english language needs of medical students in their

e-ISSN: 2637-0875

Journal of Language and Communication, 7(1), 587-611, March 2020 ©Universiti Putra Malaysia Press

ENGLISH LANGUAGE NEEDS OF MEDICAL STUDENTS IN THEIR CLINICAL

YEARS: LECTURERS’ AND STUDENTS’ PERSPECTIVES

Syazwani Wan Abdul Malik1, Mei Yuit Chan2*, Afida Mohamad Ali3 and

Muhammad Mohd. Isa4

1,2,3Department of English, Faculty of Modern Languages and Communication, Universiti

Putra Malaysia, Malaysia 4Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia

E-mail: : [email protected]; [email protected]; [email protected];

[email protected]

ABSTRACT

In the majority of medical schools worldwide, English is used as the language of instruction.

In contexts where English is a second or foreign language, medical students face the

challenge of having to learn skills and subject matter required in their field in a language they

may be unfamiliar with. For English language support provided to students to be effective,

development of language programs must be informed by an assessment of students’ needs.

The current literature shows that systematic analyses of students’ needs as a basis for

developing English for medical studies programs are rarely conducted, and there is often a

mismatch between the needs of students and the English courses offered. To obtain targeted

information about students’ language needs for program development, input from the main

stakeholders, medical students and medical teachers, is crucial. In this article, we report the

results of an English language needs analysis conducted at a medical school in Malaysia

where English is spoken as a second language by most Malaysian students. Forty-three

medical lecturers and 226 students responded to a needs analysis questionnaire. A description

of students’ English language needs ranked in order of priority for training is derived,

covering the four skills of listening, speaking, reading and writing across various learning

activities required of students in the clinical years. While students and lecturers concur on the

most important needs of students, students perceive the use of English for academic purposes

and understanding the professional mode of talk more pressing while lecturers emphasize

students’ needs for using English in the clinical setting, particularly communication with

patients and reading case related texts. Needs derived from the perspectives of medical

lecturers and students provide valuable information about the relative importance and

urgency of needs to be addressed in English language programs for medical students.

Keywords: English for medical studies; English for specific purposes; English needs analysis

for medical students

ARTICLE INFO

Article history

Received: January 9, 2020

Accepted: March 29, 2020

Published: March 31, 2020

Volume 7 Issue 1

© Penerbit Universiti Putra Malaysia

mailto:[email protected]




Abdul Malik, S. W., Chan, M. Y., Mohamad Ali, A., & Mohd. Isa, M.

588 Journal of Language and Communication, 7(1), 587-611, March 2020

INTRODUCTION

In the field of English language teaching and learning, a distinction is made between the

teaching of English and English for specific purposes (ESP). The ESP “turn” took place in

the 1960s triggered by the need of learners to learn language relevant to specific or

specialized fields particularly in commerce and technology, and to communicate in specific

contexts in line with their occupational and academic interests. More importantly, it was

spurred by English language teachers’ and trainers’ realization that language in specialized

technical fields posseses characteristics (vocabulary and structure) that are distinctly different

from language in other areas, such as in social conversations or in the creative arts and hence,

would require a different approach to teaching (for more information on the development of

ESP, see Hutchinson & Waters, 1987; Basturkmen, 2010; Ramírez, 2015; Johns, 2013; Johns

& Dudley-Evans, 1991; Richards, 2001). The central tenet in ESP is the belief that learners

learn language to fulfill their need for communication for particular purposes in particular

contexts, and that language teaching that neglects this need would result in an ineffective

program, and frustration and de-motivation among learners. Hutchinson and Waters (1987, p.

19) define ESP as “an approach to language teaching in which all decisions as to content and

method are based on the learners’ reason for learning.” The overall essence of ESP can be

duly summed up in Barber’s quote “Tell me what you need English for and I will tell you the

English that you need” (in Hutchinson & Waters, 1987, p. 8) which explicitly suggests that

the teaching of English can and should be tailored to the specific needs of learners.

English for medical studies

English for medical studies is regarded as a specific area of ESP, where much effort has been

expended to describe the language used in medicine and medical studies, to explain how

language is used in medical educational contexts, and to recommend how English can be

taught to help students in their medical studies.

Medical education is conducted in English much more than any other languages

worldwide, as shown in Boelen and Boyer’s (2001) report which placed English at the top of

the list with 45.2% of schools using English as the language of instruction, followed by

Spanish, 14%, Chinese, 6.7 %, French, 5.8 %, and the remaining schools using other

languages such as German, Japanese, and Russian. Wulff (2004, p.188) asserts that English is

the “language of choice” for international communication in medicine in this era due to its

widespread use in influential medical journals and conferences. Further, schools that use

languages other than English are increasingly moving towards adopting English as the

medium of instruction due to pressures of accreditation and internationalization (see Lu &

Corbett, 2012; Shen, 2006). In Malaysia where there are nine public and 20 private medical

schools (Malaysian Medical Council, 2017), medical education is delivered in the English

language.

In medical studies, competence in English is required for participation in academic

activities such as reading textbooks, journals and online materials, answering written

examinations, attending lectures, and participating in academic discussions and presentations.

Apart from these academic activities, students in their clinical years also need to participate

in semi-professional activities taking place in real-life practice contexts in hospital wards and

clinics. These activities include participation in bedside teaching sessions, attending ward

rounds with senior doctors, giving oral presentations of cases, and writing case histories and

reports, all of which require not only a good command of the English language but also

English Language Needs of Medical Students in Their Clinical Years: Lecturers’ and Students’ Perspectives

Journal of Language and Communication, 7(1), 587-611, March 2020 589

knowledge of specific technical vocabulary, structures and rhetorical patterns and

conventions that are appropriate for each activity type. Not less important is the awareness of

elements in the communication context that would impinge on linguistic choices, and an

understanding of how medical professionals communicate, the stance they take, and what

they mean when particular ways of talking are adopted. The differential requirements of

language and language skills depending on communication purpose and context of use are

precisely what distinguishes between the approach of general English and that of ESP, where

the latter is focused on the context sensitivity of language use in learners’ target situations1.

English language support for medical students

For students whose native language is not English, English language courses are sometimes

provided to help them cope with the demands of learning in a language in which they may

not be very proficient. As noted in several studies conducted previously, medical students

have problems learning in English, and there is a gap between the English courses offered

and the students’ language needs (Alharby, 2005; Chia et al., 1999; Hwang & Lin, 2010;

Joshani-Shirvan, 2008; Kayaoglu & Akbas, 2016; Naruenatwatana & Vijchulata, 2001; Shen,

2006; Shi, Corcos & Storey, 2001) While English for medical purposes textbooks are

available for use, most take a broad-angled approach, and are written for communication

contexts that may not be entirely suitable for particular groups of learners in particular

regions, as problems with language and communication in English are influenced by

learners’ first language and socio-cultural background (see Shi, Corcos & Storey, 2001).

The mismatch between English courses and students’ needs is attributed to the lack of

attention paid to conducting some form of needs analysis. English courses using a framework

that fails to recognize the discipline-specific requirements of medical studies would result in

students evaluating the courses as unhelpful. An informal survey of two public medical

schools in Malaysia reveals that only across-the-board English for academic purposes

courses, which are the same as those provided to university students of other disciplines, are

offered as part of the medical studies program. Instruction on the use of English in the

clinical context is often neglected; the task is left to medical teachers who provide guidance

in the form of briefings and live feedback to students on their performance. Needless to say,

learning can be a struggle for students (see Chan, 2015, for a discussion on the oral case

presentation as a rhetorical skill).

Without an assessment of students’ needs, it is unlikely that language courses can be

developed to meet those needs. Language needs assessments for medical studies are seldom

carried out, or if they are carried out, are often focused on a limited scope. In Malaysia, only

one such study has been conducted (see Osman & Abu Bakar, 2009) which investigated the

English needs of medical students in a public university with regard to the skill of writing an

academic paper. Most other needs analysis research for medical studies is conducted by

teachers and researchers working within the ESL or EFL2 context such as in (a non-

exhaustive listing) Iran (Karimkhanlouei, 2012), Taiwan (Shen, 2006; Chia et al., 1999;

Hwang & Lin, 2010), Thailand (Naruenatwatana & Vijchulata, 2001), Saudi Arabia

(Alharby, 2005), Turkey (Joshani-Shirvan, 2008; Tasci, 2007), Japan (Miyake & Tremarco,

2005; Ohtake & Morren, 2011), Hong Kong (Shi, Corcos & Storey, 2001), Bangladesh

(Hossain, Shamim & Shahana, 2010), Romania (Pavel, 2014) and Serbia (Antic, 2007).



The study

We approach the analysis of needs from the point of view of both medical lecturers and

students to obtain a clearer picture of students’ needs. The description of needs which results

from the project would be the first step towards the development of an English for medical

studies curriculum and training program.

Two caveats about how the findings of this project may be used should be mentioned.

First, a specification of needs is not synonymous with a syllabus or a curriculum.

Development of a course syllabus or program curriculum has to take account of many more

elements including the lesson objectives and structure, learning environment, pedagogical

approaches, specific rhetorical and linguistic structures, lesson activities, and materials.

However, knowing the learning activities that students find difficult to perform in English

will provide direction to the curriculum and program developer as to which language skill

and linguistic content should be given more emphasis. Second, the concept of an ESP needs

analysis presupposes the articulation of needs of diverse groups of learners from vastly

different backgrounds. An ESP project, by virtue of its objective of tailoring language

teaching to learners’ needs, must target learners who are regarded as “similar” in their needs,

as defined by some parameter. How exhaustive the criteria one chooses to impose on

defining a target group of learners depends on the purpose of the needs analysis, budget, and

practicality. When smaller groups of learners are defined, more courses will have to be

developed to cater to the many different levels of learners and their needs. Conversely,

expanding the boundary to include a larger group of learners will result in a description of

needs that may be too general or broad-angled. In this project, the needs of students in their

clinical years of study in one medical school are assessed. The value of a needs analysis

study is not only in its findings, but also in the methodology that would contribute to the pool

of methods and instruments that can be adapted for other ESP studies.

There is a wide range of methods that can and have been used for needs analysis (for

example, analysis of existing institutional documents, testing, interviews, observation and

group meetings) (Brown, 2016). Analysis of the target situation could focus on language

units as small as word and word parts (lexical and morphological levels) that language

learners need to know, to large communicative events and activities that specify the context

of communication. To determine the competence level of learners, testing (and decisions

have to be made, too, at what granularity the test should target), expert observation, and self-

report are all valid ways for obtaining information on learners’ needs.

In this project, we began with a self-report survey (completed by medical students

and lecturers) of students’ needs with regard to the learning activities in the medical program

in which English language is consequential, followed by interviews with medical lecturers as

expert informants, and classroom observation. Needs analysis does not end here, and further

steps would include analysis of speech functions and rhetorical patterns corresponding to

each activity type identified. Evaluation of learners’ competence in using the required

language and rhetorical structures in communicative activities would follow. Hence, each

progressive step in the procedure of needs analysis would provide a different quality as well

as different dimensions of information that would add on to the comprehensiveness of the

overall assessment.

In this paper, we report only the results of the survey that identify in quantitative

terms the learning (communication) activities that are relevant and important in the clinical

years of the undergraduate medical program, and evaluate students’ needs in relation to each



of these activities. The objective of the survey was to identify the English language training

needs of medical students in their clinical years in a public university in Malaysia from the

perspectives of the students and their lecturers. This includes describing the language skills

and communication activities that require training and determining their rank order according

to training priority.

METHODOLOGY

Needs analysis

Needs analysis is defined as (Brown, 1995, p.36):

... the systematic collection and analysis of all subjective and objective information

necessary to define and validate defensible curriculum purposes that satisfy the

language learning requirements of students within the context of particular

institutions that influence the learning and teaching situation.

Methods such as the use of tests and standardized criterion ratings may yield objective

measures that many researchers feel comfortable with. A proficiency type language test that

evaluates competence in grammatical accuracy, vocabulary attainment, writing and speaking

ability and other dimensions of language proficiency will provide information on the English

proficiency level of learners. However, it may not provide information on how satisfactory a

student’s performance is in English, for example, in presenting a case to a lecturer, in

interviewing a patient, or to take oral instructions from a lecturer in a ward. Ng (2005) and

John & Dudley-Evans (1980) have argued that the learners should not be the only source

providing information about their own needs when conducting needs analysis in an ESP

context; other stakeholders such as the English teachers’ and subject matter teachers’ views

should also be sought as each would contribute important insight into the needs of the

learners. For the purpose of this project, subjective information that are the felt needs of

learners and subject matter (medical) lecturers was sought.

The concept of “need” is variously defined; however, the model that is often applied

is the “deficit” model borrowed from industrial training literature (see Garavan, Costine &

Heraty, 1997), where needs are defined as the difference between “what is” and “what ought

to be”, also known as “lacks” (Hutchinson & Waters, 1987), in terms of learners’ ability to

perform particular tasks required in the target situation. Apart from lacks, Hutchinson and

Waters (1987, p. 54) propose what they call “learning needs”, which takes the focus away

from deficiency and emphasizes “what learners need to do in order to learn.” Both these

conceptions of needs are not mutually exclusive, but should be considered in tandem when

developing language teaching programs.

Another concept that has to be addressed in needs analysis is the concept of rank

ordering of needs (Garavan, Costine & Heraty, 1997). In any training or instructional

endeavor, time and budget are limited resources. Hence, decisions have to be made about

which needs should be prioritized over others. A system for ranking needs in order of priority

has to be determined to ensure the most important needs are addressed first. In most

questionnaire-based needs analysis, frequencies and sometimes learner’s levels of

proficiency are used as indicators to determine the importance of a specific item, or if a

Likert-type scale is used, the item receiving the highest average rating by respondents’ would



be high on the priority for training. However, following conventional principles in workplace

training, setting of training priority should take account of three levels, organizational,

job/task and person analysis, and within task analysis, three related but distinct dimensions

which are “importance”, “frequency” and “ability”. A fourth dimension “difficulty” is also

sometimes used. Importance and frequency are job dimensions whereas ability is the person

or learner dimension. A task or skill that is important in a workplace setting may be

performed only infrequently (for example, giving instructions on fire escape routes), while a

task that is frequently performed on a routine basis may not be given priority on the training

time-budget if the learner is already proficient in performing it. Ideally, all three levels of

analysis should be conducted in a comprehensive needs analysis project. However, the scope

of the analysis to be covered depends on time, resource and budget availability as well as the

purpose of the needs analysis project. At the level of task and person, the importance,

frequency and ability dimensions should be addressed to derive a reliable and justifiable

rank-ordered schedule of training needs.

In the current study, the concept of “relevance” as a task dimension is used to

encompass both the notions of importance and frequency. Participants were requested to

make a subjective evaluation of the relevance of a particular language task in their medical

study program by considering both the importance and frequency of the task. Hence,

participants rated two dimensions, relevance and ability. Ability is their self-reported

evaluation of how well they felt they could carry out a task in English. Further explanation

on how these two dimensions are weighted in the scoring of the questionnaire is provided in

the section on scoring and ranking procedure.

Participants

Three hundred questionnaires were distributed to the whole population of third to fifth year

students in a single academic year by approaching students in their classes. Two hundred and

twenty-six questionnaires were returned, making the response rate 75%. The same

questionnaire, modified only in the instructions requesting lecturers to assess students’ needs,

was sent by e-mail to lecturers who were identified as those teaching students in their third,

fourth and fifth years of study, totaling 144. Two reminders were sent to the lecturers by e-

mail to invite their participation. However, despite the effort made by the researchers to

obtain participation from the lecturers, the final number of lecturer respondents obtained was

43, at the response rate of 29.9%. The low response rate from lecturers is a limitation of the

study, and informal feedback obtained from several lecturers was that they did not return the

questionnaire due to work commitments. We note, however, that the target participants were

the whole population of lecturers teaching students in their clinical years at the medical

school, and not a sample of the population. Hence, the number of lecturer respondents at

29.9% of the population may not necessarily be a severe weakness that invalidates the results

of the study.

The students were aged between 20 to 27 years, with 22.6% and 77.4% of the male

and female gender respectively. The proportion of students according to year of study was

35.4% Year 3, 35% Year 4, and 29.6% Year 5 in the five-year medical program. The age

range of lecturers was between 30 and above-50, with 65.1% aged between 30 and 40 years,

and 32.6% between 40 and 50 years. Thirty-seven percent and 62.8% of the lecturers were

male and female respectively. Table 1 shows the number of lecturers according to field of

specialization.



Table 1. Specializations of medical lecturers

Specialization Frequency Percent (%)

Anatomy 7 16.3

Surgery 11 25.6

Family Medicine 9 20.9

Obstetrics and Gynaecology 1 2.3

Internal Medicine 10 23.3

Paediatrics 3 7.0

Psychiatry 1 2.3

Orthopaedics 1 2.3

Total 43 100

The questionnaire

In a questionnaire-based quantitative needs analysis, two dimensions, relevance and ability,

should be addressed. First, the tasks, activities or skills must be rated for their relevance to

the learners’ target situation, and second, the learners’ competence or ability to perform those

tasks, activities, or skills must be evaluated (the “what is” in relation to “what ought to be”).

As the approach taken is a self-report measure, respondents were asked to rate the relevance

and their level of competence for every item on the questionnaire. It is noted that in the

majority of needs analysis conducted elsewhere, respondents are asked to rate either the

frequency or the importance of tasks listed as a measure of task relevance. We contend that

frequency or importance alone is insufficient as an indicator of relevance. For example, the

activity of writing a research report may be important to undergraduate medical students, but

may not be a frequent one, and hence, is lower in relevance compared to an activity such as

presenting a case to lecturers which is both highly frequent and highly important.

The questionnaire comprises three main parts. Part 1 is concerned with demographic

details of respondents. Part 2 pertains to respondents’ evaluation of a list of English language

skills required in medical studies. Respondents rated the skills based on their perception of

urgency for training (“very urgent”, “urgent”, “somewhat urgent”, “not very urgent but

should be addressed”, and “not urgent and no training is required”), taking

into account their own competence level for each item. Part 3 requires students to rate the

“relevance” of specific academic activities in the four language skills (reading, writing,

speaking, listening), and their ability to perform those activities in English. The lecturers

received a modified version of the questionnaire, where they rated the students’ ability on the

same items. The student questionnaire is provided in the appendix.

Scoring and ranking procedure

The ranking of needs must take account of both relevance and ability of learners (see Chan,

2002; Nowack, 1991; Reda, 1989). For Part 2 of the questionnaire, ranking was achieved

with reference to the mean of the urgency for training ratings. The lower the mean, the higher

the need for training. For Part 3, weights of 1 to 4 were assigned to relevance (R) and ability

(A) for each point on the scale, where ability (A) was reverse scored. The combined product

score (R x A) was used as the measure of need for training. The RA value (ranged 1 to 16) of

each item for both the student and lecturer groups was obtained. A high RA value (high

relevance, unacceptable level of ability) indicated high priority for training, and a low value

(low relevance, high level of ability) indicated the converse. As the response format of the

questionnaires was a Likert-type ordinal scale, the values of the means derived for each item



of the questionnaire were interpreted in relation to each other in terms of ranking order rather

than absolute values. The focus of the data obtained was to determine which language task or

activity was ranked higher or lower in priority for training. With regard to extent of need for

training indicated by the mean values, rubrics were created in parallel to the descriptors for

the Likert scale in the questionnaire. Hence, the mean value descriptors for English language

skills relevant for Tables 2 and 3 are:

1 < M <1.75=very urgent

1.75 < M <2.5=somewhat urgent

2.5 < M <3.25=not very urgent but should be addressed

3.25 < M <4=not urgent and no training is required

The mean value descriptors for activities in the four skills (listening, speaking, reading and

writing) relevant for Tables 4 to 11 are:

1 < M <2=requires no training

2< M <6.5=requires optional training

6.5 < M <12.5=requires some training

12.5 < M < 16=requires full training

RESULTS AND CONCLUSION

English language skills

Students feel that they need training in all the 13 skills listed. Five of the skills pertaining to

use of correct sentence structure, adequate and appropriate vocabulary, words and word

forms, use of tenses, and communicating effectively in the oral mode are rated “somewhat

urgent” (see Table 2). The remaining eight skills pertaining to correct pronunciation in

English, switching between English and other languages, switching between medical

terminology and lay expressions, incorporating medical terms into English grammatical

structure, awareness of politeness conventions in English, listening and reading

comprehension, and communicating effectively in writing are rated “not very urgent, but

should be addressed.” Lecturers, on the other hand, feel that students need training somewhat

urgently in all the skills except one, which is the ability to switch between English and other

languages (“not very urgent, but should be addressed”) (see Table 3).

Table 2. Training needs for English language skills in order of priority as perceived by students

Students

(n=226)

Need for

training

Rank English language skill Mean Standard

deviation

somewhat

urgent

1 appropriate sentence (grammatical) structure 2.38

.86

2 overall ability to communicate effectively orally 2.41

.90

3 adequate vocabulary to communicate effectively 2.44

.82

4 appropriate use of tenses 2.46

.81

5 appropriate use of words and word forms 2.48 .85



not very

urgent,

but

should be

addressed

6 ability to switch between medical terminology and lay

expressions

2.50

.84

7 appropriate/ accurate pronunciation

2.50

.83

8 ability to switch between English and other languages (e.g.

Malay language)

2.54

.87

9 overall ability to communicate effectively in writing 2.56

.87

10 ability to incorporate medical terms into English grammatical

structure

2.66

.88

11 appropriate awareness of politeness conventions in English

2.67 .89

12 good listening comprehension

(e.g. lectures, seminars)

2.67

.88

13 good reading comprehension

(e.g. text books, academic journals, manuals)

2.62

.82

Table 3. Training needs for English language skills in order of priority as perceived by lecturers

Lecturers

(n=43)

Need for

training

Rank English language skill Mean Standard

deviation

somewhat

urgent

1 appropriate sentence (grammatical) structure 1.90

.82

2 appropriate use of tenses

1.93

.83

3 adequate vocabulary to communicate effectively 1.98

.92

4 overall ability to communicate effectively orally 1.98

.91

5 appropriate use of words and word forms

2.00

.90

6 overall ability to communicate effectively in writing 2.15

.96

7 ability to switch between medical terminology and lay

expressions

2.14

.77

8 appropriate awareness of politeness conventions in English

2.16 .92

9 appropriate/accurate pronunciation

2.19

.82

10 ability to incorporate medical terms into English

grammatical structure

2.21

.77

11 good reading comprehension

(e.g. text books, academic journals, manuals)

2.28

1.08

12 good listening comprehension 2.47 1.03



(e.g. lectures, seminars)

not very

urgent, but

should be

addressed

13 ability to switch between English and other languages (e.g.

Malay language)

2.53

.93

Students feel the least confident with regard to accuracy of language which covers

vocabulary and grammar. Students’ awareness of their problems with the English grammar is

not unexpected, as English in elementary through high school in Malaysia is taught using the

communicative approach. Hence, many students leave the school system with an acceptable

level of fluency but not necessarily accuracy. Among students, the ability to switch between

medical terminology and lay expressions is rated higher in need for training compared with

two other related activities, which are incorporating medical terms into English grammatical

structure and switching between English and other languages. It appears the students are

aware that communicating effectively with patients requires the ability to use lay expressions

appropriately and avoiding medical jargon. They are also aware that when speaking with

lecturers, lay expressions must be subordinated in favour of technical terminology. Switching

between English and other languages is less of a problem because Malaysian students, living

in a multilingual society are quite adept at language code-switching in their daily

communication.

Between oral and written communication, students feel they need training more in

oral communication (“somewhat urgent”) than in the written form of communication (“not

very urgent”). However, from the lecturers’ point of view, the students need training equally

for both oral and written communication (“somewhat urgent”), as well as for all the other

skills, except language code-switching (“not very urgent”).

In terms of the rank order of needs, both the students and the lecturers have almost

similar views about what English language skills students need training for in order of

priority, except for the item “appropriate/accurate pronunciation” which is ranked seventh by

the students but ranked ninth by the lecturers. Receptive skills (reading and listening) are

both ranked low on the scale by both students and lecturers.

The teaching of English language skills should be interpreted in relation to the

learning activities students have to participate in during their clinical years that will provide

the context for learning. Students’ needs according to learning activities are presented in the

following sections, analysed according to the four skills, listening, speaking, reading and

writing.

Learning activities - Listening

For listening skills, students place the highest emphasis on listening to abbreviated terms in

medical language, listening to professional talk among lecturers and doctors in the ward,

listening to presentations in seminars/conferences, and listening to case discussions in

meetings (see Table 4). The first, second and fourth activities have much to do with coping

with the communicative demands students are faced with in their clinical years. It is not

uncommon to hear students complaining they are not able to keep up with what is being said

at clinics and wards when doctors talk at a fast pace using abbreviated terms. These three

activities that form the strongest needs for training are related to the professional mode of

talk that students have yet to master.



Looking at the top four listening activities ranked for training priority, both students

and lecturers are in some agreement, but differ for two activities which are listening to

abbreviated terms in medical language which is not in the top four in the lecturers’ list, and

listening to presentations in class which is not in the top four in the students’ list (see Tables

4 and 5). This in a way indicates that lecturers are probably unaware that students struggle

with understanding abbreviated terms spoken in lectures and clinical discussions.

Surprisingly, the only activity that involves communication with patients (listening to

patients’ questions) is ranked rather low on the scale by students (ranked last) and lecturers

(ranked 6th). It appears that more emphasis is placed on listening to professional talk and

understanding talk in the academic context which are perceived as more difficult to handle

than listening to patients. It is also noted that lecturers rate the need for training higher for all

the activities as expressed by the mean values. Students indicate five activities for “optional

training” whereas lecturers indicate all of the activities for “some training.”

Table 4. Training needs for listening activities in order of priority as perceived by students

Students

(n=226)

Need for

training

Rank Listening activity Mean Standard

deviation

requires

some

training

1 Listening to abbreviated terms in medical language

6.63 2.30

2 Listening to professional talk among lecturers and

doctors in the ward

6.60 2.51

3 Listening to presentations in seminars/ conferences

6.58 2.28

4 Listening to case discussions in meetings

6.54 2.28

requires

optional

training

5 Listening to conversations in general interaction with

lecturers and students

6.41 2.17

6 Listening to lecturers’ questions

6.27 2.20

7 Listening to presentations in class

6.29 2.14

8 Listening to lectures in teaching sessions 6.15 2.08

9 Listening to patients’ questions

6.10 2.12

Table 5. Training needs for listening activities in order of priority as perceived by lecturers

Lecturers

(n=43)

Need for

training

Rank Listening activity Mean Standard

deviation

requires

some

1 Listening to presentations in seminars/ conferences

8.98 2.57

2 Listening to professional talk among lecturers and

doctors in the ward

8.53 2.34

3 Listening to case discussions in meetings 8.49 2.35



training

4 Listening to presentations in class

8.05 2.46

5 Listening to lectures in teaching sessions

8.00 2.50

6 Listening to patients’ questions

8.00 2.36

7 Listening to lecturers’ questions

7.95 2.45

8 Listening to abbreviated terms in medical language

7.93 2.12

9 Listening to conversations in general interaction

with lecturers and students

7.60 2.30

Learning activities – Speaking

Table 6 shows that students prioritize speaking needs in relation to professional and

academic activities. The three activities that contain the word “seminar” appear as the

activities with the highest need for training (ranked 1st to 3rd). Presenting cases in seminar-

style sessions is a common activity in medical studies. Many students find it stressful as the

exercise involves questioning from lecturers who are assessing their ability to reason, explain

and justify their answers. Although much of this activity requires medical knowledge, a poor

command of the English language will hamper a student’s performance of these

communicative functions.

In contrast, the activities that contain the word “patients”, indicating communication

with or related to patients appear only in the lower half of the list (ranked from 12th

onwards). This may be due to the fact that the majority of patients in Malaysia speak the

national language and hence, do not require students to interact with them in English. At

times when English is used, students do not feel unable to handle speaking in conversational

English with patients. Students’ main concern appears to revolve around mastering the

specialized language in professional talk in English.

Lecturers feel that the highest need for training (ranked 1st) is for “giving oral

summaries of cases” (see Table 7) which is ranked 9th by students. Lecturers are also

concerned with students’ ability to give opinions and defend their answers in English, which

is essentially a demonstration of clinical and scientific reasoning skills that lecturers seek to

teach their students. When students fail to articulate their opinions or decisions effectively,

their clinical and scientific reasoning skills are called into question. Tables 6 and 7 provide

the list of speaking activities in the order of training priority as perceived by both students

and lecturers.

Table 6. Training needs for speaking activities in order of priority as perceived by students

Students

(n=226)

Need for

training

Rank Speaking activity Mean Standard

deviation

1 Presenting papers at seminars/conferences

7.36 2.83

2 Justifying or defending answers in seminars and teaching

sessions

7.33 2.73



requires

some

training

3 Asking and answering questions at seminars

7.35 2.84

4 Speaking in the medical oral examination

7.29 2.74

5 Answering questions from lecturers

7.25 2.72

6 Having conversations with foreign colleagues

7.18 2.63

7 Giving opinions in case discussion meetings

7.16 2.63

8 Using professional language when communicating with

lecturers

7.14 2.59

9 Giving oral summaries of cases

7.08 2.55

10 Presenting cases to lecturers

7.05 2.62

11 Participate in academic discussions with other students

6.96 2.46

12 Explaining medical conditions and treatments to patients

6.93 2.51

13 Asking lecturers questions during teaching sessions

6.92 2.65

14 Having general conversations with lecturers

6.87 2.38

15 Answering questions from patients

6.86 2.49

16 Using lay (non-technical) language when communicating

with patients

6.60 2.51

requires

optional

training

requires

optional

training

17 Giving instructions while examining patients

6.46 2.41

18 Having general conversations with patients

6.39 2.38

19 Taking patients’ history

6.39 2.34

20 Asking patients for permission for history taking and

physical examination

6.08 2.33

Table 7. Training needs for speaking activities in order of priority as perceived by lecturers

Lecturers

(n=43)

Need for

training

Rank Speaking activity Mean Standard

deviation

1 Giving oral summaries of cases

10.56 3.30

2 Justifying or defending answers in seminars and teaching

sessions

10.49 3.07

3 Explaining medical conditions and treatments to patients

10.28 2.73



4 Asking and answering questions at seminars

10.21 3.04

5 Giving opinions in case discussion meetings

9.98 2.76

6 Presenting papers at seminars/ conferences

9.77 3.09

7 Speaking in the medical oral examination 9.74 2.96

requires

some

training

8 Presenting cases to lecturers

9.70 3.09

9 Answering questions from patients

9.65 2.89

10 Answering questions from lecturers

9.60 2.61

11 Participate in academic discussions with other students

9.58 2.47

12 Using professional language when communicating with

lecturers

9.53 2.91

13 Giving instructions while examining patients

9.44 3.02

14 Having conversations with foreign colleagues

9.37 3.06

15 Asking lecturers questions during teaching sessions

9.14 2.93

16 Using lay (non-technical) language when communicating

with patients

9.00 2.87

17 Taking patients’ history

8.80 2.71

18 Having general conversations with lecturers

8.77 3.30

19 Asking patients for permission for history taking and

physical examination

8.72 3.07

20 Having general conversations with patients

8.65 2.73

Learning activities - Reading

For reading needs, students place emphasis on reading activities that are academic in nature

and that could help them with self-study and obtaining technical information (see Table 8).

Highest on the list for training are reading professional journals, reading and understanding

clinical laboratory reports, reading medical textbooks reading and technical manuals in that

order. These are followed by reading activities that relate to clinical practice such as reading

medical reports and case histories. Reading and understanding abbreviated abbreviated terms

in medical language appeared as optional for training, showing that students have trouble

listening to abbreviated terms used by doctors in oral communication (see section on

listening activities above), but have no problem with abbreviations in the written form.

In contrast, lecturers are more concerned about students’ ability to read materials

related to clinical activities, and they strongly recommend that students receive training in

reading medical reports, case histories, laboratory reports, patients’ records and instructions

for patient care (ranked 2nd to 6th) (see Table 9). This is not surprising, as the lecturers who



teach students in their clinical years would expect students to be able to read and understand

materials found in the clinical context. This is where lecturers’ perceptions differ from

students’, where students feel they need help with reading journals and textbooks in English

more than they do with reading materials in clinical practice. One reason for this could be

that students perceive reading materials in the clinical context as either a low frequency

occurrence, an easy task to handle, or both, hence bringing down the overall training need

score. Furthermore, the text in these materials are usually short and do not require students to

deal with sustained and intensive reading of long, multi-sectioned texts with complex

arguments that are found in textbooks and journal articles. Reading medical textbooks and

journals is a high frequency/relevance activity throughout the span of students’ study years.

Students find journal articles difficult to read, and this reading task is especially crucial for

them when they have to carry out a research project and write a thesis, and to read for current

medical knowledge in the field.

Table 8. Training needs for reading activities in order of priority as perceived by students

Students

(n=226)

Need

for

training

Rank Reading activity Mean Standard

deviation

requires

some

training

1 Reading and understanding professional journals

6.98 2.51

2 Reading and understanding clinical laboratory reports

6.56 2.49

3 Reading and understanding medical textbooks

6.55 2.22

4 Reading and understanding technical manuals

6.54 2.41

requires

optional

training

5 Reading and understanding medical reports

6.46 2.29

6 Reading and understanding a case history

6.41 2.37

7 Reading and understanding abbreviated terms in medical

language

6.37 2.35

8 Reading and understanding doctors’ instructions for patient

care

6.32 2.31

9 Reading and understanding patients’ records

6.28 2.19

Table 9. Training needs for reading activities in order of priority as perceived by lecturers

Lecturers

(n=43)

Need for

training

Rank Reading activity Mean Standard

deviation

1 Reading and understanding professional journals

9.19 3.22

2 Reading and understanding medical reports

8.95 3.00



requires

some

training

3 Reading and understanding a case history

8.80 2.75

4 Reading and understanding clinical laboratory reports

8.81 3.12

5 Reading and understanding patients’ record

8.70 2.87

6 Reading and understanding doctors’ instructions for patient

care

8.60 2.70

7 Reading and understanding medical textbooks

8.60 2.67

8 Reading and understanding technical manuals

8.21 3.10

9 Reading and understanding abbreviated terms in medical

language

7.63 3.00

Learning activities - Writing

As shown in Tables 10 and 11, students prioritize training for writing articles for medical

journals whereas lecturers think that students’ number one training need is for writing cases.

This difference in perception between the two groups again shows that lecturers are focused

on activities related to clinical practice first (writing cases, writing case histories), followed

by activities that are more academic in nature (writing articles for journals, writing in

examinations). Students on the other hand, place writing articles for journals first before

writing cases and case histories. This finding is both interesting and puzzling. Students are

required to complete a research project in their second year of study (before the clinical

years) and write a report of it in the form of a thesis, but publication of a journal article is not

a requirement. However, it is true that students sometimes work towards publishing their

work with the guidance of lecturers, and this would impress upon the students the importance

of the skill of writing research articles. An alternative explanation is that students regard

writing a research article as similar to writing a thesis, both of which require the ability to

read journal articles and write coherently in the academic style. And having undergone the

challenging task of writing a thesis in their second year, the students would have realised the

difficulty and their own weaknesses in completing such writing. The third plausible

explanation would be that students perceive the importance of writing articles as a future

need, as the ability to publish articles would be advantageous for their future professional

development. As such a skill is best honed within an academic context, it is likely that

students have indicated their wish to be provided training in writing journal articles as part of

their medical studies program in preparation for their future career. This would account for

the high need for training indicated by students for both writing journal articles as well as

reading journals (see both Table 8 and Table 10).

Table 10. Training needs for writing activities in order of priority as perceived by students

Students

(n=226)

Need for

training

Rank Writing activity Mean Standard

deviation

requires

1 Writing articles for medical journals

7.17 2.66



some

training

2 Writing case histories

6.74 2.35

3 Writing cases (case write-ups)

6.62 2.16

4 Writing in examinations

6.58 2.10

Table 11. Training needs for writing activities in order of priority as perceived by lecturers

Lecturers

(n=43)

Need for

training

Rank Writing activity Mean Standard

deviation

requires

some

training

1 Writing cases (case write-ups)

10.47 3.14

2 Writing case histories

10.42 3.07

3 Writing articles for medical journals

10.16 3.84

4 Writing in examinations

9.70 2.85

Ranking of the four skills – listening, speaking, reading and writing

When we compare the mean averages of the four skills of listening, speaking, reading and

writing from both the students’ and lecturers’ results, it was found that both students and

lecturers concur that writing is the skill that requires the most training, followed by speaking,

reading and listening (see Tables 12 and 13). In other words, the productive skills (writing

and speaking) are emphasized more than the receptive skills (listening and reading). This

finding is rather expected, as language production is a more difficult task than reception, and

is also more visible as a demonstration of communication competence.

Table 12. Comparing listening, speaking, reading and writing needs from students’ perspective

Rank Skill Mean average

1 Writing

6.77

2 Speaking

6.61

3 Reading

6.50

4 Listening

6.40

Table 13. Comparing listening, speaking, reading and writing needs from lecturers’ perspective

Rank Skill Mean average

1 Writing

10.19

2 Speaking

9.07

3 Reading

8.61

4 Listening 8.17



CONCLUSION

In places where English is spoken as a second or foreign language, students have to grapple

with acquiring medical skills and knowledge in a language they may be unfamiliar with,

apart from coping with the demands of learning the specialized mode of communication in

medical studies and practice. In view of English fast becoming a prominent language used in

medical studies, much has to be done to provide students with language support that targets

the skills they need most.

In this article, we have described the English language needs of medical students in a

public medical school in Malaysia, a place where most students are non-native speakers of

English. The needs, presented as requirement for training for English language skills and use

of English in a variety of learning activities across the four skills of listening, speaking,

reading and writing, and the rank order of the needs according to training priority are derived

from data obtained from both medical students and lecturers. Overall, the results show where

English language skills are concerned, both students and lecturers agree on the most

important needs that straddle both vocabulary and grammatical accuracy. However, when

there is a choice between using English for academic purposes, mastering specialized

language in professional communication, and communication with patients, students opt for

the first two as their more urgent needs. Lecturers, on the other hand, tend to place more

emphasis on communication with patients and ability to use language in clinical practice.

It is difficult to compare the findings of the study to needs analysis in previous works

as the focus and approach of these past projects are quite different from the current study.

What can be observed, however, is that Tasci (2007) emphasized that the listening skill is

rated highly as an important skill by learners. This is in contrast with the result of the current

study that found listening as the lowest rated skill in terms of priority for training. Osman and

Abu Bakar (2009) and Ohtake and Morren (2011) who focused on testing learners’ writing

skills found that correct sentence construction is one of the aspects lacking in medical

students’ writing. This is comparable to the finding in the current study that both students and

lecturers rated “using appropriate sentence/grammatical structure” as the English language

skill requiring the most urgent training. The reading skill, particularly reading of journal

articles is regarded as highly important by medical students in Narunatwatana and

Vijchulata’s (2000) study who found that students felt that they needed help with this

receptive skill. In the current study, reading as a receptive skill is subordinate to the

productive skills speaking and writing.

As with any training endeavour, an English language program for medical students

must compete for students’ learning time in their medical studies program. Thus, the rank

ordering of needs is a crucial aspect of needs analysis that could assist the program developer

in making decisions about which needs should be addressed in the limited time available.

The current study addresses at the conceptual and practical level this important aspect of

needs analysis that could prove useful particularly when management buy-in is needed to

obtain time allocation for language and communication training. The detailed list of students’

English language needs in order of priority provided in this study could serve as a point of

reference for English language program developers in Malaysia and elsewhere. However, any

training program should be tailored to the specific needs of learners to the extent that is

viable. It is also emphasized that needs analysis is an ongoing process that should be repeated

periodically, as needs of learners are bound to change over time. The method employed in

this study to investigate English language needs of ESL medical students is by no means the



only method that can be used. Where possible, more information about students’ needs

should be further obtained using a selection of methodologies for a more comprehensive

coverage of needs.

When obtaining information from various sources or stakeholders, there are bound to

be differences in results obtained between the stakeholders, as has been shown in this study.

The program developer or researcher could make a subjective decision on how much

consideration is to be given to which stakeholder, which is not recommended, or they could

mobilize other available means such as stakeholder meetings to reach a consensus. Future

research on needs analysis should address how this process of reconciling findings from

various stakeholder sources can be effectively dealt with.

___________________________

Notes: 1Situations in which language learners are expected to use English 2English as a second language (ESL) and English as a foreign language (EFL), denoting

contexts where English is not the native language of students.

DISCLOSURE OF INTEREST

The authors report no conflicts of interest.

ACKNOWLEDGEMENT

The study was approved by the Ethics Committee for Research Involving Human Subjects of

Universiti Putra Malaysia (Approval ref: FBMK (EXP14) P146).

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APPENDIX

Questionnaire for Students

Dear Respondent,

PART 1: DEMOGRAPHIC INFROMATION

Please fill in the information below or tick where appropriate.

1. Gender: [ ] Male

[ ] Female

2. Age: _____

3. Year of study:

[ ] 3rd year

[ ] 4th year

[ ] 5th year



PART 2: EVALUATION OF MEDICAL STUDENTS’ OVERALL ENGLISH

LANGUAGE COMPETENCE

In the table below is a list of specific aspects of English language skills that medical students

might potentially lack. To what extent do you feel you are lacking in this skill? How urgently

should this lack be addressed?

No.

Students’ Overall English Language

Competence

To what extent

do you feel

students are

competent in

this skill?

1=not competent

2=competent

3=very

competent

At what level of urgency

should this lack be

addressed?

1=very urgent

2=quite urgent

3=not urgent, but

should be addressed

4=no need to be

addressed

1 good reading comprehension (text

books, academic journals, manuals,

etc)

1 2 3

1 2 3 4

2 good listening comprehension

(lectures, seminars, etc)

1 2 3

1 2 3 4

3 appropriate sentence (grammatical)

structure

1 2 3

1 2 3 4

4 appropriate use of words and word

forms

1 2 3

1 2 3 4

5 appropriate use of tenses

1 2 3

1 2 3 4

6 adequate vocabulary to

communicate effectively

1 2 3

1 2 3 4

7 appropriate/ accurate pronunciation

1 2 3

1 2 3 4

8 appropriate awareness of politeness

conventions in English

1 2 3

1 2 3 4

9 problems in incorporating medical

terms into English grammatical

structure

1 2 3

1 2 3 4

10 ability to switch between medical

terminology and lay expressions

1 2 3

1 2 3 4

11 ability to switch between English

and other languages (e.g. Malay

language)

1 2 3

1 2 3 4

12 overall ability to communicate

effectively in writing

1 2 3

1 2 3 4

13 overall ability to communicate

effectively orally

1 2 3

1 2 3 4



PART 3: MEDICAL STUDENTS’ ENGLISH LANGUAGE NEEDS IN ACADEMIC

ACTIVITIES

In this section, please rate the English language skills in specific academic activities

according to two dimensions – relevance and ability. Relevance refers to how necessary the

skill is to you in the medical programme. This can be estimated by taking into consideration

how important the skill is, and how frequently it needs to be used for you to succeed in the

programme. Ability refers to your subjective evaluation of your level of proficiency in using

the skills.

Relevance: 1= not relevant, 2= somewhat relevant, 3= quite relevant, 4= very relevant

Ability: 1= very acceptable, 2= quite acceptable, 3=somewhat acceptable, 4= not acceptable

i) Reading

Reading skills Relevance Ability

1. Reading and understanding medical

textbooks

1 2 3 4 1 2 3 4

2. Reading and understanding a case

history

1 2 3 4 1 2 3 4

3. Reading and understanding medical

reports

1 2 3 4 1 2 3 4

4. Reading and understanding

clinical laboratory reports

1 2 3 4 1 2 3 4


professional journals

1 2 3 4 1 2 3 4

6. Reading and understanding technical

manuals

1 2 3 4 1 2 3 4

7. Reading and understanding doctors’

instructions for patient care

1 2 3 4 1 2 3 4

8. Reading and understanding patients’

record

1 2 3 4 1 2 3 4


abbreviated terms in medical

language

1 2 3 4 1 2 3 4

Others (please specify):

10.

1 2 3 4 1 2 3 4

11. 1 2 3 4 1 2 3 4

ii) Writing

Writing skills Relevance Ability

1. Writing cases (case write-ups) 1 2 3 4 1 2 3 4

2. Writing in examinations 1 2 3 4 1 2 3 4

3. Writing case histories 1 2 3 4 1 2 3 4

4. Writing articles for medical journals 1 2 3 4 1 2 3 4

Others (please specify): 1 2 3 4 1 2 3 4



5.

6. 1 2 3 4 1 2 3 4

iii) Speaking

Speaking skills Relevance Ability

1. Having general conversations with

patients

1 2 3 4 1 2 3 4

2. Asking patients for permission for

history taking and physical

examination

1 2 3 4 1 2 3 4

3. Taking patients’ history 1 2 3 4 1 2 3 4

4. Explaining medical conditions and

treatments to patients

1 2 3 4 1 2 3 4

5. Answering questions from patients 1 2 3 4 1 2 3 4

6. Giving instructions while examining

patients

7. Participate in academic discussions

with other students

1 2 3 4 1 2 3 4

8. Having conversations with foreign

colleagues

9. Having general conversations with

lecturers

1 2 3 4 1 2 3 4

10. Asking lecturers questions during

teaching sessions

1 2 3 4 1 2 3 4

11. Presenting cases to lecturers 1 2 3 4 1 2 3 4

12. Giving oral summaries of cases 1 2 3 4 1 2 3 4

13. Answering questions

from lecturers

1 2 3 4 1 2 3 4

14. Speaking in the medical oral

examination

1 2 3 4 1 2 3 4

15. Giving opinions in case discussion

meetings

1 2 3 4 1 2 3 4

16. Asking and answering questions at

seminars

1 2 3 4 1 2 3 4

17.Presenting papers at seminars/

conferences

1 2 3 4 1 2 3 4

18. Justifying or defending answers in

seminars and teaching sessions

1 2 3 4 1 2 3 4

19. Using lay language (non-technical

language) when communicating with

patients

1 2 3 4 1 2 3 4

20. Using professional language when

communicating with lecturers

1 2 3 4 1 2 3 4


21.

1 2 3 4 1 2 3 4



22. 1 2 3 4 1 2 3 4

iv) Listening

Listening skills Relevance Ability

1. Listening to conversations in general

Interaction with lecturers and students

1 2 3 4 1 2 3 4

2. Listening to lectures in teaching

sessions

1 2 3 4 1 2 3 4

3. Listening to presentations in class 1 2 3 4 1 2 3 4

4. Listening to lecturers’ questions 1 2 3 4 1 2 3 4

5. Listening to patients’ questions 1 2 3 4 1 2 3 4

6. Listening to professional talk among

lecturers and doctors in the ward

1 2 3 4 1 2 3 4

7. Listening to abbreviated terms in

medical language

8. Listening to case discussions in

meetings

1 2 3 4 1 2 3 4

9. Listening to presentations in seminars/

conferences

1 2 3 4 1 2 3 4


10.

1 2 3 4 1 2 3 4

11. 1 2 3 4 1 2 3 4