Lesson Plan: Types of Medications

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This lesson enables students to describe different types of medication, how they are administrated and how they work. It is relevant for nursing and care students and professionals.

B1 (lower-intermediate) level

Note: this article introduces the first part of the Teachers Notes. There is a link at the bottom to download the complete set of Teachers Notes and the Student Worksheet, so you can use this in your lessons.

Teacher Notes

● Topic: Types of medications

● Timing: 30–50 minutes

● Lesson type/focus: speaking, reading, vocabulary and writing

Aims

● Speaking: discuss types of medications

● Reading: read for specific information

● Vocabulary: learn and review language for types of medications

● Writing: practise organising and presenting information

Overview

The focus of the lesson is describing types of medication. The speaking activity introduces the topic and gives students the opportunity to share their ideas and experience. The reading activity introduces some more related language and practises reading for specific information. The vocabulary activities introduce/review key vocabulary. The writing activity uses language from the lesson and students’ own knowledge to produce a piece of patient-centred writing.

Note: This lesson supports the language introduced in the following:

● Course: English for Nurses: Getting the Essentials Right

● Unit: Administrating Medications

● Module: ‘Types of medication’ pages 7, 11 and 14

Teaching Notes & Answer Key

Part 1: speaking

Put students into pairs or small groups and ask them to discuss questions 1–3 on the student worksheet. Encourage them to share examples from their own experience.

Do whole class feedback to discuss and share answers.

Answers

How many different types of medicines do you know?
oral medication (by mouth), e.g. tablets (pills), capsules, liquids
intravenous medication (in the vein)
nebulisers, inhalers, nasal sprays
eye drops / eye ointments
cream, ointment, patches
laxatives, enemas
Why is it important to explain about medications to your patients?
so patients know to take the medication properly
so patients understand possible side effects and precautions
What do nurses have to be careful about when they give out medications?
to ensure the correct dose is administered
to ensure the correct medication is given to the correct patient
to ensure they know about any allergies a patient might have and which make taking
the medication dangerous
to ensure the medication is given at the correct time

Part 2: reading

Have students work individually to read the text and reorder the sentences to complete the definitions. Then have them compare their ideas with a partner.

Go through the answers as a class.

Have students read the text through again individually and highlight any new words. Deal with any vocabulary queries.

Answers

1. Absorption: medication enters the bloodstream and becomes bioavailable
2. Distribution: medicine passes out of the bloodstream across the cell membrane
3. Metabolism: unwanted medicine becomes water-soluble
4. Excretion: unused medical waste passes out of the body through body fluids

Extension activity
Have students work individually, or in pairs, to write five questions for the text. Then have them swap their questions and answers them. Alternatively, set five comprehension questions yourself.

Example questions:
Which kind of medicines are absorbed the fastest? intravenous medicines
Why does the absorption rate of oral medication vary? amount of stomach acid, food or other medications in stomach
How does medication get out of the bloodstream? by passing across the cell membrane
What does the blood-brain barrier do? stops medication entering the brain
What happens to parts of the medication the body doesn’t need? it is excreted by the kidney

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Lesson Plan: Oxygen Therapy

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This lesson enables students to describe and discuss oxygen therapy, and covers multiple skills and vocabulary. It is relevant for nursing students and professionals.

B2 (intermediate) level

Note: this article introduces the first part of the Teachers Notes. There is a link at the bottom to download the complete set of Teacher’s Notes and the Student Worksheet, so you can use this in your lessons.

Teacher Notes

● Topic: Describing oxygen therapy

● Timing: 45 mins

● Lesson type/focus: speaking, reading, vocabulary and writing

Aims

● Speaking: discuss and practise language for oxygen therapy

● Reading: read for specific information

● Vocabulary: learn and review language for oxygen therapy

● Writing: practise organising and presenting information

Overview

The focus of the lesson is describing oxygen therapy. The speaking activity introduces the topic and gives students the opportunity to share their ideas and experience. The reading activity contextualises some of this language and practises reading for specific information. The vocabulary activities introduce/review key vocabulary. The writing activity uses language from the lesson and to produce a piece of patient/carer-centred writing.

Note: This lesson supports the language introduced in the following:

● Course: English for Nurses: Getting the Essentials Right

● Unit: Breathing Difficulties

● Module: ‘Breathing equipment’ pages 8 and 12

Teaching Notes & Answer Key

Part 1: speaking

Put students into pairs or small groups and ask them to discuss questions 1–4 on the student worksheet. Encourage them to share examples from their own experience.

Do whole class feedback to discuss and share answers.

Answers

What sort of equipment is used to deliver oxygen?
oxygen cylinders
oxygen masks, nasal cannulae (nasal prongs)
What should nurses explain about the use of oxygen to their patients?
no smoking around the oxygen cylinder (relevant for home oxygen)
check the oxygen level in the cylinder every day to make sure oxygen not running out
only use the amount of oxygen prescribed, oxygen flow rates that are too high can be dangerous
make sure oxygen tubing is clear of debris, change if necessary
make sure correct size of mask is used so it fits snugly
check elastic straps don’t chafe around ears, can cause pressure ulcers
When might patients need to be given oxygen?
only if they are hypoxic (have low levels of oxygen in the blood), e.g. if they are critically ill, after cardiac arrest
What are these pieces of equipment and what are they used for?
nasal cannulae: device which delivers oxygen through the nostrils: flexible tubing with one end which splits into two prongs which sit within the nostrils and the other end which is attached to an oxygen supply
hyperbaric chamber: enclosed space in which almost pure oxygen is breathed in higher-than-normal air pressures so that oxygen levels in the body can be increased significantly.

Part 2: reading

Have students work in individually, or in pairs, to read the text to find the answers to questions 1–6. Tell students to concentrate on finding the answers rather than any words they don’t know at this stage.

Go through the answers as a class.

Have students read the text through again individually and highlight any new words. Deal with any vocabulary queries.

Answers

1.c 2.c 3.b 4.b 5.a 6.c

Extension activity

Review the meanings of medical prefixes hyper- and hypo-.
hypo-: low, depressed levels of, reduced
Note: hypo- + word/ word part which starts with o becomes hyp-
hyper-: high, excessive amounts of, increased

Have students identify the medical terms in the text with the prefixes hypo- and hyper- (hypoxia, hyperbaric).

Then have them work in pairs to write down other medical terms which also use these prefixes. Ask them to explain what they mean.

Answers

hypo-	hyper-
hypoxia	hyperbaric
hypothermia	hyperthermia
hypotension	hypertension
hypoglycaemia	hyperglycaemia

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What is Medical Academic Writing Part 2

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SLC recently gave a webinar to a group of Chinese doctors working on research projects on medical academic writing.

We looked at the ‘nuts and bolts’ of writing before seeing how they are used in practice, specifically looking at when writing abstracts and research articles.

This post summarises what we covered in the practice section as well as some areas of grammar highlighted as common to academic writing. It also provides the powerpoint of the whole presentation to download. Part 1 looked at how to construct coherent, well written texts, looking at choice of vocabulary, sentence types, paragraphing and whole text writing.

The IMRaD format

In medical academic writing, the IMRaD format is commonly used to provide a predictable structure to both abstracts and, in a more elaborated form, research articles.

IMRaD stands for Introduction, Methods, Results and Discussion. In some texts, the writer may use Background instead of Introduction and Conclusions instead of Discussion.

The Introduction starts with a wider perspective, looking at relevant literature for example, before narrowing to the specific topic of the text. The Methods and Results then provide the core of the writing, describing the settings, the processes and the data gained. The discussion then relates the results to the literature and analysis presented in the Introduction.

When writing, it is important to remember to use the language and structure set out in What is Medical Academic Writing Part 1.

Writing abstracts

An abstract follows the IMRaD format. It stands alone, so does not need the research article it describes to support it. It presents a clearly written summary of an article, so enabling the reader to quickly understand whether they want to read the full article. As part of this, an abstract describes what the research has achieved and why it is important.

The abstract should have a clearly set out question as per the article it describes, the names of the authors and then the key IMRaD sections set out in paragraphs with sub-headings. There should be very few abbreviations, and no illustrations, references or tables.

Typically, the Introduction and the Discussion will be relatively short, while the Methods and Results sections will be longer and contain more detail.

Writing research articles

A research article follows the same IMRaD format used in an abstract. Naturally, what was summarised is elaborated on in sufficient detail to show the reader what happened, what the results were and why they are important.

The Introduction

The first part of the article states what the reader should expect to cover. It sets out the broader context of the research by discussing other articles which have been written on the topic. Citations must be used here. Once this has been achieved, then the Introduction narrows to become more specific to the topic set out in the title of the article. Here, it shows how the research will advance knowledge in this area described.

Methods

This section describes in detail how the research was carried out. It describes the settings, the methodology used and the implementation of that methodology. It describes the equipment used and where appropriate, the suppliers of that equipment. This is so readers can replicate the research should they want to. The section also describes the problems or possible problems in data collection.

When writing about the Methods, it’s often a good idea to use sub-headings to aid clarity. Research is complex and sub-headings guide the reader through the section, so they are clear on what happened and how.

Results

As with the Methods section, the Results is often lengthy and therefore needs to be carefully structured for the reader to follow easily.

In this section, the data is shown along with an initial analysis of that data. Where there is a lot of data, it’s important to look for ways to present it clearly through tables, graphs and charts, for example. It’s also important to show the relevant data as opposed to all the data. Any data must be clearly captioned and described.

In this section, you may both link back to methods that produced the data and forwards to where the data is analysed and discussed in more detail.

Discussion

Whereas the Introduction moves from the broader context to the specifics of the article, the Discussion goes in the opposite direction, starting with the results and then widening out to set them in the bigger picture.

This Discussion therefore shows to what extent the results have successfully addressed the question set out and how the findings link to the literature. It may also make recommendations for future research.

In this way, the content in the Discussion is directly related to that in the Introduction.

Grammar

In Part 1 of What is Medical Academic Writing, we looked at the lexis associated with writing well-constructed texts. However, there are a number of grammatical concepts commonly used in academic writing. We highlight three of them here.

1. The passive voice

The passive voice is typically used to focus on the process or action in a sentence, not the person or people performing that process or action.

So, for example, rather than write, ‘Our investigators performed quality control using the 835 control probes included in the array’, a more common formulation would be, ‘Quality control was performed using the 835 control probes included in the array’.

Using the passive voice adds more emphasis on the substance of the research rather than the researchers themselves. This is appropriate to scientific writing and gives a more formal, neutral tone to a piece.

2. Nominalisation

A key challenge in academic writing is to use high level, often quite technical, vocabulary without confusing the reader and at the same time remaining concise. It’s important to use unambiguous vocabulary to give a more precise meaning than when using a more general term.

One way of achieving this is to use nominalisation, whereby the writer uses the noun form of a verb in a sentence. Using nominalisation can also help remove personal pronouns in a similar way to using the passive.

So, ‘When we analysed the data, it showed that the genetic material contained a large amount of DNA and very little protein’ becomes ‘The analysis of the genetic material revealed it contained a large amount of DNA and very little protein’.

3. Hedging

Hedging is the use of language that reduces the certainty in a statement. It is used to show that data or results may be contingent and therefore change over time.

This may be expressed through an adjective, so ‘It is probable/possible/conceivable/unlikely that..’ or a modal verb, so could, may or might, for example.

In conclusion

In Part 2 of What is Medical Academic Writing we’ve looked at how to use the IMRaD format and some key grammatical points. In Part 1, we looked vocabulary, sentences, paragraphs, discourse markers and text construction.

Together, the two articles and the associated powerpoint cover the fundamentals needed by anyone in healthcare seeking to write effectively, concisely and successfully.

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This article uses material from SLC's English for Medical Academic Purposes course

The material in these articles and powerpoint come from SLC’s course, English for Medical Academic Purposes. This course is designed specifically to enable medical students and academics to engage successfully in the international world of medical research and study.

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What is Medical Academic Writing Part 1

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SLC recently gave a webinar to a group of Chinese doctors working on research projects on medical academic writing.

We looked at the ‘nuts and bolts’ of writing before analysing how they are used in practice, when writing abstracts and research articles.

This post summarises what we covered in this section and provides the powerpoint of the whole presentation to download. Part 2 looks at how to write abstracts and research articles and some of the grammar commonly used here.

In this section, we started with words before moving onto sentences, paragraphs, and whole texts.

Words

There is a clear difference in register between formal academic language and more everyday language, highlighting the use of specific lexical items with precise meaning. This is similar to using medical terms, which use affixation to create univocal words which cannot be confused with other terms, such as laparoscopy, cardiovascular and cholecystitis Together, these terms form a set of words used by healthcare professionals and students worldwide.

The use of precise academic language is illustrated by the Academic Word List, collated by Professor Averil Coxhead of the Victoria University of Wellington in New Zealand. The AWL consists of 570 words and their associated word families. These words stand outside the General Service List, the most common 2284 words in the English language, and are drawn from the analysis of 3.5 million words from a written corpus covering a wide range of academic texts. The 570 words are then divided into 10 lists, arranged by frequency of use.

Sentences

Broadly speaking, there are three types of sentences. The first, a simple sentence, contains one clause and is generally short and to the point, though may be extended by fronting the sentence with a long adverbial for example.

The second, a compound sentence, contains two clauses of equal value. These clauses are typically linked with one of the seven words delineated by the acronym FANBOYS: for, and, nor, but, or, yet and so.

The third, a complex sentence, contains a main clause and a subordinate clause. The main clause can stand independently and is the most important part of the sentence, whereas the subordinate clause does not stand alone and serves to add information such as examples, explanation and description. These subordinate clauses are adverbial, adjectival, or nominal. Discourse markers which link clauses within sentences together include which, despite, while, because and if.

Discourse markers between sentences

Using a variety of discourse markers, also called linking words and phrases, is essential to show precise relationships between different ideas and information. Markers like ‘In addition’, ‘Moreover’ and ‘Furthermore’ add weight to the sentence before, while ‘Alternatively’, ‘Conversely’ and ‘On the other hand’ introduce contrast.

Knowing how to use a range of markers enables a writer to accurately show cause and effect, qualify ideas, make comparisons, give examples, sequence events and place emphasis among others.

Paragraphs

Using paragraphs effectively provides clarity and readability to a text. This is particularly important for academic writing as they enable readers to understand complex ideas, arguments and information more easily, so making a text more accessible to a wider readership.

Paragraphs tend to be structured by starting with a sentence which states the topic of the paragraph and the controlling idea affecting the topic. The sentence ‘New research on epigenetics is showing how children can genetically inherit experience from their parents.’ introduces the topic of new research on genetics with the controlling idea of what the research shows, i.e. that children can genetically inherit experience from their parents.

A paragraph then continues with a number of sentences which support the opening sentence by providing examples, information and explanation. This may be a claim with evidence to underpin that claim, for example. The paragraph needs to stay on topic throughout, so it has clear unity.

Texts

When every paragraph demonstrates unity as outlined above, it creates a text where a reader is able to follow complex arguments with relative ease.

Broadly speaking, texts can be broken down into three types; descriptive, analytical and argumentative. A description provides the reader with information about something. This may be introducing new concepts or providing more detail about concepts they are already familiar with. An analysis looks at different aspects of a subject or topic and shows the reader how they fit together or interact. An argument describes a particular stance and provides evidence to support that stance.

Clearly some texts may seek to combine these types. In these cases, the writer needs to use discourse markers and paragraphing effectively so the reader is not lost in any way. This may involve, for example, comparing two concepts point by point in successive paragraphs rather than describing one concept and then the other.

In conclusion

In all cases of medical academic writing, a text must address the question or issue set as its title. The topic sentences starting every paragraph must provide the structure that shows the reader how you are doing this. Each paragraph must contain sufficient detail to support the topic sentences set out. And finally, the language selected, so register of vocabulary and variety of sentence type and connection, must be used to express ideas and information precisely and succinctly.

Together, these elements of academic writing enable medical texts to be written that express complex ideas with clarity, precision and accessibility.

Download the materials:

This article uses material from SLC's English for Medical Academic Purposes course

Are you a student looking for Medical English courses?

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Lesson Plan: ADLs

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This lesson plan teaches the language used to describe and discuss ADLs (Activities of Daily Living).

A2-B1 level

Teacher Notes

● Topic: ADLS (Activities of Daily Living)

● Timing: 45–60 mins

● Lesson type/focus: speaking, reading and vocabulary

Aims

● Speaking: discuss ADLs and why they’re important

● Vocabulary: learn and review language related to ADLs, identify synonyms

● Reading: read for specific information

Overview

The focus of this lesson is ADLs. The speaking activity introduces the topic and gives students the opportunity to share their ideas and experience. The reading activities focus on finding specific information and provides input for the vocabulary section. The vocabulary activities look at lexical items (synonyms) from the text and use these in discussion questions.

Note: This lesson supports the language introduced in the following:

● Course: English for Care: delivering outstanding care

● Unit: Eating and Drinking

● Module: ‘Activities of Daily Living: helping with mealtimes’ pages 3, 4 and 5

Teaching Guide & Answer Key

Part 1: speaking

Put students into pairs or small groups and ask them to discuss questions 1 and 2 on the student worksheet. Encourage them to share examples from their own experience.

Do whole class feedback to discuss and share answers.

Answers

What does ADL stand for and what does it mean?

ADL stands for Activity of Daily Living. ADLs are the basic self-care tasks a person does day-to-day. They are part of caring for oneself and maintaining independence. Ability or inability to perform ADLs is often used by health professionals as a way of measuring a person’s functional status, especially that of older adults or those with disabilities.

Additional information can be found here at NHS Trust (IoW)

What are ADLs? Make a list of examples.

Examples include: moving from one place to another, e.g. getting out of bed; showering/bathing, cleaning your teeth, skin and hair care, dressing, toileting, feeding yourself.

Part 2: reading

A Have students work in individually to read the text to find the answers to questions 1–5. Tell them to read the text quickly and just look for the answers. You could set a time limit.

Go through the answers as a class.

Answers

What does independent with ADLs mean?
That you can perform ADLs without help.
What is the opposite of independent?
dependent
How many activities did Virginia Henderson identify?
14
What did Roper, Logan and Tierney do?
Used Henderson’s research for their own model. Reduced the number of ADLs to 12.
How many groups of activities do we use today to assess ADLs?
six

B. Have students work in individually, or in pairs, to read the text to find the answers to questions 1–5. Tell students to concentrate on finding the answers rather than any words they don’t know at this stage.

Go through the answers as a class.

Answers

1.c 2.a 3.b 4.c 5.a

Extension activity: Look at some of the vocabulary from questions 1–5 in more detail. Have students read the questions and answer options again to find the answers to these questions.

What is a buzzer?

An electrical device that makes a buzzing noise and is used for signalling.

What does swallow mean?

pass down the throat

What is a hoist?

a device that lifts someone

What does chew mean?

to break food down with the teeth

What does comb mean?

to untangle the hair

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Lesson Plan: Taking a Patient’s Blood Pressure and Pulse

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This lesson plan teaches the language used when taking a patient’s blood pressure and pulse.

A2-B1 level

Teacher Notes

● Topic: Taking a patient’s blood pressure and pulse

● Timing: 40–60 minutes

● Lesson type/focus: vocabulary, reading, listening and speaking

Aims

● Speaking: discuss and practise language for blood pressure and pulse

● Vocabulary: learn/review equipment used for blood pressure and pulse

● Reading: read for specific information

● Listening: listen for gist and detail

Overview

The focus of this lesson is talking about blood pressure and pulse readings and the equipment used. The speaking activity introduces the topic and gives students the opportunity to share their ideas and experience. The vocabulary activity introduces/reviews key vocabulary which appears in the listening activity that follows. The listening activity also provides a model for the final speaking activity.

Note: this lesson supports the language introduced in the following:

● Course: English for Care: delivering outstanding care

● Unit: Patient Admission

● Module: Taking patient observations: hospital charts: early warning score, pages 9 to 14

Teaching Guide & Answer Key

Part 1: speaking

Put students into small groups and ask them to discuss questions 1 and 2 on the student worksheet. Encourage them to share examples from their own experience.

Do whole class feedback to discuss and share answers.

Part 2: vocabulary

A. Have students work individually to write the terms below the pictures.

Go through the answers as a class.

Answers

radial pulse 2. blood pressure monitor 3. sphygmomanometer 4. stethoscope

B. Have students work individually to complete the sentences. Then ask students to check their ideas with a partner.

Go through the answers as a class.

Answers

electronic 2. pulse 3. blood pressure reading 4. wrist 5. cuff 6. bulb 7. sounds
8. gauge

C. Have students work individually, or in pairs, to write the terms next to the pictures. Point out that only six terms are needed and these come from the answers in activities A and B.

Go through the answers as a class.

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Lesson Plan: Introducing yourself to patients using respectful language

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This lesson plan focuses on Introducing yourself to patients using respectful language.

A2 level

Teacher Notes

● Topic: Using respectful language

● Timing: 45-60 minutes

● Lesson Type/Focus: Reading and Vocabulary

● Level: A2

Aims

● Vocabulary: review/learn vocabulary related to ways to be respectful with patients

● Reading: improve reading skills and comprehension

Overview

The focus of this lesson is a reading activity to introduce and develop the topic of respectful language used with new patients. The text is about the different ways carers should introduce themselves to patients. The reading comprehension exercise provides students with some suggestions on how to approach new patients and with new vocabulary that can be useful in their daily life activity as carers.

Note:while this lesson plan works as an independent plan, it uses material and language in the following:

● Course: English for Care: delivering outstanding care

● Unit: Patient Admission

● Module: Introducing yourself and welcoming a patient, p6

Teaching Guide & Answer Key

Part 1: discussion

Put students into pairs/small groups.

A. For the first question, encourage students to share examples from their lives and work. Elicit or supply the words formal, informal and polite to help them to talk about differences between greetings.Elicit answers from students and feedback to class –write down the answers so that they are visible to students.

B. For the second question, put students into small groups or pairs. Show students the two pictures below and ask them to think about whether they would greet the younger and the older patient the same way. Encourage them to talk about their relationships with patients and to share examples from their lives at work.Elicit answers from students and feedback to class –write down the answers so that they are visible to students

PICTURE A

PICTURE B

Questions and suggested answers

How do you normally greet a friend?Or a colleague?Is it the same way you usually greet a stranger? Why/Why not?

The language we use with friends is typically informal, while we use more formal language with strangers. With colleagues, it may well depend on factors such as seniority or how long the relationship has been to determine what kind of language is most suitable.

How do you normally greeta patientthe age of the woman in picture A? Is it the same way you usually an elderly patient like the lady in picture B?

The way we greet younger or elderly patients is likely to vary as older people may feel disrespected if addressed with informal language. We may always use Mr/Mrs/Ms with elderly people, as opposed to first names with younger ones. We may also use Good morning/Good afternoon as opposed to Hi/Hello.

Elicit answers from students and feedback to class – write down the answers so that they are visible to students.

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On viruses

September 29, 2021

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This extract describes some remarkable and surprising facts on viruses.

On viruses

Did you know…

Viruses … are the most abundant life form on Earth – there are more viruses in the world than all other forms of life added together. (They) ‘have invaded every niche occupied by living things, including the most inhospitable places like hydrothermal vents, under the polar ice caps, and in salt marshes and acid lakes’, writes Dorothy Crawford, Professor of Microbiology at the University of Edinburgh.

We are taught to think of cells as small; the average human body, for example, is composed of 37 trillion of them. This helps put bacteria in perspective. Each bacterium is a single-celled organism. Ten thousand of them would comfortably fit on a grain of sand. But viruses make bacteria look like giants. The volume of a virus is around a million times smaller than that of a bacterium. So tiny are these most enigmatic of microbes that they remained invisible to the human eye until the invention of the electron microscope in the 1930s.

Remarkable, no?

This extract comes from ‘Breathtaking’, the mighty impressive book written by Rachel Clarke about her experiences as a doctor in the UK’s National Health Service in the first months of the pandemic. Insightful, compassionate, angry, heartbreaking, and beautifully written, every bookshelf should have a copy.

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Lesson Plan: Asking About Pain

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This lesson plan focuses on how to ask about and describe pain. It includes vocabulary, grammar and communication activities.

B1 level

Teacher Notes

● Topic: Asking About Pain

● Timing: 60-90 minutes

● Lesson Type/Focus: mixed – vocabulary development, grammar consolidation, listening and speaking skills development

Aims

● Vocabulary: learn and practise language for describing and asking about pain

● Listening: improve listening skills for gist and detail

● Grammar: improve ability to use different question types

● Speaking: improve clinical speaking skills through role play

Overview

The focus topic of this lesson is describing and asking about pain. Students’ existing vocabulary is activated with a short vocabulary discussion, after which a dialogue is used first to practise listening for gist and detail and then as the basis of a gap-fill. Language from the dialogue is then exploited in the second vocabulary activity, which expands to elicit a range of language to talk about pain. Different question types, as demonstrated in the dialogue, are explored in the next activity before a role play between a nurse and a patient closes the lesson by giving practice with language from all the previous activities.

Note: while this lesson plan works as an independent plan, it also supports the language introduced in the following:

● Course: Online English for Nurses: Getting the Essentials Right’.

● Unit: Discussing Pain

● Module: Asking about pain 1

Teaching Guide & Answer Key

Part 1: vocabulary 1

Section A

Write up the words pain, hurt and ache and ask the class for an example sentence using each one. You may want to check the pronunciation of ache (/eɪk/) at this point. Note any variation in word form, e.g. hurts, aching and elicit other members of the word families, e.g. painful.

Put students into pairs and give them a few minutes to think of sentences. Then ask for feedback to class and discuss where appropriate, e.g. to correct.

Section B

Now ask students to think of words for specific pains, e.g. headache, neuralgia. They should make a list in their pairs.

In turn, ask each pair to say an item from their list. Check their pronunciation, then make a master list for the class.

Part 2: listening

Section A: listening for gist

● Direct students to the first set of questions and check students understand them.

● Play the recording from the conversation between the nurse and the patient once and give pairs/groups a moment to confer and make some notes on the answers.

● Check answers through class feedback.

Section B: listening for detail

● Now ask students to read through the dialogue transcript and imagine what the missing words are.

Encourage them to analyse the transcript and discuss the meaning and structure of the missing language. This is an opportunity to practise varying levels of focus: reading the whole conversation without worrying about the gaps will give a general idea of the topic, while looking at a shorter section will give clues as to the meaning or function of the missing statement and concentrating on the grammar of a single line may indicate the type of language needed to fill the gap.

Section C

● Ask the class to study the phrases below the dialogue and try to fit them into the spaces. Ask them to compare them with the answers they thought of.

● Play the video/audio recording so they can check their ideas and change them where necessary. This is in the course: Online English for Nurses: Getting the Essentials Right’, as indicated above, or is available here.

● Use whole class feedback to check the correct answers.

Answers

Nurse: Hi William. How are you (1) today?

Patient: Oh. I’m OK apart from this pain. I just can’t get comfortable.

Nurse: Oh right. Is it OK if I ask you some questions (2) about the pain?

Patient: Yeah, sure.

Nurse: First, can you tell me (3) where the pain is?

Patient: It’s in my lower back. Right here at the base of the spine. I had a bike accident a few years ago and hurt my back and my right hip.

Nurse: I see. So, is the pain in your back (4) and your hip?

Patient: No, I’ve only got back pain now. My hip’s OK. But I’ve had back pain for years now.

Nurse: What (5) type of pain is it?

Patient: I’m sorry, I don’t understand what you mean. It’s back pain.

Nurse: Yes, I understand but I was trying to find out if (6) it’s a sharp pain or a dull ache. If you have a sharp pain, it is usually a (7) short-term pain, whereas a (8) dull ache can be a type of (9) chronic pain.

Patient: Oh right. I understand what you’re asking now. It’s mostly a dull ache, except if I move suddenly or try to pick up something heavy. Then I get a sharp pain.

Nurse: You said your back (10) is hurting now, right?

Patient: Yes, it’s quite painful. I couldn’t stay in bed any longer.

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National healthcare systems ranked!

September 17, 2021

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US-based healthcare think tank and funding body The Commonwealth Fund have published their 2021 comparison of the healthcare systems from 11 high-income countries. This is the fourth ‘Mirror, Mirror’ report since the first one was issued in 2010. The series is designed to ‘generate insights about the policies and practices that are associated with superior performance’.

Healthcare systems around the world have been put to the test by the pandemic. How well have they responded? How confident can patients be that they are receiving the best levels of care? How can healthcare systems improve what they do while managing unprecedented stresses?

The Fund has assessed the 11 healthcare systems using 71 performance measures across five domains: access to care; care process; administrative efficiency; equity; and healthcare outcomes. The countries were then ranked for each domain and then overall.

The summary results from the 71 measures are displayed in the table by country and buy domain.

More detail is provided on the graph:

Here, the differences are writ large. The top 3 countries – Norway, the Netherlands and Australia – are close together. There’s a relatively small gap to the next 3 – UK, Germany and New Zealand – and then again to the next countries, dipping a little for Canada. However, the subsequent drop to the 11^th country, the US, is considerable, more than the drop from the 1^st to the 10^th countries.

The inefficiencies of the US healthcare system are further highlighted by the table showing healthcare expenditure as a percentage of GDP. Here, the US spends significantly more than the other 10 countries. Something clearly is not working.

When making the comparisons, the report seeks to identify the factors that lead to an efficient healthcare system that produces better and more equitable outcomes for its patients. They identify 4 factors, stating that the top-performing countries do the following:

Provide for universal coverage and remove cost barriers so people can get care when they need it and in a manner that works for them.
Invest in primary care systems to ensure that high-value services are equitably available locally in all communities to all people, reducing the risk of discrimination and unequal treatment.
Reduce the administrative burdens on patients and clinicians that cost them time and effort and can discourage access to care, especially for marginalized groups.
Invest in social services that increase equitable access to nutrition, education, childcare, community safety, housing, transportation, and worker benefits that lead to a healthier population and fewer avoidable demands on health care.

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What is English for Doctors?

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Listening to two doctors discussing a case is not exactly straightforward, even for an experienced English language teacher. The vocabulary is often unfamiliar, not only the medical terms but also the abbreviations, acronyms and short cuts.

Medical English Language

Read the following conversation, taken from SLC’s English for Doctors course:

Consultant: Ah, Mrs Townsend? Can you fill me in a bit about her?
RMO[1]: Sure. She’s a 45-year-old woman who came in three days ago for an open cholecystectomy. You may remember that she wasn’t a candidate for a laparoscopic cholecystectomy.
Consultant: Oh yes. I remember her now. Is there any relevant past medical history I should be aware of?
RMO: Yes. She suffered from cholecystitis for quite some time and had a very large gallstone removed a few days ago, as I mentioned before. The size of the gallstone was the main reason for open surgery rather than keyhole surgery. In addition, she has a long history of alcohol-related cirrhosis of the liver. She had a recent chest infection which was treated by her GP. I’m concerned about her now because she’s in a lot of pain, despite using her PCA regularly. She’s had quite a few breakthrough doses of analgesia but is still complaining of localised pain around the incision site.
Consultant: Mm. Her temperature?
RMO: She’s been spiking a temperature between 38 and 38.5 over the past few hours.
Consultant: OK. You said she’s got a lot of localised pain around the surgical incision?
RMO: That’s right. She seems to have more pain that one would expect, even with open surgery. One of the nurses also asked me to check her wound. She noticed that it was very red and had an offensive smell. The redness has been spreading and I’m a bit worried about the possibility of a collection or abscess.
Consultant: Yes, I see. What are her other obs like?
RMO: Her BP’s elevated and she’s tachycardic. She’s also quite breathless. Her sats are running around 95, 96%.

Without medical training, how much would you understand? What was the procedure Mrs Townsend had? Why did she need surgery? What events led to her being admitted to hospital? What’s her current condition?

This is just a small example of the kind of conversations doctors have all the time. For a non-trained person, it’s no surprise that the English used by doctors may seem like a bewildering mix of medical terms, colloquialisms, abbreviations and acronyms.

Communication frameworks

Added to this is the tendency for many conversations to be structured so doctors give information or explanations using conventions we may not be aware of. The above conversation, for example, comes from a course module on SBAR. This stands for Situation-Background-Assessment-Recommendation, a communication framework often used by healthcare professionals. By having a predictable communication flow, SBAR enables important information to be transferred accurately and effectively without omitting relevant details.

The use of SBAR highlights the contextual nature of the language used by doctors and other healthcare professionals, often in high-stakes conversations where misunderstandings may have significant, real-life consequences. Accuracy and mutual comprehension are critical.

Communicating with patients

The complexity of English used by doctors then increases when communicating with patients and their families, necessitating a switch from the profession-specific English outlined to that which can be easily understood by a non-medical professional. Medical terms and procedures are translated into ‘lay language’ and related acronyms and abbreviations are explained.

Patients may be upset and frightened, so doctors also need demonstrate empathy, patience and compassion, especially when the news is not what the patient wants to hear. Again, communication strategies have been developed to establish rapport, gather information, explain difficult concepts, check understanding, recognise a variety of emotions and respond to them.

The features of written language

The specific nature of the language used by doctors is further reflected in what they write, for example when producing research papers. There are a number of features which set this language apart from other written English.

1. Medical terms

The first and most obvious is the widespread of medical terms, such as laparoscopic cholecystectomy from the conversation above. Medical terms tend to be Greco-Roman in origin. Laparoscopic, for example, comes from the Greek lapara, meaning flank, and skopeo, meaning to see, while cholecystectomy comes from the Greek khole, meaning gall, kystis, meaning bladder, and ectomy, meaning removal or excision. So, a laparoscopic cholecystectomy is the removal of the gallbladder by using keyhole surgery, when the surgeon inserts a laparoscope, a thin tube with a camera on the end, which shows the gallbladder on a screen. Simple, eh?

Medical terms are often compound words with predictable prefixes and suffixes and are frequently used in collocations or set phrases. Importantly they are mostly univocal, so mean one thing only. This lack of ambiguity enables doctors keep the language they use both accurate and clear.

2. Grammatical structures

The second key feature is the use of grammatical structures which keep the language tone neutral, empirical, and objective. The two most common examples of this are the passive – the procedure was performed, the research findings will be discussed – and nominalisation, where verbs and adjectives are used as nouns – there is a requirement for.., the analysis revealed that….

3. Lexical density

The third feature, also common to spoken communication, is the high lexical density of language used. The sheer number of terms and associated high level vocabulary items that appear in any text sets medical English apart from other ‘Englishes’, especially that used in everyday written texts such as newspaper articles. In research pieces, medical language combines with academic language so sentences may appear long and paragraphs difficult to follow without the requisite medical training.

The IMRaD convention

However, as with SBAR and other communication frameworks, research articles tend to follow a set framework. This is the IMRaD convention – Introduction, Methods, Results and Discussion. The universality of this framework enables clarity and predictability for both writer and reader. It allows medical professionals and students follow what might seem dense and difficult texts with relative ease.

To conclude

So, while at first glance, the English used by doctors may seem obscure, highly technical and impenetrable, once you look at it, you can see that there are clear regularities that make it relatively easy to analyse and understand. Terms have predictable roots and affixes that can be applied across healthcare. Communication and writing frameworks are straightforward and widely applied. Like any language or dialect however, there is some learning to get to the stage where this can be done easily.

Disclaimer: I am writing this as an English language professional who works extensively with international doctors and on materials designed to improve their English language skills. I would be grateful for the thoughts of any doctors reading this on the accuracy of this article, as well as from fellow language professionals with an interest in the issue.

[1] RMO: Resident Medical Officer

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What do teachers need when teaching with online materials?

September 6, 2021

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The advantages of online course materials over printed coursebooks are clear from many perspectives.

Online Teaching

Online materials are easily accessible and given the ubiquity of both internet and phone, incredibly portable.

Content tends to be highly visual, contain video and audio inputs, downloadable materials and links to all kinds of complementary resources.

Tasks are engaging and interactive, as students select, sort and match, move items on the screen, write in ideas, and record their voices. Feedback is instant in most cases, and students can try again as well as see tips, explanations and answers.

Online courses are easily updated so existing content can be improved and new materials added before being published at the click of a button.

Content is also customisable as online modules can be rearranged, edited and added to in order to create courses which map precisely to an institution’s needs.

However, in spite of this, widespread adoption of online course materials remains elusive even with the mainstreaming of online courses as a result of the pandemic. While many teachers use online materials to supplement a printed textbook, there seem to be several questions that need resolving for a transition to online courses to take place.

Is there a clear course structure? How can I check progress? How can I see what my students have done? How can I use an online course in a classroom setting?

Let’s have a look at how these questions may be addressed.

Clarity of structure

Most teachers seem to have come to digital by using online coursebook supplements created by publishers, or finding materials such as TED Talks, YouTube videos, or lesson plans and resources from sites such as the British Council or Macmillan Education’s Onestopenglish. So, course structure has been set by an agreed textbook – and is clearly laid out in the Contents section – and online materials are then bolted on as determined by the individual teacher.

However, this is changing. Publishing houses are digitising printed courses and a growing number of publishers are creating online courses designed to be used by a teacher. While General English and IELTS preparation courses, such as those offered by Net Languages or Guided eLearning, have led the way, more specialised courses have come onto the market in recent years. These include Aviation English courses published by Latitude and Medical English and OET preparation courses published by us at SLC.

These online courses all provide a structure that teachers can take to the classroom and use as a core syllabus. Many have been written by established textbook authors who apply the same principles they do to printed textbooks – so clear focuses for each unit, plenty of scaffolding, structured language introduction, explanation and practice, ongoing progress reviews, and lots of recycling of key language inputs.

At SLC we can also rearrange and edit courses so the structure meets an institution’s specific requirements. In this way, a medical university can map their Medical English curriculum to a degree course. As demand for tailored products extends across all sectors, I can imagine that this will become increasingly expected, perhaps even the norm, over years to come.

Checking progress and student work

In principle, it’s easy to look at a student’s textbook and see what they’ve done, perhaps mark some work and add a comment or two. At least that was the case before everything went online in March 2020, when teachers had to adapt, some switching to ebook versions of textbooks, some asking students to hold the book up to the camera on Zoom, and others asking students to photograph work and submit it via email, Moodle or Google Classroom.

As remote delivery became the norm however, it became clear that teachers would greatly benefit from being able to view, mark and comment on work done by their students online. This is particularly true of online courses that are designed to be used by teachers as core course materials. Viewing what students have done, where they have been successful and where they have struggled is critical to any ongoing tutored programme planning.

The move to online during the pandemic highlighted this issue and drove rapid progress in the online platforms available to educational institutions and teachers. Avallain AG for example, one of the world’s leading online educational publishing platforms, released Magnet, a new authoring and publishing environment which allows teachers to view and download at-a-glance reports on student progress and see a student’s work as if they were the student, the equivalent of looking at student course book they have written answers in. Courses can be set for teachers to mark and comment on submitted student work, for example where they have written or recorded something. Feedback can be left, both written and spoken.

The advantage of digital is that teachers don’t need to take coursebooks home, student scores and pages are available at the click of a button, and there are no issues with handwriting or the dog having eaten the homework. Learning management systems have been increasingly incorporated into mainstream education, for example through Google Classroom, and it was only a matter of time before online courses and the management of those courses caught up.

Using an online course in a physical classroom

While online courses increasingly provide both a clear structure and easy-to-use course management tools, the practicalities of using an online course at the core of a tutored programme remain an issue in the minds of many teachers. You can’t just say, “Open the book to page 50 and do the first exercise”.

Using online courses assumes that both teachers and students can access and use them together. There are two models now being commonly used.

In-class usage. In a face-to-face classroom, teachers need an interactive whiteboard or a device linked to a projector from which they can work. Students need computers or tablets. In this scenario, teachers and students can access the online pages at the same time, in a similar way to using a textbook in class.

In practice, the teacher introduces the target language through discussion or by using the on-screen images, video or audio. Students view this on their screens, discuss it with their teacher and then do the activities set. They may submit answers and give feedback to the class – either individually or in small groups. Just as with the textbook, teachers may choose to complement online course work with additional materials, inputs and activities.

On the system we at SLC use, the teacher’s answers can be reset, allowing the activities to be done multiple times with different groups. Student attempts can be limited to an agreed number and can be reset by their teacher where appropriate.

Flipped classroom. In this approach, students work on the online course outside the lessons, for example by going through a unit on a particular set of vocabulary, doing some writing, or working on a dialogue. The teacher then activates the language covered in the lesson, discussing what they have done and asking students to use it in practical contexts, such as role plays. The students wouldn’t necessarily need their devices in the lesson, as long as the teacher can display the content for everyone to see. The teacher also has access to what students have done and can use this to plan lessons based on where areas of improvement can be identified.

To conclude

Textbooks still form the backbone of many language learning programmes. There is comfort and familiarity in using them. Many are well-written with strong supporting materials.

However, they are being increasingly challenged by online course alternatives. And as students grow up in an environment where digital is how they learn they things they want to learn – whether it be videos on how to repair a bike, websites on investing in cryptocurrency, or talks on the future of healthcare – online will inevitably be part of their learning expectations.

Teachers will therefore need the tools to enable them to give effective online courses, including what has been outlined above – well-written, well-structured programmes, the ability to see, track and mark student work, and a clear approach to teaching the content. The pandemic has pushed online delivery into the mainstream, so now it’s up to us to figure out how best to adapt and thrive in what may seem a new environment but one which brings great rewards.

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You can subscribe to our newsletter where you will receive monthly email with the latest materials that SLC offers for free.

We also offer the latest in online medical English resources and materials to transform your teaching programmes and accelerate your students’ learning.

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Lesson Plan: Describing Position and Movement

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This lesson plan teaches the vocabulary used to describe position and movement when conducting an examination.

B1-B2 level

Teacher Notes

● Topic: the body – position and movement

● Timing: about 30 minutes

● Lesson Type/Focus: speaking & vocabulary

Aims

● Speaking: discuss language commonly used to describe position and movement during an examination.

● Vocabulary: medical and layman’s terms for the body anterior.

● Speaking: practice using the target vocabulary.

Overview

The focus of the lesson is vocabulary used to describe position and movement when conducting an examination. The speaking gives the opportunity for students to share ideas and experiences as well as vocabulary. The vocabulary activity will give the students practice for using medical and layman’s terms and the speaking activity will allow them to practice using the target vocabulary.

Note: This lesson uses material from SLC’s course, ‘English for Doctors: Advanced Communication Skills’.

Teaching Guide & Answer Key

Part 1: speaking

Put students into small groups and ask them to brainstorm language that may typically be used in an examination when asking a patient to get into a certain position or move a part of their body.

Elicit ideas and discuss as whole group.

Write elicited ideas on board for later analysis.

Part 2: Vocabulary

Section A

Put students in pairs or small groups. Ask them to complete the sentences, so adding either a term or completing the definition.
Elicits answers and correct as necessary.

Answers

1. face up 2. prone 3. side 4. sitting 5. abducted 6. toward 7. bent 8. extended 9. facing upwards 10. down

Section B

Students then look at the directional phrases used during an examination and complete the sentences with a word from the box.

Answers

1.back 2. look 3. open 4. deep 5. over 6. up 7. facing 8. ceiling 9. side 10. towards 11. middle 12. bend 13. straight 14. Straighten 15. palm 16. Rotate 17. pop

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Lesson Plan: Describing Cardiovascular Conditions

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This lesson plan teaches the language used to describe the heart and cardiovascular conditions.

B2-C1 level

Teacher Notes

● Topic: Describing cardiovascular conditions

● Timing: 45 minutes

● Lesson type/focus: reading and writing

Aims

● Reading: develop language associated with the heart.

● Vocabulary: develop language needed to describe cardiovascular conditions.

● Writing: consolidate and extend language use through writing.

Overview

The focus of the lesson is describing cardiovascular conditions. The speaking activity introduces the topic and gives students the opportunities to share their current knowledge and vocabulary on the topic. The reading activity and subsequent activity develop students’ vocabulary on the heart and associated cardiovascular conditions. The writing activity allows the students to put the vocabulary into practice and describe heart attacks using language appropriate for a patient.

Note: this lesson supports the language introduced in the following:

● Course: English for Doctors: Advanced Communication Skills.

Teaching Guide & Answer Key

Part 1: speaking

Put students into small groups and ask them to discuss questions 1 – 3. Choose a spokesperson from each group to report back the answers. After whole class feedback, students read the link below to compare their answers.

https://www.nhs.uk/conditions/cardiovascular-disease/

Part 2: reading

Put students in pairs. Ask them to read the text and choose the correct answer from the two options given. Whole class feedback.

Answers

1. organ 2. pump 3. chambers 4. flows 5. lungs 6. oxygen 7. Valves 8. relax 9. fill

10. hard 11. contract 12. away 13. arterioles 14. capillaries 15. tissues 16. thin 17. lower

Part 3: vocabulary

Students continue to work in pairs and complete the sentences with a word from the box. Students compare ideas with another pair.

Answers

1. endocarditis 2. thrombosis 3. electrocardiogram 4. phlebotomist 5. vasoconstriction

6. muscular layer 7. pericardial 8. myocardial infarction

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Lesson Plan: Greeting Patients

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This lesson plan examines different ways in which a doctor can greet patients.

B2 level

Teacher Notes

● Topic: Patient admission – greeting a patient

● Timing: about 30 minutes

● Lesson Type/Focus: speaking & reading

Aims

● Speaking: discuss and reflect on the different ways to greet a patient

● Conversation analysis: review a conversation for appropriate language and responses. Re-write conversation to make more appropriate

● Reading: rguided group research and discussion on the topic of greeting patients

Overview

The focus of this lesson is greeting a patient. The discussion activities encourage students to reflect on practices in their own context and country. The reading activities give an insight into practices in the UK. The conversation analysis/functional language section gives students input and practice in choosing appropriate phrases for greeting a patient.

Note: this lesson uses material from SLC’s course, ‘English for Doctors: Advanced Communication Skills’.

Teaching Guide & Answer Key

Part 1: discussion

Put students into small groups to discuss the questions.
Re-group students and ask them report on the ideas from their group to their new groups. Open up to whole class and continue to discuss.

Part 2: greeting patients and explaining your role

Error correction activity. Students work individually or together to find the mistakes in each sentence.

Answers

Hello. My name is Dr Rogers. I’m the doctor in on duty today.
I am responsible to for the surgical patients on this ward.
This means I look out for after patients who have just had an operation.
I am the surgical F1 in on call today.

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Lesson Plan: Developments in the treatment of Cystic Fibrosis

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This lesson plan analyses an article on a new cystic fibrosis drug and teaches associated vocabulary.

B2-C1 level

Teacher Notes

What do you know about CF?

For more information about CF – go to the Cystic Fibrosis Trust website

The term cystic fibrosis comes from:

cystic: describing a cyst, from the Greek word kystis which means bladder or pouch. In the case of CF, the cysts form in the pancreas.

fibrosis: fibrous growth in an organ (in the case of CF, in the pancreas), from the Latin word fibra which means a fibre or filament.

CF was recognised as a specific disease by Dorothy Hansine Andersen, an American pathologist and paediatrician in 1938, although descriptions of the condition are evident from the late 16^thcentury.

Language Focus

Language Focus 1: Adjectives with life

life-extending: helping people live longer

life-shortening: condition which causes people to have a shorter life than the average person

life-threatening: condition which may cause a person to die

life-affirming: something which makes you feel glad to be alive

lifespan: the period of time that a person exists

lifetime: the period of time something or someone exists (I’ve seen many changes in my lifetime)

Language Focus 2: describing death

fatal: something which is able to cause death (I a fatal illness) or a serious consequence (a fatal flaw in the design of the building)

mortal: something that causes death, e.g. a mortal blow to the head

lethal: something which is specifically designed to cause death, e.g. a lethal injection to execute someone

terminal: likely to cause death, often used to describe the end stages of an illness, e.g. terminal cancer

deathly: something which resembles death, e.g. a deathly pallor (very pale skin)

Now, read the article and answer the questions.

1. Why do people with CF require frequent hospitalisation?

2. Why might the new drug be ‘good for taxpayers and patients’?

3. What is a ‘green light’? What other expression do you know with the same meaning?

Cystic fibrosis drug given green light in England

A life-extending drug for cystic fibrosis will be available on the NHS in England, health bosses say.

NHS England reached a deal with the manufacturers of Orkambi, Vertex Pharmaceuticals, after months of negotiations. Patients should be able to get the drug within 30 days.

The drug improves lung function and can be given to children as young as two.

The firm wanted to charge £100,000 per patient per year, but a compromise has been reached in a confidential deal.

It is understood to be significantly less than the sum originally asked for.

It comes after the Scottish Government reached an agreement with the manufacturers last month.

Wales and Northern Ireland can also access the drug under the same terms negotiated by NHS England.

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What is Medical English?

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Today’s global healthcare workforce is multi-national and multi-lingual. English is the lingua franca, and non-English speaking healthcare professionals, from consultants to carers, need to get their Medical English up to speed in order to deliver the safe and effective care demanded of them.

Medical conversations are varied and important – with colleagues, with patients, and with their families and friends. The healthcare environment can be fast-paced, noisy and high risk. Mistakes can be made with serious consequences.

Meeting these critical communication needs requires excellent language skills. And not general English skills, but the language specific to healthcare – Medical English.

Medical English is Different

Medical English is not the kind of English you learn at school. It has its own language, structure and conventions. Medical English is part-technical, part-academic, and part-everyday. It has a wide variety of slang, acronyms, colloquialisms that those outside the profession find incomprehensible. It exists in highly-charged interactions.

On any given day, for example, a nurse may have to reassure, to explain, to examine, to give bad news, to calm the upset, to handle the confused, to comfort friends and family.

With colleagues, they give accurate handovers, create detailed care plans, explain incidents and near misses, and participate in multi-disciplinary team meetings.

They have to listen carefully, to understand accents, the social and cultural contexts of their patients, and then to respond appropriately and meaningfully.

How to Design Medical English Courses

Teaching such a range of language set in very context-specific situations to professionals is a tough call, but Medical English courses need to reflect this – whether it be an elementary level course for HCAs to or a much more advanced course for specialist doctors.

General English courses typically start with carefully scaffolded sets of grammar, vocabulary, language skills and functions, which are then contextualised so they make sense. With Medical English, it’s the other way round. Context is everything. Grammar, vocabulary, skills work and functional expressions are determined by the context. In this way, Medical English is situation based, and the language is practical and hands on.

Medical English course design and delivery therefore needs to follow this principle, whether it be online self-study, tutor-led classroom lessons, or combinations of the two. Course creators also need to focus on the language objectives at a times – Medical English courses are designed not to teach medical professionals how to give better care, but how to practise successfully in English.

Because of the focus on both context and language, it’s vital that both medical and language experts are involved in developing relevant curricula and methodologies. Content needs to be relevant to learners and delivered in such a way that they are able to learn and use it successfully. Only in this way can the core Medical English objectives of achieving safe and effective practice be reached.

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How do Nurses use English?

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My latest reading is a chapter in ‘The Handbook of English for Specific Purposes’, titled ‘English for Nursing’ and written by Susan Bosher. The Handbook is a great resource for all things ESP. In the article, Bosher cites three studies, one Canadian (Epp and Lewis 2008), one American (Cameron 1998), and one Australian (Hussin 2002). Each of them looks at nurses’ English language needs, and describes in some detail what areas of language use are most common. This in turn helps inform us what language tasks and skills should be integrated into the online English for Nursing courses we design.

For this post, I’d like to discuss the Canadian study. Epp and Lewis (2008) spent over 80 hours observing nurses in various clinical settings, taking notes on their communicative interactions, and them analysing them in terms of percentages spent on different tasks. They found that nurses spent 56% of their time with patients, 34% with other healthcare professionals, and 10% with patients’ families. In terms of actual language tasks, the breakdown was as follows:

Asking for information 22%
Explaining 21%
Giving instructions 9%
Informing 7%
Responding to questions 6%
Suggesting 6%
Describing 6%
Small talk 5%
Discussing 5%
Comforting 4%
Making and receiving phone calls 3%
Asking for help 2%
Offering to help 2%
Clarifying 1%
Apologising 1%

This breakdown of language use into functions is interesting and enlightening. It shows a number of key language tasks that should be integrated into any Medical English course. ‘Asking for information’ includes the grammar of questions (“Could you tell me..?”, “What happens if..?”, “How does it feel when..?”), as well as the vocabulary relevant to the context. This might range from asking about specific symptoms, to asking about pain, assessing pressure areas, carrying out a falls risk assessment, or asking about breathing difficulties.

Explaining is clearly crucial to effective communication, and again can be approached from a grammatical angle – describing sequences, cause and effect, or conditionals using ‘if-clauses’ (“If this happens, then this might happen”), as well as a vocabulary perspective. There are many interactions that require a degree of explaining, such as taking medications and their potential side-effects, common hospital procedures, pre-operative preparation, post-operative care, or giving an accurate handover.

In fact, each of the above functions listed has its own common grammar and vocabulary. What really matters here is that nurses learn the English necessary to communicate accurately with patients, other healthcare professionals (nurses, doctors, consultants), and patients, in order to ensure the provision of safe, effective care. This consists of 3 core areas:

English grammar, including talking about different times, different levels of likelihood, and sequencing events correctly.
Situation-specific vocabulary of which there is a lot. Healthcare is a wide field, and nurses need to know how to talk to patients – as well as other staff and families – about common areas, some of which are very complex.
Communicative skills, including pronunciation, understanding what others say in a range of accents and ‘Englishes’, and communication strategies, such as clarifying, re-phrasing, suggesting, expressing politeness or asking for repetition

Coming back to the Epp and Lewis’ list, while it describes the various functions nurses use English for in practice, it doesn’t go into the specific contexts in which they were using the language or identify how high stakes the interactions were. These may also be of considerable significance and impact on how a Medical English course writer designs a syllabus. For example, ‘asking for help’ only accounted for 2% of interactions. However, this specific function, especially in emergencies, may be incredibly important to get right and it therefore may assume equal importance to another language task where the stakes – and the consequences – are not so high or serious.

To take this survey further, one move may be to research a ‘Nursing English’ corpus of how English is used by nurses in practice. Corpus linguistics is a relatively new approach to language analysis but one which is having greater and greater impact on how English courses are being designed and taught. Corpus linguistics is the study of ‘real life’ samples of English, so taking large bodies of language – both written and spoken – and looking in detail at how language is used by people in practice in many different situations, in ‘real life’. To do this for nurses would be a difficult but very useful exercise. Getting a deep understanding of how English is used by nurses would allow us to develop syllabi matching the specific grammatical, lexical and communicative needs of nurses.

Until this happens, though, it is vital to use the input provided by the research of Epp and Lewis as well as others in the same field. I would also suggest we combine it with the insights provided by practising nurses. Virginia Allum, who writes our online English for Nurses courses, is a Registered Nurse, with career experience in the UK and Australia, and has also lectured extensively on English for Medical Purposes. This enables her to write courses which demonstrate a strong understanding of the issues facing non-native English-speaking nurses, as well as a real command of the environment nurses work in.

Designing online English of Nursing courses has proven to be a fascinating task so far. We are developing two courses, one at an elementary/pre-intermediate level for nurses preparing or just starting to work in an English-speaking environment, and one at a higher intermediate/upper-intermediate level, for practising non-native nurses who need to improve their accuracy, fluency and confidence in the workplace.

References: ‘English for Nursing’ by Susan Bosher, p263-281, ‘The Handbook of English for Specific Purposes’, edited by Brian Partridge and Sue Starfield, published by Wiley Blackwell, 2014

This article uses material from SLC's English for Nursing

The material in these articles and powerpoint come from SLC’s course, English for Nursing. This English for Nurses course teaches you the English you need to study and work in an English-speaking healthcare environment, attend conferences and seminars, and keep up with nursing journals and research written in English.

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What is the difference between IELTS and OET?

Stephanie Lam

Both IELTS (International English Language Testing System) and OET (Occupational English Test) are used to test the English language of healthcare professionals in different parts of the world.

They are chosen by regulatory bodies to ensure doctors, nurses and other professions have sufficient language skills to communicate at a high level with patients and colleagues, and so ensure safe and effective care.

Table of Contents

Similarities
Differences
OET and IELTS Preparation Courses
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Similarities

There are a number of similarities between the two tests:

Each one consists of four sub-tests, one for each skill: reading, listening, writing and speaking.
A test takes place on one day.
There is no pass/fail, but a graded score – different institutions need test takers to achieve different scores, such as a 7 in IELTS or a B in OET. In the UK, for example, the GMC requires doctors to score B in OET with B in each paper, or IELTS 7.5 with a minimum 7.0 in each paper. The NMC requires nurses to score B in OET with B in each paper, or IELTS 7.0 with a minimum 7.0 in Reading, Listening and Speaking and 6.5 in Writing.
In practice, the required scores in the two tests for professions such as nurses are for similar levels of language skill when measured on the Common European Framework of Reference, specifically a C1 or advanced level.
Both tests were developed in the late 1980s and are part-owned by Cambridge Assessment English. IELTS ownership is shared with ID P and the British Council. OET ownership is shared with Boxhill Assessment.

However, that’s where the similarities end. As you will see, they are quite different tests in many ways.

Differences

1. Content

IELTS tests academic English – at least the version of IELTS used by healthcare regulatory bodies around the world. This includes the ability to write essays, follow lectures, understand academic articles and discuss a wide range of topics, from the environment to education to social trends to cultural values.

OET tests healthcare English, including the ability to communicate effectively in medical scenarios, write a referral or discharge letter, understand a patient consultation, or follow a text taken from a medical journal.

2. Versions

IELTS offers 2 versions of the test – Academic as described, and General Training, used by organisations to test the more general language considered more appropriate for immigration or vocational purposes. The Listening and Speaking sections are the same for both. The Academic Reading and Writing is more geared to Higher Education than the General Training.

OET offers 12 versions of the test for different healthcare professions; nurses, doctors, dentists, pharmacists, optometrists, podiatrists, occupational therapists, vets, speech pathologists, dieticians, physiotherapists, and radiographers. The Reading and Listening sections are the same for both. The Speaking and Writing sections are tailored to the specific scenarios in which each profession uses English.

3. Format

IELTS has the following format:

OET has the following format:

4. Preparation requirements

Preparing for IELTS involves learning huge amounts of vocabulary on a wide range of academic subjects so test takers are prepared to read academic texts quickly and effectively, understand lectures and discussions, talk about abstract questions and give opinions in detail. Test takers need to learn how to write reports on a variety of data and a range of essay types. Written texts need to be at an advanced level and so include complex structures and grammar. Learning a set of key exam techniques is also crucial.

Preparing for OET involves learning a wide range of healthcare-related and profession-specific language, so test takers are able to follow, engage with and participate in a variety of clinical scenarios, as well as understand medical texts and talks. They need to be able to write a healthcare-related letter, such as a referral letter, at an advanced level. They need to acquire a range of exam techniques so they can work quickly and effectively in the test.

As a result, preparation courses for the two tests follow very different pathways and use very different materials.

5. Scoring

IELTS is marked out of 9, with a separate score for each paper. Half marks are awarded as part of this.

OET is graded from A (best) to E, with an equivalent numerical score to show more precisely where in the grade a candidate sits.

Healthcare regulatory bodies which use both exams to test English for healthcare professions tend to specify an advanced C1 level of language, i.e. around 7 in IELTS and a B in OET. The score equivalencies between the two tests are as follows:

6. Recognition

IELTS is recognised by universities, regulatory bodies, immigration authorities and companies in many countries around the world. This includes universities in non-English speaking countries where a course may be delivered in English. There are over 1,100 test centres in over 140 countries.

OET is recognised by healthcare regulatory bodies and Higher Education healthcare educators, including those in the UK, Ireland, Australia, New Zealand, Singapore, Dubai, Ukraine and Namibia. There are over 115 test centres in 40 countries.

7. Numbers of test takers

Over 3 million people took IELTS in the past year, compared to the tens of thousands taking OET. This reflects the size and reach of the global Higher Education market on the one hand and the specialist nature of the OET on the other.

8. Preparation infrastructure

IELTS has a global infrastructure developed around preparing learners to take the test, including universities, specialist training organisations, private language schools, published materials, online content, and thousands of teachers and writers.

OET has a small but global preparation infrastructure, consisting of a growing number of specialist training providers and also a small but growing materials base. OET ’s Premium Preparation Provider scheme provides a framework for training organisations to undergo a rigorous accreditation process to demonstrate their ability to prepare candidates for the specialist nature of OET. SLC was the first provider to be accredited in Europe.

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What is the Occupational English Test (OET)

The Occupational English Test (OET) is used in the UK, USA, Australia, Canada, Ireland, New Zealand and Singapore among others to assess the Medical English skills of a wide range of international healthcare professionals, including doctors, nurses, pharmacists, dentists, vets and allied health professionals.

Table of Contents

OET Background
OET Objectives
OET Test Format
OET Scores
OET Prep
OET Recognition
How do you take OET?
OET Free Preparation Materials
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OET Background

The OET was established in the late 1980s and developed under contract to the Australian Government. It was designed by Professor Tim McNamara at the University of Melbourne – one of the original developers of IELTS.

Since then, it has undergone continuous assessment and review, led by the Language Testing Research Centre (LTRC) at the University of Melbourne, in order to ensure it is fit for purpose today. LTRC is an international leader in research and development in language assessment.

The test is now owned by Cambridge Boxhill Language Assessment, a joint venture between Cambridge English Language Assessment (who co-own IELTS) and Box Hill Institute, a leading vocational and higher education provider.

OET Objectives

The OET is designed specifically to assess the English language skills of international healthcare professionals wanting to work in an English-speaking environment and reflects over 30 years of research and practice.

It consists of 4 papers: Listening and Reading cover a broad range of generally applicable healthcare topics, while Speaking and Writing test the specific language used by 12 professions within healthcare.

These are:

Dentistry, Dietetics, Medicine, Nursing, Occupational Therapy, Optometry, Pharmacy, Physiotherapy, Podiatry, Radiography, Speech Pathology, Veterinary Science.

OET Test Format

There are 4 skills-based papers: Listening, Reading, Writing, Speaking.

The Listening and Reading papers are designed to assess a candidate’s ability to understand spoken and written English, based on health-related topics and tasks common to all professions. Texts range from short workplace notices and dialogues to longer articles and talks.

The Writing and Speaking papers are specific to the 12 individual healthcare professions. They are designed to reflect common tasks performed in the workplace. The writing asks candidates to write a referral letter, for example, while the Speaking asks candidates to role play a conversation in a clinical setting.

OET Scores

Most healthcare regulators who recognise OET, require candidates to score C+ or B in the 4 papers to achieve the standard of English deemed sufficient to provide safe and effective care.

In the UK, for example, the General Medical Council (GMC) requires doctors to score B in all 4 papers in 1 sitting, whereas the Nursing and Midwifery Council (NMC) requires nurses to score a B in Reading, Listening and Speaking and a C+ in Writing. The NMC also allows nurse to ‘club’ different tests taken over a 12-month period together to achieve the grades, as long as no paper is graded at under half a band below the requirement.

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Specialist Language Courses (SLC) are dedicated to helping healthcare professionals excel in OET. Our expert-led courses focus on the specific language skills and test strategies needed to succeed. With paper-by-paper study, live webinar lessons, practice OET tests, an OET grammar course and optional personalised coaching, we ensure you build the confidence and competence required for each OET sub-test. Join SLC to boost your chances of achieving the scores you need and advance your healthcare career.

OET Recognition

The OET is recognised by regulatory healthcare bodies and councils, as well as university and Higher Education institutions, in the US, UK, Canada, Ireland, Australia, New Zealand, Singapore, Malta, the Maldives, Philippines, Qatar, UAE, Spain, Ukraine and Namibia.

How do you take OET?

OET can be taken at test centres around the world, either on paper or on computer. OET also offers an at-home testing service, so candidates who do not have a test centre in their country can take it at home instead. Know more about the different ways of taking the OET exam here.

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Medical English Tips: Giving Advice Sensitively

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Get this right, and your rapport with your patient will be a powerful factor in building a successful therapeutic partnership. Get this wrong, and your relationship may never recover.

Giving Advice Sensitively

There are some occasions, when healthcare professionals have to give advice in a sensitive manner. Think of some of the times, when you have had to do this. What sorts of things were you discussing?

Perhaps:

misuse of illegal drugs
misuse of legal drugs, e.g. using someone else’s medication, increasing the dose of your own medication
excessive alcohol consumption or lack of knowledge about safe levels of alcohol use
weight issues, e.g. obesity/overweight, underweight, eating disorders
body image issues, e.g. dysmorphia
depression or bereavement
avoiding STIs, e.g. use of safe sex

Now, think about the language you might use in these situations. It is useful to have a ‘scale’ of language in mind, when you are giving advice sensitively. In order to be effective, you will be using several communication skills. Here are 3 very useful skills:

a) Using non-judgemental language (both verbal and non-verbal)

At times, you may be talking about subjects which you find uncomfortable, so it is important to pay attention to your own body language. Are you using gestures (e.g. crossing your arms in front of your chest) or negative body positions (e.g. leaning back or away from the other person)? Are you using judgemental phrases, e.g.

You’re going to have to make more of an effort. You need to pull yourself together now?

b) Acknowledging the patient’s situation

In order to be non-judgemental, it is often a good idea to acknowledge the difficulty the patient may have with their particular health issue, e.g.

I can see you are finding losing weight very challenging.
It looks like you are having a difficult time coming to terms with your mother’s death.

c) Empathising with the patient

It is also a good idea to empathise with the patient, before giving any advice, e.g.

I imagine that it must seem almost impossible to tackle your drug issues.
I guess it must be overwhelming to deal with your weight problem.

Giving Advice

Now, onto the giving of advice in a sensitive manner. You may find you are using phrases such as:

It would be a good idea to..
It would be helpful, if you could…
It would be useful to think about…..
Would you be willing to try….?

As you can see, these phrases are similar to the phrases used to make suggestions. In contrast, when giving advice, you might say:

You should….(reduce your fat intake, exercise more etc)
You need to…(keep an eye on your weekly alcohol intake)

In the case of sensitive advice, these phrases may appear too harsh at first. Of course, in situations where immediate lifestyle changes need to be made, strong advice may need to be given, e.g. evidence of dangerous drug habits or unsafe exposure to infections. In these cases, you may use phrases such as :

You must…
It is essential that you…
It is vital that you….

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GMC English Language Requirements for European Doctors

June 9, 2016

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The GMC uses the following evidence to demonstrate that a European doctor qualifying from one of the member states of the European Economic Area (with the exception of the UK) has sufficient English language skills to practice safely and effectively in the UK.

Evidence Type 1: Academic IELTS 7.5

Doctors should have an overall score of 7.5 in the academic version of the International English Language Testing System (IELTS) from the last 2 years. As part of this, a doctor must score a minimum of 7.0 in each of the four papers: reading, writing, listening and speaking. These scores must be achieved in one sitting of the test.

This, in practice, is how most overseas doctors demonstrate their knowledge of English. The GMC may accept IELTS test scores that are more than 2 years old if a doctor can show that their English language skills have not deteriorated in that time. They may have worked in a country where English is the first language for example, or they may have taken a postgraduate course of study which has been taught and examined in English.

While IELTS is currently the only test recognised by the GMC, the organisation is open to alternatives in the future which can be shown to be reliable and appropriate tests of a doctor’s English language skills.

Evidence Type 2: A primary medical qualification (PMQ) that has been taught and examined in English.

The GMC requires the PMQ to have been taught and examined in English and to be from the last 2 years. As part of this, at least 75% of the doctor’s clinical interaction, including personal contact with patients, relatives and other healthcare professionals, must have been conducted in English

Where the PMQ is not so recent, then the GMC requires clear evidence that the doctor has extensive experience practising in English over the previous 2 years in a country where English is the first language, to include employer references.

Practice may be clinical, teaching, management or research-based. The GMC will take into account whether this is continuous or periodic, and ensure that the practice uses the knowledge, skills, attitudes and competences gained in a medicine degree and any further study.

Evidence Type 3: an alternative language test for registration with a medical regulatory authority in a country where the first and native language is English

The GMC will explore which test was used and what requirements were met. If the test pass is over 2 years old, then the GMC may ask for evidence that demonstrates the doctor’s experience of practising for the preceding two years, as outlined above in evidence type 2.

Evidence Type 4: An offer of employment from a UK healthcare organisation

The GMC requires written confirmation from the UK healthcare organisation that an offer of employment has been made, and that the healthcare organisation must be a designated body. The GMC may also ask for evidence of a doctor’s English language skills along the lines outlined above in Evidence Types 1, 2 and 3.

As part of this process, the GMC requires the appointing clinician to complete an English language reference form detailing the applicant’s skills in reading, writing, listening and speaking, and how these were assessed during the recruitment process. The appointing clinician must then get confirmation from the Responsible Officer for the employing organisation that they endorse the recruitment processes the employer has in place to ensure that the applicant has the necessary knowledge of English to practise safely in the UK.

Evidence Types, 2,3 and 4 do not apply where a doctor has taken the IELTS test and failed to achieve the scores stated in Evidence Type 1.

For further information

GMC Guidance for European Doctors

GMC Good Medical Practice

Universities not accepted as evidence of English language proficiency – in this case an IELTS score is required

For further study

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