Developing Foreign Medical Students’ Communicative Competence: Rhetorical Aspect

Abstract

In our study, we proceed from the fact that classical and new rhetoric can be both a subject of special study and a means of developing communicative competence of foreign medical students who study Russian in such disciplines as “Russian as a foreign language”, “Russian speech culture”, “Medical rhetoric”, “Russian as a foreign language for special purposes”, which are compulsory in the curriculum as well as in some selective courses. This study is of a theoretical and applied nature, since, on the one hand, it formulates the theoretical foundations of the conducted pedagogical experiment, on the other hand, it proposes to discuss and apply a rhetorical model for developing foreign medical students’ communicative competence. The study is based on a wide range of scientific literature on the history, theory and practice of developing foreign students’ communicative competence, on the theory and criticism of rhetoric as well as on pedagogical theories and practical applications of a rhetorical approach to teaching foreign and Russian students. The primary focus is on the rhetorical canons as tools to prepare students for delivering public speeches, in particular, and as reference points for the rhetorical model of teaching Russian as a foreign language in general. A pilot experiment was conducted to prove the effectiveness of the integrated rhetorical model in the “Russian as a foreign language”, “Medical rhetoric” courses, in a special course for medical residents – “Russian as a foreign language for special purposes” – with a view to form and develop professional-communicative competence of foreign medical students.

Keywords: Communicative competencerhetorical modelrhetorical canonsmedical rhetoric

Introduction

Developing foreign students’ communicative competence is one of the most important goals of teaching a foreign language. This problem can be called the classical direction of linguistic research. However, the broad scope, multidimensionality and complex structuredness of competence as well as the variety of principles for defining communicative competence and communicative proficiency do not reduce the immidiacy and relevance of research in this direction. One of the tools for developing communicative competence of foreigners who study Russian can be rhetoric as a science, academic subject, form of practice and didactic method. Compulsory and/or selective courses at Russian medical universities offer the following subjects: “Russian language and speech culture” and “Medical rhetoric”. In an internationally oriented university, these subjects are included in the curriculum for both Russian students and students from different countries who study Russian as a foreign language (RFL): L1, L2.

Currently, the developed requirements and programs do not cover all the components of the Russian system of continuous profession-oriented teaching Russian to foreign students (Kurilenko, 2017); therefore, the aim of our study is to give a linguistic and didactic description of a rhetorical approach to developing students’ communicative competence.

Problem Statement

Linguistic methodology has passed a long and difficult way in understanding the goals, objectives and methods for developing students’ communicative competence. Approaches to developing communicative competence are characterized by diversity and multidimensionality.

Interactionism is a methodological approach associated with G.H. Mead’s ideas: it combines several different directions in sociology, social psychology, cultural studies, and communicative linguistics. In this approach, the object of study is interpersonal communication as a system of interactions between an individual and a social group, during which they comprehend one another’s intentions, predict the interlocutor’s reactions and carry out their own ones. Linguistic methodology considers the main models of interaction between communicants in Self/Other mode (social and individual characteristics of interlocutors, features of communicative goals, language manifestations) and methods for teaching these interactions, including their computer-mediated forms (East, 2016; Loewen & Sato, 2018).

Dialogue learning, originating from the Socratic model of learning through dialogue and, in the modern era, from John Dewey’s ideas, involves active cooperation between students and teachers in resolving a cognitive problem situation, based on reflective thinking (Keywords in Writing Studies, 2015).

A contrastive approach is used primarily for teaching a second foreign language (Biber, 2003) and involves training by comparing foreign languages and their learning strategies: finding analogies that facilitate learning or, vice versa, identifying differences to avoid linguistic and cross-cultural interference. This approach is manifested at the linguistic and sociocultural levels and supported by the acquired learning skills at the L1 stage.

A genre approach was accepted in linguistic methodology in the early 1980s and has been in use ever since, but it has different interpretations (i.e. review, analysis and criticism: Devitt, 2004; Keywords in Writing Studies, 2015): genres are related to types of discursive forms, forms of communicative actions, generating a certain textual structure, as well as types of statements combined thematically, stylistically and compositionally. This approach is associated with M. Bakhtin’s ideas, the provisions of functional system linguistics of the Sydney school as well as the principles of the New Rhetoric school allowing the genre to be used as a tool for mastering various forms of verbal communication in practice (Basturkmen, 2014; Paltridge, 2014).

A sociocultural approach implies teaching a language based on a person’s value attitude to the world and teaching communication in terms of universal values and national cultural traditions (Keywords in Writing Studies, 2015). A special look at the problem is associated with the role of the sociocultural component of communicative competence for students studying abroad (Isabelli-García, Bown, Plews, & Dewey, 2018).

A strategic approach is based on the theories of communicative strategies and tactics that have been actively developed in recent decades (The International Encyclopedia of Strategic Communication, 2018). The strategic approach to developing communicative competence, despite all the variety of scientific viewpoints, is understood as teaching speech actions (i.e. tactics, rhetorical steps) consciously aimed at achieving the speaker’s communicative goal (review: Chamot, 2009).

Discursive and interdiscursive approaches to developing communicative competence are associated with the anthropologization of science in general and linguodidactics in particular. The relevance of discourse in teaching foreign languages is determined by its ability to open and shape the interaction mechanisms of humans as social beings and individuals, their verbal and cogitative processes and social behaviour. At the same time, the focus of pedagogical attention is on teaching not so much to create texts perfectly built in terms of linguistic laws, but rather to effectively interact depending on the communicative situation. These approaches are particularly relevant in teaching languages for special purposes and professional communication (White, Holmes, & Bhatia, 2018), including the medical sphere (Insights Into Medical Communication, 2015; Kurilenko, 2017).

Each of these approaches (the list does not cover the whole variety of linguistic-methodical research) has its advantages and disadvantages, applicability limits and bottlenecks; therefore, in modern linguodidactics, there is a search for an integrative methodological form (or “methodological plurality in the study”: (Keywords in Writing Studies, 2015, p.13) that would make it possible to simultaneously use the strongest points of several approaches.

There are some specific features in the process of developing medical students’ professional communicative competence. However, in general, experts believe that “the theoretical and methodological foundations of the modern system of continuous professionally oriented teaching of Russian to foreign medical students are shaped by the principles and provisions of the discursive, cognitive, strategic approaches, theories of foreign-language cultural-linguistic education” (Kurilenko, 2017).

Discussing the discursive orientation in developing communicative competence, we shall place rhetoric as a special academic discipline and linguistic-methodical approach into the focus of our research. The renewed interest in rhetoric, primarily as a science not so much about the beauty of the word as about the methods and rules of argumentation (Allen, 2018, p. 59; Ancient Rhetorics and Digital Networks, 2018), reflects the understanding that rhetoric as a whole is the art of developing effective (reasonable, influencing, harmonizing) speeches, which is used, in particular, to convince the audience of the validity of a particular action or viewpoint (Strating & Harkness, 2018; The Handbook of Organizational Rhetoric and Communication, 2018), including goals and objectives of professional communication (Argumentation …, 2017).

The academic programme on medical rhetoric being developed by us for both Russian and foreign students is aimed, as a training goal, at improving their communicative competence in the educational, scientific and professional fields of communication; it involves learning such concepts as communication–communicant–communicator–communicate ; speech goal–relevance ; communication effectiveness, harmonizing dialogue; communicative cooperation; speech/communicative situation; types of speech activity, forms and types of speech, types of communications; classifications of public speeches; rhetorical canons; text, strong text positions, primary/secondary text; Grice maxims/good speech properties; chreia, argumentation theory and practice, modalities and manipulation; laws of rhetoric.

Research Questions

The analysis made it possible to formulate the main research questions: (1) whether it is advisable to use a rhetorical approach for developing professional communicative competence of medical students and residents within the Second Level Certificate (TORFL-II/B-2); and (2) whether there are points of intersection (interaction) between the “Russian as a foreign language”, “Medical rhetoric” and “Russian as a foreign language for special purposes” disciplines that make it possible to systematically build communication teaching under this approach.

Purpose of the Study

The purpose of the study is to design a linguodidactic rhetorical model that will ensure the development of a tolerant professional-communicative personality of a foreign specialist who knows how to use strategies and tactics of argumentative discourse.

Research Methods

As part of the study, a three-stage pedagogical experiment was conducted. A searching experiment at the first stage allowed us to analyse the scientific and methodological materials on the research topic, identify the problem situation, formulate the research hypothesis, develop an experimental research program, specify independent and dependent variables and determine ways to control them. At the second stage, a pilot experiment was carried out, during which 2 sub-stages were identified: (1) implementation of the developed teaching materials in the experimental group; and (2) preliminary adjustment of the goals, objectives and experimental programme as well as independent, dependent and side variables. At the third stage (according to the results of the pilot experiment), changes were made to independent variables (elements of training tasks were refined, the assessment scale was detailed, the experimental situation and the choice of experimental and control groups were adjusted, and the conditions for taking into account the testees’ features, including elements of rivalry, were determined).

At the first stage, the study was based on a comparative analysis of the content and implementation forms of the professional module of the “Russian as a foreign language” (RFL) and “Medical rhetoric” courses for foreign medical students and “Russian as a foreign language for special purposes” (which is a selective course for foreign medical residents). The Medical Institute of the Peoples’ Friendship University of Russia (Moscow) served as the basis for experimental work. The pilot experiment was conducted during the spring terms of the 2016–2019 academic years, involving third-year students majoring in general medicine (medical care). The training tasks were selectively tried and tested in groups of first-year residents as well as first-year students majoring in general medicine, who were trained in the “Russian language and speech culture” and “Medical rhetoric” disciplines.

The pilot group was formed administratively, i.e. regardless of the experimental design, and included students with different learning abilities, in accordance with earlier conclusions about the effectiveness, under certain conditions, of teaching interactive communications to students with different levels of basic communicative skills within one group (Loewen & Sato, 2018).

Findings

Teaching rhetoric as the science of effective communication to foreign students has several distinctive features in comparison with the theory and practice of teaching rhetoric to audiences speaking their native languages.

On the one hand, rhetoric is universal; its study does not require perfect knowledge of Russian as a foreign language (RFL) at the first stages, which facilitates the task for both teachers and foreign students. However, due to different language proficiency levels, the progress rate in the course and the volume of learning materials are certainly different for Russian-speaking and foreign students. In addition, the laws of effective communication “lie down” on the national-cultural specifics of the communication environment and communicants themselves, which in a multinational and multicultural student audience considerably scales up the linguocultural commentary of both communication situations and speech works that arise in these situations: for example, standard etiquette greeting and farewell, request for help or apology for being late, address to the teacher, a fellow student, a colleague, or a patient have different linguocultural colours, knowledge of which allows one to better understand the culture of the target-language country, national character and historical roots; as a result, it can prevent a possible communicative conflict or show a way out of an emerging conflict situation, and helps one to form a harmonizing dialogue as one of the main forms of rhetorical interaction.

In view of an acute shortage of class time in the “Medical rhetoric” course for foreign students, the choice of types of speeches for study and pronunciation is associated with the future professional activity of students and based on the material being studied in the main RFL course. Taking into account that the RFL course helps foreign students to develop a strong skill in creating secondary information texts (extended and with compression elements), master the most important elements of Russian speech etiquette, acquire the ability to transcode the communicative content of an informative speech from one form to another (for example, from oral to written, from a dialogue to a monologue and vice versa: a dialogue between the patient and the doctor ↔ a record in the patient’s chart), and study some methods of argumentation (e.g., proving the efficacy of a drug), a persuasive speech is chosen to be the main subject of the “Medical rhetoric” course. The choice of a potential audience is professionally determined: a speech for patients, their relatives or general public.

Teaching to make persuasive speeches is associated with the consistent implementation (mastery) of the five canons of rhetoric: discovery or invention (Lat. inventio ) , arrangement or disposition (Lat. dispositio ) , style or elocution (Lat. elocutio ) , memory (Lat. memoria ); and delivery or action (Lat. actio ); The proposed approach is consistent with the idea of redirecting pedagogical efforts from teaching to write/speak (“teaching about writing ”) to arranging for a student to pass through the procedure of creating an oral/written text (“writing studies”) (Keywords in Writing Studies, 2015, p.15). Thus, while studying rhetoric, students not only theoretically master the concept of “rhetorical canons”, but also pass through all its stages in practice.

At the invention (inventio) stage, the most important tools for selecting themes, ideas and ways of argumentation in a future speech are topics (or topoi ). In a foreign audience, the emphasis on topics is not only appropriate in terms of content, but also relevant in a communicative-linguistic sense, because the main “Russian as a foreign language” course of the educational-scientific sphere is based precisely on the rhetorical principle of identifying topoi : educational texts, syntactic models and lexical units are used in a consistent teaching of all types of speech activity around such “commonplaces” as: (1) genus – species, (2) definition, (3) whole – parts, (4) object properties, features, qualities, functions, and typical actions, (5) correlation (comparison – opposition), (6) cause and effect, (7) circumstances and conditions (where, when, how, in what way, under what conditions), (8) example (trait – trait-carriers, action – actor, etc.), (9) evidence (quotes, sayings, references to authoritative scientists’ opinions), (10) name (explanation of a topic, text header, its meaning).

Thus, preparing a persuasive speech at the inventio stage is based on students’ knowledge and practical skills in the field of topics and does not require additional (special) efforts in this direction, unlike the situation with native-speaking students who are for the first time purposefully studying “commonplace” issues in rhetoric courses. Based on the understanding that the historical core of topoi , despite all the variety of approaches to defining this concept in rhetoric, literary studies, cultural studies, and philosophy, is their cognitive and, at the same time, pragmatic (ethical) content, foreign students are offered topics of persuasive speeches related not only with a utilitarian or rational complex of argumentation ( All drugs by prescription?! The customer is always right! On smoking hazards ), but also with the need to give an ethical and moral evaluation of the choice in the argumentative issue ( Euthanasia: yes or no? Abortions: allow or prohibit? Mandatory drug testing in schools: what pros and cons? Baby boxes: introduce or refuse? Are acutely experimental surgical interventions into the human body like V. Spiridonov case acceptable? , etc.).

Students also familiarize themselves with the concept of disposition (dispositio) in the RFL course, while learning to process source textual information: reading and understanding educational texts, outlining what they have read, i.e. highlighting the main and auxiliary topics and micro-topics of the source text, and analyzing their presentation sequence. The rhetoric course involves teaching productive speech activity (from analysis to synthesis): in particular, to locate components of a conceived speech in accordance with its topic, idea and goal set as well as the text functional-semantic type and orientation to the target audience. It is proposed to take a direct or inverse (indirect) chreia for the structural basis of a persuasive speech. In the classroom, discussions are conducted of options for building and designing strong text positions, ways of formulating messages, types of arguments depending on the speech situation in which a persuasive speech is to be made, attention is paid to the modes of persuasion: logos , ethos and pathos .

Verbal formalisation or style (elocutio) implies the ability to choose the necessary language material and clothe the speech content in an adequate language form. At the same time, we proceed from the assumption that the objective of the task is non-linguistic in its nature; therefore, the focus of exercises should be on communication and meaning rather than on language forms. Students should primarily use their own linguistic resources, which generally corresponds to the interactionist approach to language acquisition (Loewen & Sato, 2018). This does not hinder foreign students from continuing to improve their phonetic and grammatical skills or replenish their vocabulary, and teachers from preventing or correcting their mistakes. A greater difficulty at this stage is in the fact that the speech environment (i.e. student community communication) forms a steady need to use student slang in speech, the stylistic characteristics of which, including its relevance/reasonability, are not fully understood by foreign students. Within the “Elocutio” section, special attention is given to this aspect of verbal expression, and the results of studies showing the relationship between the choice of verbal expressions and contextual factors of communication are taken into account and further explored (Briggs, 2016).

Teaching memorization ( memoria ) is an important stage and informative unit of the course. In the classroom, the students’ educational experience in the field of mnemonics is actualized, new types and ways of memorizing speech material are proposed, and the issue of strong text positions in the aspect of memoria is discussed.

Actually, delivering a speech ( actio ) sums up the training content in the rhetoric course: it is a highly ranked control element. According to the criteria predefined and presented to students, assessments are made of their rhetorical speeches and participation in public discussions. As such, the procedures of self-assessment and mutual assessment are important components in teaching rhetoric to foreign students.

Measurements of the developed communicative skills according to the “Informative speech component”, “Compositional speech component” and “Interactive speech component” criteria, carried out in stages (initial stage, intermediate stage, final stage) by the method of expert assessment, showed on the average a significant increase (30,4%), which may indicate the effectiveness of the developed model in the pilot experiment.

Conclusion

To date, the content and presentation forms of the “Medical Rhetoric” course for foreign students of Russian universities are not fully developed; this creates certain difficulties for teachers, but nevertheless allows them to take creative initiative in structuring the course, selecting didactic material, taking into account the characteristics of their students, identifying their own methodological preferences, and testing innovative educational technologies.

The results of the pilot experiment should be considered preliminary and requiring further adjustments related to the dependent variables (taking into account the level of tolerance/aggressiveness of the speaker and the audience; variables associated with individual differences, such as anxiety and motivation; formal dynamic indicators of the final task execution), validity, reliability, and sensitivity of all evaluation criteria.

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