TEACHING EXCELLENCE DATABASE

Introduced in the new medical curriculum two years ago, the Medical Terminology course has been developed entirely to establish and improve the medical documentation skills of future practitioners and specialists. Based on authentic anonymised medical reports retrieved from the University's patient information system with the University's permission, the course was expanded in cooperation with anatomists, clinicians and demonstrator students. Our teaching materials (for extracts of class notes, Moodle, ITC etc., see 7.2 URL) are highly appreciated by students. Our initiative was without precedent in Hungary. On the one hand, the textbooks used previously were not suitable for our purposes as they were not based on authentic linguistic material. On the other, the specificity of Hungarian medical language discouraged us from translating or adapting any foreign textbooks. We have put together content-based and student-centred course materials, where the planning, implementation and assessment were based on individual learning needs and characteristics. We have set up an independent research group so we can teach international and Hungarian descriptive and clinical anatomical nomenclature along scientific research lines. We wanted our students to become acquainted with new research directions and to have the opportunity to become members of our research group. As a result, several demonstrator students have joined us. To deliver our course material in the most effective way, we use a variety of tools, the main ones being the class notes of contact sessions, ITC tools, and the Moodle platform with quizzes for home use. Through gamification we ensure high levels of student involvement, participation and interaction. We have developed the course materials interprofessionally under the guidance and supervision of anatomists and practitioners. And through a student feedback system, we can measure the success of the delivery within the framework provided by the University. By the end of the course, our students have the skills to use code-switching in different forms of medical communication: they become familiar with medical terminology, they are able to understand and use anatomical names correctly, they can provide simple clinical and pathological diagnoses in Latin, and they can communicate effectively to patients, explaining medical terms of Latin and Greek origin.

Methodology

PLANNING: Adapting to the new medical curriculum introduced at our University in 2019, our subject aims to provide knowledge that can be used bedside immediately. Medical terminology acquisition is achieved through the understanding of international Latin anatomical names and clinical terms, medical documentation skills, and accurate patient education. Our starting point was the fact that the medical language used in Hungary in the 21st century is still very Latin-based. As there is no Hungarian anatomical nomenclature, first-year students have to learn Latin anatomical names created under the rules of the Latin language in Anatomy – without any linguistic background – as a new foreign language. The first half of our curriculum is therefore based on observing the characteristics of Latin through the terms learned in Anatomy (a means of encouraging natural language acquisition), and then looking at the linguistic phenomena in authentic medical documents. Our curriculum goes well beyond the traditional medical Latin framework, as we have considered health care providers’ needs. Professionals have a legitimate expectation that students entering clinical practice should be familiar with medical documentation – the management of which is a significant part of their working time – to understand it immediately, and to express themselves in a clear, unambiguous, efficient and economical way in any oral or written genre, in doctor-doctor, doctor-nurse, and doctor-patient relations, making optimal use of code-switching between medical and lay language. Clinical findings and documentation in most specialties are also recorded in Latin due to legal regulations in Hungary; the Hungarian Health Act requires that patient education be unambiguous, while most of the terms in international classifications of diseases and interventions are based on Latin nomenclature and grammar. When designing the subject, we also looked at the curricula of leading foreign medical schools (e.g. Harvard Medical School, Heidelberg, Munich, Charité), the role they give to terminology training within medical education, and their objectives. IMPLEMENTATION: We envisioned a content-based and student-centred curriculum, where the design, implementation and testing based on individual learning needs and characteristics are paramount. Our education is structured around active and interactive processes to fully achieve the course objectives. Before and continuously during the compilation of the curriculum, we have been conducting extensive research and exploring the skills needed by graduate students and students entering the clinic in their third year. We have been preparing the basis for our curriculum through research, which we have prepared and arranged in a well-structured, cause-and-effect context for classroom and independent study, showing students the methods by which they can continue to develop their knowledge in this area. The course materials and reference works are made available to students on the University’s e-learning system (Moodle) and stay accessible after the course is completed. Our method is without precedent in Hungary or worldwide. The textbooks used previously were not suitable for our purposes as they were not based on authentic medical material; their only organizing principle was the classical teaching order of Latin grammar. Furthermore, foreign textbooks did not contain the specific use of terms employed in Hungary in context. At the same time, we are constantly aware of the differences in internationally applied professional terminology, and our curricula take into account possible sources of mistranslations and error. PARTNERS INVOLVED: We have developed a close relationship with our university's Department of Anatomy to ensure that we discuss the terms in parallel with them as much as possible, and to provide the language skills to help the students learn Anatomy. We have set up an independent research group to teach along the lines of scientific research, to introduce new research directions to students already in their first year of study, and to offer them the opportunity to become members of our research group. By presenting authentic medical documents, students can see from the outset of their studies what their output goals are and what language tools they can use in practice. Moreover, through the use of authentic medical documents our students can launch their medical socialisation and gain insights into clinical work based on the shadowing method, this being the main principle of our University’s clinical teaching. Authentic documentation (for outpatient records, final reports, examination findings, referrals, etc., see URL) is collected from several sources. After our own staff established an initial documentation database, we turned to the University clinics. For data protection and to ensure relevance, our institute has been able to employ a practicing physician for the last two years to collect and anonymize medical documents with the permission of the Clinical Centre. Our permanent guest lecturer is a specialist in traumatology and forensic medicine (Zoltán Patonai MD, PhD - s. URL). As a medical expert, he provides the students with an even more authentic introduction to the process of documentation and the importance of precise wording, as well as offering practical examples of how code-switching is performed for effective communication. In our research, we continuously involve other medical experts in documentation and patient education, such as criminal lawyers, pathologists, traumatologists, GPs and forensic experts, who have participated in the research that is then incorporated back into the curriculum. TAs and TDK students (Students' Scientific Association) have also contributed to our recent research. REVIEW: Professionals’ needs were already in mind during the designing phase, and the class notes have also been reviewed several times. We received official editorial opinions from the Departments of Anatomy and Internal Medicine, who expressed their complete satisfaction with our material. We also receive continuous feedback from the student side on the good pace of progress and the success of the delivery of the material (see URL).

Tools, equipment, technology used

To achieve our goals, the new visual, aesthetic, verified and approved class notes based on the results of our own research are a priority (s. URL; updated every year with research results, available freely to our students as a pdf print or digital download.) In the spring semester of academic year 2019/20, during the epidemic emergency, the university's e-learning platform Moodle (see URL) became fully available to our institute. We have since been able to offer our students the opportunity for experiential learning by solving quizzes with automatically displayed scores and feedback. We believe it is important that the editing of Moodle activities be preceded by conscious planning, and that the traditional and digital learning materials be complementary. Our methods include observation, recording, reproduction in a new professional context, practice, and monitoring. The course evaluation was developed based on gamification principles (see URL). In contrast to usual practice, the midterm tests are not assigned a grade, but a score - aided by Moodle quizzes to be completed by deadlines: Paper 1 for 30 points, Paper 2 for the double to maintain attention throughout the semester, and Moodle quizzes for 10 x 1 points. The best grade can only be achieved by completing all of these. We were able to motivate students in a way that exceeded all our previous expectations (see URL). Gamification is present in each lesson, with activities available on ITC tools (see URL) for all teachers (Kahoot, Quizlet, Padlet, Socrative, Wordwall, Google, and LearningApps). What can be played at home independently is made available to students in Moodle. The technical needs for these (i.e. projectors, laptops and speakers) are provided in our classrooms. Wireless internet is available throughout the University for teachers and students alike. The research needed to develop the curriculum was carried out using various language technology software. Our institute has an OCR scanner for digitising medical documents, ALRITE for transcribing oral medical communication, SketchEngine for analysing it, and MemoQ for creating terminological databases. The resulting databases, research outcomes, and glossaries for teaching and testing are available to all members of our terminology working group in MAXQDA. Our university's Zoom subscription has allowed the course to continue problem-free during the pandemic and whenever a class has had to be held online due to illness. The lectures of Zoltán Patonai from Pécs will be held on Zoom regardless of the pandemic situation. We have made available a "teaser" test on the central university server to give students an insight into the optional continuation of the course – Specialist Terminology – which can be taken from the 2nd semester. Last year we were able to start five more classes than the year before.

Outcomes and outputs, main results

We consider our most important achievement to be our success in convincing the University senate that our subject had a full place in the medical curriculum, and was therefore reclassified from an elective to a compulsory subject. The University’s quality assurance confirms that students also value the objectives of the course and are satisfied with the quality of the teaching. We consider the course results to be an indirect confirmation; all our groups are performing well above 90%, and we are able to motivate students sufficiently with the methodology described above. (see URL) In addition to the immediate continuation of the course, students have requested the launch of new courses on this topic. For three semesters we have been successfully offering the course "Linguistic aspects of patient-centred diagnosis disclosure" to 4th, 5th, and 6th year students, and a new course in specialist training is under negotiation.

Lessons learnt

Starting from authentic material helps to avoid language learning for its own sake. Only the linguistic phenomena enhancing professional language competencies are taught. To achieve this, it is essential to systematically process the available material collected. We have developed a method whereby, in contrast to the previous bulk vocabulary, we work only on terms students will encounter in Anatomy in the first half of the course. As we speak the same language as the anatomists, we reach our goals much faster by progressing to anatomy than by working with randomly selected excerpts. This systematic presentation and self-exploration of accessible, known material has proved to be more effective than a large immersion.

Adaptability and sustainability of the best practice (for other institutions)

Since our method is focused on code-switching and developing documentation and patient education skills, it can be adopted in any institution. The necessary technical means are likely to be available in most places. Our institute has prepared pilots of the most important databases based on research results, which are and will continuously be published and can be used in any language, and can be later included in contrastive research. We anticipate its adoption especially in areas where, for cultural reasons, the characteristics of the medical language show strong parallels with the one used in Hungary (e.g. East-Central Europe). In addition, our method can also be adopted in English-speaking areas, as the obligation to document exists in all jurisdictions. Its sustainability is clear at all medical schools, and all the more necessary as practical education is becoming increasingly important worldwide. The spin-off course has already been introduced at the University of Pécs.

Promotion of best practice

Our research results and course material development are continuously published at conferences and in papers. By developing the course material under the supervision of anatomists and clinicians, the medical colleagues who train the students know what prior studies the latter have undertaken with us. Our students have been in touch with their former secondary schools to report on our curriculum, so we have also received enquiries from secondary schools as to how Latin teaching in secondary schools could support us. Also taking advantage of the mandatory 50 hours of community service for secondary school students in Hungary, we have just launched our programme for them: students from grades 11 and 12 can now participate in the digitisation of our research material. Our website and Facebook page represent a permanent platform for sharing information about the course. Moreover, on the department website we have begun to make available our papers and research results on terminology for practising doctors.

Scope and impact

• Course/department level
• Faculty level
• Institutional level
• Cross-institutional level
• National level
• EU/EHEA/International level

Dep’t.: In connection with the course development, a terminology research group was formed, involving undergraduate teaching assistants - one of them working on his own research project. Fac.: We work closely with the medical faculty; they provide us with medical reports, on which we conduct research and feed the results back into teaching. They supervise and proofread our teaching materials. Inst.: our method is also being adapted for the international program available at the University, in both English and German. We hope that an improved version of our course will also be used in medical specialist education. Cross-inst.: Our invited lecturer came from Pécs, and we developed the spin-off of the course with colleagues from Pécs. Several universities have expressed interest in adopting our course. Nat.: Following the statutory requirements of medical education in Hungary, we provide our students with knowledge, professional skills and abilities to work independently in their fields. Intl: Our good practice is going to be available to medical students, including those in the international study programs. We are also promoting our initiative by conducting research in international project.

6.1 Digitalization

• Outstanding, innovative, excellent practices of online / blended / hybrid learning
• Innovative, novel methodology in using digital tools/devices in teaching
• Novel digital solutions (tools, frameworks, devices, tasks to enhance efficiency and motivation)
• Digital scientific sources used in T&L
• Data security and responsible digital presence embedded in learning outcomes

Reasoning: To provide novel course material based on scientific research, we integrated linguistic software Alrite, SketchEngine, MemoQ etc. at the preparatory phase. SketchEngine is provided by institutional subscription and is available to all students. The technical equipment in our classrooms allows the use of digital tools in class. Moodle helps motivate students to work continuously at home, and the results are GDPR protected, as is the student feedback officially required by the University.

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6.2 Internationalization

• Developing students' multicultural awareness
• Students engagement in international projects
• Courses implemented in international cooperation (projects, co-teaching, virtual/blended mobility, etc.)
• Courses offered to international multicultural students both online and offline
• International projects/research results embedded into course development and T&L

Reasoning: Our lecturers undertake international study trips, attend conferences and participate in international collaborations and joint research with universities and clinics in Mainz, Graz, and Prague. Further projects are under discussion with UCL and Houston. We also involve undergraduate teaching assistants in the terminological analysis of German-Hungarian forensic reports. Our course is now being implemented in the University’s English and German language study programs for international students.

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6.3 Inclusion and diversity, universal design

• Universally designed teaching material - adjustable for special needs

Reasoning: The course material is available to our students free of charge. For online teaching, contact sessions are accessible via Zoom. The Moodle material also offers the possibility of revision, repetition and practice, even for students with special needs. Applying the shadowing method, we can cover all the language requirements of the medical profession, and by knowing the method, students will later be able to apply code-switching and communicate effectively in any medical situation.

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6.4 Sustainability

• Environmental attitude, skill development and assessment either general or profession-related
• Sustainability aspects are considered in all phases of the learning practice - "hidden curriculum"

Reasoning: The method is sustainable and can be easily adopted both inside and outside the country. It does not require any external equipment and does not impact our physical environment. Our databases are expandable. The language material on which the skills and competences are developed and practised can be examined from new perspectives. The results obtained from several directions can be constantly monitored and incorporated into the teaching; students are therefore exposed to the latest innovations.

3.3 Public contact datas

Name	Email address	Website
Dr. Andrea Barta	barta.andrea@semmelweis-univ.hu	https://semmelweis.hu/szaknyelv/en/