Written by: Biljana Ivanovska, PhD, German and English Language teacher
The author has been teaching English for specific purposes part-time at the Faculty of Medicine, University ‘Ss. Cyril and Methodius’, Skopje, R. Macedonia
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This paper presents my two-year working experience teaching English for specific purposes at the Faculty of Medicine in Skopje, the Republic of Macedonia.
The use of multimedia technology provides the students and teachers with unlimited opportunities for learning and acquiring foreign language. The most significant outcome in the newly-developed course at the Skopje Faculty of Medicine was the change in students’ attitudes and preferred learning styles. This influenced their overall attitude to the teacher-student role, their attitude to the university education and tolerance to other professional cultures and models of behavior. Teaching Medical English via Internet improves the teaching process and makes it interesting, motivating and useful. At the same time the teachers and students are emotionally triggered and motivated. The new multimedia technology provides the teacher and the student with interesting materials, data, handouts, worksheets indicating that they have no limits to their access of learning. It is worth experimenting and investigating the potentials that Internet can offer.


The ‘Ss. Cyril and Methodius University” in Skopje is the first state university in the Republic of Macedonia which was founded in 1949 and today it represents a family of twenty-three faculties, ten institutes and other institutions.
The Faculty of Medicine was established as an independent faculty within the University in Skopje, R. Macedonia, whose mission is to be an autonomous, scientific and higher educational faculty that provides teaching, scholars and applicative activities in medical sciences. It educates highly trained professionals: doctors, graduate nurses-practitioners, graduate medical technicians, radiologists, speech and language therapists and physiotherapists, and its syllabus is designed to meet the needs of the health managing system not only in our country but also in the west European countries. The Faculty offers Bachelor and Master Degree programs. It has a freedom to decide how many academic hours should be allotted to foreign languages for specific purposes as well as the teachers are given the right to propose their own syllabus and design their own teaching materials.
In 1993 the Republic of Macedonia was admitted to the United Nations and the Council of Europe and became a member of La Francophonie, the World Trade Organization (WTO) and the Organization for security and cooperation in Europe. Since December 2005 Macedonia is also a candidate for joining the European Union and has applied for NATO membership. Unfortunately, the decision on Macedonia’s admission to NATO was postponed a month ago, in April, 2008, so my country didn’t obtain NATO membership invitation at the Bucharest Summit, although the Macedonian politicians and the Government were cooperative and willing to accept a compromise proposal and although Macedonia significantly contributed to the West Balkans’ security and stability.
With the opening of Macedonia to the western world and the activation of academic and scientific exchange, Macedonian scholars and students needed English not only for passive understanding, e.g. for reading specialized medical journals, reading textbooks on medicine and grammar drills, for maintaining personal contacts, but also the Macedonian doctors and students of medicine realized that they need to be able to communicate effectively with their colleagues from abroad. It was a prerequisite for the transition from the old to the new economic and political system.
At the Faculty of Medicine, the English, German and the French language are taught as elective subjects, within the syllabus designed for foreign languages, developing 45 academic classes in form of credit-transfer system during the first semester in the first year of studying.  The students have the opportunity to chose between the English, German and the French language and those who would like to learn English (as ESP) make a single group, which is further subdivided into 2 subgroups.

Previous teaching process

Few years ago, the course in English for Medical Purposes at the Skopje Faculty of Medicine was based on the textbooks (Pandora D., 2000, Popovska L, Panova-Ignjatovik T 2000, Siljanovska M,) approved by then the Ministry of Culture and Education. In them priority was given to memorization of fragments of medical terms and phrases in certain specific context. The teaching process was mainly grammar-based with a number of drills for automatisation and translations. It was teacher-oriented, the ESP teacher being the knowledge-provider, lecturer and evaluator. They had no say in the selection of teaching materials, texts or tasks. On the other hand, the students‘ role was restricted to the passive reception of linguistic and specialized knowledge and subsequent reproduction. Students were supposed to read and memorize the medical terms on the given topic from the text to follow. Neither had they any choice of learning styles, methods and materials. The expectations of both students and teachers were a reflection of the traditional methodology and teaching/learning styles widespread throughout the country at that time.

The importance of teaching Medical English vie Internet

I would like to focus on the importance of multimedia technology in foreign language teaching.
In Macedonia we are in the fortunate position that the government has launched a nationwide program, in which the universities are connected to the Internet, and a special emphasis has been put on the introduction of information technology to students. It means that within a couple of years we are going to face this new generation at the universities, and we should take precautions to meet the new demands.
The Macedonian government intention was to supply not only the faculties but also all primary and secondary students to have a computer within next 2 years.
For the last few years more and more Macedonian universities and schools have been equipped with computers as a result of sponsorship from different foundations, joint projects, etc. In this way some schools were in a focus on ESP. The software unfortunately is not sufficient and neither is the number of the available computers. This is why most of the students do not have regular access to these computers and the same applies to teachers. At least a couple of computers are needed to be able to work effectively, preferably a lab with 10-15 machines, and that is quite expensive. When we have the equipment we need programs: software, CD-ROMs and they also cost money.

Justification for using Internet  in the teaching process

Numerous researchers have reported on the theoretical constructs that support the use of multumedia technology for EFL instruction (Jonassen 2000; Kitao 1995; Kang 1999; Pino-Silva 2002, 2004; Step-Greany 2002, in Carlos A. Mayora, 2006). This research shows that using multimedia technology in the classroom:

  • allows students to work individually at a computer station, at their own pace, and according to their own needs;
  • helps teacher to deal more effectively with a large group of students;
  • makes the introduction and presentation of content more dynamic and attractive for students
  • increases student motivation due to the interactive nature of activities;
  • trains students  to self-monitor and self-assess their progress, which promotes autonomous learning
  • promotes a task-based approach to learning;
  • allows students to experience real-life and communicatively meaningful language situations and context; and
  • introduces  a variety of print, audio, and visual materials that match different student learning style and preferences.

My experience using Internet

The classroom setting is a well endowed  computer lab equipped with 15 computers for 30 students and a set of hyperlinked texts. In the computer room which I used as a language lab there are 15 computers allowing the students to work in pairs.
Activity 1
Students were ask to surf the net looking for sites they were interested in. The options such as advances search, preferences and language tools (which are on www-google) were previously explained to them. I split the same group into three. The first sub-group was searching the free on-line medical encyclopedias, the second one the free on-line medical dictionaries (English-English, English-Macedonian and vice versa), and the third one the medical atlases. The searched topics on the web pages were the following: Wikipedia-Medicine, Columbia Encyclopedia (which contain 52,000 entries /marshalling six and one-half million words on a vast range of topics/ more than 84,000 hypertext cross-references), MedlinePlus – service of the U.S. National library of Medicine and the National Institute of Health, Medical Atlas with 3 D images pictures and photos of diseases, Human body atlas: human anatomy and diseases, discovery Health (video, texts, mode and slides) and American Medical Association: Atlas of the body (links to images, graphics, information about various body system, health issues affecting each topic). The suggested links were the following:
I suggested them also all sites that were available through the Macedonian Central Medical Library, and web-site of the National University Library ‘ Ss. Kliment Ohridski’ in Skopje as well as the links given by the web-site of the Faculty of Medicine in Skopje.(e.g. Multilingual Glossary of technical and popular medical terms in nine European Languages Encyclopedia Britannica – Wikipedia – Columbia Encyclopedia MEDLINEplus -MedicalEncyclopedia)
I asked the students to collect a list of topics (for example: the human body, the locomotory system, the digestive system etc.) they want to talk about, then they chose one particular topic. They chose particular texts they find interesting but at the same time it is about the topic they are supposed to deal with. They feel more free to talk about things they want to. They are given some time to look for material in the free on-line encyclopedias, dictionaries or atlases about the given topic, not only texts but illustrations, pictures, tables, videos. They have to share the information they have collected and have a discussion asking each other questions, expressing their own views, etc. This exercise provides good opportunity for students to practice one of the tasks in the 1st year oral exam: they have to read and report on a text and have a discussion about the topic. From the student feedback it has been one of the most popular task. The first set of each readings and tasks is structured to flow from initial key concepts to more descriptive data containing more topical concepts and subsidiary information that, constitute reference material for current and future use. This exercise provides a variety of tasks: since words occur in context, spelling, word order, new vocabulary, brushing up old words can also be practiced.
Activity 2
In the following part of my presentation I would like to describe the way I use the case analysis  in my ESP classes, e.g. application of case analysis in teaching medical English using the article given on proposed by Jack Kimball.
The article referring to Internet-assisted language learning written by Jack Kimball has motivated me and my students to analyze the topics on medicine using the Internet. We have used the web site “Topics in Medical English” for our further analysis. Students are given a certain topic, e.g. “healthy lifestyle”  and the problems and challenges that they as future doctors have to deal with.  This is a small group activity. The case may be introduces in various ways: -a lecture on  lifestyle habits; introducing a topic with a statement; telling a personal story; referring to learners’ own experience in healthy lifestyle; and/or brainstorming.
Students should fill in the empty spaces with their own words. They comment on each item and explain how it is connected with the other problems listed (see table 1).
Table 1:

Healthy Lifestyle
Variety of nutrients, whole grain bread, fruits, vegetables. maintain a healthy weight, eat moderate portions, eat regular meals, reduce (don’t eliminate) certain food make changes gradually, select foods

The tasks that were given to the students were the following: 1. Identifying the problem: Summarize the case (the main ideas) in five sentences. Do not draw up any solutions. Describe the character of Hiroshi Tanaka using 6 adjectives. How does he should approach the problem?
2. Suggesting solutions: Task: How would you deal with the situation if you were Hiroshi Tanaka? Do you think that the solutions suggested would produce a desirable result? Students were asked to assess  each of the options and list their pros and cons.
3. Selecting “Best ” Option
What do  you think Hiroshi Tanaka should do now? How can he make sure that the situation is improved?
The basic readings which were suggested on this www-site help students become comfortable with inputting ideas and conversing about different medical issues in English and medicine, too. Easily gasped concepts such as “Diet and Cancer”, “Alcohol and Health”, “Alternative Therapies” and many others lead to more complicated biochemical concepts in associated readings and exercises on  the covered topics. They also help students to become familiarized with computing in English, surfing both the “Topics” web site and the Internet beyond, and to introduce general medical subjects for reading, discussion and writing. The multi-perspective principle, such as photographs, diagrams, charts, and other graphic representation contribute to supplement readings and discussion as audio-visual materials. The next stage will be summarizing data, fact-checking and small-group discussion and debate related to implications of data  under review. This stage encourage in-depth reading and discussion of a case study, leading to multiple drafts of a case analysis composed by each student.
The next stage was asking the students to write an article for publication in the on-line newsletter of the English language magazine. The students decide on the topic for the article in collaboration with the instructor, the news-letter editor. All articles must be original, though they can be based on information gathered from other sources e.g. interviews, readings or questionnaires. Rough drafts of articles are submitted to the instructor first, who indicates errors. The drafts must be corrected, before final word-process articles are submitted to the editor.

Activity 4
Another exercise which encourage students to take part in active discussions and which I think is encouraging one is so called aquarium or ‘fish bowl’. Five students are sitting in the middle of a seminar room. Around them are the others students as observers. The teacher gives them a certain topic, (e.g. Diabetes mellitus). The time for discussion is limited: 10 minutes. After this time, the involved students make notes and the observers give their personal evaluation on this topic: agreement and/or disagreement. In this exercises the correctness of the language is not important. The main thing is that the students actively take part in this discussions. This type of work is very interesting and useful, but can be applied only with students who have a background of intermediate knowledge of English and those with limited knowledge who are feeling uncertain should be given more attention and opportunity for self-confidence.
I stimulate the students work in pairs, constantly encouraging and assisting the weaker ones they feel safer, and when they get the taste and the skill they can work on their own. The materials should be engaging, the task stimulating and the teacher should have extra task in reserve for the quick ones.

Advantages and/or disadvantages (challenges)

Internet-assisted learning gives the students the possibility for individual work. The stress is given on acquiring practice skill. Many interesting materials, handouts and interesting discussions improve the teaching process. The atmosphere is very friendly. The students, as well as the teachers, acquire some basic knowledge, learning word processing, lurking on the Net, sending E-mail messages to a friend being able to create things and think about how to use the basic computer programs. The teaching process using Internet is very interesting, motivating and useful. Students are emotionally triggered and motivated. They are faced with different types of texts and they use computers not only for professional training but also for information and entertainment.
The teaching process is focused more and more on student autonomy so the teacher should provide students with such tools and should try to show the different approaches to learning, thus helping  them to acquire the style that suits them best and enables them to make most of their capabilities. The computer can be one of the possible helping aids with its flexibility, variability, visuality and all the other potentials it can offer, what  is especially important in higher education.
Atlases and encyclopaedias offer an enormous amount of beautifully presented information, and students are memorizing grammar and learning new words simply by exploring topics related with their specialized training (medicine) or ones of their own interest. Students also improve their linguistic features – discourse, functional, structural, lexical, which are commonly used in professional situation.
The applied techniques and strategies that motivate and satisfy the learner’s needs as potential target users of the language is also a challenge not only for students  but for the ESP teachers who should find appropriate ways to adjust the materials and methods to students’ individual learning.
One of the disadvantages may be that students are not strictly focused on the teacher, the information and the tips are on the screen together with explanations and the answers. Some technical problems may unexpected occur and the students expect the teacher to solve them. All these lead to certain limitations to the teacher’s control over students work.
Another disadvantage is that some students may be not feeling confident enough in front of machine and they need more time for practicing and learning all that huge information.
Although they enjoy the learning process but sometime, students and teachers feel frustrated, helpless and need time to overcome the psychological barrier when working with these machines.
Teachers should not be afraid of technology. They should get started and they will get used to it, as they have got used to using cassette players or videos. Many things can go wrong in a computer environment, but it should not deter us. There are always a couple of students who know more about computers that we do and they are happy to help the teacher if anything goes wrong.
Another disadvantage is that students might get lost in details and become obsessed with multimedia facilities (pictures, video, sound), lose focus, and need more time for task. However, once the novelty is over students can get more and more focused, and it takes less and less time to complete the tasks.


Teachers and students have no limits to their access of learning. It is worth experimenting and investigating the potentials Internet  can offer. The teacher can facilitate a stimulating environment in which students can achieve their maximum potential.
Exploring new frontiers of knowledge and challenging traditional notions of school, I personally believe in the statement given by the former president of the United States Bill Clinton: ”Technology is reshaping our world at an astounding speed” (WHPR, 1995c) the meaning of which was adjusted to our needs in the same article by Pedroni (1996, 2): “We, as teachers need to restructure our philosophy of teaching”.


  • Major, E. 1998. Experiences in using computer in the language classroom. Paper presented at the Conference on Foreign language for specific purposes. Varna, Bulgaria.
  • Pandora, D., eds. 2000. Medicine and dentistry: ESP English for specific purposes. Skopje: ‘Cyril and Methodius’ University Press.
  • Pedroni, E. G. 1996. The importance of the world wide web in education K-12. (August): 1-7.
  • Pandora, D.2000. ESP. Medicine and Dentistry. Skopje, R.Macedonia
  • Tatjana Panova Ignjatovik, 2000, Workbook. ESP Medicine and Dentistry, Skopje. R.Macedonia
  • Mayora A. Carlos 2006. Integrating multimeia technology in a high school EFL program. English teaching forum. 2006Vol. 44 nr. 3, pp 14-21.