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The Uni-Files

A candid look at EFL life and lessons from a university teacher's perspective.

August 07, 2009

So, why teach English to medical students?

Yes, I know that most readers here do not teach English to medical students but I’m willing to bet that many readers teach some type of ESP, EAP, or teach to specific faculties so you can apply this to your own teaching circumstances. And while the titular question may seem obvious upon first glance I think it deserves a little deeper consideration.

I’ve listed responses in the order that most people (laymen?) assume to be accurate although it will soon become clear that I have different priorities.

1. If medical students have a non-Japanese speaking patient they will be more able to communicate with them- possibly even using the language to save a life

In my view, this is not a priority- in fact it is quite far down my list. Certainly students who plan to practice in St. Luke’s, Okinawa Naval, or other hospitals that have a high number of non-Japanese speaking patients can legitimately use this as a reason study English, but not most of mine. Most non-Japanese patients in Miyazaki hospitals (and in most of Japan outside Kansai and Kanto) will have some skill in Japanese, and in fact the majority of non-Japanese are likely to be Chinese or Korean anyway. But, more to the point, expecting students to put in a large amount of study on the one-off chance that 6 years later they may have an outpatient or two who can’t speak Japanese but understand English- an encounter that may last all of 5 minutes- is not sufficient motivation or purpose to study several English courses and credits at the university level.

This type of justification reminds of teaching English courses so that students can ‘enjoy’ a one week trip to Thailand or so that they may help a stray foreigner on the streets of Tokyo, cases in which the rather pithy and nebulous ends do not justify the means, especially so when one considers that the pedagogical forum is university education. Not only that, but the notion that a doctor will reach into his or her English lexical pocket 8 years after my class and remember the exact item or phrase BECAUSE THEY LEARNED IT IN MY CLASS is not going to occur enough to make it a primary motivation for teaching or learning the language.

2. To teach them medical terminology

Not at all. Why would I teach them medical terminology? They have dictionaries, don’t they? They can look terminology up when needed and, if it relates to their specific field of interest, they will be able to encode it without my explanation. Furthermore, there is a lot of medical terminology that I don’t know myself and, since I’m not a medical student or practitioner, I don’t have a particular interest in knowing.

Terminology in every field tends to be very narrow in terms of meaning range so such items are usually concrete and have strict 1-to-1 cognates between English and Japanese (in fact the Japanese is often just a katakana-ized version of the English). Although it is widely believed that such words are ‘difficult’ in fact they are generally very easy, in that definitions are precise and visceral.

3. Because medical professionals will have to read medical information in English, attend international conferences and possibly give presentations, write and read research papers in English, and engage with other professionals in the field

Now this is more like it. It is hard for a doctor to avoid all of the above. The chances of him/her doing some or most of the above regularly and consistently is far, far higher and of more lasting value (due to the focus upon skills over specific language items) that the belief that they will use English primarily to treat NJ patients or to learn terminology.

4. To provide a basis for those who really want to get more involved in the international medical arena, to offer them a taste and develop enthusiasm for the subject.

Although this may apply to only 10% of my students, the justification that my classes can provide a platform and serve as a stimulus to take the next step is a legitimate one. In fact, at my university we provide an advanced and intensive series of seminar and international exchange courses precisely to those who wish to answer that call, with my general courses serving as a foundation for those who want to take the deeper plunge.

5. Because having some awareness of English at the tertiary level should be a basic function of higher education.

I like this reason too. I often tell my students that when they become doctors many in society will think of them as elite, and as allegedly educated elites, it is expected that they will have some facility with English (and/or another language). This may not mean conversational skills, and it does not necessarily mean extensive grammar/vocabulary proficiency, but it does mean a greater sense and awareness of the forms of medical discourse, an overriding familiarity with the topic in English. (I plan to go into more detail on this in my next Yomiuri article later this month).

6. Because focusing upon content in another language is healthy for a learner’s cognitive development in general (especially at the tertiary level)

This is probably the best response, IMO- but the one least cited. When students are engaging meaningful content in a second language it helps them to more clearly organize the patterns of thought extant in their mother tongues. Also, when they are focusing upon meaningful content and tasks they are absorbing the forms of a second language naturally and often unconsciously, but are forced to think clearly and categorically in order to complete tasks. In short, it is good brain food and a hallmark of what university education should be all about..

I wonder if I have forgotten any valid justifications? And I wonder if readers find that the same is true in their own ESP, EAP, or other focused English teaching scenarios?

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You sure are good at setting up straw men arguments, Mike. Nevertheless, I find your choice of best response to be, if idealistic, completely irrelevant to language teaching

With the rare, mostly sterile, motivation to learn another language for its own sake, learning another language, to be successful at all, must have a practical purpose.

In a good university education, (unless you are a sociocultural anthropologist, as I was trained to be, or, for another example, a student of comparative literature, in other words in an academic profession) learning a second or further language has nothing necessarily to do with the hallmark of what university education should be about.

I get the impression you're feeling pretty intellectually isolated down there in My-azaki, Mike, and certainly, as another reader has pointed out, you tend to get pretty defensive about your particularities, but this sort of sententious reasoning is pretty vacuous.

Umm.. where exactly is the straw man, Walter?

Wouldn't the bit in your response about being down in Miyazaki and thereby intelectually isolated (without refernce to any concrete point) qualify as a straw man? Or that I'm being defensive? Yes, they both would.

Look- I'm not denying practicality and motivation as a factor in teaching English in university (see points #3 and #4 in the blog entry), but I am looking closely at what aspect of practicality is paramount. I do not accept the senmon gakko view of teaching for a university- the notion that one is learning English specifically to carry out a trade. This is not a senmon gakko, it is a university. This is not a place to teach mantras to order hamburgers, abroad, this is a university (straw man enough for ya?).

Moreover, the first few years- which is where my teaching is concentrated- is called general studies. Yes, the students should have some medical orientation in these earlier courses but the understanding of general studies is basically that it's general tertiary mental development- and that foreign languages are a part of that. 500 years of classical Western university education where languages where considered essential for holistic intellectual development would appear to back that up.

Perhaps you subscribe to a view prevalent in a few totalitarian countries where the study of foreign languages was/is seen as a tool to propagate the cause or make better refrigerators, I don't know, but I think we're talking about a spurious notion of 'education' at that point. (Now, there's a straw man- but it makes a point!)

Of course, it's up to the teacher to provide some earthy orientation, to connect it to the bigger picture, yes, but I'm not going into these classes deceiving myself that the students will remember a bunch of prescribed sentences in the operating room several years down the line.

Yes, that's my defence. And I'll take the liberty of assuming that a defence of my position, since you attacked it rather strongly (and hypocritically), is warranted and is in fact, part and parcel of what should happen in a blog like this. In short, I trust that your response will not be that I'm being 'defensive' or that you will not simply argue by pulling geographical rank, on the basis that I am based in 'My-azaki'.

Whew, a spirited response, and sure had me laughing, in fact still chuckling to myself.

But yes, absolutely, this is what should happen in a blog like this, not just rants or advice or "poor me," rather a full tilt at differences of opinion, a muscular engagement with opposing views, even if it takes a bit of rhetorical flimflammery to get it going.

I'd like to know where you got that bit about 500 years of classical Western uni education including a necessary language component came from because in the lifetime I've spent in educational systems both here and elsewhere I've never heard of it. If you're referring to the Oxbridge axis, yes, maybe, if you're talking about reading the Classics, Greek and Latin, but certainly in contemporary times there is no undergraduate degree that requires a second language unless it's a specific language major or related program.

There no doubt are some, perhaps many, exceptions to this generalization, often having to do with national policies. In Canada, with which you are intimately aware, the policy, in high schools, was (is?) that matriculation required two years of French, but beyond that, in university, there is no further language requirement unless specified by a particular major.

And speaking of French and prescribed sentences, I can remember, in a North Vancouver junior high school, in grade 9, (c. 1962) the opening lines of one of the first dialogues (actually monologues) we were required to memorize: "J'entre dans la salle de classe. Je regarde autour de moi. Je regarde les autre etudiantes..." etc. That simple set of sentences, however imperfectly remembered, laid the syntactical groundwork, which still exists today, for mastering the French subjunctive (now of course buried, but not irretrievable) under several other languages.

Mais non, my point was and is that second or third or whatever language learning is not the hallmark of a university undergraduate degree, it is the product of specialized programs and/or nationalistic requirements.

I'm glad to see you spelt holistic correctly, Mike, but language learning is only a particular, optional, part of the whole ;)

Walter, I get the sense that you are fighting for sport. All the ingredients are there- just add hominem.

500 of years of Western education (give or take a few hundred) has seen languages firmly located within the Humanities, yes including the classical languages, but also an understanding that an academic familiarity with German/French/Italian was the mark of an educated person- not because the student in question was about to head off to Florence for 'dreamy gelato trip' but because it was deemed to be a major factor in developing an educated person even if they never made it to sample the waters of Baden-Baden.

To the best of my knowledge, Tubingen didn't have a marginalized 'Language Center' on campus for TOEIC training- the languages were located smack in the middle of the Humanities. For a reason.

But you might want to look more closely at intrinsic vs. instrumental goals and motivations. Instrumental language goals have, of course, a shorter 'incubation' period, more specific orientations, and thereby a greater focus upon specific skills and/or discrete language forms that are expected to be utilized (and posibly forgotten) within a short span. Intrinsic, of course, implies the opposite.

Teaching 1st and 2nd year medical students sits somewhere on the continuum between instrumental and intrinsic. So yes, it is medical school (appears instrumentally focused) but it is also general university education (instrinsic). Yes, we can easily imagine useful medical discourses but the chance employ them in vivo is 4 to 6 years away for most (beyond most instrumental learning range). Also consider the large and varied class sizes. The more you think about it the more this appears to be the platform for addressing intrinsic motivation or goals.

This is not unlike what is expected of all those sociology, psych, poli sci, and philosophy classes one takes as a part of our general education. No one expects the learner to be applying them instrumentally in the real world anytime soon but they are nonetheless an important part of a university educated person's (wait for it) holistic development. And no, we shouldn't just discard what we have acquired in them upon reaching the end of the course because they do provide a basis, a schema, for future intellectual development.

And my own students, while generally not remembering the precise English speech formulae for taking a patient history (which we go over in year one) by the time the 5th or 6th years come around, will nonetheless have a retained some general notions about the directions and procedures, the choices and schematics of medical discourse, which they can also apply in the real world if they wish.

A little bit for sport, yes, but in a playful sense, fighting an ad hominem battle, definitely not: I respect your opinions and if I criticize the way you put them (in this case my "straw man" comments) it's a tease, not a put-down. However, since it appears you have felt put down, all I can say on this score is that it was not my intention.

As to the crux of the matter, I still disagree. Historical evidence aside, though thanks for bringing the details from Germany to my attention, the fact remains that second language learning is not a central nor compulsory component of the contemporary undergraduate degree -- in most cases.

As to intrinsic vs. instrumental motivation, I wrote several years ago a paper on the subject, though my version was intrinsic versus extrinsic, and in the context of a content course. I can give you the reference if you like (it's in the Bunkyo University Journal, which is not refereed) but nevertheless I do know whereof I speak. If I speak, at times, a little too sportively, I hope you won't take it too seriously.

Hi Walter.

Actually, it's not that I feel 'put down' or chafed in any way, but I am curious as to people's motivations in writing adverstively (to put it in academese, I could cite the flouting of Grice's maxim of quality and the implicature that is subsequently generated). A devil's advocate role keeps me on my toes, but I am wary of those who are just targeting for the sake of targeting. I'll assume you are closer to the former category than the latter.

I have to admit though that I was left nonplussed by your French subjunctive example from two posts back. The ability to memorize a decontextualized but presribed sentence or discrete form (in this case an example of the French subjunctive) doesn't seem to me to be a valid example of practical English per se but in fact is a memory more akin to having remembered the words to advertisement jingles from the 70's (while having trouble with the names of significant members of our own family), or remembering some Anglican catechism and assuming that this implies an understanding of theology.

Thanks for the assumption, Mike, in this case it's pretty close to the reality of things. At the same time, sidetracked by my "sportiveness," there remains the point I was trying to make, which is in reference to your motivation list, sections 5 and 6.

Sections 1 to 4 are instrumental, in your terminology, practical in mine. Section 5 is normative, at least in title, then reverts to ESP in content. The title is what raised my hackles. On the face of it, it looks like a global imperative, subject to protests of linguistic imperialism. I skipped that part, knowing from what followed that you meant "a basic function of higher education" in Japan, and then suggested to you that it was second language learning in general that was the basis of your "should" assertion. This you followed up with historical evidence which has next to nothing to do with contemporary times, least of all in Japan, where everything has to do with with the (assumed) practical, witness the TOEIC craze. However, even taking your title to mean that some awareness of a second language should be..., there is no evidence whatsoever that it is. Perhaps your next Yomiuri article will provide some.

In which case, the evidence will probably include some aspects of point 6. To whatever extent focusing upon content in another language has beneficial cognitive effects, it is not the only or necessary focus which has such potential beneficial effects. It may be good "brain food," but it is not the only cognitive nutrition, nor a necessary one, which leads to a good university education, here in Japan, where English is vastly over-taught, or other countries with second-language learning programs. As should be clear by now, it is the programmatic, universalist nature of your titles, and the disjunct between them and your specific job reasoning that I have taken objection to. As you have pointed out to me, it is the way you have made your points, in one sense, rather than the points themselves (5 and 6, which I still find objectionable) which has become the problem. I hope this clarifies things a bit.

As to the French example, remembering a bunch of prescribed sentences and those memorized, in your version giving immediate mastering of the French subjunctive, and your genealogical and theological similes, though amusing, are misleading, and, understandably, mischievous. The point was (and I guess the reason for so many of such points having turned into red herrings, have to do with the medium in which they have been put) that mastering those prescribed sentences set down the French sentence patterns, which in the Chomsky universal grammar sense, were a practical precondition to the eventual learning of the subjunctive.

On the whole, I think this is a tempest in a teapot. I wonder, if there are any, what others are thinking.

Walter, I'd say that Mike is spot on with this one. Indeed I agree with Mike's last point--I would say it for my own classes, and I teach a lot of non-English majors.

I'd like to point out one specific point that the two of you seem to have confused: Mike didn't say that a foreign language was "the" point of a university education, it was just one:

Mike: "In short, it [the study of a second language] is good brain food and a hallmark of what university education should be all about."

Walter: "[M]y point was and is that second or third or whatever language learning is not the hallmark of a university undergraduate degree, it is the product of specialized programs and/or nationalistic requirements."

I'd also disagree with Walter's contention that a secondary language component is not compulsory at university ("[T]he fact remains that second language learning is not a central nor compulsory component of the contemporary undergraduate degree." And again, "[C]ertainly in contemporary times there is no undergraduate degree that requires a second language unless it's a specific language major or related program."). Nonsense. At my school (a US university of about 40,000 students and 150 academic programs), 2 years of a foreign language (or equivalent: you could proficiency out) was a university-wide requirement. I think that is standard. And Mike's mention of a 500-year history is reflection of the fact that a foreign language was an even more central component of higher education in the West until the 20th century than it is today.

Well, Tristan, thank you for your response and sorry for this belated reply, have been away in lotus-land.

Anyway, I didn't say, nor did Mike, that second language acquisition (note the difference between "study" and the latter) was "the" point. My disagreement was with the term "hallmark." There are many universities and many programs, and I'd bet there were some of them of yours among them, that do not require second language courses for graduation. Even if I were to lose that bet, I can tell you for a fact that the two years of French I took in high school were sufficient to exempt me from any compulsory language classes at the University of British Columbia.

Let's be precise about this. I've not been arguing about the value of second language learning, it's indisputable. What I disagreed with was Mike's normative "should" assertion in terms of a university education. While it may be cognitively worthwhile, and in some cases even practical, it is neither necessary nor sufficient to achieve the goals of an undergraduate, or even graduate (say in higher physics, not in Japan) degree.

Which leads me to rephrase Mike's original, typically rhetorical, question: Why teach English in Japan at all?

Before you start frothing at the mouth, all of Mike's answers to his original question would fit my rephrasing, modulo my objections.

Let me put it this way: the number of people "studying" English in Japan is inversely proportional to the number of people who actually have a need or opportunity to put it into practice.

As to hallmarks and brain food, nonsense indeed, the language of Norman aristocratic England was French, the language of law and religion was Latin, the language of the people was Middle English, all worked to practical, not cognitive, purposes.

My point remains, there is no necessary or even desirable intellectual purpose to learning a second language, as good an exercise as that may be (there are other exercises that serve the same function) and if you invoke history you would do better to understand English-teaching in Japan by considering the impact of 1945.

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