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Testing Reading Comprehension In Medical

English Teaching

Conference Paper June 2014


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Petra Zrnikova
Comenius University in Bratislava


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Testing Reading Comprehension In Medical English Teaching

Petra Zrnkov

Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava


The issue of assessing reading comprehension, the theoretical background from the
psycholinguistic viewpoint, and development of language and communicative strategies is in the
centre of our attention. The theoretical background is composed of two models of reading
comprehension the multi-level model of text processing and the construction-integration model.
Different approaches to development of cognitive, learning and language strategies are being
compared. The goal of the paper is to manifest application of these models in didactics of English
for specific purposes, and present the results of our experiment. It shows readiness of medical
students to comprehend a scientific text assessed by means of cloze-test. The experiment brought
positive results. In general, approximately 40-50 students can manage to comprehend English
medical text efficiently, to combine their prior knowledge with new information, to detect the
relationships among the pieces of information, and thus to go beyond the explicit meaning of the
text. Conversely, there are the students who fail in applying cognitive and reading strategies in
order to get the meaning of the text, what may be caused by lack of their knowledge of English
language, motivation factors or other subjective aspects influencing their actual performance.
Therefore, the suggestions based on the standardized tests, for example First Certificate English
(FCE), are provided in the conclusion of the paper.

Keywords: reading comprehension, testing, text processing, reading strategies development,

cloze-test, medical English teaching

Testing Reading Comprehension In Medical English Teaching

1. Introduction

Reading scientific texts in English is an inevitable part of the medical profession. Therefore,

teaching English for medical purposes at the tertiary level should include deliberate and constant

development of ones reading strategies. Teacher can use many techniques to do so, e.g. cloze

tasks, also known as cloze-test or filling gap exercise. Cloze-test, originally intended to test reading

comprehension in English of second and foreign language users (ESL/EFL), was introduced by W.

Taylor in 1950s. Its idea comes from Gestalt psychology reception of an object as a whole at

first, and then understanding the details. Since then cloze-test has been considered very effective

technique verified in various researches (Brown, 1980, Gavora, rajerov, 2008/2009, Greger,

2005, Kamalski, 2007, Zrnkov 2013).

Unfortunately, in Slovakia its value is still not broadly accepted. Moreover, teachers in

Slovakia often may be confronted with the students opinion that this kind of testing task is unfair

because they are given unknown text for an exam, and thus it is too difficult, because it is not

possible to study for it anyhow, to memorize the vocabulary, etc. Therefore, our experiment aims

to popularize cloze-test and gives evidence to be seen as: a) an effective tool in reading strategies

development; b) an objective way of assessment of reading comprehension in teaching EMP; c) an

appropriate research tool. The results of the experiment manifest readiness of the 1st grade

students of General Medicine at the Jessenius Faculty of Medicine in Martin to process the

scientific text in English as well as it lists the common mistakes and lack of their language

knowledge or reading strategies. The suggestions for further improvement of reading

comprehension, especially for poor and average readers are provided in the conclusion.
2. The models of text processing

In order to understand text processing in general, not only when completing cloze-test

task, there are two models which are frequently referred to in the scientific literature. Both

models are closely related to development of learning (especially reading) strategies which are

also described in this section.

The cognitive strategic model of text comprehension consists of several stages occurring

parallelly. It isnt level-oriented but complexity-oriented, i.e. it goes from the understanding of

words, to the understanding of clauses, and then to complex sentences, and finally to overall

textual structures. The first stage is called surface code because a reader deals with processing

letters forming words and decoding the meaning based on knowledge in morphology and

lexicology. However, constructing the word meaning has to be done in relation to the other words

and to context of sentence sequences. Because a reader uses syntactic and semantic properties of

the text, the second stage is called text-base. The third stage known as a situational model

involves processing the text combined with previous reading experiences, general knowledge and

prior knowledge about the topic in order to make a meaningful link between the pieces of

information, e.g. cause-effect relationships, chronological order of events, etc. (van Dijk, Kintsch,

1983, Graesser, McNamara, 2011).

The stages mentioned above are closely related to the particular reading strategies defined

by the authors. Language strategies are strategies of the cognitive system, usually beyond the

conscious control of the language user. Also, they apply to sequences of mental steps that

perform a number of tasks. These tasks are different in nature and scope for example,

identifying sounds or letters, constructing words, analyzing syntactic structures, and

understanding sentential or textual meanings (van Dijk, Kintsch, 1983, pp. 71). However, ability

to understand all words in the text doesnt mean that a reader will get the message from the text.
Grammatical strategies allow us to make presumptions about the missing word. They are not

limited to the use of rule-governed information from the cognitive grammar and its specific levels,

units, or categories (e.g. morphology or syntax), but will at the same time use information from

other levels or even from the communicative context (van Dijk, Kintsch, 1983, pp. 74). Linguistic

and grammatical strategies are applied within the category of discourse strategies. According to

the authors, as the production and comprehension of sentences depends on textual information

of a large scope, then conversely, the semantic and pragmatic interpretation of a discourse will

have sentential information as input. Semantic strategies result in text coherence and cohesion

and pragmatic strategies lead a language user to a choice of appropriate language means in order

to express particular communicative intension within the particular communicative situation.

Next, the construction-integration model is characterized as follows: It combines a

construction process in which a text base is constructed from the linguistic input as well as from

the comprehenders knowledge base, with an integration phase, in which this text base is

integrated into a coherent whole (Kintsch, 1988, pp. 164). The model synthesizes the linguistic

aspects of text organization (macro- and micro-principles) with the individual factors (e.g. prior

knowledge, motivation, reading goal and purpose, attitude and perspectives on the topic, etc.)

brought into the comprehension and interpretation process by a reader. The construction process

relies on knowledge-based construction of meaning. The schema (also called proposition, or

frame) does not bear any meaning itself, but the meaning must be created. The power of the

construction process is an activation of the links in an associative network. While reading, there

can be activated several schemata, if the word has more than one meaning. Then, based on the

context and communicative situation, there has to be chosen the most appropriate one. In other

words, the meaning is context dependent and situation specific. The second part of the model,

the integration process requires reconstruction of the pre-existing schema by re-evaluation,

adjusting or removing the links which arent suitable anymore, resulting in a new schema. In

principle, it includes information at many text levels: lexical nodes, text propositions, knowledge-

based elaborations (i.e. various types of inferences), as well as macroprinciples (Kintsch, 1988,

pp. 168).

In comparison to this, H. D. Brown (2001, pp. 123) distinguishes two main types of

strategies learning and communicative strategies: The former relate to input to processing,

storage and retrieval, that is, to taking in message from others. The later pertain to output, how

we productively express the meaning, how we deliver the message to others. Cognitive

strategies are a subtype of learning strategies, consisting of: deduction, recombination, imagery,

auditory representation, keyword, contextualization, elaboration, transfer, and inferencing. For

reading comprehension development he suggests the following list of strategies: identifying the

purpose, decoding words using bottop-up approach, using efficient silent reading for rapid

comprehension, skimming for main ideas, scanning for specific information, semantic mapping,

guessing the meaning, vocabulary analysis, dinstinguishing between literal and implied meanings,

and understanding discourse markers to process relationships.

In terms of our contribution, learning-cognitive strategies emphasize the role of learners

prior knowledge of the language in order to process new text, e.g. applying rules of the language,

combining known elements in a new way, analyzing the word structure, guessing the meaning,

relating pieces of information, etc. When completing a cloze-test task, reading strategies can be

applied in two types of reading: the first is called intensive attention to grammatical forms,

discourse markers, and other surface structure details for the purpose of understanding literal

meaning, implications, rhetorical relationships, and the like (Brown, 2001, pp. 312), and the next

is known as extensive focus on general understanding, applying skimming and scanning

strategies. The students readiness to use all these strategies across the multi-level text processing
model, resulting in understanding and achieving new information, was investigated in our


3. The experiment

3.1. Methodology

The participants were the students of the 1st grade of General Medicine at the Jessenius

Faculty of Medicine in Martin. The experiment is based on the data from two academic years:

2012/2013 (47 students) and 2013/2014 (23 students). In total 70 students took part (though in

the first cloze-test only 65 students took part because 5 of them were missing at the lesson).

To measure reading comprehension, two cloze-tests, whose full length was 527 words in

average, with hint in mixed order were used. In each text 30 items were omitted in frequency of

every 12th word; besides numerals, proper names, and abbreviations. Students performance was

scored 1 point for a word in the correct place and zero for the incorrect or missing one; no minus

points were given. Total score was 30 points. The first cloze-test (CT1) was introduced as an extra

activity at the lesson to them, whereas the second (CT2) was a part of the final test in the winter


Students performances were divided into three levels of reading comprehension: Level 1

(L1) Advanced, independent reader (30 28 words; 100 90%); Level 2 (L2) Good, average skilled

reader needing little help (27 19 words; 89 60%); Level 3 (L3) Poor reader, demanding constant

help and correction (less than 18 words; 59 %). The levels reflect students reading skills,

independence in comprehension, and their readiness to learn from scientific medical text. The

assessing percentage scale is the same as the one used at the Comenius University in Bratislava to

pass the courses within the official curriculum.

The second phase of the data interpretation was done by means of item analysis for each

cloze-test and research group (Shi, 2013 online). The item facility index (IF) and the item

discrimination index (ID) were counted. IF index (the scale from 0.00 to 1.00) shows the value how

difficult or easy was for to fill in particular word into the text. The words with the index under 0.30

are too difficult; those to 0.39 are of average difficulty; the words to 0.84 are considered to be

reasonable; and those over 0.85 are very easy. The other ID index shows the difference in

performance difficulty among participants with the lowest score (IF-bot) and the highest score (IF-

top) for each item. Its role is to prove whether particular word with low IF index is really difficult,

or there are other factors which should be taken into consideration. ID is judged on the scale from

+1 to -1, where zero means no difference in performance. The subscale of values was adjusted as

follows: good difference (1 0.40), reasonable (0.39 0.20), and no difference (0.19 0 and


3.2 Results

At first, the overall results based on data gathered in both academic years are presented,

and then performance in CT1 and CT2 is compared. The average score in CT1 as well as in CT2 is

23 points. Also the percentage of students who achieved the highest and average level of

comprehension (L1+L2) is very close to each other: 77% in CT1 in comparison to 80% in CT2

(taking into consideration the total amount of students).

The figure 1 presents the data of students reading comprehension in each text (CT1, CT2)

and at particular level of text processing (Level 1, Level 2, Level 3). When having a closer look on

data in CT1 for each academic year, there is important difference in the lowest amount of score

achieved 12 points in the 2012/2013, but only 6 points in the 2013/2014. The highest score (30

points) was achieved by 2 students in the 2012/13, and also in 2 cases in the following year. In CT2

the minimum score is all the same as in CT1 for each academic year. However, important
difference occurred in the maximum score achieved by 12 students in the 2012/13, and only in 1

student in the next year.

Figure 1. Students reading comprehension according to levels of text processing

The item analysis (see Figure 2) showed that the texts are not very difficult because the

students were able to complete at least 70% of words in each text. The best score for word is over

90% and the worst over 60%.

IF 0,76 77% 0,81 81%
IF top 0,91 91% 0,95 95%
IF bottom 0,61 61% 0,68 68%
ID 0,30 30% 0,27 27%
Figure 2. The avarage values of the item analysis

Our research revealed that the majority of students can comprehend the scientific text at

good, average level. Their knowledge of General English is sufficient enough and helping them to

read through the medical article. On the other hand, the students with the lowest score lack the

knowledge from General English as well as from English for medical and academic purposes. They

made mistakes at all three stages of text processing (surface code, text-base, situational model),

including prepositions, passive voice, tenses, medical terminology, and scientific language.
4. Conclusion

Reading comprehension was explained from the point of view of psycholinguistics, in more

details on the basis of the well-known multi-stage models. Reading is a very complex activity in

which many aspects play a significant role. Reading for academic or occupational purposes can be

improved by applying the strategies suggested in didactic literature. Unfortunately, in general,

there isnt any specialized course focused on academic skills development at the universities in

Slovakia. The most common possibility for students to improve their reading skills and language

knowledge are teachers of General English at high schools, or teachers of ESP at particular

faculties, who will provide them with the appropriate tasks and guidelines how to succeed.

The other option is to follow the tips how to develop the strategies for managing reading

comprehension tasks and use of language tasks presented in the coursebooks for standardized

tests, such as First Certificate English (FCE). The cloze-test task, as it is applied in our experiment,

constitutes the independent part of the examination called Use of English in FCE by Haines, B.

Stewart (2011). Open cloze (without any hint; testing ones accuracy with grammar and

vocabulary in context) as well as multiple-choice lexical cloze (testing accuracy with vocabulary,

including differences in meaning between similar words and in their grammatical structure in

terms of fitting sentence) are used in this coursebook. In an open cloze task one should read a text

quickly to get the general idea of the topic, re-read the text to decide about the word part of the

missing word, writing the possible answers, second re-reading and filling in the remaining gaps

based on guessing strategy if a learner can find the correct word. When doing multiple-choice

version, scanning the text for the general understanding should be done at the first time. When

second time reading, the A-D options should be studied based on the sentence/text context.

Eliminating the inappropriate options based on ones knowledge of grammar or guessing strategy

should be done then (Haines, B. Stewart, 2011). In the part called Use of English (S. Burgess, R.
Acklam, 2002) cloze-test tasks with randomized hints to test learners knowledge of vocabulary

and grammar are used. In principle, the instructions are the same: to get the global idea of the

content; to fill in the gaps with words, which is a learner sure of; to select the words according to

their word class; to make decisions based on the meaning of the sentence and the whole text; to

consider the semantic, syntactic and discourse aspects of text composition, etc.

The evidence based on the standardized tests for English proficiency proves that using

cloze-test to test reading skills is reasonable. Whether it measures only use of language at the

surface stage and text base-stage depends on constructing procedure (word class of omitted

items, frequency of omitted items, etc.). However, referring to other scholars, it can measure use

of language as well as global comprehension at the deepest level. It was proved by the many that

it has very good methodological features, reliability and good validity and correlation with other

research tools. To sum up, cloze-test as a reading assessment tool and a research tool is easy to

construct and score for a teacher (a researcher), and at the same time the instructions can be

understood by a student easily.

For further research, there is left investigation of the relationship between subjective and

objective assessment. The first is done by a reader by means of assessment scale, and the later is

based on the score achieved in cloze-test as presented in this study. In research carried out

around the world, it is also quite frequent to investigate readers metacognitive skills by means of

assessing scale, and then to suggest techniques and tasks for their intentional development.


Petra Zrnkov is doing research in the field of psycholinguistics and didactics. Since September
2012 she has been teaching English for specific purposes in General Medicine, Nursing, and Public
Health. The author graduated at Faculty of Education, University of Trnava, as a teacher of Slovak
and English Language and Literature for primary schools. In her diploma thesis she dealt with the
communicative approach in teaching Slovak language. In 2012 she achieved Ph.D. degree in
Educational Sciences. The dissertation thesis was aimed on comprehension of causative discourse
markers in the explanatory texts. Authors scientific work has been influenced by Erasmus
scholarship at Utrecht University.


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