THE UNDERLYING CONCEPT OF MOTIVATION IN MEDICAL ENGLISH TEACHING

There is irrefutable evidence that medical English cannot be taught at the same level as general English language. The aim of studying English at this career specific level is acquiring contextually-based practical use of language within the given domain, rather than focusing on grammar and structure. The teacher's job is to design an appropriate curriculum that can be adjusted to satisfy the needs of the educational institution, while enabling students to perform medical jobs in a qualified, safe and competent manner. If asked to identify the strongest influence on language learning, motivational factors would appear at the top of few teachers’ lists. Nevertheless, motivation is rooted in human behaviour so profoundly, that we often fail to realize its underlying presence. This paper attempts to shed light, i.e. demystify the somewhat metaphysical concept of motivation, as well as to demonstrate how gravely and unjustly neglected the notion of motivation has been. Acta Medica Medianae 2018;57(2):40-44.


Introduction
It is a well-known fact that medical English cannot be taught at the same level or by using the same methods as general English language. The language of medicine and health care is of idiosyncratic magnitude, laden with academic expressions, colloquialisms, acronyms and abbreviations alike. As for gaining medical English proficiency, like in all scopes of English, the higher the applicable value of the material learned, the higher the levels of student motivation.
When it comes to motivational factors during a course of language teaching, motivating students is both an immense challenge, and one of the most serious sources of difficulties. Motivation is, in fact, the primary impetus and the driving force behind this demanding process. People often take motivation for granted, reducing its actual importance and omnipresence, and yet, without proper motivation, even those with outstanding abilities will fail short of achieving long-term goals.
It is the teacher's job to design an appropriate curriculum which will serve as a framework that can be developed in order to satisfy the needs of the educational institution in question. It is of paramount importance that the knowledge thus acquired enables students to perform their jobs safely and competently within the scope of their expertise.

The importance of student motivation
The word motivation derives from the Latin root "motivus"-a moving cause. As the name suggests, motivation is what moves us to perform. It is the purpose or psychological cause for our actions, the desire or willingness to do something. From the most trivial activities such as getting out of bed in the morning, to far more complex endeavours such as acquiring a new language for specific purposesmotivation is virtually ubiquitous.
Motivation is an absolute prerequisite to successful language learning. Maintaining a high level of motivation over the entire process is the best suited way to ensure the process is the most effective. When it comes down to medical English acquisition, motivation is a psychological drive that spurs us towards achieving a goal -whether it is mastery of a language, communicative competence, or even basic communication skills (1). Teachers are facing a tremendously difficult task of setting the favourable micro-climate by promoting positive attitudes and the students' self-esteem, while providing their own emotional involvement. Both teachers and students seem to have reached the consensus that the main focal point for motivation (and demotivation alike) is the teacher. It can certainly look like a Sisyphean task at times, but good teachers have a plethora of methods, resources, and tricks up their sleeves to maximize the ultimate results.
What better way to motivate your students than to guarantee them a closer contact with all relevant factors from their field of expertise. One way is to use materials both useful and relevant for their future careers, while ensuring they are going to learn as efficiently as possible (2). Misconceptions about motivation as a learner-centered phenomenon were present for a long time, while the teacher's function was seen predominantly as a provider for materials and conditions for learning. The tables have turned, however, and teachers nowadays are expected to encourage learners to take ownership in learning, help them identify and decide for themselves the relevant learning goals, while providing continuous support (2). It is vital to perceive the class not as a unified group, but as a set of individuals different from one another, and address them correspondingly.
There are two basic kinds of motivation, the integrative and the instrumental. The integrative motivation reflects on the desire to integrate into the wholesome culture of the target language, while the instrumental concentrates on achieving concrete aims such as: promotions in career, the ability to understand foreign literature, getting a job abroad, or any other pragmatic goal (3). Intrinsic motivation has a number of relevant factors: the level of aspiration (can be rigid or adjustable, depends heavily on the level of ambition, getting a D on an exam can be either a catastrophe, or a cause for celebrations of Biblical proportions for two different students), pleasantness (we humans are designed to be more prone to remembering/acquiring something pleasant than something very unpleasant, while least likely to remember something we are indifferent to; it explains how we first remember the words we are most interested in, than those really long medical expressions that seem impossible to grasp at first, while having many problems with those small, often monosyllabic words that always mean something), sincere intention to learn something (46 forced repetitions have a lesser effect than 6 repetitions with a real intention to learn), interest (which grows proportionally as we start to connect the new material with something interesting, getting to know its significance and its practical use in real life, i.e. in medical practice for EMP students).
The concept of motivation is so incredibly complex, it takes a respectable number of interrelated disciplines (psychology, sociology, linguistics, etc.) to arrive anywhere near reasonable understanding of its different facets. However, being omnipresent as it is, we often fail to recognize the importance of motivation in the process of foreign language teaching/learning. The more the students see their progress, the more they want to do even better. On the other hand, perceptions of failure demotivate.
Students' language skills cannot be improved without their genuine engagement, while motivation is seen as the crucial element for success in the classroom and beyond. There is only so much a teacher can do, the rest is up to students. Students need to develop learner autonomy in order to succeed in the course, later classes and in future jobs. The teacher's attitude can enhance or inhibit autonomy and motivation. Finally, educators must not forget the culture of students nor ethical considerations of their profession to encourage and eventually allow students to take control of their own learning. Other factors include: how important it is for students to feel autonomous, classroom methodology, selection of appropriate medical materials, and helping students overcome their natural anxiety, particularly during classroom activities such as oral presentations and test taking.
There is a whole range of possibilities for teachers to increase motivation in the classroom. Generally speaking, they fall into the before mentioned categories of intrinsic and extrinsic motivation. As far as the former is concerned, the topics ought to be in the sphere of interest of a particular learning group, and not to force any topic the students are not interested, under no circumstances whatsoever. Students' curiosity must be stimulated at all times by providing challenging, and yet achievable goals in order for them to feel how much they are progressing. When considering extrinsic motivation, teachers can help students establish high (and yet achievable) expectations, and also help them develop positive (and yet realistic) attitudes towards language learning.

Overcoming obstacles
One of teachers' main concerns is to help students perceive why they are learning the language and what possibilities it can open for them in their professional lives. Upon realizing the connection between what they are learning in the classroom, and what they can apply it to practically in medicine, most students continue to work even harder. Acquiring medical terminology and its concise clear manner does not happen overnight; it is a painstaking process that takes lots of practice, causes a lot of frustrations, and demands a great deal of patience; the teacher's role is to convince them that the process is going to be worthwhile in the end, while giving them positive feedback throughout the entire two-way process.
It is not always possible for a person who is not a professional linguist to express himself/herself precisely in the target language, therefore, the students ought to be encouraged to think of synonyms and alternative ways to express their thoughts in verbal communication, with the teacher as a mere facilitator. The important thing is that the message is communicated and understood in a safe and correct way. The goal of medical English must be acquisition and applications of language rather than memorization or direct focus on vocabulary, grammar and syntax. Lest anyone wonders why that is the case, it suffices to say that when you make a mistake in syntax, case, spelling, 3 rd person singular, (or any other grammatical category for that matter), you might provoke a sneer, giggle or smile. But when you make a mistake in medical English terminology, it might have life-threatening implications for your patient. Therefore, it is a very important challenge for all the parties involved, because one day it might mean the difference between life and death.
It is next to impossible for a layman English learner to comprehend all the acronyms and abbreviations used in career specific medical jargon. It is basically a language of its own. Teaching and learning are dynamic intertwined processes and feed off each other. Even with the developed curriculum, it serves merely as a framework within which the students are supposed to thrive. Whereas the goals of the curriculum are somewhat fixed, extra attention needs to be paid to students' interests and needs, which provide valuable feedback. Therefore, it is essential that the curriculum is adjusted to any particular group of students, while bearing in mind that it is prone to modification, as their needs and goals might change over the period of time. The teacher also needs to be highly flexible. Medical English needs vary from student to student, but each person will have specific demands to meet their individual desired results (4).
The teacher needs to be a master of strategies, there are no unique approaches that work with everyone, one needs to adjust constantly. A couple of techniques for creating positive classroom environment do stand out, though. These include: using structural formats (e.g. making smaller groups), carefully choosing content (as not to estrange students from the subject, or kill their interest), initiating semi-controlled activities such as group discussions (not entirely controlled as not to stifle the students' creativity and sense of self-reliance). Those who are more interested in professional development seem to be more committed than those with shortnoticed aims such as purchasing careers abroad as this diverse teaching field offers lucrative opportunities.
Medical English poses a great challenge given the fact that, unlike in teaching general English, students have more knowledge in the field of expertise. Therefore, symbiosis is required, and coordination and cooperation are crucial. The teacher's role is to guide and facilitate, not to be the centre of attention. Moreover, one approach is never enough. Hence, a combination of several usually makes the highest impact. Those must be carefully implemented and interwoven to achieve the most satisfactory results for both parties involved. Personal sensitivity from the teacher is highly desirable, as is the overall resilience and versatility that covers a wide spectrum of methodological alternatives.

Novel approaches to methodology
A foreign language teacher plays a specific role in learners' education: by teaching foreign language, we are also teaching them foreign cultures, opening gates to the whole world for them. Activities related to the target culture facilitate language acquisition drastically, open up new horizons and stimulate their curiosity, thus contributing to their motivation for learning the language in question significantly. Given such impetus, at that point, students will usually take initiative and explore further on their own (5). Medical English language teaching demands a novel and modern approach. It appears that earlier methods notoriously applied to students of medicine predominantly focused on acquiring the language while embedding health terminology as a subsidiary contribution. However, nowadays it is believed that it should be vice versa.
Every course starts with a curriculum, which is designed to help doctors and medical students develop listening, speaking, reading and writing skills in English. It aims to give the students the opportunity to learn specialized vocabulary and expressions, to activate passive vocabulary, to learn the English pronunciation of medical terms and to increase fluency and confidence in using English in professional contexts. The four skills of reading, writing, listening and speaking can be taught through the use of various materials ranging from research papers and case presentations to medical interviews and works of literature (6). The goal of learning English at this level is not to learn grammar and structure primarily, but to acquire and use the language of practice and social relations within the career (7).
Medical English teacher will find a way to teach students, but also to encourage independent learning. This can be achieved provided the teacher does not lack enthusiasm and commitment towards the target language, the field of medicine and its noble causes, but even more importantly to the learners. Students need to feel appreciated and supported by teachers who love their jobs, and who want to establish a good rapport with them. A stimulating classroom atmosphere and integrating students into class performances will inevitably lead to higher levels of stamina, which is absolutely essential in the language learning process.
Medical students, nurses, doctors and international health care workers worldwide who do not speak English as their native language are filling up medical English classes. Schools, individual health care workers, and government bodies are looking for teachers who specialize in teaching medical terminology, concepts, and attitudes to instruct these people. Whether to enable communication of specialists in scientific exchanges thus enabling scientific progress, facilitating worldwide access to learning, or continuing studies in English in one of the 50 English speaking countries among approximately 375 million people who speak the language, dominant position of medical literature in English is unquestionable.
We have to bear in mind that students are intelligent adult people, self-conscious and dedicated to a noble goal, and it is the teacher's task to pave their way to the top by offering their best. EMP teachers act as managers, facilitators, organizers, monitors and helpers, which sometimes requires nerves of steel, large amounts of trust and empathy. In order to do that, they must be willing to interact not only with their students, but also with experts from the medical field.
The material used in EMP should cover all the relevant topics to the required field of medicine. In order to trigger the interest and hold the attention of the students it must come in various forms: medical articles, audio materials, videos, a combination of academic preparation that includes behavioral and cognitive approaches. Lessons would ideally be empirically and contextually based to provide immediate opportunities to use the acquired knowledge. In interactive classes that promote discussion, cooperation and team work, students will benefit by achieving the sense of improvement and accomplishment. The use of authentic materials is just as important as making the lectures interesting. Again, this is the teacher's task. Through your own behavior, course design and teaching practices, you can create classroom conditions that encourage engagement and motivation to learn on a variety of levels (8).
The traditional teacher-student roles are a thing of the past. The new approach requires substantial sensitivity when it comes to teaching methods and a wide array of methodological alternatives. EMP teachers have far greater responsibility than general English teachers. One must integrate medical knowledge and the mastery of English language in order to pass on all the skills and findings regarding proficiency in medical terminology, procedures and concepts necessary for practicing medicine in a native English speaking country. It is a prestigious vocation to be a guide to future doctors, to people in whose hands so many lives will be placed.

Conclusion
Modern methodology recognizes the importance of motivational factors, and puts them very high on the list of priorities. One of the teachers' main concerns is to help students perceive why they are learning the language and what possibilities it can open for them. Upon realizing the connection between what they are learning in the classroom, and what they can apply it to practically in their professional lives, most students continue to work even harder. Activities related to the target culture facilitate language acquisition drastically, open up new horizons and stimulate their curiosity, thus contributing to their motivation for learning the language in question significantly. Given such impetus, at that point, students will usually take initiative and explore further on their own. Medical English teachers will find a way to teach students, but also to encourage independent learning. A stimulating classroom atmosphere and integrating students into class performances will inevitably lead to higher levels of motivation, which is essential in a language learning process. The teacher's role in increasing students' motivation is crucial, and through a variety of teaching methods students can be not only motivated positively, but also remain motivated for long periods of time.