Healthcare Terminology Teaching/Learning
The goal of this work is to create something that will be of value to nursing students, nursing instructors, ESL and ESP students and instructors, and other English language learners interested in studying English for the healthcare professions. Indeed, among the desired outcomes of this project there are the need to encourage a professional dialogue on hospital English, to develop study materials and resources for use in the ESL learning, to develop independent study materials and resources for those interested in the healthcare field, to examine and study materials to encourage research concerning the best methods to teach hospital English.
TEACHING MEDICAL TERMINOLOGY
Included among the desired outcomes of this work are the following:
Out of the potentially endless amount of material that could be explored, the focus has been narrowed and limited to three areas relevant to the topic of Hospital English:
There is a multitude of options open to the learner and to infer the meaning of the item:
Medical terminology, which consists largely of Greek and Latin morphemes, and grammatical elements of scientific writings, provide a rich context for linguistic analysis. The medical documents alone are vast and worthy of study. The language of the hospital setting comprises the content to be taught in the ESP classroom. Physicians' interactions with patients, such as the doctor-patient interview, comprise a large portion of the discourse. The business and management of healthcare, and the associated legal implications are current topics of interest. The psychology of illness, roles of patient and caregiver, and theories of medicine and nursing are other complicated topics. In particular, when considering an occupation and its accompanying language three terms come to mind:
A register , as defined by Crystal1, is “a socially defined variety of language, such as scientific or legal English”. Jargon refers to “the technical language of a special field” 2 and lexicon is the vocabulary of a language.
Register, is a term often used in recent linguistic and stylistic research. There are distinct varieties of language, associated with people's occupations and to these the name ‘register' has been given. It is defined as a consistent variability of language conditioned by its use in a given social context, a professional or other field, or in discussions of a certain theme. The idea of a register as a characteristic configuration of functional choices on various levels of language is close to the concepts of sublanguage or genre, i.e. a class of utterances. The professional communicative register has to be precise, exact and coincided and the lexical units have to be unambiguous unlike the common language that doesn't make reference to the concepts or to the objects in a univocal way. This opposes, nevertheless, with the evidence that the scientific disciplines are not unified and that in the reality of the written and oral texts, there are different denominations of the same concept, according to the communicative context in which it is applied, with the consequent loss of the monosemic character of the terms when they are inserted in a context. It will also have a specialized vocabulary which will not have much resemblance to the vocabulary that I have been using.
Registers are potentially important in language teaching because people do have an occupational purpose in learning a foreign language.
ESP is distinct from other kinds of special use of English. Slang, for example, is a sociolect; it is not limited to people sharing the same activity.
Jargon is a slightly derogatory term for ESP connoting opaqueness to non initiates. Like other disciplines in modern technological society, the health sciences have developed their own jargon for describing the human body, its normal functions, and its abnormal conditions. This jargon is a tool for precise description and effective treatment of health problems, but it can also be a barrier, blocking communication between specialists and laypeople. This is especially true since there are often several medical words describing the same condition but constructed from entirely different roots or arrangements of those roots. It also denotes informal usage within LSP, e.g., Eternal Care Unit, involuntary in Western medicine, or terms that are superfluous or obscure, e.g., ethanolism, pseudopseudohypoparathyroidism, and normochromia.
The vocabulary of a language is its lexicon3. Within the realm of healthcare and Hospital English, the use of Greek and Latin elements to create medical terminology is obvious. There are many medical terminology textbooks that teach the roots and affixes that form medical nouns, adjectives, and verbs. For example, hepatitis is formed from the root hepat-, pertaining to the liver, and the suffix – itis, meaning inflammation. The adjective myocardial comes from myo -, muscle, and cardio -, heart. A foundation in anatomy and physiology is necessary to describe the structures and functions of the human body, and their spatial orientation, using Greek and Latin terms. There are many words which are used in everyday life, but have a special meaning when they are used in the hospital. It is half-way between general usage and highly technical medical language. It is often the cause of communication breakdown between native and non-native speakers. Examples include words such as drip (an intravenous medication), rhythm (heartbeat), gas (a blood test), negative (a good test result), stone (a British unit of weight), and echo (a diagnostic study of the heart).
With respect to written forms of communication, Marco 4 examined grammatical frameworks in medical research papers, and noted the prominence of nominalizations and agentless passives. As defined by Crystal5, a nominalization is the process of forming a noun from some other word-class, or the derivation of a noun phrase from an underlying clause (e.g., red + ness). Nominalizations, as well as agentless passives, hide the human agents, emphasizing the entities studied, rather than the researcher's actions6. An example of an agentless passive is the sentence “the research was conducted” (a form of be + a past participle), as opposed to “the scientists conducted the research.” The author suggests that “students can improve their ability to understand and write medical papers if they are made aware of the function of these frameworks in the paper”. 7
Frequently in nursing documentation, when charting about one particular patient, the pronouns he, she, and the word patient are omitted, unless another person is brought into the narrative, such as a family member, for example, “up and into chair; took 100% of breakfast. Complains of headache; medicated for pain; states medication relieved headache.” 8 state that the grammatical forms of the passive voice, multiple embeddings, if... then constructions, and expository discourse used in scientific prose may be difficult for ESL students to comprehend.
A study conducted by Ferguson focused on if-conditionals in naturally occurring medical discourse. “Conditionals can function as a resource for politeness in face to face interaction. Another common use of conditionals is in the description, or the elicitation, of symptoms”9. The author notes that there is a difference in the use of if conditionals in spoken and written medical discourse. Perhaps this type of research would assist the English language teacher in identifying linguistic forms in order to explain their usage to students.
Dialect is not an important type of language variation for teaching. Although the potential teacher and the advanced learner might be made sensitive to the fact that there is dialect variation in the target language just as there is in the mother tongue, we rightly settle for the teaching of a single dialect to most learners. Dialect features are the product of the individual's geographical and class origin. Educational experience is also significant, but this is partly dependent on class anyway. If two speakers differ in grammar, pronunciation and vocabulary, we will conclude that they speak different dialects. Variation in pronunciation, but not in grammar and vocabulary, would be considered difference of accent here is no clear quantitative linguistic measure to indicate where difference of dialect becomes difference of language. The issue is political and social, not linguistic. Everybody speaks a dialect, which is not seen, as it is traditionally, as some kind of deviation from the norm of standard English. Nor would a linguist feel that there was any linguistic justification for saying that one dialect or accent is better than another. It is a social judgment that leads people to say that one English dialect is the correct' one.
If asked to justify the teaching of the metropolitan standard that is normally adopted as the model for foreign language teaching, we would presumably say that it is the form of language most acceptable to the native speaker and therefore the form that will enable the non-native speaker to be accepted by the host community.
Culture influences one's response to illness and hospitalization. As different cultures come into contact amid stressful circumstances, it is important to be sensitive to potential areas of misunderstanding that can lead to communication breakdown. Nurses are taught to strive for therapeutic communication at all times during patient care. An awareness of culture and how it affects one's experience in the hospital can facilitate more effective and therapeutic communication. Caring for the sick involves intimate contact with patients and interacting with their friends and family members. Behavioural norms are codified in culture. Culture is not intended here in its aesthetic, artistic sense, but in its sociological sense. The culture of a society consists of whatever one has to know or believe in order to operate in a manner acceptable to its members. Culture indicates knowledge, prescribed behavioural patterns, socially transmitted ways of doing things, capabilities, habits, arts, beliefs, morals, customs, laws norms of conduct, ideals and values acquired by man by virtue of belonging to society. Culture affects all dimensions of communication. Behavioural norms are codified in culture. Furthermore, "cultural" mistakes are generally deemed far more serious than mistakes of "form" (grammar, lexis and phonology) by native speakers. Culturally deviant behaviour may be judged as being rude, arrogant, tactless, insensitive, ignorant, or as indicating a rejection of or unwillingness to conform to foreign language cultural patterns, and therefore as a sign of distant, disapproval, or hostility. This reaction is mainly due to the fact that native speakers are normally unaware of the difficulties cross-cultural differences create because they have internalized the norms of their own culture and are therefore unconscious of the workings of such norms
“ Culture refers to the integrated patterns of human behaviour that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, and/or social groups”10. A patient's cultural background will influence his or her response to illness and hospitalization. One important aspect of illness is pain. It's easy to think of pain as a biological phenomenon with an involuntary, universally-accepted response exhibited by all people. Reactions, however, can be involuntary (instinctual), or voluntary. The response to pain and how that is communicated to others can be described as pain behaviour. Some involuntary physical reactions are increased heart rate and blood pressure, facial grimacing, tensing of muscles, and withdrawing from the source of the pain.
Voluntary reactions, and how or whether people communicate their pain to health professionals, are particularly influenced by social and cultural factors11. The attitudes that a particular cultural group has toward pain, such as it being a normal and accepted part of life, may influence their reaction to it and/or their way of communicating it to others12.
TEACHING LANGUAGE AS COMMUNICATION: USE, USAGE AND THE COMMUNICATIVE CONTEXT
It is not the words on the page but the communicative context (also referred to as ‘context of situation', non-verbal context', or simply 'context') in which the configuration of words, sounds and non-verbal devices occur that determine the meaning to be attributed to each linguistic exponent and to the text as a whole. The context in which a speech event occurs provides extra-linguistic information (i.e. information which is not explicitly declared or implicitly entailed in the language itself, which enables the participants to eliminate ambiguity and decipher the text. (Indeed, participants are rarely even aware of possible ambiguities since the communicative process normally runs smoothly.) In other words, language by itself is incapable of transmitting messages, which is the message model view of communication. Language cannot exist in a void: it exists in context. Context is one dimension which furnishes the extra non-linguistic information which is required to be able to interpret the information conveyed by the language items. An important set of variables revolve around the participants in a speech event. This includes individual identity (personality), social identity (differences in sex, class, religion, ethnicity, age and role are overtly marked linguistically to differing degrees in all cultures), the personal and social relationships between interactants, the presence or absence of an audience. These factors have both on what is said and how it is said. Indeed, compared to low socio-economic status groups, members of high status groups may raise the generality or abstractness of accounts, while the conversations of low status groups revolve more around the concrete and specific. Members of high status groups generally use longer sentences, complex clause constructions and syntax, complicated nominal verbal and prepositional structures more frequently than the members of low status groups and they exhibit greater diversity of lexis, tending to use more correct or standard language forms as well as more prestigious language forms. This latter point is due to the interplay between class and variables such as education, interests and role (sub-features of identity). Hence contextual variables represent constraints on language use since they are associated with rules of use which lay down what content and what language forms (including which language variety and style) are appropriate in given contexts. Thus, apart from learning grammatical rules (or rather, rules of linguistic form, since grammar is not the only symbolizing pat tern), students also learn the rules of use. Use is the citation of words and sentences as manifestations of the language system, and Usage is the way the system is realized for normal communicative purposes. Knowing a language is often taken to mean having a knowledge of correct usage but this knowledge is of little utility on its own. A knowledge of use must of necessity include a knowledge of usage but the reverse is not the case: it is possible for someone to have learned a large number of sentence patterns and a large number of words which can fit into them without knowing how they are actually put to communicative use. Both the manifestations of the language system as usage and its realization as use have meaning but the meaning is of a different kind in each case. Words and sentences have meaning because they are part of a language system and this meaning is recorded in grammars and dictionaries. The term signification was used to refer to this kind of meaning: the meaning that sentences have in isolation from a linguistic context or from a particular situation in which the sentence is produced. This was distinguished from what was called value and this was defined as the meaning that sentences take on when they are put into use in order to perform different acts of communication. Thus the signification of the following sentence:
The doctor is taking a blood test can be found by recognizing that here we have a declarative sentence (as opposed to an interrogative one), that the verb is present in tense, (as opposed to past) so and on: continuous in aspect (as opposed to perfective or ‘unmarked) and so on: the signification is derived from the relationship between the grammatical meanings of the syntactic choices and the dictionary meanings of the lexical items doctor, take and blood test. In terms of value, however, this sentence might serve a number of different communicative functions depending on the contextual and/or situational circumstances in which it were used. Thus, it might take on the value of part of a commentary, or it might serve as a warning or a threat, or some other act of communication. If it is the case that knowing a language means both knowing what signification sentences have as instances of usage and what value they take on as instances of use, it seems clear that the teacher of language should be concerned with the teaching of both kinds of knowledge. In the past the tendency has been to concentrate on usage on the assumption that learners will eventually pick up the necessary knowledge on their own. This would seem to be too optimistic a view to take; The evidence seems to be that learners who have acquired a good deal of knowledge of the usage of a particular language find themselves at a loss when they are confronted with actual instances of use. The teaching of usage does not appear to guarantee a knowledge of use. The teaching of use, however, does seem to guarantee the learning of usage since the latter is represented as a necessary part of the former. This being so, it would seem to be sensible to design language teaching courses with reference to use. This does not mean that exercises in particular aspects of usage cannot be introduced where necessary; but these would be auxiliary to the communicative purposes of the course as a whole and not introduced as an end in themselves. It was suggested that perhaps the best way of doing this was to associate the teaching of a foreign language with topics drawn from other subjects on the school curriculum. It might be added here that even if there are administrative and other difficulties in the way of adopting such an approach from the beginning, it should be possible to do so at a later stage of learning. I think that it is possible, in principle, to teach use in the way that it has been proposed from the first language lesson, but particular practical factors may not be favourable for applying principle. What is important is not that the teacher should embrace this suggestion as an absolute dogma to be adhered to unthinkingly, but that they should consider its possibilities and put it into practice at what seems to be the most appropriate and practicable time.
METHODOLOGIES FOR TEACHING MEDICAL TERMINOLOGY
Though students are relatively familiar with colloquial English phrases for describing medical conditions and anatomy, they are much less familiar with medical terminology. This thesis provides both a rational and suggested approach for teaching medical terminology. Acquiring proficiency in this specialized language is one of the fundamental challenges of medical studies.
Medical terminology is not commonly taught separately, but rather as incidental to clinical studies. Acquiring medical terminology will occur concurrently along with the vast body of clinical information that students must assimilate.
Students develop some grasp of medical terminology through repeated encounter, inference and memorization, but this thesis considers these learning methods inherent in common practice both inefficient and insufficient.
The first learning method presumes that students acquire knowledge of medical terminology by repeatedly encountering terms. This assumes that students come to recognize, understand and remember terms just as they rise incidentally in medical texts and lectures. It assumes sufficiently frequent exposure to terms; it requires that students be continuously multitasking – listening for terminology, recognizing and remembering it.
The second learning method is one by which students gradually, without explicit instruction, come to recognize and extrapolate from lexical patterns the medical terms; in other words, terminology will be learned through interference. This is possible through persistent study of a medical dictionary. Medical dictionaries are essential references, but provide comprehensive and detailed, not succinct, definitions. Hence definitions require time to isolate, in addition to the difficulty of sourcing terms within the cumbersome volumes. As well as being a time consuming process, memorization has other drawbacks, relying on memory to the exclusion of other cognitive and analytical capacities. Moreover, the alphabetical arrangement of dictionaries runs counter-intuitive to ways in which the mind registers and recalls language, by subject and chronology. Teaching and learning all the words seem to be an impossible task. Hence, teaching learners vocabulary learning strategies for inferring the word meanings is more efficient than teaching every vocabulary item encountered and it enables more efficient dictionary use and greater comprehension.
Another very efficient method is the CLIL method which, starting from reading texts, draws on the lexical approach, encouraging learners to notice language while reading. The treatment of this lexis has the following features:
Indeed, for medical and nursing professionals, the first step to access medical language is to learn medical words. Terminology centred learning proves to be an efficient way to bring the students into medical English world.
Like much scientific terminology, medical terms are largely derivations of either Latin or Greek origin and have their own rules of word building with distinctive characteristics. A medical term is typically comprised of words parts that are either entirely Latin or entirely Greek in origin; the two derivative languages rarely intermingle to form a given term. Hence, there are numerous duplicate terms, both a Greek and a Latin term which refer to the same anatomical and psychological aspect. For example, the Greek root nephr and the Latin root ren both refer to the kidney. Generally Greek derived terms refer to diagnosis and surgery, whereas Latin-based terms refer to anatomy and psychology, (but the question of provenance is of little relevance to trainee doctors).
It will be helpful to provide some description of the general lexical structure of medical terms. That structure, since comprised of Latin and Greek derivatives is typically a variant of the combination of prefix, root and suffix. Terms may be formed with two or more combined roots. Some common formations are: prefix-root-suffix; prefix-root-root-suffix; prefix-root; prefix-root-root; root-root; root-suffix; root-root-suffix.
Prefixes specify some aspect of the adjoining root. Prefixes may refer to aspects such as: number and measurement, location or spatial characteristics, colour, density, time or time order, severity and so on. There are common prefix-root collocations, but a given prefix may be adjoined to an array of roots.
Suffixes can be grouped under two categories: grammatical or semantic. In addition to expressing grammatical function, noun or adjectival forms, etc., suffixes often have a specific semantic role in medical terminology, indicating aspects such as condition, disease or procedure.
Combining forms in terminology are where the vowel ‘o' combines two roots and/or prefix and root, or root and suffix (where the latter begins with a consonant). Combining forms have the functional purpose of facilitating pronunciation, as seen in the examples cerebrovascular or streptokinase. If a suffix begins with a vowel, the combining vowel is usually omitted, examples: cardits (not cardiotditis) and gastralgia (not gastroalgia) However, where the root ends with a vowel other than ‘o', the combining vowel is often applied, examples: arteriosclerosis, osteoblast, cardiodynia. Two root combinations exclusive of a vowel are often joined with a combining vowel, for example: nephrolitectomy (not nephrlitectomy), which would be unpronounceable.
For the reasons I have just described above, student should be taught to parse terms according to composite parts: prefixes, roots and suffixes, construct meaning form parts, and in turn use composite parts to encode terms. In other words, the goal is to teach comprehension through analysis, rather than sight recognition, inference and memorization.
A class schedule would be sufficient for students to learn the rudiments necessary to decode and encode a substantial body of medical terminology. The schedule of a course of study might be organized as follows: commencing with a detailed study of prefixes, proceeding to suffixes, then, introducing roots representative of various medical specializations and consolidating decoding and encoding skills. Teaching terminology in these three stages allows for progress assessment at the end of each stage. Moreover, students learn to recognize the function and semantic value of prefixes, suffixes and roots respectively, and to parse terms accordingly. The number of roots introduced should not be exhaustive, but be sufficient to represent and describe the procedures and conditions most common to a range of specializations.
Though introducing prefixes, suffixes and roots separately appears to facilitate the learning process, it is helpful to give examples of word parts in the context of a complete term, and to do practice exercises with complete terms. Students should learn several common roots at the outset in order to begin recognizing and practice constructing prefix-root-suffix patterns. Introducing common roots, such as cardia, gastro, osteo, hema, entero, arthro, proves helpful in teaching students to encode and decode terms. Students can experiment with combining newly-studied prefixes and suffixes with familiar roots to form medical terms, adding a purposeful, creative dimension to the lesson.
Example of prefix glossary:
2 D. Crystal, The Cambridge encyclopedia of the English language, ibidem, p. 424.
3 David Crystal, The Cambridge encyclopedia of the English language, ibidem, p.424.
4 M. J. L. Marco, Collocational frameworks in medical research papers: A genre-based study. “English for specific purposes: An international journal of ESP”, Vol. 19, n° 1, 2000, p. 63-86.
6 M. J. L. Marco, Collocational frameworks in medical research papers: A genre-based study,” English for specific purposes: An international journal of ESP”, ibidem, p. 65.
7 A. U. Chamot, J.M.. O'Malley, The Calla Handbook: Implementing the Cognitive Academic Language Learning Approach , Addeson-Wesley, Longman, White Plains, NY, 1994.
8 M. J. L. Marco, Collocational frameworks in medical research papers: A genre-based study,” English for specific purposes: An international journal of ESP”, ibidem, p.75.
9 G. Ferguson, If you pop over there: A corpus-based study of conditionals in medical discourse. English for Specific Purposes, vol. 20, 2000, pp. 61-82.
10 Juliene G. Lipson, & Suzanne L. Dibble, Culture and clinical care, San Francisco: UCSF Nursing Press, 2005, p. xi.
11 C. G. Helman, Culture, health and illness (3rd ed.), Oxford, UK: Butterworth- Heinemann, 1994, pp. 179-180.
12 C. G. Helman, Culture, health and illness (3rd ed.), ibidem, p. 182.
Published in January 2018.
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