Written by: Valentina Angelova, Varna Medical University, Bulgaria

Svetla Trendafilova, Varna Medical University, Bulgaria
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One important prerequisite for a well-organized English Language Teaching and English for Specific Purposes course still remains an appropriate core textbook. The aim of this article is to share the authors’ major concepts and experiences while writing and piloting the course book English for Medicine for students at Varna Medical University. Textbook writers attempt to analyze their motivation for writing the textbook and describe its structure and content along with some observations on its implementation.
Learning foreign languages at university level is primarily focused on the specific terms and grammar items that describe the language necessary for the specific profile of the given university. The English for Specific Purposes module at Varna Medical University comprises 60 contact hours and it is a credit-bearing module. There were no suitable course books available on the market at the time the writing of the textbook started and still very few course books are relevant to this type of curriculum. Most of the textbooks available are targeted for students studying English for 90 contact hours and above. The textbooks available are also at least twice as expensive as the textbooks published in Bulgaria. We needed a textbook that was most suited to the needs of our students. The bottom line was that we had to produce a course book that Bulgarian students of medicine would be willing to buy and work with.
The cultural context of writing a textbook at university level is probably very different from the context in which textbooks are being written in some other countries. In Bulgaria teachers usually invest time, money and a lot of effort, knowledge and understanding, expertise, creativity and imagination, desktop publishing skills in order to design and create a course book suitable for their students. We presume that in other countries a preliminary contract is signed and authors get some financial support and time for writing the course book. This is not the case in Bulgaria. That is why we say it is a very challenging experience in many ways. Sometimes there is not enough time for piloting all activities developed because of the pressing circumstances, e.g. the beginning of the new academic year, deadlines that the publishers have to meet, etc.
Students are usually mixed level groups of 7-20 students in number. Most of them are at B1 and B2 level of language proficiency according to the Common European Framework of Reference for Languages. Over the last few years there is a tendency of the groups to become more and more diverse in terms of their educational, cultural and social background. We have Bulgarian students who have studied for a number of years in America or some European countries and come back for continuing their higher education in Bulgaria. There are some students of Turkish, Greek, Macedonian origin or representatives of other nationalities.
After a needs analysis was carried out the following decisions were made:
A textbook is necessary as a major support in the ESP seminars with at least 12 units to meet the curriculum and syllabus parameters. From a methodological point of view a balanced approach of language focused work and communication skills is pertinent. For that purpose a combination of topic and task-based syllabus with elements of a lexical and grammar-based syllabus seemed adequate. Texts for listening and reading had to be topical, directly related to contemporary issues in medicine, interesting and motivating for students. Sources for the developed tasks were derived from books, journals, dictionaries, the Internet, encyclopaedias, brochures, etc.
Another important consideration to bear in mind was the main unit structure. The major input would have to come from texts for developing the receptive skills with questions that check comprehension. Then based on these texts we would develop vocabulary focused tasks with a plethora of awareness raising of Latin/English transfer, e.g. cholelithiasis and gallstones.
The grammar focus had to be typical of scientific discourse with more emphasis on functions, e.g. describing processes in the body using passive voice, giving instructions to the patient using the imperative, etc. Last but not least, enough opportunities had to be provided for productive skills to be enhanced. A special feature was designed, For your portfolio, at the end of each unit in order to ensure the integration of skills. It stimulates choice of individual or pair/group written tasks as well as application of the internet as a resource for creative work on part of the students. Here are a few examples of the different types of activities designed for developing the four psycholinguistic skills.

Types of Activities for Listening

Our major goal was to make listening interesting by choosing a great variety of materials on various interesting topics. On the formality continuum in terms of register there are informal doctor/patient dialogues at one end and formal lectures at the other. The tasks also focus on different micro skills and hence students perform activities such as listening comprehension with multiple choice questions or T/F, listening and note taking usually to mini lectures e.g. Lactation and Birth Spacing; listening for specific information  and gap-filling, e.g. a doctor-patient dialogue or details in case reports; listening and error correction.

Types of Activities for Reading

The main type of input is achieved through different types of tasks for reading and understanding, bearing in mind that reading and understanding is specifically what our students need the language for. Here are some types of reading activities common throughout the course book: reading for gist or for specific information; reading and multiple matching; reading and sequencing events: e.g. resuscitating a victim; reading and drawing a comparison: e.g. anaemia/leukemia; reading and prioritizing: e.g. stress symptoms; reading of texts with different register: e.g. literary texts, case reports, dialogues, lectures, summaries, etc.

Types of Activities for Writing

Labelling a picture of one of the systems in the body is a typical activity for writing. It is particularly useful as a pre-reading task and students of all levels of proficiency seem to find it exciting. Model writing is another common writing task, e.g. definitions, writing a paragraph, describing a process, describing an event focusing on cause and effect. Occasionally tasks of the information transfer type are suggested, e.g. form-filling, describing diagrams. Some of the writing tasks concentrate on typical medical documentation, e.g. a letter of referral, a case report. Writing tasks that are primarily related to academic writing have also been included, e.g. writing a summary; for more advanced students: writing an argumentative essay; writing for the portfolio at the end of each unit. The aim of the portfolio is to bridge the textbook with extended extracurricular work and home assignments and it often encourages students to do research on the Internet, to work in pairs or small groups. While developing their portfolio students search different websites, create their own materials and thus improve their autonomous learning skills.

Types of Activities for Speaking

A variety of tasks for developing speaking skills have been designed. Some of them work better with some groups of students but as a whole students feel motivated to share their views on medical topics. These are important issues that they are interested in, such as whether men or women make better doctors, whether it is easy to implement the Hippocratic oath in contemporary Bulgaria and other countries. Typical activities for speaking are: expressing personal opinion: e.g. discussion on male/female professions; discussing similarities and differences; making predictions and talking about a sequence of events; enquiring about a problem and developing professional communication strategies e.g. doctor-patient interaction, raising awareness of how to talk with children, explaining to and reassuring patients. Students are stimulated to prepare and give mini talks. Awareness raising of switching register according to context turns out a valid activity too. Occasionally students have the chance to take part in role-plays and simulations, e.g. they have to prepare a short individual oral summary as well as a long-term assignment: getting ready for an oral presentation which could be done with a partner. Cultural diversity topics are also discussed, for instance, blood transfusion or transplantation of organs in different countries, health care systems across cultures.

Focus on Grammar in Context

The grammar activities are typical for scientific discourse and are based on the texts for reading and/or listening. Most often than not they are concentrated on grammar items such as irregular plurals, prepositions and adverbs describing location, passive voice, reported questions, cohesive devices, relative clauses. Special attention is drawn to the importance of functions, e.g. describing cause and effect; sequencing of events, asking special questions to elicit information, expressing probability and certainty. All in all the grammar items included in the course book have communicative value in the medical discourse.

Focus on Vocabulary

Vocabulary tasks are also varied and are related to language awareness of word formation: derivatives, cognate words and compound nouns, adjectives, etc; comparison of medical terms and common names; focus on synonyms and antonyms, collocations; paraphrasing typical expressions and fixed phrases; inferring meaning from context; highlighting common verbs for description; drawing semantic webs to help memorising, etc. Some pictures, diagrams and other non-verbal props have been used to help students while working on vocabulary.

The Appendix

The main function of the appendix is to provide supplementary material for optional activities at various levels of proficiency. Thus it becomes a major tool for meeting the different needs of students. Its structure comprises at least one extra activity per unit called Supplementary Activities. Translation Time offers one text in Bulgarian for translation into English which is envisaged to be what students will need in the future as presenters at national and international conferences and seminars. Some useful Guidelines for Productive Skills have been included as support for various kinds of writing. They are aimed at intermediate level students who have not covered that component in high school. A section has been developed on Common Medical Abbreviations and Metric Conversions for reference.
The sample test at the end of the textbook plays a two-pronged role. On the one hand it helps students revise part of the material covered and helps the lecturer and students evaluate and assess the mid semester progress of the students, on the other hand it allows students to prepare themselves for the final test by experiencing the solution of different tasks. Similar components would then be included in the final written exam.

Why is Textbook Writing a Creative Process

Textbook writing is a creative process because it keeps lecturers committed to their students needs. Throughout the process authors had to make decisions on which text to choose; what type of activity the selected text lends itself to, e.g. with a language or skills focus, the type of exercises suitable for the particular text exploitation, e.g. MC or T/F reading, etc. Another kind of creative choice we had to make was establishing a logical sequence of activities within a unit and then the units within the book. Solving problems such as how to design the layout of a page and a whole unit, how to achieve better visualization through pictures, diagrams or tables that would allow more natural foreign language acquisition, was in itself an exciting, energizing and creative activity. The process necessitated negotiating and reaching a consensus on the part of the textbook writers. Authors gained insights into the evolving, emergent and artistic character of the course book. The process of piloting involved students as co-authors and creators. This definitely helped the improvement of the final version. They provided invaluable anecdotal feedback which in itself was an incentive for them to regularly attend English classes.

Why is Textbook Writing Challenging

Some of the creative activities enumerated above can also be very challenging because it turns out that textbook writing is a complex process that involves among other things:

  • meeting the needs of students that come from diverse educational, social and cultural background
  • meeting students’ needs as future doctors, hence science-oriented texts and tasks
  • matching the curriculum, syllabus and students’ needs
  • balancing content and language awareness
  • balancing grammar and vocabulary focused tasks
  • developing integrated skills
  • ensuring progression of tasks within a unit and throughout the textbook.

Positive Outcomes

Textbook writing is a long-term commitment but it may be rewarding in many ways. To begin with, if there is a course book that is the core support of the process of teaching and learning, it allows teachers to focus more on the structure and organisation of the teaching process and hence improve both. Otherwise the teachers’ attention is primarily on the ‘what’ exactly they are going to teach. Students are also able to do some autonomous work in case they are absent or if they feel they need further preparation for the English seminars. The textbook helps both advanced and lower level students in different ways. More advanced students can work on the useful websites or some of the extra activities for reading or translation, while lower level learners can do the same activities again or read the texts at their own pace of acquisition, understanding and learning. A textbook as a prop creates more opportunities for teacher and learner interaction since it provides the medium of shared knowledge, the starting point of discussions and developing speaking skills. To recapitulate, the course book gives invaluable opportunities for carrying out useful, helpful and stimulating seminars. As a whole it helps students improve their academic performance.