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Integration of Linguistic and Aesthetic Education: An Integrated Cultural Approach for Teaching Medical English

Foreign language teachers are now actively using modern technologies to the detriment of others, which are no less effective and perform successfully the functions of arts and cultural education. Teaching a foreign language for special purposes (ESP)
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  Integration of Linguistic and Aesthetic Education: An Integrated Cultural Approach for Teaching Medical English Anna Sergeevna Bobunova RUDN University Miklukho-Maklaya str.6 117198, Moscow, Russia +7 (909) 9471135 Elena Aleksandrovna Notina RUDN University Miklukho-Maklaya str.6 117198, Moscow, Russia +7 495 787-38-03 (1532) notina Irina Aleksandrovna Bykova RUDN University Miklukho-Maklaya str.6 117198, Moscow, Russia +7 495 787-38-03 (1528) bykova ABSTRACT  Foreign language teachers are now actively using modern technologies to the detriment of others, which are no less effective and perform successfully the functions of arts and cultural education. Teaching a foreign language for special purposes (ESP) is not often connected to works of art and has no practical application in professional communication skills training. The  purpose of this study was to prove the effectiveness of the application of art in ESP teaching. The experimental training course enrolled 60 students of the Institute of Medicine of RUDN University who studied in the field of clinical medicine in the period from September to December 2018. 60 students who studied under the standardized curriculum were considered as a control group. 16 professional translation lessons were integrated with fine art. The course was divided into three stages (5-6 lessons each): classroom lessons, visit activities at an art gallery, individual project presentation. Before and upon completion of the training course, students were tested on the levels of their linguistic knowledge, motivational involvement, cultural and professional development. As a result, the majority of experimental group benefited from participating in the course: (language aspects mastering - 92%, motivational involvement - 100%, cultural development - 95%, professional development - 96%). We can conclude that ESP teaching by means of art education is an effective means of enhancing students’  linguistic, professional, and cultural competencies and contributes to increasing the motivation to learn a foreign language. CCS Concepts   •   CCS Applied computing Education E-learning Keywords Language education for special purposes; integrated learning, aesthetic learning; cultural development; translation competence. 1.   INTRODUCTION Foreign languages in higher education are taught for professional  purposes. The basic material for such training is usually  professional texts that are not captivating. Sometimes, the only motivating factor for language learning is the need to pass an exam or successfully defend a diploma. Classes organized in connection with the cultural objects and artworks can help to diversify the language training. [1, p.203]. Another disadvantage of foreign language training programs is the lack of aesthetic components in students’ development in the  professional sphere [2]. The issues of integration of the professional sphere, language and aesthetics have not found a place in scientific research and methods yet. The role of art was underestimated in higher education. In agreement with language teachers and methodologists, we found that the role of art could be not only aesthetic but also affecting academic performance. The experience of museum lessons has become a common practice in all academic stages. Implementation of art in ESL has shown sufficient outcomes and call for more research in this area [3, 4, 5]. 1.1 Literature review There is a gap between teaching general English (GE) and specialist English. GE is considered as a part of a broad educational process. On its behalf, ESP is based on a course related to a particular discipline or profession. Traditional methods of teaching concerned mostly contexts that were acceptable to a specific branch [6, 7]. Many ESP teachers became slaves to the published textbooks available, without any opportunity to diversify their lessons. We  believe that ESP practitioners can accept the various roles to go  beyond that of the classroom lessons. Integrated course is seems to  be an effective means of engaging students to collaborate and  perform academic research on artworks. The advantage of integrated course is its flexibility and tolerance to individual or group needs. Practices of moral and aesthetic education are of great importance in increasing students' motivation to learn the subject. Aesthetics can awaken kindness and creativity in a person [8]. Kisak P. defines a esthetics as “the study of sensory or sensori -emotional values, sometimes called judgments of sentiment and taste”. More broadly, scholars in the field define aesthetics as “ critical reflection on art, culture and nature” [ 9]. The fundamental concepts of aesthetics are natural beauty, art  beauty, truth, semblance [10]. We can say that nothing but aesthetics contributes to human development, awakening in him such qualities as hard work, accuracy, patience, and the desire to fight such vices as laziness, intolerance, looseness, lack of discipline, inertia, and irresponsibility. Education and culture have been inextricably linked to the levels of scientific, technical, spiritual and moral development of society. A comprehensively educated person is competent not only in technical and humanitarian areas but in also spiritually developed [11]. The integrative course of ESP in comparison with traditional ones should take into account that education and culture are closely related to each other. Thus, education is incomplete without studying history and culture. This knowledge not only replenishes the cultural background of students but also enhances the quality of intercultural  communication. Linguistic diversity effects the cultural achievements of peoples, enriching both themselves and other  peoples through intercultural communication and the mass media. One way or another, social transformations are powerfully affected  by cultural developments [12]. According to Donaghy K., art has the function of the evocative powers. When students are exposed to  paintings related to social issues and health problems, they gain thematic language knowledge and the opportunity to see how the aesthetic component of art meets the symptoms of diseases depicted by artists unconsciously [13, p.101]. The multiple involvements of students in working with paintings helped them to “enact thinking -dispositional behavio r” [1 4, p.4] such as curiosity, concern for truth and understanding, and a creative mindset. The new teaching methods, including such methods and techniques as the use of multimedia content, open lessons, mobile applications, learning games, classroom theater, songs and integration with other areas of knowledge contribute to the increase of motivation in language learning and facilitate its study [13]. Regarding university education, the inclusion of artistic and cultural components is advisable for students from the second academic year. Students already speak a foreign language, can use medical vocabulary and describe symptoms and suggest the diagnosis. The purpose of this study was to test the effectiveness of the integrated learning methodology in improving the quality of knowledge and motivation in learning languages for professional  purposes. To achieve this goal, there was a need to choose and study the cultural layer, which would be interesting to students, and integrate it into ESP process. 2.   METHODOLOGY  The cross-sectional study was held at the Institute of Medicine of RUDN University. 60 third-year students were enrolled in the experimental group in the period from September to December 2018. The selected group of students had been studying a module “ English language for medical  purposes”  for 2 years. Integrated lessons took place during the practical course of professionally oriented translation. The control group consisted of 60 students who studied under the same module as the experimental one. During the course, 16 lessons were held, among them, there were classroom classes, visits to The Pushkin State Museum of Fine Arts in Moscow and preparation and presentation of an individual research project. Students’ self  -study took up to 25 hours. The control group was given 16 lessons according to the standardized curriculum. For the experimental training, we have chosen classical sculpture and canvases as the cultural material integrated into professional English language for healthcare and medicine course. Students detected symptoms when describing the person appearance simulating the diagnostic process. They observed the clinical presentation and tried to establish a diagnosis using their medical and linguistic skills. According to signs, medical students diagnosed some diseases that were present in a person of a  particular epoch, age, profession, and geographic region. The task of a teacher was to combine professional activities with cultural experience, introduce English professional terminology in connection with cultural backgrounds.  Note writing and history taking helped students become more attentive and focused, involved in collective learning, discussion, and diagnosing. They started investigation with a visual examination of the head and neck with a particular note made on swellings or deformity, asymmetry of the face, abnormal colour or scars on the skin or lips. All findings had to be recorded in detail. Students observed, made predictions and developed their story-telling skills when talking about the causes of the disease and expected outcomes of treatment. The process of inclusion of the art and cultural materials in the foreign language course had three stages: classroom training with the use of visual materials, museum lessons, and project work. Each stage possessed its own aim and a number of activities. 2.1   The first stage The purpose of the classroom stage was to activate the vocabulary and practice of a foreign language to discuss the diagnosis, on the one hand. On the other hand, students got acquainted with artworks and artists, learned interesting facts from the history of masterpieces. While working in the classroom the following  paintings were discussed: “The Extraction of the Stone of Madness” by Hieronymus Bosch , Portrait of Susanna Lunden ('Le Chapeau de Paille'), “ The Three Graces ”  by Peter Paul Rubens, “Wings of a Triptych” by Jan (Mabuse) Gossaert, etc. Before conducting the lesson, the body systems associated with the disease were announced to the students. At home, students prepared a list of relevant diseases and their main symptoms with English translation. After discussing the symptoms and diagnosis, students analyzed the lexical and grammatical errors. Then the teacher made adjustments of terminology and errors. The proposal diagnoses and historical description of the picture were displayed on mobile devices by links. The description of the depicted people and epoch were taken from encyclopedias and gallery websites. The following questions were given after the first presentation of a painting: What is going on in this painting? Do you see any signs of abnormality or disorder? What do you see that makes you say that? The first two questions provoked different answers and interpretations. The third one asked learners to prove their ideas with evidence of what they saw. They had to look for details that justify their answers. Studying the terminology of thyroid disease, the students got acquainted with the works of Swiss portrait painters of the 15-19 centuries, the analysis of which allowed the students to conclude that the goiter was “epidemic” in those parts of the country and allowed to establish that women suffer almost twice as often as men. Indeed, according to the encyclopedia, at that time there was a serious iodine deficiency in the region. Thyroid disorders were depicted in the works of many artists who worked at different times and countries. An example was the famous painting by P. Rubens “ Portrait of Susanna Fourment ” . The  proposal disorder was evidenced by pronounced mucous edema of subcutaneous tissue, especially on the face and eyelids. Diseases of the joints were observed in Michelangelo's portraits (Fig.1). Students assumed that the artist suffered from osteoarthritis. The lack of tophi specific for gouty arthritis at the fingertips indicates that the changes in the joints were degenerative. We used 3D models from to visualize the condition and demonstrate students the internal injuries. This helped both to provide the lesson with digital materials and to get new medical terms in English. After describing the visual representation of the proposed disease, students’ attention was paid to a 3D model of the pathology with a short description in English (Fig.2).    2.2 The second stage The second stage included extracurricular activity in the art gallery. Students visited The Pushkin State Museum of Fine Arts in Moscow. They were divided into groups of 5 people each. Students found canvases and sculptures that display the symptoms of the disease within a fixed time frame. The task was to make a diagnosis, present it to other groups and conduct a collective discussion. As an example, the students analyzed the sculpture of David by Michelangelo Buonarroti (Fig.3). According to some researches, famous David (posing model) suffered from an umbilical hernia. Students studied other sculptures of the author, detected similar signs and concluded that the sculptor  portrayed the same person. The combination of medical discussion and artistic images  benefited both speaking skills and listening comprehension. Listening learner’s discussions  allowed the teacher to understand the students thinking algorithm and test the acquired knowledge. Furthermore, it was very important to begin this process with a discussion of famous works of art in order to involve students in active learning. The time of active work in the museum took 3 hours. 0.5 hours were set for preparatory and organizational work. For 1.5 hours, students were examining paintings and sculptures and establishing a diagnosis. The presentation of the analysis and discussion with other groups took an hour. 2.3   The third stage Project activities were related to research works. Students were asked to perform a retrospective analysis of the incidence of diseases by searching in medical databases. They had to review cases in a general population in different regions and describe symptomology. Students were also asked to find paintings, sculptures, literary works where the symptoms of the investigated disease were mentioned. The projects were presented as a final work at the end of the semester. In total, all participants studied 320 works of art and 60 literature examples. In comparison to the studied group, the controls attended only classroom lessons without the museum lessons and project work. 3   RESULTS From the experimental group, 60 students successfully completed training (attendance of classes, museum discussion, and project work) At the beginning of the semester, both groups were surveyed in order to assess the following criteria: linguistic training, motivational involvement, cultural development, professional development. Students’ linguistic progress was measured by an oral test. The questionnaire was conducted to check the motivational components: activation, persistence, and intensity (readiness to conduct tasks, giving time and resources for extra work and research, an intensity in achieving the goal). Students themselves evaluated professional developments (getting professional knowledge in the field of medicine). The gained cultural  background was considered as “ satisfactory ”  when students showed the knowledge of artists and artistic epoch during the exam. The number of students who passed the final test satisfactorily was  processed statistically for each criterion. Table 1 presents the analysis of the introductory results in control and experimental groups. The results had a normal distribution, so comparisons were made between two groups’ values before the  beginning of the experimental course using Student’s  t-test. The results of the introductory test and questionnaire (Table.1) showed insignificant differences in the level of the professional development and cultural competence of the medical students. The number of students with motivation to study English is low in both experimental and control groups. All groups displayed mean language skills level. Figure 1. Figure 2. Figure 3  Table. 1. Variables before completing the course in control and experimental groups Based on the recorded data after completing the course, we observed clear changes in the compared parameters in the experimental group in comparison to the control group. 92% students of the experimental group (55 vs. 42) showed satisfactory linguistic skills, 100% showed motivational involvement (60 vs. 35), 95% increased cultural development (57 vs. 33), 96% (58 vs. 47) were satisfied with professional development (Table 2, Fig. 4.). Table. 2. Variables after completing the course in control and experimental groups 4.1 DISCUSSIONS According to a study by Farokhi. M., with the help of art, ESL teachers can foster creativity, build on prior knowledge, scaffold instruction, create a bridge between written and spoken language and make learning relevant and meaningful. That can help students develop self-esteem, appreciate the past, foster higher order thinking skills, emphasize interpreting and communication of ideas, e nhance students’ ways of observing, responding  to, and representing the world [15]. In addition to the described  possibilities, we can add the power to change students’ attitude to the philosophy of education, its purposes and methods. The influence of art on student’s  cognition is still under discussion. The findings of this survey showed that integration of art into ESP is the source of students ’  inspiration supported by the sense of tension and anticipation. Accurate depictions of the human body on canvas or in stone and the fine work of masters can make them a subject of study by artists, art historians, and specialists from other fields. Thus, some works of art can be interesting not only as an artistic image but also as an object for medical research. The portraits and sculptures are realistic depictions of existing persons, contemporaries of the master, with their individual characteristics. According to these signs, a medical specialist can diagnose some diseases that were  present in a person of that time, age, profession, and geographic region. The tasks of a foreign language teacher are the following: to combine professional activities with cultural experience, introduce English professional terminology in connection with cultural  background. Students ’ tasks are to  detect symptoms when describing the person ’  characteristics and appearance, simulate the diagnostic process, find appropriate English terms and conduct the  bibliographic research of medical databases, prepare and present an individual project. 4.1 Conclusion   This paper first proposes the effectiveness of the application of art in ESP teaching. The experimental results of the integrated course verify the validity of the proposed method. Due to the fact that the results in the experimental group were significantly different from ones in the control group, it can be concluded that the combination of cultural content and professional subjects in teaching a foreign language leads to increasing motivation and expanding  professional vocabulary, as well as contributes to the cultural and  professional development of students. The findings of this study are the basis for further research into the topic of integration of linguistic and aesthetic education. The application of the principles of interactivity of this study should be tested in students of other medical specialties, such as pharmacists, dentists, veterinarians. In addition, the analysis should be repeated with a much longer exposure than 16 lessons (an academic semester). Moreover, the importance of linguistic and aesthetic integration in education is becoming more and more obvious. Hence, the investigation of the proposed integrated course is an interesting and challenging direction in the future. Group Number of students T-Value LinguisticissueMotivation Cultural development Professionaldevelopment  Control group   60 34 43 32 47 Experimental group   60 36 39 30 40 P-values   > 0,05 > 0,05 > 0,05 > 0,05 Group Number of students T-Value LinguisticissueMotivationCultural developmentProfessionaldevelopment Control group   60 42 35 33 47 Experimental group   60 55 60 57 58 P-values   ≤ 0,05 ≤ 0,05 ≤ 0,05 ≤ 0,05 42353347556057 58 0102030405060 L i   n  g ui    s  t  i    c i    s  s  u e M o t  i    v a  t  i    on C  ul    t   ur  a l    d   e  v e l    o  pm e n t  P r  of    e  s  s i    on a l    d   e  v e l    o  pm e n t   Control groupExperimental group  5   REFERENCES [1]   Vernier, S., Barbuzza, S., Giusti, S. D., Moral, G. D. 2008. The five language skills in the EFL classroom.  Nueva Revista de Lenguas    Extranjeras, 10: 263  –  91 [2]   Byram, M., Risager, K. 1999. Language teachers, politics and cultures. Clevedon, UK: Multilingual Matters . [3]   Cloutier, G., Ibrahim A., Pratt D. 2016. Subversive identities at the art museum: an ESL university student’s experience at the national gallery of Canada. Canadian Review of Art  Education,  43 (1): 139-152. DOI= [4]   Buchanan, H. E. 1992. ESL Field Trips: Maximizing the experience both in and out of the classroom, 49 p. [5]   Shoemaker, M. K. 1998. Art is a wonderful place to be: ESL students as museum learner.  Art Museum. School Collaborations . 51, 2:40-45. DOI= [6]   Anthony, L.1997. Defining English for specific purposes and the role of the ESP practitioners.  Annual Review , 115-120. [7]   Dudley-Evans, T., St John, M., 1998. Developments in English for Specific Purposes: A Multi-Disciplinary Approach. Cambridge: Cambridge University Press , 303 p. [8]   Ramdhani, J., Ramsaroop, S. 2015. The reawakening of teaching through aesthetics in education: Students'  perspectives. Koers - Bulletin for Christian Scholarship. 80, 2 (2015) DOI= [9]   Kisak, P. 2015. Aesthetics: “ The nature of art, beauty & taste ”   Create Space Independent Publishing Platform; 6th edition  (Nov.12, 2015), 120 p. [10]   Adorno, T. W., Adorno, G., Tiedeman, R. 1997. Aesthetic theory. London,  Athlone Press ., 414 p. [11]    Niehoff, R., Wenrich, R. (Eds.) 2011. Thinking and learning with images: interdisciplinary approaches to aesthetic education. Kopaed Publishing, Munich., 211 p. [12]   The image in English language teaching edited by Donaghy, K. and Xerri, D. 2017.  ELT Council.  [13]   Tishman, S., Palmer, P. 2007. Works of art are good to think about. Centre Pompidou Evaluating the Impact of Arts and Cultural Education, conference proceedings, Paris , 89-101. 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