Abstract

This study is concerned with the learning of medical terminology by nursing pre-professionals in Taiwan. It aims to investigate the use of learning strategies in relation to medical vocabulary use. The subjects under study included 89 Taiwanese college nursing majors. Participants' mid-term scores and medical terminology learning strategy questionnaire were used to inquire learners' use of learning strategies. The results of this study indicated that students in general prefer to use written repetition, verbal repetition, bilingual dictionary strategies. In addition, the students most proficient in medical terminology used various kinds of strategies more often than the less proficient students. Implications of these and other findings are discussed and suggestions are made regarding the teaching of learning strategies in medical terminology courses.

Key Words

medical terminology, bilingual dictionary strategies, L2 vocabulary learning strategies

 

Introduction

Of interest for the present study is the learning of medical terminology by nursing pre-professionals in Taiwan. We are particularly interested in learners' strategy use in the learning of medical terminology. Medical language is the language employed by doctors and nurses in writing medical records and communicating with each other. Doctors need to learn to read and write medical terminology in L2 to complete hospital admission notes, diagnosis, and orders, which, later on, nurses must read, follow in order to carry out nursing interventions and take care of their patients. For these medical and nursing professionals, their first step to access medical language is to learn medical words.

In Taiwan, nursing pre-professionals are required to take the course "Medical Terminology" to meet the demands of their future jobs. Insofar as the researcher knows, the nursing pre-professionals of the nursing college where the researcher is teaching have to take Medical Terminology course from second to fifth year. Every semester, more than one third of nursing pre-professionals fail their Medical Terminology course. In order to help teachers to overcome the challenge of teaching medical terminology and help nursing pre-professionals learn medical terminology more effectively, the researcher is motivated to explore the learning of medical terminology.

In view of Gylys and Wedding (1983), medical terminology is a specific terminology which is used to achieve the purpose of communication in the health care field efficiently and precisely, such as in writing diagnosis and nurses' notes. Basically, medical terminology has two characteristics. First, except for the one-syllable words, most medical words are made of roots and affixes. The affixes can be classified into prefix and suffix. Any single medical term has at least one root determining its meaning and one or more prefixes or suffixes to change the part of speech or change the meaning of the word.

Teachers generally use this specific word formation to help students deal with these words. But, recognizing the word parts used to build medical terms still seems to be a major obstacle to students' learning medical terms. Moreover, using word parts occasionally has pitfalls in guessing word meaning from context. Schmitt (2000) warned when students use word parts as an initial word-guessing strategy, they must be careful to check the surrounding context to see if their guess makes sense. Haynes and Baker (1993) also found that students sometimes made an incorrect guess about what an unknown word meant in a given text, and then stuck with that erroneous meaning in other context even though the surrounding context made clear it make no sense.

Second, medical vocabulary is an open system with a large number of low-frequency words and newly created words. Teaching and learning all the words seem to be an impossible task. Hence, teaching learners vocabulary learning strategies for inferring the word meanings is more efficient than teaching every vocabulary item encountered. As Nation (1994) suggested, teaching students strategies is especially important when it comes to dealing with low frequency words. Indeed, following Nation, Schmitt also suggested that high-frequency words should probably be taught, whereas learning low-frequency words will require strategies for determining their meaning.

Could learners use appropriate learning strategies based on the characteristics of medical words, such as guessing from context and using word parts when learning medical words? Chamot and Kupper (1989) indicated that high proficiency language learners know how to use appropriate strategies to reach their learning goals. Oxford (1985) asserted that successful learners use a wide range of strategies which are appropriate for their learning tasks. Do high proficiency students use different strategy patterns from those used by low proficiency students as revealed by the above-mentioned studies? To get more insights on the use of learning strategies of successful students, the strategy patterns used by successful and unsuccessful learners are also the focus of attention in the present study.

Research Questions

The primary purpose of this study is to explore the learning of medical terminology by Taiwanese nursing pre-professionals. It focuses on the frequency of use of strategy by nursing pre-professionals in learning medical terminology and to identify the strategies related to success or failure in learning the target. The secondary aim was to describe the strategy use pattern by different proficiency levels.

In brief, this study attempts to seek answers to the following research questions:

1. What are the strategies used most and least frequently by the learners in the study?
2. Which strategies are used most often by the students who are the most proficient in medical terminology?
3. Does the overall medical terminology learning strategy use vary across different proficiency levels?
4. Does the use of six categories of medical terminology learning strategy vary across different proficiency levels?

Literature Review

In order to get more insights on the study of medical words learning strategies, this section will first review two recent studies of L2 vocabulary learning strategies and then studies of individual medical terminology strategies.

Fan (2003) surveyed a sample of 1067 students at 7 institutes in Hong Kong to examine the relationship among frequency of use, perceived usefulness, and actual usefulness of L2 vocabulary learning strategies. The findings of Fan's study indicated that the students used the strategies for reviewing and consolidating their knowledge of known words and perceived them as useful, and that they had a preference for dictionary strategies. The most proficient students depended much more on sources, guessing, dictionary, and known words strategies than the less proficient students. Regarding the discrepancies between frequency of use and perceived usefulness in learning L2 vocabulary, the findings revealed the complexity involved in strategy use. For example, even though students reported using more guessing strategies, they did not perceive these strategies as useful. In contrast, though the students seldom used management strategies, they thought these strategies were useful.

Schmitt (1997) conducted a large-scale study in Japan to assess which vocabulary learning strategies the learners actually used and how helpful they believed these strategies to be. Schmitt found that the learners used more repetition and dictionary strategies and considered them more useful than other strategies. Semantic grouping and imagery strategies were less used and regarded the least useful. There was also some evidence that more advanced learners tended to use more complex and meaning-focus strategies than less advanced learners. Whether these findings are supported by the learning of technical terminology in the field of English For Specific Purposes (ESP) needs to be further explored in related research. This is exactly what the current study is going to do.

A number of studies have sought to examine the effectiveness of some specific strategies for learning medical terminology (Fang, 1985; Troutt, 1987; Dunkle, 1983). Two studies that are relevant to the current study will be reviewed here.

A study by Fang (1985) investigated the success of two medical terminology learning strategies: (1) the analysis of affixes and roots and (2) finding the relationship between sound and script. The strategy 'to analyze affixes and roots' engages learners to analyze word structures. For example, in order to learn the medical term 'endocarditis', the internal inflammation of the heart, learners must learn to analyze this word into endo- (prefix, within), card (root, heart), and -itis (suffix, inflammation). On the other hand, the strategy 'finding the relationship between sound and script' involves attempts to find the relationships between pronunciation and spelling of medical words. Fang's study has provided some initial evidence to suggest that the use of analyzing affixes and roots promotes more medical terminology learning than the method of finding the relationship between sound and script.

Troutt (1987) investigated how method of instruction for college students, keyword versus traditional was related to acquisition and retention of medical terminology in a classroom setting and in individualized learning. Five intact classes containing a total of 120 college students were taught three lessons of medical terminology by one or more of three methods: traditional, keyword in a classroom and key word in individualized learning. The results indicated that the class taught to use the keyword strategy retained significantly more words than the class taught by a traditional method for initial acquisition of medical terminology. However, there was no significant difference between traditional and keyword methods for long-term range retention of medical words at four and eight weeks. No difference was found in medical word scores between a keyword/classroom method versus a keyword/individualized method for either acquisition or retention. This study has provided empirical evidence to present the effectiveness of keyword method for initial acquisition of medical terminology.

Both Fang and Troutt focused on the effectiveness of two strategies, however, two learning strategies alone are not enough for us to get the whole picture of how students learn medical terms more effectively. In order to gain an overall picture of the optimal use of learning strategies for medical terminology learning, studies that deal with all the strategies as a group are a complement to Fang's and Troutt's approaches.

Methodology
Subjects

Subjects in the current study were 89 female nursing majors from two second-year classes at Chang Gung Institute of Technology, Taiwan. Medical terminology is a required subject in this five-year nursing college from second to fifth year, so all of these participants were taking Medical Terminology course. The class met one hour a week.

Instrument

The test for evaluating the subjects' proficiency level in the current study was the Medical Terminology mid-term exam made by nursing teachers in the school. This is a curriculum-specific achievement test, rather than a general proficiency test. There were 50 questions in total in the test. Subjects were required to write medical words on the basis of the English definitions of each test item.

The instrument employed for collecting data on strategy is the medical terminology learning strategies questionnaire developed by the researcher. The categories of medical terminology were based on Schmitt's (1997) taxonomy for studying vocabulary strategies. Subjects were required to answer questions on their strategy use on a five-point Likert scale ranging from 1 ("never or almost never true") to 5 ("always or almost always true of me.") The questionnaire, written monolingually in Chinese, was made of two sections. Section one contained five questions, the purpose of which was to collect such background information as subjects' English proficiency, mid-term score of medical terminology. Section two included 42 items grouped into six categories of medical terminology learning strategies:

I. Discovery strategies

II. Consolidation strategies

The questionnaire was tested and revised following a pilot study conducted on 48 nursing pre-professionals with status similar to the participants in the study.

Survey Procedure

All data were collected after the midterm week of the 2003 spring semester. Before the questionnaire was administered, a brief explanation of the purpose of the study was provided to the subjects. Subjects were advised that responses would not affect their academic grades. Subjects were also told that they had to answer in terms of how well the statement of each item in the questionnaire describes them. The answered questionnaires were collected right after the subjects completed them.

Data Analysis

In order to identify the most and least used strategies, the average mean score for each of the 42 strategies was calculated and rank ordered. Significant variation in mean strategy use across the entire strategies by proficiency (the independent variable) was determined using a one-way analysis variance (ANOVA), as were differences in mean strategy use in the six strategy categories (the dependent variables) as related to the independent variable. A standard post hoc test, the Scheffe, was employed to determine where specific significant differences lay. The probability level of significance for one-way ANOVA is set at .05. After the statistical procedures, the relevant discussion based on the three research questions is presented.

Each subject's responses to the medical terminology test were given scores. A correct answer is assigned 2 points and incorrect answer is given no point. The total possible points were 100. Based on the test scores, subjects were grouped into three proficiency levels. The high-level group refers to those who score higher than 80, and the low-level group refers to those who score lower than 60. Those who score between 80 and 60 belong to the intermediate-level group. Consequently, 36 subjects were defined as high-level learners, 28 intermediate-level ones and 25 low-level ones.

Results

In answering research question one, we look at the strategies used most and least frequently by the learners. Table 1 lists the most and least preferred strategies for all subjects. Results reveal that item 29 (4.34, written repetition) has the highest average frequency, and next is item 28 (4.02, verbal repetition), followed by item 5 (3.84, using bilingual dictionary), item 33 (3.76, vocabulary section in the textbook) and item 32 (3.76, take notes in class). The least preferred strategies are item 9 (1.19, ask teacher for a new sentence including the new medical word), and next is item 34 (1.31, listen to tape of word lists), followed by item 11 (1.36, discover new meaning from group activity), item 35 (1.43, put medical words on physical objects), item 8 (1.52, ask teacher for synonym of new medical word).

Table 2 indicates that the most preferred strategies for high-level learners are item 33 (4.53, vocabulary section in the textbook), item 32 (4.42, take notes in class), item 5 (4.25, bilingual dictionary), item 28 (4.19, verbal repetition), and item 29 (4.07, written repetition). The least preferred strategies are item 13 (1.17, interact with foreign medical staff), item 9 (1.17, ask teacher for a sentence including the new medical word), item 11(1.28, discover new meaning from group activity), item 34 (1.31, listen to tape of word lists), and item 35 (1.36, put medical words on physical objects).

The most preferred strategy for low-level learners are, as shown in Table 3, item 29 (4.04, written repetition), item 28 (3.76, verbal repetition), item 10 (3.60, ask classmates for meaning), item 4 (3.28, guess from textual context); and item 5 (3.28, bilingual dictionary). The least preferred strategies are item 13 (1.12, interact with foreign medical staff), item 9 (1.16, ask teacher for a sentence including the new medical word), item 34 (1.40, listen to tape of word lists), item 20 (1.52, use new word in sentences), item 35 (1.52, put medical words on physical objects).

In answering research question three, we looked at nursing pre-professionals' overall strategy use. Participants recorded an overall strategy use mean of 2.59. Thus, strategies are "sometimes used" by all participants. Additionally, the means of strategy use increase according to proficiency levels (means were 2.34, 2.50 and 2.83). Overall strategy use, according to the ANOVA results in Table 4, varied significantly (F = 8.65, p < .05) across different proficiency levels. The post-hoc Scheffe test showed no significant difference for overall strategy use between intermediate and low levels, but significant differences did occur between high and each of intermediate and low levels. Although variation by proficiency was significant, all means fell between 2.5 and 2.8, the range which Oxford (1990) defines as medium use.

A summary of the ANOVA results for the six categories is shown in Table 5. According to Table 5, proficiency level had a positive significant effect for the determination, memory, cognitive and metacognitive categories (all representing positive variation, i.e., more use by more successful students). With the determination and metacognitive strategy groups, the post hoc Scheffe test indicated low-level students (means were 2.64 and 2.12) used these strategies significantly less often than intermediate (means were 2.82 and 2.15) and high-level students (means were 3.11 and 2.87) did, but there were no significant differences in levels of use at the intermediate and high levels. With the memory group, the Scheffe test revealed significantly greater strategy use by the high-level students (mean 2.98) than by the intermediate and low groups (means were 2.54 and 2.32 respectively). With the cognitive group, high-level students (mean 3.22) used strategies significantly more frequently than both the intermediate (mean 2.95) and low students (mean 2.65) did.

Discussion

This section will discuss the medical terminology learning strategies of Taiwanese nursing pre-professionals, the strategies found to used most often and least often by the nursing students who were most proficient in medical terminology.

In the present study, results indicate that there are major differences in patterns of strategy use among students of different proficiency levels. High-level learners are better at gaining knowledge of a new word; they remember more effectively; they control and evaluate their own vocabulary learning better than low-level learners. However, neither the high-level learners nor the low-level learners are good at employing social strategies to discover new meanings and learn vocabulary. These social strategies involve asking for clarification or verification, cooperating with peers, and interacting with native speakers of the target language. Since teacher-centered approach is employed by most of the Taiwanese teachers, students rarely have chances to discuss and cooperate with peers. Moreover, very few students have courage to ask questions in class. This behavior might be influenced by the Chinese educational system. Furthermore, in an EFL context like Taiwan, few chances are available for students to interact with native speakers or foreign medical staff.

When strategies used by high-level learners are compared to those by low-level learners, it is found that written repetition and verbal repetition were the most and the second most popular strategies among both high-level and low-level learners. This finding is consistent with Schmitt (1997), which showed that repetition of a word's verbal or written form was used frequently in Japan. This can be attributable to the learning style encouraged by the Asian school system. Asian students are commonly required to memorize vocabulary and grammar through repetition.

Compared to Japanese, Chinese are more likely to use modeling and repetition as a means of studying particular skills. The practice of memorization is usually applied in the Chinese classroom so as to help students develop particular language skills through modeling and repetition (Sheridan, 1981). The practice of memorization is also linked to the Confucian tradition of reverence for authority. Thus, the strong preference for the bilingual dictionary can, at least partially, be attributable to Confucian tradition of reverence for authority as well. When students encounter questions or difficulties, they would look up dictionary to find the answer instead of resorting to the authority, represented by their teachers.

Not surprisingly, 'interact with foreign medical staff or native speakers' is relatively unused by both high-level and low-level learners. English is studied as one of many foreign languages and serves little communicative function for students once they finish the actual course in Taiwan. For most students, their non-native English speaking teachers are their main source of English input. The use of English for any purpose outside the classroom is minimal and of short duration. Hence, very few students use English on a regular and long-term basis to establish social contacts with native speakers.

The lack of use of item 9 (ask teacher for a sentence including the word) by the subjects has also been influenced by their educational system and cultural background. As stated previously, in the Chinese-learning context, Chinese students are expected to listen to adults, not interrupt, sit quietly and listen attentively. As a result, they are reluctant to speak in the classroom even when invited to make comments or ask questions. Thus, when encountering a new word, they would just listen attentively to teachers rather than ask teachers for synonym and making new sentences. Many students believe that if they ask questions in class, there is a high risk of resembling a fool. Some would reflect carefully before participating, in order to be sure their point is valid and useful. Others would rather ask after class in order to minimize the loss of face if the questions seem foolish-their class will not hear them if they ask alone (Scarcella, 1990).

In light of the findings of Yang and Su's study (2003), the main difficulty nursing pre-professionals encountered in speaking is their poor pronunciation. Nonetheless, to the knowledge of the researcher, none of the textbook used in Medical Terminology course in the researcher's school has included an audiotape on which word lists had been recorded to improve pronunciation and aural understanding of the words. Even though nursing pre-professionals have problems pronouncing these medical words, they are not able to find any single tape useful for solving their problems. Obviously, this could explain why item 34 (listen to tape of word lists) is one of the least used strategies by all nursing pre-professionals.

Since the advantages of group work for language learning are not widely recognized, teacher-fronted teaching is still the main focus of classroom of Taiwn. Some teachers are afraid of group work. They feel that they will lose control of the class; they can not monitor all groups at once and students' errors will be reinforced in small groups. Naturally, for teachers who prefer teacher-centered approach, learning medical words is treated as an activity best achieved individually. The low usage of item 11 (discover new meaning from group activity) could be attributed to this factor.

Conclusion

The study sought to provide valuable information concerning the strategy use of Taiwanese nursing pre-professionals when learning medical terminology and to explore what kind of relationship exists between strategy use and proficiency in medical terminology. Findings of the study revealed that nursing pre-professionals in general prefer to use written repetition, verbal repetition, bilingual dictionary strategies. In contrast, asking teacher for a new sentence including the new medical word, listening to tape of word list, and discovering new meaning from group activity are the strategies least used by learners. Like previous researchers, we found significantly greater overall use of learning strategies among more successful learners and significant differences by proficiency level in students' use of four strategy categories: determination, memory, cognitive and metacognitive. However, neither the high-level learners nor the low-level learners are good at employing social strategies to discover new meanings.

Pedagogical Implications

According to the results of the present study, high-level learners appear to use learning strategies more frequently than low-level learners. Investigating Chinese EFL learners' learning strategies of oral communication, Huang & Van Naerssen (1985) also found that distinguished successful learners were more willing to take risks for employing strategies and practicing strategies than less successful learners were. Learning strategies can be taught as found by some studies (Cohen & Aphek, 1980; O'Malley, Chamot, Stewner-Manzanaraes, Russo, & Kupper, 1985). Here are some tips that teachers have to know when teaching learning strategies. First, awareness of strategy use should be raised. To help students cultivate their awareness of language learning strategies, teachers may introduce them to the wide range of alternative strategies, help students understand their own current strategies, and assist them to find out the circumstances under which a given strategy can be applied effectively.

Second, it is important for teachers to recognize that some strategies may be more suitable to some learners than to others because of individual differences in strategy choice. If language teachers have a better idea of students' preference of strategy choices, they may teach students to choose some strategies which are more effective for students. Third, Schmitt's (1997) findings suggest that learners naturally mature into using different strategies at different times of their life, so it seems reasonable to introduce them to a variety of strategies and let learners decide which ones are right for them.

Ellis(1994) stated the beneficial effect of strategies may be relative to the kinds of tasks that strategies are deployed in. Effective strategy use may consist of the flexible deployment of the right strategies in the right task. Fourth, therefore, teachers may introduce the learning strategies and demonstrate how to take appropriate strategies to meet students' needs in different learning tasks. Finally, these learning strategies should be practiced in different learning tasks. Only through numerous practices will help students become more familiar with these learning strategies.

Limitations and Future Research Directions

The limitations of the present study are essentially about the recruitment of subjects. First, all the subjects come from the same nursing college. The findings would be more useful if we recruited more students from different nursing college in Taiwan. We need to know the extent to which the specific patterns of strategy use would occur in other nursing college and other cultural settings. Second, also worthy of further investigation is the relationship of year of learning to the choice of individual strategies and combination of strategies. Owing to the unique semester system of the school where the research was conducted, nursing pre-professionals of different year level were not all available at the time of research conducted. To get a whole picture of the trends of nursing pre-professionals' strategy use, nursing pre-professionals with different years of studying medical terminology should be included in the future study.

References

Chamot, A. U. & Kupper, L. (1989). Learning strategies in foreign language instruction. Foreign Language Annals, 22(1), 13-24.

Cohen, A., & Aphek, E. (1980). Retention of second language vocabulary over time: investigating the role of mnemonic association. System, 8, 221-235.

Dunkle, S. (1983). A comparison of medical terminology exam scores of students studying by computer with students studying by slide-tape. ERIC Document. No. ED244825.

Ellis, R. (1994). The study of second language acquisition. New York: Oxford University Press.

Fan (2003). Frequency of use, perceived usefulness, and actual usefulness of second language vocabulary strategies: A study of Hong Kong learners. The Modern Language Journal, 87(2), 222-241.

Fang, F. S. (1985). The investigation and evaluation of the teaching methods on medical terminology. Paper presented at the Second National Conference on TESOL, Taipei, Taiwan, R.O.C.

Gylys, B. A., & Wedding, M. E. (1983). Medical terminology. New York: F.A. Davis Co.

Haynes, M., & Baker, I. (1993). American and Chinese readers learning from lexical familarization in English text. In T. Huckin, M. Haynes, & J. Coady (Eds.), Second language reading and vocabulary learning (pp.130-52). Norwood, N. J.: Ablex Publishing Corporation.

Huang, X., & Van Naerssen, M. (1985). Learning strategies for oral communication. Applied Linguistics, 6, 287-303.

Nation, I. S. P. (1994). The word on words: A interview with Paul Nation. The Language Teacher 19(2), 5-7.

O'Malley, J., Chamot, A., Stewner-Manzanaraes, G., Russo, R., & Kupper, L. (1985). Learning strategies application with students of English as a second language. TESOL Quarterly, 19, 285-296.

Oxford, R.L. (1985). A new taxonomy for second language learning strategies. Washington, DC. ERIC Clearinghouse on Language and Linguistics.

Oxford, R. L. (1990). Language learning strategies: What every teacher should know. Boston: Newbury House.

Scarcella, R. (1990). Teaching language minority students in the multicultural classroom. Englewood Cliffs, NJ: Prentice-Hall/Regents.

Schmitt, N. (1997). Vocabulary learning strategies. In N. Schmitt, & M. McCarthy (Eds.), Vocabulary: Description, acquisition and pedagogy (pp. 199-227). New York: Cambridge University Press.

Schmitt, N. (2000). Vocabulary in language teaching. Cambridge, England: Cambridge University Press.

Sheridan, E. M. (1981). Literacy and language reform in the People's Republic of China. Reading Teacher, 20, 804-808.

Troutt, E. D. (1986). Evaluation of the keyword mnemonic method for acquisition and retention of medical terminology. Unpublished Ph D. dissertation, University of Southern Illinois University at Carbondale.

Yang, M. N., & Su, S. M.(2003). A study of Taiwanese nursing students' and
in-service nursing professionals' English needs. Journal of Chang Gung
Institute of Technology, 2, 269-284.