Format Template Vol. 3, No. 2 | July - December 2020 SJET | ISSN: 2616-7069 | Vol. 3 | No. 2 | © 2020 Sukkur IBA University 90 Teaching Oral Communication Skills to Healthcare Personnel Using Communicative Language Teaching Technique Faiza Khadim Arain1,,Hira Khadim2, Munsif Ali Jatoi3,Hina Manzoor2 Abstract: The importance of communication skills has long been established in the medical and nursing education. Although such skills are taught in medical and nursing undergraduate curriculum around the world, but less attention is being paid towards the communication skills of healthcare personnel in Pakistan. The primary focus of this study is to determine whether the communicative language teaching (CLT) technique had an effect on oral English communication skills of nursing students. This quasi-experimental study was conducted at undergraduate nursing students. Purposive sampling was employed. A pre-test, based on role-plays, was conducted on the baseline status of students followed by a sixteen-hour course. The same role- play scenarios were given as a post-test. Participants were assessed through rubrics adapted using proficiency descriptor and Cambridge English assessment scale. The Wilcoxon signed- rank test was employed to compare scores obtained from pre-test and post-test. The result revealed that the Communication language teaching technique had a significant effect on the oral English communication skills of nursing students. Keywords: Oral Communication skill; Communicative Language Teaching technique; Role- plays; Statistical Tests; Healthcare; Nursing Education 1. Introduction Language is often defined as a communicative tool that helps to exchange ideas and, thoughts. It is widely known that human beings learn their mother tongue in their natural situation. Similarly, the same is the case with foreign languages. It can easily be learnt in a friendly and comfortable situation where language learners are encouraged to participate naturally. In the learning process, both teachers and learners are equally involved. Therefore, the teaching process should be as much interactive as possible. In [1], it was claimed for effective 1 Department of Management Sciences, Barrett Hodgson University, Karachi, Sindh, Pakistan 2 NED University of Engineering and Technology, Karachi, Sindh, Pakistan 3 Department of Biomedical Engineering, Barrett Hodgson University, Karachi, Sindh, Pakistan Corresponding Author: Munsif.jatoi@bhu.edu.pk teaching, the methods employed to communicate with the students, should be effective. In this regard, the communicative language teaching approach is considered as the best option to teach foreign languages. In many schools, colleges and universities, more antiquated teaching methodologies (such as grammar-translation or audio-lingual) are still being employed, but over time, the needs of learners have changed. As a result, it has become essential for ELTs to reflect upon their teaching pedagogies to cater to the needs of learners and learning context. In the mailto:Munsif.jatoi@bhu.edu.pk Faiza Khadim (et al.), Teaching Oral Communication Skills to Healthcare Personnel Using Communicative Language Teaching Technique (pp. 90-98) SJET | ISSN: 2616-7069 | Vol. 3 | No. 2 | © 2020 Sukkur IBA University 91 nursing profession, the basic aim is to provide care to patients. In the process, language plays a pivotal role in both understanding and providing nursing care to patients. However, previous studies have not dealt with training nurses received regarding the language in which they are communicating with their patients, or how this language is central to their practices; or how it could assist or deter them in their work [2]. Despite the availability of a wide variety of communication methods which could be used to impart education in nursing programs, it has been impossible so far, to determine which of these techniques should be considered the best to improve communication skills of nurses. The communication skills-based courses are included in every discipline including health care. According to [2], “Spoken and written communication is a vital aspect of nursing activity. The demand for nurses to communicate effectively in both speech and writing has become more important as a wide audience of patients, purchasers, professional bodies and the law demand satisfactory”. Considering the significance of communication skills, this study aims at exploring if the Communicative Language Teaching technique affects the oral English communication skills of nursing students. The purpose of Communicative language teaching technique is to help evolve what Hymes called “competitive competence” [3]. It can be defined as the extent to which a speaker needs to be familiar with any given topic to be able to speak competently in a given speech community. In [4], it is asserted that Communicative Language Teaching follows the idea that language teaching syllabi should include not only the aspects of language which must be taught but should also shift the paradigm by focusing on exactly how to teach. The strategies in CLT teaching technique include real-life communicative situations, where the ability to achieve a task is more important than language accuracy. Thus, more focus will be placed on their ability to communicate than on any particular language forms. It implies CLT aims to improve students’ oral communication skills of learners According to [6], various communicative activities can be employed to teach oral communication skills. These include techniques such as role-play, language games, and scrambled sentences. In [7], it is stated that several activities are commonly used in CLT include interviews, games, role-playing, information gap, surveys, games, pair work and language exchanges. The statement was supported by [8], who stated that several games, for example, role-plays in different settings have been designed specifically with CLT classes in mind. In [10], it is further added that these practices should be based on real-life situations that entail communication. This paper is organized as: Section II discusses literature review, Section III provides research questions for this work, Section IV provides methodology adopted, Section V gives an account for data collection protocol and finally Section VI presents the results and discussion. Finally, the conclusion from this research work is produced. 2. Literature Review According to [11], “Communication skills can be taught in courses, are learnt, but are easily forgotten if not maintained by practice”. While it is considered most advisable to learn communication skills during clinical placements at medical school, no previous study has investigated has specifically addressed this question. It has been emphasized by several studies that teaching method should be experiential, as the instructional method of teaching failing to provide the desired results. In [12], by simulations and role-plays, students can become more confident and competent in both academic and professional lives, since they receive the theory and practice at the same time. These activities create multiple situations where language learners may use target language efficiently Faiza Khadim (et al.), Teaching Oral Communication Skills to Healthcare Personnel Using Communicative Language Teaching Technique (pp. 90-98) SJET | ISSN: 2616-7069 | Vol. 3 | No. 2 | © 2020 Sukkur IBA University 92 and they would have the chance to express their opinion explicitly without being judged allow them to speak in publicly [9]. Another experimental study was conducted by [13] to compare the impact of conventional and cooperative teaching techniques on the communication skills of nursing students when they were interacting with their patients. For that, two groups were randomly selected and nursing courses were taught with different methodologies. Results indicated that cooperative learning was a very effective tool in helping to better and enhance the communication skills of students, allowing them to hone interactive skills. According to [14], every student has their own style of learning that helps them to mediate their oral communication skills, and ensure that their communication can have the maximum possible impact, for this, however, teachers should not only be using the usual large-group pedagogic teaching but should also focus on ensuring that their style of teaching is compatible with the students’ learning styles. This will ensure that a large number of students can learn how to communicate properly. For that reason, excessive attention must be paid to the educational requirements of the students at hand. Since nursing students are expected to work in various multicultural as well as social scenarios, it is of utmost importance that they understand not only their cultural context but also that of the patients’ they will be tending to. In the Nursing and Midwifery Council document, the emphasize is given to the significance of communication in its code of conduct, and asserts “nurses must meet people’s language and communication needs and share with people in such a way they can understand the information they want or need to know about their health”. This would likewise help them to make more informed decisions about the healthcare that they wish to receive as well as the form of treatment they would like to take [15]. Consequently, nurses are required to have a command over communication skills. Research Questions 1. Does the communicative language teaching approach have an effect on the students’ oral English communication skills? 2. Does the use of role-play technique have any significant difference in Pre and Post performance of nursing students’ performance? 2. Methodology The study employed quasi- experimental design. Sample size was calculated by using the online openEPI calculator by taking pre-mean score=10.77±3.1, post mean score=18.04±2.08, power of test=80% and 95% CI as documented by a study assessing the effect that targeted instruction can have on the communication skills of final year students in a medical college in India. OpenEPI stands for open source epidemiologic Statistics for Public Health and is used for statistical applications i.e. descriptive and analytical studies. The least sample found was 6. However, 44 participants were taken as the sample size of the study. In this study, purposive sampling technique was employed. Purposive sampling is defined as “the process of selecting a sample that is believed to be representative of a given population”. Therefore, the teacher- researcher identified the following criteria for selecting sample technique: (a) students enrolled in the first year of their academic programme, (b) students who do not have any prior English language training at college. The students included in the study were enrolled at a nursing institute. They were also enrolled in the English classes being conducted. One intact class, with 44 students, was selected. 14 (30%) girls and 30 (70%) boys participated in the study. The first language of the students varied between Urdu, Punjabi, Sindhi, Hindi, Gujarati, and Chitrali. The average age of participants was 18 years, although the group contained individuals Faiza Khadim (et al.), Teaching Oral Communication Skills to Healthcare Personnel Using Communicative Language Teaching Technique (pp. 90-98) SJET | ISSN: 2616-7069 | Vol. 3 | No. 2 | © 2020 Sukkur IBA University 93 between 18 to 22 years. It was observed that the participants’ English proficiency in speaking, listening, reading, writing and knowledge of grammar was between beginner and low intermediate. For intervention, prescribed syllabus for students was used from the nursing curriculum, and the study was a continuum of the co-curricular activities. In the pre-test and post-test, the students were given role-play situations and they were tested for grammar, lexical choice, fluency, comprehension, range, and interactive comprehension. Role- plays are an integral part of the communicative language teaching technique because this strategy provides students with the opportunity to implement their learning in various social situations and within different societal roles [17]. On the other hand, it is stated in various works that role-play activities involving role-plays are designed to help students understand a wide array of situations, and imagine how they could act appropriately on each one of them. In [18], it is stated that the role-play can enhance the speaking abilities of students through creating real life situations in a conversation form. Similarly, [19] identified role-play as a teaching practice that motivates students’ engagement in the language learning process. For tool validity, peer debriefing, internal and external validity was used. Two experts, i.e. one nursing manager and one English as a Second Language (ESL) teacher, were involved to validate the rubric. Expert insured the face, construct and content validity.Fig.1 shows the methodology flow for this research work. 3. Data Collection Protocol Firstly, a pre-test was designed to assess the data about the students’ baseline status of their proficiency in English communication. In the pretest, students were given situations in which they were asked to assume the given role and act out an adopted role. Students were assessed through rubrics. After evaluation of pre-test, students were taught different domains of communication- based on their curriculum through different teaching techniques. After teaching, another similar post-test was administered and scores of the participants were recorded to evaluate the effectiveness of the intervention. Fig. 1: Flowchart of Methodology All participants were asked to complete the pre-test in class under the supervision of an ESL teacher. Students were instructed about the nature of the speaking test and the amount of time they would be given. The participants were divided into a group of 4. They were randomly assigned situations for role-playing. Role-play situations were designed to test the participants’ threshold point. An analytical rubric was used to assess students score based on their performance and to minimize the chances of subjectivity, an ELT expert was called upon for evaluation. The main teacher acted as a secondary Research Approach Study Design Sampling Technique Tools and Analysis Start End Faiza Khadim (et al.), Teaching Oral Communication Skills to Healthcare Personnel Using Communicative Language Teaching Technique (pp. 90-98) SJET | ISSN: 2616-7069 | Vol. 3 | No. 2 | © 2020 Sukkur IBA University 94 assessor. After discussion when both teachers agreed on common ground, scores of participants were recorded and study plan for a communicative language teaching approach was formulated. The full score for the test was 20. In the intervention, eight classes were planned and each class lasted 120 minutes. Students were taught using the following activities: short talk, warm-up activities, role- play (pair & groups), interviews, discussion, authentic text, poster presentation, debate, and impromptu speeches. These activities consist of group and pair work and were selected from [20]. In the first speaking session, students were grouped in pairs and each of them received a blank identity card. Then, they interviewed each other to fill in the blanks on the identity card. Each student introduced his partner to the whole class using the identity card as an aid. Each student was required to ask those things from his partner, which he/she thinks are significant or exciting. In the second speaking session, students were divided into groups. One student in a small group was given a series of pictures that have a story sequence. He/she showed the pictures of the story to the class and asked them to predict the rest of the narrative. Then, at the end of the sessions, each group was asked to narrate the story to the whole class. In the third speaking session, students were divided into groups again. In each group, one student (who either volunteers or is drawn by lot) was interviewed by all the other group members. In the fourth speaking session, students were divided into groups and they all were given role-play situations and were asked to express their feelings. For example, “you have just learned that a colleague’s father has died”. In this session, students were instructed to structure their roles. For that, they were given 30 minutes for preparation. At the fifth speaking session, the teacher distributed handouts that had a copy of different column from a recent newspaper. They were instructed to read it and make a poster. Afterwards, they were asked to present their posters to the entire class. In the sixth speaking session, the class was divided into two groups. One of the groups was told to support the topic while the other was told to speak against it. Besides, the students were instructed to use expressions of agreement, disagreement, partial agreement, and interruption. For instance, some people think teachers should ask disruptive students to leave the class. In your opinion, what’s the best way to deal with such students? In this way, a kind of a debate competition takes place in the class where each student from each group got a chance to speak once before the entire class to refute his/her point/argument. In the seventh speaking session, the teacher involved students in discussion activities. For example, the teacher outlined the task in which students were given a list of 14 occupations. They were instructed to rank them according to two criteria. Firstly, they had to arrange the jobs in the order these jobs are paid in our society. After completing this, they were asked to propose a list of occupations based on how important they think each job should be. Students were instructed to work with their neighbor and then discuss it with others. In the eighth and the last session, students were asked to give impromptu speeches. They were randomly assigned different topics and allotted fifteen minutes for brainstorming. The session aimed to make students speak in a complete spontaneity without researching and organizing their ideas. In all eight interactive sessions, the teachers guided class and from time to time observed the students’ performance. She acted as a facilitator of the activities, but she did not herself interact with the students. Most of the time, the teacher was a co-communicator and establishes the situation that prompt communication between and among the students. After the teaching of sixteen hours, the same pre-test was administered and the scores of the students Faiza Khadim (et al.), Teaching Oral Communication Skills to Healthcare Personnel Using Communicative Language Teaching Technique (pp. 90-98) SJET | ISSN: 2616-7069 | Vol. 3 | No. 2 | © 2020 Sukkur IBA University 95 were recorded for further analysis. The flowchart for data collection protocol is provided below in Fig. 02: Fig. 2: Flowchart of Data Collection 4. Results & Discussion The data was statistically analyzed by using SPSS version 19. For each participant, marks obtained before and after the test were summarized. Standard Statistical measures such as mean, mode, median, standard deviation was computed of both tests. Then, Wilcoxon signed rank test analysis was applied to assess and compare scores before and after the test. Table I: Mean, Standard Deviation, Minimum and Maximum of Pre and Post Test N Me an Std. Devi ation Mini mum Maxi mum Ra ng e P re - te st 4 3 10. 230 2 3.36 845 6.60 18.8 0 12. 20 Table 1 represents the summary statistics of Pre-test. Mean of sum scores of Pre-tests among student nurses was 10.23 with a standard deviation of 3.36. The Minimum score was 6.60 and the maximum was 18.80 with a range of 12.20. Table II: Mean, Standard Deviation, Minimum and Maximum of Post Test N Me an Std. Devi ation Mini mum Maxi mum Ra ng e P re - te st 4 3 12. 776 7 3.58 003 6.60 20.0 0 13. 4 Table 2 represents the summary statistics of Post Test. Mean of sum scores of Post Test among student nurses was 12.77 with a standard deviation of 3.58. The Minimum score was 6.6 and the maximum was 20.0 with a range of 13.4. It can be noted that students performed better in post-test as compared to pretest. The overall statistics showed there was a statistically significant difference in the oral communication skills of nursing students from pre-test to post-test. Start Pre Test Interventions Speaking Sessions Post test End Faiza Khadim (et al.), Teaching Oral Communication Skills to Healthcare Personnel Using Communicative Language Teaching Technique (pp. 90-98) SJET | ISSN: 2616-7069 | Vol. 3 | No. 2 | © 2020 Sukkur IBA University 96 Table III: Rank Table N Mean Rank Sum of Ranks Post-Pre Negative Ranks 1a 2.00 2.00 Positive Ranks 38b 20.47 778.00 Ties 4c Total 43 a. Post< Pre b. Post> Pre c. Post=Pre The Ranks table provides insights into the comparison of participants' Before (Pre) and After (Post) intervention. Wilcoxon test was applied to find out whether there was a difference between pre-test and post-test performance. Hence, mean is provided to make the analysis statistically valid. The post and pre prefix defines the results before and after intervention rspectively. As seen in Table 4, the analysis indicated that the communicative language teaching approach had a significant effect on the learners’ performance from a pre to post-test. The Wilcoxon sign rank test indicated that the scores obtained after the test were considerably higher than those obtained before the test. Therefore, it can confidently conclude that the CLT approach can yield statistically significant and improved result in nursing students’ oral communication skills with a Z value of -5.422 that indicates the high statistical significance of the result. Table IV: Test Statistics The results of the experiment found clear support that the communicative language teaching approach proved to be effective in improving oral communication skills of nursing students. From the above findings, it is clear that students tend to learn more in those activities where a “real communicative context is the focus, where real information is exchanged, and where the language used is not predictable”. In [5], it is claimed that communicative language teaching approach could be used to reduce the anxiety level of students in an EFL classroom. It can also be applied in the current study because the performance of students was increased after implementing CLT activities. It may, therefore, be assumed that due to interactions and real communicative tasks i.e. Role-play, students’ anxiety level was decreased and it would, in turn, help them to improve their performance. Since communicative activities not only provide opportunities for the students to perform at their optimum level but also, they get a chance to learn in more realistic and real-life situations. For that purpose, in this study researcher has used role-plays as a tool for pre-test and post-test and the mean score of post-tests depict a very comprehensive illustration of increased students’ performance. That further strengthens that role-plays were effective in assessing and enhancing the students' performance. In [21], it is examined how students; speaking skills can be improved through classroom interaction. The results were affirmative as it was found that students’ communication inside the classroom enhanced their speaking ability. She further suggested that devoting few hours as Post-Pre Z -5.432b Asymp. Sig. (2-tailed) .000 a. Wilcoxon Signed Ranks Test b. Based on Negative Ranks. Faiza Khadim (et al.), Teaching Oral Communication Skills to Healthcare Personnel Using Communicative Language Teaching Technique (pp. 90-98) SJET | ISSN: 2616-7069 | Vol. 3 | No. 2 | © 2020 Sukkur IBA University 97 classroom interaction would motivate students to have profound conversations and ultimately their communicative skills would polish. In addition to this, in the current study through the results of post-test, it can also be interpreted that students became more motivated after the intervention. In [22], it is explored the correlation between CLT related activities and the impact it had on the motivational levels of students aiming to learn English. The results revealed that language learners considered CLT activities to be motivating because when they were involved in communicative activities it helped them to improve their fluency, pronunciation, and performance. In the same vein, in the current study students improved their grammar, lexical choice, fluency, comprehension, range, and interactive comprehension. While implementing CLT, the teacher should consider that correction of mistake should not be done spontaneously rather it can be done during discussion or feedback session. In this way, students’ performance would not be affected. In [23], it is investigated EFL learners’ opinions to predict their attitude towards implanting communicative activities in the classroom. He found a very high level of conformity regarding implementing CLT among students. There is the effectiveness of using CLT in learning speaking. In his study, the means of both the pre-test, as well as the post-test scores indicate that the post-test mean is considerably higher than the pre-test mean. The findings of the study help us to understand that students’ speaking score improved after they were taught through CLT methods. It is worth noting that the results of the present study corroborate the results of previous studies. A similar results’ pattern was obtained after analysis and it can be claimed the CLT method of teaching is an effective method when it comes to improving the oral communication of nursing students. 5. Conclusion The overall findings of the study indicate that there is a statistically significant difference in nursing students’ performance before and after the test. From the results, it is also concluded that the use of role-play as communicative language teaching (CLT) techniques was found effective in improving oral communication skills of nursing students. The findings of this study have a number of practical implications to ensure successful implication of CLT in Pakistani ESL context: (a) The teacher should create or adapt activities that are interesting and meaningful to encourage learners to communicate as smoothly as possible. For example, activities that require active participation i.e. Role- plays or discussion activities should be more integrated. It can reduce anxiety in learning and would help to increase participation and create a cooperative learning environment. (b) The teachers should also be aware that they are teaching mixed ability students where there is a combination of beginners, intermediate and advanced students. In order to involve all students, tasks should be simplified and comprehensive. (c) The teachers should ensure that students interact a great deal with one another. They do this in various configurations: pairs, triads, small groups and whole groups. (d) The teachers should understand their role as facilitator and co-communicator. In addition, future researchers could explore other dimensions of the same study in several ways, for example, a controlled group can also be taken or comparative analysis may be done. 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