TEACHING ENGLISH TO NUTRITIONAL THERAPISTS: USING AUTHENTIC MATERIALS FOR THE CULTIVATION OF LANGUAGE SKILLS Robert Helán Masaryk University Faculty of Medicine Language Center Kamenice 5, 625 00 Brno, Czech Republic rhelan@med.muni.cz Abstract The paper deals with practical aspects of teaching English for Specific Purposes in the Nutritional Therapy bachelor degree program at the Faculty of Medicine, Masaryk University in Brno. Within the IMPACT project, new study materials and teaching methods are being developed to better prepare the students to make use of the attained language knowledge and skills in their future practice or follow-up studies. The paper will discuss: (1) the value of including field-specific articles and presentations in the lessons, (2) possibilities of the effective use of controversial topics for the purpose of practicing discussion skills, and (3) benefits of e-learning implementation for the lessons. These points will be illustrated by specific examples. Introduction The aim of this paper is to demonstrate what innovative study materials and teaching methods have been developed for the English Language I course, taught to students of the Nutritional Therapy bachelor degree program at the Faculty of Medicine, Masaryk University in Brno, Czech Republic. These innovations have been developed within the IMPACT project (Innovation, methodology, and quality of language education and professional education in foreign languages in the tertiary sphere in the Czech Republic), key activity 2 (Innovation of specific language courses at project research and development workplaces). The aim of the innovated course is to provide English language practice in areas of communication relevant to the field of Nutritional Therapy. These include the nutritionistclient communication, medical and nutritional terminology, and field-specific spoken and written genres (such as the abstract, presentation, letter of motivation, and consultation), together with important language skills and subskills (such as discussions, giving advice, and expressing opinions). The required level of the students’ language skills and knowledge is B2 of the Common European Framework of Reference for Languages. The paper focuses on three practical aspects of teaching English to Nutritional Therapists (belonging to the English for Medical/Specific Purposes (EMP/ESP) sphere of English language teaching). Important issues are discussed in the sections below concerning: (1) the value of field-specific articles and video lectures for the development of students’ language skills and subject knowledge; (2) the use of controversial topics as a springboard for practicing critical discussion skills; and (3) the benefits of e-learning implementation in connection with a new system of testing, which is also being innovated under the IMPACT project. Each of these points is illustrated with examples and notes on their use in the lessons. 1 Field-Specific Articles and Video Lectures This section deals with the use of field-specific articles and presentations incorporated into the course of English for Nutritional Therapists. In the former, the genre of medical case reports was made use of to familiarize the students with the conventionalized language through typical collocations occurring in the genre. In the latter, video lectures on nutritional topics [1], delivered by a registered dietitian, were included in the course as home assignments. These different modes of professional communication used in the course – i.e., written and spoken – fulfill two functions: they provide students with field-specific content (nutrition) and train them in specific academic genres (medical case reports and presentations). The medical case report is a description of a pathological condition or trauma in a single patient. If multiple cases of patients are included in a single report, the genre is referred to as the medical case series. Despite being regarded as somewhat inferior to the more statistically oriented research articles, medical case reports lend themselves well to the meaningful classroom use from a pedagogical point of view. The genre is characterized by a highly conventionalized language, the features of which can be explicitly demonstrated to the students. In terms of grammar, they include the use of agentless passive sentences (e.g., The patient was found to have both oedema and tumour.), metonymic expressions (e.g., Chest radiographs showed over-inflated lungs.), and existential constructions (e.g., There was no evidence of infection.). [2] As far as lexis is concerned, medical case reports contain collocations which do not tend to be found in other genres. For example, categorization is typically used for the clinical identification of the patient (e.g., A 34-year-old Caucasian male), causes of pathological conditions are linked to histories (e.g., family history, past medical history, social history), verbs connected to patients (e.g., the patient was admitted to, presented with, denied, was referred to), and prepositional phrases (e.g., on examination, upon admission, within normal limits). The above-mentioned features can be practiced in a cloze-test type of exercise, as is demonstrated in the following extract from a case report (possible gaps are indicated in bold type): A 30-year-old Caucasian male without significant past medical history presented with a two day history of nausea, vomiting and diffuse abdominal pain. The patient denied use of any medications (prescription or nonprescription) or any illicit substances. He did admit to occasional ethanol ingestion stating that he consumed four alcoholic beverages (approximately 0.6 ounces ethanol each) the night prior to the onset of symptoms. The patient had a family history of diabetes mellitus type 2 on both the paternal and maternal side. On presentation, the patient appeared in mild distress secondary to his stated abdominal pain. BMI on admission was 27.1 (weight 91 kilograms), vital signs were within normal limits, and the patient appeared euvolemic. Complete physical examination was normal including a normal abdominal examination. Initial laboratory studies revealed a high anion gap metabolic acidosis (arterial ph 7.34, arterial PCO2 23 mmHg, serum bicarbonate 12 mmol/L, serum anion gap 21) and hyperglycemia (serum glucose 267 mg/dL). The patient was found to have both ketonemia and ketonuria. [3] Sentence transformations can aid in students’ understanding of the highly-conventionalized language by avoiding the mention of agents. The transformed sentences demonstrate that conventionality, as seen in the genre of medical case reports, renders the sentences shorter and more condensed, hence more academic. The doctor found that the patient had diabetes. → The patient was found to have diabetes. The doctor did not find any evidence of infection. → There was no evidence of infection. The doctor examined the patient’s hip movement, which was normal. → Examination revealed normal hip movement. The genre of medical case reports has been used to demonstrate to students the conventions and typical lexico-grammatical features of professional writing in medicine. As far as the area of academic presentations is concerned, the innovation of the course also involves the use of video lectures on nutritional science, dealing with topics such as Facts on Fiber, A HeartHealthy Lifestyle, and Demystifying Food Labels. [1] Students watch selected lectures as a home assignment in addition to reading important literature of their choice regarding the same topic as in the lecture(s) in order to present these topic(s) in class. By actively reading and listening to/viewing the lectures, they are provided with important lexical, grammatical, and subject-matter input, hence becoming better prepared for their own class presentations of the selected topics. 2 Controversial Topics in the Field of Nutrition This section demonstrates the way controversial topics can be used in the ESP classroom. In the field of medicine in general and nutritional therapy in particular, such controversial but rather common topics can be amply found, lending themselves well to their use in English lessons. Several of the topics have been considered particularly suitable for the innovated ESP course taught to bachelor students, including the issues of vegetarianism, obesity, milk, supplements, dieting, anorexia/bulimia, preservatives, and herbal remedies, to name a few. Each of these topics can be critically discussed from the viewpoint of its supporters and opponents. Developing critical discussion skills in a foreign language appears to be one of the most important goals of language teaching at the tertiary level of education. To be able to discuss the above-mentioned controversial issues, students need to acquire certain subskills, the most important of which appear to be the ability to analyze and persuade. [8] Analyzing involves brainstorming and/or mindmapping ideas about the given topic and then comparing and contrasting the answers with other students. See Table 1 for a sample mindmap activity concerning the causes of obesity. Tab. 1: Mindmap for the Topic of Obesity OBESITY • CAUSES sedentary lifestyle (lack of exercise, time spent with PC/TV, ...) poor eating habits (junk food, overeating, fast food, ...) • DEFINITION body mass index difference between overweigh/obesity • RISKS psychological (poor self image, depression, ...) physical (stress on joints, lethargy, ...) • TREATMENT pharmacological (weight-loss medication, appetite suppressants,...) surgery (liposuction, gastric bypass,...) • PREVENTION role of education balanced diet Source: [6] As far as the second subskill of persuading is concerned, it can be practiced with the help of the ProCon.org website [6], which addresses selected controversial topics by listing pro- and con-arguments based on unbiased and objective sources of scientific information, thus debunking some of the common myths related to the topic. Students can study and analyze these arguments as a home assignment prior to the actual English lesson dealing with critical discussion skills. As a result, students are exposed to both sides of a given argument, enabling them to make informed decisions regarding important nutritional issues. See Table 2 for an example of a pro/con analysis of vegetarianism. Tab. 2: Pro vs. Con Analysis of Vegetarianism PRO Vegetarian CON Vegetarian “It is cruel and unethical to kill animals for food when vegetarian options are available.” “Eating meat is not cruel or unethical; it is a natural part of the cycle of life.” “Human anatomy has evolved to support a primarily vegetarian diet.” “Eating meat has been an essential part of human evolution for 2.3 million years.” “A vegetarian diet lowers the risk of heart disease.” “A meat-centered diet can help with weight loss.” “Raising animals for food creates 18% of global greenhouse gases – more than the transportation sector.” “The right to eat what we want, including meat, is a fundamental liberty that we must defend.” Source: [6] In order to be able to discuss these controversial topics, students also need to familiarize themselves with useful functional language used in discussions. An ideal activity would consist in brainstorming the most important functions and typical language used for those functions. For more advanced students, the activity can be made more challenging by categorizing the functions according to their formality of use (i.e., from least to most formal). See Table 3 for a demonstration of functional language. Tab. 3: Functional Language of Discussion with Examples FUNCTION EXAMPLES Agreeing I think you’re absolutely right...; That’s a good point...; Exactly... Disagreeing I see what you mean but...; I’m afraid I can’t agree with you... Expressing opinion In my opinion/view...; Personally, I think...; Actually, I don’t think... Source: Own 3 E-learning as a Practice of Test Skills and Field-Specific Content This section reports on electronic study materials, created in the Information System of Masaryk University (IS MUNI) with the objective to prepare our students for the new system of standardized foreign language testing at the Medical Faculty. The IS MUNI offers a unique platform for developing a variety of e-learning exercises. This platform has been made use of within the IMPACT project for tailor-made activities focusing on test-skills practice in terms of format and on field-specific English in terms of content. Regarding test-skills practice, required types of test exercises have been created on the B2 level of the Common European Framework of Reference for Languages and in line with agreed-upon new test criteria at the Faculty of Medicine. These types include the multiple choice and open-ended comprehension questions for the listening part; the cloze test, multiple choice, word formation, and sentence transformation for the lexico-grammatical part; the true-false and gapped text comprehension questions for the reading part; and the letter of motivation for the writing part. Regarding the content, the e-learning exercises have been created from field-specific texts, i.e. from specialized literature on medical and nutritional terminology. [4, 5, 9] See Table 4 for an overview of the types of test exercises with examples. Tab. 4: Types of Test Exercises with Examples Developed for E-Learning Listening Open-ended questions What is the basic treatment for GERD? The most important is ___________. Multiple choice Stable angina usually occurs after • hard work. • intensive exercise. • drinking a lot. • having a rest. Lexico- grammar Cloze test Diarrhea can ___________ in many ways because it has many potential causes. Most cases of diarrhea are ___________ by some type of infection. Mutliple choice The colon is divided ___________ three parts – the ascending, transverse, and descending colon. • in, • on, • into, • onto Word formation Gastritis is a common ___________ of the stomach lining that is often caused by the bacterium Helicobacter pylori. (INFLAME) Sentence transformation Dr. Hanson was treating the patient for rhinitis. The patient ___________ by Dr. Hanson for rhinitis. Reading True-false Four-fifths of all the stomach cancer patients in the UK die within the first five years. T F Gapped text Unfortunately, in more than 25 percent of cases studied, such prescriptions are useless because the infection stems from a virus, which cannot be treated with antibiotics. ___________. For example, these types of drugs kill more of the "good" bacteria found in our bodies ... Writing Letter of motivation Dear prof. Newton, Excuse me for approaching you and asking you for your help in the following matter: I am currently a student of Nutritional Therapy at Masaryk University... Source: [7] Conclusion The paper reported on the innovations carried out, under the Impact project, in the English Language I course, taught to bachelor students of Nutritional Therapy at Masaryk University in Brno, Czech Republic. It described the way field-specific articles (medical case reports) and video lectures can be used in ESP courses. By being explicitly shown the characteristic features of the genre of medical case reports in terms of typical collocations and required conventions, students can become aware of the way academic discourse in their field is traditionally constructed. The use of video lectures aids students in their preparation for presentations, required as part of the final oral examination. The second section of this article dealt with the use of controversial topics as effective methods for teaching students critical discussion skills, particularly analyzing and persuading. While the former can be practiced by means of brainstorming and mindmapping, the control of the latter is connected with the belief in and striving for unbiased, objective information on which valid arguments are based. Final section demonstrated the usefulness of e-learning study materials in preparing students for the new system of testing, which is being developed under the Impact project. These study materials contain exercises training students in test skills and using field-specific texts. By being interconnected with materials taught in the lesson, they provide students with additional practice that would be virtually impossible to include within the course. Literature [1] ANDING, R. H.: Nutrition Made Clear. The Teaching Company, Chantilly, 2009. ISBN: 978-1598036060 [2] ANSPACH, R. R.: Notes on the Sociology of Medical Discourse: The Language of Case Presentation. In: Journal of Health and Social Behavior. 1988, vol. 29, no. 4, pp. 357 – 375. ISSN: 0022-1465 [3] CHALASANI, S.; FISCHER, J.: South Beach Diet associated ketoacidosis: a case report. In: Journal of Medical Case Reports. [online]. 2008, 2:45 [accessed 2013-08- 25]. Available from WWW: [4] EHRLICH, A.; SCHROEDER, C. L.: Medical Terminology for Health Professions. Delmar Cengage Learning, Clifton Park, 2009. ISBN 978-1-4180-7252-0 [5] JONES, B. D.: Comprehensive Medical Terminology. Thomson Delmar Learning, Clifton Park, 2008. ISBN 978-1-4180-3920-2 [6] Pros and Cons of Controversial Issues [online]. ProCon.org, Santa Monica [accessed 2013-08-20]. Available from WWW: [7] Study Materials – Fall 2013 [online]. Information System of Masaryk University, Brno, 2013 [accessed 2013-08-27]. Available from WWW: [8] Teaching English [online]. British Council and BBC, London [accessed 2013-08-20]. Available from WWW: [9] THIERER, N.; NELSON, D.; WARD, J. K.; YOUNG, L. T.: Medical Terminology. Language for Health Care. McGraw-Hill, New York, 2010. ISBN 978-0-07-337472-7 Mgr. Robert Helán, Ph.D.