Barnett argues that tertiary education is essentially a site where students can develop critical reflection, which may include the freedom to question the very values on which their education is based. He stressed that education should be more than merely the acquisition of a set of skills. There should be space for ‘critique’, ‘understanding’ and ‘values’. He points out that “The practice of medicine and the academic discourse called ‘medicine’ may be about disease and the treatment of patients, but the two discourses are different. The practical discourse is about wrestling pragmatically with all the medical, interpersonal and ethical issues presented by individual patients to busy practitioners lacking most of the desirable resources; the academic discourse is about forming truth claims, hypotheses and theories, and presenting evidence for critical scrutiny by one’s peers.” The study considers in some non-English speaking countries such as Taiwan, if English classroom in medical education can turn into a site for critical relfection and combine the development of language competence and professional values.

In the case of Japan, Taiwan and Korea, for example, medical schools typically offer undergraduate programmes lasting 6 or 7 years. These often consist of General Education and Basic Science courses, followed by pre-clinical training and fianlly clinical training (referred to as clerkships or interships). In preclinical years, it is also considered foremost to develop medical students' competence for 'critique', 'understanding' and 'vaules'.

• Needs Analysis

1. Indiviudal wants.    What do the students want? 
The students in our case study (2008) express an awareness of the importance of English to their studies, and they also express interest in a mixed of general topics and medical topics using literature and film in their language classes.

To respond: in my case study, I suggest that the medical English course be organised  around a series of topics. These may be more general or specific areas in medicine, including opportunities for raising critical cultural awareness

2. Institutional Necessities. What does the he educational programme demand of the students?

      a. need to master a large number of special medical terms in a short time.

      b. develop reading (textbook) skills

      c. practice active participation in class discussion

3. Social agenda: The society expects health professionals to have compassion, empathy and faireness.

To respond: The study consider an intercultural approach to English language teaching in medical settings is well-placed to extend the discourse of pedagogical needs beyond student ‘wants’ and ‘institutional necessities’ towards the abilities that are variously formulated as aspects of cross-cultural or intercultural communicative competence.

Course Design for an English for a  two hour English for Medical Purpose which includes four inputs: techinical languages, visual arts (two images of childbirth) and literature (a poem) and NHS birth plan website (writing a birthplan).

Rationale for using literature and visual images:

The use of literary texts in both language and medical education, and illustrates some ways of using them with medical students, both to improve language skills and address the human issues that health care professionals need to be able to consider. As with literature, the visual domain has long been recognised as a valuable resource in language education (e.g. Goldstein, 2009). Some courses in medical humanities (e.g. Boisaubin and Winkler 2000) use fine arts, both as a point of access and stimulus to encourage observational skills and to encourage discussion of the human issues that are often on vivid display.

Rationale for using NHS website:

The sociology of medicine thus portrays childbirth as a site of struggle and control: who is the prime agent with responsibility for delivering the child – the mother, the midwife or the physician? How is power and authority distributed amongst the participants involved? What, if any, is the role of the father, or other family and friends, at the moment of birth? These issues are indeed lively, and so useful for stimulating debate in intercultural language classes for medical students, where attitudes across cultures, genders and the lay/professional divide can be explored.Current institutional attitudes to birth in Britain are expressed, for example, in the UK National Health Service’s advice to pregnant women, given on the NHS Direct website. Various assumptions and points for negotiation are evident in this advice. Students therefore can compare their own cultural perspectives with British ones, for example.   

Selected class slides

     3. curricular goals can be achieved through this class

•      knowledge of language, e.g. the learner’s knowledge of general and technical vocabulary of women’s health

•      language skills, e.g. the learner’s ability to read (the website), write (birth plan), and speak (discussion) in a range of contexts

•      intercultural savoirs/resources; e.g. the learner’s willingness to reflect critically on his or her own values; to demonstrate curiosity about the other; to identify ethnocentric perspectives

•      Professional values: understand feelings , unpack assumption of childbirth, reflect upon own perspectives through interpretation of visual images

4. A space for literature in medical education.

A questionnaire conducted with 92 first year medical students of General English classes at the same university also showed that through deliberately designed topics, and materials, students were empowered to develop critical cultural awareness. The questionnaire was conducted with a group of 92 1^st year medical student (2012) participating a one-shcool year General English course at the end course. This course was organized around a series of topics using literary works such as short stories, essays related to current issues, or book chapters. It is deliberately designed to aim at developing students’ intercultural competence as well as language competence.  Generally speaking, the majority students prefer literary works such as short stories, and essays of current issues. They thought they have developed an open attitude to different cultures and are able to reflect upon the differences and similarities and generated their own critical opinions.

The qualitative data, which was also the end-of-course open feedback conducted with the same group of students also showed that they have developed some competences, in addition to language ability, related to their future profession.

•      61 out of 81 valid responses indicated thata  language classrooms for medical students integrated with medical humanities, different from traditional language classrooms, provide opportunities to know different cultures, understand different values, promote understanding of human experiences, and mostly critical thinking ability. 

 •      40 Students also responded that their general language ability has improved, and they were able to express their opinions more clearly in both written and spoken form.

English in Medical Education: An Intercultural Approach to Teaching Language and Values (2012)

    http://www.multilingual-matters.com/display.asp?K=9781847697769