Book chapter on student agency in medical ESP due out December

I have a chapter coming out in Theorizing and Analyzing Agency in Second Language Learning: Interdisciplinary Approaches, edited by Ping Deters, Xuesong Gao, Elizabeth R. Miller, and Gergana Vitanova titled ‘Critical Discourse Analysis in a Medical English Course: Examining Learner Agency through Student Written Reflections’. I’ve shared my abstract for the chapter on my page, but here I wanted to talk in a less formal way about what I was trying to accomplish with writing the chapter.

When I started as Associate Professor at the University of Toyama October 2011, one of the classes I was looking forward to teaching was the Medical English class for third year students majoring in medicine. While I enjoy teaching all levels of students and appreciate the opportunity to work across three different degree programs, the Medical English students are on track to become medical doctors, which means I can use more challenging material with them. After more than ten years of teaching in Japan, I felt I was relatively comfortable with how to go about teaching my other classes, and believed that this course in particular would have the potential to challenge me as a teacher.

And challenge me it did. The first semester was a total disaster, for a variety of reasons, but most of all because it was my first time teaching the class, and since I didn’t know what was in store for me going into it, I decided to follow the class plan my predecessor had used, which was a presentation syllabus, where the students’ work culminated at the end of the course in presenting some medical topic of interest to them. Unfortunately, by the end of our time together, no one appeared happy with how the class had went, including me. And I was faced with the dilemma that I was going to have some of the same students to teach again in the following spring semester.

So I knew I needed to come up with something that would wow these already unhappy students and which I would be able to apply successfully in my future classes. Going over what had gone wrong, and trying to think around the factors that had been out of my control, I decided that part of the problem was I had expected too much, too soon, from the students, and that given the freedom to excel many had decided to take that opportunity to underachieve. This isn’t a particularly uncommon problem in classrooms in general, and is certainly a phenomenon I’m used to encountering in Japanese English classrooms.

Thus what I needed was to narrow the scope of what I was teaching, and narrow the aim of the tasks I was asking my students to complete, so that there were clearer markers of success, and so my expectations regarding for their work were clearer. But more than that, I needed a lever with which to pry away their expectations based on their negative experience of our previous course and its failures so that I could get their attention early and make sure that our second course together didn’t fail before it had even started. I concluded that meant I needed to teach something I know better than them, so that I could act as the expert in that subject area in order to rebuild some of the respect lost in their experience of my first class. I also needed some external validation of my abilities as a teacher, someone to show them that I really am competent at what I do.

Thankfully, that particular year my father was visiting Japan. Since he’s an oral surgeon, he came with some of his models and slides (as in real slides from before the age of PowerPoint and digital projectors) and gave a presentation about the different kind of surgeries oral surgeons do, and the lifestyle benefits these have for patients. This earned me some points with the students by association, especially because they happened to be taking an oral surgery intensive course at the same time, and so what my father said reinforced what they were learning in another lesson. I also invited a former student from Nagano Chuo Hospital, where I had taught an English class for doctors once a week for a few years. He gave a presentation in English that he had presented as a poster at an international conference. Dr. Kojima started by telling the students what a good teacher I was, which gained me some more credibility in their eyes. I didn’t even ask him to say that, so it was a bit of a magical moment for me. He talked about Endoscopy, his speciality, and it was obvious that the students were impressed I understood the content of his presentation better than they did. It helped that I had given him feedback on his presentation and edited his slides several years before, but they didn’t need to know that part.

Nevertheless, while these two presentations won me some points with my students, I still had to teach the rest of the course, and so I needed something that  I could teach. I decided that since I’m trained in language and analysis of conversation and discourse, that I would play to my strengths, so I went to the literature on doctor patient discourse looking for papers that highlighted some issues in medical communication that I could take advantage of in my class. Thankfully I found three papers that I was particularly happy with, as they had actual extracts of conversations which I could use in the classroom, and so I got the students to go through the process of analyzing discourse from the bottom up, starting them with the text extracts from the papers, and asking them what was going on in the conversations. Then we could go to the published papers from which the extracts were pulled and consider what the authors had to say about them.

That course wowed the students, and so when I had the new fall group that same year, I refined what I had done a bit, but was happy with the template I had established. I wrote about the evolution of the course to this point in more academic language for the IATEFL ESP SIG Journal, Professional and Academic English. If you’re interested, you can download the PDF from

The course assignments included in-class work and reflective reports students were expected to write for homework, and it was those reflective reports I turned to in order to examine how successful my students thought the classes were. While the majority of the reports showed that the students ‘got it’ in the sense that they were thinking critically about the language used between the doctors and patients in the examples I was sharing in class, there were a small minority of students who appeared to have trouble with the course contents as I looked at their reports. They seemed to be missing the point of the course, or bringing their own expectations of what the class should be with them, and so their expectations appeared to cloud what we were actually covering and discussing.

I wanted to unpack those outlier reflections a bit more and examine what was going on with those students, and I thought a chapter in Theorizing and Analyzing Agency in Second Language Learning would be an excellent space in which to do that. So my chapter uses ‘critical incidents’ as theoretical lens through which to examine how those students reacted and adapted to the course as it unfolded. Looking in more detail at what some selected students had written was very encouraging—it appeared that even with students who struggled at first, there was some learning going on, although perhaps not as much as with the more successful students, but I’ll take some evidence for learning over no evidence any day.

Looking forward, I can see a bigger project would be to examine all of the students’ writing, using some coding schema, but that will have to wait until I’ve finished my PhD, so for now I’ll have to be content with what I’ve found from this smaller scale investigation of students who appeared to have problems in the course.