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My Medical English SOAP Opera
A 90-minute hands-on guided tour of a Todai classroom:
what's taught in the "Medical English" courses at the Hongo campus of the University of Tokyo, and how

Christopher Holmes
University of Tokyo Faculty of Medicine

19 March 2008



Everyone's active vocabulary (the words one actually uses frequently) is much smaller than one's passive vocabulary (the words one recognizes, understands, and might be able to use).


My purpose in Medical English 1 & 2 is not so much to increase my students' passive vocabulary, but to induce them to use actively much more of it: in other words, to activate their passive vocabulary.


So what do we do in class? And how?


"Docendo discimus." (Latin for "We learn by teaching")
Students also learn by teaching: they teach themselves (studying) and they teach each other medical "need-to-knows" in my class.
One student's observation: "I've always found that I learned a foreign language better when I used it to learn something else."


Reading (silently, to oneself) is deferred one-way communication.
Reading aloud is just like any other form of communication.


Students do a lot of writing in my classes.
They are also encouraged to send me email (but they rarely do).
"What I learned in class today" is my feedback form. Students spend the last ten minutes in class writing what they did. This provides proof of attendance, feedback, and (in theory) application of knowledge and newly acquired skills.


One of the things I say the most often in my classes is
"The time for asking questions is always NOW!"


Yes, that's correct: I do not test my students.
Every day, I correct one of their written compositions.


What I do, like what I don't do, is all needs-based.
Students' needs depend both on what they know and on what they don't know.


That my students know how to pass exams is beyond question.


That's what they were taught to do.
They have not been taught communication skills.


Students are not taught the basics in the Japanese educational system.
The basics are "too easy" (and in reality too difficult) to serve as materials for quizzes, tests, exams.
Japanese students are not taught what they need to actively use their passive knowledge of English.


Their summaries, purely academic exam-driven exercises, neglect and omit the most basic givens of summarization, without any regard for real readers' and listeners' needs-to-know. (For some reason, they are often in the first person, without citing the name of the author or title of the original work.)


Problems are found here notably in the use of prepositions and verbs (verb tenses, especially the conditional).


Here the errors in the use of prepositions, verb tenses, and the indefinite article have been corrected.
This essay was not a test, but note that the student ends up talking mainly about tests.


This is another student's short essay. His errors are mainly of English usage.


This was much better, and the errors were easy to fix. The ellipses above indicate corrections by deletion of incorrect or inappropriate words.
This student got the prepositions right and didn't say anything about his tests.


In this student's short essay, the problems are few, and are caused more by poor organization, though there are a few grammatical errors as well.


This revision of the content is based on some guesswork.
He left out some essential information (why did he retire to his home for ten days?), and he put some information (about his hometown and his home) in the wrong order.
It is likely he did this because he was writing for himself, not with the reader's needs in mind.


Here's a short essay by a student whose articles are very indefinite and whose verb tenses are wobbly.


This student had problems in every area: prepositions, articles, verbs, usage, organization.


Common English words that Japanese can't pronounce correctly: girl, world, woman, women, hurt, heard, career, carrier; pose, pause, major, measure, valuable, variable, drug, drag, bowl, ball.
When writing a composition, students put commas and periods on the next line, and sometimes write everything floating between the lines (because kanji written in Japanese are not supposed to touch the outline of the box in which they are written).
Circular definitions are OK in Japanese.
Many students don't see the need to clarify distinctions between similar things (the difference between an ER and an ICU, between a symptom, a sign, and a disease, between injury and damage).
Many resist being specific: ("I went with my team." "I'm a member of a rock band." "I learned the difference between symptom and sign.") What sport? What instrument? What are the some of the differences?


And my students are Japan's "élite"! How sad!
They have been ill prepared by the Japanese educational system to use English.
They are victims of a defective system.


To "field" questions means both to answer and deliberately to avoid answering questions.
Building rapport can be done by talking about the weather, family, pets, telling jokes, etc.
These are things that I think all students should have learned in high school.


Learn to walk before you run!
You cannot master specialists' vocabulary unless you master basic vocabulary.
You cannot write for publication if you cannot write clearly and correctly about your summer vacation.
You cannot make a full-length presentation unless you can make a short one.


I have made some subjective and objective observations about the capabilities and needs of my medical students.
I now turn to my assessment and plan.


Medical students in Japan, like most or all Japanese students, should have been better prepared (but were not) by their English teachers in elementary, middle, junior high, and high school.
(The fault is mainly of the system, not the teachers.)


Every suggestion here is feasible.
These suggestions require no special tools or talents.


Teachers should be facilitators and moderators (emcees, what the French call animateurs) in the classroom.


This is the same as Slide 34.
Medical students are always asking "What are the need-to-knows?"
I repeat: these are things that all students should have learned in high school.
It is not too late to do these things in medical school.
It will be too late after medical school.


In the next few slides, I show a few of the practical and effective approaches I use in the classroom.


Don't waste time on roll calls: use name cards that students pick up at the door and leave at their places at the end of the class. (Name cards left at the door belong to absent students.)
The self-introduction template phrases in the slide can be used, unchanged, in any setting or situation, for the rest of the students' lives. Practice, rehearse them!


For a start, individual students can be assigned short talks (key facts only!) on medical specialties (not specialities!) and symptoms.
This is medical vocabulary!
By teaching each other, by pooling facts and reporting need-to-knows, students activate their passive vocabulary, acquiring knowledge and skills at the same time.


At MITA, we demonstrated a Chaos Chorus: everyone in the large room read different things aloud, as loud as possible, not in unison. When they got to the end of a passage, they began reading from the beginning again. "Repeat, rehearse!"


There are two sides... to every sheet of paper.
And so it was at MITA's Chaos Chorus with the handout, which had passages in English for Japanese speakers on one side and in Japanese for English speakers on the other side.


Reading is deferred one-way communication.
Reading aloud is just like any other form of communication.
Round-robin reading – reading of the same text, read aloud, sentence by sentence or paragraph by paragraph, by one person at a time, in turns, to the rest of a small group -- demonstrates the communicative nature of reading aloud.
Paragraph labeling (which can be done individually or in small groups) helps students to organize and assimilate difficult material as they read it.


Note that "reading" means more than is generally assumed.
Even my students cannot read as well as they are reputed to. Can you and your students read a text aloud so that it is understood by their classmates? If they can't read that way in English, how can they be expected to speak in public?


If someone says something incorrectly three or four times before getting it right, and then goes on to the next thing without repeating it correctly even once, what are his chances of getting it right the next time?


Any questions?


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