Evaluation of an ESP Medical Textbook: Instructors and Learners’ Perceptions in Focus

Evaluation is basically a matching process, which concerns matching learners’ needs to available solutions. Through analysis and assessment of ESP textbooks, a much more promising and desirable approach to a theory of ESP takes place. To this aim, the purpose of the present study was to evaluate the ESP medical textbook. To gather the necessary data, two researcher-made questionnaires and one interview protocol were used. Medical instructors and learners answered to a 30-item questionnaire to express their attitudes towards different aspects of their ESP textbook. Besides, some members of both groups participated in the interviews to gain in depth information about the study. They were both male and female. The findings revealed that instructors and learners had positive attitudes towards the content part of their ESP textbook. In addition, the findings revealed that there is a significant difference between the instructors’ and learners’ attitudes concerning the ESP textbook. The results of this study have a number of implications for medical instructors, learners, and syllabus designers.


Introduction
English is an international language and its importance causes people to use it around of the world.Teaching the English language is one of the matters that are in the process of developing.One of the most important uses of English in current years has been teaching English for specific purposes.
Based on Dudley-Evans (1998) ESP is an approach to language teaching placed in a meaningful situation.According to Hutchinson and Waters (1987), ESP is an approach in language teaching in which all decisions as to content and method is made on the learners' reasons to learning language.
Based on Dudley-Evans and St. John (1998), in which English consider as a foreign language not a second language, the main and the only source of English is ESP classroom.In ESP course, materials play an important role in confronting learners with language.In our country, Iran, the main source for the learners to gain input is their textbooks and language practices of the classroom.In fact, textbooks are the determiners of the content and nature of the procedure of learning and teaching of the course.A beneficial guidance of the trend of an educational course, and what to teach in the course, and the expectation of that course, is textbook.According to Riazi (2003), in a second or foreign language context, after teachers, textbook is the prominent factor.
The language of the most of the educational textbook notably in medicine or engineering in foreign language country such as in Iran is English.Therefore, the universities of these countries in their curriculums have the ESP course as an essential course.Although, nowadays the ESP course is one of the most important courses, and becomes more practical these days, this course is confined to just learning some vocabularies, language functions, grammatical points or translating texts.In this procedure, enough attention is not paid to the personal concerns and interests of the learners and their needs so, it often causes foreign language learners to have low motivation and as a result, their performances in using English in their future jobs decrease.role in learning another language as well as it has an effect on success or failure of the learners (Finch, 2008;Zainol-Abidin et al., 2012).In some countries such as Iran, more attention must be paid to the needs of the learners and some strategies for making positive attitudes in them concerning language learning.In all of the Universities of the Iran English language is taught to learners as one of the obligatory course.Because most of the learners feel that this course of the study is unrelated to their future occupation, they become uninterested and unmotivated to learn English language (Sayadian & Lashkarian, 2010).

ESP
Although, there are numerous definitions of ESP, all of them show the emphasis on how ESP teaching expands procedures, which is good for learners whose main objective is learning English for a goal instead of just learning another language.That goal may be educational, or professional, and ESP requests to rationalize how well it makes learners ready to obtain the required goals.When having a part of ELT, ESP has made its own procedures, its own materials, and its own teaching methodology (Dudley-Evans & St. John, 1998).
Similarly, "ESP is an approach to language teaching in which all decision as to (the) content and method are based on the learner's reason for learning" (Hutchinson & Waters, 1987, p. 19).ESP is English language teaching that is prepared to meet the specified demands of a learner (Strevens, 1988)."ESP students are usually adults who already have some acquaintance with English and are learning the language in order to communicate a set of professional skills and to perform particular job-related functions" (Lorenzo, 2005).

Attitude
Attitudes are one of the several elements of affective variables of learning a second language (Skehan, 1989;Gardner & MacIntyre, 1993).However, this idea is an abstract one and it is meant that it is not an easy task to gain a solid decision about what is meant by this affective variable (Ellis, 1985).
An important role in teachers' classroom practices and professional growth is language teachers' belief and understanding of teaching and learning.Teachers decide about classroom instruction with the consideration of theoretical beliefs they have about teaching and learning.Teachers' goals, procedures, materials, classroom interaction patterns, their role, their students, and the schools they work in all are affected by teachers' beliefs (Harste & Burke, 1977).Likewise, Richards and Rodgers (2001) asserted that teachers hold positions and assumptions about language and language learning, and that these prepare the basis for a specific approach to language instruction.Therefore, it is indicated that if theoretical orientation is a main component and determinant of how teachers act during language instruction, then teacher educators are able to influence classroom practices by making sure that the teacher expands a theoretical orientation that is "reflective of current and pertinent research in the field" (Cummins, Cheek, & Lindsey, 2004, p. 183).

Related Study
In Iranian context, the attitude of EFL teachers and learners of medical science was examined.To do this research 175 medical students and 25 EFL instructors were chosen from four medical universities (Zanjan University, Tehran Islamic-Azad University Shahid-Beheshti University, and Tehran University).The instruments for data collection were a questionnaire and interview.The results reflected that there is not any difference between teachers and learners' attitudes about their ESP course book.Nevertheless, there are significance differences between their attitudes about their understanding of the six aspects of their book.
In another study in Iranian context done by Arani (2004), the language learning requirements of medical students at Kashan University of Medical Sciences were examined.Determining the attitude of learners about learning English as a school subject i.e. prior entering the university was the most important objective of this study.The research sample of this study was 45 medical students who registered in the first and second year of study.To collect the data, diverse kinds of questionnaires were given to the sample at the beginning, in the middle and at the end of the English for Medical Purposes (EMP) courses.The outcomes indicated that most of the subjects had positive attitudes towards both learning English and the English language teacher.Baleghizadeh and Rahimi (2011) indicated that the systematic evaluation of textbooks is not often conducted and students' requirements and opinions concerning the materials developed for them are neglected in Iran.Likewise, Eslami-Rasekh (2010) pointed out that ESP textbooks developed for the students of engineering by the Ministry of Higher Education in Iran is not born out of any systematic needs analysis.In another study done by Amirian and Tavakoli (2009), they assessed and evaluated the elements of ESP textbooks for engineering students.They reported that ESP courses have been useful and successful in making background knowledge on terminology and reading proficiency of that specific field in the minds of future engineers.Finally, in an evaluation of the academic language requirements of computer science engineering students according to English for Specific Academic Purposes (ESAP) programs, Atai (2008) understood that written skills and language elements are of high value to learners.He found that the students had some problems with skills of reading, writing, speaking, and listening.

Objectives and Significance of the Study
Designing a course on the administrators' beliefs and interests or the instructors' perceived needs would not be a realistic approach in designing a course.Learners' needs requirements and interests should be taken into consideration in designing a course.Providing such a course, require a careful needs analysis of the learners under consideration.Such an analysis of the needs make the instructors more aware of the learners' needs and help design a more effective and efficient language course.Because English is a very important part of the future job of the medical learners, this course of their education have a great effect on their future academic and professional progress.
This study intended to examine the medical instructors' and learners' attitudes towards the content of ESP course book.In addition, comparing the differences between the instructors' and learners' attitudes towards the ESP textbook.

Research Questions
More specifically, this study sought to answer the following research questions:

•
What is the attitude of Iranians medical instructors and learners towards the content of their ESP course book?
• Are there any significant differences between the attitude of Iranians medical instructors and learners towards the ESP course book?

Participants
To conduct the study, 3 Iranian EFL instructors who were teaching medicine and had MA and PhD degree in English were selected.In addition, the total number of students participating in this study was 86.They were freshman and sophomore learners of medicine science who were selected randomly participating in an ESP course in two universities.Both male and female learners and instructors participated in this study.It was assumed that these groups were aware of the English learning needs of medicine because they were completely familiar with the present status of ESP course in their field of study and had some knowledge about their lacks and wants towards their ESP course book.Especially instructors with their experiences were familiar with this ESP course book and knew its needs.
A notable point about these 86 students is that all of them were in the age range of 18 to 30.It is worth mentioning that common to all of these participants is the minimum four years of exposure to EFL instruction at high school and pre-university level.Besides, before coming to the university most of the medical learners passed an English course and to some extent, they were familiar with the English language.It was so helpful for them.

Instruments
This study was conducted to identify the attitudes of medical learners and instructors towards the ESP textbook and its content.To achieve this objectives, two research tools were used namely, questionnaires and interviews.

Questionnaire
The main instrument for data collection in this study was a questionnaire.Two questionnaires, one from instructors, and one from learners collected the qualitative data.These questionnaires adopted from some questionnaires, which are related to this topic and then modified by the researcher.Based on the research topic some questions that related to the research added to the questionnaire by the researcher.Those checklists which were used in designing the questionnaire including checklists of Litz (2005), Littlejohn (1998), Ur (1996), Cunnigsworth (1995), Eskey andGrabe (1988), andSheldon (1988).Common features of these checklists were selected.These two questionnaires with the reliability index of 0.78, obtained through Alpha Cronbach aimed at eliciting the instructors' and learners attitudes towards the content, topics, and exercises of the ESP textbook.
The first part of the learners and instructors' questionnaire named demographic information.The second part of the their questionnaire included phrases to obtain some information about the different aspects of the Medical ESP textbook such as content and exercises, topics, skills and strategies, teaching and learning methodologies, and there were some other items about their general attitudes towards the ESP book.In addition, instructors' questionnaire had a part including some questions about the functional and grammatical parts of the textbook.All of the items in these parts were designed on a five-point Likert scale of frequency, in which 1 = strongly agree, 2 = agree, 3 = undecided, 4 = disagree, and 5 = strongly disagree.These sections included 47 items.

Interview
The second tool to gather information of the research was an interview.The purpose of the researcher for doing the interview was to gain an insight to the research questions.Besides, the researcher can make sure that the information she gathered through the questionnaire was correct.It was conducted with two medical instructors and eight medical learners.Instructors' interview consisted of 14 questions and as for the learners; it was composed of 13 items.

Materials
Medical Terminology is the name of the book this survey aims to evaluate that and consider the attitudes of medical instructors and learners towards this textbook.The book is a specialized book for medical learners in universities of Iran.Barbara Janson Cohen wrote it.Sixth edition of this book has been thought in Islamic Azad University of Najaf Abad and National University of Isfahan, Iran.This book teaches to the learners of medicine field of study in two semesters.Medical terminology: an illustrated Guide is geared to the mid-level medical terminology course, and includes moderate amount of anatomy and physiology.

Data Analysis
After collecting the initial required data for this study through the questionnaires and the interviews, the data were analyzed to find out what the learners' and instructors' attitude toward the content of the Medical ESP textbook is and if there are any differences between the instructors' and learners' attitude toward the Medical ESP course book or not.To this end, descriptive statistics determining the frequencies and percentages of the learners' and instructors' answers indicating their attitudes were computed.
In order to analyze the results of this study, the Statistical Package for Social Sciences (SPSS) was used.Before statistical analysis, the researcher used the One-Sample Kolmogorov-Smirnov Test to make clear the attitudes of instructors and learners and distribution of variables.Then T-Test was used to determine the differences between their attitudes.This study included both descriptive and inferential statistics.Cronbach's alpha coefficient was calculated to test the internal reliability of the questionnaire's items.A series of tables and figures were used to display the statistics.

Analysis of the Questionnaires
First of all the general characteristics of these two groups were presented in the following tables (Table 1 & Table 2).As is shown in the table (Table 1 & 2) majority of participants in this study was women.Most of the instructors who were participating in this study were between 30-40 years old and most of the learners were between 17-20 years of old.
In the following tables, the instructors and learners' perception towards the content of the ESP textbook were presented.As it is apparent from table 3, most of the instructors believed that this textbook is based on the curriculum but nor base on the syllabus.Moreover, most of the instructors agree that the grammatical points of the textbook were appropriate to learners' level.They believed that this book was designed based on the learners' needs and complexity from easy to difficult.They were also consent that this textbook content are interesting and challenging but its subjects were not generally realistic.Furthermore, they believed that the materials were relevant to the course book and learners and helpful in understanding the content, but they agree that the materials were not interesting and up to date.
Towards the topics of the ESP textbook, all the instructors believed that ESP course book topics were relevant to the medical learners; however, most of them agree that it would be better to revise the content of the ESP textbook to become more relevant to the learners.All the instructors who were participated in this study agree that vocabularies of this textbook reiterative very much.Majority of the respondents believed that load of the vocabulary of the textbook is at an appropriate level, and the grammatical points and vocabulary introduced in easy and in motivating text.
As it is apparent from table, 66.7 percent of the learners believed that reading text of the textbook were suitable for learners' level and just about 33.3 percent of them believed that the amount and length of reading passage were not enough and interesting to motivate learners.In spite of this 66.7 percent of instructors believed that, the ESP course book should be revised to include more skills.Additionally, they believed this field of study needs more ESP course and they agree this book can arouse learners' interest in using English in future life.It is apparent from above table learners had agreement towards the general content of the ESP textbook and the material used in the course book to help understanding the content.In addition, they were mostly consent towards the curriculum and syllabuses of the textbook.The majority of respondents felt that the exercises and the grammar points of their textbook were not understandable concerning their needs or their level.Additionally most of them believed that this book could not motivate learners and make challenging and interesting lesson for them.
It is clear from table; most of the learners had agreement on the topics of their ESP course book, variety of its topics, and its relevance to their needs.They believed that the load of the vocabulary of this book was enough for this level of education and they were approved this part of the ESP course book.Towards the reading part of the textbook learners believed that, texts of the book are enough and based on the learners' level but they are not interesting.
It is necessary for the researcher to determine the type of the contribution of the variables before statistical analysis of the variables.This can be achieved by using Kolmogorov-Smirnov Test.As is clear from the data presented in Table 5 the results of the test for the instructors attitude is 0.368 with p-value equivalent 0.999 and for learners is 0.802 with p-value equivalent 0.541.In accordance with the expressed P-value, data follow the normal distribution.After presenting descriptive statistics, researcher used the Leven's test according to the table7 for the equality of the variances in the two populations.As it is clear from the data presented in table, P-value equal to 0.130 and that is greater than 0/05.Therefore, the hypothesis about the equality of the two societies' variances is not accepted and the second line of the table is acceptable and the difference between the attitudes of the two groups is equal 0.47718 and the results of the t-test is equal to 1.809 and the P-value is equal to 0.263.
Therefore, answer of the second question is positive and there is a great difference between the instructors and learners' attitude toward the ESP course book.However, both of them had positive attitudes towards the content of ESP course book.

Analysis of the Interviews
Regarding to the content and exercises in these interviews, the interviewer asked just one question from the interviewees.This question investigated about the relevance of the content and exercises of the ESP course book to the needs of the learners.In respond to this question instructors stated that" This book has very brief and simple text and students get familiar with special technical terms related to their field of study.The content of this textbook is good and relevant to the needs of the medical learners additionally because this book has some exercise for reviewing vocabulary of each lesson it is helpful for memorizing them".Learners have the same idea and added that "we ourselves must study some original resources to gain more knowledge, because this book cannot be enough for our future and claimed that the content of the ESP textbook is relevant to the needs but about exercises is not true".
One of the interview questions concerned with the topics of the ESP textbook.This question was asked to make clear to how extent the topics of the ESP text relevant to the needs of the learners.Instructors regarding this question argued that," Topics of this textbook completely related to the diseases and vocabularies, which are needed for the future of the learners.However, this textbook is not enough for the learners lonely.In addition, the asserted In Isfahan University the other textbook is taught to the learners that are very more challenging.Medical terminology has very simple and easy and brief texts that are not challenging and do not force the learners to think about them very much".Learners have positive attitude towards this part of the ESP course book.
Other part of the interviews questions referred to the attitudes of the respondents towards the ESP course book.This question seeks to find their attitudes towards the importance of the ESP course book in comparison the other subjects.Regarding this question, instructors averred that, "The importance of this course in comparison with other course is very much because this course can be very helpful for the students especially in future and the students themselves know this".Learners added that, "It can help us to comprehend the English words that are used in our books but in comparison other books it is placed in lower degree of importance".

Results and Discussion
To sum up the results of this study, this study made an effort to seek answers to two questions.The questions will be restated and the answers, based on the findings of the study, will be provided below.

How Do Iranians Medical Instructors and Learners Perceive the Content of ESP Course Book?
The first research question of this study proposed that Iranian medical instructors and learners have positive attitude toward the content of their ESP course book.The results obtained from the instructors' and learners' questionnaires and interviews revealed that both of them, instructors and learners have positive attitude toward the content of their ESP textbook.Instructors claimed that the content of the ESP course book with the brief and simple text and reviewing parts is good and relevant to the learners' levels and their needs.Learners also concurred with the instructors' view and just mentioned that it is better for them to use text that is more original in this course because this textbook cannot be enough for their future.
6.2 Are There Any Significant Differences between the Attitude of Iranians Medical Instructors and Learners towards the ESP Course Book?
The second research question claimed that there are significant differences between the attitude of Iranian medical instructors and learners toward the ESP course book.Contrary to the expectation, this research found that there is a great difference between the instructors' and learners' attitude toward the textbook.

Conclusion and Implication
In sum, the results of the present study offered that both instructors and learners have positive attitude towards the content of their ESP textbook.Instructors claimed that the content of the ESP course book including the brief and simple text and reviewing parts is good and relevant to the learners' levels and their needs.Learners also concurred with the instructors' view and just mentioned that it is better for them to use texts that are more original in this course because this textbook cannot be enough for their future use.The results also showed that there was a significant difference between the instructors and learners' attitude toward the content of the textbook.
Learners and instructors' attitudes towards second and foreign language learning and teaching play a crucial role in the success of any language course.By knowing learners' and instructors' attitudes towards the content of the textbooks, book editors and syllabus designers have a better understanding of what must be and not be included in the textbook and the next editions of the book will be mostly based on instructors' and learners' needs and requirements.Similarly, conducting needs analysis helps book writers to improve their works and also develop and write the materials that are according to the learners' needs.Instructors can also be aware of the needs of the learners and pay enough attention to their requirements.It is also of interest to include more exercises about other language skills except for reading skills.Medical students need to get familiar with the requirements of their future job in real life situations to have professional progress.

Table 3 .
Descriptive statistics of instructors' perception towards the content of the ESP textbook

Table 4 .
Descriptive statistics of learners' perception towards the content of the ESP textbook

Table 6 .
Mean group statisticsThe results of the table 6 present that the learners' attitudes mean score and equality of variance toward the content of their textbook respectively are 3.1135 and 0.96331 and about instructors, they are 2.6364 and 0.34284.

Table 7 .
Independent sample t-test