tasks. The Speaking chapter focuses on such skills as using suitable question types, organising information when explaining things to the patient, checking for understanding and communicating with empathy. There is, in my view, a good balance between the professional skills needed for nursing in English and the linguistic skills needed to speak intelligibly and appropriately – which involves an understanding of the role of intonation. Of course, speaking practice can’t effectively be done alone and with just a textbook for company – candidates are strongly advised to get live practice before they sit the test – but what the book presents is highly useful.
The book includes two practice tests, with all audio recordings and answers available on an online platform. In terms of look and ease of use – well, like a lot of titles these days, there’s a fair amount of text but the font size is good, blue is used throughout to highlight box-outs, etc and there’s also enough white space so that eyesight isn’t strained.While many books try to work as both self-study and class texts, they don’t all succeed. This does and would work very well in both contexts in my view. In fact, one of the things I liked about the title was the ‘voice’ behind the text felt like that of a teacher. For this reason, the book could be useful for aless experienced teacher, or one who was less familiar with the OET exam.
All too often what is being taught and tested on ESP courses is specific vocabulary – though not necessarily that needed to perform specific communicative tasks in the workplace. Throughout The Cambridge Guide to OET Nursing, reference is made to the professional skills being tested which serves as a constant reminder of the focus of the OET exam, and of the utility of this book.
I highly recommend the book for candidates (with a B2+) and their teachers.
What’s the position of medical communication skills training in India?
Medical communication skills training in India is still in infancy. Before 2019 there wasn’t any formal curriculum though in that year the Medical Council of India revised the medical curriculum and introduced the AETCOM module (Attitude, Ethics and Communication module). Spread over five years of medical school, the module covers skills around attitude, ethics and communication. Since 2019, communication has been taught in all medical schools in a staged manner.
In the absence of any regular programs, I have conducted more than 1500 both short and long programs for multiple medical schools and hospitals across the country in the last 10 years. These programs are specifically focused on clinical communication including topics like conducting patient interview and information sharing (based on the Calgary Cambridge guide), handover tools, understanding patient’s expectations, breaking bad news etc.
Do you teach medical communication as a skill, independent of the language being used? Or are your programmes about communication in English only?
All programs in the medical schools are in English. Other programs for residents and nurses across the country are conducted as per the preferred language of the audience. It is mostly English or Hindi.
Are your programmes specifically aimed at medical professionals looking to work an English-speaking culture? Do you work with a range of healthcare professionals, including nurses?
Although most of the programs are conducted in English they are not meant to only prepare professionals for working with an English speaking culture. Rather, I have designed my programs to meet the communication needs of my country. The programs are designed to suit the healthcare delivery system specific to my country. I do work with a range of healthcare professionals including nurses and paramedics. Selection of the language is done based upon the audience and their preferred language.
Medical culture varies quite a bit from country to the next, particularly in how patriarchal the culture is and in the expected roles of doctors and patients. How does this variation affect how and what you teach? Or how the programme is received by participants?
Doctor-patient communication in our country is very peculiar and has changed drastically over the last few decades. Patients, who never asked anything, now wish to ask questions and be informed about their illness and the options available to treat a medical condition. This comes as a shock to some of the doctors, who are not used to this kind of communication expectation. As a result, many are not receptive to communication skills programs. They feel they are being forced to learn communication skills. Many of them also are resentful of the fact that poor communication is leading to lots of violence against doctors and they put the blame on patients for being too demanding.
Keeping this in the background, I design my programs very carefully. Through my programs I help them see the changing doctor-patient relationship. I also help them see the benefits of communication in terms of a better doctor- patient relationship, reduced errors in patient care leading to ensured patient safety, continuity in patient care and better health outcomes. Without offending anyone, I help them understand the need for these programs.
I have attended lots of communication programs in US and India, but I do not try to transfer all the learning as is. It’s important to generate genuine understanding for the subject rather than loading them with everything in one go. Some of the communication practices I learnt abroad are practically too difficult to be implemented immediately.
I have customized the programs based on my experience of working with Indian healthcare industry for the last 30 years and my learning at various institutes. I have made an amalgam of the same and move from basic to advanced level depending upon the training needs of the specific healthcare facility and receptivity.
How does your background as a psychologist inform your work in the field of medical communications?
My background as a psychologist helps me greatly in the field of medical communication programs. There are lots of soft skills trainers in India trying hard to work on medical communication programs but my background as psychologist and having had worked in healthcare greatly helps me quickly develop rapport with my audience. I am able to bring lots of examples from healthcare to help them relate with the content I deliver. Being a psychologist also helps me design and deliver my program in a manner that highlights the benefits of medical communication to the audience. They are able to see what is in it for them.
My understanding of adult learning helps me design the delivery of the program, which is based on adult pedagogy. Most of the content is delivered through hands on training, including role plays and videos followed by discussion, self- introspection questionnaires leading to self- reflection and discussion. I also make use of the professional skills I’ve developed as a psychologist, skills such as being non-judgemental, being accepting, empathetic and being receptive without blaming or complaining. It helps me develop wonderful rapport with my audience and makes them receptive to my programs.
Dr Indu Arneja, Director of the Indian Institute of Healthcare Communication, holds a PhD in Psychology and an MBA in Hospital Administration. She is a visiting professor at a number of universities in India and is a member of the advisory board of the National Human Rights Commission.
A lesson for online or the classroom based on a TED presentation by biochemist Gregory Petsko who convincingly argues that unless we take action, in 30 years most of the world will be experiencing an epidemic of neurological diseases.
Language work, video comprehension and communication activities. Level B2
Targeted at students for clinical practice and for those preparing for the Writing component of the Occupational English Test, this is a useful and affordable book written by a former GP and an ESL teacher/writer. It’s A4 in size, with 12 units, all following a similar format: case notes are followed by an OET-type letter writing task, with model letters for each task. Each unit contains language work focusing on grammar or lexical aspects of use for the OET candidate and a ‘Writing Clinic’ which focuses on the nuts and bolts of letter writing such as paragraphing, organisation of information, punctuation and common spelling errors.
As the title suggests, the book is very much aimed at doctors, though clearly much is of use to any professional needing to practice professional letter writing, while an experienced teacher will be able to adapt and substitute tasks that are more suitable for other professions, particularly nurses, looking to sit the OET exam (the writing task is profession-specific).
The book was independently published which means it hit the shelves a lot faster than if it had been traditionally published, i.e. with a publisher. It also means that some of the niceties of traditional publishing are absent: colour, graphics, fancy fonts and images are entirely absent. While these aspects may be of little concern to some teachers and students, it does mean that this is a very text-dense book. In my experience, text-dense language books work better when study is teacher-led. Had there been an editor involved, the book would also have contained more succinct, less wordy language explanations. This is an important point when attempting to target the book at a learner with a B1 in English. That being said, most of these are aspects that can easily be improved upon for the 2nd edition.
This is a very useful text, it’s fairly priced and – a nice touch this – half of its profits are going to the Refugee Council in the UK. It would certainly be of great use for doctors looking to improve their clinical writing skills for work in the UK and for those looking to sit – and pass – the Occupational English Test.
Published 2019; independently published/available on Amazon
119 pages; £15
I arrived back in a rain-washed Gatwick last night, reflecting on a diverse, interesting and rewarding international English for Healthcare conference. Excellent plenaries, presentations, workshops and posters along with lots of great discussions and chats over coffee, lunch, and OET-sponsored wine. The conference was well-attended and we met a truly global cross-section of Medical English teachers from across Europe, Japan, Australia and the US among others. Lots of familiar faces and plenty of new ones too.
A particular highlight for me was Professor Elena Semino’s plenary highlighting the impact of communication on healthcare provision through two research projects, one on using visual means to describe pain and one on the use of metaphor in the understanding of treatment and cancer. Both projects inspired me to consider how we can integrate such research into our Medical English courses to add further depth and reach. One of the advantages of digital content is the ability to integrate research results and link to studies as they are published, so providing learners with rich, up-to-date content.
Between myself, Bethan and Virginia, SLC gave three sessions on teaching English to nursing students, the hows and whys of how teachers can use online content in classrooms, and the principles informing the design of SLC’s online Medical Terminology course. All the sessions were well-attended and participants appeared engaged, asking a range of interesting questions.
It was also great to see the interest from a wide range of universities and teachers in our courses at the stand we had in the reception area. We were able to share content on the screen, describe how courses worked for students and teachers, as well as show the teacher books we have just published with answer keys, video and audio transcripts and teaching ideas. We hope that teachers got a clear sense of how the courses can be used to support and engage their students and look forward to continuing a number of conversations we started.
The venue – Jaume 1 University in Castellon, Spain – was hugely impressive. Modern, high-tech facilities, great food and lovely weather. The daily temperatures of twenty-five degrees or more certainly made a change from the previous week of autumnal rain in the UK and allowed for a very pleasant weekend in Valencia afterwards!
So, a mighty round of applause to Catherine Richards and her EALTHY team for organising an excellent, thought-provoking event. We’re already looking forward to the next one.
Since taking his first job as an English teacher in Barcelona back in 1989, Chris Moore has designed curricula, trained teachers, run schools, organised worldwide corporate language programmes and created multiple online study courses. He has a particular interest in designing and delivering technical and business language courses which make a real difference to the lives of those taking them.
Professor John Skelton, Bern, Switzerland, 2017
A full lesson on high-blood pressure, sometimes referred to as ‘the silent killer’. Reading, vocabulary focus, video and communicative activities by Catherine Richards.
Katherine Heathcock of Birmingham University Medical School talks about the importance of using simulated patients to train medical students, a tool that gives students a unique insight into their own communication, character and consultation style.
In October 2002, my partner at the time had been riding a bicycle through the streets of Singapore, scouting the route for the Singapore marathon, for which he was the race director, when he was hit by a taxi travelling at 50 miles per hour. He was thrown high into the air and landed on his right side, with his head 2 inches from the kerb. A piece of his scalp was missing and he sustained some nasty bruising, but the main injury was acetabular – the head of his right femur had been forced through its cup-shaped socket in his pelvis. He needed to be on traction and to undergo pelvic reconstruction at Singapore General Hospital before being allowed to return home. The surgery and treatment he received in that hospital was exemplary and after 3 weeks I was able to fly out to bring him back to Britain.
I accompanied him to the first consultation with the orthopaedic specialist registrar at our local hospital. The registrar was astounded by the history and incredulous at how quickly Pete had recovered, moving out of his wheelchair and walking only with the assistance of a stick. I don’t think he fully believed the story, until he saw the x-rays, showing extensive metal work in Pete’s pelvis. He was clearly impressed by the quality of the workmanship. But I shall never forget the words that escaped him that day. He said to Pete “We would expect patients with this kind of injury either to die at the scene of the crash, or to limp to the grave”.
Though his utterance was likely motivated by the esteem he felt for his colleagues in Singapore, from the patient’s perspective, neither of the options on offer was particularly attractive, but Pete had thankfully not died at the scene, which left him with the other choice: that of limping to the grave. Being a very proud Welshman, he downright refused to alter his gait, despite his pain. I was shocked by the registrar’s statement but what must it have felt like to the patient? Perhaps the registrar judged wisely and could see the grim determination that had pulled Pete through this traumatic event and was man-on-man encouraging and rewarding his fortitude? In that moment, he was likely completely oblivious to the imbalance of power that is always present in the doctor/patient dynamic, that exaggerates the influence of any statement a doctor makes, whether newly qualified foundation doctor or senior consultant, the difference in status being obvious to the professionals, but less visible to the trusting patient.
The registrar’s initial disbelief and his subsequently insensitive and dismissive language in fact only served to stiffen Pete’s resolve to walk straight and upright and never to limp. But it could have gone a very different way. The registrar had no insight into how his words might be perceived or their potentially negative effect upon the patient and his recovery. He was likely blissfully unaware that his words were hurtful and potentially damaging to the psychological well-being of the patient in front of him. And I don’t suppose today that he would have the slightest recollection of having said those words; whereas for us, they will never be forgotten. Much has been written on the power of language but to quote Sigmund Freud “Words have a magical power. They can bring either the greatest happiness or the deepest despair”.
People generally enter medicine or related professions in order to help people and yet many patients and relatives, certainly in the UK have a similar story to tell of inadequate or unsympathetic communication. So why do healthcare professionals so often get it wrong? Can we really be content to blame the system with its undeniable pressures of underfunding and under resourcing? Undoubtedly, the economic and temporal pressures form part of the picture but the system is made up of human beings, interacting with other human beings and given the right insight and training, the choices they have about how they communicate with each other and with patients can be clearer.
At Birmingham University’s College of Medical and Dental Sciences, the Interactive Studies Team teaches Clinical Communication to healthcare undergraduates. We currently work across Medicine, Dentistry, Pharmacy and Physician Associate programmes, using role play as our main methodology. Our simulated patient (role player) team is made up of over 100 professionals with backgrounds as diverse as the performing arts and the military. We have dancers and nurses and martial artists and researchers and students and retirees on our books but all have an interest in developing the healthcare workers of the future.
Members of our team are trained to pick up a scenario, with a richly detailed background based on a real case and to simulate (or act out) that scenario with students. The role player will be required to play a patient with a certain condition or set of symptoms, or a relative or colleague. There is no script just background information, which might include past medical history, history of the presenting complaint, social history etc.; there will be learning outcomes for the scenario, which might have to do with handling the anxious relative of a patient, for example. The student is required to engage with the scenario, which will play out according to the behaviours of that individual student. In other words, if the student behaves in a way that reassures the anxious relative, the role player will respond accordingly.
If the student is dismissive or unassertive for example, the simulated patient will respond in role with corresponding behaviours, which may include increased anxiety or perhaps disengagement for example. The interaction is watched by a group of between 3 – 10 other students, depending on the programme and year group, all or some of whom will get the chance to role play subsequently with different scenarios.
Following the scene’s conclusion, the student will be asked to reflect out loud upon how well they think they handled the interaction and if there were moments when they felt uncomfortable or would, in hindsight, like to have done something differently. The observers will be consulted for their impressions of what took place, what they appreciated in their peer’s handling of the situation and what, if anything they would do differently. Then comes perhaps the most valuable part of the learning experience: the role player’s feedback.
Our role players are trained to give feedback ‘out of role’, in other words as themselves, describing the effect of the student’s language, non-verbal communication, questioning, listening, empathy, rapport-building etc. on the patient/relative/colleague they were representing. We ask for it ‘out of role’ because these sessions can be emotional for students and the added objectivity of third-person feedback, helps to decrease any heightened feelings in the room and to protect the simulator from personal criticism. This feedback can be powerfully formative. It enables insight for the student into how they may be perceived in communication. It creates a sense of positive ‘self-consciousness’, which is necessary in the formation and development of self-reflective practitioners. And the role player’s perspective can’t be argued with. When a role player says “when you did this, Mrs Jones felt that”, who can contradict? As a facilitator of these small groups, before the role player feedback I may ask the student observers how they thought the role playing student made the patient (for example) feel. There may be several opinions and these may be debated. However, when a role player makes the statement to the student about the impact on his or her character of the student’s behaviours, it is incontrovertible, potentially generalizable and often the cause of a great deal of reflection. Any anxieties on the part of students about role play generally evaporate in the intense engagement with these discussions. Role players are trained to give balanced feedback in a way that is palatable to the students, so as to minimise defensiveness, which we rarely, if ever see.
This feedback may be a springboard into a more general discussion about empathy and listening. If a role player were to say in feedback “when you told my character that patients with this kind of injury usually ‘die at the scene of the crash, or limp to the grave’, my character felt shocked and defeated”, this would be a powerfully influential experience for the student and may trigger a group discussion about how the choice of words can have an enormous impact on a patient’s recovery and the attitudes that may underpin, and are expressed by, what we say.
In our teaching sessions, the learning is for all participants and observers can learn as much from the interventions as those actively playing in role. (Incidentally, we never ask our students to be anyone other than themselves). A health professional has enormous scope to benefit his or her fellow humans. It is imperative that all learn the power of their own language and attitudes and that their unique and individual way of communicating is flexible; each of us makes choices about what and how we speak and behave towards others and the more self-aware our doctors, dentists, nurses and other healthcare professionals become, the better will be their choices and the consequent impacts on the people in their care.
Katharine Heathcock, is a full time Teaching Fellow for the College of MDS at Birmingham University Medial School, teaching Clinical Communication across the MBChB, Pharmacy and Dentistry courses, with responsibility for MBChB years 1 and 2 and GEC. She also teaches at postgraduate level. Katharine has experience as a coach facilitator on the Referred Student programme. She is a Personal Mentor and has responsibility for academic programming for the Biomedical Science International Summer School. She has a background in theatre, professional role play, training and assessment but her passion is teaching.
Virginia Allum is Head of Medical English at SLC (Specialist Language Courses) and also works as a freelance medical English writer. Author of several online Occupational English Test courses – SLC Reach OET B Medicine 2.0 (doctors) and SLC Reach OET B Nursing 2.0 (nurses) as well as general medical English preparation courses for healthcare professionals: SLC Medical Terminology, SLC English for Nurses: Getting the Essentials Right, SLC English for Doctors: Advanced Communication Skills and SLC English for Care. As a freelance writer she recently co-authored OET Preparation Nursing (CUP India) 2019, author and is a regular contributor of medical English articles for Infirmiers.com (online magazine for the IFSI -French Nursing Diploma).
You’re a nurse who also works as a materials writer for medical and nursing English. What first led you to medical English?
Like many people, I have meandered through a few different areas of study and associated jobs. Writing medical English materials was a natural progression through previous studies. After school, I started an Arts/Law degree in Sydney. This was a combination Law degree with an Arts degree in languages (Spanish, French and German). I soon realised that my main love was the study of languages. At the same time, I had been working in a care home to earn pocket money for a planned overseas trip. I also realised that I loved Nursing too. After dropping out of university and travelling for a while, I returned to Australia and trained as a nurse at Royal Prince Alfred Hospital in Sydney.
Working for a while in hospitals, I decided to set up a Home Nursing Service in Sydney which developed into a Palliative Care Nursing Service (by accident). I found that Palliative Care was the area of Nursing I loved (you may notice that I always add role plays or units about end-of-life care in my books and courses).
Moving on a few years and I started on a new direction – I became a Nurse Preceptor, teaching students of the ‘College Course’ in Nursing, as it was then called. Nursing was moving into the tertiary sector and this was the first step. I found that Teaching was another area I enjoyed, especially as it was in the workplace and very practical. By chance I read an advertisement for an intake of students for a Grad. Cert. TESOL course. With a love of language learning behind me, I thought this may be an interesting direction to go. After a few years teaching EFL, I was led (again, by chance) into teaching medical English. A Japanese Nurses’ Study Tour was about to walk into the doors of the college where I taught…’You were a nurse, weren’t you? Could you put something together for the tour? Always one to say ‘Yes’ before really considering the ramifications, I agreed. Unfortunately, the existing medical English books were outdated and the college’s materials which were kept in a bottom drawer and were not very useful.
I linked up with the Nursing department of the college to try to find out the needs of international Nursing students and found that much targeted language support was needed, but not available. A comment about this to a friend (Patricia McGarr) led us to the writing of the ‘Cambridge English for Nursing’ books, as (again, by chance) Cambridge University Press were looking for authors for a new series (‘Cambridge English for..’) and need someone to write the Nursing title.
This was the beginning of a new direction for me. I had the advantage of a nursing background to add to EFL training. I found it satisfying to be able to produce materials which were meaningful and near authentic. In fact, many of the dialogues I write come from previous experience. Most are a conglomeration of different interactions I have had with patients, their relatives and other healthcare professionals.
It’s a long way from those first materials found in the bottom drawer which contained useful expressions such as ‘Doctor, my elbow hurts.’
Has awareness of language and communication in nursing changed (in Australia and the UK) since you first qualified? (In what ways? Etc)
Definitely. There have been many changes in communication between healthcare professional colleagues and between healthcare professionals and patients. When I completely my hospital-based training in Sydney in 1982, nurses were ‘on the outer’ regarding communication with other healthcare professionals, particularly doctors. We were still viewed as ‘handmaids’ to doctors, not entitled to view opinions or be part of medical discussions. In my opinion, the change to a Bachelor in Nursing changed this. Nurses became better educated and confident in providing specialist input to patient care. Many bedside nursing tasks are now undertaken by health support workers (Healthcare Assistants in the UK), leaving higher level Nursing tasks to Registered Nurses. From a medical English perspective, this means that communication between colleagues can require an increasingly technical vocabulary.
Communication with patients requires the ability to translate technical language regarding procedures and medication into an everyday health language. An example of this is wound care. When I finished my training in 1982, we had around three types of dressings we could choose from; dry dressings (a piece of gauze), saline dressings (gauze soaked in saline), Eusol dressings (a kind of chlorine solution). Documentation of dressing changes was scant (I remember a ‘Communications book’) and care plans or care pathways were unheard of. There has been a huge change in the level of Health Literacy in patients, so that they have greater expectations of interactions with healthcare professionals. Previous comments such as ‘Don’t worry, it will all work out fine’ don’t wash any more. Patients and their carers expect accurate information which they can understand. Patients may have researched their health status online – accurately or inaccurately. These are new interactions which healthcare professionals now have with patients, either tactfully correcting inaccurate information or being able to build on a basic understanding.
As well, there is a greater understanding of the effect of poor communication. Patients whose anxiety is ignored or minimised often become more anxious which can delay recovery. Tactless interactions when delivering bad news can be traumatic for patients. Lack of understanding of different cultural expectations in hospital or when communicating can also cause distress. I have seen great strides in confronting these sorts of communication issues since my early days as a nurse. I still remember a consultant talking to a patient from New Caledonia who had been transferred to our hospital in Sydney for major brain surgery. The patient only spoke French. The consultant was convinced that his minimal French was sufficient to explain the procedure of a craniotomy and burr holes. The horror of his explanation remains with me (‘I’ll make a hole in your tête and then we’ll…’).
You are also Head of Medical English at Specialist Language Courses, the UKs leading digital provider of medical English training. In your view, is digital training the future for EMP?
Providing medical English training to healthcare professionals has one major difficulty – unpredictable shifts. Healthcare professionals who are already working, but hoping to move to an English-speaking country often have limited opportunities to attend face-to-face classes. I believe that digital learning offers a solution to this. Webinars can supplement the digital content of an online course, allowing for a feeling of personal contact and pronunciation correction. Pages of online courses can be downloaded, if students want to practise writing answers and activities can be done again and again, until the student masters them. As a materials writer, the digital environment is great for a field which changes quite frequently. I often find that I read an article about a new treatment or drug just after producing material on the same topic. In the digital world, I can update immediately. I am lucky to be working with SLC, as the company produces a very good quality product – plenty of pictures to help students understand complex technical jargon and a great team who edits and exercises quality control. It’s very satisfying to see the CPD accreditation on SLC courses which suggests that digital learning works well in the healthcare environment.
You’ve also been closely involved with the occupational English Test and have co-authored a very recent test preparation book, ‘OET Preparation Nursing’ which was published by Cambridge Press India. What makes this book different?
Although there have been quite a few OET preparation books published recently, Cambridge University Press India wanted to produce a book which initially appealed to the Indian market, but was not India-centric. Indian nurses, as well as nurses from other countries in the region (Nepal, Myanmar, the Philippines) have attempted the OET in order to work in Australia and New Zealand. Recent changes in the UK have seen a growth in non-EU nurses applying to work there. Nurses from South-east Asia, predominantly India and the Philippines have turned their attention to the UK as a work destination. Whilst nursing practice is similar in India, for example, the opportunities for interaction with patients is not the same. Time constraints mean that nurses working in India do not have the opportunity to develop a rapport with patients or spend time explaining procedures, so they are understood by patients. There can be hesitance about asking for clarification or admitting that something has not been understood. These differences in cultural interaction between India and Australia or the UK need to be appreciated for a candidate to be successful in the OET, hence the need for a book which is published in India with these issues in mind. As with all OET materials, the idea behind them is not to stop learning about healthcare interaction as soon as the test is passed – an awareness of the importance of effective communication in the workplace is paramount and can go a long way to helping a healthcare professional settle into a new workplace environment.
Medical English has evolved greatly- from lists of vocabulary and short phrases to learning about communication in a medical environment which includes intercultural communication and the ability to switch between technical and everyday health language. For this reason, whilst the OET Preparation book is published in India, it will have a wider appeal for all candidates who should use OET as an opportunity to examine their own methods of interaction with colleagues and patients and perhaps develop alternative modes of communication.
Many of the teachers and trainers who are involved in medical and nursing English are teachers and language specialists but do not have a medical background. Is there any advice that you, with your background in nursing, can give them?
Whilst a background in Medicine or Nursing is not entirely essential to teach medical English, there are obvious advantages in a healthcare background when teaching workplace-based courses. Having said that, a person with a background in Medicine or Nursing will probably not know everything about Medicine or Nursing. Every teacher has to do some research, before teaching a new module. Compare with a History teacher who specialises in the History of the 18th century and is suddenly faced with teaching the History of Ancient Greece.
There are numerous health sites which explain healthcare-related topics. Find one which is easy for you to follow. Have a passing relationship with medical terminology – remember that by learning some of the commonly occurring prefixes and suffixes, you’ll have half a hope of guessing the whole word.
Keep in mind that most, if not all, verbal interactions follow the same structure as any other interaction, e.g. asking for information, providing information, allaying anxiety. Use your students’ experience in their own language to compare interactions. Are they similar or different?
Academic medical English follows the same path as regular academic English. Some texts may be challenging for you to understand, but can be used in teaching to identify medical terms. Abstracts are quite useful for this. Make use of your students as a resource to discuss health-related topics.
They won’t expect you to be experts in Medicine – you are the language expert. Sometimes, it’s handy to have a ‘friend in the business’ who can be asked questions like ‘Which word would you use to explain this?’ Use EALTHY as your ‘go to’ resource. There are plenty of members who can answer specific questions.
With regard to OET texts, remember that they are less likely to contain a large amount of medical terms and any that are used should be explained. So, as a teacher, you are purely training students to understand what a patient says (e.g. during a snippet of a consultation), what a healthcare professional says to a colleague or patient (in a short text of 100-150 words) or an opinion or attitude a healthcare professional expresses during an interview or short presentation.
There are a number of reasons people may not like to talk about language tests. Teachers sometimes find them irrelevant to their teaching and thus unfair to their students and inaccurate measures of what their students know and can do (Shohamy, 2007). For similar reasons, learners often find language tests irrelevant to their needs and thus unfair, stressful, and poor measures of what they know and can do with the language they have been learning (In’nami, 2006; Alderson & Clapham, 1995). Often, too, administrators find language tests somewhat mysterious and wonder what all the fuss is about regarding validity and reliability (Bachman, 2004). In this paper, I want to suggest that there is no reason why language tests, and particularly English for specific purposes tests, have to be painful, irrelevant, or mysterious. If a test is clearly relevant to the test takers’ needs and background and reflects what they have been studying, it will be less stressful for them and more appropriate in the eyes of teachers. If adequate documentation is provided about test objectives, development, and measurement qualities, administrators will have a better understanding and appreciation of what the test is measuring and how to interpret performance on it. We language teaching and assessment professionals have an ethical responsibility to ensure that the tests we make and use are as fair, accurate, relevant, and transparent as possible for the test takers and score users.
The ultimate purpose of the paper is to argue that tests of English for specific purposes should adhere to an overriding criterion of fairness – fairness to the test takers, to teachers, to educational programs, and finally to the societies in which the tests operate. This point is in line with current thinking in language testing generally, that ethical language testing is a much-needed focus in assessment, one that has been neglected for too long. In this paper I will discuss principles of assessment in ESP, going back to such basic questions as the following:
Why is ESP testing necessary?
What makes ESP tests specific?
What is English for Specific Purposes?
What problems are associated with ESP testing?
Why is ESP Testing Necessary?
Over the years, language specialists have made the following assertions with respect to the field of ESP testing: 1) Specific purpose language proficiency is really just general purpose language proficiency with technical vocabulary thrown in; 2) specific purpose language tests are not necessary since, if we test general language knowledge, specific uses will take care of themselves; 3) specific purpose language tests are unreliable and invalid since subject knowledge interferes with the measurement of language knowledge; 4) specific purpose language tests cannot be justified theoretically; and 5) specific purpose language testing is impossible anyway, since the logical end of specificity is a test for one person at one point in time (Davies, 1990; Alderson & Urquhart, 1985; O’Neill et al. 2007; Read & Wette, 2009). I will argue in this paper that these assertions are not true, that there is a theoretical justification for ESP, that ESP is different from general purpose language, that language knowledge and specific purpose background knowledge are both part of the ESP construct, and that specific purpose language testing is not only possible but necessary.
We often think of two broad purposes for ESP tests: Academic purposes, to determine whether applicants have enough control over the target language to succeed in academic studies, and occupational or professional purposes, to determine whether job applicants or employees can carry out necessary functions in the target language. There are two reasons why practitioners take the trouble to create ESP tests even though there are plenty of more general purpose tests easily available:
Reason One: Language performances vary with context, and
Reason Two: Specific purpose language is precise.
Language performances vary with context. Nurses use language differently when they are working directly with patients than when in an operating theatre. In the former situation, they use less technical language, more one-on-one social interaction, more interrogatives and directives. In theatre, nurses use more technical language, more receptive language, fewer well-formed sentences. Thus, we adapt the language we use to the communicative situation we are in. This is in part what specific purpose language is about (Douglas, 2000).
Specific purpose language is precise. Consider the following dialogue (Beare, 2011):
Nurse: Good morning, Ms Adams. How are you doing today?
Patient: Horrible! I can’t eat anything! I just feel sick to my stomach. Take the tray away.
Nurse: That’s too bad. I’ll just put this over here for now. Have you felt queasy for very long?
Patient: I woke up during the middle of the night. I couldn’t get back to sleep, and now I feel terrible.
Nurse: Have you been to the bathroom? Any diarrhea or vomiting?
Patient: I’ve been twice, but no diarrhea or vomiting. Maybe I should drink something. Can I have a cup of tea?
Nurse: No problem, I’ll get you a cup right away. Would you like black tea or peppermint tea?
Patient: Peppermint, please.
Adapted from Beare (2011)
The expressions felt queasy, been to the bathroom, diarrhea, vomiting, and black tea or peppermint tea are examples of precise, though not necessarily technical, specific purpose language. Bathroom is a particularly American expression – Americans find the word “toilet” somehow a bit too earthy, I think. Although these expressions may not strike the reader especially as examples of the type of language we usually associate with specific purpose English, they do represent a desire on the part of the speaker to be precise. In this context, precise means the use of language which, while accurate and exact, is clear and likely to be understood by the listener. Even the offer of two kinds of tea is an attempt on the nurse’s part to make sure the patient will not be surprised by the flavor of the tea when it arrives.
Specific purpose language tests are also necessary from a pedagogical point of view. They are fairer than non-test evaluations since all test takers are given the same instructions, input, and scoring criteria. They are more relevant to the learners than general language tests because ESP tests are based on an analysis of the target language use situation and so reflect the actual communicative needs of people in that context, and they reflect the learning content and style in the ESP course. Finally, ESP tests are more accurate than non-test assessments in giving test takers numerous opportunities to demonstrate what they can do in relevant situations. Thus, ESP test scores can be interpreted as evidence of communicative ability in a target language use situation.
What Makes ESP Tests Specific?
Authenticity and Knowledge make ESP tests what they are. Authenticity of task means that test tasks share features with target language use tasks: in our case, the work of nursing (Douglas, 2000). The interaction between language knowledge and specific purpose content knowledge means that both types of knowledge are necessary components of ESP tests. Authenticity refers to the degree to which a learning activity mirrors real-life language use, but as Widdowson (1979) put it:
It is probably better to consider authenticity not as a quality residing in instances of language but as a quality which is bestowed upon them, created by the response of the receiver. Authenticity in this view is a function of the interaction between the reader/hearer and the text which incorporates the intentions of the writer/ speaker…Authenticity has to do with appropriate response (p. 66).
Widdowson also made a distinction between genuine and authentic:
Genuineness is a property of written and spoken texts and refers to the origin of the text in an actual communicative situation.
Authenticity, on the other hand, is a perception by language users that communication reflects real life language use and is thus not a linguistic property but a cognitive one.
Consider the following dialogue between a nurse and a patient (Shahady, 2008):
Nurse: Good morning! I see you are in for your annual physical. Do you have any concerns about your health?
Charles: No, I’m feeling pretty good.
Nurse: Would you be willing to take a few minutes together to talk about your health and weight?
Charles: I guess so.
Nurse: How do you feel about your weight?
Charles: I know I could stand to lose a few pounds. My wife nags me about it every day!
Nurse: She’s probably just concerned about your health. Right now your body mass index, or BMI, is 30.1. A healthy BMI is below 25. Also, your waist circumference is 41 inches. We consider a healthy waist circumference something less than 40 inches. Your current BMI and waist circumference put you at risk to develop conditions that I see run in your family, like diabetes and heart disease. What do you think about this?
Charles: It sounds like I have some work to do. I’ve watched my brother deal with diabetes and it doesn’t look like much fun. How much weight do I need to lose?
Nurse: Any weight you lose will get you closer to a healthy weight. Have you ever tried anything to get to a healthier weight?
Charles: My wife tries to get me to eat salad and vegetables, but I’m more of a meat and potatoes guy.
This is a genuine dialogue, transcribed from an actual conversation between a nurse and a patient. Given its origin in a real clinic, it is also an authentic dialogue. Several features give the dialogue it authenticity:
Language: Standard English, some medical terminology
Norms of Interaction: Patient-provider, knowledgeable to less knowledgeable
Genre: “Medical consultation”
If we were to use this dialogue in a language lesson, however, we might choose to focus on certain linguistic and pragmatic aspects of it. For example, the patient says his wife “nags” him about his weight. How does the nurse respond to this? Why? What
does body mass index mean? The nurse asks the patient how he feels about his weight and about the risk of diabetes and heart disease. Why? What is the meaning of “run in your family”? In discussing these aspects of the dialogue, we are still working with a genuine text, but I would argue that we lose some authenticity. We lose a number of the aspects of authenticity in the classroom or test:
Setting: Classroom furnishings and atmosphere
Participants: Learners, teacher
Purpose: Language acquisition
Content: Vocabulary, syntax, pragmatics, culture
Tone: Didactic, communicative
Language: Standard English, some Medical English
Norms of Interaction: Indirect, teacher-student
Genre: “Language lesson”
So although we may use genuine materials in our teaching and testing, authenticity will not necessarily follow unless we try to build it into our lessons and tests. We could do this, for example, by furnishing a corner of the classroom to resemble a medical examining room by bringing in some medical equipment such as a stethoscope, weighing scale, and examining table, we could give the person playing the role of the “nurse” a white coat, and we could perhaps even spray some antiseptic around (Douglas, 2000).
It is usual, too, to distinguish between carrier content and real content in ESP materials (Dudley-Evans & St John 19982). For example, in the writing task illustrated in the next section, based on case notes, the case notes are the carrier content and are probably genuine, or slightly edited, taken from actual medical records. However, in the ESP classroom or test, the real content is language related: vocabulary, comprehension, written rhetorical conventions, and professional communication between nurses. This distinction helps make it clear why authenticity is so important in ESP teaching and assessment: simply using genuine input material does not guarantee that learners/test takers will perceive the tasks we set for them as representative of communication in the target language use situation.
Interaction between Language and Content Knowledge
There are several pieces of information you need to know in order to purchase medicine at a pharmacy. You probably need to know whether the particular medicine requires a prescription or not, what your symptoms are, and perhaps some possible alternatives. Just knowing the language will not get you very far in communicating in specific purpose situations: you also need to have relevant background or content knowledge. An example writing task illustrates the need for content knowledge in ESP testing (OET Writing Subtest, 2009):
Patient History Maria Ortiz is a seven-day-old baby. Her mother has been discharged from the maternity hospital. Social History Mother Violetta Ortiz (Mrs), DOB 07/08/1980. Husband Jose, 36 years. Occupation security guard (night shift). Other children Sam, 5 years (currently not attending school), Teresa, 3 years. Accommodation Two-bedroom flat (rented).
Nursing Notes Normal birth. Breast fed. Mother anxious about coping with 3 children. Baby sleepy; reluctant to feed. Baby’s weight: Birth – 3010g. Discharge – 3020g. Father unable to assist with children (night work). Mother very tired. No car; 20-minute walk to shops. Discharged from hospital, 10 April 2010
Using the information in the case notes, write a letter of referral to the maternal and child health nurse who will provide follow-up care in this case: Ms Josie Hext, Maternal and Child Health Centre, 133 Elm Grove, Oldmeadows.
In your answer: Expand the relevant case notes into complete sentences. Do not use note form.Use correct letter format. The body of the letter should be approximately 180-200 words.
OET Writing Subtest 2009
It seems to me that this task requires field specific background knowledge, first to understand the input text, the test taker must know the meaning of DOB, the significance of the birth and discharge weights of the baby, the meaning of letter of referral and “correct” referral letter format, and secondly, to complete the task, the test taker must be able to judge what is “relevant” in the case notes. Thus, in order to carry out this task, the test taker has to use both language knowledge and content knowledge, which makes this task a defining example of an ESP assessment.
What is English for Specific Purposes?
First, there is the question of whose English we are talking about. The field of World English calls into question not only the notion of whether Standard English exists or not, but also of what it means to be a native speaker of English (World English, 2004). Secondly, we need to know what we mean by Specific. When we talk about English for Nursing, we might mean that used for Licensed Practical Nursing, Nursing Practice, Travel Nursing, Oncology Nursing, Operating Room Nursing, Cardiac Nursing, Radiology Nursing, Nursing Education, Private Duty Nursing, Disabilities Nursing, Gynecology Nursing, Forensic Nursing, Critical Care Nursing, Clinical Nursing, Nursing Home Nursing, Ambulatory Care Nursing, Gastrointestinal Nursing, Pediatric Nursing, or Anesthetic Nursing (Nursing Guide, 2010). How different is the English needed for each of these specializations? Finally, we need to understand what we mean by Purpose. There is no such thing, of course, as English for no purpose. What, then, is General English? I would argue that the traditional distinction between general English and English for specific purposes is no longer tenable since all language teachers these days seek to provide learners with an ability to solve on their own the profusion of communication problems they will encounter when they leave the language learning classroom.
With regard to the notion of specificity, I have argued that rather than talking about specific purpose or general English as if they are dichotomous, it is better to think of a continuum of specificity, with something like “English conversation” at the more
general end, and something like “English for cardiac nursing” at the more specific end, as shown in the figure below:
English for Specific Purposes has long been categorized into English for Academic Purposes and English for Occupational Purposes. The latter has been categorized into Vocational and Profession Purposes, and each of these consists of both pre- and in-service programs, as shown in the figure below:
Finally, ESP is not a type of language, teaching material, or method, but rather, since its inception, has been an approach to language teaching/learning based on why learners need to learn English and designed to meet specific learner needs. Its content and methodology are derived from specific disciplines, occupations, and activities, and may be restricted in scope. ESP is usually goal directed, taught for a limited time period, to homogeneous groups of learners (Douglas, 2000; Grove & Brown, 2001; Hutchinson & Waters, 1987; Robinson, 1991; Strevens, 1988). Although these references are fairly old, they are not out of date, and the issue of defining and refining the concept of specific purpose language teaching is an ongoing and current task for practitioners (Douglas, Forthcoming).
ESP tests are based on an analysis of a target language use situation, usually known as needs analysis. Needs analysis techniques include Register Analysis, focusing on technical and sub-technical vocabulary and grammatical features; Discourse Analysis, focusing on specific language forms associated with various language use; and Learning Needs Analysis, focusing on the end product, learning skills for independent learning and language use (see Long 2005, for a discussion and examples of needs analysis).
To conclude this section, my definition of a specific purpose language test is as follows:
A specific purpose language test is one in which content and methods are derived from an analysis of a specific purpose target language use situation so that test tasks and content are authentically representative of tasks in the target situation, allowing for an interaction between the test taker’s language ability and specific purpose content knowledge, on the one hand, and the test tasks on the other, and allowing us to make inferences about a test taker’s capacity to use language in the specific purpose domain.
Douglas 2000, p.19
What are Some Problems Associated with Specific Purpose Language Testing?
The first difficulty with specific purpose language testing is determining where specific purpose language ability resides. Briefly, it resides in our brains: language
ability is a cognitive construct which cannot be observed directly, and can only be predicted or inferred, as if trying to determine what is in a black box that produces a certain outcome and ask the question of what is in the black box.
We can observe the situational, linguistic, and background knowledge content of the input; we can observe the output; we must infer the nature of the language ability that produced the output (Douglas, 2010). We can make inferences about decontextualized language ability, for example Can write a letter using correct spelling, syntax, and punctuation. Here there is no reference to situation or content knowledge. However, in ESP assessment, we wish to make inferences about language ability and specific purpose background knowledge in the target language use context: Can write a letter of referral, including appropriate medical information. This task implies that the test taker will need knowledge of the situation in which a letter of referral is needed as well as the knowledge of what such a letter should contain. We may need to disentangle language and background knowledge in cases of non-experts, such as trainee nurses, for example. The test tasks should reflect the level of technical expertise the learners have at the time of testing.
With regard to the inferences and decisions we might want to make on the basis of ESP test performance, McNamara (1996) has distinguished between a strong and a weak performance hypothesis. If we adopt the strong hypothesis about what we may infer from test performance, we might say something like This nurse will be able to communicate with physicians, other nurses, and patients while working in a Critical Care facility. Note that this inference refers to what the nurse will be able to do without reference to his or her personality, state of anxiety, or level of knowledge. Adopting the weaker hypothesis, however, we might say something like This nurse can use both technical medical English and colloquial English appropriate to the context of working in a Critical Care facility. This inference focuses on language ability in a context of use, though again without reference to personality or knowledge.
McNamara has stated that he preferred the second of the two since it does not require us to deal either with job performance or specific purpose content knowledge, which he saw as unrelated to language ability.
I would suggest a middle ground, however. We, as language teachers and testers, should indeed make inferences about language ability, not job performance, but specific purpose background knowledge is a part of the ESP construct. Therefore, when we make inferences about the level of ESP language knowledge a test taker possesses, we are also inferring some level of specific purpose content knowledge. This is not easy since it requires us to know something about the field of nursing, not just the field of English language, but I think it is part of what it means to be an ESP teacher or tester.
The procedures and approaches discussed in this paper will make the ESP tests we develop and administer less painful for our learners, more relevant and useful for teachers, and more accessible and interpretable for administrators. Less painful because they will help ensure that the tasks and content of ESP tests are based on the needs and expectations of the test takers; more useful because the inferences and decisions based on test performance will be more applicable to teaching and materials design; and more accessible and interpretable because the results will be more clearly related to eventual job performance in vocational contexts.
The language in ESP tests should be directly related to that used in the target situation, and the tasks in ESP tests should be adapted directly from the target situation (e.g. Grove & Brown 2001). Both the language and the tasks in ESP tests should also reflect the English in the specific purpose syllabus and methodology. Thus ESP tests will be more relevant and more motivating for test takers and also make the inferences and decisions we make about learners, based on test performance, more accurate and fair. English tests for specific purposes, like having a blood sample taken, can never be entirely painless – they are, after all, tasks that require learners to put forth their best efforts – but they need not be agonizing for test takers if they are clearly relevant to their needs and expectations and are based on the learning that has taken place prior to the testing. We have an ethical responsibility to make sure the tests we use and develop are as fair, relevant, and accurate as we can make them.
Reprinted with kind permission of Dan Douglas, Professor Emeritus, TESL/Applied Linguistics Program English Department, Iowa State University.
Since this paper is based on a keynote talk presented at the 2010 ESP International Symposium, in Kaohsiung, Taiwan, focusing on ESP for Nursing, many of the examples will be from the field of nursing. However, I hope the principles I advocate will be applicable to ESP practitioners in all fields and languages for specific purposes.
Readers will note that many of the citations in this paper are more than 10 years old. This is because there has been relatively little research over the years on the topic of assessment in ESP for nursing or other areas of medical English. I have cited the most recent and relevant work in this paper.
Alderson, J. C. & Clapham, C. (1995). Assessing student performance in the ESL classroom. TESOL Quarterly, 29(1), 184-187.
Alderson, J. C. & Urquhart, A. (1985). The effect of students’ academic discipline on their performance on ESP reading tests. Language Testing, 2, 192-204.
Bachman, L. (2004). Statistical Analyses for Language Assessment. Cambridge: Cambridge University Press.
Beare, K. (2011). English for Medical Purposes: Feeling Queasy. Retrieved on January 6, 2011, from http://esl.about.com/od/intermediatereading/a/d_mqueasy.htm
Davies, A. (1990). Principles of Language Testing. Oxford: Blackwell.
Douglas, D. (2000). Assessing Languages for Specific Purposes. Cambridge: Cambridge University Press.
Douglas, D. Forthcoming. Assessment of Academic Language for Specific Purposes. In C. Chapelle (Ed.), The Encyclopedia of Applied Linguistics, Oxford: Wiley-Blackwell.
Douglas, D.(2010). Understanding Language Testing. London: Hodder Education.
Dudley-Evans, T. & St John, M. J. (1998). Developments in ESP: A Multi-disciplinary Approach. Cambridge: Cambridge University Press.
Grove, E. & Brown, A. (2001). Tasks and Criteria in a Test of Oral Communication Skills for First-Year Health Science Students: Where From? Melbourne Papers in Language Testing, 10(1), 37-47.
Hutchinson, T., & Waters, A. (1987). English for Specific Purposes: A learning-centered approach. Cambridge: Cambridge University Press.
In’nami, Y. (2006). The effects of test anxiety on listening test performance. System, 34(3), 317-340.
Long, M. (2005). Second Language Needs Analysis. Cambridge: Cambridge University Press.
McNamara, T. (1996). Measuring Second Language Performance. London: Longman.
Nursing Guide. (2010). Retrieved on January 6, 2011, from http://www.nursingguide.ph/articles_ archive-8/Nursing_Specializations.html
OET Writing Subtest. (2009). Retrieved on January 6, 2010, from http://www.scribd.com/ doc/22275773/General-Information
O’Neill, T.R., Buckendahl, C.W., Plake, B.S., and Taylor, L. (2007). Recommending a Nursing-Specific Passing Standard for the IELTS Examination. Language Assessment Quarterly, 4(4), 295-317.
Read, J. and Wette, R. (2009). Achieving English Proficiency for Professional Registration: The Experience Of Overseas-qualified Health Professionals in the New Zealand Context, in Osborne, J. (ed.), IELTS Research Reports, Volume 10. IELTS Australia, Canberra.
Robinson, P. (1991). ESP Today. New York: Prentice-Hall.
Shahady, E. (2008). Three to five minute discussion – patient with obesity. Retrieved on January 6, 2011, from http://www.fafp.org/Foundation/shahadyobesity/ArticleA4.pdf.
Shohamy, E. (2007). The power of English language tests, the power of the English language and the role of ELT. In J. Cummins & C. Davison (Eds.), International Handbook of English Language Teaching (pp. 522-531). New York: Springer.
Strevens, P. (1988). ESP after twenty years: A reappraisal. In M. Tickoo (Ed.), ESP: State of the Art (pp. 1-13). Singapore: SEAMEO Regional Language Centre.
Widdowson, H. (1979). Explorations in Applied Linguistics. Oxford: Oxford University Press.
World English. (2004). Retrieved on January 6, 2011, from http://world-english.org/
Corresponding author. Address: TESL/Applied Linguistics Program, English Department, Iowa State University, U.S.A.
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