A survey on the english speaking ability of doctors at some hospitals in hcm city reality and recommendations a thesis submitted in partial fulfillment of the requirements for the de

The study sets out to do “a survey on the English speaking ability of doctors at some hospitals in HCMC: reality and recommendations” to identify the difficulties doctors have to encount

A SURVEY ON THE ENGLISH SPEAKING ABILITY OF DOCTORS AT SOME HOSPITALS IN HCM CITY:

REALITY AND RECOMMENDATIONS

A THESIS SUBMITTED IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE DEGREE OF

MASTER OF ARTS (TESOL)

Submitted by: DUONG THANH TRUNG

Supervisor: NGUYEN BICH HANH, MA in TESOL

HO CHI MINH CITY, 2010

A SURVEY ON THE ENGLISH SPEAKING ABILITY OF DOCTORS

AT SOME HOSPITALS IN HO CHI MINH CITY:

REALITY AND RECOMMMENDATIONS

In terms of the statement of requirement for theses in Master’s programs

Issued by the Higher Degree Committee

Ho Chi Minh City, 2010

DUONG THANH TRUNG

degree of Master of TESOL, accept the requirements of the university relating to the retention and use of Master of Theses deposited in the library

In terms of these conditions, I agree that the original of my thesis deposited in the library should be accessible for the purposes of study and research, in accordance with the normal conditions established by the library for the care, loan

or reproduction of theses

Ho Chi Minh City, April 2010

DUONG THANH TRUNG

encouragement and comments during the time of implementing the thesis

I am greatly indebted to all the leaders, teachers and staff members of the TESOL graduate program at the University of Social Sciences and Humanities - HCMC for their dedication and helpful instruction during the course

My sincere thanks to all the doctors at the hospitals who have been willing to respond to the questionnaires, especially to administrators and teachers at the University of Medicine and Pharmacy as well as the ones at hospitals in HCMC They have offered precious information and helpful advice for my study

Last of all, I would like to thank all of my family members, friends and doctors

at the hospitals for their love, encouragement, understanding and support

people nowadays Although the majority of doctors at some hospitals in HCMC have learned English for many years and made a great effort on improving it, but many of them find spoken English very hard to master They still have a long and hazard way to get their target for which many of them desire

The study sets out to do “a survey on the English speaking ability of doctors at some hospitals in HCMC: reality and recommendations” to identify the difficulties doctors have to encounter when they speak English, find out the main factors leading to these difficulties and give some recommendations for improving their English speaking ability

The findings reveal that doctors have to encounter some serious difficulties when speaking English due to poor listening and pronunciation, lack of vocabulary and grammar structures to express ideas The affective factors also play a part, as the data analysis shows that lack of positive attitudes towards English speaking, low motivation and lack of self-study and practice have led to doctors’ poor ability to speak There are some other main factors concerning teachers and/or administrators

at UMP and five hospitals in the survey These factors are teaching methods, few opportunities to communicate, materials and study-aids, facilities, and testing and evaluation is administered, the amount of limit of time to learn English, and heavy work-loads

Based on the findings, the supervisor’s suggestion and the researcher’s experience of learning and teaching English to medical students and doctors, some recommendations are given to administrators, teachers and doctors as learners of English

retrained to cope with the more challenging of tasks: teaching the language for communication with the focus on listening and speaking, and get away from the grammar translation method that still lingerssome institutions As their methods are applied, teaching and learning materials should be improved to fulfill the objectives

of the English courses at UMP Doctors themselves should also be aware of the importance of English speaking ability, and find out some good ways to improve their spoken English

In general, there is no single method or best measure that can help doctors improve their speaking ability immediately The main factors causing the difficulties of doctors when speaking English have identified, the problem of doctors’ inadequate ability to speak English can be solved if there is a close co-operation of the doctors, teachers and administrators, and we must take action at once

TABLE OF CONTENTS

Certificate of originality ii

Retention and use of the thesis iii

Acknowledgements iv

Abstract v

Table of contents vii

List of tables x

List of abbreviations xii

CHAPTER I: INTRODUCTION 1.1 Background to the study 1

1.2 Statement of purpose 3

1.3 Significance of the study 3

1.4 Scope of the study 4

1.5 Organization of the thesis 4

CHAPTER II: LITERATURE REVIEW 2.1 The nature of speaking 6

2.1.1 The importance of speaking 6

2.1.2 What is speaking? 7

2.1.3 Components of speaking ability 8

2.2 Factors affecting learners’ speaking ability 11

2.2.1 Age or maturational constraints 11

2.2.2 Aural medium 12

2.2.3 Socio-cultural factors 13

2.2.4 Affective factors 14

2.3 Other factors 17

2.3.1 Self-study 17

2.3.2 Personal circumstances 18

2.3.3 Language environment 18

2.3.4 Organizational impediments 19

2.3.5 Testing and evaluation .19

2.4 The approach applied in teaching EFL speaking skills .20

2.4.1 The communicative approach 20

2.4.2 Fluency and accuracy 20

2.4.3 The role of teachers and learners 22

2.4.4 The role of teaching and learning materials in CLT 22

2.5 Summary 23

CHAPTER III: METHODOLOGY 3.1 Research questions 24

3.2 Research design 24

3.2.1 Subjects of the study 25

3.2.1.1 Subject selection 25

3.2.1.2 Characteristics of the subjects .26

3.2.2 Instruments 29

3.2.2.1 Questionnaire for the doctors 29

3.2.2.2 Questionnaire for the teachers 30

3.2.3 Administration 31

3.2.4 Data collection procedures 32

3.2.4.1 Data collection from the doctors 32

3.2.4.2 Data collection from the teachers 32

3.3 Summary 32

CHAPTER IV: RESULTS AND DISCUSSION 4.1 Data analysis .34

4.1.1 Analysis of responses to the questionnaire for doctors 34

4.1.2 Analysis of responses to the questionnaire for teachers 52

4.2 Summary .67

CHAPTERV: RECOMMENDATIONS AND CONCLUSION 5.1 Recommendations 68

5.1.1 Recommendations to the doctors 68

5.1.2 Recommendations to the teachers 69

5.1.3 Recommendations to the administrators 70

5.2 Conclusion 73

5.3 Limitation of the study and recommendations for further research .75

BIBLIOGRAPHY 76

APPENDICES 80

APPENDIX 1: Questionnaire for the doctors (English version) 80

APPENDIX 2: Questionnaire for the doctors (Vietnamese version) 84

APPENDIX 3: Questionnaire for the teachers (English version) 88

APPENDIX 4: Questionnaire for the teachers (Vietnamese version) 92

LIST OF TABLES

Table 3.1: The name and location of the hospitals in the survey 25

Table 3.2A: Summary of the doctors subjects’ characteristics 27

Table 3.2B: Summary of the doctors subjects’ characteristics 28

Table 3.3: Summary of the teachers’ characteristics 29

Table 3.4: Summary of the objectives of the questionnaire for doctors 30

Table 3.5: Summary of the objectives of the questionnaire for teachers 31

Table 4.1: Doctor’s motivation in English study 34

Table 4.2: The degrees of the importance of English language skills for doctors 35

Table 4.3A: Doctor’ attitudes towards the English speaking skill 36

Table 4.3B: The English speaking ability of doctors 37

Table 4.4: The ability of doctors’ using the four language skill 38

Table 4.5: Doctors’ frequency of using the language skills for research and work 39

Table 4.6: The degrees of difficulty in learning the language skills 40

Table 4.7: Doctors’ opinions about difficulties in speaking English 41

Table 4.8: The main factors (related to doctors) 44

Table 4.9: The main factors (related to learners and/or teachers) 46

Table 4.10: Doctors’ motivation for learning English 52

Table 4.11A: The importance of listening to doctors .53

Table 4.11B: The importance of speaking to doctors 54

Table 4.11C: The importance of writing to doctors 54

Table 4.11D: The importance of reading to doctors 55

Table 4.11E: Summary of the importance of each language skill 55

Table 4.12: Teachers’ ideas about doctors’ attitudes towards the speaking skill 56

Table 4.13: The ability of teachers’ using the language skills .57

Table 4.14: Teachers’ frequency of using the four language skills 58

Table 4.15: The degrees of difficulties in teaching the language skills 58

Table 4.16: Doctors’ difficulties in speaking English 59

Table 4.17: The main factors (related to doctors) 61

Table 4.18: The main factors (related to learners and/or teachers) .63

H115: People’s Hospital 115 UMP: The University of Medicine and Pharmacy UMH: University Medical Hospital

CHAPTER I:

INTRODUCTION

1.1 Background of the study

In recent years, many new policies in Vietnam have been implemented effectively, so the economy in the country has changed dramatically, especially since Vietnam joined The World Trade Organization This change has a strong impact not only on the development of the economy but also on that of other fields

of life, which offers many opportunities for Vietnamese people to go abroad to study, travel for pleasure, or do business It has also attracted a great number of foreign tourists, businesspersons and investors to Vietnam As a result, the need to learn English, especially spoken English has been sharply increasing in many fields recently

In the field of medicine today, there is an urgent need to exchange experience between doctors of different nationalities to fight global epidemic or find cures for diseases Therefore, doctors not only read materials in English but also often exchange information and experience with colleagues, experts and partners face-to-face communication in English Spoken English is required for the employment in international hospitals, scholarships to foreign countries and workshops, where doctors have to give their presentations and discuss with their foreign colleagues Even when they are in country, they may have to communicate with English speaking clients or patients As the number of English speaking foreigners is on the increase, in these cases a good command of spoken English is strictly required for the doctors to ensure that no misunderstanding can happen If this happens, it may endanger the patients’ health, and even lead to death

Obviously, the ability of speaking English well will open wide horizons for doctors: with the increasing number of international hospitals, medical centers and scholarships, doctors have ample opportunities to work in high standard hospitals,

go abroad to get training courses, or attend overseas workshops and conferences They also have to negotiate with foreign partners on contracts of medical supplies and equipments worth hundreds of thousands of dollars, and any miscommunication can cause serious damage

Needless to say, doctors are highly motivated to study English, especially they want to be able to speak the English language They consider speaking English fluently as “a golden key” to master their major, achieve promotion in their career and succeed in their life However, it is very difficult for them to achieve this target Reality shows that many of them can hardly communicate with foreigners in English in spite of their great effort Another surprising fact is that some of them are intern doctors considered as clever, studious and hard working in the field of medicine They can memorize thousands of words and many grammar rules Yet they cannot speak English well This is, in fact, expected as Davies and Pearse (2000: 82) stated, “Speaking comes naturally to humans, but it is not as simple as it seems.” The difficulty is doubled when people speak a second language

Under such circumstances arise, an urgent need to help doctors get over the difficulties in using spoken English and improve their English speaking ability Therefore, a survey on “the English speaking English ability of doctors at some hospitals in HCMC: Reality and recommendations.” was conducted to find out the difficulties doctors encounter in their work concerning speaking English This survey was carried out at 5 hospitals in HCMC: 1- Cho Ray Hospital; 2- Eyes Hospital; 3- Hogan My Hospital; 4- People’s Hospital 115; 5- University Medical Hospital; and one medical institution - HCMC University of Medicine and Pharmacy

The study hopefully will find out some good ways to help doctors improve their English speaking ability And it is also hoped that the information and data collected from the study are useful feedback for teachers at UMP to change the English curriculum at UMP, administrators and foreign partners who are interested

in training medical students, or retraining doctors at hospitals in HCMC in English can also benefit from the study

1.2 Statement of purpose

Based on the achievements of previous studies as well as the experiences of colleagues, medical experts, and the researcher himself in teaching English to doctors at some hospitals and at the University of Medicine and Pharmacy in HCMC, this study aims:

(1) to identify the difficulties that doctors at some hospitals in HCMC have

to face when they speak English;

(2) to find out the major factors causing such difficulties;

(3) and to offer some recommendations for improving their English speaking ability

1.3 Significance of the study

Today English speaking plays an extremely important part in various fields

in society In medicine, it affects not only the future career of doctors in our modern life but also the whole development of national health services including the healthcare of people However, there has been no study on this issue Therefore, as the first step, this study will give a brief description of doctors’ English speaking ability at the hospitals mentioned above, identify the doctors’ difficulties in speaking English, and find out the major factors causing their difficulties, and give some advice to improve their speaking abilities The findings from the study will help teachers of English, medical administrators and authorities, who are interested

in improving the English speaking ability of doctors in HCMC The information and data collected from the study will help the administrators at HCM hospitals and UMP in HCMC have a better view on this problem so that they can give a good decision on learning and teaching English to medical students and doctors in HCMC Further more, the study will provide essential information and data for

international education organizations or investors who intend to invest capital in setting up medical school facilities in HCMC to train students or retrain doctors, and help them improve English for effective communication Finally, the feedback from the doctors and teachers in the survey will help administrators at UPM improve English curriculums by using quality assurance

1.4 Scope of the study

The study focuses mainly on the main difficulties that doctors have to encounter when speaking English and the major factors of these difficulties This study takes place at leading and well-known hospitals, both private and public ones The findings are based on the survey questionnaires for the doctors involved in the survey; and the other questionnaires for doctors and teachers who have had a great deal of experience in teaching English or specific medical subjects to medical students and doctors in English

1.5 Organization of the study

There are five chapters in the thesis as the following:

Chapter I is the introduction, which provides background to the study, the purposes, significance, the scope and the organization of the study

Chapter II covers the literature review related to the study in terms of theoretical background and previous related researches

Chapter III focuses on research methodology employed in the study including a list of research questions, a brief discussion of how to design this study and a description of the study’s subjects, instruments and data collection procedures

Chapter IV analyses the doctors’ responses to the survey questionnaire, and the semi-structured questionnaire for the teachers Finally provided in this chapter is the discussion of the findings as an answer to the research questions and as a foundation for some recommendations in the next chapter

Chapter V draws a conclusion, and offers some recommendations for improving teaching and learning speaking skills to doctors in particular, and the quality of teaching and learning English at the University of Medicine and Pharmacy as well as other medical universities in HCMC in general Finally, there are two sections at the end of this chapter: limitation of the study and recommendation for further study

CHAPTER II:

LITERATURE REVIEW

In order to provide effective guidance in developing competent speakers of English, Richards and Renandya (2002: 204) suggest it is necessary to examine the factors affecting doctors as adult learners of oral communication, components underlying speaking effectiveness, and specific skills or strategies used in communication

2.1 Nature of speaking 2.1.1 The importance of speaking

In society

Richards and Renandya (2002: 201) says that a large percentage of the world’s language learners study English in order to develop proficiency in speaking because it brings so many benefits to the learners Indeed speaking is used for many different purposes We may conduce it in casual conversation in English, engage in discussion with someone (e.g., to express opinions, to persuade with someone about something, or to clarify information) We also may use the spoken English to describe things, to complain about people’s behavior, to make polite requests, or to entertain people, etc in short, to achieve communicative purpose

According to Kahn (1993: 7, 462 & 495), speaking well can have a dramatic effect on your professional and private life, and being an effective speaker is still one of the best ways of achieving prominence in public life, as well as of influencing others in your private and business life He concludes that the greater your skill in speaking, the greater your chances of success in many aspects of life, from friendship to business dealings

In language learning

Many language researchers provide evidences to prove the importance of speaking, not only in society but also in language learning Nunan (1999: 225) says that when someone asks: ‘Do you know another language?’, they generally mean

‘Can you speak the language?’ Ur (1996: 120) thinks that of all language skills, speaking seems intuitively the most important because people who know a language are referred to as speakers of that language, as if speaking included all other kinds

of knowledge Similarly, Lewis (1999: 156) said, “speaking helps with your writing, reading and listening It turns out that speaking (of course writing) is important for the whole learning process It helps your fluency and it also helps your accuracy.” Additionally, emphasizing language speaking skills’ importance, Burkhart (1998) states that there are many language learners who regard speaking ability as the measure of language They regard speaking as the most important skills they can acquire, and they assess their progress in terms of their accomplishments in spoken communication

In general, “speaking is the vehicle par excellence of social solidarity, of social ranking, of professional advancement and of business It is also a medium through which much language is learnt, and which for many is particularly conducive for learning.” (Bygate, 1987: vii)

2.1.2 What is speaking?

There are many different opinions about what speaking is According to Websber Dictionary (1984: 256), speaking is to utter words, to express thought by words, to utter speech, discourse, to talk, to make mention, to communicate ideas, etc in any matter Richards and Renandya (2002: 210) says speaking is one of the central elements of communication It is a process, which involves two or more people They use language for interaction and transactional purposes It is not the oral expression of written language Moreover, Books and Heath (1999: 7) implies that speaking or speech communication is the process by which information,

meanings, and feelings are shared by the persons through the exchange of verbal and nonverbal messages Bygate (1997: 3) states that there is a difference between knowledge about a language and skill in using it This distinction between knowledge and skill is crucial in teaching speaking Knowledge itself is not enough

It has to be used in action

2.1.3 Components of speaking ability

In order to develop speaking proficiency, Burkhart (1998) proposes that learners and instructors of EFL need to recognize that speaking involves in three areas of knowledge:

1- Mechanics (pronunciation, grammar, and vocabulary): Using the right words

in the right order with the correct pronunciation 2- Functions (transaction and interaction): Knowing when clarity of message is essential (transaction/information exchange) and when precise understanding

is not required (interaction/relationship building) 3- Social and cultural rules and norms (turn taking, rate of speech, length of pauses between speakers, relative roles of participants): Understanding how

to take into account who is speaking to whom, in what circumstances, about what, and for what reason

Many other linguistics researchers have similar ideas about this issue Hymes (cited in Richards and Renandya, 2002: 206) assumes that L2 learners need to know not only the linguistic knowledge but also the culturally acceptable ways of interacting with others in different situations and relationships And Nunan (1999: 226) thinks that it is not adequate that learners possess linguistic competence, which consists of knowledge of how to articulate sounds in a comprehensible manner, of adequate vocabulary and syntax; on the other hand, they need to develop communicative competence

Communicative competence, according to Ellis (2000: 696), is the knowledge users of a language have internalized to enable them to understand and produce messages in language Hymes (1974: 75) defines that communicative competence is what a person “needs to know in order to communicate effectively in culturally significant situations.”

Richards, Platt & Wesber (cited in Numan, 1999: 226) suggest that communicative competence includes the following areas of knowledge:

1- Knowledge of the grammar and vocabulary of the language;

2- Knowledge of rules of speaking (e.g., knowing how to begin and end conversations, knowing what topics can be talked about in different types of speech events, knowing which address forms should be used with different persons one speaks to and in different situations);

3- Knowing how to use and respond to different types of speech acts such as requests, apologies, thanks, and invitations;

4- And knowing how to use language appropriately

Building on Hymes’s theory, Canale & Swain (cited in Brown, 1994: 227) propose that communicative competence is described as a combination of grammatical competence, discourse competence, sociolinguistic competence, and strategic competence, which reflect the use of linguistic system and the functional aspects of communication

Grammatical competence

It includes vocabulary, word formation, sentence formation, pronunciation (of words, intonation, and stress), spelling (basic sounds of letters and syllables) and linguistic semantics In order to convey meaning, Shumin says that EFL learners must have the knowledge of words and sentences: That is, they must understand how words are segmented into various sounds, and how sentences are stressed in particular way Thus, grammatical competence enables speakers to use and

understand English language structures accurately and unhesitatingly, which contributes to their fluency (cited in Richards & Renandya, 2002: 207)

Discourse competence

In addition to grammatical competence, EFL learners must develop discourse competence, which is concerned with inter-sentential relationships It regards to the mastery of how to combine grammatical forms and meanings to achieve a unified spoken or written text in different genres In Brown’s (1994: 228, and 2000: 247) it

is the complement of grammatical competence in many ways; and it is the ability

we have to connect sentences in stretches of discourse and to form a meaningful whole out of a series of utterances While grammatical competence focuses on sentence-level grammar, discourse competence is concerned with inter-sentential relationships

Socio-linguistic competence

Sociolinguistic competence, according to Brown (2000: 247), is “the knowledge of the socio-cultural rules of language and of discourse.” In deed, knowledge of language alone is insufficient for learners to use the target language efficiently and appropriately They must have sociolinguistic competence This type

of competence requires users of the target language to know what is expected socially and culturally “That is, learners must acquire the rules and the norms governing the appropriate timing and realization of speech acts Understanding the sociolinguistic side of language helps learners know what comments are appropriate, how to ask questions during interaction, and how to respond nonverbally according to the purpose of the talk.”(Kang Shumin; cited in Richards

& Renandya, 2002: 207)

Strategic competence

Strategic competence, together with sociolinguistic competence, reflects the functional aspects of communication It is perhaps the most important of all the communicative competence elements Canale and Swain (cited in Brown, 2000:

247, 248) describe strategic competence as the verbal and non-verbal communication strategies that may be called into action either to enhance the effectiveness of communication or to compensate for breakdowns in communication due to performance variables or due to insufficient competence In fact, Brown (1994: 228) concludes strategic competence is the way that learners manipulate language in order to meet communicative goals

To sum up, although there are many different ideas about what components which should be included in a model of communicative competence, it is believed that communicative competence determines learners’ speaking proficiency Therefore, Richards and Renandya (2002: 202) propose that each of the components

of communicative competence should be addressed in a speaking course, and learners and instructors need to know these components in developing speaking ability

2.2 Factors affecting learners’ English speaking ability 2.2.1 Age or maturational constraints

According to Shumin (cited in Richards and Renandya, 2002: 205), age is considered as one of the most commonly cited determinant factors of success or failure in L2 or foreign language learning

Emphasizing on possible effects of aging on learning abilities, Williams (1984: 65) stated that as one ages chronologically, he/she experiences a “critical period”, during which the brain flexible and language learning can occur naturally and easily Since this period ends around puberty, adolescents and adults can no longer call upon these natural learning capacities The result is that language learning becomes an artificial, laborious process

Similarly, Numan (1999: 42) explains that at around puberty, the brain loses its plasticity, the two hemispheres of the brain become much more independent of one another, and the language function is largely established in the left hemisphere

After these neurological changes have taken place, acquiring another language becomes increasingly difficult

Furthermore, Oyama’s study (cited in Richards & Renandya, 2002: 205) shows that many adults fail to reach native-like proficiency in a second language because of a phenomenon called “fossilization”- the permanent cessation of second language development This shows that the aging process itself may affect or limit adult learners’ ability to pronounce the target language fluently with native-like pronunciation Even if they can attain perfect pronunciation in second/foreign language, they will have problems with prosodic features such as intonation, stress, and other phonological nuances, which still cause misunderstandings or lead to communication breakdown

Krashen, Long, and Scarcella (1982; cited in Richards & Renandya, 2002: 205) pointed out “acquirers who begin learning a second language in early childhood through natural exposure achieve higher proficiency than those beginning

as adults.” And Ellis (1992: 484) concluded: “one’s ability to learn a second or foreign language peaks at a young age and then tapers off slowly is generally true for most individuals.”

2.2.2 Aural medium

No one refuses the central role of listening comprehension in the L2 or foreign language acquisition progress Shumin (cited in Richards & Renandya, 2002: 205) affirms that listening plays an extremely important role in the development of speaking abilities Speaking feeds on listening, which precedes it Usually one person speaks, and the other responds through attending by means of the listening process In fact, during interaction, every speaker plays double role – both as a listener and as a speaker If one cannot understand what has been said, one

is certainly unable to respond So, speaking is closely related to or interwoven with listening, which is the basic mechanism through which the rules of language are

internalized If learners are not good at listening, it is obvious that the development

of their speaking abilities is negatively affected

In addition to social aspects, culture plays an instrumental role in shaping speakers’ communicative competence, which is related to the appropriate use of language (e.g., how native speakers make an apology and what kind of form the apology takes) Generally, appropriateness is determined by each speech community In other words, it is determined by the shared social and cultural conventions of a particular group of speakers Therefore, it is essential to recognize different sets of culturally determined rules in communication Just as Brown and Yule [1983:40] say, “a great number of cultural assumptions which would be normally presupposed, and not made explicit by native speakers, may need to be drawn explicitly to the attention of speakers from other cultures.”

Remember that oral communication involves not only a verbal communication system but also a very powerful nonverbal communication system including nonlinguistic elements such as gestures and body language /posture, facial expression, and so on All of these elements may accompany speech or convey messages directly without any accompanying speech Therefore, lack of familiarity with nonverbal communication, EFL learners usually does not know how to pick up nonverbal cues, which often leads to misunderstanding

2.2.4 Affective factors

“The affective side of the learner is probably one of the most influences on the language learning success or failure.” (Oxford, 1990:140) The term ‘affect’ refers to emotion or feeling According to Brown (1994; cited in Richards & Renandya, 2002: 206), the affective factors related to L2 or foreign language learning are emotion, self-esteem, empathy, anxiety, attitude, and motivation, in which motivation and attitude are paid most attention because many studies show that there are a strong relation to success in language learning

Self-esteem

Self-esteem may be high esteem or low esteem According to Brown (2000: 145), a well-accepted definition of self-esteem is as the following: Self-esteem is a personal judgment of worthiness that expressed in the attitudes that individuals hold towards themselves It is a subjective experience that the individual conveys to the other by verbal reports and other overt expressive behavior (Coopersmith,1967: 4

& 5) Brown also claims that no successful cognitive or affective activity could be carried out without some degrees of self-esteem, self-confidence, knowledge of yourself, and belief in your own capabilities for that activity Tarone and Yule (1989: 139) affirm, “There seems to be a consensus that general notion of self-esteem may be a crucial factor in the learner’s ability to overcome occasional setbacks or minor mistakes in the process of learning a second language.”

Anxiety

L2 or foreign language learning is a complex task that is susceptible to human anxiety (Brown, 1994:141), which is associated with feelings of uneasiness, frustration, self-doubt, and apprehension, or worry (cited in Brown, 2000:151) Shumin (cited in Richarchs and Renandya, 2002: 206) says that speaking a foreign language in public, especially in front of native speakers, is often anxiety

provoking Sometimes, extreme anxiety occurs when EFL learners become tied or lost for words in an unexpected situation, which often leads to discouragement and a general sense of failure Unlike children, adults are concerned with how they are judge by others They are very cautious about making errors in what they say, for making errors would be a public display of ignorance, which would be an obvious occasion of “loosing face” in some cultures, as in China Thus, the sensitivity of adult learners to making mistakes, or fear of “losing face”, has been the explanation for their inability to speak English

tongue-However, anxiety can be a positive factor in a certain situation According to Brown (1987), this is the “good” kind of anxiety It is called facilitating anxiety, which can be useful in keeping students alert and on their toes; and the ‘bad’ kind of anxiety is known as debilitating anxiety, which harms the learners’ performance in many ways both indirectly through worry, fear, and self-doubt and directly by reducing participation and creating overt avoidance of using the language

Motivation

According to Harmer (1991: 3), motivation can be considered as some kinds

of ‘internal drive’ that encourages someone to peruse something which they wish to achieve Similarly, Brown (1994: 152) defines that motivation is commonly thought

of as an inner drive, impulse, emotion, or desire that moves one to a particular action More especially, human beings universally have needs or drives that are innate, yet their intensity is environmentally conditioned

Many other studies emphasize on the importance of motivation because it is widely used in every field of life It is considered that motivation is a key to learning a second language and it seems to be the biggest single factor affecting language learners’ success Below is what Brown (1990: 112) admitted about motivation:

“Motivation is probably the most often used catch-all term for explaining the success or failure of virtually any complex task It is easy to figure that success in a

task is due simply to the fact that someone is ‘motivated’ It is easy in second language learning to claim that a learner will be successful with the proper motivation.”

Remember that the majority of adults do not learn for the pleasure of learning Neither the process nor the possession of knowledge is the main motivation for adult learners, participation (Aslanian & Brickell, 1980) Adults are engaged in language learning primarily for being able to apply and use the knowledge Their typical motivations include a requirement for competence, an expected (or realized) promotion, job enrichment (e.g workshops and conferences

in English), a need to maintain old skills or learn new ones, a need to adapt to job changes, or the need to learn in order to comply with company directives

Attitude

Baker (1992: 11) stated that attitude is used to explain the direction and persistence of human behavior Motivation is defined as a construct made up of certain attitudes Finnegan (1994) says that language attitudes can have profound effect on our learners’ abilities to acquire a second language, especially beyond

Second language learners have benefit from positive attitudes, and negative ones may lead to decreased motivation and, in all likelihood, because of decreased input and interaction, to unsuccessful attainment of proficiency Yet it is necessary

to be aware that everyone can have both positive and negative attitudes The negative attitudes can be changed, often by exposure to reality – for example, by

encounters with actual persons from other cultures Negative attitudes usually emerge from one’s indirect exposure to a culture or a group through televisions, movies, new media, books, and other sources that may be less reliable (Brown, 2000: 181), so instructors should remind learners to avoid exposure to such things Briefly it is strongly supported that attitude is everything It means if we change our attitude, we will change our life as Keller [1995] stated in his book – the best seller in the U.S in 1995 A great number of readers have highly appreciated this point of view and applied this point of view to their study, jobs, and daily life successfully This view should be also applied to language learning and teaching thoroughly, and it is certainly that we will achieve the aim – improving the English speaking ability of doctors at hospitals

2.3 Other factors 2.3.1 Self-study

Learners normally receive their formal education at high schools, colleges, or universities have to take two main types of learning: classroom learning and self-study, which is called autonomous learning The former takes place under teachers’ instruction while the latter provides the learners with many opportunities to work independently in their own way and at their own pace In addition to studying at school, most of successful learners have to spend much time on their self-study, because they do not have enough money or time to study everything at school Harmer (1991: 37) also states that we cannot teach students everything, so we have to train them to teach themselves

In reality, many famous learners in Vietnam have successfully applied study in their life Truong Vinh Ky (1837–1899) and Ho Chi Minh (1890–1969) are taken as excellent examples about self-study More recently, mass media in Vietnam (www Tuoi tre Newspaper, dated Sep 17, 2004) informed that Nguyen Quoc Nam Anh at the age of 8 gained 550 marks in the international TOEFL test She has been considered as the youngest Vietnamese learner of English achieving English

self-proficiency as well as a genius of learning English in Vietnam so far To have such achievement, she has to study herself English on the computer at least two hours everyday Generally, a normal person cannot achieve success without their great afford There is an idiom: “No pain, No gain.” that Vietnamese people and other peoples in the world often apply it to teaching the children in their early life This point of view is quite correct not only in our daily life but in teaching and learning languages as well

2.3.2 Personal circumstances

It seems that personal circumstances cannot affect one’s study so much However, they are the factors make many learners get into trouble and cannot follow their ambition in order to change their life In fact, together with age and health, McKay and Tom (1999: 4 & 5) states, other personal circumstances such as accommodation, employment or lack of it, workload, difficulties with childcare or transportation, or concerns about problems at home and at work also take priority; making attendance, punctuality, and concentration difficult for some adult learners as well as teachers

2.3.3 Language environment

Exposure to the target language is called language environment Carroll (cited

in Dalay, 1982: 15) shows that a natural language environment can enhance the development of communication skills in a second or foreign language On contrary, if students are just exposed to a list of words together with a few readings in a new language, they may maintain some improvement in reading skill, but not in listening and speaking skills Similarly, Shumin (cited in Richards & Renandya, 2002: 204) concluded in his survey, “owing to minimal exposure to the target language and contact with native speakers, adult EFL learners in general are relatively poor at spoken English, especially regarding fluency, control of idiomatic expressions and understanding of culture pragmatics Few can achieve native like proficiency in oral communication.”

2.3.4 Organizational impediments

In addition to the roles of teachers and learners, nowadays school facilities and materials (which consist of textbooks, audio-visual aids, slides, computer software and internet) play an extremely crucial role in learning and teaching a foreign language Lack of these things, especially materials - one of the five main components (including learners, teachers, teaching methods, materials and evaluation

in language instruction) can prevent or reduce the effectiveness of learning and teaching

In deed, Brown (1994: 144) affirms that we could have conversations, plays, discussions and blackboard work, but much of the richness of language instruction is derived from supporting materials Allwright (1991) emphasizes that materials help learning and teaching, and even control learning and teaching How can we teach or learn languages without materials? In fact, experienced teachers can teach English without textbooks or other study-aid equipments for a while, but they cannot do it all the time

role-2.3.5 Testing and evaluation

Davies and Pearse (2000:170) state that the two concepts testing and evaluation are expressed the same word in many languages, but the distinction that

is conveyed by the two different words in English is important Evaluation is more general concept than testing We can evaluate teaching, teaching materials, tests as well as learning Furthermore, learning can be evaluated in several different ways, not only with the formal tests that the teachers often give to the learners The evaluation of learning is based on class participation, progress tests, homework, and projects rather than final tests alone Especially, the term “assessment”- one of the aspects of evaluation is often used to evaluate the learners’ progress in language programs, or assess one’s language ability However, Cohen (1994: 29) says that the best way to assess students’ ability in a foreign language or second language is still a master of debate So testing is still the main instrument for evaluation of

learning in most teaching situations It is part of the reality of the classrooms at school or university, so educational administrators and teachers prefer to focus mainly on tests and testing, but not other instruments in order to evaluate learning and teaching as well as materials

In order to succeed in teaching and learning subjects at school, testing can be done in the way that will have positive effect on students’ progress The key to effective study is the realization that testing has a profound effect on what goes on

in the classroom Teachers are motivated to teach and learners have motivated to study materials which will be covered on tests Tests should be given to promote the use of acquisition Oral testing is now considered as the most challenging of all language tests to prepare, administer and earn scores Yet in reality, language testing or examinations usually include only a written test Oral testing is never tested at many schools or universities in spite of requiring all of the four skills in teaching and learning a foreign language Therefore, students and learners start to feel reluctant to spend time on anything that is not in the examination (Sesnan, 1997) Gradually, students ignore their studying and practicing speaking English

As a result, their English speaking ability is so poor If the way of testing, examinations and their purposes are not changed, it is certain that students’ speaking ability is hardly improved

2.4 The approach applied in teaching EFL speaking 2.4.1 Communicative approach

The majority of language teachers pay attention to communicative approach

as the methodology they choose to employ in their speaking classes today Communicative language teaching (CLT) is promoted as an approach to language teaching which supports the development of learners’ ability to use language fluently and meaningfully

2.4.2 Accuracy and fluency Accuracy is the ability to produce correct

sentences using correct grammar and vocabulary Accuracy is relative A child in

early primary is not capable of the same level of accuracy as an adult Teachers who concentrate on accuracy help their learners to produce grammatically correct written and spoken English There are some typical accuracy activities such as grammar

presentations, gap-filling exercises, or frame dialogues

Fluency is the ability to read, write or speak easily, smoothly, and expressively In other words, the speaker can read, understand and respond in a language clearly and concisely while relating meaning and context despite limitations in his or her communicative competence Language teachers who concentrate on fluency help their learners to express themselves in fluent English They can pay more attention to meaning and context, use communication strategies, correct misunderstandings, and work to avoid communication breakdowns They are less concerned with grammatical errors Typical fluency activities that are created in the classroom are role-plays, speeches, communicative activities, or games The differences between fluency activities and accuracy can be summarized

in the table below:

Activities focusing on fluency:

- Reflect natural use of language

- Focus on achieving communication

- Require meaningful use of language

- Require the use of communication strategies

- Produce language that may not be predictable

- Seek to link language use to context

Activities focusing on accuracy:

- Reflect classroom use of language

- Focus mainly on the formation of correct examples of language

- Use practising language out of context

- Practise small samples of language -Donot require meaningful communication

- Choice of language is controlled

To sum up, accuracy and fluency are two factors, which can determine the success of English language students in the future Students learning accuracy without fluency, and vice versa, is one of the biggest threats to successful learning;

and balancing accuracy and fluency should be the aim of any English language teacher

2.4.3 The roles of teachers and learners

According to Breen and Candlin (cited in Richards and Rodgers, 1992: 77), the teacher has two main roles The first one is to facilitate the communication process between all participants and various activities and texts The second one is

to act as an independent participant within the learning-teaching group Meanwhile, the role of the learner as negotiator between self, the learning process, and the object of learning emerges from and interacts with the role of joint negotiator within the group and within the classroom procedures and activities that the group undertakes The implication for the learners is that they should contribute as much

as he gains, and thereby they can learn or practice speaking English in an independent way

2.4.4 The role of teaching and learning materials in CLT

There are so many materials that have been recommended to support communicative approaches to language teaching, namely textbooks, task-based materials, and realia However, materials should be selected carefully According to Richards and Rodgers (1986: 36), the materials in Communicative Language Teaching should focus on the communicative abilities of interpretation, expression, and negotiation They also focus on understandable, relevant, and interesting exchanges of information rather than on the presentation of grammatical forms Moreover, they should include involve in different kinds of texts and different media, which the learners can use to develop their competence through a variety of different activities and tasks

In brief, materials are extremely necessary for teaching and learning a language, particularly the speaking skill It is very hard to teach and learn any language or any language skill without materials because they influence the content,

methods, and procedures of the language instruction and learning Teachers should prepare extra materials, textbooks, and other aid-equipments well in advance

2.5 Summary

Chapter 2 covers an overview of teaching speaking to EFL learners and an analysis of their characteristics Also included in this chapter are prior researches on teaching and learning speaking to EFL learners These researches serve as a theoretical background for the study’s further discussions on the difficulties and the main factors of these facing doctor subjects as well as recommendations for improving the speaking ability of the doctors at the hospitals in HCMC as mentioned in Chapter I

 What difficulties do doctors have to encounter when they speak English? There are also two sub-questions to be addressed as the followings:

 What are the major factors causing their difficulties in English speaking?

 What should be done to improve their English speaking ability?

because there are many types of data that can be gathered by using surveys Survey research can describe, explore, or explain physical characteristics, phenomena, behaviors, attitudes, and so forth The possibilities for doing language survey research seem even greater when we consider that any research that is done today might be usefully be repeated in five or ten years to investigate how people’s ideas, attitudes, opinions, and so forth, have changed overtime Brown (2001: 6) and many other writers also state that survey questionnaires are particularly efficient for gathering data on a large-scale basis and effective for obtaining the views of all the participants Therefore, in this study, group-administered questionnaires are chosen for a large number of doctor subjects (286) at the hospitals and teachers (20) at UMP in HCMC as well as at the hospitals

3.2.1 Subjects of the study

The subjects of the study comprised two groups of subjects: the doctors, and the teachers The survey was carried out from 26 March to 5 May 2010

3.2.1.1 Subject selection Doctors at the hospitals:

Table 3.1: The name of the hospitals and the number of doctors in the survey

The subjects were selected from typical departments (i.e those that often deal with foreign patients and partners) at these hospitals (see Table 3.1) for the study because their workplaces are considered as the leading and well-known hospitals in

No Hospitals’ name The number of doctors (286) Percent (100%)

01 Cho Ray Hospital 82 28.7%

HCMC, where doctors often need to use English, especially spoken English in their work daily than those at other hospitals do

Teachers at UMP

There were 20 teachers from different departments in the University of Medicine and Pharmacy Thirteen teachers of English were in the Department of Foreign languages The others were from other departments at this university These subjects were selected because most of them were experienced teachers of English, and the others who worked as both doctors at hospitals and teachers at this university They taught medical students and doctors specific subjects in English and often dealt with foreign practicing students, doctors, or partners in English

3.2.1.2 Characteristics of the subjects Doctors at the hospitals

Subjects in this group studied English at high school for about 3 or 7 years, and at UMP or other medical universities for appropriately one or two years Many

of them also studied English for one or two terms in postgraduate courses Some of them studied English at other medical institutions (e.g Pham Ngoc Thach University-HCMC, the University of Medicine - Hue city, Can Tho University, etc.) for a few years, and only a few of them had been in English speaking countries such

as USA, Australia, England, etc The summary of the characteristics of the doctor subjects in terms of the personal attributes is showed in Table 3.2 below The data show that there is considerable improvement of English proficiency perceived by the learners themselves

Table 3.2A: Summary of the doctor subjects’ characteristics at the five hospitals

Doctors subjects CRH HEH HMH H115 UMH Total

82 25 42 51 86 286 100% Gender Male 58 09 29 18 57 186 65.5%

Female 24 16 13 33 29 100 35% Age Under 30 05 02 06 04 11 28 11%

30 – 35 13 03 11 14 32 73 28.6%

36 – 45 20 16 16 19 21 92 36.1% Over 45 31 03 09 4 15 62 24.3% Graduated from UMP 59 19 28 33 77 216 77.1%

Others 20 04 14 17 08 63 22.5%

Medical education level

General doctor 14 00 16 16 07 53 18.9% Intern doctor 01 03 01 00 03 08 2.9% Specialist 1 19 05 17 13 21 75 26.8% Specialist 2 18 08 01 02 08 37 13.2% M.S 17 07 05 18 38 85 30.4% Ph.D 11 00 00 02 09 22 7.9%

Table 3.2B: Summary of the doctors’ English levels and speaking ability at the five hospitals in the survey

(NOTE: * at the time doctors entered medical university; ** at the present time)

Doctors subjects CRH HEH HMH H115 UMH Total

82 25 42 51 86 286 100 %

English level Elementary * 38 06 14 20 43 121 45.1 %

** 10 01 06 05 10 32 11.4 % Intermediate * 36 17 20 27 38 138 51.5 %

** 59 20 29 41 65 214 76.2 % Advanced * 02 00 01 01 05 09 3.4 %

** 12 02 06 04 11 35 12.5 % Speaking

ability

Not at all 02 00 01 01 00 04 1.4 % Below average 14 02 10 12 08 46 16.1 % Average 38 09 18 29 41 135 47.9 % Fairly good 24 12 08 07 35 86 30 % Excellent 04 00 04 01 02 11 3.9 % Years of being in English speaking

countries

34 11.9 %