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UDK: 377.112.4
BIRINCHI KURS TALABALARIGA KLINIK LUG‘ATI BILAN O‘RGATISH
ОБУЧЕНИЕ КЛИНИЧЕСКОЙ ЛЕКСИКИ СТУДЕНТОВ ПЕРВОГО КУРСА
TEACHING UNDERGRADUATE STUDENTS CLINICAL VOCABULARY
Sharipova Feruza Ibragimovna
1
1
Sharipova Feruza Ibragimovna
– Tashkent Pediatric Medical Institute, teacher
Abstract
The purpose of the study, described in the article, was to implement and evaluate a method for teaching
undergraduate student to use clinician vocabulary instruction during shared patient’s cards reading. Undergraduate
students enrolled in after semester 2 weeks practicum participated in the study. Prerecorded teaching modules may be
an efficient, effective way to teach specific empirically supported practice to undergraduate student with clinic vocabulary.
Future studies can examine the potential of these types of teaching modules for other outcomes or with groups of
practicing clinic vocabulary.
Аннотация
Целью данного исследования, описанного в статье, было внедрить и оценить метод обучения
студентов первого курса использованию лексики клинициста во время практика, в частности анализа
истории болезни. В исследовании приняли участие студенты бакалавриата, проходящие после первого
учебного семестра 2-недельную практику. В первом этапе исследовании наблюдалось эффективная
реализация словарного запаса большинством студентов-бакалавров. На втором этапе исследовании для
сравнения группа показало низкие результаты усвоения лексики клинициста. Предварительные учебные
модули могут быть эффективным и действенным способом обучения студентов бакалавриата во время
прохождения практики с использованием словаря клинициста. В будущих исследованиях можно изучить
потенциал этих учебных модулей для других результатов или для групп практикующих клиническую лексику.
Abstract
Ushbu tadqiqotning maqsadi bakalavriat talabalariga bemorlar kasallik tarixi birgalikda o‘qish paytida klinik
lug‘atidan foydalanishni o‘rgatish usulini joriy etish va baholash edi. Tadqiqotga semestrdan keyin 2 haftalik amaliyot
o‘tayotgan bakalavriat talabalari jalb etildi 1-tadqiqotda ko‘plab bakalavriat talabalari uchun klinika lug‘atining ta'siri bor
edi. 2-tadqiqotda guruhlarni taqqoslash klinik lug‘atga fikr-mulohazalarning past ta'sirini ko‘rsatdi. Oldindan yozib olingan
o‘quv modullari bakalavriat talabalariga klinik lug‘atdan foydalangan holda maxsus empiric qo‘llab-quvvatlanadigan
amaliyotlarni o‘rgatishning samarali usuli bo‘lishi mumkin. Kelajakdagi tadqiqotlar ushbu o‘quv modullarining boshqa
natijalar yoki klinik lug‘at bo‘yicha amaliyotchilar guruhlari uchun imkoniyatlarini o‘rganishi mumkin.
Key words:
Undergraduate students, clinic vocabulary, evidence-based practice
Ключевые слова:
Студенты младших курсов, клинический словарный запас, доказательная
практика
Kalit so‘zlar:
Birinchi kurs talabalar, klinik lug‘at, dalillarga asoslangan amaliyot
INTRODUCTION
An important challenge facing the discipline of medical sciences and linguistic ones is the
application of research evidence in clinical practice. Substantial efforts have been devoted to
bridging the gap between research and practice, including an emphasis on evidence-based
practice. The clinical practice is a decision-making process that integrates scientific evidence,
clinical expertise, and client preferences
[1]. From the point of view of the medical sphere, the
methods of teaching medical subjects in English and the sequence of the educational process are
determined by achieving harmony with medical science and the exact system of knowledge [2]. For
English learning medical students using practice in English speaking clinics, decisions about
assessment and intervention are informed by evidence from research, as well as by clinical
expertise and an understanding of the wants and needs of individual patient. Practicing students
are aware of and acknowledge the importance of using clinic vocabulary. However, many report
that important barriers, for example, a lack of professional lexicon, prevent them from using clinic
vocabulary in clinical decision making [3]. In addition, learning clinic vocabulary indicated that they
are more likely to make a decision based on previous experiences than on research evidence [4].
Expecting practicing clinic vocabulary to be responsible for incorporating the findings of research
into practice may be insufficient to address the research-to-practice gap. Instead, we need to
identify feasible and effective approaches to increase the use of research evidence in clinical
practice. Perona, K., Plante, E., & Adam, R highlight implementation science as an approach to
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address the gap between what we know from research and what we do in practice. In
implementation science, researchers and practitioners directly examine the specific barriers and
steps necessary to incorporate evidence from research into practice in real-world settings
[5].
Several implementation science models exist to describe and guide implementation research [6]. In
the discipline of medical sciences and linguistics, a growing interest in implementation English
vocabulary has motivated recent special issues in journals
[7]. Implementation science approaches
have been highlighted in the development of phonological awareness interventions
and in the
delivery of caregiver-implemented shared-reading interventions
[8,9].
In the current study, we focused on one component of clinic vocabulary during empirically
supported practices to undergraduate student to increase their use in real-world settings. Here, we
are using the term empirically supported practice to describe an assessment or intervention
approach that has a strong div of research evidence to support its use. We hypothesized that
one way to address the research-to-practice gap would be to teach clinic vocabulary to
undergraduate students. McGregor, K. K., & Duff, D. argue persuasively that student clinicians
need to experience clinic vocabulary (CV) not just in classroom assignments but also in clinical
training, stating that “nothing can replicate the genuine experience and skills of integrating and
applying CV directly in clinical practicum”[10]. Our goal was to teach undergraduate students with
CV during empirically supported practice as part of practicum experiences to lay the foundation for
later clinical practice that is evidence based.
The procedures and design of the current study were informed by findings of a previous
related study
[11]. In the study of Perrona K., 10 undergraduate students enrolled in a clinical
practicum experience were asked to watch three prerecorded teaching modules that taught
empirically supported practices for vocabulary instruction during reading with children.Outcomes
were the use of taught strategies on lesson plans and during video-recorded reading book
sessions. When participants watched teaching modules, moderate increases in the use of taught
strategies were frequently observed. Of the taught strategies, participants were most successful in
implementing taught strategies to select appropriate vocabulary targets. This study also had an
unexpected finding: The majority of the students did not watch the prerecorded modules. Of the
expected 30 viewings, participants watched just 14 teaching modules. This finding was surprising,
given that these were high-achieving, engaged students who were selected to participate in the
clinical practicum experience. In the current project, we made small adjustments to our procedures
to improve engagement with the modules. First, teaching modules were included as part of the
curriculum of the practicum experience, rather than a separate opportunity related to a research
project. This decision was consistent with the goals of the practicum experience; all students,
regardless of enrollment in the research project, were expected to learn for vocabulary instruction
in English speaking clinics.
Second, we used the course management system to track students’ use of the teaching
modules.
METHODS AND MATERIAL
To increase the use of clinic vocabulary during practice by first –year students, high-quality
education and clinical training are necessary. Instructional technology, specifically teaching
modules and patient’s card performance feedback, presents an efficient, low-cost opportunity for
delivery of evidence-based content that is feasible for implementation. Explicit vocabulary
instruction has a strong evidence base and can be readily incorporated into clinical training
experiences. The purpose of the current project was to examine the effects of prerecorded
teaching modules and patient’s card performance feedback on the use of clinical vocabulary during
practice in clinics by first-year students. In Study 1, patient’s card analysis design study was used
to determine if there was a functional relation between prerecorded teaching modules and the
student clinician’s use of clinic vocabulary. In Study 2, an experimental design was used to
determine if patient’s card analysis performance feedback, delivered in conjunction without
prerecorded teaching modules, increased student use of clinic vocabulary.
All study procedures were approved by the university institutional review board.
All students who were enrolled in the clinical practicum were invited to participate in the
research study; no additional inclusionary or exclusionary criteria were applied. Before the
practicum began, the practice tutor and the investigators met with students, explained the purpose
of the study, and obtained consent for participation. All students who were enrolled in the
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practicum chose to participate. On a brief survey, all participants reported about no previous
experiences reading with patients’ cards. About half of the students reported some experience
reading books with clinic vocabulary (e.g., Human Anatomy discipline), and one reported that they
had taught clinic vocabulary. All participants indicated that they had completed some coursework
related to English language.
A number of prerecorded teaching modules were organized for the purposes of this project.
Each instructional module was prerecorded using PowerPoint slides and video links by the
authors, and modules were between 25 and 35 min long. Brief one- to two-page handouts
accompanied each module and included an outline of the module content, practice exercises, and
key take-home messages. Modules and handouts were available via the MOODLE system of the
institute. The teaching modules were developed and refined in an iterative process based on
findings from previous studies and feedback from the students of senior courses. For example, in
previous studies, participants indicated that PPts were helpful so the modules and handouts were
revised to include additional illustrations and tables. In addition, observations of videotaped
sessions indicated that some tutors struggled with keeping first-year students engaged in English
speaking practice in the clinic. Thus, the content of the modules was revised to include simple
strategies to increase student’s engagement.
In the current study, a short, introductory module provided a brief overview of study
procedures and presented general background on the importance of patient’s card analysis. This
module also served as an opportunity to familiarize students with how to access the teaching
modules and the expectation that they would view the entire module. The modules delivered the
instructional content for clinician vocabulary instruction during practice in with analysis of patient’s
cards.
The clinician vocabulary taught in the teaching modules were drawn from an extensive
review and synthesis of the literature conducted for this and other related projects
[13] as well as
for presentations and professional development sessions conducted by the authors.
The modules focused on three topics: Module 1: Conversation with Clinic staff, Module 2:
Doctor and Patient 3: Patient’s Card. The foundation for the content was the model of robust
vocabulary intervention, and research evidence was synthesized to identify empirically supported
practices. In general, these modules were intentional, explicit instructional strategies that
emphasized teaching for depth of understanding. To guide students in selecting words within the
broad category, good choices for vocabulary targets were defined as words that were new, useful,
and could be taught well in the context of patient’s card analysis. For Module 2: Doctor and Patient,
three professionally supported practice was identified: Use a patient-friendly definition, make
connections with the disease and anamnesis, and use examples from the patient’s life. For Module
3: Patient’s Card, the following specific practices were taught: Use active engagement strategies,
give opportunities to analysis the patient’s card and tests, and give other meaningful response
opportunities.
The modules were designed to maximize learning of participants and included information
about the rationale for the practice, detailed procedures, and opportunities for active learning. In
each module, a brief explanation of the rationale for a specific clinician’s vocabulary (i.e., the
“anamnesis”) was followed by detailed procedures for implementing that practice. As an example,
in the last module, the first few minutes provided an overview of the conditions in the clinic to
express vocabulary explicitly. Then, the module explained specific components of clinician’s
vocabulary, including providing a patient-friendly definition, using the context, and sharing an
example relevant to the patient’s life. Each module included opportunities for participants to
engage in active learning. For example, in the first instructional module, Choose Appropriate
Words, the module and accompanying handout guided participants through the process of
selecting vocabulary targets. At each step in the process, participants were given opportunities to
work through the example on the accompanying handout. The clinical practicum took place in
program affiliated with the institute Department of Foreign Languages.
RESULTS
The purpose of the single-case design study was to evaluate the effects of the teaching
modules, with or with- out analysis of patient’s card performance feedback, on use of vocabulary
instruction during English speaking supported practice for by first year students. Using an online
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calculator, data from each participant and each phase of intervention were entered. When an
increasing baseline trend was present, a correction was applied to the calculation. Mean effect
sizes and confidence intervals for each group and condition are provided in Table 1. High
variability in baseline was observed for all participants. However, many participants had a high
degree of overlap between baseline and intervention.
Table 1.
Effect sizes for the single-case design study
Outcomes
Only Modules
Without Modules
Feedback
1 Study
87%
65%
76%
2 Study
48%
58%
54%
Note:
% is a percentage of efficiency on number of participants
DISCUSSION
The purpose of the two studies was to implement and evaluate an approach for teaching
clinician vocabulary during English speaking clinic practice to undergraduate student. All
participants watched prerecorded teaching modules that taught specific empirically supported
strategies for learning vocabulary during analysis of patient’s cards. Half of the participants worked
with performance feedback online. The results of Study 1 provide some evidence of an effect of the
intervention and an increase in use of taught strategies. In each condition, visual analyses
indicated a functional relation for at least three participants, but effects were not consistent across
participants. In Study 2, participants who did not watch teaching modules made errors in their
selection of appropriate vocabulary words or in their use of explicit vocabulary strategies. Patterns
of performance were inconsistent both within and across participants. However, even an
incremental increase in use of empirically supported practices may have important implications for
children’s learning. Particularly for the outcomes of clinician’s vocabulary explicitly and teaching
with interaction, we can noticed an improvement. Participants rarely scored at the top of the range
for either of these outcomes, indicating that undergraduate student were rarely able to use explicit
and interactive learning strategies consistently for clinician’s words in the practice. Student during
practice are likely to need additional support to use strategies proficiently. Additional research that
can inform refinements to efficient and effective ways to teach these practices is necessary.
One important strength of the current study is that we chose to measure how student as
future clinicians could apply new knowledge and skills when working with patients in real-world
settings. As teachers and supervisors, we have frequently experienced that student practicing in
English speaking clinic often have difficulty transferring what they know into what they do. By
measuring what student could do in an authentic, practical setting, the findings of the current study
provide insight into how linguistically supported practice might best be taught to improve clinical
vocabulary.
The second study was that student clinicians did not watch the teaching modules. Changes
to procedures in the current study appeared to address this problem; the course management
system report in the MOODLE platform indicated that not all participants watched all modules. Of
course, this report is not an indication that students were truly engaged with the content. When
instructional technology is incorporated into clinical practicum experiences, careful decisions will
need to be made about ways to promote student engagement.
CONCLUSION
Young B.J. describes the potential of implementation science to address the gap between
what we know from research and what we do in practice[12]. In the current study, we applied an
implementation science frame work to examine a method to learn clinician’s vocabulary to first-
year student during practice in the English-speaking clinic as one approach to bridge that gap.
Findings from this study suggest that prerecorded teaching modules may be an effective way to
teach targeted clinician’s vocabulary to undergraduate student. Analysis of patient’s card feedback
did not appear to provide a substantial advantage for implementation of the learned strategies.
Additional research can examine the use of similar approaches to teach medical vocabulary to
undergraduate students in the English-speaking clinic.
The findings of this study highlight several important directions for future research. One, the
use of instructional technology, specifically teaching modules and feedback in analysis of patient’s
cards, was effective in increasing use of the specifically learned clinician’s vocabulary during
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English speaking clinic practice. Future studies can examine the use of this approach to teach
empirically supported practices in other areas of instruction and intervention. In this study, the
outcome of interest was the use of clinician’s vocabulary by undergraduate students. In future
studies, it would be important to examine the ways in which the use of those practices relates to
English specific purposes learning.
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