OXFORD ENGLISH FOR CAREERS V7 ted em CrT ted Lote) 4OXFORD ENGLISH FOR CAREERS iit 4? N Teacher’s Resource Book OXFORD UNIVERSITY PRESSOXFORD (Great Clarendon Stee, Oxford 0x2 60 (Oxford University Pres isa department ofthe University of Oxford Iefrthers the Unversity sobjecive af excellence in researc, scholarship and education by publishing worwie in ‘oxford New York [Auckland CapeTown Dares Salam Hong Kong. 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Handbokof Cla pelts 70h Editon, edited by Coli ea 2006), Reproduced by permision of Oxford University Press: 101 Excerpts rom pps fom Of Handbof sychay. eited by Semple 31 (2005, Reproduced by permission of Oxford University Press. Sources: p20, 27, and 30 Oxford Handbook of Cinical Medicine 7th Edition (2007); 28 OyordHandock jor te Foundation Programe 2nd Edition (2008 AS Of Hondo Gees Prati: 2d Elion 2006). Althea ver fr ase ado trace an cota copright holders ere lication thao en sib rome aes We apg fr ary apparent fargo f pri an ted. he pur we leased tect any ‘rn or omson he sakes oppor ‘ford University Press makes no representation, expressor implied that ‘the dg donages inthis book re correct Readers must herefore aways ‘heck the product information snd linia pocedaes withthe mon > todate published proc information ad data sheets provided bythe ‘manufactures and the most recent codes of conduct and safety regulations ‘The authors nd publishers do not accep responsibility oF legal ability or ny eros the tea of the misuse or misapplication of material in this work. We woulda ie otha the owing or persion to erate aang sheogop Alam 9100 mann wheel Astasles. 105 elene Rogers ‘Corbis p10s woman in wheelchair Forze), Cert Images p107 (Thomas Norcheuifesize Puncstock pp8s (Doug Menueaotodise, 103 (lack mother and sick chile KandalfDigtal Vision), 105 thre teenagers) ‘Ableimages/Digital Vision: Science Phot Library p03 (nurse with child) ‘Guscoimages, Images orc hy: Pctrereseateh cok over mag cures GettyWArTe Image Bank Collection.(Molasses Introduction pa Background, teaching notes, tips, and additional activities 1 Presenting complaints p.6 7 Parents and young children p.41 2 Workingin general practice p11 © 8 Communication p48 3 Instructions and procedures p.17_ 9 Workingin psychiatry p.s6 4 Explaining andreassuring p.23 10 Terminalillness and dying p.62 5 Dealing with medication p.29 11 Working inateam p68 6 Lifestyle p34 12 Diversity at work p.74 Grammar tests and communication activities Instructions for communication activities p.s0 1 Presenting complaints p.s2 7 Parents and young children p.94 2 Working in general practice ps4 8 Communication p.96 3 Instructions and procedures p.86 9 Workingin psychiatry p98 4 Explaining and reassuring p.88 10 Terminalillness and dying p.100 5 Dealingwith medication p.90 11 Workinginateam p.102 6 Lifestyle p.oz 12 Diversity at work p.104 Grammar tests key p.106 ‘Symbols and abbreviations p.1104 Introduction Introduction ‘Medicine is aimed at preparing trained and trainee doctors, and trained nurses, who intend to get.ajob in medicine. presents them with English froma wide variety of medical fields and situations, develops their communication skills, and provides them with background in major medical and care concepts. This, ‘Teacher's Book assumes that a teacher of English for medicine is unlikely to be a doctor, and information is given throughout tohelp with medical terminology. Check up This isdesigned asa warm-up activity tothe unit.1t usually consists ofa numberof pictures and often introduces key vocabulary or concepts. It should be used toget students to focus on the topic It’s my job These occur regularly and are all based onauthentic anterviews and sources, They are designed tobe of interest tothe students as they stand with only minimal tasks. Students will ead about a varity of people n different medical environments and gain insight into the skills required General focus questions fort's my jab'are: What do you think his /her job involves? What skills and experience does he/she need? Would you like to doit? ‘Asan ongoing project, encourage the cass to build up ‘portfolio of other't's my job’ features. For example, if students have contact with someone whois fully qualified and works in medicine, they can write their own, 't'smay jab article or interview, with photos. Patient care Increasingly in medicine, itis not enough tohave technical skills, qualifications, and knowledge of the field, Doctors and nurses must also be skilled communicators— not only with fellow care professionals, but with patients and their family and friends~ often about difficult or sensitive matters, They also need to be able to convey instructions to patients in a sympathetic but clear way, which can be extremely demanding, The Patient care feature gives students practice in these important ‘soft skills, Top margin ‘This top part ofthe page contains facts, statistics, and ‘quotes. These are optional extras and can be used to add variety and interest to your lessons, or provide additional material for strong students who arefast finishers’ Ways of exploitation include asking whether your students are surprised by the facts and statistics or whether they agree, disagree, or can identify with the quotes ‘Thereare also definitions for difficult words or phrases ‘which are important to understand a text which appears onthe same page. Vocabulary Students meet alarge amount of vocabulary during the course. Itis important to encourage good learning skills, from the start, for example: «© organizing vocabulary into word sets and word groups rather than simple alphabetical lists © understanding the context of vocabulary and whetheritisa key word needed for production or for comprehension «© checking and learning the pronunciation of a word or phrase. Language spot This focuses on the grammar that is generated by the topicof the unit and concentrates on its practical application. If your students need revision after completing the Language spot, direct themto the Grammarteference, ‘which provides a handy check Theres also one photocopiable Grammar test for each unitin this Teacher's Resource Book. Listening, Reading, Speaking, Writing These activities give realisticand communicative practice of language skills needed in medicine. ¢ Inthe listening activities students are exposed to situations related to medicine, including doctor- patient consultations, conversations with colleagues, and presentations. They also hear variety of English accents, both native-speaker and non-native speaker.© Inthe reading sections students meet a variety of ‘medicine-based texts (see Reading bank) ‘© Inthe speaking sections, try toensure use of English during activities, particulary those involving some discussion. Encourage this by teaching or revising any functional language students may need. The photocopiable activities in this Teacher's Resource Book also provide additional, freer discussion activities. © Writing practice in the units is designed as consolidation and extension of the topic with structured, meaningful writing tasks. Pronunciation This practises aspects of pronunciation which are of, ‘maximum importance for intelligibility You can repeat the recordings in Pronunciation as often as you like until you and your students feel confident they have mastered a particular sound or feature, Project ‘This encourages students to take an active rlein the learning process, both in terms of their English language work and the subject of medicine itselt Projects can be set as homework assignments, but itis worth spending time in class preparing students forthe ‘task Students are usually required to use search engines such as www google com to find information, as wells websites dedicated to medical issues. Help can alsobe given by brainstorming some standard places where they can gather information. Checklist Thisallows students to check their own progress. You may wantto get students to grade orassess how wellthey can perform each ofthe'Can do'statements.eg ‘easily, with difficulty, or'not at al: They can also test each otherin pairs, by giving examples from the tinttof each of the‘Can do statements Key words These are the main items of medical vocabulary introduced in the unit. A definition of each of these words appears in the Glossary. You should certainly check students’ pronunciation, including the stress, of words likely to be used orally. Introduction 5 Useful reference This section provides students with usefuleferences tokey medical handbooks where they can find further information on the topics discussed in the unit. Reading bank ‘Thisis in the middle ofthe book and gives specific skills practice in reading, The ability to read and understand texts in English has never been more important in medicine than tis today with the amount of written information available on the internet, the majority of which isin English. The reading texts are accompanied by pre-reading tasks and comprehension questions. They can be used throughout the course, either in class, orasself- study or homework Theres also an Answer key in the Student's Book to encourage students to check their work Speaking activities ‘This section contains one ormore parts ofthe information gap activities from Speaking in the main units (see Speaking). Grammar reference ‘This can be used together with the Language spot, asa handy check or revision. Itshows the form of a particular grammar point, briefly explains its use, and provides ‘example sentences as well as indicating likely student Listening scripts ‘This is a complete transcript ofall the recordings. Direct students toit for checking answers afterthey have completed a Listening task or allow weaker students to read itas they listen toa particular recording, perhaps for a final time. Glossary Thisis an alphabetical list of all the Key words. Each word isfollowed by the pronunciation in phonetic script the part of speech, and.adefinition in English ‘The section begins witha phoneticchart, with an example word from medicine to illustrate each of the sounds Abbreviations Alist of common medical abbreviations is included at the end of this Teacher's Book for easy reference.6 Unit 1 Presenting complaints Background Patients are vulnerable when they come into contact, with medical professionals, so when taking a history, doctors and nurses need to learn toask questions ina way ‘that instils confidence in patients and elicits accurate information. ‘The case history begins with the presenting complaint (C) and the recent history. Doctors have different ways of asking about the PC and probably stick to one or two of these. The tenses that are used in the recent history relate primarily to the present and recent past: the Present Perfect Continuous, the Present Continuous, the Present Simple, the Present Perfect. The Past Simple also occurs, of course, as will other tenses. [tis as important for doctors tobeable touse these tenses effectively ata simple level asit is for doctors to be able to understand patients when they use them. Any misunderstanding can affect the doctor's or nurse's ability to make the correct diagnosis. You wil therefore have to balance accuracy with fluency, encouraging the latter without sacrificing the former. Itissaid that 80 per cent ofthe diagnosis comes from taking the case history and the other 20 per cent from ‘investigations and so on. So being able toask simple polite questions using the word Can, being able to askabout personal details, and questions relating to pain are the basic tools of any doctor or nurse. Ina patient-centred approach to history-taking, which {s increasingly the focus of history-taking in the UK and in many other countries. the patient is at the heart of the health care provision. all care revolves around the patient, not the doctor. In this situation, taking a history is not just about asking the questions that a doctor or nurse feels they haveto ask, but about relating the history to each, patientas an individual, not as a hospital number. As your students go through this book, they will lear the skills to beable to become more patient-centred. {As the first step in helping your doctors and nurses to become more aware of the patient and of their own. behaviour in the patient's eyes,a basicanalysis of body language is introduced. For your own further reading about asking questions read p.4,5,and 22 in Oxford Handbook of Clinical Medicine (Murray Longmore etal, 7th edition, OUP, 2007) and refer your students to the same pages. The handbooks are very accessible and useful source books foryou and your students. Useful reference: Oxford Handbook of Clinical Medicine, ‘th edition, Longmore etal Check up © Before students do the matching task in J, ask them to describe what is happening in each picture and to compare the scenes with sirnilar situations in their own countries. ‘© Askstudents to brainstorm answers to in pairs or groups eg. inaccurate ‘information could lead to giving the wrong treatment, performing the ‘wrong operation,etc).Colate the information on the board. Encourage students to give at least one reason for each answer. Follow on with an open lass discussion for3. Set time limit. Ow 102 b3 cl dé Listening 1 Personal details «© @ For¥and2ask students tolookat the chart before listening and decide ‘hat possible mistakes could be made Let them isten again to check thelr tneeers * Tip lo= complaining ofPresentingcomplaints 7 ES NE DT SE Additional activity Askstudents toask you questions using gentle questions and /or a mixture of gentle and shorter questions asin the conversation in Listening 1. ake the names numbers simple or dificult according to the level of your students. Ask ‘them to write down the detailsand then compare them witha partnerbefore you check the answers with the whole lass. *Tip Lookat the Listening scriptto see which ‘ype of questions the doctor asked. Experience willtellthestudentshow to mixthe mee gentle and short questions ‘safe’ way/sto start withthe more gentle questions and then mix What... and short auestions ending with gentle Can... Butt alldepends onthe individual! Additional activity withthe whole clas allow the students achancetotake a history fom you. Start vith volunter and then choose nother student tofolow on * Tip Your students will needtobe abletouse the questions eating to pain frequently and accurately To help them remember, refer themtothe mnemonic SOCRATES site, onset, character, radiation, associations, timing, exacerbating and alleviating factors, severity Askthem toworkin pairs anddothe following exercise ordo it with thevwholeclass Say theletterSor‘site’ and askstudents to give you the appropriate question as quickly as possible. Tyt again 32a waemerinthenextlessonangthen severalessons later *Tip Encourage students to learn two.or three questions intl forthe presenting complain (PC)s0thatthey donot mix them and make mistakes. Additional activity You can use skeleton and attach the non: technical names for the various parts of thebody, eg the ribs, the skull, the elbow, ete by way of follow-up. Orask students todraw an outline ofthe body and write ‘the names against each part they know inpairsand then compare with other students From this, make amaster diagram labelled with the various parts of the body. ‘© For3,askstudents to look atthe Listening script on page 132 Make sure they write the answers down as they will use them in Language Spot 1 You can get them touse the headings on the chart toask each other questions, using fictitious detailsifthey wish Ow 11 Karlson 3 2pm. 5 7953 7 comect 2 correct, 4197330856 correct ‘8 Drones. Language spot Asking short and gentle questions © Students do1-8in pairs, Set a time limit of 10 minutes for 4, and encourage any early finishers to do it again. Ow 1 Possibleanswers Canyoutellme: ‘your family name / what your family nares? ‘your first name(s)/what your first names? ‘youraddress / what your address is? When you were admitted? the date you were admitted? ‘your hospital number / what your hospital numberis? ‘your date of birth / what your date of birth is? ‘your telephone number /what your telephone number is? whether you are married orsingle? ‘your job / what your job is/what you do fora living? the name of your GP / who your GPis? 22 Wheredoyougetthe pain? 'b Does the pain spread anywhere else? € Does it wake you up at right? 4 Can you tell me what the pain slike? © Can you describe the pain for me? Howlong have you had the pain? g Is there anything which makes it worse /better? h When diditstart? | Isthere anything which brings ton? | Isthe pain constant? Haveyouhad the pain before? 31f 2h 3cld/e) 4i Sb Gdande 7g 8a 9k 10) Listening 2 Presenting complaints © @ students give their own answers to1, then complete 2-6. Play the recordingas necessary. Ow 2if 2a 3d de 5g 6b 7¢ Bh 31 What's brought you here? 2 Can you tell me what seems to be bothering you? 3 What canwedoforyou? 4 Possible answers What seems to be troubling you? What's troublingyou? What brings you here? What's the problem? What's the matter? What can do for you? Ste 2) 3g 4k 548 Unit * Tip Note American pronuncitionand stressof bie: ako E2 Additional activity Putstudentsinto groups andaskeach srouptochoose one ofthe conditions lintand describe how they would differentiate between thisconition and something simular Get them todiscuss tach chosen condition in tum, etatime imi but allow the discussion tocontinue fit looks asiitis developing wel: Try nottointerfere,and.use the discussion to bul your knowledge whieh wl neease your confidence Give feedbacken points lke pronunciation tenes, question formation and vocabulary. *Tip Pointouttostudents that, with egardto pain whatis considered mildbyone person may be severe for another. There aremany factors invohed n assessing pain, such as ageand culture; so mil sever, and very severe are subjective interpretations. a collarbone e navel,belly-button i shinbone b gullet £ gut, bowels jheelbone breastbone grist (bone) ankle bone) 4 tummy,belly kneecap Pronunciation Medical terms: word stress © @ Askestudentsto complete tin pairs, then listen to check their answers. Followon with ©. Students can do 4 in pairs. The missing words are from1. © ForS, putstudents in groups of 3 or 4. Set a time limit of 10-15 minutes, but if the discussion is going well, allow it to continue. Make a list of points to correct or discuss at the end. When you have finished discussing any follow: up, doa quick check of pronunciation by pointing to parts of the body. Ow tt sternum,talus,carpus _3 patella, intestines 2 dlavicle, abdomen, tibia 4 umbilicus calcaneus, oesophagus, 4a calcaneus patella f carpus bb abdomen sternum umbilicus € oesophagus Vocabulary Describing pain © Students may give more than one answer for1-the important thingis that they understand the correct meaning of the descriptive words. Allow them to justify their choices. © Get students to doin pairs and discuss how to differentiate between the different types of pain. They can do this by asking as many pain related questions as possible or by encouraging patients to talk about the pain following SOCRATES at the top of p.7.See also OHCM7, p.22. Asking about the site of the pain, the nature of the pain, and whether it spreads anywhere else are the most obvious ways to differentiate between types. Students remain in pairs for 3and 4. Ow tic 2f 3e 4g Sh 6d 71 Ba 9b 10) 31M 2v 3V 45 5V The possible conditions described could be: 1 tension headache 2 sub-arachnoid haemorrhage 3 acute pancreatitis 4 appendicitis (or burst appendix) 5 degenerative arthritis 4 Example answer You can ask the patient to compare itto the worst pain he/she has everhad It’s my job «Ask students todiscuss Tin pais, then read the text, and complete 2* Tip Seta timelimitof 5-20 minutes forthe Speaking exercise. allow students to dscuss freely withoutintrfringanduse the discussion to build yourknowledge. void answering questions at this stage and Collect items for fedback * Tip Use diagramst-stohelpexpiainthe tenses. Often the tenses overap, but the key point isa change emphasis, * Tip Aefore you students start emind them ofthe mnemonic SOCRATES andthe ‘questions relating tothe presenting complaint. Encourage them to introduce themselves clear *Tip Encourage students to form discussion sroups outside the lass todiscussthe tveriesin the untsane todo ole-plays simarto the scenarios intheclassorat work fyoucan, provide aplacein the institution where they study The meeting Canelther be informal and at anytime o formal ata paticulartime each week. The students could rotate the responsibilty for cxgonzation Presenting complaints 9 Ow 21 Thehighlytrained team 2 Their work (the triage nurses, receptionists,etc)isvitalto the 3 ..nextofkinfor contact (is taken) in case of emergency. 45 . the potential for confusion is great unless the data that are taken areaccurate 6 information is checked to make su itis correct and that the patients can confirm ther identity. Listening 3 Apresenting complaint ©) Getstudentstodo in pairs or small groups. For ask them to write notes while listening t the recording and then compare them witha partnerorin groups. let themlisten again to check their notes. They will need toeep these torefertointhe Speaking exercises. Ow 1 100/min 100 beats perminute 8p blood pressure mm/Hg millimetres of mercury we jugular venous pressure os cardiovascular system NAD _noabnormality detected 0/E —_onexamination CNS central nervous system Speaking © Get students to discuss 1-4 freely in groups, Ow Possibleanswers 2 angina 4 administration of aspirin and oxygen; pain elie 3 Angina or myocardial infarction Language spot Tenses in the presenting complaint ‘© Ask students to match the statements and diagrams in’ ‘witha partner, Ow tai b4 cl d4 e1 f4 g2 h2 13 21 hasbeen having 2 Doyounormally go 3 haseased 4 have been lying 5 Is getting /has been getting worse Look at the diagrams. The Present Continuous emphasizes that the action isstll happening ‘around the time ofthe presenting complaint. The Present Perfect ‘Continuous emphasizes that it has been happening before and ‘round the presenting complaint. 6 amnot taking 7 Has / Does the pain spread The Present Perfect relates to the time ‘up tonow and covers the recent history. The resent Simple covers the recent history and asks about each time the pain happens.10 Unit ‘Additional activity Mespenpsentecesuiensts Speaking explaintoeachotherwhattheythine _-@ -Askstudents to work in pairs for 1and2.In 2 questions relating to pain ‘the iagnosisisin eachcase and to give need tobe asked for both notes, as well as questions relating to general, evidence from the patients answers. family.and social history, and to diet and drinking habits. Students remain ‘Then allow a whole-class discussion at inpairsfor3and4, theend about the diagnosis and possible cexaraplesof eases but emphasize the Ow 1 a Possible diagnosis: acute pancreatitis, gastritis, duodenitis, peptic confidentiality ofthe patient Set atime ulcer limit, butallow the discussion to continue b Possible diagnosis: (acute) appendicitis, cholecystitis, gallstones, stmecessary, ureteric clic * Tip oonateafaidtoalowteetsinghee Culture project anddo not worry about not knowing the medicaldetaiConcentrateonthe © ‘Before students do, ask them to explain in their own words what they language andpick upafewrelevantdetals. _thinkis happening, This can be done as agroup or pair work exercise tofeed backon Never be afraid of saying Explain how body language can mean more than one thing and how it youdon't know the answer. The students canbe open to misinterpretation, even within cultures. Refer students to willtespect you fori Reading 8 in the Reading bank, What a half-smile really means Additional acti © Askeach group to produce list for 2 and then together make a class list. As, By way ofrevsion akstudentsinpairs 3 requires computer access, ou can sett as homework and ask students to ‘tprekecty oneof the peenoriog umn t the beginning of the next lesson by way of revisi ‘the unit again. Askthem to concentrate Sosa ee eee by way en conthelr own and the patient's body Ow tia 2 3 4 5 oupags language Ifyou have acess toa camera, 3 1 Everyarea oflife where people communicate with each other, video some ofthe role-plays and play for example business, diplomatic service, teaching, counselling, them back with and without the sound shot Ge ee Eabing ete ionceateats othe boy laniguagecny. 2 itis an approach which means that the doctor needs to deal ‘You may findthe students will want todo Derelyapis ‘with the patient as a person, rather than just the illness, giving, them the opportunity to speak and make decisions about their Additional a treatment. The doctor needs tobe able to interpret the patient's, Youcan turn the internet research intoa body language and mood, notjusttheiriliness. project by putting students into groups 3 The Calgary Cambridge method isa patient-centred approachto sind aiking then thetcinataratoms2 a ‘communicating. Itteaches tools such as asking open questions, collectinformation. Ask or volunteers to present the information tothe class with, orwithout visuals. dealing with patients’ concerns and expectations, and non- verbal communication such as body language. Additional activity Writing ‘Asa quickcheck of your students ability ‘make questions ask them in pairs orasa, Acasa report | dlasstomakeaverballistofthequestons Students do Vand alone or in pais. asked using thetextin Writing e a Ow 11 presented 3 radiated 5 smoked 7 worked 2 was 4 had 6 was 2. Onexamination, he was sweaty but no abnormalities were foundin ‘the cardiovascular or respiratory systems, Hisblood pressure was 138 /82and his pulse rate was 10 / min regular. Hewas given analgesia and streptokinase intravenously and his beta blockers were continued, His pain settled and after two days he began to mobilize. Checklist, Key words «© See suggestions on p5.Go through the list of words to check students" pronunciation and understanding Remind students totransfer useful words and phrases to their vocabulary notebooks.Background Inthe UX, private health care provision exists, but most people are treated within the National Health Service (NHS), which provides free health care. Primary care ‘within the NHSis provided by general practitioners (GPs) who work in practices / clinics called surgeries. Secondary careis provided by hospitals. The general doctors who work in hospitals are called general physicians. Most people inthe UK are registered with a GP There are just over 40,000 GPs in the UK and about 250 million consultations every year. (See pairwork activities on Student's Book pp.114 and 116 for more facts about GPs in the UK) Insome GP practices there is only one GP but thisis increasingly rare as many now work in teams with other GPs and health professionals like practice nurses, district nurses,and midwives. GPs diagnose iliness,treat minorillness within the ‘community, promote better health prevent disease, certify disease monitor chronic disease, and refer patients who need specialist attention ortests toa hospital. General practices the primary point ofaccess tohealth care services. Although 80% of patients have seen their GP within the last year, nly 13% are referred for hospital care.In orderto dothis GPs must: «© have a working knowledge of the whole breadth of medicine ‘© maintain ongoing relationships with their patients— they are the only doctors to remain with their patients ‘through sickness and health ‘¢ focus on patients’ response to illness rather than the illness itself, taking account of personality, family patterns, and the effect of these on the presentation of symptoms ‘ be interested in the ecology (ie. the science of ‘organisms as affected by their environments) ofhealth and illness within communities and the cultural determinants of health beliefs ‘¢ be able to draw on afar wider range of resources than, are taught in medical school, including intuition, knowledge of medicine, communication skills, business skills,and human empathy. ‘Thereare three commonly-used definitions of general practice covering many of the points in the list above: Leeuwenthorst 1974, McWhinney 1997, lesen 2000. For furtherinformation on these see p3 ofthe Oxford Handbook of General Practice (Chantal Simon etal, 2nd edition, OUP,2006) and for more general background on the ‘work of GPsin the UK see pp1-98 ofthe same publication. Useful reference: Oxford Handbook of General Practice 2nd edition, Simon etal. |Additional activity (weaker students) ‘After2, get studentsin their pairstoclose theirbooks and ask each other questions about the differences between the obs discussed, eg What does.a health visitor Check up «© Askstudents to work in pairs and discuss the pictures in Vand the questions in2-This could also form aclass discussion. do? Vocabulary * Tip ‘Ask students to compare procedures between counties they have knowledge of. Forexample, here they could discuss the relative functions of medical personaelin hospitals /elniesin their own countries. Medical jobs © Askstudents to match the job titles to the pictures, and complete the sentences in 2, making sure they use the plural where necessary. They can then doBasa pair or group exercise, or discuss asa lass Ow 11f 2a 3g 44 Se 6b Te 2.1 practice manager 5 practice nurse 2 Health visitors 6 midwife 3 Receptionists 7 Districtnurses 4 general practitioner12 Unit2 *Tip Genera 'Ssenaral soften pronounced 35 _atworsilable word: dsenral Note aso thedifferenceinemphasisbetweendlstict nurse and practice nurse. [Additional activity Encourage students toask each other questions and to develop the conversation by explaining giving reasons and examples. Time limits exercseslik this, bat allow some freedom fortherato develop. Let students ask you questions but youdor'thavetoreveal the truth about yourselt * Tip If necessary, get students to look backat the questions in Unit Language pot. * Tip Vary the activity by putting students into groups and asking them tomakealistof theirideas onaflipchartoracomputr Tell sr0upsto appoint one personto feedback tothewhole class Pronunciation 1 Main stress © @ int.askstudents tolisten and identify the main stress. Ask students to discuss and 8in groups, then feed back their answers to the class. The best answer is probably that they are all equally important, as the team would not work without everybody performing their respective tasks! Ow 1 practice manager ee: 5 district nurse (ow 2 receptionist 0m 6 health visitor (ese) 3 general practitioner (wees) 7-practicenurse(@. 4 midwife (e+) Listening 1 AGP’sjob @ Ask students todo individually then discuss 2in pairs and feed back to the whole class Ow 17 2F 3F 47 SF Language spot Present Perfect and Past Simple Students can do on their own and compare their answers with a partner or work in pairs ‘Ask students to work in pairs for 2and ask each other questions, using Have ‘and What .. etc giving as full answers as they can. Then ask them tomake a list of questions for3. You could then create a master list which the whole class can refer to when doing the role play in 4. Ow 11 Thecoughing started five days ago andit has been so badit has, ‘woken me up every night. 2 When did the attacks first come on? 3 Has anything madeit worse sinceit started? 4 Hehas never taken any medication in his life. 5 What happened when you were near animalsas.a child? 6 My father died over 20 years ago. 7 Did you get these problems every day when you lived in Africa? 8 Have youever had coughing attacks like this before? 9 Has anyone in your family ever had an illness like this as far as ‘youare aware? Speaking Students do Vin pairs and remain in pairs forthe discussions in 2.Get them tofeed back to the whole class, allowing as many students as possible a chance to speak. Encourage students to talk to each other rather than just to address you as the teacher.Working in general practice 13 ‘Additional activity Asks your students toresearch information about asthma, COPD, and pulmonary oedema the day before you 4o Listening 2in cass. Give them the references for the Oxford Handbooks listed in the answerkey to listening 2, ‘exercise 3,oraskthemtosearch on the internet. *Tip ‘Appoint someone from each group to feed backtheiranswers tothe whole ass. * Tip COPD = chronic obstructive pulmonary disease PEFR = peakexpratory flowrate FBC full blood count UME» urea andelectroytes (CRP-=Crreactve pretein {A3G= arterialblood gas *Tip Studer neetobe aeulwhen theyask dteut serous esses he malgnangy (cance) because the ptt maythen ‘hintheyaresuterngtomthis See oucing22 Tip Be prepared or dsagrement and aon ite happen Ak students tocheck thet anowesina medal textbook neces tg oneot the OnerdRandboots. Ow 1 Student A: Student 8: Vien 4.42000 1 250million 4 14 21988 510500215 578 3 freecomprehensivecare 6 quarter 37000 «6 40 Listening 2 Acasehistory © G Before students listen ask ther toworkinpairsto discuss thetopicin {use thisas an opportunity to build your own knowledge. Then play the recording for2s0 students can complete the nots. © Putstudents in groups of three orfourto discuss the questions in3and 4 Set atime limit, but allow extra time ifthe discussion seems tobe going well. Again, use the discussion as an opportunity to build up your knowledge of the subject. Don'tbe afraid of saying you don’tknow specific medical answers. Make alist of grammar and pronunciation mistakes to feed backto the clas. Ow 21 breathlessness 5. atnnight 9 known 2 wheezing 6 inthemoming. 10 asthma 3 cough 7 three 11 previous 4 phlegm. 8 tightness 12 ecema 3 1 intrinsicand extrinsicasthma, COPD, pulmonary oedema, 2 PEFR, sputum culture, FBC, UBE, CRP, ABG analysis. 3 Teach the patient to use a peak flow meter to monitor PEFR twice a day. Use a step-by-step approach: Step 18-2 agonist a5, required for symptom relief. (See OHCM?, p.164-167). 4 Example questions: Doyou haveany brothers and sisters/children? Are they in good health /alive and well? Are your parents/close relatives alive and ‘well /in good health? Have they had any majorilinesses in the past? Has any one in your family had anything like this? Vocabulary igns and symptoms © Askstudents todo and 2 in pairs. A sign is an indication of particular disorder that the doctor sees but which is not apparenttto the patient. A symptom is what the patient notices him / herself. Sometimes, signs can be classed as symptoms and vice versa, Allow sufficient time for discussion and give feedback about grammar and pronunciation, To help expand your knowledge, ask the class to explain the answers to you afterwards. «© Students write answers for on their own, and compare in pairs. Ow 1 Condition a: Condition b: Condition: 1 Symptom 1 Symptom 1 Sign 2 Sign/Symptom 2 Sign 2 Symptom 3 Sign/Symptom 3 symptom 3 4 Symptom 4 symptom 4 Sign 5 Symptom 5 Sign 5 Symptom 6 Sign/Symptom 2a sinusitis asthma gastroenteritis. (See OHFP2for further detailson each of these conditions)14 Unit2 *Tip flats = breakingwind R= perrecum UFatetilise fossa sats= oxygen saturation * Tip (weaker students) Allow student to read the Listening script fiom Ustening2or practise eading I aloud ‘Additional activity Encourage students tokeep alistof ‘echnical words and their non-technical equivalents, Youcould createa master list ‘onacomputer, which the whole class adds toperiodically asa revision exercise. Every ‘ime you update, an electronic orpaper versioncan be given toeach student. * Tip Point out non-technical equivalents of ‘echnical words and purely medical words each time youcome acros ther. *Tip A =increased PEFR = peak expiratory flow rate FBC =fullblood count UBE = urea and electrolytes CRP = C-reactive protein BG =arterial blood gas WC= white cellcount 3: Symptoms: abdominal pain cramps (usually left-sided, improves with bowel opening) irregular bowel habit, fiatus bloating, PR bleeding. Signs: increased temperature, increased pulse, + decreased BP, LIF tenderness, + peritonitis, distension, (See GHFP 2 for more information about this disease.) ’b)Pneumonia: Symptoms: cough, increased sputum (green), pleurtic chest pain, breathless, haemoptysis, fever, unwell, confusion. Signs: Increased temperature, increased RR, increased pulse, decreased sats, unequal ar entry, bronchial breathing, dull percussion, reduced expansion. Speaking ‘¢ Askstudents to workin pairs todo the role-play in © Putstudents in groups for2and3. Ask them to make a master ist of gentle and short questions for? to feed back to the class. Seta time limit and ask one person to be responsible for ensuring the questions are written down, A different student can give feedback to the whole class. Ow 2 Possible questions: ‘a Can you describe the pain for me? Have you had any fever? Is there anything that makes the pain better/worse? b What seemsto be bothering you? Can you describe the tightness a bit more for me? Isthere anythingelse associated with the tightness? When isthe coughing worse? «Are your bowels OK Any diarthoea/vomiting? What isthe pain like? 3 Main investigations: a CTscan,butrarely necessary b PEFR, sputum culture, FBC, UBE,CRP blood cultures, ABG analysis ¢ WICC, CRP, stool cultures, and possibly an abdominal X-ray Vocabulary Non-technical language © Ask the whole class to answer Yas a warm-up. Then get students to work in pairs for 2and3 Listen to as many pairs as you can and give feedback on question formation. Ow 11 start 2 precipitate 21 do 4 prone 7 stickto 2hasgot _§ comesand goes. 8 admitted 3 avoid Gthereallthetime 9 booked Listening 3 Short questions in the general history © @ Askstudents to listen and write down the questions. Ow 11 Isyourappetiteok? 3. Waterworks OK? 2 Bowels OK? 4 Sleeping OK?Additional activity ‘Ask students to workin pairs and takea history from each other about pneumonia oranother condition of their choice Ifyou can videoone ormore of the conversations and play them back othe students. fthisisthe fist time you use a video with your students be positive in giving feedback Allow students tofeed back about themselves fist Additional activity Checkattheend ofthe ass that students can make short questions a5 automatically as possible Askthemto listen out for examplesof hort questions enV /rada ete Pointoutthatthey are used in altypesof communication. You canbegin your subsequent checking wit Foundany? * Tip Insome lass discussions you maywant to make the discussion as fees possibleand not provide feedbackat the end * Tip Social ss refersto people with profesional occupations. eg doctors, Chartered accountants, engineers. Socal clasacefersto people with managerial or technical occupations eg managers Journalit shoo! tenchers, Working in general practice 15 Patient care «Students do1 on their own, then compare answers witha partner before youcheck with the whole class. «Ask students to work n pairs for2 and 3to practise shortening and lengthening the questions. You may want to play the recording again before they do. Ow 11 Areyou/Have you been eating well? 2 Isyour appetite OK/ Has your appetite been OK? 3 Are you/ Have you been sleeping OK? 4 ‘Are you/ Have you been passing water alot? 5 ‘Are your periods/ Have your periods been OK? 6 Have you had any diarrhoea? 7 Have you lost any weight? 8 Have you been living there long? 9 Have you been keeping well? 10 Are you/ have you been OK in yourself? 11 Are youy/ have you been looking after yourself? Pronunciation 2 ‘Questions: rising and falling intonation © @ Read the introduction as a class before students listen to «@ @ Play the recording n2.Let students compare their answers witha partnerbefore listening again. They can stay in these pars for3 reading the ‘questions from thelistening script toeach other. Ow 1 Thedoctor's voice rises. 2IF 2F 3R AR SF GR 7R ER 9F 10R ‘© ‘Students do Tin pairs. For? ask them to the scan the text individually for the symbols / abbreviations, then read the text in full, and answer the questions in3 witha partner. ‘© Putstudents in small groups to discuss 4, and then feed back tothe ‘whole class. This can lead into class discussion of 5. seta time limit and. encourageas many students as possible to participate. Ow 1a homelessness or sleepingrough b cramped housing /accommodation ‘¢ smoking (in front of children) d eatingtoo much (See OHGP2, pp.222-3,) aly 2M 3c 49 31 homelessness, sleeping rough, employment and unemployment, divorce and immigration status 2.80 years ago, tobacco was fashionable and more affordable for those in higher paid jobs. 3 Some general reasons are general anxiety about living conditions, lack of security, worry about the future. 4 Some reasons are they probably have little or no money; no access to cooking facilities; lack ofa balanced diet with fresh vegetables; no fixed routine.16 Unit2 4 Possible answers: Poor diet and stress increase the risk of coronary vascular diseases and cancers. Those who are unemployed or under the threat of unemployment may not be able to afford to eat properly or may besuffering high levels of stress due to uncertainty about their future, therefore are more likely to suffer from these diseases. Violence and accidents may occur for various reasons lke frustration and angeras a result of work oss, One study showed that afterthe announcement ofa factory closure, GP consultation rates increased by 20% and referral rates by 60% (See OHGP2,p.223) Writing Areferralletter © Ask students to work in pairs to read the letter and complete 1to5, Encourage them to make notes in 4 for use in completing 5, which could be done in class or as homework. Ow 1 Allpointsinthe ist are covered except 9, 12,and 13. 2.1. NHS Number 6784335792 2 Hospital Number 1017865 3 Re David Hunt 17 May 1975 (M) 4 18 Greencross Street, London SET? 2PD 5 ..onand off for more than three months. 6 The rashes have also decreased in frequency and 7 ..to be related to allergy to carpets, nor work or other common factors 8 The patient spent several yearsin East Africa working 9 .asateacherin his early 20s 3 has complained Present Perfect has erupted Present Perfect hhas also complained —Present Perfect hhave also increased —Present Perfect does not appear—Present Simple hhas responded — Present Perfect hhas had~Present Perfect, spent —PastSimple ‘may have~ modal verb + infinitive without to would appreciate -Second Conditional Project © ‘Icanbe done in class oras homework, individually, in pairs,or in groups ‘Tohelp structure the activity, make sure students understand they will be required to give feedback In class, set atime limit and ask students tocompete to see who finds the information first. Then use 2as an ‘opportunity for a whole-class discussion. Checklist, Key words © See suggestions on p 5. Gothrough the list of words to check students pronunciation and understanding. Remind students to transfer useful ‘words and phrases to their vocabulary notebooks.Background Ina training environment, doctors, nurses,and other health professionals need to beableto give and receive instructions about how to performa wide range of procedures. In such settings, itis possible to be very direct and use the imperative form of the verb: nsert the needle between... This can be varied by adding the word you You insert the needle... The imperative does not sound {impolite here,as each command formsastep whichis partof an accepted procedure that islearnt like a formula ‘The person receiving the instruction will perhaps pass on the steps to someone else as partof their teaching oras part of revisinga procedure. However, when it comes o talking to patients ina patient-centred environment, it is essential to take a ‘more gentle and more indirect approach tofit in with the conventions of politeness in English. This is especially important when people are feeling vulnerable and pethapsill at ease. Common ways to express polite requests when asking patients tofollow instructions are by using Could you /Can you... For example, a doctor unit3.17 ‘may need toask a patient to get undressed. itis not advisabletto say Undress /Take your clothes offs this ‘would sound rude in English instead, your students need toleam and observe polite conventions in English, for example Could you take your clothes off please? Immany cases,as inall languages, politeness depends onthe speaker. A native speaker may be able o give an instruction which for someone else may seem rude. Ifa doctor keeps repeating Can you /Could you without any variation itcan end up sounding rather artificial and possibly insincere. Itis important to encourage students tolearntostart with Could you /Can you and then vary these requests with expressions that soften imperatives Jike Just [lit up your legl for me, ifyou can please; 1 lke ‘youto..;0rIneed youto...ifyoucan. Politeness and gentleness are different indifferent languages. A literal translation from one language to another can seem strange. Students need tolearn that its the meaning that they need to translate, not the words. Useful reference: Oxford Handbook for te Foundation Programme, 2nd edition, Hurley et al. Check up «Students can do Tand 2in pairs and then form groups for the discussion in 3. Ow 1 Theyall showa newly qualified /junior doctor at work, 2. Anewly-qualified /junior doctor is asking a patient to get undressed. The doctor perhaps took a case history before the scene in the picture and afterwards examined the patient. b Anewly-qualified /junior doctor's writing up case history notes. The doctor perhaps tooka case history, and after writing upthe notes, saw another patient. Aslightly older doctor is explaining a procedure to newly Qualified /junior doctors. he senior doctor perhaps asked the students what they knew and, after demonstrating, asked for volunteers to show what they learnt Anewly-qualified /junior doctor's talking with a consultant and the team during a ward round. The consultant may have asked the junior doctor questions about the patients and then advised on treatment, investigations, et. «© Anewly-qualifed /junior doctor is asking a phlebotomist to take some blood from a patient. senior doctor may have asked for thettest. The junior doctor may have had difficulty and then called the phlebotomist totake the blood instead * Tip Ifyou think it btterto concentrate on the students’ best experiences, then encourage this. However itis important for students, totalkabout difficult situations and eases sothat they can learn from them. They might find somebody in ther group who faced a similar problem. tis alsoimportant for personal development, as wellasinjob interviews, to review difficult situations they have dealt with.18 Unit3 6 Anewiy-qualified /junior doctorishanding over at the end ofa shift. He may have written list of particular jobs to be done, handed over and gone home. Listening 1 Additional activity Preparing for the first ward round Toueanastgiupstopeparelistof tis Yowomaskgurtoperrsalf¥is § act tadentsin groups te lsat thetipsin forexample which they ‘them inorder of importance. Each group have found useful themselves or wish they/d been given, or any they might canthen present the information tothe disagree with or wish toamend. Get feedback from the class for2, with whole class and compare their rankings. examples where possible Invite students to give examples fram their own experience. ‘# @ Students can do3 on their own, then compare their answers witha partnerbefore forming groups again forthe discussion in @ Encourage themto discuss other tips from their own experience, in addition to those given Ow 3 2 familiarwith your patients. b looking for patients, refertothem quickly. d the patients on the ward. € access information easily. | Additional activity Patient care Toencouragethe incusionof Inwoductionsinprocedures whenever ® Getstudents todiscuss Tand in pairs and feed back tothe whole class. youdoa role-play, always askstudents to Ow 1.1 Consent rom the patient isa legal requirement where the Introduce themselves and give their title procedure is invasive. The consent may be necessary in writing. and position in greetings: Good afternoon, {See OHCM?,p 554) arleLmrneelsaneln 2 itis important that the patient knows who the doctor i, to put the patient atease. The doctor may be wearing a name badge, but the patient may not be wearinghis /her glasses; the patient ‘may not be ble toread, etc : 3 Allnecessary equipment needs tobe present. missing instrumentin the middle ofa procedure may cause problems. 2 Possible answers Explain the procedure tothe patient simply and clearly. Explain whyitisnecessary. Explain what the procedure will belike forthe patient ‘Think about previous successful procedures you have done. Prepare the procedure by thinking through each step and use this, process to check though the equipment Decide whether you need an assistant. Vocabulary * Tip Instructions fora procedure (CSF =cerebrospinal fluid ‘© Students can do on their own, then form pairs to discuss 2 Ei Additional activity Ow 1 aWithdaw = c Mark Obtain. —_g Prepare Askstudentsin pais to take tums saying iNet di Waet> oh fSteitzal tea hesttach theverbstocach other andelicting the covatietatbed bane a 2 The instructions relate to the first stages of alumbar puncture. For check vocabulary with the whole clas. the ull setof instructions, see OHCMT7/pp.756-7)Additional activity Forhomework, ask students to choose ‘theirown procedure to explain step by step. If possible, they could dothisin pairs r groups. Ask them to present theirproceduretothe dlassat the following lesson. Allow 5-10 minutes for presentation and S minutes for feedback and discussion, [Additional activity ‘Asanalterativetoaskingastadentto talethrough the set ofinetictions, ak forvolunteerstodo tin fron oftheclast orforatudentto doit with you. Invite feedback ist fromthe student orfrom thevolunteers themselves then ask the classand then give your ow feedback ityouthen have other volunteers allow severaltodoit Always encourage constructive feedback *Tip Allow about 15 minutes forthe discussion Setting.time limit encourages students to focus and organize their discussion. t alsohelps yout organize and contol the classroom activities. ‘Additional activity ‘Askstudentstouse the notes made fromtheir discussion to write 150 words explaining the notes taken. Thiscan bea class orhomework activity. Instructions and procedures 19 Language spot Giving instructions Go through the introduction as a class. Ask students to workin groups or pairs todo Tusing the imperative, and 2 using the present simple with You. Invite students to suggest other linking words: then, before, after, when once, immediately as soon as. Put students in small groups for3.They can write down the instructions together or they can prepare the lis verbally, then write it down on their own, and compare with each other You can check students are using the correct language without needing to know what these steps ae. (The OHFP gives full desriptions ofboth IM injections and ABC) Speaking ‘Students do 1 on their own, form pairs to compare their answers, and then explain the procedure in2. Allow students tolook at the vocabulary the firsttime they do this. Then ask ther todo it again with reference tothe diagram only. Students could be encouraged to think about 3 for homework Put them into groups of three or four to discuss. Allow about 15 minutes. One group member should take notes for feedback to the class. Before feedback is given, ask each note-taker to summarize what the group discussed. Give a time warning after 10 minutes. Make sure you vary the note-taker and the group members each time you do this type of activity. Seta time limit for feedback (Ow 1 a Wet hands.and forearms under running water. b Take soap from dispenser. Soap up, rubbing palm to palm. Rub with fingers interlaced. © Massage between fingers, right palm over back of left hand, left palm over back of right hand. f Rub with Fingers locked, including fingertips. Rubrotationally with thumbs interlocked, h Rinse thoroughly. i, Dryhands thoroughly using a paper towel. | Dispose of towel into foot operated pedal bin. Do not re-contaminate hands by touching the bin lid. ‘Ask students to do Tin pairs. Then for2 they talk briefly about how the verb and noun pairs might relate to the text. This will help them to predict parts of the text and develop the general gist before reading. They can then do3 on their own before comparing answers with thelr partners. Put students in groups for & Either follow the procedure for group discussion as in the Speaking section or make this a whole-class activity, where student volunteer writes the notes on the board. When you have finished, ask several students to volunteer to summarize the notes taken.20 Unit3 * Tip ‘Askfora volunteer totype upa master listo instructions toshare with his/her colleagues. Choosea diferent student teach ime you askfor volunteers to typeup notes. Additional activity Collect photographsof different proceduresorask students to collect them foryou. Usethemfor group discussion / paitwor/random testing /cast Additional activity Before playingthe recording students can.use the ilustrations to give their own instructions (without referringtothe Listening serip) *Tip Ifyou have access toa clinical dummy, ask students touseitforole-play Additional activity Askstudentsto give instructionstoa patient fora lumbar puncture or primary survey, Ow 11 provide feedback 5 administer medications 2 undertake procedures 6 seekhelp 3 assess competence 7 consider feelings 4 identify strengths 31 various 5 very 2 solely 6 may 3 created 7 considered 4 expected Speaking Students describe the steps, either verbally or in writing They then swap partners and take turns explaining the procedure. Ow Possibleanswers Primary Survey Airway Protectthe cervical spine. ‘Assess for any signs of obstruction, Ascertain patency, establish a patent alway Breathing. Determine respiratory rate, Check bilateral chest movement. (Fora fuller description, see OHCM7 p.767) Listening 2 Giving instructions © @ Students can do Vand 2on their own, then form pairs to do3 Elicit the answer to 4, Then put students in pairs or groups for Sand 6.Remind them tose polite requests Ow 14 b7 cz d3 e5 f6 gt : 4 WVcannulation 5 Possible answers Canyou sitin an upright position for me? That's fine. Can you lie down flat for me? ‘Now like you to roll up your right sleeve above the elbow. OK, thankyou. Id like you toraise your elbow—that'sit. (to apply the tourniquet) ‘Canyou lift yourarm for a second for me? (to put a paper towel underneath to collect any blood spills) Thankyou. ‘And just stretch out your arm and relax. Thankyou. Just relax and keep nice and stil for me, ifyou can, Canyou clench and unciench your fistfor me? ‘Can you wait fora second while get a senior colleague? (ifthe ‘cannula can't be inserted) (See OHCM?,pp.748-9)*Tip Set atime limit of about an hour forthe whole activity but be exible. Go round helping students and give time reminder every 10 minutes to encourage them to organize themselves *Tip Remind students about confidentiality and nonyity tall times when talking about particular cases. *Tip iepatoenireoener se ache bacterin pt ot rs erin palaces ‘ane ue pees lal ands Instructions and procedures 21 Language spot ‘Making polite requests to patients «© Read through the introduction asa class, Students then do Vand 2in pairs. ‘Ow 1 cand gare inappropriate as they are very abrupt. 2 Possible answers 1 Can you just pop behind the screen 2 ..50if you could turn onto your stomach (for me), (please). (Thank 1). 2 listaough forme 4 Vike youto stand up forme. 5 Could you (ust) tiityour head 6 Canyou makeattghtfist 7 Fle youto keep nice and still. Listening 3 Instructions © @ Askstudentstolisten and correct their sentences from Language spot It’s my job «Students read the textin and find the information. Ow 11 afirm 2 twosenior doctors 3 specialist registrars (SpR) 4 specialist registrars (SpR) 5 theconsultant 6 the consultants’ rounds 7 the junior doctor Speaking © Ask students to work in groups for Get a student from each group to give feedback from their discussion so that you cover the whole class. When you have gone through the checklist, ask if anyone wants to add anything, ‘Some suggestions for discussion would be why each stage is important ‘and useful (for audience and presenter), how much information to give and when, and how to handle comments. (See OHEP section on ‘Case presentation’) © For2,putstudentsin groups of three. Encourage them to use as many of the Useful expressions listed as possible. They will need torefer to thedetail of this casein Writing3. © For3.and4, each student presents the case history he/she has prepared toapartner in another group, who takes notes while listening. Again, encourage them to use the Useful expressions. The listening students write down questions which they then ask the presenters when invited todo so For5, students give constructive feedback to the presenter, considering factors such as organization, clarity, and fluency.22 Unit3 Writing *Tip Case notes FEC =ful blood count eee « ForT,students discuss in pairs what each note means and what the patient's condition is. Check that students understand the underlined items in2.Then get them todo30on their own. Ow 2we Ward Round RIA/RTC road trafficaccident /road traffic colision Obs Observation(s) o temperature BP blood pressure oft onexamination INR international normalized ratio ur liver function test Ute urea and electrolytes (H) home mane tomorrow (0/P n6/52) Out-patientin 6 weeks Checklist, Key words ©. See suggestions on p.S.Go through thelist of words to check students" pronunciation and understanding Remind students to transfer useful ‘words and phrases to their vocabulary notebooks.Background Your students may be used tolistening to procedures being described to them but may not be familiar with describing procedures themselves, as they may have to do inteaching settings. They may be even less familiar with ‘explaining procedures to patients. ‘The language used in explaining procedures to patients is very different from that used when one health professional isexplaining something to another. The most obvious difference that comes to mindis in vocabulary -the use oflay terms instead of sub-technical words and technical words that are pure medical terminology. Sub-technical ‘words are words like visualize, insert, attach, etc. ie. words ‘that are technical, but which may be found in othernon- medical technical fields such as chemistry or engineering Medical terminology also consists of technical words ike diverticulitis gastroscope, anaesthesia etc, which are words unit 23 When talking to patients, tis not just the vocabulary which is different, butalso the grammatical structures that are used. Before a patient signs a consent form or gives verbal consent, he or she needs to understand clearly what is going to be done. Using be going toimplies that the intention is tocarry outthe procedure, but it depends con the patient giving written or verbal consent. ‘Another feature of explaining procedures to patientsis structures such as What we are going to donextisto/ What happens next is we... These encourage students to use simple language and help to avoid using the passive. Some procedures, like colonoscopy or colposcopy, involve talking about intimate areas ofthe body. Medical students should not be embarrassed, soit s important that you are not embarrassed either. Useful reference: Oxford Handbook of Clinical Medicine, ‘Thedition, Longmore etal ‘Additional activity ‘Asa whole-clas activity, askstudents to discuss the similarities and differences in procedures suchas gastroscopy in their own countries Isthe equipment different? Who carries out the procedures? *Tip Remember alwaysto keep patient confidertilityin mind Telistudents when they discuss case detllsnot to use real namesorsayanything medical orotherwise) which wouldidentify the patient. *Tip Before you start the Pronunciation exercise, check students remember what is meant by | Word stress and know what asuffixis, ‘that you would expect to find only ina medical setting, Check up © Blicit the answer to Ifrom the class. Then put students in pairs todo2. For questions 1-3 of 2, encourage students to think about the patient's physical, and emotional reaction compared to their own. For question 4, encourage students to talk about procedures they have done. Remind them that not, only is this good language practice, but also good practice for job interviews, ‘where they need to be able to give specificexamples of their own rather than an example from atextbook Ow 1 Anendoscopy (or gastroscopy) Pronunciation Word stress © @ Students do and 2. Then they listen and check their answers for. © Getstudents to identify the stress patterns in 4 and then decide which of the statements in Sis true.In medicine, many words that students will, encounter have more than two syllables, where the stress usually falls on the third syllable from the end. A useful guide sto use thisasa‘rule’ and find exceptions, eg. endoscopic. With words ending in-scopicthe stress is always on the second syilable from the end. ‘© Putstudents in groups of three to discuss 6.The instruments area proctoscope /proktoskoup/, a colposcope /kolposkoup/,and.a bronchoscope "bronkoskoop/; check the pronunciation as students are talking24 Unita Ei Additional activity Ow 11 24 3a 4b Get students in groups tolistas many 2 endoscope ( endoscopy (9@ee) endoscopic (ewe) ‘wordsas possible withthe suis 4 A (ee) 2 em) 13,5. (8+) 46,7 fom Pronunciation Write ther answers saris onthe board, andaskstuéentst explain toyou whateach procedure or items. Askfora vointettotypeuupamaster eiaeit listfor the whole lass. Examples might Listening 1 ‘nee ppendectmy,tonsiletomy, Patlentcare Timpectony hepiectomy, atectony, laparotomy, laparoscopy, tracheotomy, © @ Students listen and make notes on their own for, then compare with a iteectomy /liektomil, ileostomy, ileotomy, partner for2. They can stay in pairs todo3. hysteroscopy, ysterectomy, Ow 1/1 Thepatientis asked to stop anti-acid therapy fortwo weeks * Tip beforehandif possible seis bso, concceprectRe 2 The patientisalso.advsed to take nil by mouth for eight hours latestinstruments andr ald instruments before the procedure is done, but nate that water upto fourhours ‘oraskstudents each to bring ina picture. before the operation (pre-op) may be OK. Getstudentstoscus themand decide 3 The patientis advised not to drive if sedation is involved whatthey are/were used or 23 Themost common verb form isthe Present Simple Passive. *Tip foravestecssstopthecodingater — Language spot each piece of advice and alow students tocomparenotes. hen paythe whole Explaining investigations / procedures with the Present recording straight through once again. Passive Alternatively play the recording and ask Studentstodktorenotestoyoutowriteon © Gothrough the introduction as a class ifstudents have not already read it theboard.Avoldcorectingthe answersat for Listening 3. Students can then dot. thisstage Another way todo thisistowrite theanswers on the board, but adaingin Some mistakes. number stopanti-acid ‘therapy forthree weeks) andaskstudentsto listen and correct «© Students can do 6 on their own, then compare with a partner, They remain in pairs for7. They may want to add to or expand the stepsin the procedure. © Putstudents in pairs for. They can then do Bon their own before pairing up again for @ and§5.Don't let them write the answers down for sothey have to think about the answers for. Ow 11 Theneedle'sinserted (by the doctor) 2 This procedures often performed by a nurse /nurses. 3 Gentle pressureis then applied tothe puncturesite (by the doctor) 4 The procedures explained tothe patient (by the sister). 5 The skins cleaned (by the nurse) 6 This emergency procedure s not performed by doctors without additional activity training ‘Askstudentsin groups tomake similar 7 Thevein is tapped (by the doctor. statements about one ofthe procedures 8 Generally, this procedure is not performed by nurses. carried out withthe instramentsinthe In sentences 13,4,5,and 7 the agent is left out when explaining a Pictures you broughtin for Pronunciation procedure because it isnot necessary:it is clear from the context 6 Don'tlet them write the statements Shen oe eR Ne, who the agentis.In 2,6,and 8 the agent is necessary because ‘naming the agent isthe purpose ofthe sentence. ‘out forhomework eae seas i Additional activity 3 1 consent /obtained 5 air/ blown ‘When students have done Language spot 2 anaesthetized 6 patient /given 3-2askthemtotellyouthe verbs used in 3 sedated Fa rales fection ‘order. List them vertically onthe board, then ask studentsto makea complete sentence for each verb without referring tothe book. 4 endoscope / advanced 8 mucosa/ biopsied 41 Obtain informed consent. 2 Anaesthetize the pharynx usinga spray. 3 Sedate the patient to induce drowsiness 4 Introduce the endoscope and advance it further down...Explaining and reassuring 25 PT] El additional activity Give students the lay terms for pats of the ody and ask tern togive you the medial name. Ask students to wite these medial names on pleces of paper and take tums sticking theron toa Steeton Then ask them to wnitethelay terms onto the labels or suppty them, yoursefiecesary) Make suestodents distinguish between fingersandtocs if youdon'thaveasteleton you couldusea Toughoutlineon the boardoralarge sheet of paper. Ask fora volunteer tocallstthe stand typeitupforthe whole dass * Tip A gestrascopyis atype ofendoscopy. *Tip Allow weaker students toread the Ustening scripttogether before they do. Take one of the sentences I-8,for example We're just going to take some fluid from ‘your backbone. Write the sentenceon the board and say t withthe main stress on different words:just fluid your, backbone. Ask students to identify the main stress and give you the meaning in each case. Once they are familiar with this ask them toworkin groups towrite thelr ‘own sentences using words like simple, orother reassuring words.Go round checking the sentences. Ask them to work witha partner from another group and. say their sentences toeach other. The partner says the word which is being stressed and explains the meaning, 5 Blowair into the stomach via the side channelin the endoscope 6 Give the patienta plastic mouth guard tobite on. 7 askthe patient to swallow the first section of the endoscope. 8 Biopsy the stomach mucosa using the thin grabbing’ instrument: 6 1,2/3,6,7/4,5,8Note: 2and 3 occur closely together.as do 7and 4. Listening 2 Explaining gastroscopy (endoscopy) © @ Students listen and do Tand2. For 2, the lay words may be phrases rather than a single word. You may need to play the recording again. They canthen do3-in pairs. Ow 1 Steps',3,2,4,8,and5. 21 gullet 4 bendy 7 look at 2numb 5 (take)atinytissuesample 8 belch 3 throat 6 somethingtohelpyourelax 9 see 3 +e: flexible, biopsy, sedative, visualize 4.1 We're going to do something called a gastroscopy. 2 What we are going to dois tohaveaalookat your gullet and your stomach to see what's goingon there. 3 First, we're going to give you something to help you relax. 4 Weare going topassa bendy tube, which isno thicker than your little finger, down through your throat into your stomach. 5 Thetube ill havea tiny camera on the endso that we can ook atyour stomach. 6 We'realso going to blow someair into your stomach to help us seea bit better 7 If we see anything, what we can dos take atinytissue sample. Vocabulary Reassuring © Students do Tand2. You may want to ask them to give reasons for their answers in for example, how would each statement make the patient feel, how could it have been said differently? Ow 1 sentences Sand? 21 simple -» straightforward 4 tiny small, scratch pinprick 2 some-a litle 6 only->just 3 slightly atte bit 8 hardly ~ barely Listening 3 Emphasis ‘© @ Students listen and do on their own, then discuss in pairs. Ask them what they would say and discuss the need for and implications of explaining detailin such situations. They remain in their pairs for3. Ow 11 simple 3 just 5 ten 7 pleasant 2 just 4 tiny 6 only 8 anything ‘The doctor emphasizes the words to reassure the patient.26 Unit4 2 Possible answer Thedoctor could acknowledge that its scary and then emphasize ‘that it won't take long or that it sn'tas bad as it sounds. The doctor needs to explain the procedure so that he /she can obtain informed consent, but givingall the detail can scare the patient! 3 Possible answer The doctor might talk about the feeling afterwards, point out the risks of the procedure, and answer the patient's questions. Language spot Additional activity Explaining procedures with be going to future Ingroups,askstudents to write another sentence deseribinga diferent partof each procedure in, beginning What, @ Read the introduction as a class before students dot either on their own or in pairs, taking turns to say a sentence for their partner to transform. Put ‘Thiscan beset ashomework ‘them in pairstodo2, Ei Additional activity Ow 11 We're going toremove a tiny piece of tissue from your bowel. Using theirown knowledge ask groups 2 What we're going to do then sattach the end ofthe guttoan of studentsto prepare a brie al lasting ‘peningin your tummy wall rnomore than five minutes on any aspect 3 We're goingto take tiny piece of tissue from the neck ofyour womb, of oneof the procedures in2.They should 4 What we're going todo afte thats (to) pass this tubethrough appoint someone tolead the discussion Rbeineihre ea pmuegesjojahsnotes ire Shem, 5 What we're going todo then is(o)removetthe glandsin your armpit. about 15 minutes to prepare. Then ask teach group to present theirtalktothe class. Allow questions and comments 6 What happens nextis thata tiny piece of yourlungis removed / 'Whatwe ae goingtodonextis (to) remove tiny piece of your lung. retscn fotos: 7 What happens nextisa tube's then passed down / What we are - Boing to donextisto passa tube down past the prostate into * Tip your bladder. 8 What happens next that we / What we are going to donextis ERCP = endoscopic retrograde : 5 Hulsigesaenaceaeey Ra etes eb ie eae eae tetany io kendsioo penkristograi 9 We're goingtouse a mesh to repairthe muscle. 2a7 b5 c2 di e3 f8 g4 h6 i9 * Tip Speaking Inole play practice remindstudenst0 4. pyt students in pars todo. Encourage them touse What./be going to sgekennseal pare necessary: and the Usefill expressions. For 2,ask students to expand the notes into fullsentences using the expressions listed. They willbe practising these sentences with a partner in the next exercise «Students workin pairs for3, taking turns asking questions about the conditions in 2, and answering using the explanations they have devised ‘They can remain in pairs todo or you could doit asa whole class. Ow 2.1 appendicitis: it'sa condition where the appendixis inflamed and ithas to be removed, 2 Alzheimer’s disease: it’s a condition where someone has memory Joss and mood changes, for which the cause is not known. 3. haemorthoidectomy: t’sa procedure where plesaretied orcut out. 4 diverticulitis: it's a condition where sacs or pouches form at weak points in the gut. When the sacs are infected, inflammation ‘occurs and causes pain, diarrhoea, and constipation. 5 sigmoidoscopy: it’s a procedure where we look at the colon and take a sample ifnecessary.Explaining and reassuring 27 6 anaesthesia: it’s a procedure where youare givena ‘general anaestheticto put you to sleep before an operation and then you come round after't is over. 4 Informed consent is given after the’ whats goingto happen and why: implied consent isnot explicitly stated but clear from the patient's actions, for example, ifthe patient offers you their arm when youare about to take blood. Expressed verbal consents when information about a procedure is explained and the patient verbally agrees to have it done. Expressed written consents when an extensive explanation is given and the patient and the doctor both sign a consent form. Consultant consent s given by two senior doctors where a patient lacks capacity to consent themselves for example in cases of severe mentalillness (Forfurther information, see OHCM7 pp.554-5) * Tip Reading Agood introduction to ary readingexercise canbetogetstudentsto predict he contentof the text rom titles, headings pictures.ete © Get students to predict the content of the text in ,eg. what information about the preparation, after-effects, reliability, and side-effects of gastroscopy might be given to patients. ‘© Students can do2 on their own, then form pairs for 3and 4. They should do with books closed, Ow 21 Donitest 4 somebody to accompany you home 2 relaxed 5 not foolproof 3 operatemachinery 6 amildsorethroat 3.1 What do you need to do for 4~6 hours before the procedure? 2 How will the sedative make you feel? 3. What should you not do for 24 hoursafter the sedative? 4 What doyou need after the operation? 5 How successfulare the results of the test? {6 What dosome people have afterwards? Vocabulary Explaining com © Students can doand2in pairs. Ow 11 usually 3. never 5 always 2 often 4 rarely 6 sometimes Order of frequency: never, rarely, sometimes, often, usually, always 2 rarely: seldom, almost never, not often sometimes: occasionally, now and then often: frequently, regularly usually: typically, habitually, generally, commonly ‘Additional act Aineencormivsecmn asksudertsin _Ustening 4 parstotaketumsselecting procedure _Diseussing complications dred deserbing the possible complications toapatent Alsthemtodescietwoor © @ Students can do in pairs.They listen and do2-4 on theirown, Pay the thre procedures each, recording agninf necessary. They then listen againto do528 Units * Tip Hfstudents need prompting for refer them tothe last section ofthe Reading text on P33. *Tip While students are talking about medical matters listen and use this as alearning ‘opportunity to build your understanding of thesubject Additional a Collectarange of pictures showing different emotionstobring tothe clas. Put the students into groups and give ‘each group twoor three different pictures ‘Ask them to discuss the emotions being shown and how they would deal with them. Ask the groups to present their pictures tothe class and describe how they would deal with each situation. Ack them totalk about visual cuesin their ‘own cultures /countries. Additional a ‘Youcan askstudents to explain the complications to youin lay terms. * Tip ifstudentsarereuctantto‘acta pat in role-play, rermind them that tisbeter to practise now and make mistakes on each bother than ona real patent! Ow 21 amildsorethroat 2 youmay feel abit tired afterwards 3 [some people can get] a chest infection or pneumonia 4 some bleeding or infection inthe gut 5 [it}can also puncture the gullet or stomach 3 Sothe patient is aware of them before he signsthe consent form. 4 occasionally + on the odd occasion automatically > necessarily seldom rarely 5 1 Icanassure you that in mostcases the procedure is problem-free. 2 But remember this does not mean that you will necessarily get theseas well 3 but thishappens very rarely. Speaking © Students can do Tandon their own or in palss.Get them to discuss 3 witha partner. Then ask for suggestions from the whole class. They can remain in pairstodo 4. Ow 123 b6 cl dd es f4 21b 2e 3c/f 4f/c 5a 6d 4-2 constipation, infection abdominal discomfort, perforation pain, bleeding d headache, nausea, paralysis € (dependingon the drugs): vomiting / nausea, hairloss pain, bleeding, collapsed lung & pancreatitis, bleeding Project © Youcan suggest students use other websites they know of and suggest other procedures for them to investigate, for example, colonoscopy or bronchoscopy. You could ask them to briefly present thelr findings to the class using some of the language learnt in this unit, as if explaining the procedure to a patient, Le. gentle, reassuring, tc Writing © Students can do and in pairs and and 4 on their own. For 4,askthern to use lay terms and reassuring language, ‘© Putstudents in pairs for , with one of them actingas the patient. ‘Ow 1 ABG: bleeding, haematoma, arterial damage and peripheral ischaemia, infection, pain, local tendon /nerve change injections: anaphylaxis, drug overdose, local irritation, thrombophlebitis leakage of drug from tissued cannula,haematoma Checklist, Key words © See suggestions on p.5.Go through the list of words to check students pronunciation and understanding. Remind students to transfer useful words and phrases to their vocabulary notebooks.Background ‘The administration of drugs requires attention ona number of levels, First ofall, there isa need for accuracy about the dosage (for children and adults) and the ‘frequency and the method of delivery. Which patients should be given a drug and whether they have any allergies also needs to be taken into consideration. There are safety considerations about drug dependency and possible harm, sodoctors need to know when toseek advice about the administration of drugs, especially if ‘they are unfamiliar with them. Another important aspect of drug treatment is compliance, or concordance. Itis one thing for a doctor or nurse to prescribe a medication, and another thing for the patient to comply with the advice given. The first factor which has a bearing on compliance isthe way in which the doctor presents the benefits and side effects of any ‘medication tothe patient. Additional activity ‘Check the pronunciation and stress of the medications: Check up © Students do Ton their own. Note that aspirin is considered a cardiovascular Units 29 Explanations about benefits and side effects have to be finely balanced so that the patient can make an informed choice about whether or not they will take the medication If patients understand the benefits to themselves without being frightened off by the side effects, they may be more inclined to take the medication. Soitis crucial for doctors to know how to communicate effectively inthis area ‘There are, of course, other factors which can affect whether a patient will comply with a prescription, such astthe patient’ situation or ability to follow a regimen, The elderly, for example, may find compliance difficult. ‘The timing of the doses may also affect the patient beneficially or adversely ~ see the Reading text on p.2 Lastly, safety is ofcourse a major consideration when administering medication, so any mistakes (or potential mistakes), however minor, need to be carefully monitored. Useful reference: Oxford Handbook for the Foundation Programme, 2nd edition, Hurley etl ea arg vbich ey beso tenet tira do Hipage ‘b eyelizine /sarklazisn discuss 3 as a class. g Siapsnete 2 Sentence api oan eet cman ot cre far ee agitate coos tog dng ood bed cease at # maura toputient or reduction nfture research forether rugs rerun benefits / | cinkenr tits Scbimentstopocr/ wealty enti 2 darn epee Ow tie 23/8 38 4h st 60/74 He 1 ste han crea aerate 3° antiemetic / enti:e’meuk/ ‘¢ widen the bronchi 4 sedative /'sedauv/, hypnotic /hup'nouk/ relieve pair jin the blood / help the blood flow more easily, and 5 gastrointestinal /,geestraum'testinl/ help prevent heart attacks ; Sausacereu fenton : cardiovascular /ko:dioo'vaskslo 8 respiratory /resprott, res pte Additional activity Divide the class into two groups and turn the discussion on generieforms ofdrugs into adebate, for and against. F treat gastro-oesophageal refluxdisease 8g treat reactions to drugs or anaphylactic shock hh make patients less agitated Patient care ©. Students discuss 1and 2 in pairs or groups. Ask each group to make alist of all the guidelines on large sheets of paper or lipcharts, or the computer.30 Units Ow 11 Thedoses may be different for children and adults Ifyou are unfamiliar with a drug, you may give the wrong dose. 2 Itisimportant not touse.a drug f you are unsure about anything. ‘You may give the wrong dosage. A senior colleague can advise you 3 Check the type ofthe reaction, eg, true allergy, toxicetfect, predictable adverse reaction, idiosyncratic reaction. Ifthe reaction is mild, itis possible you may deny a patient alife-saving 39C); cough not prominent ‘Note: The distinction may not be clear cut fin doubt, admit to hospital (See Oxford Handbook of Clinical Speciatis, 8th edition, for further, details.) ‘4 Management: supportive— paracetamol, fluids, topical calamine lotion tolesions. Admit complications are suspected. (See HGP2)p.494. For more detail about drugs see OHCSB)44 Unit? * Tip if youhave accesso telephones, orif students have free callsontheirmobiles, askstudentsto telephone eachother They canthen sitin different parts ofthe om sothat they can't see each others facial expressions which adds tothe challenge and makes the role-play more realistic f you don'thave access to telephones, askthe students to sit backtobackso they can't see cach others faces, Students may want to repeat the same conversations several times like this Fllow "upwitha discussion about the differences between face-to-face communication and talking onthe phone * Tip Teaching students how to give and receive feedback helps them to understand themselves, not least because ts often easierfor themtocitiie eachother rather than themselves. tia sklthey can then developin giving feedback’ tothe patient about their linss rather than always Seunding negative talsohelpsto develop self-awareness andthe ability totalkabout oneself ina balanced way * Tip Discuss the oleplayin with the lass as. awhole, lookingatit from diferent angles—what they found enjoyable, difficut.et You can take diferent angles cach time you give your own feedback, focusingon one elemento several ata time at st you could fous ust on non technical vocabulary pronunciation and the importance of ftng nto the oe ofthe patient, what this teaches the student doctor, andits importance in achieving empathy withthe patient Youcan then build on this each time you do a role-play. Vocabulary Signs and symptoms © Students do and Zon their own, then form pairs for3 and 4, When they do the role-play in 4, encourage them to ask other questions using their own knowledge and experience of the illness Ow 1 meningitis 21 headache 5 raised temperature 2 photophobia 6 +/~rash (canalso be a symptom) 3 neckstiffness 7 abnormal mood 4 abnormal mood 8 seizures 3.1 Does he havea headache? Ishishead sore /hurting? 2 Does he avoid orshy away from bright lights? 3 Ishisneckstiff2 Can he move his neck freely? 4 How is he generally? \s he his normal self? Has he ever been /had anything like this before? 5 she feverish? Is herunninga temperature? Hashe got temperature? 6 Has he gota rash? Where is it? What happens when you press Blass on the rash? 7 Has he been behaving differently in any way? 8 Ishe makingany abnormal movements? Speaking «© Put students in groups for the role-play. ach role-play has two parts: Group students role-play a doctor first and then a patient; Group Brole-play a patient first, and then a doctor. Refer to the Tip for 4 in Listening 2 below for suggestions about giving feedback on these role-plays. Listening 2 Reassuring an anxious parent ‘© @ studentslisten and complete the sentences in then compare answers with partner for2 Play the recording again for them toadd any missing words. © Youcould do3 as a whole class. Ask students which of thestatementsin Ithe doctor uses to reassure the patient and which statement shows empathy. ‘© Pat students in pairs for While they are doing the role-plays, watch discreetly without interfering, Make notes about language, pronunciation, body language, ‘role understanding / play’ etc: You might want to focus onthe empathy that the students role-playing the doctors show. At the end of each role-play, ask students to give each other feedback, allowing each student to assess his/her own performance first.In giving feedback, students should always begin with the positive points first, followed by constructive criticism for development. Ow 11 croup 5 every mother might feel 2 'llhelp toease 6 eyeon him 3 expect 7 anychanges 4 dmaybehave 3 reassuring: 3,4,7 empathy:5Parentsand youngchildren 45 Language spot First Conditional vs Second Conditional «© Read the introduction asa class. Then get students to do on their own, Ow 1 g she would have a realy bad barking cough (hypothetical) 2 F itwillincrease the risk of permanent damage (ral) 3-4 itwillbe easierto carry out the procedure (real) 4 a she will normally stare back (real) 5 @ | would prepare forthe consultation better (hypothetical) 6 c wewill carry out the 6-week check (rel) 7 h itwill help stop him from bringingit up (eal) 8 b would ertainly bea lot more sympathetic. (hypothetical) Project © Students can work in pairs, groups, or individually to do Yand 2, then form, pairs to role-play explaining the checks in3. (See OHGP2 pp.816-23,) Ow 11 Theneonatal check (by adoctor): performed within the frst 2hoursof birth 2 The six-week check (by a doctor}: includes physical examination, health education, and developmental screening, ie. gross motor, development; fine motor development, vision, hearingand speech, and social behaviour 3 The8-and 18-month checks bya Health Visitor):include physical examination, health education, and developmental screening as above. 2 Gross motor development screening: Head control: pulling the baby up holding the hands from a lying position. Baby should keep head upright nd not wobble. ‘Moro reflex (0-6months): support the head and shoulders about 15cm from the examination couch. Suddenly allow the baby's head to drop back slightly The response ~extension ofthe arms followed by adduction towards the chest should be brisk and asymmetrical ‘The reflex disappears by 6 months Ventral Suspension (0-10 months): suspend the baby horizontally, face down. The head should be in line or slightly higher from the body and the hips semi-extended. Prone position (from birth: place the baby face down on a flat surface. He/she should be ableto lift his/her head momentarily from the surface. Fine motor development and vision screening: Stars, follows horizontally to 90 (degrees) Patient care ‘© Putstudents in groups todo Then let them work on their own tomakea list for, Or 1 Notreassuring. The parents would probably be afraid that their child would be one of that small percentage. 2. Reassuring The statement helps the parent realize that having 2 rashdoesn't mean having meningitis.46 Unit? =Tip Invite the students to askyou questions about language. Don't beaaidtosay thatyou don't know the answer iitisa medical question Youcould asktherest ofthe clas, allowing the students time to discuss the question medically from heir ‘own experience. Seta time limit, as these discussionscan goon foralongtime! * Tip ‘an Objective Structured clinical Examination (OSCE) is used to test skillssuch as communication clinical examination, medical procedures, prescribing and interpretation of results. Ienormallyconsists ofa numberof short (5-10 minute) stations (practical tests) and each isexamined ona one-to-one basis with ethereal or simulated patients factors) * Tip After the ole playin you could offerto actasthe patient forthe dass. This helps You develop you le play sks within the Context of medicine, Get the whole dassto askyou, the patient, questions about one of the scenarios, Alternatively youcould asktwo students to roleplay scenario infront ofthe class. in this case évde the rest ofthe lass into two r0ups:one togve feedback onthe doctor andoneonthe patient Setatime-imit and follow the same procedure as above for feedback and discussion. Note that asyou develop the role-play, your knowledgeof thesubjectareawill increase. However alays emind the student (and yourself that you arenot doctor and that they mustcheckany ‘mecical details themselves 3. Reassuring.The statementis fairly technical, butitis reassuring thatitisnot a problem now,asthe childisnot sixand a half. 4 Reassuring. The doctor is sympathizing with the patient usi examples of what is seen in the surgery. 5 Notreassuring. The phrase Ican assure you may be quite strong, bbut denying the parents the right’ to be worried ifthisis how they feelis very dismissive and patronising. 6 Not reassuring. The parents arlikelytothink that 7 Reassuring. itis technical buts saying that the evidence suggests itisnota brain tumour. Speaking © Students choose five criteria from the list for 1, Where possible allow the students to make the choice of criteria they feel are important, but with guidance ifnecessary. © Putstudents in pairs to do and3. The instruction for the role-play in3 says it should be done ‘without preparation’ but judge how much information. youneed to give the students, Points to consider: Scenario I: The parent is anxious about the child:he/she thinks that the child is at high risk and doesn't know how fragile the virus is. Doctors should think about: Was the skin broken? Did the child bleed? Where is ‘the needle now? Was there blood on the needle? Who uses the park? Was there anyone around the area of the needle? HIV virus cannot survive for ong outside the body. Is the child high risk or low risk? Is the child fully vaccinated? Booster needed? Is reassurance needed? Scenario 2: The parents concerned about autism and whether the vaccine {ssafe. Doctors should think about:Is there a confirmed connection with autisrn? Is there a danger to leaving the child unprotected? Is there greater danger from, say,measles? Can you empathize / sympathize? Scenario 3: The parent.is worried about the coin getting stuck or poisoning the child. Doctors should think about: Is the parent feeling guilty? Is reassurance needed? Does this sort of situation happen frequently? What normally happens? [sit better to let nature takes its course? Is an X-ray necessary? What happens ifthe parent doesn't see the coin come out? Should the parent watch for it coming out? © For4, students give feedback on the role-play using the checklist they created in Asin Listening 2, they should give positive feedback first, followed by constructive criticism for development. Remind students that giving feedbacks skill that can be developed, and which will help them to develop self-awareness and to give patients feedback about theirillness. Listening 3 © @ Students listen and do on their own Ow 11 nervous 3 insensitive 5 well 2 disorganized 4 lesstense 6 alot 7. He would change his way of doing things—be more patient, prepare before speaking toa patient, speak to the nurse, get basic details right.* Tip Beingabletosetfanalyseisavery important kil andreleanttojob-seeking asitshows that students ae aware f their own abilities (strengths) aswellas areas where they may need further development or help (weaknesses) How they have dealt / propose to deal with bth these areasis aningication of their potential ability to developonajoband whether they would fitintoateam environment, learing from andteaching others Parents and youngchildren 47 Reading ‘© Putstudents in pairs for. They can do2-4 individually. in groups,orasa class discussion. Ow 1if 2e 3b 4a Se 6g 7d 2 Allowing three months between doses is likely to maximize the response rate, particulary in young children under the age of 18 months where maternal antibodies may reduce the response to vaccination. Where protection against measles s urgently required, the second dose can be given one month after the first. ifthe child is given the second dose less than three months after the frst dose and atless than 8 months of age, then the routine pre-school dose (a third dose) should be given in order to ensure full protection 3 See OHGP2 p.480 for ful table ofimmunizationsin the UK. 4 Immunization may cause concern for parents due to factors such as culture, literacy, myths about /ignorance of / fear of vaccines and general availability of medications. Measures to overcome this can include national education programmes through schools, the media, and health workers. Atan individual level explanation, sympathy, and empathy can also work. Culture project ‘©. Students work in pairs to answer Yand2 Encourage them to talkabout the different procedures, the ease or difficulty of organizing work the process of references, and the changing job market in their own country and the UK. Ow 1 Answersvary by country culture, butin the UK, the answers would be: TTrue 2 False 3 False 4 False 5 True Writing Reflecting on one’s own experiences ‘© Putstudents in groups for J, then let them work on their own to do2. They can help each other, but they need to make this a personal and individual piece of writing. For Writing 2, remind students that there should be no details such as names that could identify any patients. Checklist, Key Words © See suggestions on p5.Gothrough the list of words to check students! pronunciation and understanding. Remind students to transfer useful ‘words and phrases to their vocabulary notebooks48 Units Background ‘This unit focuses on a patient-centred approach to communication in medicine, looking from different viewpoints at the communication between doctorand patient. One way of developing patient-centred communication {sto approach any conversation or consultation from psychological point of view. Students can do this by considering what the patients themselves might be thinking, and what barriers there are to communicating clearly, which apply toll ofus. tt isnot really an option to tellthe patient to just sayit! Patients may want tosay something, but they may not have the words tosay it orthey may be too embarrassedto say it directly So, for example, they may hint at something inaway they thinkisfaily direct, by stressing a word. Ifstudents are not sensitive to these verbal cues, they ‘may misunderstand the patient. This in turn could lead toconflict with the patient ifthese verbal cues are not acknowledged. One example used in the unitis a patient saying: haven't taken any prescribed drugs. ifthe patient's hints missed, itis possible that the statement would be taken tomean that the patient doesn’t take any drugs atl, but the hint may be:Ido take recreationaldrugs but Idon’t know how to say this directly The patient might think the doctor may not approve, sois cautious Patients may also use thisasa strategy totest whether they fel comfortable talking with a doctor or not Raising awareness ofthis will help students tonegotiate patients language Additional activity ‘Askstudentstogive examples where they have faced similar situations tothose in Cheek up. * Tip Askthe students to makea ist of strategies enaflichartoronacomputerandthen © print outa copy30 that they have this for reference Check up ‘© Students do Vand 2.on their own orin pairs, then form groups for 3-5. For3, the same strategies might be suitable for more than one situation, ‘Vagueness like this can come in other ways. When patients talk about habits such as smoking or drinking, they may use vague language like a couple of drinks, not ‘many, sometimes. In fact, couple may mean three or four, and more on certain days of the week. So doctors need to be able to extract clarification by asking: When you saya couple, what do you mean? Seeking clarification like this is probing gentiy, not prying. These strategies enable the doctor to help the patient be more specificsothe doctor can make a diagnosis more easily. Another way to practise patient-centred communication and help improve students’ consulting skills is by teaching them about the difference between closed and open questions. n a doctor-centred approach, doctors may be more used toasking closed questions, which can only be answered yes or no, Asking open questions helps the patient to'paint a picture’ oftheir illness or situation, which the doctor can then expand on by asking closed questions and other open questions. From the students’ point of view, the difficulty initially with asking ‘open questions is what to do with the answers ~a lot of, information seems thrown’ at them by the patient in response. They may feel at aloss as to how to continue. ‘Simple strategies can be adopted to overcome this, like learning to respond appropriately by summarizing and focusing on one main issue or checking specific points using closed questions. Useful reference: Oxford Handbook of Clinical Specialties, 8thedition, Collier and Longmore. © When students have discussed 4, ask each group to present their suggestions to the lass oneatatime, Get the whole class to discuss § together. Ask for any personal examples of misunderstanding. As discussed in Unit7, students may find it difficult to talk about their difficulties or mistakes, but remind them that we all. learn from our mistakes and they can become better doctors as.a result. | Remember to bring body language and facial expression, gender, age, and other relevant factors into the discussion. Ow 1 Allofthesituations illdepend on the age and the gender of the doctor and the patient, accompanying parents and relatives, and family status.Encouraging communication 49 TTT LT TET * Tip Encourage students tothink of examples in their own lives for, both inside and ‘outside medicine. The former may be more helpfulin getting them to understand the difficulty patients haveinsaying what they wanttosay Askthemaliotothinkoftheirown performancein the language class. This willhelp students empathize with their patients and also help them in role-playing Patients in pairworkexercises ‘a The doctor might have difficulty encouraging the patient to speak, even though he has come to see the doctor and probably wants totalk. The patientisembarrassed about his condition and may ‘not know how to articulate what he wants to say. b This situation is similartoa, but the patient may be uncooperative and may find it difficult todeal with an adult « Itmay be difficult to persuade the patient ofthe need to stayin hospital ifshe cannot see or feel anything wrong with herself 4d The patient may be very defensive about his drinking, orina state Cf denial. He may fel too guilty to admit the extent ofthe problem, and may be fearful of addressing it. The patient may know alot or think that she knows everything. tmay then be difficult or even impossible to convince her of something, Thisisa common problem resulting from greater access o information, through the internet in particular, The difficulty hereis being impartial. The patient may feel that you are covering for your colleague, however fair youare trying tobe. 21b 2d 3c 4e Sf 6a 3 Possible answers Encourage patients to talk by asking open questions; encourage patients to give thelr own answers to a situation or problem; agree with patients’ suggestions where possible and then add ‘your own ideas; listen carefully to what patients havett say and invite them to develop anything which appears to be very general Cr vague: be sympathetic, empathic, and sincere. Patient care © Read the introduction asa class; Then put students in pairs todo The main issue here is to encourage them to adopt a patient-centred approach by trying to understand what the ‘thinking’ is behind the way patients speak. «© Students work in groups todo3, then come together asa classfor8, Tiss a chance for you to clarify the issue and give examples in the frontoof the class (see Tip). You may want to give examples of your own, Ow 2 With friends, itisikely that people are moredect, but there are times when people hint at things rather than say them directly. For example, It’ cold in here could really mean Close the window. Similarly My tea iscold could be hinting they like another cup. These ae simple examples to illustrate that itisnot just patients who have difficulty being direct sometimes. In professional situations, students may sometimes find themselves thinkinglike the patients in +6 Listening 1 Acknowledging verbal cues «Read the introduction asa class. Then put students in pairs todo Yand2. Ask students toread the text about verbal cues, then decide what they think the context is and which information they would ike to ask about in each case © @ Play the recording for the matching taskin3, then again for students to do4. They can check their answers against the Listening script on p37 of the Student’s Book50 Unite © For, students give their own answers to each of the doctor's questions, as iffthey were the patient. Ask students to prepare one or more answers for ‘each of the questions. If they have difficulty, encourage them to give simple answers or give some suggestions of your own, © Putstudentsin pairs todo 6, Ow 12 alcohol/drinkinghabits — d work weight problems © weight /eating € recreational drugs 3b 2¢ 3a 4e Sd 5 Possible answers 1 three or four meals a day / several snacks between meals / three or four bars of chocolate between meals 2 about 2 or 3 days per week / at least twice aweek 3 usually two but sometimes three or four / four or five at the weekend 4. He said | was fat / overweight / that | should lose some weight / that my frend is slimmer. 5 There's more work to do, / People are off sick. run myown business, /lamon my own, Ihave ust started a new job. Additional a s Get students todo the Speaking exercise peaking withyouasthepatient Startwiththe | © Putstudentsin pairs todo the role-play. You may want to put the Asand role pay card fromthe Student's Book, Bs n groups frst to study the role-play cards. Check that they understand then give your own answers and seesf the procedure and ll the answers. Encourage the patients tobe vague, students can develop You can asthe but not difficult. Encourage the dactors to probe gently untilthey obtain class todothisasa whole orask several satisfactory answer that is specific Follow the same basic procedure as stadentnte doit hytien, Stodentamey ‘Speaking in Unit 7 (Teacher's Book p.46). At the end, you can ask patients to wean fades aU aaaae eerie tell doctors any pieces of information they didn't manage to get, and ask students to suggest questions which would have elicited that information, Pronunciation EE Additional activity Stressin the sentence Askstudentsin groupsto create fve © @ Putstudents in pairs todo Vand listen and check for? simple sentences of their own,eg saw ‘rsJonesthismoming.Thenaskthem. _g Students listen and do on their own, then compare with a partner for So thon thal cuitanoes fo a partaarin 4: They should try to respond to the verbal cue given in the emphasis the another group They aythestatements Patent hasused, totheirpartner and the partner identifies thestressed word © They remainin their pairs todo. Make sure thatthe stressed wordis clear, Be students may have to exaggerate slightly atthe beginning, Ask them to Trnajranstpatestonthebour) wotkwitha diferent pane fr6 computer screen toshow students. You ee raneanE sree ee ee couldalsoturn the exercise intoa min 2 preeUUOB 2a corey See rmeag te paesone 2 Line3: because the patientindicated he had taken something een eae else by stressing the word prescribed ie. not prescribed, butsome. other kind. Line: the patient stressed recently, ie. not recently, but pethapsat sometime in the past. a1 3 first 5 me 7 few 2 café 4 work's, 6 normalEncouraging communication 51 ‘Additional activity ‘Tohighlightthedifference between open and closed questions, doa role-play with the whole class where you ae the patient ‘with (eg) aheadache,and students have ‘to‘diagnose’ you. Get them toaskyou closed questions, which only have the answers yes or no Refuse togive answers toopen questions Ask the class to begin with: Are you OK? (We), Have you gota pain? Is the pain... ‘when you have finished, dothe role-play ‘again but with open questions. Youcan emphasize the point by giving more information in your answersto these, 4 Possible answers 1 But what about your partner? 2 What were you eating / drinking? 3. When was the first time? How many times haveyou had itsince? 4 What about your family / home life? 5 Did your partnerattempt tohelp? {6 When you say ‘normal’ what do you mean by that? 7 Canyoutell mewhat‘a few’ means for you? Speaking © Putstudents in pairs todo 1 Below isalist of some areas totalk about, but you ‘may need to suggest some ofthese tothe whole class as part ofthe discussion. ‘© Students can do2.on their own or in pairs, then compare their answers to and2 with the whole class for. Follow the procedure as in Speaking above and in Unit7. Before students start allow them toask you any questions. AS away to build students’ confidence, allow them todo the role-play with you before or after they do the exercise. At the end, you could ask for volunteers to dothe role-play in front of the class. Afterwards, allow time for discussion about the content and the performance from the doctor's and the patient's points of view. Emphasize the need tohold a conversation with the patient rather than just thinking about medicine @ Students remainin their pairs todo4, Ow 1 Areas toask about: work, home, family relationships, stress. Did the depression pre-date the car accident? 2 Some points the patient might be thinking about: his accident; his injury and pain; his low mood: his divorce; ts effect on his ‘and himself; coping with being a single parent; his children’s behaviour; their well-being nd future; coping witha heavy workload; coping with household chores, Allow the students to explore major issues like those above as well ‘as specific things like doing the shopping, ironing, washing, etc. Language spot Open and closed questions Read the introduction as a class before students do Yand2.They can then do 3-Singroups. Ow 11 Canyoutell me. few more details about the pain? 2 Tell me about the way the injury affects you. 3. What happened when you had the accident? 4 How do you think things will develop after this? 5 Canyouttell me what worries you have here? 6 Describe atypical day for me. 7 What about your ob? How are things there? 2.1 Open 3 Open 5 Open 7 Open 2 Closed 4 Open 6 Closed 3 Open questions are usedin a patient-centred approach totaking a history, where patients are encouraged to talk about their iliness, ‘much lke creating a narrative. Ths allows patients the opportunity to say things they might otherwise omit: Therefore, open questions are generally used at the beginning ofthe history and later, when52 Units the doctor wants to encourage patients totalk about something. vague they have said or hinted at 4 Generally speaking, open questions are used to obtain general information from the patient’s point of view, and closed questions are used to checkand elicit detail. Closed questions tend to be easier todeal with but they are not as effective as open questions in obtaining an overall picture. 5 fallthequestionsin the history are closed, t can sound ikean interrogation t also doesn't givethe patient the chance to elaborate, which may give the doctor important information he/she hadn't specifically asked about. Patient care © Read the introduction as a lass;then put students in pairs todo. The aim. Isto get the students to focus on the most significant plece of information Additional activity Ask twostudents torole-play the dialogue intwhile the rest ofthe class watch and Bees eset ae prthayarie Inthiscazesittingin the cafes significant because drinking coffe can yom leadto raised heart rte which can be mistaken forahear problem Unless Wen they have nishedasktherest the doctor asks open questions and considers context, he/she could miss of teclasttod the sare in pa, thie vital information, Students often atch on tothe wrong information developing therle-paydiaoguefurther_andoverlookthe important point doaawtouepenquesions Gm 1.1 No-the patienthasalreay given hisinformation 2 No-the patient has said i’ the first time. 3 Information about what the patient was doing in the café; what the patient was drinking, 4 Itcould be. For example, the raised heart rate could be from the ‘affeinein a strongcoffee. 5 Yes. The doctor could say something like When these things come ‘on suddenly, they can seem frightening, but can you tell me.. Listening 2 Appropriate response ¢ @ Students listen and do1on their own, then do2-4 in pairs. Ow Tic 2 3¢ 4b Sb 2.1 Alternatives possible, but cseems the most logicalnextstepasthe Patient has already mentioned and b. However, the doctor might ‘want further details about the ype of pain and appetitea tte later. 2 Alternatives not suitable -the patient has already answered aandb. 3 Alternatives not suitable —ais not helpful and bis wrong because the patient sounds lke he does need help. 4 Alternatives not suitable -the patient hasalready answereda and c. 5 Although and bare similar, bisthe most appropriate: ahas already been answered, and while the patient may want painkillers, the statement rather dismissive and not appropriate. Vocabulary Alcohol © Students do on their own. They can discuss 2-4 in pairs, roups,oras a whole classEncouraging communication 53 nal activity © Ask them to don their own. You could suggest they add open questions Askstudentstoworkin pairsand describe of theirown. animaginary patient toeach other Ow 11 heavy 3 teetotal 5 drink 7 Binge without using onect the words1-8.The Dartmerhastosay which wordthestodent 2 annoyed 4 social 6 guity 8 moderate gene 2 CAGE isa mnemonicfora screening test for alcoholism. Sentences 2 and 6 relate to CAGE. The letters in CAGE stand for: *Tip Have you erereltyeuought abut down oriyour drinking? bts =DeliiumTremens severe form of Hove people annoyed you by ring your drinking? dtshol wthdawalhicheausesbody Hove you everflt bador ult about your drinking? tremorsandchongesin mental tate 30h Habe you ex de aftertaste youtnerves i thermorigt as confusion agitation, and anxiety. CAGE (two or more yes answers) is quite good at detecting alcohol . “abuse and dependence (sensitivity 43-94%), (See OHCM7 p.274,) *Tip 3 if patients deny tothemselves that they havea problem, then Be sensitive toculturalattitudes to alcohol may be difficult to treat it. The first step is to prove to patients that staltimes ther isa problem Then they can accept they need to make changes. 4 Students can ask colleagues how they have done it. One simple ‘approach is first toask the patient ifhe /she drinks alcohol, and then askan open question about the drinking, Probe any vague answers corhints to find out how much the patient drinks, what he /shedrinks, the regularity of drinking, whether he / she drinks alone orwith friends, and whether the drinking patterns the same at weekends. Askthe patient if he / she keeps a count of units (one unit = one small glass of wine, half a pint of beer, a single measure of spirits) and how many units he /she thinks he /she drinksina week Compare this tothe recommended daily maximum inthe UK, this is three to ‘our units per day formen, two to three units per day for women). ‘Ata point where the patient appears comfortable with your questions, ask the CAGE questions. 51 How would you describe yourdrinking? 2 What kind of drinker would you say you were? 3 Tell me aboutyour drinking recently. ‘4 What about drinking earl in the day? When do you have your, first drink? 5 Are there any advantages of cutting down? Have you ever thought of the advantages of cutting down? 6 How do your family / friends feel about your drinking? 7 How do you feel about your drinking? Do you want to stop? Project ‘© Ask students to find the information for Yand2, For2,ask them about similar organizations in their own countries ~ if there aren't any, should they exist? Sensitivity tonational attitudes towards alcohol should always bebornein mind, «© Get students to research 3, Ask them to give examples from other English speaking countries and examples from their own languages. Ow 1 TWEAKStands for: Have you an increased tolerance to alcohol? (Do you worry about your drinking? Have you ever had alcohol as an eye-opener the morning? Doyou ever get amnesia after drinking alcohol? Have you ever felt the need toc{k)ut down on your drinking? ‘Two points ar given fora yes’ answerto the first two questions, and