English and What Else.doc.x

8/8/2019 English and What Else.doc.x

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BUILDING FOUNDATIONS 2004:

Paper for Theme 6: International Programs

Title: English and what else?

The linguistic and socio-cultural needs of Foundation students intending to study in specific courses

at the University of Newcastle.

This paper looks at some of the considerations that may be taken into account when designing

English Foundation courses for International students who intend studying in Australian

Universities. Particular reference is made to a study of the particular needs of students from

Botswana intending to study Medicine at the University of Newcastle.

The paper examines the possibility of whether some form of Needs Analysis (either formal orinformal in nature) would be a useful tool to assess the needs of students going into specific

courses.

Overseas students coming into some courses requiring specific skills are often not so much

challenged by the language needs of the course, although this can be the case in some instances. It

is however highly likely that other factors, for example, socio-cultural difficulties, personality

differences, degrees of motivation etc will play a large part in their ability to adjust to Australian

life and to courses which demand a higher level of understanding of Australian Culture and of

particular forms of Academic English used in these courses.

Needs analysis, either formally or informally administered can be an important first step in

assessing curriculum changes that may be necessary to accommodate students particular needs.

Anne Morris

Teacher of English

International Foundation ProgramEnglish Language and Foundation Studies Centre

University of Newcastle


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ENGLISH AND WHAT ELSE?

The power holders of any culture will use linguistic resources effectively to

construct and maintain a discourse favourable to themselves, and therefore thosewho cannot engage with these powerful discourses may be excluded by them'

(Gollin, S.1997)

1. INTRODUCTION:

Those who cannot engage with these powerful discourses may be excluded from them

This is surely the most important factor in any learning. Learning a new language should be a

means of empowerment, an enabling tool, a means of strengthening, not a cause of anxiety,

bewilderment, perplexity and uncertainty. An Australian overseas, in a new culture, knows what itis to learn a new language, knows the struggle of fitting into the new environment.

As an English teacher (a TESOL teacher for the last 12 years), I have also worked in the State

Secondary and TAFE Education systems for at least 25 years, often dealing with students from

overseas with specific problems in English. Some part of this paper may however be of relevance to

teachers of disciplines other than English.

Although the whole area of teaching English to International students is a complex, ongoing,

explorative and investigative field, there are, no doubt, some certainties in teaching and designing

English Foundation Courses for International students who intend studying in Australian

Universities. Firstly, all student courses in Foundation, whether designed for Australian orInternational Foundation students are crafted to enable students to undertake, more successfully,

courses in Universities or other tertiary institutions. Secondly, the preparation for these students,

whether Australian or International, is often similar. Thirdly, courses in the programs are designed

to meet immediate as well as ongoing needs.

To a certain extent, these courses can be formatted before the students arrive. The core elements of

the course are really however, where the definite parts end. In both Foundation and International

Foundation, it often becomes increasingly and urgently apparent that it is necessary to involve a

larger amount ofunscripted teachingi.e. teaching that the teacher, and the students cannot

foresee as being necessary until the students arrive and the nature of the group is understood.

This paper deals largely with a study that was undertaken involving a specific group of students

hoping to gain entrance to the Medical Faculty of the University of Newcastle. Although this paper

deals with a specific group of students (predominantly from Botswana) going into a specific area of

study, much of what is dealt with could be seen to be relevant to other courses of study and students

in other courses. My interest in the area came about when teaching English to students intending to

go into the Medical Health area (1999 to 2001). There was also interest because for many years I

had served as a community member of the Admissions Board of the University of Newcastle

Medical Faculty.


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2. BACKGROUND TO THE STUDY/PROGRAM:

Firstly however, it would seem appropriate to give an outline of the nature of the Foundation

Program that prepares students for courses (including Medicine) at the University of Newcastle.

Two institutions offer courses specific to overseas students. The Language Centre (ELICOS) andInternational Foundation Studies program are part of Enabling Programs, the former offering

English language instruction, while the latter offers a variety of courses including Mathematics,

Chemistry, Physics, Health Studies, Economics, Business Studies and Humanities, which are

designed to support and prepare the students for their undergraduate courses. This program has been

operating since 1992 and provides the opportunity for accelerated progression from certificate level

through to degree studies. Students must pass second semester English to enable them to enter

University courses. For admission into Foundation, students require an IELTS score of 5.5, in some

cases, 6.0. In the past, students have come from all parts of the world, but currently our students

come from Botswana, Zimbabwe, Mozambique, Tanzania, Kenya, Morocco, South Korea, Japan,

Mainland China, Singapore, Hong Kong, Taiwan, Malaysia, Germany, the USA and Turkey.

Secondly, the Medical Faculty at Newcastle has specific features that need to be taken into

consideration. The Faculty, when first conceived, was, and still is, considered a trailblazer in the

field of Medical Education. Curriculum and teaching techniques were, in their initial state,

considered radical and unique. More traditional universities were initially sceptical of the approach,

which was largely reliant on problem-based learning. Other features include early clinical

exposure and substantial community involvement students are expected to understand and

respect the community as a living thing that students are expected to see the individual in

context, treating a patient as a whole person and in a manner consistent with their social and

physical environment. The students must also have both intellectual ability and personal qualities

considered suitable for the course. (http:// www.newcastle.edu.au/school/medprac-pop)

There would certainly appear to be a need for recognition of students needs for an English course

(and Health Studies program), that will give them a reasonably comprehensive idea of Australian

culture (with all its variations, quirks and unknowns).

3. THE CASE FOR CULTURE: THE RESEARCH BASIS FOR INCORPORATING

SOCIOLINGUISTIC MATERIAL IN ENGLISH LANGUAGE ACQUISITION:

One of the most important things to do was to establish the research basis for implementing such a

curriculum. In a Masters Thesis undertaken as part of study in Applied Linguistics at Macquarie

University, I sought to gain an understanding of the power of language and cultural understanding

as seen by leading linguists and specifically its importance in the successful practice of medicine

and other areas of health science. The following writers in the area of Applied Linguistics are

unanimous in their support of the socio-linguistic approach to the learning of English.

The teaching and learning of any new language is bound up with the society in which the language

is used. Learning language is learning culture. To teach or learn a second foreign language can

mean being confronted with a range of attitudes, behaviours and experiences which may be

startling, amusing, confusing or even offensive. The psychological process of coming to grips with

this experience is known as acculturation (Gollin,S. 1997)

Canale and Swain (1980,in Scarcella,1992) say that communicative competence in any language,

includes a variety of competencies ie. knowledge of the linguistic code (grammatical); socially


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appropriate use of the linguistic code( socio-linguistic);the capacity to combine forms and

meaning to achieve unified text (discourse/conversational) and the mastery of communicative

strategies to enhance communication or to compensate for breakdown (strategic competence)

Saw - Choo Teo (1998) refers to theLinguistic attributes of language (phonology, lexis etc) and the

Sociolinguistic attributes. The author contends that Communicative and Sociolinguistic

competence is an absolute prerequisite and describes parameters that determine language use andlanguage choice (ie. what, who with whom, when and where). She also talks of the taboos,

domains, formality intent, in other words the necessity of not just acquiring knowledge of structure,

but the necessity forcross -cultural awareness, sensibility and presupposition. Other areas

include paralinguistic rules - rules largely referring to body language, as well as rules of customs

like turn-taking.

Brick (1991,2) uses the example of children growing up and learning how to act in their own

culture, describing children learning appropriate actions in a given situation, interpreting those

actions. Children have to not only master the vocabulary and grammar of a language, but must

absorb the social rules that govern how they use vocabulary and grammar in concrete

situations. Brick emphasises how language and culture are inextricably linked; that learning of alanguage means learning culture and vice versa and that in moving from one culture to another,

people take their world view with them.

It informs their interpretation of the new situations they experience so that theinterpretations they reach are frequently inappropriate The interpretations they put onevents in the new culture frequently do not match the interpretations reached by membersof the new culture

(Brick, ibid)

Damen (1987,58 ) also, emphasises the cultural aspect of learning: Those who learn about

unfamiliar cultures are often painfully aware that a rose is not a rose - or at least a friend is not

always a real friend - when encountered outside one's own world of cultural givens. Although all

human beings find themselves faced with similarproblems of survival, nurture and protection, they

do not apply similar solutions to these universal problems .

Those involved with any aspect of teaching would agree that language is culturally skewed, and

loaded with cultural bias and knowledge. Cultural attitudes are conveyed through both spoken and

written language. As all discourse spoken and written, is embedded in its social context, there is no

such thing as an ideologically neutral text or speaking situation. All levels of language, whether

formal or academic, slang or colloquial, convey attitudes, ethics, values, beliefs, religious attitudes

and social opinion (Morris,1999). Chur-Hansen and Barrett, (1996) concerned with students'

inability to master the nuances of informal/colloquial English language (the everyday carrier ofsocial attitudes and values), say that they face major problems in clinical settings. 'This can lead to

misunderstanding, inappropriate interventions, and potential embarrassment for student and patient

alike' (ibid,413)

4. OF CULTURAL STRANGERS THE STUDENTS DILEMMA

Kim and Gudykunst (1988, 9) speak of the particular language needs of all international migrants

of any culture and language, required to cope with substantial cultural change. They conclude that

eventually, the 'cultural strangers' will be able to make better sense of a personally relevant situation

in the host society and become proficient in handling their daily activities in the new culture withimproved skills to deal with the situations they encounter. The authors refer to the studies of short-

term adaptation that have emphasised the psychological wellbeing and mental health of cultural


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strangers encountering unfamiliar environments. There is recognition of the problematic nature of

the cross-cultural adaptation process; the frequent reference in literature to culture shock and

similar terms such as transition shockorculture fatigue.

Damen (1987) advocates teachers awareness of students cultural needs saying that while cultural

guidance is seldom part of the stated curriculum of the ESL classroom, it is often part of the hidden

agenda, an unrecognised dimension which colours expectations, perceptions, reactions, teachingand learning strategies, and is a contributing factor in the success or failure of second language

learning and acquisition.

Ardener (1983, in Damen,1987) refers to a typical example of differing cultural understanding in

medicine:

'a hand may be classified as exclusive to all parts of the forearm to just below

the shoulder or merely as inclusive of the palm and fingers. Thus, if a person

from a just-below-the shoulder culture, such as the Ibo of south-eastern Nigeria,

is asked to give a hand, an entire forearm may be offered'.

The recognition of the need for a socio-cultural component in the teaching of a new language is the

first hurdle. Teachers need to recognise and point to the elements of the language and culture that

they feel necessary for the students to succeed in their chosen areas of study. It is also important to

remember that the early identification of students who may experience difficulties in the acquisition

of language skills is of prime importance (Chur-Hansen et al,1997). In the area of Applied

Linguistics, some form of Needs Analysis is accepted by most practitioners and researchers as a

requirement of effective communicative learning. However it is difficult to find a workable

definition of what Needs Analysis encompasses, what its limitations are and what, where and why it

should take place.

The area is a large one to cover in a paper such as this, and is not covered in detail. Writers in thearea of Needs Analysis tend to disagree on the terms and methodologies eg. Brindley, Hutchison

and Waters. However, Hutchison and Waters diagram in association with my diagram may help to

explain the components of needs analysis.


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5. THE NEEDS BASED APPROACH

DIAGRAM 1:

The development of a needs-based approach in the communicative learning environment:

The nature of the particular target and learning situation

NEEDS ANALYSIS

Figure 1: Factors affecting ESP course design This diagram (Hutchinson and Waters (1987, 22) explains

the role of needs analysis in a target learning situation, showing the important position of needs analysis

within the overall planning of ESP courses.

ESP

COURSE

HOW?

Learning

Theories

WHAT?

Language

Descriptions

Syllabus Methodology

Who?

Why?Where?

When?


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Language and Cultural Needs

Target Needs - Objective

EXTERNAL

External

Language

Audits (West)

INTERNAL

Target Needs - Subjective

Including Students: (Current and Future)

- Attitudes

- Motivation

- Awareness

- Personality

- Wants

- Expectations- Learning styles

NEEDS

AS SEEN BY TEACHER

(FACILITATOR/INTERPRETER)

USING A NEEDS BASED APPROACH

TRANSLATION TO COURSE DESIGN

DIAGRAM 2: Language and Cultural Needs (Morris,1999,17)

CLIENT NEEDSCURRENT

COURSE NEEDS

STUDENT NEEDS


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6. THE NEED FOR NEEDS ANALYSIS:

The main difference between the two diagrams lies in the inclusion, in the second diagram of the

specific needs of the students and the emphasis on the needs of the clients.

A study undertaken by the author in 1999 came to the conclusion that Needs Analysis is bestapplied where the students coming into the program are in a distinct group and proceeding into a

specific program, where the needs of both the clients and the students can be identified and

matched. A possible timetable for this (Nelson,1992) can be found in the Appendices.This attempt

to identify and match needs is a distinct luxury in most cases. Most often, students in each

Foundation class plan to enter a variety of courses at University. In such instances, English teacherscan only hope to manage a core curriculum, with perhaps some branching out into the perceived

areas of the students study where this is possible. In many cases however, teachers are forced to

use somewhat more general material, relying on this material to teach the specific skills necessary.

Teachers who have students entering courses in Medicine and Health Sciences are in a much better

position to pinpoint the needs of their students. The students all have in common the fact that theywill be dealing very closely and early in their courses with people who in the main, require a level

of caring and understanding that no other professional area will demand. These students need not

only knowledge of the language in which they are learning but also, and no less importantly,

need the knowledge of the culture in which they are learning and practising.

Researchers and teachers in the Medical School at the University of Newcastle have already

recognised some of the problems that their International students encounter. Studies carried out in

Newcastle by Treloar and others (2000) were undertaken because, while the authors realised that

research on the factors affecting progress in medical schools had typically focussed on

mainstream (non-Indigenous Australian, non-international) students in traditional, didactic programsand that these results may not be applicable to students, particularly those from culturally diverse

backgrounds, undertaking problem-based learning courses.

This study explored and compared factors affecting progress for mainstream Australian students

(non-Indigenous and non-international) with international students in a problem based learning

medical course. As a result of this study, intervention strategies were devised on the basis of the

participants experiences.

The Medical School has now seen a need to identify the languageneeds of its students. One of the

measures that the School has undertaken in 2004 is an English test for all incoming students into the

faculty. The test, known as the AUSTEST, was developed as an alternative to the Screening Test ofAdolescent Language (STAL) through the work of Farnill and Hayes (University of Sydney) and

Chur Hansen (University of Adelaide). Austest has been extensively used by the Medical Schools

of both Universities (Hill, 2004). In Newcastle the test is administered in the first weeks of the

course and is followed by the STAL interview process undertaken by those students who have not

performed well in the Austest. Chur -Hansen (and others) has published widely in this area,

concentrating on the needs of students at the University of Adelaide Medical School, but referring

also to the needs of students at other universities in Australia. Adelaide set up a Language

development Program in 1994 to identify language problems and devised forms of intervention

programs for students experiencing language difficulties.

It is early days so far but already the Medical Faculty at the University of Newcastle has counselledsome students, consequent to the test results. The students are also receiving individual tuition from

a member of the Learning Support Program who is concentrating on the use of medical material


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suitable for the use of students at the first year level of the medical course. Further measures in the

pipeline include a series of workshops, continued consultation and a Blackboard Group (Hoystead,

2004).

There would certainly appear to be a need for an English test to gauge general English ability. The

Austest, with the Stahl interview will no doubt prove to be very valuable. However, it could be

contended that this only goes part of the way. One person dealing at close hand with the studentsspeaks of the fact that it is well known to many who deal with them, that their greatest problem is in

fact homesickness; and that there is sometimes resistance and anger in response to any criticism of

the knowledge of the language. (Carter, 2004). Loveday (1982) says that there is evidence to

suggest that as a person begins to master a second language, he or she develops feelings of

alienation. In such instances, the learner hovers between two ethnic groups, neither fully identifying

with one or the other. Treloar (2000) speaks of international students experiencing 'isolation', during

group learning, as a result of their different cultural background: 'if two people are interacting, if

they have the same sort of background the same way they think, the same cultural values, the

same language, the same environment, it is easier for them to interact' (Manese et al 1988)

This paper contends that a needs-based approach to the teaching of ESL is not complete without aconscious recognition of the contribution that the knowledge of cultural peculiarities makes to the

learning of a language and vice versa. Even when students of my era learnt French, Latin and

German at High School, there were attempts by the teachers to contextualise the language, giving us

an account of the culture of those countries (even if we hadnt, by any stretch of the imagination,

reached the audio-visual age!) This recognition is even more pressing when the students involved

are going into a relatively well-defined target area such as Medicine and the associated area of

Health Studies, Law and Sociology. In these areas, linguistic and cultural knowledge could be

crucial to student success.

LANGUAGE, CULTURE AND MEDICAL STUDIES:

Shortly after beginning their training in the Medical School at the University of Newcastle, students

are expected to make decisions about patients and to make diagnoses of disease and illness. The

students are actually awarded marks for this, on their ability to look at the patient directly and to

engage the patient. For many overseas students (and Aboriginal students also), this is totally

antipathetic to their own culture. Success in dealing with these situations can also be dependent on

their understanding of both the more common and basic functions of language such as greeting and

farewelling, requesting and thanking as well as the 'deeper' levels of the language, of their ability to

comprehend bias, nuance, connotation and inference in the language.

Vanci-Osam (1998) speaks of research on rules for language use within sociology and

sociolinguistics (known as "ethnomethodology). He says that this area has generally focused on

relatively small linguistic units; that important examples include sequencing in conversational

openings, telephone conversations, and service encounters, or rules for the use of terms of address

as they relate to cultural contexts or socio-political sentiments. He mentions other previous studies

on speech acts for example, the terms of politeness, the expression of gratitude; complaining and

commiserating and apologising.

Candlin's (1974) study at the University of Lancaster recognised the particular language problems

of overseas doctors entering the English system and investigated their needs. The aim was the

analysis of discourse used in the hospital environment (casualty departments of Lancaster

hospitals), in order to construct language learning courses and to suggest the stages in a program ofcourse design. The study recognised some of the particular difficulties faced by doctors in a new

system. Taxonomies of language skills were made, as well as language functions. In the final report


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(IV) Candlin concluded that task-specific language demands can be established by study of

language in use on the job, and that pragmatically defined language functions constitute the

soundest base for course design. Candlin made a provisional list of language functions including:

greeting, eliciting, interrogation, making sure, action - informing (telling a patient whats to be

done), diagnosing informing (telling patient about the diagnosis made) , directing, apologising,

talking (general, rather than consultation talk), med-asking (gaining information relevant to clinical

consultation) and reassuring. Most of these areas, although identified as appropriate in theconsultation setting, also have relevance in social settings and represent some of the areas of

difficulty experienced by overseas students.

Cameron and Williams (1997,421/2) looked at problems facing overseas students placed in

American hospitals. They looked at problems of pronunciation stress, deletion of final consonants

and consonant clusters, as well as syntactic features such as lack of auxiliary verbs, articles and

prepositions, and word order errors. Some of these problems were such that the students lack of

clarity in English led to the patients questioning of the students proficiency.

The authors contend that in cross-cultural interaction in medical settings, there is a great potential

for failure of communication increased when language proficiency of one of the communicators is

low. Research in medical contexts shows that interaction between patients and medicalprofessionals is best understood as being complicated, fitful, and asymmetrical. The authors

conclude that the language of illness spoken by medical care providers represents a set of cultural

beliefs and conventions distinct from the language of illness spoken by lay people. Although they

have good communication, they do so across a cultural divide, a result of their different

perspectives about the origins and meaning of illness, and how to respond to it; the roles in the

process of responding to illness and to different ways of speaking about illness. Considering the

potentially complicating issues of cross-cultural communication and low language proficiency, the

authors ask how any degree of successful communication could be possible.

STRATEGIES FOR IDENTIFYING and DEALING WITH SOCIOLINGUISTIC NEEDS:

The results of the Newcastle study undertaken by Treloar (2000) suggested that interventions

aimed at reducing barriers to progress, need to promote students confidence, motivation and

subsequent participation in course learning opportunities. The study also found that these results

would have application to other problem based learning courses, particularly those which face the

challenge of providing an optimal learning environment for students from diverse backgrounds.

Professor Dimity Pond, Head of the Discipline of General Practice at the University of Newcastle

was asked to supervise an intake of Malaysian students who had undertaken their first two years at a

Malaysian campus and were transferring to Third Year in the Newcastle Medical school. Professor

Pond was given three days only in which to acculturate these Malaysian students into the

Australian way of life and problem based learning in the Medical Faculty (Pond,2004). Although

given little time, Pond attempted to cover as many areas as possible and among other things called

on the help of a Sydney-based Malaysian doctor and Medical Educator, Dr Hooi Toh to address the

students (cf. Copy of program for these students).

Another study (2004) undertaken by Dr Louise Wright, who has taught in the Health Studies

Program in the International Foundation Program, found from student feedback that The students

would like to extend their English program, and increase their knowledge and practice of PBL. The

Faculty itself said that they required better English communications skills and a higher competency

in team and group work.


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A study entitled A Matter of Life and Death in the USA, by Van Naerssen (1978) took the

subject of lack of communication in the field of medicine very seriously. Van Naerssen speaks of

foreign graduate doctors new to the United States who are ill-equipped initially to assume their role

alongside American counterparts in residency programs or practice. She says that the doctors often

lack the necessary proficiency in written and spoken English, that many fall short in basic medical

concepts and skills and that almost all are unfamiliar with professional routines and interpersonal

relations in the U.S. The results have been situations potentially dangerous for the patient and athreat to the emotional well-being of the foreign physician.

Van Naersson refers to the ECFMG Guide* which suggests, that before the graduates leave their

homelands they be given basic information about the hospital, duties and responsibilities,

community organisations and other basic knowledge. Probably of more relevance in this context are

the suggestions made about the possible advantages of a joint language and cultural orientation

program

(*The Educational Commission for Foreign Medical Graduates coordinates the ECFMG examinations which all FMGsmust pass before entering an AMA approved training program. It also functions as a clearing house for information for

FMGs)

Post-Arrival Orientation

On arrival in the U.S. FMGs should have:

A. Communication skills evaluated and remedied.

B. Community-cultural orientation through discussions, information packets and trips and an introduction to thehistory of the USA, its geography, economics, education, arts, religions, communication media, the legal system,major, current domestic and international issues, and American Society

C. Cultural orientation to American medical practice.

Table 1: The ECFMG Guide

The ECFMG guide also recommends the initiation of an inexpensive language orientation program

including work on using and understanding medical English, rapid-fire medical vocabulary

practice, English slang expressions and two word verbs, practice in listening comprehension of non-

standard English whenever appropriate as well as extensive oral practice in translating a medical

diagnosis and follow up treatment from medical terminology to laymans language.

In Australia, Pauwels (1984,93) wrote of the perceptions of health professionals, of problems ofcommunication in cross - cultural contexts. Her project was undertaken by the Centre for

Community Languages in the Professions at Monash University:

'The Centre's objectives are the development of specialist language courses (eg Chinese for Health

Professionals) and the examination of cross - cultural communication difficulties in the contexts of

medicine, social work, law, education, librarianship and business.

Pauwels discovered that health professionals who had regular contact with people from diverse

cultural backgrounds were aware of the influence that culture can exert on the attitudes and

behaviour of NESB people in relation to health care. Her study interviewed a wide range of health

professionals working in Melbourne, including medical training and community health sectors.


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ENGLISH AND WHAT ELSE? THE CASE STUDY

In a qualitative study undertaken by the author (1999-2000), interviews were conducted with

students studying in the International Foundation Program at that time, past students, faculty

members and with Doctors practising in the hospitals (who are asked to tutor and mentor Medical

students, often overseas students). The author found that there was a similarity in perceptions to

those already stated. The student questionnaires investigated four major areas: language history;goals and perceived language needs; student perceptions of themselves as language learners and of

their preferred methods of learning; whether the course had fulfilled their needs. The following are

summaries only of responses given.

Students (all from Botswana) who were in the International Foundation Course at the time of

the survey provided only broad responses to the questions re perceived language needs.Answersranged from one candidate who felt that there weren't any language situations they would need in

the Medical Course (!), to those who saw as perceived needs the following:

Writing: Theses, prescriptions, experiments, essays, reports.

Speaking: Communication with patients, lecturers and other students; speaking clearly inseminars, meetings and presentations; responding to questions in class.

Reading: Medical books, journals, newspapers; 'Medicine requires a lot of reading'

Listening: Patients, colleagues, radio and TV, PA Systems

Separate interviews undertaken with three of these students (all female) provided interesting

material including reference to the teaching methodologies under which they had learnt in the

primary and secondary systems of their country, in all cases, counter to the problem-based

system of learning in the medical course.

The answers of the current students were understandably without the benefit of a great dealof knowledge re the Medical Faculty Courses, and hence the answers of the continuing

students (again from Botswana) were found more relevant. In answer to the question on

improving their attitude to learning, one student expressed confidence in all areas of English

usage, but other students recognised difficulties with communication because they spoke with

a low voice and had an accent which people found hard to understand and lacked confidence

in use of the language to talk freely with colleagues.

The area ofgenerallanguage needswas perhaps the most interesting because here lies a morerealistic,' experienced' view of needs. All of the students referred to the importance ofspeaking.

Answers included: ' Most of our learning is done in group discussions and everyone has to

participate'. 'At the end of the year we have to talk about a topic to an examiner about our learninggoals. I have no problems writing English but can't seem to express myself clearly '. One spoke of

'a lot of everyday reading In terms oflistening,students mentioned lectures and seminars; ' at theend of the year we have a long case assessment for which we have to interview a patient and then

submit the patient's history to the examiner, who asks us questions regarding the patients'

condition'. Writingin many ways appeared to be the least important; there were no difficulties in

note-taking, summaries of lectures and written assignments. When questioned about what they felt

had been the most important part of their course in Foundation, all emphasised spoken English, and

also skills in interaction, group discussion, group dynamics and skills in critical reasoning.

Finally, the clients (including Doctors from the medical Faculty and local hospitals). Some

perceived that an understanding of the cultural context ofproblem-based learning(PBL) was one ofthe greatest difficulties for students; that PBL as a Western cultural phenomenon and that some


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students have no real knowledge of how this process is to be achieved and may spend a lot of time

negotiating the process and not its outcomes.

Some spoke of the need for an understanding of body language, for being able to speak correctly.

One respondent said that the compiling of patient histories created many difficulties for the students

( the use ofcolloquialisms). It is felt that although youth and inexperience contribute to this

difficulty, lack of awareness ofbody language compounds this problem. As one client replied: 'Students sometimes struggle with attitudes and their inability to read body language'. The client

added that patients are also not always aware or understanding of the problems experienced by the

students. It was felt that while such situations may create embarrassment, there are other situations,

for example during surgery, where lack of communication can become a matter of life and death. In

such situations, gestures and unspoken attitudes are absolutely essential/unavoidable. Refusal to

admit problems of communication, for any number of reasons including the desire to 'save face',

would cause difficulties for one or both participants (Hofstede,1986).

As far asspecific language needs are concerned, one client commented that because the course is

primarily taught within groups, students need to be able to communicate effectively with other

group members, a process hindered by any problems with spoken English and generalcomprehension. Another point made was that introverted students within the group may cause

difficulties. One client made the point that effective communication is important to alllevels withinthe group, within the hospital (patients and staff) and within the Faculty (academics and

administrative staff).

In the area ofreading, most clients recognised the importance of many aspects of reading, citing

the amount of technical language as being one of the greatest difficulties facing all students.

Respondents also thought that perceived problems in this area were often overcome by the students'

vigorous application to their studies, and that there was often more of a tendency for students to

find non-technical jargon(colloquial) more difficult than technical language.Some clients

mentioned the need of the technical reading skills of skimming and scanning, and the necessity of

being able to separate the relevant and the irrelevant quickly and efficiently. Others referred to the

need of being able to read and comprehend complex examination questions. Another area of

concern was Fixed Resource Sessions (FRS)(similar to lectures) where students are required to read

quickly from overheads. As one client said, students often have problems listening, writing and

extrapolating the 'essence' of lectures. Also, tutorial working problems need to be read and

understood quickly.

Writing, interestingly, was in some cases interpreted as handwriting. One client mentioned the

necessity of being able to decipher many forms of handwriting. Although a comment often made in

jest, the perception or reality that doctors have illegible handwriting, demonstrates the importanceof clear written English. Having legible writing is imperative for students in their written case notes

and in their presentations. Interestingly, one client said that one of the greatest problems was a

sometimes blas approach to clarity in the writing of numerals, an approach which could have very

serious consequences. It was considered by most that writing skills are probably most important in

two areas - in written exams and in FRS where notes are not distributed. In these situations, students

are expected to write quickly and concisely. Reference was made also to the difficulties some

students have when asked to 'critique' experts. Students not used to questioning the printed word,

consider this task difficult.

Active listening was seen as a 'crucial' skill, most clients emphasising that they meant listening with

understanding, not just the 'appearance' of listening. One client stated that an experienced listener isable to formulate patient problems in a few minutes. It was felt by some that a student's inability to

listen could be attributed to nervousness at being placed in an unfamiliar situation.


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Another explained that students are expected to talk and listen to patients to ascertain accurately

patient history; that there was the need for a good grasp of colloquial language because during oral

exams students listen to a 'patient' telling them their problems. The same client described student

discussion in tutorials; there was a need to comprehend quickly (it is) the heart of the entire

process'.

Many respondents recognised the importance ofspeakingwith confidence and communicating wellwith a wide variety of people including academics, administrators, patients and fellow students.

It was indicated that students need to participate fully in tutorial discussions, or they can easily miss

out on the whole problem-based process. Students are also expected to give clearly enunciated

presentations, and to express themselves clearly in oral examinations. Many respondents asserted

that overseas students in both class and hospital situations tend to be too passive; asking technical

questions and few general questions. It was suggested by others that perhaps the students don't want

to embarrass themselves. It was pointed out that there was often some awkwardness experienced in

areas of giving simple instructions to patients eg. In areas of some intimate contact where

explanations are needed as to why patients are being asked to remove clothing. (Author's comment:

cultural, linguistic, individual, age or all of theseAustralian students also find this difficult).

Closely allied was the feeling that many of the students aren't able and possibly not willing torecognise visual clues from their patients, for example failing to register a lack of understanding of

a patient's accent This failure to face particular problems can lead to a lowering of student self-

esteem and frustration and annoyance on the part of the patients.

Many clients spoke of problems in the understanding ofcultural issues, particularly in relation to

clinical skills eg. the understanding of subtle comments or gestures. There appeared to be some

problems in the questioning of patients about health problems. It was felt that some students find it

difficult to be self-promoters, a quality needed in a largely student - centred system of learning.

There is however, evidence from some clients that students often develop excellent skills given

sufficient time and support.

DISCUSSION:

The study found that while Academic language and vocabulary has to be considered very valuable

for the students, it is also necessary to consider the students' facility in colloquial language for use

in group work; the use of slang and the understanding of the vernacular, idioms and common

clichs. 'Conventional' needs analysis processes did not identify these things they were observed

and catered for when perceived as needs (largely by the teacher and clients, sometimes by the

students themselves). Many respondents, particularly the clients felt that students need a great deal

of extra experience in socio-cultural skills and the following areas were pinpointed as being

important- roughly divided into general and cultural.

General:

The ability to argue a case whether in role-play or in the discussion of a relevant topic beingdiscussed in class.

The ability to understand the hypothetical; the capacity to handle dilemma.

The willingness to develop speaking and listening skills i.e listening with understanding eg. inthe taking of case histories.

Awareness and tolerance of different learning processes and approaches.

The ability to handle 'independent learning' and associated research skills.

The ability to operate in a group situation.

The development of skills in critical reasoning and reading. The development of a range of reading skills.


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The development of questioning behaviour and the means of doing this (Wajnryb andCrichton,1997,24); for example, asking for clarification, further explanation, examples,

disputing, hypothesising, formulating conclusions.

The ability to give clear instructions ( i.e. to patients, fellow students etc) incorporating not only'global fluency' but also accent, rate of speech, colloquial language and grammatical constructs.

(Chur-Hansen,1997, 262)

Cultural needs.

Interaction in a new culture needs to include:

Knowledge of the common functions of English, for example, asking and receiving, requestingand replying, greeting and farewelling (c.f. Hinton and Marsden)

A detailed knowledge of 'medical colloquialisms'

The use of appropriate register in particular situations.

Knowledge and recognition of body language.

Empathy training (Novack 1998, in Winefield and Chur-Hansen, 2000) e.g. giving bad news,confronting the drug addict, detecting and responding to domestic violence etc

Recognition of the role and the idea of culture shock; of some common cultural 'quirks' of thesociety in which the student will temporarily operate.

Acknowledgment of the importance of different value and belief systems and discussion ofcomparative values.

It should also be remembered that language level at the beginning of a course is not always a good

predictor of final success (Criper and Davies, cited in McNamara (1989). The authors showed that

language plays a role but not a dominant role in academic success once the minimum threshold of

adequate proficiency has been reached. After this it is individual non-linguistic characteristics both

cognitive and affective that determine success. In support of this it must be said that personality is a

major factor in learning. Needs analysis does not measure character, nor the amount ofdetermination possessed by individual students; both personality and determination play an

important role in student success.

When needs are recognised and negotiated possibly using Nelsons model of Needs Analysis as a

beginning (c.f. Appendices) it is then necessary for the teacher, with the cooperation of the students

to construct a program covering as many areas as possible in a sensitive, non-threatening and

productive manner. One of the greatest problems for the teacher as curriculum developer is the

construction of a coherent program. The teacher, attempting to discover some of the learners needs,

even after the group has been created, is able to increase the relevance of the course and learners are

more sensitised to their own preferences, strengths and weaknesses. Nunan (1988) says that while

analysis is important, what really counts in the development of second language skills is the processof engaging learners in interesting and meaningful classroom experiences

(In the preparation of interesting and meaningful lessons, some texts proved useful in the teaching

of the group in this study. These suggestions, by no means comprehensive, can be found in the

Appendices). There is a wealth of writing in this area, which many may find interesting.

CONCLUSION:

The main needs of the students of the study undertaken were in the area of cultural learning, socio-

cultural pragmatics and cross cultural understanding, particularly the needs of those students going

into specific areas which are people-intensive and where clear communication is vital. Medical

faculties (and other faculties) in universities throughout Australia, are under increasing pressure to

provide places in Australian universities for overseas students and to design courses for external


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use. They could well look to the recognition of the important role they can play in considering and

providing for the specific needs of overseas students coming into their courses. There is room for a

deal of further consideration of, research into and finally, action in these areas. Chur-Hansen gives

reasons for this type of action but concludes with the following Providing high calibre academic

support to students of NESB has benefits for all concerned.

If the Universities are able to get this right, then they could well offer such courses to Australianstudents as well?

REFERENCES:

Ardener, E.1983. Social anthropology, language, and reality. In R. Harris (ed.)Approaches tolanguage. London. Pergamon Press.

Brick, J.1991. China: A Handbook in Intercultural Communication. Language and Culture: SeriesOne. Sydney. NCELTR.Macquarie University.

Brindley, G 1989.Assessing achievement in the learner-centred curriculum. Sydney NCELTR.

Macquarie University.

Cameron, R. and J. Williams.1997. Sentence to Ten Cents: A case study of relevance and

communicative success in nonnative native speaker interactions in a medical setting, Applied

Linguistics ,18:4. 415 445 Oxford University Press.

Canale, M and M. Swain.1980. Theoretical bases of communicative approaches to second language

teaching and testing.Applied Linguistics 1:1, 1-49.

Candlin, C., J, Leather and C. Bruton.1974.English Language Skills for Overseas Doctors andMedical Staff. Linguistics Section, Department of English. University of Lancaster.

Carter, J. 2004.Conversation with author. University of Newcastle. N.S.W (3rd March)

Chur-Hansen, A and R.J.Barrett.1996. Teaching colloquial Autralian English to medical students

from non-English speaking backgrounds. Medical Education, 30: 412-417

Chur-Hansen, A, 1997. Language background, English language proficiency and

selection for language development. Medical Education, 31: 312-319.

Chur-Hansen, A. J. Vernon-Roberts and S. Clark.1997. Language background, English languageproficiency and medical communication skill of medical students. Medical Education, 31: 259-263

Damen, L.1987. Culture Learning: The Fifth Dimension in the Language Classroom.Massachusetts. Addison-Wesley Publishing Company.

Davies, A. C. Criper and A.P.R. Howatt. 1984.Interlanguage. Edinburgh.Edinburgh University

Press.

Farnill, D and S.C.Hayes.1996a.A Users Guide to the Australian Tertiary English Screening Test

(AUSTEST). Sydney. University ofSydney, Glensdale Press


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Farnill, D and S.C.Hayes.1996b. Screening higher education students for English language

problems: Development of the Australian Tertiary English Screening Test. Higher Education

Research and Development, 15:61-71.

Gollin,S.1997.Introduction to LNED 803 The Social, Psychological and Cultural Context of

Language Learning. Notes for Graduate Diploma in Language and Literacy Education. Sydney.

Macquarie University.

Hofstede, G. 1986. Cultural differences in teaching and learning.International Journal of Intercultural Relations. 10, 301-20 in Lucas, P et al. 1997.

Hutchinson, T. and A. Waters. 1987.English for Specific Purposes: A learning -centred approach.

Cambridge. Cambridge University Press.

Kim,Y.Y and W.B.Gudykunst (eds) 1988.Cross Cultural Adaptation: Current Approaches.Published in cooperation with The Speech Communication Association Commission on

International and Intercultural Communication. California. Sage Publications.

Loveday, L. 1982. The Sociolinguistics of learning and using a non-native language. Oxford.

Pergamon Press (pp 8-33).

Lucas,P. M. Lenstrup, J. Prinz, D. Williamson, H. Yip and G. Tipoe, 1997. Language as a barrier to

the acquisition of anatomical knowledge. Medical Education.31: 81-86

Morris,A.(1999) The Role and Effectiveness of Needs Analysis .Unpublished.Master of Applied

Linguistics. Dissertation. Macquarie University. Sydney.

McNamara, T.F. 1996 Measuring Second Language Performance. London. New York. Longman

Nelson, M.1992.A model for course design in ESP for Business. Unpublished. M.Ed. TESOL.

Dissertation. University of Manchester. U.K.

Pauwels A. 1990. Health Professionals' Perceptions of Communication Difficulties in Cross -

Cultural Contexts inARAL, Series S.7: 93 111.

Pond, D. 2004.Interview with Author. University of Newcastle. N.S.W.(10th March)

Scarcella, R.C and R.L Oxford.1992. The Tapestry of Language Learning: The Individual in the

Communicative Classroom. Boston. Heinle and Heinle Publishers.

Teo,Saw -Choo 1997.(unpublished) What it means to learn another language. LNED 803 Notes.Sydney. Macquarie University.

Treloar,C., McCall,N., Rolfe,I.,Pearson,S-A., Garvey,G.,and Heathcote,A. (2000) Factors affecting

progress of Australian and international students in a problem-based learning medical course.

Medical Education 2000. 34: 708-715.

Vanci-Osam,U (1998) May you be shot with Greasy Bullets: curse utterances in Turkish.Asian

Folklore Studies.April.v56 i1,71

Van Naerssen, M. M.1978. ESL in Medicine: A matter of Life and Death. Tesol Quarterly 12, 2.193 - 203


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Wajnryb,R and J.Crichton,1997. To ask or not to ask: questions of face in the language learning

classroomEnglish Australia . 15. 1. 7-27

West, R.1994. Needs Analysis in language teaching.Language Teaching27:1 - 19.State of the ArtArticle.

Winefield, H. R. and A. Chur-Hansen. 2000. Evaluating the outcome of communication skill

teaching for entry-level medical students: does the knowledge of empathy increase? Medical

Education. 34: 90-94

Wright, M.L. 2004.Review of International Foundation Program: Introduction to Health

Professional Studies (unpublished) University of Newcastle. N.S.W. Australia.

A few suggested teaching resources:

Listening Skills:James, K et al.1991.Listening, Comprehension & Notetaking Course. London.Harper-Collins

Maley,A & Duff,A.Beyond Words. Cambridge. C.U.P (Book and Tape)

Speaking/presentation:

Hinton,M and R. Marsden.1987. Options: Advanced English. Surrey. Nelson.

Sadler,R.et al.1988.New Senior English. Melbourne. MacMillan

Ur:P. 1981.Discussions that Work. Task-centred fluency practice. Cambridge. C.U.P

Academic Writing skills:

Dwyer, J.1993.The Business Communication Handbook.3rd Ed. Sydney. Prentice Hall

Jordan,R.1992.Academic Writing Course. 2nd Ed. London. Nelson

Oshima, A and Hogue,A. 1999. Writing Academic English.3rd Ed. New York.Addison Wesley Longman

Vocabulary/ Comprehension skills:James, D.V. 1995. Medicine: English for Academic Purposes Series. Hemel Hempstead. PhoenixELT.

Maclean, J.1996. English in Basic Medical Science. Oxford. Oxford University Press

Oxford Concise Medical Dictionary. 2002. 6th Ed. Oxford. Oxford University Press

Riley, D.1995.Test your vocabulary for Medicine: a workbook for users. Middlesex. Peter Collin

Publishing.

Specific cultural needs/ Awareness of culture shock:Brick,J. 1991.China;A Handbook in Intercultural Communication.NCELTR


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APPENDICES:

1) Nelsons Model of Needs Analysis (1992)

Interpret Results

Preliminary Course Design -defined by subject areas

Materials chosen from MaterialsData Base

Course Begins - negotiation withstudents about course plan

Mid-course evaluation: studentsevaluate course so far; possible re-

orientation, new materials, etc.

Final Test: course specific

Final evaluation of the course bythe students

Evaluation 1

Oxford Placement Test(Allan 1985/1992)

Evaluation 2

Needs analysis carried out:a) of the studentsb) of the company point of view


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2) ORIENTATION PROGRAM, 2004 (Pond, 2004)

Wednesday 18th February

9am: Meet outside Lecture Theatre 202, Medical Sciences BuildingTransport to Newbolds Building

Prof Dimity Pond

9.30: Introduction

Mock PBL tutorial

Dr Cathy Regan; Prof Dimity Pond

10.30: Morning tea

11 am: Visit to city centre

12.30: Lunch at Dr Cathy Regan's house

Meet Dr Bhawni Murugasu

2.30: Introduction to death and dying

Professor Peter Ravenscroft

Newbolds building

4pm: Debrief

Thursday 19th February

9-1 lam: General orientation for new students

Richardson lecture theatre

11.30 Get a life at the university

Dr Hooi Toh

Prof Dimity Pond

1pm Lunch

2.30: Introduction to Sexual counseling skills

Dr Sue Outram

4pm DebriefMeet Suman, President, Newcastle Medical Society

Friday 20th February

9-12 Introduction to consulting skills

Dr Hooi Toh

(see detailed program)

12pm Lunch

1-3 Visit to Nursing Home


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