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LINGUIST List 25.956

Wed Feb 26 2014

Review: Applied Linguistics: Lu & Corbett (2012)

Editor for this issue: Joseph Salmons <jsalmonslinguistlist.org>

Date: 28-Oct-2013
From: Catherine Richards <crichards.golinigmail.com>
Subject: English in Medical Education
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Book announced at http://linguistlist.org/issues/23/23-3425.html

AUTHOR: Peih-Ying Lu
AUTHOR: John Corbett
TITLE: English in Medical Education
SUBTITLE: An Intercultural Approach to Teaching Language and Values
SERIES TITLE: Languages for Intercultural Communication and Education
PUBLISHER: Multilingual Matters
YEAR: 2012

REVIEWER: Catherine Richards, Scuola Superiore Medico Tecnica

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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