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A Longitudinal Study on the Use of Films with Medical Themes
in the Classroom
－Do students in medical-related disciplines prefer medically themed films?－
Teruhiko KADOYAMA (Hiroshima International University)
Abstract This longitudinal study aims to examine learners’ evaluation and
preferences regarding films used in English classes, obtaining feedback from students who studied with both film-based EGP and ESP materials in two consecutive semesters. With the ever increasing need for ESP in recent years, language teachers are often compelled to take an ESP approach, prioritizing their ESP needs over learners’ preferences in the selection of films for their classes. The use of a medically themed film has the potential to motivate students in medical-related disciplines further in their studies of both language and their chosen fields. Few medically themed films, however, are familiar to those students, and to date, few ESP studies have examined learners’ evaluation of those films. A one-year experiment was conducted on 89 students of medical-related disciplines, and the results revealed that more than 70% of the participants preferred learning with medically themed films to learning with generally themed ones. This suggested that an ESP approach with the use of a medically themed film adequately addresses the needs and preferences of students, as well as those of teachers. It was also found that the film-based ESP material is effective in improving learners’ listening abilities. The implications of the findings are also discussed.
Key words: ESP, material development, medically themed films
1. Introduction
The selection of films has constantly been an important aspect when planning to use films in the language classroom. Kobayashi (2003) states the importance of considering learners’ and teachers’ viewpoints in the selection of films, so that learners can watch them with interest. Many of the previous reports on the use of films took learners’ views and preferences into consideration and utilized so-called blockbuster films familiar to students, such as Titanic (e.g., Yanagawa, 2003; Nakamura, 2004).
With the ever increasing need for English for specific purposes (ESP) in recent years, however, teachers are often compelled to prioritize their needs over learners’ preferences in
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the selection of films for their classes. For example, at a university offering various medicine-related programs, where the author teaches, an ESP approach is recommended not only for ESP classes, such as Medical English, but also for English for general purposes (EGP) classes offered to first-year students, in which teachers are also encouraged to cover medicine-related topics. Under such circumstances, the selection of films is heavily subject to teachers’ viewpoints and needs, and the author himself decided to use films with medical themes in his classes, although they are not familiar to students. However, the following questions remain: Do students enjoy watching films selected mainly based on teachers’ own needs and points of view? Are such films still effective in motivating students and improving their English proficiency?
Kadoyama (2015) developed ESP material based on a medically themed film, Awakenings, and examined learners’ evaluation of the material and its effect on their listening abilities, comparing these with the evaluation and effect of EGP material based on a popular film that was not related to the learners’ major subjects. The results indicated that the listening abilities of learners in both the ESP and EGP groups significantly improved, and no significant difference was observed between the groups. The evaluation of the film-based materials by learners in both groups was extremely positive, and no significant difference was observed between the groups. However, this study was cross-sectional; so, it is not exactly clear as to which material the participants preferred. Moreover, the sample size was limited; therefore, the generalizability of the results in Kadoyama’s (2015) study is severely limited.
Based on the above concerns, this longitudinal study aims to closely examine learners’ evaluation of and preference for films on a larger scale, obtaining feedback from students exposed to both film-based EGP and ESP materials in two consecutive semesters. The participants were exposed to film-based EGP material in the first semester and ESP material in the second semester. The study also aims to further examine the effectiveness of ESP material developed based on a medically themed film.
2. Use of medically themed films in medical education and ESP
Medically themed films have commonly been used as learning resources in the education of health professionals (e.g., Hyde and Fife, 2005; Datta, 2009; Gallagher, Wilson, Edward, Cowie, and Baker, 2011). For example, Lumlertgul, Kijpaisalratana, Pityaratstian, and Wangsaturaka (2009) used five such films as a catalyst for class discussion and reported that they were very useful for teaching medical students a variety of ethical matters, such as the meaning of informed consent, clinical trials on patients, and an appropriate doctor–patient relationship. Hallberg (2007)lists the following eight films as those that medical students
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should see: The Doctor, Awakenings, Wit, Patch Adams, Something the Lord Made, And the Band Played On, One Flew Over the Cuckoo’s Nest, and The Painted Veil. Harrah (2013) has also listed top 10 medically themed films for medical students, and his list is quite similar to Hallberg’s.
When planning to use an ESP approach in the English classes of students in medical-related disciplines, the medically themed films listed above would be considered relevant, because they provide an interesting format for learning about various healthcare topics and could be utilized as a catalyst for class discussion. In fact, some previous studies, such as Yamamoto and Nakagawa (2006) and Yamamoto, Okura, and Watanabe (2007), are based on the above-mentioned films. Only a few of the medically themed films listed above, however, seem familiar to current college students. The results of the author’s in-class survey showed that more than two thirds of the students (n = 90) did not know any of the eight films listed by Hallberg. Some of the films are not even available on DVD in Japan.
Apart from the use of films in medical education, as described above, their use in language education has mainly focused on their motivational effects on learners. Thus, the familiarity of films to students has always been one of the most important considerations in the selection of those to be used in class. Especially, in the case of low-proficiency learners, who often lack the motivation to learn English, the choice of an appropriate film is considered to be crucial. However, the selection of films in an ESP approach typically involves a different screening process, with the film’s theme considered more important than the film’s familiarity to learners. This may lead to films’ motivational effects on learners being sacrificed substantially or to some extent. However, to date, few ESP studies have examined learners’ evaluation of those films. Despite their unfamiliarity to students, however, it is also possible for medically themed films to significantly draw students’ attention and interest, since many students in medical-related disciplines have already chosen their future careers and their interest in their chosen fields seems relatively high.
3. Purpose of this study
The purpose of this longitudinal study was to examine learners’ evaluation of and preferences regarding the films used in English classes, obtaining feedback from students exposed to both film-based EGP and ESP materials in two consecutive semesters. The study also aimed to examine the effectiveness of ESP material developed based on a medically themed film in improving learners’ listening abilities. The following two hypotheses were posed:
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medically themed films to learning with films with general themes (i.e., not medically themed).
2. Participants’ listening abilities will show significant improvement when they learn with medically themed films and with generally themed films.
4. Method 4.1 Participants
The participants were first- and second-year students (n = 90) in the nursing, clinical nutrition, and pharmaceutical sciences departments at a university in Hiroshima Prefecture. Based on their results of the placement test administered in April 2015, they were enrolled in three Oral Communication classes that catered to students with the same proficiency level. Their English proficiency level was estimated to range between 350 and 500 in the Test of English for International Communication (TOEIC). One student’s data were excluded from the analysis, as he was absent for one of the four tests (pretests and posttests) and did not complete the task. Data from the remaining 89 students were analyzed in this study.
4.2 Instruments
This longitudinal experiment took place over two semesters, and a pretest and a posttest were conducted on the participants in each semester to measure their listening abilities. Under such a condition, use of the same test four times is not appropriate; due to the so-called “practice effects,” scores in the second semester would be expected to be higher than those in the first semester. Therefore, two test sets with the same format were required; however, it is difficult to develop two test sets with exactly the same level of difficulty.
Considering these factors, two test sets (Test A and Test B) were preliminarily developed and administered to a total of 65 students, who are not the participants of this study. They took the two tests within a period of one week; it was assumed that their proficiency levels did not change during that period. The results confirmed the two tests to be of about the same level of difficulty. These tests were used in the current study to measure the participants’ listening abilities. Prior to the experiment, a pretest was conducted in April 2015. The pretest was modeled after, and therefore, similar to the listening section of the TOEIC, and the full mark was 50. The mean score was 29.23, and the SD was 5.94.
In addition to the pretest, a pre-treatment questionnaire was administered to the participants, in order to survey their motivation and interest in learning English. They were asked to write their names on the pre-treatment questionnaires, so that their scores on the pretest could be tracked down. The questionnaire’s only item, “Are you interested in learning
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English?,” was answered on a five-point Likert scale from 1 (No, not at all) to 5 (Yes, very much). Figure 1 shows the results of that survey. Participants who answered “Yes, very much” and “Yes” (n = 37) were classified as the “Interested Group,” while participants who answered “No, not all” and “No” (n = 43) were classified as the “Uninterested Group.” Nine participants who answered “I don’t know” were excluded from the analysis relating to participants’ preferences regarding the theme of the film based on classification under either the Interested Group or the Non-interested Group. The mean score was 2.88, and the SD was 1.30.
Figure 1. Pre-treatment interest in learning English.
After 11 weekly teaching sessions in each semester, a posttest and a post-treatment questionnaire were administered. Similar to the pretest, the posttest (either Test A or B) measured listening skills. In the post-treatment questionnaire, the participants were instructed to evaluate the material used in class, with regard to the extent to which they found it interesting enough to apply while learning (“In this class, you learned English watching a film. Do you think the film used in class was interesting to learn English communication with?”), on a five-point Likert scale from 1 (No, not at all) to 5 (Yes, very much). This was the post-treatment questionnaire’s only item in the first semester. In the second semester, the participants were asked to answer one additional question related to their preferences with regard to the theme of the film used (“In this class you learned English watching two films with different themes: a generally themed film (non-medically themed one) in the first semester and a medically themed film in the second semester. Which do you prefer, the medically themed one or the generally themed one?”). The question was also answered on a five-point Likert scale from 1 (Definitely generally themed one) to 5 (Definitely medically themed one). A free-text field was included in the questionnaire to obtain additional comments and ideas from the participants regarding their preferences in terms of the film theme used. The free-text item was as follows: “Do you have any comments or ideas about
10% 31% 10% 33%
16% Yes, very much.
Yes. I don’t know. No.
8 your answer to the first question?”
4.3 Material development 4.3.1 Film selection
Two film-based sets of teaching materials (ESP and EGP) were developed for this experiment, using the same instructional design. The materials were designed for English communication instruction, based on a functional syllabus. The ESP material was based on a medically themed film, Patch Adams, while the EGP material was based on a generally themed film, Ghost. After screening 10 medically themed films listed in Harrah (2013), via a systematic process described by Wilson, Cowie, Baker, and Howden-Chapman (2010), Patch Adams was chosen as best suited to the purpose of this study, given that it contains a variety of medical themes that could be beneficial for class discussion, such as the physician–patient relationship, and use of humor in treatment. The film, Ghost, was used in Kadoyama (2015), which used a sample of students in medical-related disciplines, similar to the current study, and was, thus, deemed appropriate for this study.
4.3.2 Course structure
In this study, as described below, the whole film was presented to the participants, to ensure that they understood the storyline, which was considered essential for meaningful class discussion. All students were shown the generally themed film in the first semester and the medically themed one in the second semester. Considering the length of one class period and the number of classes in one semester, each film was divided into 11 segments, each segment approximately 10 minutes in length. This ensured that the participants could watch the whole film in one semester. A short target scene (up to three minutes) was chosen from each segment and was shown without Japanese subtitles, for use in the tasks described below (See Table 1), while the remaining scenes were shown with Japanese subtitles, to help the participants follow the storyline.
Various tasks were created by the author, based on the target scenes selected; Table 1 shows the tasks allocated for each unit. The tasks for EGP and ESP were identical. The ESP material, however, had highlighted content related to the medical field, as shown in the tasks shown in Table 1, whereas the EGP material did not. For example, many of the target scenes in the ESP material are conversations between medical students and contain suitable healthcare topics for class discussion.
9 Table 1
List of tasks for each unit
Tasks Contents
Pre-viewing Activities
Vocabulary Check Vocabulary exercise
Useful Expressions Key sentences exercise
Listening Tip Explanation and exercise on phonological changes
Viewing Activities
True/False Questions Comprehension questions
Partial Dictation Partial dictation exercise using film dialogue
Role Play Role-play activity using film dialogue
Post-viewing Activities
Discussion Topics Discussion on issues related to the target scene
Grammar in Focus Explanation and exercise on grammar points
Language in Focus Explanation of language functions
Expansion Composition/skit production exercise
Table 2 lists examples of the healthcare topics used in the ESP material, in which
learners were instructed to discuss medical issues from various perspectives, such as those of patients, medical students, and medical staff.
Table 2
Examples of discussion topics
Standpoint Topics
Patient Patch uses humor in his treatment. If you were a patient, would you think his approach is good, or do you feelthat it is not necessary?
Medical student Patch is accused of practicing medicine without a license. What do you think of what he did? Should he be accused, or did he do a good thing?
Medical staff Patch is good with people. How about you? Are you good at getting along with patients, or do you find it difficult?
4.3.3 Development of the handouts and accompanying e-learning course
Based on the procedures described in Section 4.3.2, handouts for 11 units and accompanying e-learning courses were produced. The e-learning courses were created using Moodle, an open-source course management system (CMS), to support students’ learning. The e-learning courses provided various types of hints and sample answers, to facilitate discussion and other classroom activities. They also provided additional online exercises to facilitate students’ out-of-class study.
4.4 Procedures
The entire experiment, comprising exposure to film-based materials, was conducted over two semesters, from April 2015 to February 2016. The film-based materials described in Section 4.3 were used during the experiment period. Material based on a generally themed film, Ghost, was used in the first semester (April to August 2015), and that based on a medically themed film, Patch Adams, was used in the second semester (September 2015 to February 2016). Identical teaching procedures were used in the two semesters. The author
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taught the participants English. After their review of vocabulary and colloquial expressions, the participants watched a short film segment without any subtitles. Then, they were given various listening tasks based on the segment in each lesson. Group discussions followed. In the first semester, they discussed general topics related to the segment, while in the second semester they discussed medical topics related to the segment. An accompanying e-learning course was also provided in both semesters, and during each lesson, participants were instructed to complete various additional listening and writing exercises on the CMS as homework assignments. After 11 weekly teaching sessions in each semester, a posttest was conducted and a post-treatment questionnaire was administered.
The study participants, who were enrolled in three different classes at the time of the study, were divided into two groups (Group 1 and Group 2). Therefore, the number of participants in Group 1 and 2 was not even. However, a possible difference in the level of difficulty between the two tests was largely, if not completely, counterbalanced. Test A and Test B were administered to participants in each of the two groups, in order to counterbalance the difference between the two tests’ levels of difficulty. As shown in Table 3, Group 1 took Test A as a pretest and Test B as a posttest in the first semester, while Group 2 took Test B as a pretest and Test A as a posttest in that period. In the second semester, the order was reversed.
Table 3
Tests administered to each participant group
First Semester Second Semester Pretest Posttest Pretest Posttest Group 1 (n = 55) Test A Test B Test A Test B Group 2 (n = 34) Test B Test A Test B Test A
5. Results and discussion 5.1 Listening abilities
Table 4 and Figure 2 illustrate the changes between the pretest and the posttest in the two semesters. The paired t-test results revealed a significant difference between the listening scores in the pretest and the posttest in both semesters (t = -6.81, p < .01, r = 0.59 for the first semester; t = -3.54, p < .01, r = 0.35 for the second semester). The results of the t-test showed a significant difference between the pretest in the first semester and the posttest in the second semester (t = -8.17, p < .01, r = 0.66).
11 Table 4
Results of listening pretests and posttests
First Semester (FS) Second Semester (SS)
Pretest Posttest Pretest Posttest
n M SD M SD M SD M SD
Treatment Group 89 29.24 5.94 32.78 5.01 31.45 6.49 33.47 5.34
Figure 2. Results of listening pretests and posttests.
5.2 Interest and preferences regarding film themes
Table 5 and Figure 3 reveal the results of the post-treatment questionnaires administered to identify participants’ interest and preferences regarding film themes.
Table 5
Interest in the material
EGP ESP
n M SD M SD
Treatment Group 89 4.79 0.46 4.66 0.61
Figure 3. Preferences regarding film themes.
The results showed that interest in the material was very high during both semesters, with
29.24 32.78 31.45 33.47 27 28 29 30 31 32 33 34
FS Pretest FS Posttest SS Pretest SS Posttest
23% 49% 15% 12% 1% Definitely medically themed one. Medically themed one. I don’t know. Generally themed one. Definitely generally themed one.
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no significant difference observed between EGP and ESP (t = 1.94, p > .05). This suggests that the participants’ interest in the ESP material was as high as that in the EGP material. The results also revealed that 72% of the participants preferred the medically themed film, while 13% preferred the generally themed one.
The quantitative data analysis was supported by the analysis of the free-text responses to the following question: “Do you have any comments or opinions about your answer regarding the first question?” Typical comments made by participants who chose “medically themed film” in the first question were as follows:
・ I am studying to become a health professional now; so, medically themed films seem much more useful to study with.
・ I learnt a lot about medical professionals, as well as various medical terms; so, I was motivated to study.
・ Medically themed films will be very useful for my future job.
In contrast, participants who chose “generally themed film” made the following comments:
・ I think that I learnt many expressions that I can use in daily conversations from the generally themed film than from the medically themed one.
・ I cannot even conduct daily conversations in English; so, generally themed films are better suited as teaching materials than are medically themed ones.
・ We often watch medical documentaries in other classes; so, in English classes, I want to learn more about different cultures, not medical-related matters.
Next, Table 6 shows preferences about the theme of the film by the Interested Group and the Non-interested Group. The item was answered on a five-point Likert scale from 1 (Definitely generally themed one) to 5 (Definitely medically themed one). The results indicated that both groups preferred medically themed films, but no significant difference was observed between the two groups (t = -1.49, p > .05).
Table 6
Interest in the material
n M SD
Interested Group 37 3.62 1.14
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5.3 Discussion
First, more than 70% of the participants, who watched both medically themed and generally themed films, preferred the medically themed one. This indicates that medically themed films are suitable not only from teachers’ point of view and in consideration of their own ESP needs, but also from learners’ point of view. Many of the participants who preferred medically themed films mentioned, as the reason for their choice, that they could learn medical terms and various other aspects related to their future jobs. On the other hand, participants who preferred generally themed films indicated that these were a valuable source from which to learn various useful expressions, as represented by the comment, “I can’t even conduct daily conversations in English; so, generally themed films are better suited as teaching materials than are medically themed ones.”
One could argue that the above-mentioned results are due to the individual films that the participants watched in class. However, a special instruction was given to the participants to answer the question solely based on the themes of the films (medically themed or not). Moreover, the results of the questionnaire in the first semester showed that the participants rated the generally themed film that they had watched very highly (4.79 out of 5). Thus, it is unlikely that the results were affected by the individual films that they had watched in class. As for how differences regarding interest in learning English affected the participants’ choices, it was found that both the interested and non-interested groups preferred medically themed films to generally themed ones. No significant difference was observed between the groups. Therefore, Hypothesis 1 (Regardless of their interest in learning English, participants prefer learning with medically themed films to learning with films with general themes) was supported.
Next, with regard to participants’ listening abilities, significant improvement was observed, based on the pretest and the posttest results obtained in both semesters. No significant difference was observed between the two semesters. The results suggest that the film-based ESP material was as effective as, if not more effective than, the film-based EGP material, in improving learners’ listening abilities. Thus, Hypothesis 2 (Participants’ listening ability will show significant improvement when they learn with medically themed films and with generally themed films) was supported. The results also support Kadoyama’s (2015) findings, and the effectiveness of the film-based ESP materials developed in this study was confirmed.
In general, medical terms are often regarded as “too difficult” for college students who are not interested in learning English. In addition, few medically themed films are familiar to them. Thus, many language teachers may hesitate to use those films in class, fearing that
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students will show no interest in them. However, it was found that both students who were interested in learning English and those who were not, preferred studying with medically themed films to studying with generally themed ones. The results suggest that an ESP approach involving use of a medically themed film adequately addresses the needs and preferences of students in medical-related disciplines and those of teachers and, thus, the approach should be explored further.
6. Conclusion
In this study, two film-based sets of teaching materials were developed, so as to improve English communication skills. These were ESP, based on a medically themed film, and EGP, based on a generally themed film. They were identical in format and teaching procedures. A longitudinal study was conducted on 89 students of medical-related disciplines, who learned English communication with EGP material in the first semester and with ESP material in the second semester. The learners’ perceptions and preferences regarding the teaching materials were surveyed through pre-treatment and post-treatment questionnaires. Their listening abilities were measured through listening pretests and posttests in each semester.
The results indicated that both EGP and ESP materials had a highly motivational effect on learners, and statistically significant improvement in listening abilities was observed in both semesters. These findings support the results of the author’s previous study. It was also found that students in medical-related disciplines tended to prefer ESP material to EGP material. Many of those students have already decided on their future jobs when entering university and their interest in their chosen fields is said to be generally high, which is clearly reflected in the results of this study. The findings of this study suggest that an ESP approach is preferable when teaching students in medical-related disciplines, even when they are not eager to learn English. Rather, regardless of their interest in learning English, this approach can stimulate and sustain their interest and attention in the classroom.
In conclusion, implications for further research should be mentioned. Firstly, follow-up experiments are essential to generalize the findings of this study, which examined only two films. Although a special instruction was given to the participants to answer the questions of the questionnaire solely based on the themes of the films (medically themed or not), it may still be possible to say that the results of the questionnaire are partly due to the individual films that they watched in class.
Secondly, medically themed films should be explored further for possible use in the language classroom. The use of such films in previous studies is still limited. In this study, 10 films listed as “suitable for medical students” in Harrah (2013) were screened, but the
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usefulness of similar lists, such as “Movies every nursing student should see,” should also be examined.
Thirdly, the effects of ESP tasks, such as film-based discussions on medical-related topics, should be explored further. This study examined only the effects of ESP material on learners’ listening abilities, although the materials developed in this study have a much broader scope than the development of listening skills only. Thus, further studies are required, involving a comprehensive evaluation of the film-based materials developed.
Acknowledgements
This research was supported by JSPS KAKENHI Grant Number 26370684. I’d like to express my appreciation to the two anonymous reviewers who offered insightful comments and suggestions.
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