BUILDING FOUNDATIONS 2004:

Paper for Theme 6: International Programs

Title: English and what else?

The linguistic and socio-cultural needs of Foundation students intending to study in specific courses
at the University of Newcastle.

This paper looks at some of the considerations that may be taken into account when designing
English Foundation courses for International students who intend studying in Australian
Universities. Particular reference is made to a study of the particular needs of students from
Botswana intending to study Medicine at the University of Newcastle.
The paper examines the possibility of whether some form of Needs Analysis (either formal or
informal in nature) would be a useful tool to assess the needs of students going into specific
courses.
Overseas students coming into some courses requiring specific skills are often not so much
challenged by the language needs of the course, although this can be the case in some instances. It
is however highly likely that other factors, for example, socio-cultural difficulties, personality
differences, degrees of motivation etc will play a large part in their ability to adjust to Australian
life and to courses which demand a higher level of understanding of ‘Australian Culture” and of
particular forms of Academic English used in these courses.
Needs analysis, either formally or informally administered can be an important first step in
assessing curriculum changes that may be necessary to accommodate students’ particular needs.

Anne Morris

Teacher of English
International Foundation Program
English Language and Foundation Studies Centre
University of Newcastle

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 ENGLISH AND WHAT ELSE?

The power holders of any culture will use linguistic resources effectively to
construct and maintain a discourse favourable to themselves, and therefore those
who cannot engage with these powerful discourses may be excluded by them'
(Gollin, S.1997)

1. INTRODUCTION:

‘Those who cannot engage with these powerful discourses may be excluded from them’

This is surely the most important factor in any learning. Learning a new language should be a
means of empowerment, an enabling tool, a means of strengthening, not a cause of anxiety,
bewilderment, perplexity and uncertainty. An Australian overseas, in a new culture, knows what it
is to learn a new language, knows the struggle of fitting into the new environment.

As an English teacher (a TESOL teacher for the last 12 years), I have also worked in the State
Secondary and TAFE Education systems for at least 25 years, often dealing with students from
overseas with specific problems in English. Some part of this paper may however be of relevance to
teachers of disciplines other than English.

Although the whole area of teaching English to International students is a complex, ongoing,
explorative and investigative field, there are, no doubt, some certainties in teaching and designing
English Foundation Courses for International students who intend studying in Australian
Universities. Firstly, all student courses in Foundation, whether designed for Australian or
International Foundation students are crafted to enable students to undertake, more successfully,
courses in Universities or other tertiary institutions. Secondly, the preparation for these students,
whether Australian or International, is often similar. Thirdly, courses in the programs are designed
to meet immediate as well as ongoing needs.

To a certain extent, these courses can be formatted before the students arrive. The core elements of
the course are really however, where the definite parts end. In both Foundation and International
Foundation, it often becomes increasingly and urgently apparent that it is necessary to involve a
larger amount of ‘unscripted teaching’ i.e. teaching that the teacher, and the students cannot
foresee as being necessary until the students arrive and the nature of the group is understood.

This paper deals largely with a study that was undertaken involving a specific group of students
hoping to gain entrance to the Medical Faculty of the University of Newcastle. Although this paper
deals with a specific group of students (predominantly from Botswana) going into a specific area of
study, much of what is dealt with could be seen to be relevant to other courses of study and students
in other courses. My interest in the area came about when teaching English to students intending to
go into the Medical Health area (1999 to 2001). There was also interest because for many years I
had served as a community member of the Admissions Board of the University of Newcastle
Medical Faculty.

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2. BACKGROUND TO THE STUDY/PROGRAM:

Firstly however, it would seem appropriate to give an outline of the nature of the Foundation
Program that prepares students for courses (including Medicine) at the University of Newcastle.
Two institutions offer courses specific to overseas students. The Language Centre (ELICOS) and
International Foundation Studies program are part of Enabling Programs, the former offering
English language instruction, while the latter offers a variety of courses including Mathematics,
Chemistry, Physics, Health Studies, Economics, Business Studies and Humanities, which are
designed to support and prepare the students for their undergraduate courses. This program has been
operating since 1992 and provides the opportunity for accelerated progression from certificate level
through to degree studies. Students must pass second semester English to enable them to enter
University courses. For admission into Foundation, students require an IELTS score of 5.5, in some
cases, 6.0. In the past, students have come from all parts of the world, but currently our students
come from Botswana, Zimbabwe, Mozambique, Tanzania, Kenya, Morocco, South Korea, Japan,
Mainland China, Singapore, Hong Kong, Taiwan, Malaysia, Germany, the USA and Turkey.

Secondly, the Medical Faculty at Newcastle has specific features that need to be taken into
consideration. The Faculty, when first conceived, was, and still is, considered a trailblazer in the
field of Medical Education. Curriculum and teaching techniques were, in their initial state,
considered radical and unique. More traditional universities were initially sceptical of the approach,
which was largely reliant on problem-based learning. Other features include early clinical
exposure and substantial community involvement … students are expected to understand and
respect the community as a living thing … that students are expected to see the individual in
context, treating a patient as a whole person and in a manner consistent with their social and
physical environment. The students must also have both intellectual ability and personal qualities
considered suitable for the course. (http:// www.newcastle.edu.au/school/medprac-pop)

There would certainly appear to be a need for recognition of students’ needs for an English course
(and Health Studies program), that will give them a reasonably comprehensive idea of Australian
culture (with all its variations, quirks and unknowns).

3. THE CASE FOR CULTURE: THE RESEARCH BASIS FOR INCORPORATING

SOCIOLINGUISTIC MATERIAL IN ENGLISH LANGUAGE ACQUISITION:

One of the most important things to do was to establish the research basis for implementing such a
curriculum. In a Master’s Thesis undertaken as part of study in Applied Linguistics at Macquarie
University, I sought to gain an understanding of the power of language and cultural understanding
as seen by leading linguists and specifically its importance in the successful practice of medicine
and other areas of health science. The following writers in the area of Applied Linguistics are
unanimous in their support of the socio-linguistic approach to the learning of English.

‘The teaching and learning of any new language is bound up with the society in which the language
is used. Learning language is learning culture. To teach or learn a second foreign language can
mean being confronted with a range of attitudes, behaviours and experiences which may be
startling, amusing, confusing or even offensive. The psychological process of coming to grips with
this experience is known as acculturation …’ (Gollin,S. 1997)

Canale and Swain (1980,in Scarcella,1992) say that communicative competence in any language,
includes a variety of competencies ie. knowledge of the linguistic code (grammatical); socially

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appropriate use of the linguistic code( socio-linguistic);the capacity to combine forms and
meaning to achieve unified text (discourse/conversational) and the mastery of communicative
strategies to enhance communication or to compensate for breakdown (strategic competence)

Saw - Choo Teo (1998) refers to the Linguistic attributes of language (phonology, lexis etc) and the
Sociolinguistic attributes. The author contends that Communicative and Sociolinguistic
competence is an absolute prerequisite and describes parameters that determine language use and
language choice (ie. what, who with whom, when and where). She also talks of the taboos,
domains, formality intent, in other words the necessity of not just acquiring knowledge of structure,
but the necessity for cross -cultural awareness, sensibility and presupposition. Other areas
include paralinguistic rules - rules largely referring to body language, as well as rules of customs
like turn-taking.

Brick (1991,2) uses the example of children growing up and learning how to act in their own
culture, describing children learning appropriate actions in a given situation, interpreting those
actions. Children have to not only master the vocabulary and grammar of a language, but must
absorb the social rules that govern how they use vocabulary and grammar in concrete
situations. Brick emphasises how language and culture are inextricably linked; that learning of a
language means learning culture and vice versa and that in moving from one culture to another,
people take their world view with them.

It informs their interpretation of the new situations they experience so that the
interpretations they reach are frequently inappropriate… The interpretations they put on
events in the new culture frequently do not match the interpretations reached by members
of the new culture
(Brick, ibid)

Damen (1987,58 ) also, emphasises the cultural aspect of learning: ‘Those who learn about
unfamiliar cultures are often painfully aware that a rose is not a rose - or at least a friend is not
always a real friend - when encountered outside one's own world of cultural givens. Although all
human beings find themselves faced with similar problems of survival, nurture and protection, they
do not apply similar solutions to these universal problems… ‘.

Those involved with any aspect of teaching would agree that language is culturally skewed, and
loaded with cultural bias and knowledge. Cultural attitudes are conveyed through both spoken and
written language. As all discourse spoken and written, is embedded in its social context, there is no
such thing as an ideologically neutral text or speaking situation. All levels of language, whether
formal or academic, slang or colloquial, convey attitudes, ethics, values, beliefs, religious attitudes
and social opinion (Morris,1999). Chur-Hansen and Barrett, (1996) concerned with students'
inability to master the nuances of informal/colloquial English language (the everyday carrier of
social attitudes and values), say that they face major problems in clinical settings. 'This can lead to
misunderstanding, inappropriate interventions, and potential embarrassment for student and patient
alike' (ibid,413)

4. OF CULTURAL STRANGERS … THE STUDENTS’ DILEMMA

Kim and Gudykunst (1988, 9) speak of the particular language needs of all ‘international migrants’
of any culture and language, required to cope with substantial cultural change. They conclude that
eventually, the 'cultural strangers' will be able to make better sense of a personally relevant situation
in the host society and become proficient in handling their daily activities in the new culture with
improved skills to deal with the situations they encounter. The authors refer to the studies of short-
term adaptation that have emphasised the psychological wellbeing and mental health of cultural

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strangers encountering unfamiliar environments. There is recognition of the ‘problematic’ nature of
the cross-cultural adaptation process; the frequent reference in literature to ‘culture shock’ and
similar terms such as transition shock or culture fatigue.

Damen (1987) advocates teachers’ awareness of students’ cultural needs saying that while cultural
guidance is seldom part of the stated curriculum of the ESL classroom, it is often part of the hidden
agenda, an unrecognised dimension which colours expectations, perceptions, reactions, teaching
and learning strategies, and is a contributing factor in the success or failure of second language
learning and acquisition.

Ardener (1983, in Damen,1987) refers to a typical example of differing cultural understanding in

medicine:

'…a hand may be classified as exclusive to all parts of the forearm to just below
the shoulder or merely as inclusive of the palm and fingers. Thus, if a person
from a just-below-the shoulder culture, such as the Ibo of south-eastern Nigeria,
is asked to give a hand, an entire forearm may be offered'.

The recognition of the need for a socio-cultural component in the teaching of a new language is the
first hurdle. Teachers need to recognise and point to the elements of the language and culture that
they feel necessary for the students to succeed in their chosen areas of study. It is also important to
remember that the early identification of students who may experience difficulties in the acquisition
of language skills is of prime importance (Chur-Hansen et al,1997). In the area of Applied
Linguistics, some form of Needs Analysis is accepted by most practitioners and researchers as a
requirement of effective communicative learning. However it is difficult to find a workable
definition of what Needs Analysis encompasses, what its limitations are and what, where and why it
should take place.

The area is a large one to cover in a paper such as this, and is not covered in detail. Writers in the
area of Needs Analysis tend to disagree on the terms and methodologies eg. Brindley, Hutchison
and Waters. However, Hutchison and Waters’ diagram in association with my diagram may help to
explain the components of needs analysis.

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5. THE NEEDS BASED APPROACH

DIAGRAM 1:

The development of a needs-based approach in the communicative learning environment:

WHAT? HOW?

Language Learning
Descriptions Theories
ESP
COURSE
Syllabus Methodology

The nature of the particular target and learning situation

Who?
Why?
Where?
When?

NEEDS ANALYSIS

Figure 1: Factors affecting ESP course design This diagram (Hutchinson and Waters (1987, 22) explains
the role of needs analysis in a target learning situation, showing the important position of needs analysis
within the overall planning of ESP courses.

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 Language and Cultural Needs

Target Needs - Objective

EXTERNAL

CLIENT NEEDS External

CURRENT
Language COURSE NEEDS
Audits (West)

INTERNAL
Target Needs - Subjective

Including Students’: STUDENT NEEDS

(Current and Future)
- Attitudes
- Motivation
- Awareness
- Personality
- Wants
- Expectations
- Learning styles

NEEDS
AS SEEN BY TEACHER
(FACILITATOR/INTERPRETER)
USING A “NEEDS BASED” APPROACH

TRANSLATION TO COURSE DESIGN

DIAGRAM 2: Language and Cultural Needs (Morris,1999,17)

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6. THE NEED FOR NEEDS ANALYSIS:

The main difference between the two diagrams lies in the inclusion, in the second diagram of the
specific needs of the students and the emphasis on the needs of the clients.

A study undertaken by the author in 1999 came to the conclusion that Needs Analysis is best
applied where the students coming into the program are in a distinct group and proceeding into a
specific program, where the needs of both the clients and the students can be identified and
matched. A possible timetable for this (Nelson,1992) can be found in the Appendices.This attempt
to identify and match needs is a distinct luxury in most cases. Most often, students in each
Foundation class plan to enter a variety of courses at University. In such instances, English teachers
can only hope to manage a core curriculum, with perhaps some branching out into the perceived
areas of the students’ study where this is possible. In many cases however, teachers are forced to
use somewhat more general material, relying on this material to teach the specific skills necessary.

Teachers who have students entering courses in Medicine and Health Sciences are in a much better
position to pinpoint the needs of their students. The students all have in common the fact that they
will be dealing very closely and early in their courses with people who in the main, require a level
of caring and understanding that no other professional area will demand. These students need not
only knowledge of the language in which they are learning but also, and no less importantly,
need the knowledge of the culture in which they are learning and practising.

Researchers and teachers in the Medical School at the University of Newcastle have already
recognised some of the problems that their International students encounter. Studies carried out in
Newcastle by Treloar and others (2000) were undertaken because, while the authors realised that

… research on the factors affecting progress in medical schools had typically focussed on
mainstream (non-Indigenous Australian, non-international) students in traditional, didactic programs
and that these results may not be applicable to students, particularly those from culturally diverse
backgrounds, undertaking problem-based learning courses.

This study explored and compared factors affecting progress for mainstream Australian students
(non-Indigenous and non-international) with international students in a problem based learning
medical course. As a result of this study, intervention strategies were devised on the basis of the
participants’ experiences.

The Medical School has now seen a need to identify the language needs of its students. One of the
measures that the School has undertaken in 2004 is an English test for all incoming students into the
faculty. The test, known as the AUSTEST, was developed as an alternative to the Screening Test of
Adolescent Language (STAL) through the work of Farnill and Hayes (University of Sydney) and
Chur Hansen (University of Adelaide). Austest has been extensively used by the Medical Schools
of both Universities (Hill, 2004). In Newcastle the test is administered in the first weeks of the
course and is followed by the STAL interview process undertaken by those students who have not
performed well in the Austest. Chur -Hansen (and others) has published widely in this area,
concentrating on the needs of students at the University of Adelaide Medical School, but referring
also to the needs of students at other universities in Australia. Adelaide set up a Language
development Program in 1994 to identify language problems and devised forms of intervention
programs for students experiencing language difficulties.

It is early days so far but already the Medical Faculty at the University of Newcastle has counselled
some students, consequent to the test results. The students are also receiving individual tuition from
a member of the Learning Support Program who is concentrating on the use of medical material
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suitable for the use of students at the first year level of the medical course. Further measures in the
pipeline include a series of workshops, continued consultation and a Blackboard Group (Hoystead,
2004).

There would certainly appear to be a need for an English test to gauge general English ability. The
Austest, with the Stahl interview will no doubt prove to be very valuable. However, it could be
contended that this only goes part of the way. One person dealing at close hand with the students
speaks of the fact that it is well known to many who deal with them, that their greatest problem is in
fact homesickness; and that there is sometimes resistance and anger in response to any criticism of
the knowledge of the language. (Carter, 2004). Loveday (1982) says that there is evidence to
suggest that as a person begins to master a second language, he or she develops feelings of
alienation. In such instances, the learner hovers between two ethnic groups, neither fully identifying
with one or the other. Treloar (2000) speaks of international students experiencing 'isolation', during
group learning, as a result of their different cultural background: 'if two people are interacting, if
they have the same sort of background … the same way they think, the same cultural values, the
same language, the same environment, it is easier for them to interact' (Manese et al 1988)

This paper contends that a needs-based approach to the teaching of ESL is not complete without a
conscious recognition of the contribution that the knowledge of cultural peculiarities makes to the
learning of a language and vice versa. Even when students of my era learnt French, Latin and
German at High School, there were attempts by the teachers to contextualise the language, giving us
an account of the culture of those countries (even if we hadn’t, by any stretch of the imagination,
reached the audio-visual age!) This recognition is even more pressing when the students involved
are going into a relatively well-defined target area such as Medicine and the associated area of
Health Studies, Law and Sociology. In these areas, linguistic and cultural knowledge could be
crucial to student success.

LANGUAGE, CULTURE AND MEDICAL STUDIES:

Shortly after beginning their training in the Medical School at the University of Newcastle, students
are expected to make decisions about patients and to make diagnoses of disease and illness. The
students are actually awarded marks for this, on their ability to look at the patient directly and to
engage the patient. For many overseas students (and Aboriginal students also), this is totally
antipathetic to their own culture. Success in dealing with these situations can also be dependent on
their understanding of both the more common and basic functions of language such as greeting and
farewelling, requesting and thanking as well as the 'deeper' levels of the language, of their ability to
comprehend bias, nuance, connotation and inference in the language.

Vanci-Osam (1998) speaks of research on rules for language use within sociology and
sociolinguistics (known as "ethnomethodology”). He says that this area has generally focused on
relatively small linguistic units; that important examples include sequencing in conversational
openings, telephone conversations, and service encounters, or rules for the use of terms of address
as they relate to cultural contexts or socio-political sentiments. He mentions other previous studies
on speech acts for example, the terms of politeness, the expression of gratitude; complaining and
commiserating and apologising.

Candlin's (1974) study at the University of Lancaster recognised the particular language problems
of overseas doctors entering the English system and investigated their needs. The aim was the
analysis of discourse used in the hospital environment (casualty departments of Lancaster
hospitals), in order to construct language learning courses and to suggest the stages in a program of
course design. The study recognised some of the particular difficulties faced by doctors in a new
system. Taxonomies of language skills were made, as well as language functions. In the final report

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(IV) Candlin concluded that task-specific language demands can be established by study of
language in use on the job, and that pragmatically defined language functions constitute the
soundest base for course design. Candlin made a provisional list of language functions including:
greeting, eliciting, interrogation, making sure, action - informing (telling a patient what’s to be
done), diagnosing – informing (telling patient about the diagnosis made) , directing, apologising,
talking (general, rather than consultation talk), med-asking (gaining information relevant to clinical
consultation) and reassuring. Most of these areas, although identified as appropriate in the
consultation setting, also have relevance in social settings and represent some of the areas of
difficulty experienced by overseas students.

Cameron and Williams (1997,421/2) looked at problems facing overseas students placed in
American hospitals. They looked at problems of pronunciation stress, deletion of final consonants
and consonant clusters, as well as syntactic features such as lack of auxiliary verbs, articles and
prepositions, and word order errors. Some of these problems were such that the students’ lack of
clarity in English led to the patient’s questioning of the student’s proficiency.
The authors contend that in cross-cultural interaction in medical settings, there is a great potential
for failure of communication increased when language proficiency of one of the communicators is
low. Research in medical contexts shows that interaction between patients and medical
professionals is best understood as being complicated, fitful, and asymmetrical. The authors
conclude that the language of illness spoken by medical care providers represents a set of cultural
beliefs and conventions distinct from the language of illness spoken by lay people. Although they
have good communication, they do so across a cultural divide, a result of their different
perspectives about the origins and meaning of illness, and how to respond to it; the roles in the
process of responding to illness and to different ways of speaking about illness. Considering the
potentially complicating issues of cross-cultural communication and low language proficiency, the
authors ask how any degree of successful communication could be possible.

STRATEGIES FOR IDENTIFYING and DEALING WITH SOCIOLINGUISTIC NEEDS:

The results of the Newcastle study undertaken by Treloar (2000) suggested that ‘interventions
aimed at reducing barriers to progress, need to promote students’ confidence, motivation and
subsequent participation in course learning opportunities’. The study also found that these results
would have application to other problem based learning courses, ‘particularly those which face the
challenge of providing an optimal learning environment for students from diverse backgrounds’.

Professor Dimity Pond, Head of the Discipline of General Practice at the University of Newcastle
was asked to supervise an intake of Malaysian students who had undertaken their first two years at a
Malaysian campus and were transferring to Third Year in the Newcastle Medical school. Professor
Pond was given three days only in which to ‘acculturate’ these Malaysian students into the
Australian way of life and problem based learning in the Medical Faculty (Pond,2004). Although
given little time, Pond attempted to cover as many areas as possible and among other things called
on the help of a Sydney-based Malaysian doctor and Medical Educator, Dr Hooi Toh to address the
students (cf. Copy of program for these students).

Another study (2004) undertaken by Dr Louise Wright, who has taught in the Health Studies
Program in the International Foundation Program, found from student feedback that ‘The students
would like to extend their English program, and increase their knowledge and practice of PBL. The
Faculty itself said that they required better English communications skills and a higher competency
in team and group work’.

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 A study entitled ‘ A Matter of Life and Death in the USA, by Van Naerssen (1978) took the
subject of lack of communication in the field of medicine very seriously. Van Naerssen speaks of
foreign graduate doctors new to the United States who are ‘ill-equipped initially to assume their role
alongside American counterparts in residency programs or practice’. She says that the doctors often
lack the necessary proficiency in written and spoken English, that many fall short in basic medical
concepts and skills and that almost all are unfamiliar with professional routines and interpersonal
relations in the U.S. The results have been situations potentially dangerous for the patient and a
threat to the emotional well-being of the foreign physician….

Van Naersson refers to the ECFMG Guide* which suggests, that before the graduates leave their
homelands they be given basic information about the hospital, duties and responsibilities,
community organisations and other basic knowledge. Probably of more relevance in this context are
the suggestions made about ‘ the possible advantages of a joint language and cultural orientation
program’

(*The Educational Commission for Foreign Medical Graduates coordinates the ECFMG examinations which all FMGs
must pass before entering an AMA approved training program. It also functions as a clearing house for information for
FMGs)

Post-Arrival Orientation

On arrival in the U.S. FMGs should have:

A. Communication skills evaluated and remedied.

B. Community-cultural orientation through discussions, information packets and trips and an introduction to the
history of the USA, its geography, economics, education, arts, religions, communication media, the legal system,
major, current domestic and international issues, and American Society

C. Cultural orientation to American medical practice.

Table 1: The ECFMG Guide

The ECFMG guide also recommends the initiation of an inexpensive language orientation program
including work on using and understanding medical English, ‘rapid-fire’ medical vocabulary
practice, English slang expressions and two word verbs, practice in listening comprehension of non-
standard English whenever appropriate as well as extensive oral practice in translating a medical
diagnosis and follow up treatment from medical terminology to layman’s language.

In Australia, Pauwels (1984,93) wrote of the perceptions of health professionals, of problems of

communication in cross - cultural contexts. Her project was undertaken by the Centre for
Community Languages in the Professions at Monash University:

'The Centre's objectives are the development of specialist language courses (eg Chinese for Health
Professionals) and the examination of cross - cultural communication difficulties in the contexts of
medicine, social work, law, education, librarianship and business’.

Pauwels discovered that health professionals who had regular contact with people from diverse
cultural backgrounds were aware of the influence that culture can exert on the attitudes and
behaviour of NESB people in relation to health care. Her study interviewed a wide range of health
professionals working in Melbourne, including medical training and community health sectors.

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ENGLISH AND WHAT ELSE? THE CASE STUDY

In a qualitative study undertaken by the author (1999-2000), interviews were conducted with
students studying in the International Foundation Program at that time, past students, faculty
members and with Doctors practising in the hospitals (who are asked to tutor and mentor Medical
students, often overseas students). The author found that there was a similarity in perceptions to
those already stated. The student questionnaires investigated four major areas: language history;
goals and perceived language needs; student perceptions of themselves as language learners and of
their preferred methods of learning; whether the course had fulfilled their needs. The following are
summaries only of responses given.

Students (all from Botswana) who were in the International Foundation Course at the time of
the survey provided only broad responses to the questions re perceived language needs. Answers
ranged from one candidate who felt that there weren't any language situations they would need in
the Medical Course (!), to those who saw as perceived needs the following:

• Writing: Theses, prescriptions, experiments, essays, reports.

• Speaking: Communication with patients, lecturers and other students; speaking clearly in
seminars, meetings and presentations; responding to questions in class.
• Reading: Medical books, journals, newspapers; 'Medicine requires a lot of reading'
• Listening: Patients, colleagues, radio and TV, PA Systems

Separate interviews undertaken with three of these students (all female) provided interesting
material including reference to the teaching methodologies under which they had learnt in the
primary and secondary systems of their country, in all cases, counter to the problem-based
system of learning in the medical course.

The answers of the current students were understandably without the benefit of a great deal
of knowledge re the Medical Faculty Courses, and hence the answers of the continuing
students (again from Botswana) were found more relevant. In answer to the question on
improving their attitude to learning, one student expressed confidence in all areas of English
usage, but other students recognised difficulties with communication because they spoke with
a low voice and had an accent which people found hard to understand and lacked confidence
in use of the language to talk freely with colleagues.

The area of general language needs was perhaps the most interesting because here lies a more
realistic,' experienced' view of needs. All of the students referred to the importance of speaking.
Answers included: ' Most of our learning is done in group discussions and everyone has to
participate'. 'At the end of the year we have to talk about a topic to an examiner about our learning
goals’. I have no problems writing English but can't seem to express myself clearly '. One spoke of
'a lot of everyday reading’ In terms of listening, students mentioned lectures and seminars; ' at the
end of the year we have a long case assessment for which we have to interview a patient and then
submit the patient's history to the examiner, who asks us questions regarding the patients'
condition'. Writing in many ways appeared to be the least important; there were no difficulties in
note-taking, summaries of lectures and written assignments. When questioned about what they felt
had been the most important part of their course in Foundation, all emphasised spoken English, and
also skills in interaction, group discussion, group dynamics and skills in critical reasoning.

Finally, the clients (including Doctors from the medical Faculty and local hospitals). Some
perceived that an understanding of the cultural context of problem-based learning (PBL) was one of
the greatest difficulties for students; that PBL as a Western cultural phenomenon and that some

12
students have no real knowledge of how this process is to be achieved and may spend a lot of time
negotiating the process and not its outcomes.

Some spoke of the need for an understanding of body language, for being able to speak correctly.
One respondent said that the compiling of patient histories created many difficulties for the students
( the use of colloquialisms). It is felt that although youth and inexperience contribute to this
difficulty, lack of awareness of body language compounds this problem. As one client replied: '
Students sometimes struggle with attitudes and their inability to read body language'. The client
added that patients are also not always aware or understanding of the problems experienced by the
students. It was felt that while such situations may create embarrassment, there are other situations,
for example during surgery, where lack of communication can become a matter of life and death. In
such situations, gestures and unspoken attitudes are absolutely essential/unavoidable. Refusal to
admit problems of communication, for any number of reasons including the desire to 'save face',
would cause difficulties for one or both participants (Hofstede,1986).

As far as specific language needs are concerned, one client commented that because the course is
primarily taught within groups, students need to be able to communicate effectively with other
group members, a process hindered by any problems with spoken English and general
comprehension. Another point made was that introverted students within the group may cause
difficulties. One client made the point that effective communication is important to all levels within
the group, within the hospital (patients and staff) and within the Faculty (academics and
administrative staff).

In the area of reading, most clients recognised the importance of many aspects of reading, citing
the amount of technical language as being one of the greatest difficulties facing all students.
Respondents also thought that perceived problems in this area were often overcome by the students'
vigorous application to their studies, and that there was often more of a tendency for students to
find non-technical jargon(colloquial) more difficult than technical language.Some clients
mentioned the need of the technical reading skills of skimming and scanning, and the necessity of
being able to separate the relevant and the irrelevant quickly and efficiently. Others referred to the
need of being able to read and comprehend complex examination questions. Another area of
concern was Fixed Resource Sessions (FRS)(similar to lectures) where students are required to read
quickly from overheads. As one client said, students often have problems listening, writing and
extrapolating the 'essence' of lectures. Also, tutorial working problems need to be read and
understood quickly.

Writing, interestingly, was in some cases interpreted as handwriting. One client mentioned the
necessity of being able to decipher many forms of handwriting. Although a comment often made in
jest, the perception or reality that doctors have illegible handwriting, demonstrates the importance
of clear written English. Having legible writing is imperative for students in their written case notes
and in their presentations. Interestingly, one client said that one of the greatest problems was a
sometimes blasé approach to clarity in the writing of numerals, an approach which could have very
serious consequences. It was considered by most that writing skills are probably most important in
two areas - in written exams and in FRS where notes are not distributed. In these situations, students
are expected to write quickly and concisely. Reference was made also to the difficulties some
students have when asked to 'critique' experts. Students not used to questioning the printed word,
consider this task difficult.

Active listening was seen as a 'crucial' skill, most clients emphasising that they meant listening with
understanding, not just the 'appearance' of listening. One client stated that an experienced listener is
able to formulate patient problems in a few minutes. It was felt by some that a student's inability to
listen could be attributed to nervousness at being placed in an unfamiliar situation.

13
Another explained that students are expected to talk and listen to patients to ascertain accurately
patient history; that there was the need for a good grasp of colloquial language because during oral
exams students listen to a 'patient' telling them their problems. The same client described student
discussion in tutorials; there was a need to comprehend quickly ‘… (it is) the heart of the entire
process'.

Many respondents recognised the importance of speaking with confidence and communicating well
with a wide variety of people including academics, administrators, patients and fellow students.
It was indicated that students need to participate fully in tutorial discussions, or they can easily miss
out on the whole problem-based process. Students are also expected to give clearly enunciated
presentations, and to express themselves clearly in oral examinations. Many respondents asserted
that overseas students in both class and hospital situations tend to be too passive; asking technical
questions and few general questions. It was suggested by others that perhaps the students don't want
to embarrass themselves. It was pointed out that there was often some awkwardness experienced in
areas of giving simple instructions to patients eg. In areas of some intimate contact where
explanations are needed as to why patients are being asked to remove clothing. (Author's comment:
cultural, linguistic, individual, age or all of these…Australian students also find this difficult).
Closely allied was the feeling that many of the students aren't able and possibly not willing to
recognise visual clues from their patients, for example failing to register a lack of understanding of
a patient's accent This failure to face particular problems can lead to a lowering of student self-
esteem and frustration and annoyance on the part of the patients.

Many clients spoke of problems in the understanding of cultural issues, particularly in relation to
clinical skills eg. the understanding of subtle comments or gestures. There appeared to be some
problems in the questioning of patients about health problems. It was felt that some students find it
difficult to be self-promoters, a quality needed in a largely student - centred system of learning.
There is however, evidence from some clients that students often develop excellent skills given
sufficient time and support.

DISCUSSION:

The study found that while Academic language and vocabulary has to be considered very valuable
for the students, it is also necessary to consider the students' facility in colloquial language for use
in group work; the use of slang and the understanding of the vernacular, idioms and common
clichés. 'Conventional' needs analysis processes did not identify these things … they were observed
and catered for when perceived as needs (largely by the teacher and clients, sometimes by the
students themselves). Many respondents, particularly the clients felt that students need a great deal
of extra experience in socio-cultural skills and the following areas were pinpointed as being
important- roughly divided into ‘general’ and ‘cultural’.

General:
• The ability to argue a case whether in role-play or in the discussion of a relevant topic being
discussed in class.
• The ability to understand the hypothetical; the capacity to handle dilemma.
• The willingness to develop speaking and listening skills i.e listening with understanding eg. in
the taking of case histories.
• Awareness and tolerance of different learning processes and approaches.
• The ability to handle 'independent learning' and associated research skills.
• The ability to operate in a group situation.
• The development of skills in critical reasoning and reading.
• The development of a range of reading skills.

14
• The development of questioning behaviour and the means of doing this (Wajnryb and
Crichton,1997,24); for example, asking for clarification, further explanation, examples,
disputing, hypothesising, formulating conclusions.
• The ability to give clear instructions ( i.e. to patients, fellow students etc) incorporating not only
'global fluency' but also accent, rate of speech, colloquial language and grammatical constructs.
(Chur-Hansen,1997, 262)

Cultural needs.

Interaction in a new culture needs to include:

• Knowledge of the common functions of English, for example, asking and receiving, requesting
and replying, greeting and farewelling (c.f. Hinton and Marsden)
• A detailed knowledge of 'medical colloquialisms'
• The use of appropriate register in particular situations.
• Knowledge and recognition of body language.
• Empathy training (Novack 1998, in Winefield and Chur-Hansen, 2000) e.g. giving bad news,
confronting the drug addict, detecting and responding to domestic violence etc
• Recognition of the role and the idea of culture shock; of some common cultural 'quirks' of the
society in which the student will temporarily operate.
• Acknowledgment of the importance of different value and belief systems and discussion of
comparative values.

It should also be remembered that language level at the beginning of a course is not always a good
predictor of final success (Criper and Davies, cited in McNamara (1989). The authors showed that
language plays a role but not a dominant role in academic success once the minimum threshold of
adequate proficiency has been reached. After this it is individual non-linguistic characteristics both
cognitive and affective that determine success. In support of this it must be said that personality is a
major factor in learning. Needs analysis does not measure character, nor the amount of
determination possessed by individual students; both personality and determination play an
important role in student success.

When needs are recognised and negotiated possibly using Nelson’s model of Needs Analysis as a
beginning (c.f. Appendices) it is then necessary for the teacher, with the cooperation of the students
to construct a program covering as many areas as possible in a sensitive, non-threatening and
productive manner. One of the greatest problems for the teacher as curriculum developer is the
construction of a coherent program. The teacher, attempting to discover some of the learners’ needs,
even after the group has been created, is able to increase the relevance of the course and learners are
more sensitised to their own preferences, strengths and weaknesses. Nunan (1988) says that while
analysis is important, what really counts in the development of second language skills is the process
of engaging learners in interesting and meaningful classroom experiences

(In the preparation of interesting and meaningful lessons, some texts proved useful in the teaching
of the group in this study. These suggestions, by no means comprehensive, can be found in the
Appendices). There is a wealth of writing in this area, which many may find interesting.

CONCLUSION:

The main needs of the students of the study undertaken were in the area of cultural learning, socio-
cultural pragmatics and cross cultural understanding, particularly the needs of those students going
into specific areas which are people-intensive and where clear communication is vital. Medical
faculties (and other faculties) in universities throughout Australia, are under increasing pressure to
provide places in Australian universities for overseas students and to design courses for external
15
use. They could well look to the recognition of the important role they can play in considering and
providing for the specific needs of overseas students coming into their courses. There is room for a
deal of further consideration of, research into and finally, action in these areas. Chur-Hansen gives
reasons for this type of action but concludes with the following ‘Providing high calibre academic
support to students of NESB has benefits for all concerned’.

If the Universities are able to get this ‘right’, then they could well offer such courses to Australian
students as well?

REFERENCES:
Ardener, E.1983. Social anthropology, language, and reality. In R. Harris (ed.) Approaches to
language. London. Pergamon Press.

Brick, J.1991. China: A Handbook in Intercultural Communication. Language and Culture: Series
One. Sydney. NCELTR.Macquarie University.

Brindley, G 1989. Assessing achievement in the learner-centred curriculum. Sydney NCELTR.

Macquarie University.

Cameron, R. and J. Williams.1997. Sentence to Ten Cents: A case study of relevance and
communicative success in nonnative – native speaker interactions in a medical setting, Applied
Linguistics ,18:4. 415 – 445 Oxford University Press.

Canale, M and M. Swain.1980. Theoretical bases of communicative approaches to second language

teaching and testing. Applied Linguistics 1:1, 1-49.

Candlin, C., J, Leather and C. Bruton.1974. English Language Skills for Overseas Doctors and
Medical Staff. Linguistics Section, Department of English. University of Lancaster.

Carter, J. 2004.Conversation with author. University of Newcastle. N.S.W (3rd March)

Chur-Hansen, A and R.J.Barrett.1996. Teaching colloquial Autralian English to medical students

from non-English speaking backgrounds. Medical Education, 30: 412-417

Chur-Hansen, A, 1997. Language background, English language proficiency and

selection for language development. Medical Education, 31: 312-319.

Chur-Hansen, A. J. Vernon-Roberts and S. Clark.1997. Language background, English language

proficiency and medical communication skill of medical students. Medical Education, 31: 259-263

Damen, L.1987. Culture Learning: The Fifth Dimension in the Language Classroom.
Massachusetts. Addison-Wesley Publishing Company.

Davies, A. C. Criper and A.P.R. Howatt. 1984. Interlanguage. Edinburgh.Edinburgh University

Press.

Farnill, D and S.C.Hayes.1996a. A User’s Guide to the Australian Tertiary English Screening Test
(AUSTEST). Sydney. University of Sydney, Glensdale Press

16
Farnill, D and S.C.Hayes.1996b. Screening higher education students for English language
problems: Development of the Australian Tertiary English Screening Test. Higher Education
Research and Development, 15:61-71.

Gollin,S.1997. Introduction to LNED 803 – The Social, Psychological and Cultural Context of
Language Learning. Notes for Graduate Diploma in Language and Literacy Education. Sydney.
Macquarie University.

Hofstede, G. 1986. Cultural differences in teaching and learning. International Journal of

Intercultural Relations. 10, 301-20 in Lucas, P et al. 1997.

Hutchinson, T. and A. Waters. 1987. English for Specific Purposes: A learning -centred approach.
Cambridge. Cambridge University Press.

Kim,Y.Y and W.B.Gudykunst (eds) 1988.Cross Cultural Adaptation: Current Approaches.

Published in cooperation with The Speech Communication Association Commission on
International and Intercultural Communication. California. Sage Publications.

Loveday, L. 1982. The Sociolinguistics of learning and using a non-native language. Oxford.
Pergamon Press (pp 8-33).

Lucas,P. M. Lenstrup, J. Prinz, D. Williamson, H. Yip and G. Tipoe, 1997. Language as a barrier to
the acquisition of anatomical knowledge. Medical Education.31: 81-86

Morris,A.(1999) The Role and Effectiveness of Needs Analysis .Unpublished. Master of Applied
Linguistics. Dissertation. Macquarie University. Sydney.

McNamara, T.F. 1996 Measuring Second Language Performance. London. New York. Longman

Nelson, M.1992. A model for course design in ESP for Business. Unpublished. M.Ed. TESOL.
Dissertation. University of Manchester. U.K.

Pauwels A. 1990. Health Professionals' Perceptions of Communication Difficulties in Cross -

Cultural Contexts in ARAL, Series S.7: 93 –111.

Pond, D. 2004. Interview with Author. University of Newcastle. N.S.W.(10th March)

Scarcella, R.C and R.L Oxford.1992. The Tapestry of Language Learning: The Individual in the
Communicative Classroom. Boston. Heinle and Heinle Publishers.

Teo,Saw -Choo 1997.(unpublished) What it means to learn another language. LNED 803 Notes.
Sydney. Macquarie University.

Treloar,C., McCall,N., Rolfe,I.,Pearson,S-A., Garvey,G.,and Heathcote,A. (2000) Factors affecting

progress of Australian and international students in a problem-based learning medical course.
Medical Education 2000. 34: 708-715.

Vanci-Osam,U (1998) May you be shot with Greasy Bullets: curse utterances in Turkish. Asian
Folklore Studies.April.v56 i1,71

Van Naerssen, M. M.1978. ESL in Medicine: A matter of Life and Death. Tesol Quarterly 12, 2.
193 - 203

17
Wajnryb,R and J.Crichton,1997. To ask or not to ask: questions of face in the language learning
classroom English Australia. 15. 1. 7-27

West, R.1994. Needs Analysis in language teaching. Language Teaching 27:1 - 19.State of the Art
Article.

Winefield, H. R. and A. Chur-Hansen. 2000. Evaluating the outcome of communication skill

teaching for entry-level medical students: does the knowledge of empathy increase? Medical
Education. 34: 90-94

Wright, M.L. 2004. Review of International Foundation Program: Introduction to Health

Professional Studies (unpublished) University of Newcastle. N.S.W. Australia.

A few suggested teaching resources:

Listening Skills:
James, K et al.1991.Listening, Comprehension & Notetaking Course. London.
Harper-Collins

Maley,A & Duff,A. Beyond Words. Cambridge. C.U.P (Book and Tape)

Speaking/presentation:
Hinton,M and R. Marsden.1987. Options: Advanced English. Surrey. Nelson.

Sadler,R.et al.1988. New Senior English. Melbourne. MacMillan

Ur:P. 1981. Discussions that Work. Task-centred fluency practice. Cambridge. C.U.P

Academic Writing skills:

Dwyer, J.1993.The Business Communication Handbook.3rd Ed. Sydney. Prentice Hall

Jordan,R.1992. Academic Writing Course. 2nd Ed. London. Nelson

Oshima, A and Hogue,A. 1999. Writing Academic English.3rd Ed. New York.
Addison Wesley Longman

Vocabulary/ Comprehension skills:

James, D.V. 1995. Medicine: English for Academic Purposes Series. Hemel Hempstead. Phoenix
ELT.

Maclean, J.1996. English in Basic Medical Science. Oxford. Oxford University Press

Oxford Concise Medical Dictionary. 2002. 6th Ed. Oxford. Oxford University Press

Riley, D.1995.Test your vocabulary for Medicine: a workbook for users. Middlesex. Peter Collin
Publishing.

Specific cultural needs/ Awareness of culture shock:

Brick,J. 1991.China;A Handbook in Intercultural Communication. NCELTR

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19
 APPENDICES:

1) Nelson’s Model of Needs Analysis (1992)

Evaluation 1 Evaluation 2

Oxford Placement Test Needs analysis carried out:

(Allan 1985/1992) a) of the students
b) of the company point of view

Interpret Results

Preliminary Course Design -

defined by subject areas

Materials chosen from Materials

Data Base

Course Begins - negotiation with

students about course plan

Mid-course evaluation: students

evaluate course so far; possible re-
orientation, new materials, etc.

Final Test: course specific

Final evaluation of the course by

the students

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 2) ORIENTATION PROGRAM, 2004 (Pond, 2004)

Wednesday 18th February

9am: Meet outside Lecture Theatre 202, Medical Sciences Building
Transport to Newbolds Building
Prof Dimity Pond
9.30: Introduction
Mock PBL tutorial
Dr Cathy Regan; Prof Dimity Pond
10.30: Morning tea
11 am: Visit to city centre
12.30: Lunch at Dr Cathy Regan's house
Meet Dr Bhawni Murugasu
2.30: Introduction to death and dying
Professor Peter Ravenscroft
Newbolds building
4pm: Debrief

Thursday 19th February

9-1 lam: General orientation for new students
Richardson lecture theatre
11.30 Get a life at the university
Dr Hooi Toh
Prof Dimity Pond
1pm Lunch
2.30: Introduction to Sexual counseling skills
Dr Sue Outram
4pm Debrief
Meet Suman, President, Newcastle Medical Society

Friday 20th February

9-12 Introduction to consulting skills
Dr Hooi Toh
(see detailed program)
12pm Lunch
1-3 Visit to Nursing Home

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22