Significance of learning English in the Era of Globalization

Interviewer: T. Takashia, MD,PhD :(T)
Chairman, Japanese Educational Clinical Cardiology Society,
Takashina Clinic, Osaka
Guest speaker: T. J.Brien :(O)
Professor, Ohtani Women’s College, Osaka
At Takashina Clinic Conference Room on Thursday, January 19, 2006

I: How to Motivate Student to Learn English

T: Welcome to Takashina Clinic this afternoon. I am very pleased to have you here today and we would like to talk about how to motivate students to be good in English, as the first topic.

O: I am pleased to be here too. When you talk about motivation, usually we have two kinds of motivation. One is, for probably, the student who wants credits for graduation, and actually getting something from our university. The other kind of motivation is personal, it is the students who want to do something by themselves. If we can tie those two kinds of motivation together, one is intrinsic motivation, for getting a credit, eventually for graduation, plus students themselves from their heart. When we can talk about those two things, we have very good motivation.

T: I agree with you what you said. If they want to enter medical school, they want to have a credit or degree after their graduation. They also wish to have such credit, if they would graduate from a famous university, they would feel that he or she should have a high social ranking. I am quite interested in recent postgraduate training system that has just started since 2004.

O: In Japan?

T: Yes. When I graduated from the Medical School of Kobe University, I took an internship at the US Army Hospital in Osaka, when the Korean War had just tereminated. However, the postgraduate training program in Japan was interrupted due to various reasons. As you might know, the School Conflict (GAKUEN-FUNSO) had been taking place and our training program had been interrupted of 36 years. In 2004, the new postgraduate training system has just started.

O: Is that right?

T: They became more willing to learn clinical skills which can not be learned at their university hospitals.

O: Are they taking the clinical training, outside of university hospitals now?

T: Yes, they feel that teaching hospitals are more suitable places for them, because there are more fresh clinical cases with good staff (physicians) and they can receive high quality of clinical training, compared with university hospitals. Those staff at those teaching hospitals showed more interest in the new system. As the result of the event, close to 50% of medical college or medical school graduates are receiving their training outside of university hospitals.

O: Huum.

T: Now, this phenomenon creates various problems.

O: Huum.

T: Medical students are now becoming more active and independently thinking of their future. Recently, I had chances to teach a different group of medical students, and I found that these students are quite diligent and thinking positively about their future.

O: Is that course a medical school request or one on a volunteer basis?

T: Volunteer basis. I believe that this kind of tendency is very good.

O: That is a very good sign, isn’t it.?

T: I think that motivation to be a good doctor in the future is depending upon giving fresh and important information to them.

O: Motivation is very difficult thing, something I have written about. We know it happens, but we cannot test it.

T: That’s right.

O: We can talk about it forever. We can’t give magic medicine to make motivation. That is a problem. But in practical terms, we can change it or we can encourage it. And also, in some schools or universities, we can find that they discourage their student’s motivation.

T: Would you say that it is due to the teacher’s responsibility?

O: I think that if students are loosing their motivation, that is due to something wrong with the educational system, whether the curriculum or the syllabus is wrong.

T: I see.

O: Or, with the teaching staff something is wrong. May be these the curriculum can change. The syllabus can change and also we can retrain teachers.

T: I know what you mean.

O: We can put in several “in-course seminars”. We rejuvenate teachers (sort of recharge them). I think that is something very important. If teachers are kind of arrogant, and very proud of what they are doing, they are very difficult to retrain.

T: Yes, they might say that I am a well trained and refined teacher, so that I need no further training.

O: That is almost the same in high schools, universities or medical schools. Probably, the same in business or top managers. It is very difficult to teach or retrain top people. If they can do that, the university education system is exciting.

T: I think so too.

O: There are two ways in the education system, such as the European and American system, when I compare that with the Japanese system, by my observation of 30 years in Japan. I think that Japan has top-down system.

T: Yes, professors used to say “do this, do this” to their students.

O: I am in a good system (laugh). Probably, the European and American system is a bottom up system.

T: That’s right. The Japanese system is quite different from others,

O: My case, as an university professor, I have talked to students about the education system whish is bottom up. I make the idea that I am a “Gardener”.

T: That ‘s interesting!

O: If I can consider to put in roots, put in seeds, provide encouragement, and then people can grow, students can grow,

T: You can give water and nutrients into soil. I think your point is quite true and give a good atmosphere to students. I certainly feel that to elevate the motivation depends on the teacher’s attitude.

O: Not all students are equally motivated. Because I had taught at a medical school a couple of times, however, their basic manner was sometimes so poor to be good social people.

T: I’d like to know about your experiences at that medical school.

O: I think that this is a typical medical school. Some students in the class were very carefully taking notes. They want to learn, they are very hungry. That is good.

T: That is good to hear.

O: But we have so many more students, who sit and go to sleep (laugh). But all these people will pass the test. I felt it was very sad. What we need for 1st year and 2nd year courses is “awareness” of what a doctor should be. A doctor is not a paper or qualification, but a person.

T: That’s right.

O: What makes a doctor? He is a kind of analyst of people and machines and systems. Obviously, medical students are not matured people. It takes years. We can put awareness into students of 1st year and 2nd year. Give them personal targets, e.g. how to become medically qualified, and socially qualified. I think most of students are not aware of the social aspect.

T: Let’s me ask you this. I believe that for qualification to be medical students in the USA, they have to graduate a 4 year system college first. Then, they can go into medical schools. How about this in the UK?

O: That’s not my main study. I did not do my homework(laugh).

T: O.K. (laugh). That is quite different from the education system of a Japanese medical school. Therefore, when you compare their age of 1st year medical students in USA, they are 4 years older than Japanese students. However, another interesting aspect of medical education in USA is the whole term to be a specialist in medicine is too long. As the result of this long training, postgraduate students become quite old when they become specialists.

O: In America?

T: Yes. Many doctors are now fussing about this. And also, ordinary people are not willing to see a highly qualified doctor at the first occasion. Now, many medical schools, including Harvard university, are now providing
the course of the generalized specialist who has wider and deeper knowledge in medicine. I believe that this is an ideal way it should be.

O: Probably in England, most of the doctors are GPs and you have to register to be seen by one doctor in your home area. Your choices are quite limited. If you have something technically difficult, wrong with you, he would not catch that. Because he is not a specialist, the first gate is closed. There is a problem. The GP is good to catch ordinary diseases, e.g. influenza, and for broken bone, he would send the patient to a hospital for X rays But something difficult or tricky in cardiology, he won’t catch it.

T: I see.

O: In Japan, we can knock at the door of a different doctor’s office everyday. Each doctor is specialized and a patient can go and search for further information.

T: I think this kind of conversation in our interview is so important to know the medical care system in England, because not many people know about that.

O: I think that GP idea is very good, but you should be backed up by specialists at the nearest hospital.

T: Now, does the GP refer his or her patient to a specialist?

O: Yes. Because medical care in England is usually the National Health Service(NHS).

T: Does your government pay a good salary to doctors?

O: NHS doctors are not rich. But a private medical practitioner is different.

T: Here, I am a cardiology specialist, 51 years after my graduation. However, the national health insurance system pays the same medical treatment fee, as a 1st year graduate student. I think that is ridiculous.

O: Now, in England, the number of medical school students is going down.

T: Is that right?

O: Now, a doctor is an ordinary worker in England.

T: I also heard the same kind of story in Germany recently. Not many medical students are interested in taking care of patients.

O: Here, almost 6,000 students are graduating from medical schools in Japan.The population of Japan is double compared with England. But in England the number of graduate students is very small.

II: English is not a Target, but a Tool

T: After I spent teaching medical English classes at Kobe University School of Medicine for 17 years, I became so disappointed , because most of the students were not interested in learning clinical English, so I stopped my teaching at the Kobe University in 1985.

O: I came to Japan in 1974, and started teaching English to students. English education learning and teaching in Japan, traditionaly has been always knowing about language. All our test or entrance exams for high school and university and “EIKEN” are always knowing about English- things like grammar or spelling and sentences. But in about 2002, “Monbu-Kagakusyo” made a change to reflect Europe and America. Europe changed 30 years ago and Japan changed 4 years ago.

T: Oh, what’s the difference(laugh)!

O: Monbu‐Kagakusho wants schools to try to change from knowing language, to using the language. That is the way to use the language for communication. Now students have to know how to speak to people, when to speak, we have to be in sympathy with people. We have to recognize that language is now not knowledge of grammar, but social skills. In a recent paper I said that, if we have communicative learning ( communicative language learning), it is social. So 50%, we have to teach English, such as grammar or spelling and sentences, but rest of 50% we have to teach about society, and how to be a social person. We have to know how to talk with people, and how to encourage the conversation, and how to repair it when it goes wrong. If I make joke and you don’t laugh, then something is wrong. I have to repeat the joke again or do something.

T: That’s quite right(laugh).

O: That is a way to teach social skills. Many students are even very poor in social skills in Japanese.

T: Even in Japanese?

O: That’s right This a problem. Do we make a foreigner or native speaker teach social skills plus English, or do we require Japanese teachers to teach social skills? We have to be pre-teachers.

T: I see.

O: One of the biggest things now is that social skills are becoming weaker in English communication, in language communication. One of the things is TV. Now TV is setting the standard of social behavior for almost all people. When I was young at home in England, we had no TV.

T: I saw the first TV program, when I was an intern at the US Army Hospital in Osaka in 1954.

O: We were lucky, because we could talk at home. Now kids watch TV or watch VTR and watch video games. They are not actually talking with people. They are without face to face conversation. Also, the mobile phone system is another example. That is really fantastic, but now we have faceless conversation. We don’t need face to face, we don’t even need a voice. So we have faceless, voiceless communication.

T: You are right about the recent trend in communication.

O: That is the KEITAI-DENWA problem. We have also an incomplete communication with KEITAI-DENWA. If we go back to 20 years or 30 years, people used to write letters. This was before the FAX. A letter was especially important. Today, if you ask students or kids ”How many emails did they send today?” Their answer is 30 ~ 40. What they are doing with 40 emails or 50 emails today, is sending of “parts of communication”. They send one or two words or three words, and the reply is also one or two or a few words.

T: That is what I thought too.

O: So, we are now having incomplete communication. So we have to change doctors. So, we have to retrain them with more social skills. We have to have doctors who can actually look at body language and recognize body language.

T: I agree with you. Actually, I proposed a concept of “Three clinical languages” in 1972. The first one is spoken language, second one is body language, and third one is organ language of the patient. Unless you understand these 3 clinical languages at the bedside, you can not call him or her a “Doctor”.

O: Now, doctors are not listening anymore. This is what I call “Positive listening”, not passive listenless. Just like TV is passive. You have to listen to patients, you have to be a positive and a very good listener. You have to listen to the inside of the conversation. Listening inside is going back to the old style of Japan, the TATEMAE-TATEMAE style. So if a doctor asks a patient “How are you today?” and then patient says, “I am fine, thank you”. So, why did he come to the doctor?

T: It is quite strange (laugh).

O: On the surface, we have a language and then inside of the conversation is a different intent. We have to have good doctors. They have to train to listen to the intent, “Is there something more, something that is not said?” This kind of personal contact must be encouraged. It must be explained to students in medical school. It must be practiced, it must be simulated, and students must become social people.

T: I am pleased to hear that you mentioned about surface and the inside of communication.

O: I know of one doctor, who is a very good doctor, But his conversation is perfectly about medical problems, and only medicines. He never extends from that. As a social person, he does not really generate any more interest in people. He is a good doctor, but he can’t become a complete person.

T: You are really pin-pointing on the core of a medical interview.

O: So more training in social skills would be advantageous.

T: That is a very good suggestion, and I am so impressed. And what is happening in most of big hospitals in Japan is the widely used “Electronic chart System”, I hear many comments from patients that, “Doctors at hospitals are becoming much colder in their attitude, than before. Doctors are only looking at computers on the desk, and not looking at me. Doctors won’t touch me or examine me, not even placing stethoscope on my chest.” One patient told me that a doctor stopped his conversation, when he was so anxious to speak up. “As you can see, I have so many patients who are waiting behind you, so please go back to Dr.Takashina. I will send him a report in the next few days. Good bye,” He said that a new system is probably necessary for hospitals, but we don’t appreciate it. “It is like a machine”.

O: Almost liked a drive-through “McDonalds”.

T: That is true(laugh).

O: You can order through a microphone first, and you can get medicine.

T: That what is happening around here everyday. We really have to change our training system. We have to go back to the previous good system. Another thing I’d like to mention today is a trend of medical students. Some of them are quite active and willing to take an externship at some university hospitals in the USA or other countries for 4 weeks or so. They are searching for what they need in medical training in foreign countries, not in Japan.

O: We are the same. Even you went to America, and you were studying in America. You can realize many more things by stepping outside of your society. I came to Japan when I had been a high school teacher for two years, in order to discover something more. That was 31 years ago.

T: Is that right?

O: From my experiences, of sending students abroad from my university, we send them for short 3 weeks programs in summer to one year abroad studies. Even in 3 weeks, students have amazing experiences and come back as different people. Eyes become wider and their heart becomes larger. They can do that easily by stepping outside their society. This is the reason why reason what I wanted to come Japan. To step out of your regular society, to step outside of your own country. Probably, by this you can see your society easier.

T: You need to be step out from your home for a while, right?

O: In my case, I wanted to be in Japan for 2 years to see some differences of society. I enjoyed it so much that I did not go back to England. Now I have been in Japan, just over half of my life.

T: Is that right?

O: At this point, I am very excited and I think I have become international.

T: I believe so.

O: I think I have got 2 sets of feeling; 2 sets of eyes and 2 sets of hearts. Now, I am understanding society from 2 sides, not a simplicity such as like or dislike anymore, but a deeper understanding. This is my international point. That is very important for student. Students begin to do that during 3~4 weeks in summer. During the 1st year, 2nd year & 3rd year, they change very much.

T: Some people said that there are stages for going abroad. The first stage is the time of high school student. The second stage is the time after several year of experience in their own country and then going abroad. The third stage is the time after you have accomplished your work as a specialist. He or she might see things better than when they were young. What do you think about this?

O: I think that if they are in junior high school or high school to go to foreign countries for home stays, I think that is too early.

T: High school students are too early?

O: Maybe they go to Australia with a junior high school, boy scouts or a rotary club or something.

T: Yes.

O: If I interview those students very carefully, most of them did not speak English when they went to the home stay, then they were not able to communicate. Simply, their English language was too low. So they could not understand very much, except sign language and body language, and so on. Most of their understanding is a negatively-formed experience. Mentally they suffer.

T: Oh, yes. I saw such cases several times in the past.

O: Homestay families I talked to, also, are saying the same thing. High school students are too young. This is my feeling. Another point is socially, in Japan, perhaps, in junior high school or high school it is not so good. They have to go to a foreign country, as directed to be an ambassador for Japan. When they are so young, they can’t do that even within Japan. Of course, they can’t do that in English.

T: Too young to perform such a kind of role.

O: If they go for a short stay, this is in my university, the short stay in university should be first year and second year. If they go abroad for one year to study in any university, may be the third year is the time for starting a one year abroad study. That is my feeling.

T: They may be mature enough to see things in a foreign country.

O: Right. And also, a sabbatical. I think they need a basic grounding in Japan.

T: I understood very well what you said. I think that most of Japanese people are always comparing with their own country and foreign countries. Basically, Japanese are shy, so that they won’t speak up first, unless he or she is asked by somebody to speak up. They know their English is not so good, so that they hesitate to speak up in poor English to foreigners.

O: I understand.

T: I had a very interesting experience recently in Australia. I happened to meet a gentleman while I was walking. I said “Hello” to this gentleman and we started our conversation. Right after I began to talk, he said, “You are the first Japanese looking at my eyes and talking in English. I have met so many Japanese before, however, none of them were looking at my eyes and talking. I felt uneasy. I know that most of the Japanese are visiting this country on a group tour with a Japanese speaking guide. Wherever they go, they are always, with a Japanese speaking guide, for sightseeing, shopping, eating at a Japanese restaurant, and they go home with their group. I don’t know whether this is Japanese culture or not. But I don’t understand. Even when they are visiting this country, they are not communicating with our people at all.”

O: Huum.

T: And he asked me, “By the way, what kind of work are you doing?” “I am a doctor.” “No wonder you speak English and you are really the first person looking at my eyes while we are talking. I enjoyed to talk with you,” and then we shook hands.

O: Oh yes. I understand his comment, because most of the people I met in Japan, are the same as what he said. Like a Japanese businessman is talking to an European or American, the eye contact is different. The American businessman looks at Tanaka-san’s eyes. Tanaka-san feels bad. Tanaka says, “He did not like me.” Most Japanese are looking at the nose, mouth, and chin areas. This is about 70% of the time.

T: Is that right? Huum, I did not know about that.

O: They are avoiding the foreigner’s eyes. Foreigners feel bad. They say that the Japanese guy is sneaky. He is hiding something. He did not look at me directly. He is looking at my nose, so may be I forgot something on my nose.

T: Ha ,ha. That’s something (laugh).

O: During this talk about a basic culture exchange between one Japanese and one foreigner, we have a kind of miscommunication.

T: I am quite lucky, because I stayed in the USA for 4 years, and I have had many chances to talk in English with foreigners almost everyday in 50 years. I feel easier to talk to foreigners than to talk to old styled Japanese people.

O: Probably when we want to use the word international, these people are not socially or internationally well trained, but maybe they are domestically well trained in Japan. This country works well with very polite people.

T: This is the core of our conversation today. I believe that most of the medical students now are the same as his friends. Because of the reason, when they were in high school, they were not well oriented internationally. Even after graduation of medical school, they are still on the same track. On many occasions, at medical scientific sessions or symposiums, most of the participating young doctors are not speaking up even if they have some questions to ask the speakers, unless they have confidence in English. At the time of discussion, almost all doctors are so quiet and calm in the auditorium. So, the speakers feel uneasy, “What’s wrong with me?” “Did I say something wrong?”

O: I see. That is a lack of international training. In my lectures, I have no question time in Japan.

T: Is that right?

O: If I give the same lecture in England or in America, probably 40% of the time is for question.

T: In Japan, most of the people will not want to be asked by the speaker. When I give lectures at the University of Arizona, School of Medicine, 50~60% of the lectures are questions. In that way, we have very good and vivid communication .in lectures.

III: How to Teach Globalization to Students

O: How to teach students to become “globalized”. I think one of the biggest points is to realize that English is not the ticket for globalization.

T: I see.

O: English is the way, but not the passbook. It is not a magic ticket. The more you learn English, the more you become globalized. I think that students who want to become globalized people, such as doctors, they have to make a big effort, and enjoy joining that club. You have you fight to get a high education, not simply by walking through bottom door. In that case, you have to be internationally or socially aware. You have to have awareness of today’s active life, people and society, psychology and probably the news. They need to know what is happening inside of the business world or other field of science.

T: That is true. You have to pay attention to the rest of world.

O: Like the Internet, if you click a couple of times, you can access all kinds of newspapers in the world. You can read summaries of all news, if it is available.

T: That’s right.

O: Before I start work in the morning, I read the news in many different countries. I get general opinions, so if there is a problem in one country, how does America feel about, how does England feel about, or how does Japan feel about it. If there is any interesting news, we can read that.
So this becomes social and international awareness. So they need effort. It is not passive education, they need to be very active and that is how they can become globalized people.

T: They should be active to learn many things through the Internet or news everyday.

O: How do they feel about English. What is English? Again, they have got to change their target and, not to say I got a TOEIC, score of 900, so I am O. K. or EIKEN- first class. I am O. K. If they realize that English by itself is not a real goal.

T: I can see your point.

O: English is a tool. If they learn English to speak English, read English, and write, that is fine. So how do they use it? If you have a hammer, a couple of screws and couple of nails, you can build your house. Those are tools. English is the same.

T: That is an interesting comment to hear.

O: You can build something. You can build yourself. I think, if you can change the target, changes that students recognize as the targets which are the goals, not getting a passbook or some credits. Then we are actually achieving credits, and a tool for further education.

T: Advanced education.

O: Yes. Looking back 30 years ago, Japan or European education was that learning English was a way to learning engineering or law or medicine, learning something international. Then, about 30 years ago, universities in Japan stopped that. They have EIBUNKA, and the target, then became English.

T: That is strange, isn’t it?

O: Then we have a problem, that is extending student targets, extending goals for students. 

T: I agree with what you said about opening our eyes wider to the rest of world and to learn more about other fields of human society is true. Even I spent 51 years in medical practice, I have so many things I never experienced, so I became to show more interests in other fields of sciences and human cultures, beside cardiology.

O: Usually, when you become about 40 years old, we improve our social skills very quickly, so that is part of our middle age crisis.

T: Huum. We can’t do the same kind of activities like sports we used to. We have matured probably, as social people, and also we have better eyes from our experiences. You can see the education system in medical schools. They have to learn English but it is not a ticket to become international people. They have to open their eyes and to have more common sense to communicate with people. I saw some articls written by many medical students in the Igakukai-Shinbun . I was quite impressed that they had very good experiences as externs in some universities in the USA, even if they could not to speak good English. So finally, would you give some message to medical students?

O: Well, the energies of students are good. I think teachers are like sports coach perhaps. Well, you know the guy who runs fast in 100 m. We know he is going to be a world champion. With a good coach, he becomes a world champion earlier, like 2 years or 3 years earlier. Without a coach, he will take another 2~3 more years, to become a world champion. The teachers are the same.

T: That is quite an interesting model of a teachers’s role.

O: During 4~5 years inside university, teach him to reach a high level in a shorter time and get a better level.

T: Yes, you are quite right. However, one interesting opinion is brought out in the USA. A good friend of mine, Dr. Gordon A. Ewy who is a professor of medicine and cardiology at University of Arizona College of Medicine, told me that the total training period to be a medical specialist in the USA is too long. So that, when you consider about their age to be aspecialist, they become older than 35 years old. In the way of cost effectiveness, they will try to shorten the term of training of specialization.

O: Hum, talking about 30 years ago , we had a change in educational psychology, and language teaching and other things. Up to the 1960s, learning language was learning by habit, making habits. So you had to repeat and repeat. This is learning by memory, which is good. From 1960 to 1970th , the idea of learning changed to cognitive learning, using intelligence. So now we have a change from habit repeating to thinking and using intelligence. Both are good.

T: Huum. That is historical change in the education of language.

O: I think Japan is still teaching pre-1970th.

T: Huum.

O: Pre-1970 is a behavior. What you call behavioristic (behaviorism).
And then, from 1970, we have cognitive (thinking and intelligence). This is really English communication, isn’t it? I still feel that a lot of universities are still pre-1970. It is not old or bad. We need to know, we have to select carefully.

T: Would you say that a lot of Japanese English teachers are doing their teaching style with pre-1970 ideas?

O: Yes, I think so. That is when I got a job in Japan and I have got a few years before I retire. I’d think that professors in Japan are well qualified. But they got to change idea to be professors “Perfect specialization people into sales people”. They got to be sale their specialization, sale how to know students. English universities made their professors to take courses in teaching methods. That was a radical idea and it tries to improve the quality of the teacher as a good salesman. Again I would like to mention that the universities and staff are doing a good job in Japan, but the students and the staff have a chance to become better, At that time, education in universities would become exciting.

T: Thank you very much for your coming this afternoon, Prof. O’Brien.

O: Thank you very much.