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                                        Helen Mullins
                                Language Development Program
                                     Faculty of Medicine
                                    University of Adelaide

In this paper the steps taken in the introduction of an English Language Development Program
in the Faculty of Medicine at Adelaide University in 1994 will be briefly described.
The majority of students participating in this program are either International Students or
residents with Language Backgrounds Other Than English ( LBOTE ).
The concerns / challenges resulting from a program such as this will also be presented. Prior to
a look at the processes and their associated outcomes it is essential to consider the context out
of which this program emerged.

At the commencement of each Academic year approximately 130 students enter the first year
of the Medical Course. As can be seen from Table 1, in 1994 37% of the First Year intake,
based on the students nominated 'home language', came from Language backgrounds other
than English. In 1995 38% of the total intake was from LBOTE, with 58% of this group being
International Students.

       Year            Total student          LBOTE                LBOTE:               LBOTE:
                          intake                                 International          Residents

       1994                 140                   52                  34                   18

       1995                 140                   53                  31                   22

           Table 1: Language background of Med.1 student intake for 1994 & 1995

Towards the end of 1993, in response to an increasing awareness that some students in the
Clinical years of the Medical Course, particularly those with backgrounds other than English,
were exhibiting less than adequate English Language communicative proficiency in their
interactions with patients, it was decided to investigate the feasability of setting up a Language
Development Program for selected students within the first two years of their Medical Course.
After consultation with Dr Douglas Farnill, Department of Behavioural Sciences in Medicine at
the University of Sydney, and with Ms. Carolyn Webb, Head of the Language Assistance
Centre, University of Sydney it was decided to go ahead with a Language Development
Program within the Faculty of Medicine at Adelaide University.
The observations of Professor S.C.Hayes and Dr. D. Farnill ( 1993 ) matched those of lecturers
and facilitators within the Adelaide Faculty

       "The number of students of non-English speaking background (NESB)
       attending universities and gaining professional qualifications has increased.
       While some speak excellent idiomatic English anecdotal evidence from university
teachers suggest that many are not yet fluent communicators in English.
        Teachers in professional disciplines are increasingly concerned about graduates
        with deficits in ELP working with clients who are predominantly English
        Students with ELP deficits are seriously disadvantaged in the learning process.
        Early identification of students who require special help with English Language
        and providing resources and assistance for NESB students are important "
                                                Hayes S.C & Farnill D ( 1993 )

The position of Coordinator of the Language Development Program was funded by the Faculty
as a .5 position in 1994 with the purpose of setting up a program appropriate to the needs of
first year students considered at risk.
A modified STAL Test ( Screening Test of Adolescent Language ), with permission from
Hayes and Farnill who are involved in significant research in this area, was administered to all of
the 1994 intake into the Medical school and a cut-off score determined. Follow-up interviews
were held for all students who achieved at or below the cut-off score in order to identify both
false negatives and false positives. Four members of the Language Development Committee,
which had been set up to oversight the implementation of this program, were involved in these
initial interviews - three were members of the Medical Faculty and one was an applied linguist
from the Language and Learning unit of the Advisory Centre for University Education (ACUE)
at Adelaide University.
Following the interviews students who were still considered at risk were recommended to
participate in the learning program for a period of 1.5 hours a week. Within the 1994
recommended group of 30 students there were 9 who, having scored close to or at the cut-off
point in the STAL test and having performed adequately in the interview, were recommended
to the program for a period of six months.
The option to self-select or be recommended into the program by a member of staff is always
available for any student. There were four students who 'self-selected' into the program shortly
after its commencement and one who was recommended in Term 4 by a member of staff. Two
of the four students who 'self selected'at the beginning of 1994 have chosen to remain in the
program in 1995.
Student participation is not confined to the formal sessions - approximately 90% of students
made individual appointments in order to access more specific learning arrangements e.g.
Pronunciation, intonation and stress in Australian English.
Participation in the program, at this point in time, is for a period of two years. In the
examinations at the end of the second year there are barrier exams in (clinical) Communication
Skills and English language skills. This barrier exam (English Language skills) is presenting a
particular challenge to both the participants and coordinator of the Language Development
Program and will be referred to again later.


The purpose of the program is to provide a diversity of learning opportunities which will enable
the students, largely by their own efforts and reflection, to further develop their communicative
language skills and strategies in order to function effectively, not just in their undergraduate
years but in their professional and private lives.

The program is, of necessity
        ¥goal focussed
        Many students, not just those with a language background other than English, enter the
course with a long term goal - that of being a 'successful' doctor.However, when confronted with
the subcultures that exist even within the first year of the course and the culture of their
particular university, let alone the culture of the community at large, they often lose sight of this
long term goal in order to focus on the more immediate ones. This focus is often determined
by assignment and examination dates.
        While this is understandable, particularly in the first year experience, it is imperative that
these students become adept at seeing the reason for and putting in place short, mid and long
term goals, just as it is imperative that they are aware that the communicative skills and strategies
that they are acquiring are life long ones.

         ¥ needs-based
         At the beginning of the academic year, many of the student needs as identified by the
students themselves are to do with 'settlement' into the new culture(s) - a formidable task which
certainly casts considerable doubt on the concept of a 'level playing field' at the commencement
of tertiary study. The following simple graph (table 2), which was constructed from answers to
open ended questions in a needs analysis questionnaire, illustrates this point.

        Table 2: Language and Learning needs as perceived by 1st year Med. students

         Certainly these needs must be attended to in the first instance if the LBOTE student
is to focus on the language and learning needs required for success in the course.

        ¥ learner centred
        Students entering any course at any University will become aware, often through
painful experience, that there is a plethora of 'teacher- learning relationships within a
        (Ballard B. 1994) and that learning to maximise these relationships requires a
diversity of skills and strategies. However, within this Language Development Program the
students and their needs are the focus. Ballard's 'Student - centred model of the the
teaching-learning relationship' which applies to the teaching - learning experiences of all first
year students, is of particular significance to LBOTE students entering the country /
university culture for the first time.

                                                          adapted from Ballard B. 'The
                                                          integrative role of the study advisor' in
                                                          Integrating the Teaching of Academic
                                                          Discourse into Courses in the
                                                          Disciplines (1994)

         The Language Development Program under discussion sits with the students in order
to assist them in the acquisition of the skills and strategies for success. Opportunities exist for
on-going reflection, identification of new needs and readjustments to the learning program.
         There is a clear focus on the need for students to direct and take responsibility for
their own learning - in other words, OWNERSHIP of the program, its content and
direction. This creates the opportunity for students to acquire those strategies and skills so
fundamental to balance and control within their medical course.

There are several steps in the introductory process which contribute to the shape of the
learning program.
        ¥ recommendation to the program
         As has been mentioned earlier, students are recommended to the program as a
result of their test score and follow-up interview with a member of staff.
         As coordinator of the program I have, for a variety of professional reasons, chosen
to remain separate from this process.

       ¥ timetabling of language development groups
        Once recommendations have been made students are allocated to learning groups
 which fit with their other learning committments within the first year of the course.
        Serious attempts are made to keep the groups as small ( 8-12 people) and diverse in
        terms of membership as possible.

        ¥ introductory session
         This session provides the opportunity for the group of 'recommendees' to familiarise
 themselves with the philosophy and possible directions and dimensions of the program in
an environment which allows for the expression of possible concern and anger at inclusion
in the program.
         Some of the key concepts INTRODUCED at this stage are
                . experiential learning
                . self directed learning
                . needs based language development
                . language and empowerment
                . socio-cultural diversity
                . triangulation
                . formative assessment-self, peer & other
               . summative assessment
       `       . independent learning skills

       ¥ goal clarification and needs analysis
         Individual questionnaires are admimistered after small group discussion which
focusses the students attention on what they need to attend to if they are to be    successful.
By the time this exercise is undertaken the students have already     participated in two
weeks of learning activity within their medical course. As indicated earlier in this paper the
students were primarily concerned with socio-cultural features in the first instance.

       ¥ writing exercise
        The purpose of this exercise is to determine the level of writing competence,
including the ability to deal with a particular genre.

        ¥ interview
         A non-structured interview is held for all students prior to the organisation of the
learning program. This helps to ensure that the students, having had time and
opportunity to consider their own particular language needs, are able to contribute to the
structure of their learning program.

It takes three weeks before the on-going language development program commences.
However, the time spent in this preparatory stage is crucial in ensuring that the program
starts where the students are at, thus encouraging ownership of and responsibility for the
learning process.


The program is based on a sociolinguistic approach which views language in both its spoken
and written forms as a strategic, meaning making resource - a social process, enabling the
          functioning of the individual in a social environment. This approach asks students
to focus on HOW people use language to make meanings and HOW language is organised
to enable those meanings to be made. The work of M.A.K. Halliday and his colleagues
(Sydney University ) has informed this field of systemic linguistics.
The emphasis in this Language Development Program on communicative language teaching
reflects this concern with language as a 'social activity' - being able to do things with the
language, not just knowing about it.
The continuing challenge for the students has been to begin to comprehend the relationship
between language and the social and cultural contexts of its use. These contexts include the
quite focussed ones which are specific to medical students. Throughout all learning activities
the emphasis has been on strategic and communicative competence - doing what you have
to do with the language in both its written and spoken forms, and succeeding.
The methodologies used are diverse as are the learning activities.Every attempt is made to
involve the students in interactive situations with what they refer to as 'real people'!

Assessment of student progress is monitored by both the student and the facilitator and takes
a variety of forms
        ¥ questionnaires, interviews and small group discussions which encourage
reflection on learning and the modification of skills and strategies when appropriate, together
 with a retrialling and further modification of these skills and strategies.

       ¥ feedback from peers and 'real - life' contacts

         ¥ feedback from teaching staff - an opportunity exists within the first year program
for teaching staff to give feedback to individual students concerning their use of language
skills and strategies in the problem based learning tutorials. Any concerns the tutors have
about individual students can be given to the language coordinator so that appropriate
action can be initiated.

       ¥ portfolios - the collection of learning materials showing the development for
example, in writing progress. This would include a collection of writing pieces from the
beginning through to the end of the year. It would also include an assignment from its
rough draft through to its final editing

        ¥ evidence of self assessment - in the form of a simple reflective journal which is so
structured that students have to initiate change as a result of their reflections

Students are encouraged to view assessment and feedback as a means of improving their
language development and performance. They are well aware then that this program is a
language development program, it is not a program designed to provide language support for
a particular subject within their studies. The skills and strategies they work so hard to acquire
can and should be applied across the discipline and in their everyday lives.


The challenge for me as a teacher in and coordinator of this program is to provide and
allow for forms of assessment which ensure that students are constantly raising their sights,
are reviewing their progress in terms of language skills and strategies, are gaining in
confidence in their language use and are acquiring the language clarity and communicative
competencies so essential to their effectiveness in the clinical years of their Medical course
and to their effectiveness as doctors in the community.
How to set in place a formal assessment which allows for 'progress' to be determined but
which doesn't cause students to lower their sights and view language development as
something which ends with an exam at the end of their second year is the associated

Analytical thinking skills
Much has been written on variations in styles of thinking , teaching and learning ( surface and
deep learning) and the value put on these variations by different cultures. It is a fact that
analytical thinking skills are of importance in Australian Universities and that LBOTE
students need to acquire them. The delicate challenge is to provide opportunities for these
students to acquire the skills without them considering themselves as deficit models. - a
variety of approaches to thinking and learning are desirable, and analytical thinking skills are
ones they need to add to their already existing collection. Difference must not be seen as
I am working in collaboration with the Problem based learning coordinator in order to
design a learning program which will focus on the acquisition of analytical thinking skills, and
one which can be accessed by anyone who wishes to improve their skills.
It is essential that LBOTE students are constantly part of the mainstream, and are seen to be
part of the mainstream rather than a little group which is constantly drawn aside for
'remedial' assistance.

Maintaining relevance
It is not easy to fall into the trap of classroom based language learning as the students are
constantly requesting and initiating opportunities for practising their language skills in
situations which reflect reality.
One such activity involved the students working individually or in pairs. They were given a
thumbnail sketch of a person working within the University and had to
         ¥ research the background of that person
         ¥ reflect on this information and decide which particular aspect of the person's work
they      wish to focus on
         ¥ formulate the questions they wished to ask
         ¥ ring and make an appointment to interview the person
         ¥ carry out the interview
         ¥ evaluate the information gathered
         ¥ clarify any ambiguities resulting from the interview
         ¥ extract the most appropriate information
         ¥ prepare to give an oral presentation to the peer group ( with a specified time-limit )
         ¥ give the oral presentation
         ¥ answer questions and accept both peer ( in written form ) and facilitator feedback
         ¥ respond to the feedback
Feedback was also given by the interviewee.

Other challenges exist but for the purpose of this paper enough has been said. Suffice it to
say that
Dr Martin Seligman, the guru of 'learned helplessness' who has now shifted his focus to the
concept of'learned optimism', provides two VERY useful concepts for reflection for both the
students and coordinator of this particular Language development program.The students
themselves have provided ample challenge in the uncensored and independently
administered feedback sheets contained in Appendix1!

Student Evaluation of Teaching

Semesters 1 & 2, 1994

         The Subject

         23. What were the best aspects of this subject, and why ?

                 ¥ it is not a 'formal type' subject
                  - I'm able to study better
                  - I'm able to express my opinion with less difficulty
                  ¥ it helped me with many aspects of English Language

                 ¥ it actually gives us spiritual supports. It gives us initiatives to work on our own, esp.
in           terms of confidence
         ¥ gave an opportunity to me to talk in English without being embarrassed of mistakes

                 ¥ oral presentation

                 ¥ help me improving my English - think, essay writing, oral presentation

                 ¥ give me the chance to practice my presenting skills in class + doing the interview.
Also        the tutor helps me with my essay writing & gives me support to be assertive during
            group meeting

                 ¥ offers opportunity to improve one's communication skills, greater confidence

                 ¥ the chance to consult the tutor at any time. The tutor did an excellent job.

                 ¥ the tutor was very helpful in helping the students

                 ¥ pronunciation, I've spent most of time

                 ¥ It helps me to do better in other subjects.
                   It does put a lot of pressure on students

                 ¥ the teacher tried to encourage each student to participate in the class

                 ¥ learn new words

                ¥ oral skills in communication because it allows students to improve in talking.
                  However if the students who require less help in this area but more of writing skill,
this      programme will be almost useless and can even be a waste of time.

                ¥ most students get around and get to know each other quite well and I learn a lot of
things      especially English communication skills and Australian culture 'a bit'.
        The Subject

        24. In what ways could this subject be improved ?

               ¥ give us some works that we are able to get feedback from them, especially written

               ¥ should have more oral presentation
                 - have sessions which can interact with Australian people

               ¥ more writing skills should be taught. More guest speakers of relevant areas

               ¥ the subject could be more improved if the situation of the class better ( i.e. reduce
the                number of student in one class, so that the teacher could focus on / concentrate on
                   particular student who needs the 'extra care'.

               ¥ if it allow students participated more emphasize on writing too

               ¥ this subject could be improved if we have more access to the society rather than
doing it           in the same room routinely. More practice on writing should be encouraged

               ¥ more guest lecturers, interactive work e.g. presentation, literature review.

               ¥ more activities - outdoors e.g. interviews, picnic.
               - indoors e.g. discussion, debate

               ¥ make it not compulsory to attend at certain time but students can ask for help at
any              time when they have any difficulty because some English session might be more
useful if        they do other things

               ¥ more oral presentations which could be done spontaneosly rather than preparing it

               ¥ guest speakers to tackle related problems or concerns of the group

                ¥ there should be more sessions of the students to give speeches or participate actively
in          the class

               ¥ more emphasis on essay writing skills and interaction with Australian people

               ¥ include more oral presentation

               ¥ more practice

               ¥ perhaps organise two short sessions rather than one long session

               ¥ change the subject's format
                ¥ include course material on English grammar and writing skills and taught in a
            systematic way

               ¥ do more writing if possible ; on the spot & quick essay & get feedback as soon as
possible.         That's a very good idea I suppose
      The Subject

      25. In what ways could the teaching method be changed to allow for more effective learning

              ¥ more structured works

              ¥ have more presentation

              ¥ try to extract student's ability to think critically

              ¥ such as writing essays for other subjects or discussing about anatomy. But this
English         class is very useful for to miss it. Therefore, I strongly suggest that any International
                 students can just walk in at any time if they have any problems

              ¥ have more communication skills practical

              ¥ students must be helped to identify their area of weakness, i.e. through short exam.
                 Then the student should be grouped according to the aspect of weakness.

                ¥ encourage participation in class

              ¥ more interesting, flexible, dynamic.

               ¥ perhaps increase the student's oral presentation session which can help them build
up        their confidence in talking to public

              ¥ encourage more talking. i.e. presentation
                - encourage essay writing

              ¥ much smaller classes e.g. 3 or 4 students

              ¥ outdoor activity i.e. discussion at the Botanical Garden or things like that

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