Written by: Valentina Angelova, Svetla Trendafilova, senior lecturers of English
Department of Foreign Languages, Varna Medical University

The teacher’s primary responsibility is response-ability
Peter Wilberg, 1988

The lexical approach (LA) was developed some 15 years ago and yet most of its major principles sound pertinent and appropriate for the English language classroom. It is extremely useful while working with students studying English for medical purposes.
The target groups of students studying medicine, dental medicine, nursing, obstetrics, etc., are usually mixed-level groups. Some of them have graduated from English language medium schools and have quite an advanced level of language proficiency. They have also studied biology, chemistry and some other subjects in English in high school. Others have extensively studied English for a number of years but they have not had the anatomy, chemistry, biology component in English. Last but not least there is a third group of students who are from false beginner to pre-intermediate level and they really need to invest a lot of effort to catch up with the rest of the students trying to learn both general English and ESP. Occasionally there might be a more homogeneous grouping in which most students are more or less at the same level, e.g.advanced or intermediate level. The logistics of organizing foreign language teaching at the university does not allow to stream students according to their levels. On the one hand from the point of view of students’ academic progress this is not a very good educational context. But on the other hand from an attitudinal point of view, students are getting used to ‘differentness’ in the level of proficiency. They learn from their peers and begin respecting different cultures, social background and educational systems.
Learning vocabulary specific for the medical profession is important for all ESP students and this is one of the main focuses of the teaching and learning process. We believe in using a wide variety of activities some easy and some quite difficult so that students of different levels could have a challenge and are able to cope with at least part of what is being taught.
Here are some of the important principles of the LA that we adhere to as they had been formulated by Michael Lewis in his book The Lexical Approach:

“Language consists of grammaticalised lexis, not lexicalised grammar. (Recently there has been a piece of advice on the Internet to focus on communication, meaning and understanding while teaching: ‘Don’t be a grammar snob!’)
The grammar / vocabulary dichotomy is invalid; much language consists of multi-word ‘chunks’.
Language is recognised as a personal resource, not an abstract idealization.
Successful language is a wider concept than accurate language.
The central metaphor of language is holistic – an organism; not atomistic – a machine.
Task and process, rather than exercise and product, are emphasized.
The Present-Practice-Produce paradigm is rejected, in favour of a paradigm based on the Observe-Hypothesise-Experiment cycle.”

Since students of medicine generally tend to be high achievers and ambitious motivated learners, and most of them have a scientific bias, the Observe-Hypothesise-Experiment cycle typical of scientific exploration is extremely fruitful in the context of ESP as well.
The better part of our students are genuinely motivated to learn English. They seem to understand that “A foreign language can be a valuable personal asset, liberating financially, culturally and emotionally.”
One of our major goals while teaching English at the Medical university and college is to establish ‘a terminology which provides a framework’ for students’ future work in English beyond the halls of learning in a real life situation where they have to use the language as competent professionals. The lexical approach involves ‘an increased role for word grammar (collocations and cognates) and text grammar (supra-sentential features)’. So we try to focus on presenting and recycling patterns with various degrees of generative power. “Recent research suggests that using lexical items as pattern generators is more helpful than restricting that role to grammatical forms.”
Here are some of the typical tasks that students have to do while acquiring and learning English for medical purposes. We have not followed a very strict hierarchy of activities and have not graded them according to difficulty but in practice we did a more difficult and an easier task alternatively which is a good teaching strategy as it keeps mixed level groups motivated.
Labelling pictures, diagrams, etc.
Teaching the different body systems: respiratory, skeletal, etc. we often use pictures that prompt students to label them. Students label them with separate words, but also with polywords and collocations. e.g.:
Label the diagram about the passage of air through the different parts of the respiratory system.
Pleural membrane
Nasal cavity
Oral cavity
To meet the different levels of language proficiency we would suggest to more advanced learners to try and label the diagram without looking at the words and collocations suggested while less advanced learners would look at the list of terms provided for support on the right. Thus varying the difficulty of the activity we try to keep it challenging enough for different groups of students.
Another typical task accessible to all level of students is matching. Matching terms and definitions develops both reading and understanding skills as well as it helps recycling terms in context.

Match the key terms of the respiratory system with their definitions.

1. Bronchi a. The tube through which food passes from the mouth down into the stomach
2. Pleural membrane b. Tube through which air passes from the nose to the lungs (also known as the windpipe)
3. Trachea c. Thin sheets of muscle between each rib that expand (when air is inhaled) and contract (when air is exhaled)
4. Oesophagus d. Covering the lung and lining the chest cavity, this membrane has 2 thin layers
5. Intercostal muscles e. The two main air passages into the lungs

This is just an example of what a matching task may look like and of course to make it much more difficult and challenging we may include many more terms, as many as twenty. Then the teacher may decide whether students could cope with the task indvidually or whether it would be a more fruitful activity if they work in pairs and negotiate the correct combinations. It is a good teaching strategy to allow the students to decide how they want to work on the task in pairs or on their own. At the age of  20 and above, most students have good awareness of their capacity for coping with a task. This strategy allows them to self-evaluate and make decisions on how to perform an activity thus helping them to become more autonomous learners.

An interesting activity for students of medicine is when they have to categorise or classify some polywords and chunks according to a given criterion. The focus is on reading comprehension and meaning so hopefully the word chunks would stick to the mind as an organic whole.

Read the list of some of the most common signs and symptoms of stress and try to classify them according to the effect on the following: systems, emotions, mood, behaviour.
Most common signs and symptoms of stress

1.  Frequent headaches, jaw clenching or pain 12. Forgetfulness, disorganization, confusion
2.  Stuttering or stammering 13. Trouble learning new information
3. Neck ache, back pain, muscle spasms 14. Difficulty in making decisions.
4. Frequent blushing, sweating 15. Nervous habits, fidgeting, feet tapping
5. Frequent colds, infections, herpes sores 16. Obsessive or compulsive behavior
6 Unexplained or frequent “allergy” attacks 17. Excessive defensiveness or suspiciousness
7. Heartburn, stomach pain, nausea 18. Rapid or mumbled speech
8. Sudden attacks of panic 19. Social withdrawal and isolation
9. Poor sexual desire or performance 20. Constant tiredness, weakness, fatigue
10. Increased anger, frustration, hostility 21. Frequent use of over-the-counter drugs
11. Depression, frequent or wild mood swings 22. Excessive gambling or impulse buying

The beneficial role of such activities is that they develop critical thinking skills as well as enhance language acquisition and reading comprehension. Also the task allows for varying its difficulty depending on the students’ proficiency language level.
Similar tasks for classification can be designed for categorizing types of diseases and other topics.

Mind mapping
Another useful activity to help long-term memorizing of medical terms is using the so called ‘mind mapping’ or semantic webs. The typical technique that goes with mind mapping is brainstorming students on a given lexical pattern thus encouraging them to  draw on their background knowledge. Another way is to explore a text while reading it and represent visually the way this pattern works.



This helps students remember highly generic patterns and is a good learning strategy for students with predominantly spatial intelligence. Students are frequently prompted to organize types of tissues, muscles, pain, etc. using this efficient way of displaying lexical models.
Gap-filling on a sentence level

Yet another typical activity is gap-filling with a focus on vocabulary and its accurate use. The difficulty of these activities may be controlled by changing the number of sentences, giving some support for the students or if they are more advanced prompting them to use their previous knowledge and find a suitable word or phrase that goes in the appropriate gap. This is an example of what such a task may look like:
Complete the sentences with the appropriate form of the nouns below.

bacillus bacterium
vertebra phenomenon
hypothesis nucleus

  1. _________________ cause severe infections which are treated with antibiotics.
  2. There are many _________________ for the origin of the human race.
  3. Nuclear energy is derived during the division of the _________________ of radioactive chemical elements.
  4. No plausible explanations have been found about _________________ such as telekinesis, hypnosis, telepathy, etc.

Gap-filling on a text level

A more challenging task which has a higher communication value is the gap-filling activity for derivatives or phrases. This allows learners to see the thematic progression in a text and follow the logic of its structure.
Each day doctors encounter ____________ that are an intrinsic part of medical practice. They work with intensely emotional aspects of life for which their training is grossly inadequate. Interacting with patients who may be frightened or in pain is itself ____________, as is dealing with their relatives who may be very anxious or even deliberately hostile. In addition, doctors often have to deal with the demand for certainty while medical science may not always have clear or easy answers. While many of us realize that ____________ is a medical problem, few of us realize just how ____________-prone doctors themselves are.
The Intruder/Odd man out

This typical activity for revising vocabulary and developing thinking skills is very useful in a context of teaching and learning medical English. Here is a task demonstrating what it looks like:

For each set of terms below, choose the one that does not belong and then explain why it does not belong:
__________________            thyroid gland, liver, adrenal glands, pineal gland
__________________            oxytocin, prolactin, epinephrine, ADH
__________________            cortisol, parathyroid hormone, epinephrine, aldosterone
__________________            aldosterone, estrogen, progesterone, testosterone
__________________            insulin, thyroxine, GH, prostaglandin
Activities of this type are thought-provoking and amusing for students as well. They enhance their reasoning skills and prompt genuine discussions between them.
Word searches
Wordsearch is a highly amusing technique for recycling vocabulary in a topic – based context. Medical equipment in the operating theatre, diseases related to a given system, names of medical wards or medical professionals, collocations describing pain, are suitable groups of words to be recycled in such a way.
Find at least six adjectives that describe various types of pain:


Common/medical terms
Another set of activities focused on vocabulary building and recycling is the one that combines the everyday common word or phrase with the corresponding medical terminology. Students are motivated to learn them because it stands to reason that in a real life communication with their patients they would need the common term or phrase rather than the scientific ones. Along with this in order to read and understand the latest developments in the sphere of medicine, dental medicine, etc., they would need the scientific terms too. Here is an activity of this type:
Look at the table below and give the medical term that corresponds to the common name of the diseases from the text. Give examples of diseases that belong to each category.

Common name Medical term or area Examples
diseases of the skin dermatological
diseases of the lung pulmonary
diseases of the stomach gastric
diseases of the heart cardiovascular
diseases of the head mental

Again for more advanced learners the last column is open for them so that they can refer to their background knowledge of medicine and English and fill in the respective examples. In case the group of students are not so advanced we may supply examples in a box and then what students have to do is infer their meaning and combine them properly.
Abbreviations / acronyms

Abbreviations are extremely useful as a mnemonic device for students of medicine, dental medicine, etc. There exist a number of activities focused on this way of helping students memorize the vast amount of necessary information for their future profession. For 1st and 2nd year students it may be a good strategy to start with a simple abbreviation they know from general English and give them its medical meaning. For instance, they have all heard of a CV, which in a medical context would be cardiovascular and not the well known curriculum vitae. Some abbreviations can be quite exciting for teachers too.
TPR is no longer the total physical response but temperature, pulse, respiration. MI in its turn does not stand for multiple intelligences but for myocardial infarction while stat comes from Latin statim which means immediately. Sometimes we may raise students’ awareness of such funny abbreviations such as ‘a gomer’ that comes from literary sources. ‘Gomer is an acronym for “Get out of my emergency room!”. Gomers are people who enjoy poor health. That is their hobby.’
Communication focus
Authors often claim that much native speaker language is formulaic and the native speaker has a ‘vast range of formulae’. That applies to a great extent to the doctor-patient communication and can successfully be used in teaching ESP. It is important to bear in mind that the integrity of multiword items should be preserved. Students find it motivating to learn such institutionalised expressions that enrich their pragmatic competence. Here is an activity that prepares students for typical doctor-patient encounters.
Look at the questions a doctor usually asks to find out about a patient in pain. There is a logical order in asking the questions. Match the labels to the groups of questions:

Duration                      Relieving factors                     Type of pain
Precipitating factors                Other               Frequency                   Location

1. Can you describe the pain?
What’s the pain like?
2. Where exactly does it hurt?
Where is it sore?
3. How long has it been bothering you?
How long does the pain last?
4. When do you usually get the pain?
How often do you get it?
5. Does anything make it worse?
Does anything special bring it on?
6. Is there anything that makes it better?
Does ………. help the pain?
7. Have you taken anything for it?
Have you noticed any other problems?

In the process of teaching and learning we have also come across some differences between British and American English, for instance, make rounds (US) and do rounds (UK). We wonder if this reflects the attitude to doctors’ work and whether in America it happens to be regarded as a more creative type of activity while in Britain it is more routine, or it may be that such a way of thinking is too much of a generalization and people use it alternatively nowadays on both sides of the Atlantic. It is a puzzle for a Bulgarian teacher and learner of English.
Methodology and Technology
Most of the activities discussed may be designed for computer-based work. In such interactive environment they could be even more interesting for learners since they would acquire the medical terms while interacting with the computer which is a natural way of learning for most young people today. The interactive ‘drag and drop’ labelling or matching activities are extremely pleasant when it comes to learning different organs or systems in anatomy and physiology or when students have to categorize diseases. There are video films available that describe a typical process (breathing or muscle contraction), a disease (AIDS, malaria), etc., that can be effective and memorable, and can imperceptibly develop students’ medical English at the same time. The problem here is insufficient technical equipment in some universities so that such activities could be used on a regular basis as an integral part of the teaching/learning process. As is the case today this can be done once or twice a semester with a lot of effort on part of the students and the teacher trying to organize the proper equipment and provide a good adequate interactive material.
The list of activities discussed above is by no means exhaustive but aims to point out some of the typical tasks used in an English for Specific Purposes context. They are very useful because they are based on critical thinking and provoke students to play with the language and make meaning. The mixed-level teaching environment is challenging cognitively and emotionally but it also develops invaluable social skills such as tolerance to people with lesser or greater knowledge and skills in English, so enriching the attitudinal aspect of the teaching and learning process is beneficial for the students. The language component is sufficient to scratch the surface of ESP but our aim is to encourage students to continue improving their English either autonomously for the fluent users or to join a course and further improve their English for lower intermediate or elementary level students. We tend to stimulate them to take certified test levels so that they have standardized evidence of their English proficiency.

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