Scientific English for Medicine

i

PREFACE
Scientific English for Medicine is designed to help the Students fulfill the needs of
learning English for Medical Purposes. It serves them the opportunities to develop their
English skills more communicatively and meaningfully through the well-arranged
activities.
This book consists of eleven chapters. The first eights chapters focus on the topics
which are related to the students’ future career as Doctors. The skill units such as journal
reading, speed reading, and critical reading and writing are organized to support their
study in this department. The exercises in these primary chapters comprise nutrition-
based passages in which the vocabulary used is essential for their study in the School of
Medicine. Speaking section and Morning Report are given to equip the students with the
needed skills for their upcoming job. The last two chapters encompass the TOEFL-based
topics and present the grammar and reading sections. Listening and Reading sections are
presented in the separate chapters in order to be delivered comprehensively.
For the better edition and quality improvement, criticisms and suggestions for the
present issue are welcome.

Author

ii

TABLE OF CONTENT

PREFACE.................................................................................................................................................... ii
TABLE OF CONTENT.................................................................................................................................. iii
Chapter 1 Beyond the Sentence ................................................................................................................2
Chapter 2 Journal Reading Medical Students’ Characteristics...................................................................7
Chapter 3 Why Do You Want to be a Doctor? ........................................................................................13
Chapter 4 Speed Reading........................................................................................................................16
Chapter 5 Own Journal Session...............................................................................................................24
Chapter 6 Critical Reading and Writing ..................................................................................................32
Chapter 7 Let’s Talk!...............................................................................................................................35
Chapter 8 Morning Report......................................................................................................................39
Chapter 9 Academic Debate ...................................................................................................................43
Chapter 10 Introduction to English Proficiency Test (1)..........................................................................45
Chapter 11 Introduction to English Proficiency Test (2)..........................................................................53
Reference:...............................................................................................................................................57

iii

Chapter 1 Objectives:
• Find the meaning of contextual
Beyd ond the Sentence
vocabulary
• Differentiate word class from a sentence
• Explain the meaning and function of

certain group of words
• Explain the function of sentence

connector
• Writing effective sentences

Extra

Below are some reliable
online dictionaries for
better learning. Click and
explore!
1. Oxford Dictionary
2. Longman Dictionary
3. Merriam-Webster

Dictionary

Vocabulary Bank

carry out field deal use
cut store
professional view site

meet run

A Pay attention to the words listed in the

Vocabulary Bank section. Those words
are taken from a passage entitled The
New Revolution? Laboratory Information
Systems. Without reading the passage,
find some definitions of those words by
looking them up in the monolingual
dictionary.

B Write the definitions in the table below.

Word Definition 1 Word Definition 2 Word
Class Class

carry out
field
deal
use
professional
view
cut
store
meet
run
site

C Read the following passage.

The new revolution?

Laboratory Information Systems

Laboratory Information System (LIS) is a type of
computer software that is used in the laboratory to
manage patients' samples and the reporting of results
from analyses carried out on these samples. Both LIS
and Laboratory Information Management System
(LIMS) perform similar functions. However, LIMS are
generally used more in commercial analysis, such as
the pharmaceutical or biotechnology fields. LIS is run
more commonly in the clinical market, for example in
hospitals and other clinical labs.

Laboratory reporting has clearly changed
significantly in the last 30 years, and LIS has undoubtedly contributed a great deal to that development.
Before computerization, laboratories depended on large bound books for data entry and sample tracking.
In addition, charts were often hand drawn with final reports manually typed and carbon copied. Obviously,
this was very time-consuming for the laboratory scientist. The 1980s saw the introduction of sophisticated
software programs for data crunching and sample tracking. Although better than the handwritten report
books, they were expensive and slow. In the 1990s, LIS moved to the PC allowing the use of databases and
resulting in easier programming and documentation. The biggest step forward with this change was the
speed of reporting. Analytical reports evolved from postal mail to overnight deliveries to faxes to emailed
PDFs and electronic files.

Laboratory data management has arguably changed the most in the 21st century with the introduction
of web-based data exchange. This allows real-time interface with analytical instruments for information
sorting and comparison by staff, who are physically a long way from the laboratory. Data is processed into
a variety of formats for use by all the professionals involved in processing. For example, a nurse or doctor
may view lab results seconds after they are entered, allowing them to prescribe the relevant medicine
quickly. Clearly, the turnaround time has been cut drastically. Furthermore, the current commercial systems
store huge amounts of data for future use and allow for fast, remote data retrieval.

LIS and LIMS make available an ever-increasing amount of information. This is to meet the demands of
the modem laboratory, which has a large array of analysis equipment and is required to perform a large
number of functions. Firstly, there are the sample tracking functions within the laboratory. In addition,
detailed data on productivity for work areas is provided for each department. The key concern for many
commercial lab managers is probably the ability to work out financial information depending on test, client
and dates. Both forms of software are often run with web-enabled Global Positioning Satellite GPS use (GPS)
technology for geo-referencing location at the time of sample collection. The typical package will include a
number of other key functions. Firstly, the patient management function records information about the
patient for all parties to access at any time. Secondly, the decision support function catalogues all patient
tests and allows review when necessary. Additionally, the systems provide quality assurance by making sure
that tests are carried out using current practices and regulatory standards. Finally, the direct reporting
function allows clients to access data directly.

Clearly, there are benefits to using LIS and LIMS-type software systems in the laboratory. Processing is
much faster and with fewer input errors due to the transfer of data directly from the laboratory instrument
to the program. Moreover, the real-time data and quality control is a huge benefit to all modern laboratories.
Nevertheless, many commercial labs need to consider the costs of customizing LIMS systems to meet
specific lab or client needs. Data integrity and confidentiality are probably areas of high concern when
implementing this type of software solution. It is very expensive to guarantee sensitive information and this
can add to the overall cost of the system.

The future of LIS/LIMS will depend on what is required of these systems. Many laboratory managers
want direct downloads of data collected from sites outside the laboratory, such as hospital wards or other
specialized laboratories. This eliminates the need for multiple entries of the same data. Commercial sector
managers might ask for standardized interfaces so that systems are compatible with each other and can
therefore communicate more freely and share information. Future systems will very likely offer richer
content; for example, the capture, storage and sharing of images in surgical pathology. It is possible that
they will communicate and centralize infectious disease data better, helping healthcare systems to react
faster and better to immediate needs. Programmers will need to keep pace with laboratory needs in order
to meet the needs of their increasingly demanding clients.

D Go back to Section B and choose the relevant definitions of the words listed previously based on

the context. You may add another one if your definition is irrelevant.

E After reading the passage, choose the correct topic for each paragraph from the list of topics

provided.

List of Topics Paragraph

Benefits Paragraph 1 …

Function Paragraph 2 …

LIS uses Paragraph 3 …

GPS use Paragraph 4 …

Problems Paragraph 5 …

Types Paragraph 6 …

Skill Bank

As you have finished doing Section B, you may notice that the sentences used in the
previous passage help you to identify the information related to the topic. Those sentences
represent “effective sentences” since the ideas are successfully delivered. To be effective, a
sentence should consist of some qualities such as correctness, unity, clarity, coherence and
emphasis (Wang, 2003).

Example:
Previous efforts have focused on processing abstracts or full-text articles from the primary
biomedical literature, with promising early results in laboratory settings. Yet, consuming the
primary literature is labor intensive and not compatible with busy clinical workflows.
Rather, clinicians prefer online resources, such as UpToDate and Dynamed, that are written
by experts who synthesize the latest clinical evidence on a specific topic.

The information in example has three major parts: (1) the use of primary biomedical
literature, (2) an interpretation of that output (promising early results in laboratory setting),
and (3) the conclusion that the condition shows unexpected result with yet (not compatible
with busy clinical workflow). The writer wisely states the denial and gives corrective sentence
with rather. Sentence connector helps the writer to link the ideas so that the sentences are
coherence.

Extra E Work in a group and identify the sentence connectors in “The new

More examples and revolution? Laboratory Information Systems”. Then, discuss the
practice related to function of each sentence connector.
Sentence Connector are
available here: Sentence Connector Function
• Examples
• Practice 1
• Practice 2

Skill Bank

Developing ideas in a paragraph

Introducing the topic
In a text, a new paragraph indicates the start of a new topic.
The topic is given in the topic sentence, which is at or near the beginning of the paragraph. The topic
sentence gives the topic, and also makes a comment about the topic.

Example:
Laboratory data management has arguably changed the most in the 21st century with the
introduction of web-based data exchange.
The topic is Laboratory data management.
The comment is that this has arguably changed the most in the 21st century (with the introduction of web-
based data exchange).

The sentences that follow then expand or explain the topic sentence.

Example:
Clearly, the turnaround time has been cut drastically. Furthermore, the current commercial
systems available will store data for future use by all those involved in the process.

Developing the topic
A paragraph is normally about the same basic topic (the 'unity' principle). However, within a paragraph,
ideas often develop beyond the initial comment. This development is often shown by

• a discourse marker: however, in addition, additionally, nevertheless, etc.
• a stance marker: unfortunately, probably, clearly, arguably, etc.

Examples:

However, LIMS are generally used more in commercial analysis, such as the pharmaceutical or
biotechnology fields.
Probably of key concern for many commercial lab managers is the ability to work out financial
information depending on test, client and dates.

Discourse markers generally make a connection between the previous information and what comes next.
They mainly introduce contrasts or additional information.
Stance markers show the attitude of the writer to the information, i.e., whether he/she is surprised,
pleased, unhappy, etc., about the information.

F Work in a group and prepare a draft for one paragraph passage consisting of 150 words. Start your

draft by choosing the topic related to medicine or healthcare. Then develop your topic into a topic
sentence and complete paragraph.

Extra Present Simple
Verbs in the present tense add an 's' in the third person singular: I work,
• Here is the answer key you work, he/she/it works. But the 's' has three different
KEY pronunciations. Look at these examples:
A: /s/, for example treats
B: /z/, for example heals
C: /iz/, for example changes

1. The patient breathes with difficulty and coughs and sneezes Group A: /s/
1..............................
constantly. 2..............................

2. This drug helps to alleviate the symptoms and reduces the risk of 3..............................
reinfection. 4..............................
5..............................

3. A person whose resistance is low catches diseases more easily. 6..............................
7..............................

8..............................
4. When someone panics his heart beats more rapidly and his 9..............................
temperature rises.

Group B: /z/
5. The laboratory analyses the blood samples and then the doctor 1. breathes

examines the results and diagnoses the condition. 2..............................

3..............................

6. He then recommends a course of treatment and prescribes any 4..............................
5..............................
necessary drugs. 6..............................

7. This drug relaxes the muscles and relieves pain. 7..............................
8..............................
9..............................
8. The gland releases hormones into the bloodstream, causing an Group C: /iz/

immediate reaction. 1..............................

9. If the patient sleeps well, he wakes feeling refreshed. 2..............................
10. She suffers constant pain and controls it by using morphine.
11. This treatment counteracts the effects of the infection. 3..............................
12. It is a procedure which cures the condition or kills the patient. 4..............................
5..............................
6..............................
7..............................
8..............................
9..............................

13. If the surgeon operates now the chance of success increases to
about 50%

14. The sinoatrial node regulates the heart beat.

Chapter 2 Objectives:
• Find the meaning of contextual
Journal Reading
vocabulary
Medical Students’ Characteristics • Grasp the idea of specific part in a text
• Use sentence connector to show process
• Write a procedure paragraph
• Introduce the abstract format

A journal is a
scholarly publication
containing articles
written by
researchers,
professors and other
experts. Journals
focus on a specific
discipline or field of
study.

Vocabulary Bank A Pay attention to the words listed in the Vocabulary Bank section.

present, outline, employ, Those words are strong verbs for writing an article. Find the
invalidate, establish,
corroborate, survey, meaning and categorize each word based on its functions.
indicate, purport, support
aim, disprove, highlight, Function Sugessted Word Meaning
refute, reject, prove,
investigate, administer, To express the purpose
confirm, proffer, challenge,
explore, investigate, of a paper or research
contend, feature
To introduce the topic
Extra of a project or paper

Go to the websites below To discuss methods
for more references on
Academic Wordlist: To discuss the findings
• Reference 1 of existing literature
• Reference 2
To express agreement
between one finding
and another

To present
contradictory findings

To highlight a paper’s
conclusion

B Read an article from the BMJ entitled Medical students’ characteristics as predictors of

career practice location: retrospective cohort study tracking graduates of Nepal’s first medical
college. You can access the article by opening the links below.

Alternative 1 (HTML) Alternative 2 (pdf)

Preview Alternative 1
Preview Alternative 2

C Work in a group and discuss the True, False, and Not Given statement taken from Medical

students’ characteristics as predictors of career practice location: retrospective cohort study tracking
graduates of Nepal’s first medical college. Write T, F, or NG.

Introduction Research Methods

1. The migrations of medical doctor bring 1. Year of graduation shows the historical

positive impacts for the patients. trend.

2. The study comparing destination 2. The questionnaire is the main source of

countries which involves the traits of data utilized in the study.

medical students has not been 3. Of all graduates, 39.3% questionnaire

conducted. data are obtained indirectly.

3. Geographical features of Nepal is a 4. The data analysis compares doctors

hindrance to the proper delivery of who live in foreign countries with those

health care. living in rural areas.

4. Among the five characteristics, rural

upbringing seems to be the most

influential factor.

5. The existing admission criteria can be

modified on the basis of the research

results.

Results Results

1. Year of graduation shows the historical 1. The US is the most popular destination

trend. for Nepalese Doctor.

2. The questionnaire is the main source of 2. While the US remains the most

data utilized in the study. attractive place to work in, China is an

3. Of all graduates, 39.3% questionnaire increasingly popular country for

data are obtained indirectly. developing career as medical doctor.

4. The data analysis compares doctors 3. Compared to their female counterpart,

who live in foreign countries with those male doctors tend to work in rural

living in rural areas. places.

4. The majority of the graduate work in

home country.

5. When compared, the rural birth place

and older age at matriculation are the

most influential factors determining

practice location.

Discussion

1. A large majority of empirical evidence concerning the international migration of medical

doctors are derived from the high income countries.

2. The number of graduate working overseas recently is larger than those staying at home

country.

3. Dovlo found that only 25% Ghanaian medical graduates work in home country

4. The study found that male doctors prefer to do medical practice overseas.

5. Students from rural places always returns to their place of origin to do the practice.

Skill Bank

Using Sequence Connectors to Show Process

Sentence connector is an essential requirement in a paragraph to link the ideas. In this section, we will
focus on using Sequence Connectors in a paragraph showing process. Sequence connectors are used to
link opinions from one sentence to the next and to give paragraphs coherence. Here is the list of sequence
connector.

D Take a look at Data Collection section in Medical students’ characteristics as predictors of career

practice location: retrospective cohort study tracking graduates of Nepal’s first medical college.
Those paragraphs show the process of collecting data in a research. Rewrite them into one
paragarpah telling the process. The example and figure below may help you to rewrite the
paragraph.

Example:
Systematic reviews and meta-analyses were therefore needed that summarises the
evidence about the prognostic value of particular factors. In this article, eight key steps
involved in this review process were described. The first step is to define the review
question. CHARMS (checklist for critical appraisal and data extraction for systemratic
reviews of prediction modelling studies) provides guidance for the researchers to formulate
a review question. The next step is to identify primary studies that are eligible for review;
studies that address the review question defined in step 1 following the PICOTS framework.
After selecting the studies, the researchers extracted its key information from each selected
study. Data extraction provides the necessary data from each study, which enables
reviewers to examine their (eventual) applicability to the review question and their risk of
bias. … (Riley, R., Moons, K., Snell, K., Ensor, J., Hooft, L., Altman, D., Hayden, J., Collins, G. and Debray, T., 2019. A guide to systematic review and meta-analysis

of prognostic factor studies. BMJ, p.k4597.)

Data Phase 1 What,
Collection Phase 2 how/why
Phase 3
What,
how/why

What,
how/why

Skill Bank: Abstract Writing

Informative and Structure Abstract
Informative Abstract

Informative abstracts are generally used for science, engineering or psychology reports. You must
get the essence of what your report is about, usually in about 200 words. Most informative abstracts also have key
parts in common. Each of these parts might consist of 1-2 sentences. The parts include:

• background
• aim or purpose of research
• method used
• findings/results
• conclusion
Structured Abstract
An abstract is a type of summary, and may be found in special collections of abstracts, such as Medline, or in
conference programs, as well as at the beginning of a research article. Many journals require contributors (authors
wishing to publish their articles in the journal) to provide a structured abstract - an abstract which is divided into specific
sections as in The BMJ.
The British Medical Journal structured abstract is divided into the following sections:
• Objective
• Design
• Setting
• Subjects
• Main outcome measure
• Results
• Conclusion

Sample of Informative Abstract

https://doi.org/10.1016/j.mpmed.2018.11.013

AGE AT RETIREMENT AND LONG-TERM SURVIVAL OF AN INDUSTRIAL POPULATION: PROSPECTIVE COHORT
STUDY

OBJECTIVE
To assess whether early retirement is associated with better survival.

DESIGN
Long term prospective cohort study.

SETTING
Petroleum and petrochemical industry, United States.

SUBJECTS
Past employees of Shell Oil who retired at ages 55, 60, and 65 between 1 January 1973 and 31 December
2003.

MAIN OUTCOME MEASURE
Hazard ratio of death adjusted for sex, year of entry to study, and socioeconomic status.

RESULTS
Subjects who retired early at 55 and who were still alive at 65 had a significantly higher mortality than those
who retired at 65 (hazard ratio 1.37,95% confidence interval 1.09 to 1.73). Mortality was also significantly
higher for subjects in the first 10 years after retirement at 55 compared with those who continued working
(1.89, 1.58 to 2.27). After adjustment, mortality was similar between those who continued working (1.89,
1.58 to 2.27). After adjustment, mortality was similar between those who retired at 60 and those who retired
at 65106092 to 1.22). Mortality did not differ for the first five years after retirement at 60 compared with
continuing work at 60104082 to 131).

CONCLUSIONS
Retiring early at 55 or 60 was not associated with better survival than retiring at 65 in a cohort of past
employees of the petrochemical industry. Mortality was higher in employees who retired at 55 than in
those who continued working.

(BMJ 2005;331: 995 Amended with permission from the BMJ Publishing Group)
Sample of Informative Abstract

Chapter 3 Objectives:
• Identify relevant information from
Why Do You Want to be
a Doctor? spoken text
• Find the meaning of contextual

vocabulary
• Read some historical event texts
• Use simple past tense in context
• Write personal essay on historical

event

Study the following words
before listening to the
recording.

Vocabulary Bank

course, acute, sickle cell,
Code Blue, chest
compression, social
recognition, attack, upset,
hyperventilation

Press the play button
A You are going to watch a video from some students of Medical School talking about “Why Do You

Want to be a Doctor?”. Write the reasons why they choose to be a Doctor in the table below.

Skill Bank: Listening

Student 1 Student 2 Student 3

Personal
Reasons

B Read the following passage.

Text 1 What Made You Want to be a Doctor?

“Your grandfather has a growth in his lungs,” my aunt said to me, her voice quavering, betraying her
affectation of stoicism.

I gazed piercingly into her bloodshot eyes; I saw nothing but desperation in them. I glanced at everyone
else present in the room: my mother, shocked into silence; my grandfather’s wife sitting desolately, not
saying a word; my grandfather himself, resting placidly in his recliner, a trace of anachronistic
cheerfulness on his wizened face.

A “growth”.

What did that mean?

I wasn’t there in the doctor’s office when the unfortunate news was given. Presently, standing there in the
funereal atmosphere, I felt my stomach twisting into uncomfortable knots and simultaneously, my mind
racing with a furious drive.

A “growth”. I knew she was probably repeating part of the physician’s diagnosis verbatim, but could my
aunt have been any more vague?* Studying the various expressions on the four different faces in the
room, I knew I wasn't in the right place to get any answers about what was really going on inside my dear
granddad’s body. And that infuriated me. I was hungry for information, I wanted to understand everything.
Somehow, I thought that would help to alleviate the tension, as if enhanced knowledge of the problem
itself could not only help us in our aims to solve it but also in attaining that coveted peace of mind.

At the time, I was one paper away from completing two years’ worth of A Level studies. My dream was to
study Chemistry with emphasis on Medicinal Chemistry, because… reasons. It was either that or Psychology
(I was interested in Clinical or Forensic Psychology). A few months later, I received my results and was
accepted into all of the universities I applied to.

But then one day, everything changed. I can’t quite describe it but suddenly it just made sense that I
should do medicine.

Months spent in the hospital, the heartbreaking experience of witnessing or going through the suffering of
the patient (my grandfather) and his family (us), the high I got every time a new piece of information was
revealed and elucidated, the joy of having something to puzzle over, watching procedures being performed
by the doctors and nurses alike… I just knew; I wanted to be a health care professional, but specifically a
medical doctor. At the time, it seemed to be the biggest badluck I could give to my grandfather’s
condition, and to cancer in general.

The “growth” in my grandfather’s lungs turned out to be, you guessed it, a tumour. He had just turned 76
years old when it was discovered. Ultimately the cancer metastasised to various organs and bone sites. He
got to live another 17 months after first receiving the unfavourable diagnosis.

I was always a bright and precocious kid. I excelled in school academically as well as in extracurricular
activities. I would often be seen with a book or two in hand, being a voracious reader. I demonstrated clear
leadership skills and was seen by many to have the confidence and intelligence to succeed in life.

However, throughout most of my life, these were all things I took for granted. My achievements were
nothing more to me than proprieties, things I had to do in order to look good. It took the blow of
someone I loved being diagnosed with Stage 4 cancer to shake me into my senses and inspire me to put my
potential into good use, that is, to help society.

Naturally, when I first started out med school I was particularly intrigued by the field of oncology and
genetics, heavily influenced by my grandfather’s condition. However, I soon discovered that the field of
medicine is vast and really, really cool. Medicine is a challenge, but it is a fascinating subject like no other.

Text 2 To Save Lives in Unexpected Emergencies

Those words feel incommensurate to the passion and drive that most doctors and physicians have for their
work. But, for a third-year medical student Moshe Karp, that is the simple truth behind his decision to
pursue a career in emergency medicine.

On June 22, 2017, Karp was on a flight to New York City, ready to begin clinical rotations after completing
basic science studies at SGU in Grenada. Approximately an hour into his flight, another passenger went
into cardiac arrest.

Karp, with 11 years of experience as an NYC paramedic, recognized the signs: The passenger was cool, pale,
sweating heavily, experiencing agonal respirations and had no pulse. Karp quickly began cardiopulmonary
resuscitation (CPR) and assisted ventilation. He continued this for approximately eight minutes and
ultimately brought the passenger back to an alert state with a strong pulse.

"To be able to help is very rewarding."

“To be able to help is very rewarding,” Karp says. Before this experience, he was strongly considering
entering family medicine, leaving his days of emergency care behind him.

“I had thought about going into family medicine because you develop closer relationships with patients, but
I think I thrive in emergency medicine,” Karp says. “I do love that type of environment, and this taught me
this is maybe where I’m needed most.”

Skill Bank: Using Past Tense

After listening and reading about being a doctor, you may recognize a kind of tense used in the video and passage to
tell about someone’s historical event.

“I went in to the room …”
“When I was about ten years old …”
“I just knew; I wanted to be a health care professional …”
“Karp quickly began cardiopulmonary resuscitation …”

Click the picture below for more explanation about Past Simple

Chapter 4 Objectives:
• Find the meaning of contextual
Speed Reading
vocabulary
Skill Bank • Read effectively and efficiently
What is speed reading? • Find specific information and main
Speed reading is the process of rapidly
recognizing and absorbing phrases or ideas
sentences on a page all at once, rather • Find explicit and implicit meaning
than identifying individual words. • Find synonym

Skill Bank: How to Read Faster

To increase your reading speed, you must learn to read in groups of words that form logical units of
thought within sentences. Look at the following sentence:

Britain has been a popular choice for thousands of international students over many years.

Notice how you can think of the sentence as being made up of 3 main parts:

1. Britain has been a popular choice (What and where?)

2. ... for thousands of international students (Who for?)

3. ... over many years. (When?)

Note also, that in this case (and many others) all the phrases answer wh/how questions. It may be
helpful at first to think of wh/how questions when trying to read in phrases.

If you read each word in a sentence one at a time, you will read very slowly and most likely
misunderstand the meaning of much of what you read. So read your sentences in phrases by
considering all the words of a phrase as a single unit.

Notice how much quicker it is to read the sentence, and how the meaning of what you say is more
clear. Practise reading in phrases everyday. Look ahead on the page as you read, and always aim to
find logical places in the sentences where phrases begin and end. Note also that there is often more
than one solution as to where the logical breaks between phrases occur within sentences.

Read faster by reading words in groups that form logical units of thought

Exercise
In the following passage, the phrases are clearly marked for you. Can you read it by focusing your
eyes on phrases instead of words?

The Supreme Court
of the United States
is the highest judicial body
in the nation.
One of its most important functions
is to determine whether
federal, state, and local governments
are acting
in accordance with
the United States Constitution.

Because the Constitution
is stated in general terms,
it is responsibility
of the Supreme Court
to interpret the meaning
by deciding specific legal cases.

Once a decision
has been made
by the court,
all of the other courts
throughout the United States
are required
to follow the decision
on the similar cases.

Rhetorical Organization

The preceding information describes a "generic paragraph," one most likely written
as a stand-alone paragraph. In reality, however, paragraphs, especially those
undertaken for academic purposes, take on specific forms for specific purposes.

Most discourse can be categorized into one of three types:

1. narrative
2. informative

3. persuasive

"Narrative writing" discloses the writer's experiences, feelings, or perceptions and, as such, is writer-
oriented. In "informative writing," the emphasis is on explaining the subject matter. This type of
writing is used to convey knowledge, give instructions, or share ideas. While informative writing
emphasizes the subject, the focus of "persuasive writing" is on the reader. The purpose of
persuasive writing is to influence, frequently with the underlying goal of effecting change (National
Assessment Governing Board, 1998).

Each of these types of writing has corresponding "organizational patterns." These organizational
patterns provide a structure for relating details to the main idea, thus determining relationships
within the paragraph. Understanding these relationships can help readers better understand the
information in the paragraph. That is to say, if readers recognize the organizational pattern, they will
better know what to expect in the paragraph.

Organizational patterns for rhetorical writing (Atkinson & Longman, 1992; Trimmer, 1992) are as
follows:

A. Subject development organization-used in narrative writing
B. Comparison/contrast-used in informative writing
C. Cause/effect-used in informative writing
D. Enumeration/sequence (also called problem/solution)-used in persuasive writing

Organizational patterns vary according to content, topic and purpose. Additionally, each
organizational pattern is characterized by its own set of "transition or signal words."

1. Subject Development

Subject development organization is used in narrative writing. The term "narrative writing" actually
includes discourse that describes, explains, or shows a process or a work of fiction. In subject
development organization, the topic sentence forms the basis for a collection of details that describe
or sometimes define the topic. They relate to the topic but may not relate to each other. This type
of organizational pattern can be found in both fiction and nonfiction writing and is also frequently
found in text chapters (see enumeration/sequence pattern below).

The following is an example of a narrative paragraph:

Camera movement at the moment of exposure can produce what is known as camera shake.
Camera shake, which can cause blurred pictures, can occur for two reasons. Sometimes the camera
itself is held incorrectly. To be certain the camera is steady, wrap your right hand around the camera
grip and stead your hand by setting your elbow lightly against your body. Use your left hand to hold
the lens from underneath. When you are ready to look through the viewfinder, press the camera
against your forehead. Even though the camera may be held correctly, camera shake can still occur if
the shutter button is incorrectly depressed. To correctly depress this button, always use the center of
your finger to touch the shutter button. Be certain you are holding the camera with your entire right
hand before depressing the shutter button. When you are ready to take the picture, apply steady but
gentle pressure to the button. Following these simple steps will help prevent most cases of camera
shake.

The above narration explains the possible reasons for the occurrence of camera shake and offers
specific directions on how to prevent it.

Signal words or transitions typically used with subject development paragraphs include: after, as
long as, during, then, at the same time, later, since, second, as soon as, at last, until, subsequently,
whenever, before, next, finally.

2. Comparison/Contrast
Discourse that is organized to compare or contrast is used to inform. The purpose of this kind of
writing is to show relationships between concepts or objects. The pattern may be organized in one
of two ways: (1) point-by-point or (2) block.
In the "point-by-point" organization, a detail or idea related to one object is compared with a
corresponding detail or idea related to another object. In a "block comparison," all of the cogent
details for the first topic are enumerated and then corresponding details for the second topic are
enumerated. Visually, a point by point paragraph will be set up as follows:

Visually, a block style paragraph will be set up as follows:

The following is an example of a comparison/contrast paragraph organized following the point-by-
point style:

Although no one will refute the simplicity and convenience of a point-and-shoot camera,
anyone truly serious about photography will need to purchase a fully manual SLR camera. While the
SLR requires a great deal of practice, it offers better control in focusing and better framing precision.

With a point-and-shoot camera, focusing is accomplished by the camera. Despite this seeming
convenience, the primary subject of the composition may not always be front and center. When this
is the case, the subject may blur, since the auto focus hones in on the most central figure in its range.
With the SLR camera, focus control remains with the photographer. Since it is up to him to assign
focus, the primary subject of the composition may be far left, far right, or even behind a closer
object, such as an animal in a zoo behind bars. A second advantage to the SLR camera is precision of
framing. With the point-and-shoot, what the photographer sees in the view finder is not identical to
what the lens itself sees. While the view finder has etched corners which are supposed to indicate
outer margins of the photo, these are less than exact. However, with the SLR, the photographer looks
directly through the lens. This enables him to precisely frame his composition. Thus, even though a
point-and-shoot camera offers convenience and ease of use, it lacks the control and precision
available with the SLR camera.

This paragraph compares a point-and-shoot camera with an SLR camera and is organized point by
point. That is, focus control (the first point) is discussed in terms of both the point-and-shoot camera
and the SLR camera. Then framing (the second point) is discussed first in terms of the point and
shoot and then the SLR camera.

Visually, this paragraph will appear as follows:

Point #1: focus control

topic #1: point-and-shoot camera

topic #2: SLR camera

Point #2: framing

topic #1: point-and-shoot camera

topic #2: SLR camera

If the information in the above paragraph were formatted to fit a block style organization, visually it
would appear as follows:

Topic #1: point-and-shoot camera

point #1: focus control

point #2: framing

Topic #2: SLR camera

point #1: focus control

point #2: framing

That is, the writer would discuss the attributes of focus and framing first with the point-and-shoot
camera and then these same attributes with the SLR camera.

Signal words or transitions typically used with the comparison/contrast paragraph include: similarly,

likewise, however, on the other hand, on the contrary, one difference, unlike, while, both,
another similarity.
To use the comparison/contrast pattern, students should be able to (1) identify the signal words
that show the comparison or contrast and (2) identify the items to be related (compared or
contrasted).
3. Cause/Effect
A cause/effect pattern shows relationships between an action or response and a pre-existing
reason. Said another way, a cause is what makes an event occur, and the effect is the result of the
event. This pattern describes what happened and why it happened. Discourse that shows a
cause/effect relationship is informative because it gives information to the reader. This pattern can
be organized in one of three ways:

The following is a cause/effect paragraph that represents the first kind of organization:
Although social activities in college can be very tempting, students must know when to

resist such temptations and turn instead to the task of studying. To postpone studying at the college
level is to court certain disaster. The most immediate consequence of not studying is that the
student is ill-prepared for the next class. Not only will the student be unable to participate in
discussions, he or she likely will be unable to effectively understand the lecture, especially if it is of a
technical nature. Beyond the immediate consequences, not studying on a regular basis means

putting in additional work at a later time just to catch up. Compounded, this can lead to an almost
insurmountable task, the result of which is cramming. Cramming for exams is rarely effective,
producing instead a hazy understanding of the subject matter, overlaid by a heavy need for sleep. A
student who has crammed for an exam is almost certain to do poorly, and poor exam scores can
lead to failure. Failing an entire course seems a high price to pay for the distraction offered by the
many social events offered in college.

The above paragraph represents the first kind of cause/effect organization. In this paragraph, one
cause-social activities-leads to a series of results (effects). Note also that the effects are enumerated
emphatically. That is, they are ranked according to importance with the most important one, failure,
placed at the end of the paragraph.

Signal words or transition words used with the cause/effect paragraph include: therefore, thus,
because, as a result, one cause, one effect.

To use this pattern, students should identify whether the paragraph will discuss cause or effect. The
cause or effect word should appear in the topic sentence. Students should also rank order either the
causes or the effects, or both.

Source:

https://www.ntid.rit.edu/sea/processes/paragraph/process/rhetorical

4. Enumeration/Sequence

The enumeration/sequence pattern lists major points of support in one of two ways: (1) random
order-that is, all items share equal importance with each other; or (2) rank order (also called
emphatic order), where the list is sequenced. When support is randomly ordered, the pattern may
become indistinguishable from the subject development pattern (see above). However, when the
topic support is rank-ordered, any one of several types of persuasive writing is the result.
Organization of this type, therefore, is also known as "problem/solution pattern."

In discourse of this type, brief background information is presented, followed by a statement of the
problem. The remaining sentences offer solutions. While the step-by-step progression of ideas can
be developed using chronological sequencing or even spatial sequencing, emphatic sequencing is
the most common organizational structure.

Although this structural pattern offers solutions to problems or answers to questions, its main
purpose is to influence the reader into taking action of some kind on the topic. Recognizing this
pattern enables the reader to better understand the content. To best use this pattern, the learner
should be able to: (a) identify the topic, (b) identify the writer's perspective on the topic, (c)
recognize the support points, and (d) identify the signal words that indicate the points (frequently a
numerical progression of points).

The following is an example of a enumeration/sequence organization found in a persuasive
paragraph:

Despite the dangers we are daily warned against in all kinds of meat and meat products, a
strong case can be made against turning to vegetarianism as an alternative. First, it is not
convenient to be a vegetarian. Finding foods on many menus that can fill the dietary and sometimes

moral needs of a vegetarian can be difficult. The situation is compounded when traveling. While
airlines offer food for special dietary needs, arrangements for them must be made well in advance.
More important than convenience, however, is the consideration of dietary balance. To be a
vegetarian means to learn appropriate and healthy alternatives for protein found in meat and
animal products. Not to do so is to risk the vegetarian's very health since protein is an essential part
of the human diet.

This paragraph is organized emphatically, with the most important point, that of health risks, left to
the end.

Signal words or transitions for this kind of paragraph include: first, third, then, next, finally, above
all, best of all, especially, in fact, more important, the last point to consider, worst of all, most
important.

Chapter 5 Objectives:
• Find the meaning of contextual
Own Journal Session
vocabulary
• Identify keywords from an article
• Create a fishbone

Vocabulary Bank

case-control study, case,
exposed, risk factor, cohort
study, cohort, subjects,
longitudinal study,
exposure, prospective,
followed up, retrospective,
intervention, trial,
controlled trial, study
group, placebo, bias,
constant, confounding

A Read the Passage A, B, C, and D.

A. Case-control studies
In a case-control study, a group of people suffering from a disease (the cases) is compared
with a group who do not have the disease, but are similar in other ways (the controls). The
two groups, the participants in the study, are compared to see if they were exposed to a
possible risk factor or not. A risk factor is something which may contribute to the cause of
disease. This type of study is often used as a first step in identifying the cause of a disease.

B. Cohort studies
In a cohort study, a group (cohort) of people (subjects) who are similar is studied over a period
of years (a longitudinal study) to determine if there is a relationship between exposure to a
risk factor and development of a disease. At the beginning of a prospective study, none of the
subjects has the disease. They are followed up for a number of years, and at the end of the
period, those who have developed the disease are compared with those who have not. In a
retrospective study, the researchers look back, by studying hospital records for example, at
what has happened in the past, comparing subjects who have developed the disease with
those who have not. In a cohort study and in a case-control study the subjects are only
observed and there is no intervention such as drug treatment or surgery. A cohort study is a
more reliable method of identifying the cause of disease than a case-control study. But for
proof of cause, a trial is needed.

C. Trials
In a trial, a group of people who are suffering from a disease are given a particular treatment.
To determine the effectiveness of the treatment, a controlled trial is performed. Two groups
are studied: one group (the study group) is given the treatment and the other the control
group) is not. The controls may be given a placebo – something which seems to be identical
to the treatment but which has no effect. If there is an equal possibility that patients may be
selected for the study group or for the controls, the trial is said to be randomized. A
randomized controlled trial makes bias - error in a study which influences the results - less
likely. An additional way of removing bias is blinding: patients do not know if they are
receiving the treatment or the placebo. If, in addition, the researchers do not know who is
receiving the treatment, the trial is a double-blind trial. Randomized controlled trials are used
to test treatments or preventive measures.

D. Variables
If the subjects in a study are all aged 50, then age is a constant in the study. If their ages range
from 20 to 70, then age is a variable. A confounding variable is any variable which is
associated with both the disease and the risk factor being studied (for example, smoking in
the case of cooks and lung cancer discussed in Unit 44). If such variables exist there is no way
for the researcher to know whether the difference in the risk factor or the confounding
variable is the one that is truly causing the disease.

B Complete the table with words from Passage A, B, and C.

Noun Verb
exposure bias
control

participate
intervene
Study

C Complete the sentences with a word from A, B, C or D.

1. People who are not receiving the experimental treatment, but who are otherwise the same
as those receiving it are ____________________.

2. A trial in which neither the subjects nor the researchers know who is receiving the treatment
is a ____________________ - ____________________ trial.

3. A study that follows the participants over many years is a ____________________ study.
4. A ____________________ is a group of people with similar characteristics.
5. Allocation to groups is ____________________ if all participants have equal chance of being

in either group.
6. A harmless substance given to some participants to test the effect of a trial substance is a

____________________.
7. Something that might be a part of the cause of a disease is a ____________________ factor.
8. Something that might cause confusion about the cause of a disease is a

____________________ variable.

D Read the eight extracts from an article in the British Medical Journal entitled Paternal and

schizophrenia: a population-based cohort study. Decide which section of the article each extract
comes from. There are two extracts from each of the four sections.

1. People with older fathers were more likely to lose their parents before they reached the age
of 18 years.

2. Using a large Swedish record linkage database, we investigated the association between
paternal age and schizophrenia in offspring.

3. We used Cox's proportional hazards models to assess the influence of paternal age on
psychosis.

4. Our cohort comprised 754,330 people born in Sweden between 1973 and 1980 and still alive
and resident in Sweden at the age of 16 years.

5. Our findings confirm an association between increased paternal age and schizophrenia in
offspring, which remained even after we controlled for a wide range of potential confoundin
factors.

6. There is growing evidence that factors operating at different points in life contribute to an
individual's risk of developing schizophrenia.

7. The main limitation of our analysis is that case ascertainment was based on people admitted
to hospital only with diagnoses recorded on an administrative database.

8. Table 1 shows the characteristics of subjects in relation to the age of their father.

(BMJ 2004329 : 1070 Amended with permission from the BMJ Publishing Group)

Skill Bank: Research Articles
The Structure of Research Articles
Research articles are typically divided into four main sections:
• Introduction
• Methods
• Results
• Discussion

This is sometimes called the IMRaD structure of articles.
The Introduction contains background information; in other words, it reminds the reader what is already known
about the subject. It includes information about previous studies, and explains what has not been investigated
previously. Finally, there is usually a statement of the objective, or purpose of the research (why they did it).

In the case of clinical research, the Methods section gives details of the people who were studied - the
participants in the research. The method section also contains information about any intervention carried out,
for example medication, advice, operations. It gives details of the steps taken in the study, how the participants
were chosen, and includes the main things measured, such as blood levels. Finally, there is information about
statistical analysis.

The Results section tells what was found, the findings of the study.

The Discussion section contains explanations, and claims for the importance of the study. It may also list
limitations, or parts of the study which were unsatisfactory, and suggest what research needs to be done in the
future. There is usually a Conclusion, which is sometimes a separate section.

At the end of most articles, there is a short section called Acknowledgements. In this the authors thank people
who have helped them in their research. Finally, there is a list of References - the books and articles which the
authors have used.

Journal Article in 7 Steps

By Chris Drew, PhD

Journal Articles make even the top students’ eyes glaze over.

They’re boring, hard to read and always more complicated than they need to be.

Worst of all, you’ve probably never been taught how to read a journal article! You’re just given the
article and told … go on … read it!

So, in this article, I offer seven simple strategies for how to read a research paper effectively.

Let’s dig in!

Contents
1. Read the Abstract First
2. Stop Reading the article if it Doesn’t make Sense
3. Scan before you Read
4. Always read the Literature Review
5. You Probably Don’t want to read the Methodology
6. Jump to the Conclusion
7. If it’s a Set Reading, Take Notes – Even if you Don’t Understand it

1. Read the Abstract First

The abstract is usually on the first page of the piece, always before the introduction. You are likely to
find it indented underneath the title.

The abstract is the most important part of a journal article. It tells you whether or not you need to
read the article at all.

When reading the abstract, ask yourself these questions:

• Is this relevant to my essay topic?
• What is the key argument of this piece?
• How is this article related to the other ones I’ve read?

You should be able to tell by the end of the abstract what the journal article is all about, and
whether it will be of value to you.

If your article is an assigned reading, it will definitely be of value, so you’ll have to keep reading. You
should still be able to jot down the key ideas the article covers and what the authors’ argument is. I
give guidance on this in Point 7.

If your article is not an assigned reading, feel free to make a value judgement about whether to keep
or discard the article. Don’t be afraid to throw it away and look for one that’s more relevant.

2. Stop Reading the article if it Doesn’t make Sense

The first page usually provides an introduction to the article. It should orient you to the topic and the
authors’ stance. It goes into more detail than the abstract and should provide a compelling reason
why you should or shouldn’t keep reading the piece.

At the end of the first page, ask yourself:

• Did I understand at least 50% of what was written?
• Is this article still relevant to me?
• Did I jot down one key point that I can use in my essay?

You should be able to say ‘yes’ to all three of these points for the article to still be of value to you. If
so, feel free to keep reading.

If the article just doesn’t make any sense to you, search for another article that will be easier to read
and understand. Have a look through Google Scholar or your University’s Online Library for journal
articles that might be more readable and relevant. Textbooks are also a great, more readable,
alternative.

3. Scan before you Read

Scanning involves looking through an article to find the important sections to read.

Ask yourself: ‘Do I have to read it all? Which part will give me what I need?’

Maybe you have a journal article and only want to know the findings. It might therefore be
worthwhile to scan through the article until you reach the ‘findings’ and ‘conclusion’ sections.

A journal article’s abstract is a brief, one paragraph overview of the article. The abstract is designed
to help you to know whether the journal article is valuable for you to read or not.

Read smart. Don’t read sections you don’t have to. Remember you’re here reading the journal
article for one reason: to dig out the information you need, and move on.

To scan the journal article, look through all of the article’s headings to get a general idea of what will
be discussed in each section. Below is a list of the common sections you’ll expect in a journal article.
The sub-headings for these sections will likely vary:

Title
The title is self-explanatory and the easiest element to identify.
Abstract
The abstract is unique to journal articles. This is a brief, one paragraph overview of the article. The
abstract is designed to help you to know whether the journal article is valuable for you to read or
not. The abstract is usually on the first page of the piece, always before the introduction. You are
likely to find it indented underneath the title.
Introduction
The introduction also gives an overview of the piece. While the abstract explains the key
arguments of the piece, the introduction is usually used to give context and a rationale to the
piece. It usually also signposts what will be said in each section of the article.
Literature Review / Theoretical Framework
The literature review summarizes and analyses previous research on the topic that the author is

reporting on. This is an important section for showing readers what is already known about the
topic, and how the study expands on existing knowledge by introducing new ideas and information
that hasn’t been discovered before.
Methodology
Methodologies are important for providing the ‘recipe’ on how the research took place. The
methodology answers the question ‘How did you reach your conclusions?’ This is what
distinguishes research from hypothesis. Logic and reason are required in order to establish
knowledge within academic research. The methodology should therefore “demonstrate the logic
used to reach the conclusion” (Drew, Hardman & Hosp, 2008, p. 18).
Findings
The findings section outlines what the study found out. It is often separated into themes, outlining
some of the key ideas that have emerged out of the research project. This is where you finally find
out what the authors actually discovered through their project. It is usually quite detailed, taking
readers through the findings step-by-step.
Discussion / Conclusion
The conclusion will sum up the findings and explain how and why the findings are important,
relevant or interesting. It may explain what the implications of the findings are for practitioners,
policy makers or researchers.

4. Always read the Literature Review

The literature review section – often under the title ‘Literature Review’, ‘Background’ or ‘Context’ –
will reference some important sources.

I strongly recommend you read the literature review to ensure you have a clear understanding of
the background information on the topic.

What’s the Literature Review all About?

The point of the literature review is to summarize and analyse key information that is already known
on the topic. In this sense, the literature review is sort of like a mini essay on the topic. When
reading the literature review, take the opportunity to steal ideas for your own essay. Make sure
you paraphrase them and cite the article correctly.

For example, if you’ve been set an essay on ‘How Canadian Television Advertisements Sell Beer’, and
your journal article is titled ‘Canadian Advertising in the age of Multiculturalism’, you’re likely to find
that the literature review will give you a lot of information about Canadian television
advertisements.

Mine that information! See what key sources this expert is using and use those same sources in your
essay. See what this expert says are the most important points to remember about the topic and
paraphrase those points for your essay, too.

In other words, look at reading a journal article as an opportunity to mine ideas for your own
writing.

When reading the literature review, see if you can identify several key points that will be worthwhile
for your own essay. In the literature review section I usually try to jot down four key points and four
key sources that I will reference in my own essay.

5. You Probably Don’t want to read the Methodology

You’re reading a journal article to find out the answers to a question. The methodology section
explains how the answers we gathered.

Methodologies are very important if you’re writing a critical literature review at Master’s level.
They’re also vital if you’re trying to assess the reliability of a source. But for most students trying to
quickly gather some facts on a topic, they’re a waste of your time.

If a journal article has made it to publication in a journal article, its methodology will have already
been evaluated by two anonymous experts and a journal editor. These people are much smarter
than you and they gave it the green light.

You can trust that a journal article’s methodology is sound.

Reading the methodology is usually a waste of your time. Skip it unless you feel there’s a good
reason to find out how the study took place. Otherwise, skip it.

6. Jump to the Conclusion

What’s in a Journal Article Conclusion?

Journal article conclusions are just like your own essay conclusion. They usually summarize the
article’s findings, weaknesses and implications.

When reading an article to gather new information and key ideas for an essay, the findings are what
you’re really looking for.

Once you’ve read the abstract and introduction, taken some notes on the article’s main arguments,
and mined a few key points from the literature review, skip the next few pages and leap to the
conclusion.

I know, I’m going to get a million emails from angry doctoral students and professors telling me I’m
doing a disservice to academia. They’ll tell me I’m teaching students to take shortcuts. They’ll tell me
I’m not taking research seriously enough.

But heck, this is a strategy for success and study productivity. Read journal articles to mine key
information then move the heck on to writing your essay. No more, no less.

Get what you want, and get out.

7. If it’s a Set Reading, Take Notes – Even if you Don’t Understand it

Getting ahead at university is about showing your teacher you deserve a good mark.

You need to convince your teacher that you’re smart, you know the rules, and you deeply
understand the content.

One way to do this is to make sure you turn up to class with questions and comments.

Not understanding the article is no excuse. If you’re set a journal article to read, make sure you read
it. Use the strategies above to save you time, but make sure you come to class with some notes.

What to do if a Journal Article Doesn’t Make Sense

Write down what you don’t understand and why you don’t understand it. You should do three
things:

Notes to Take when the Article doesn’t make Sense

• Write down what you think the author is saying (make an educated guess);
• Write down three words that didn’t make sense to you;
• Highlight one sentence that confused you.

When it comes time for you to talk in class, don’t just stare at the teacher like a deer in the
headlights. Tell your teacher what you think you understood, but also be honest, say:

“I didn’t really understand what the article was about, but based on the abstract I think were saying
[X]. One thing that confused me was the language they used. They kept using [X] word and I didn’t
really know what it meant. Like in this sentence: [Read out a confusing sentence]. Could you explain
it for me maybe?”

Your teacher will give you brownie points for having made the effort to read the piece, and coming
to class with the intention of getting clarification.

Group Work
Work in a group and choose one article to be discussed. Then, summary the points of the
introduction or literature review into a fishbone diagram.
See example below

Chapter 6 Objectives:
• Find the meaning of contextual
Critical Reading
and Writing vocabulary
• Differentiate fact and opinion
• Use language function for giving

argument
• Write a simple argumentative essay
• Express the argument

Skill Bank

What is critical reading? The
most characteristic features of
critical reading are that you will:
• examine the evidence or
arguments presented • check out
any influences on the evidence or
arguments; • check out the
limitations of study design or
focus; • examine the
interpretations made; and •
decide to what extent you are
prepared to accept the authors’
arguments, opinions, or
conclusions.

Why do we need to take a critical approach to reading?
Regardless of how objective, technical, or scientific the subject matter, the author(s) will have made
many decisions during the research and writing process, and each of these decisions is a potential
topic for examination and debate, rather than for blind acceptance. You need to be prepared to step
into the academic debate and to make your own evaluation of how much you are willing to accept
what you read. A practical starting point therefore, is to consider anything you read not as fact, but as
the argument of the writer. Taking this starting point you will be ready to engage in critical reading.

Critical reading does not have to be all negative
The aim of critical reading is not to find fault, but to assess the strength of the evidence and the
argument. It is just as useful to conclude that a study, or an article, presents very strong evidence and
a well-reasoned argument, as it is to identify the studies or articles that are weak.

Key Features of Critical Writing

Key features in critical writing include:

• Presenting strong supporting evidence and a clear argument that leads to a reasonable conclusion.
• Presenting a balanced argument that indicates an unbiased view by evaluating both the evidence

that supports your argument as well as the counter-arguments that may show an alternative
perspective on the subject.
• Refusing to simply accept and agree with other writers - you should show criticality towards other's
works and evaluate their arguments, questioning if their supporting evidence holds up, if they
show any biases, whether they have considered alternative perspectives, and how their arguments
fit into the wider dialogue/debate taking place in their field.

• Recognizing the limitations of your evidence, argument and conclusion and therefore indicating
where further research is needed.

Giving Argument

Essentially, the aim of an essay (and other forms of academic writing, including dissertations) is to
present and defend, with reasons and evidence, an argument relating to a given topic. In the
academic context argument means something specific. It is the main
claim/view/position/conclusion on a matter, which can be the answer to the essay (or research)
question. The development of an argument is closely related to criticality, as in your academic
writing you are not supposed to merely describe things; you also need to analyse and draw
conclusions.

Tips on devising an argument

• Try to think of a clear statement. It may be as simple as trying to prove that a statement in the
essay title is right or wrong.

• Identify rigorous evidence and logical reasons to back up your argument.
• Consider different perspectives and viewpoints, but show why your argument prevails.
• Structure your writing in light of your argument: the argument will shape the whole text, which

will present a logical and well-structured account of background information, evidence,
reasons and discussion to support your argument.
• Link and signpost to your argument throughout your work.

Argument or arguments?

Both! Ideally, in your essay you will have an overarching argument (claim) and several mini-
arguments, which make points and take positions on the issues you discuss within the paragraphs.

A Read the following task and the sample answer, then do questions a-f below

People who have original ideas (e.g. people who invent or discover things) are of greater value to society
than people who are simply able to copy the ideas of others well.
To what extent do you agree or disagree?

Sample answer
I certainly agree that people who come up with new ideas are terribly important to our society.

However, I also think there is a role in society for good imitators.
No one would deny that certain individuals must be thanked for providing us with facilities that we

use every day. Where would we be, for example, without basic items such as the washing machine, the
computer and, more recently, digital cameras and mobile phones? These inventions are now used so
regularly that we tend to take them for granted.

In fact, the society we live in today has become increasingly consumer-oriented and while it may be
possible to constantly update and improve consumer goods, not everyone in my country can afford them
Furthermore not everyone lives in an area that has access to the latest models on the market. For these
reasons, it is useful someone can provide good copies of expensive products.

Having said that, certain innovations have a more serious impact on our lives than others and cannot
easily be replicated. Vital medicines like penicillin and vaccines against dangerous diseases also exist
because people made continual efforts to develop them. Scientific ideas such as these enable us to live
longer and avoid illness.

Undoubtedly, scientists and engineers work extremely hard to make life better for us. In some areas
the work just adds comfort to our lives, and if people copy their ideas, it allows a wider population to
benefit from them However, in other areas, their contribution is unique, cannot be copied and without it
we would be unlikely to survive or move forward.

A. Underline the words in the opening paragraph that paraphrase the task.
B. What is the writer’s position?
C. Underline the main ideas in paragraphs 2,3, and 4.
D. Underline a supporting point in each paragraph.
E. How does the writer use paragraphing to develop the answer?
F. What does the writer do in the conclusion?

Chapter 7 Objectives:
• Identify relevant information from a
Let’s Talk!
spoken text
Case Study • Use certain phrases and idiom for a
Scripts
situational context
• Demonstrate the conversation

Case Study “Jessica”
Sample Session Script
#1
Setting: Private Practice Office
Assessment
Jessica is a 16-y o white female, 5’5”, 125#, competitive swimmer who has come to see the private
practice RD because she wants to improve her times. Her diet recall is notable for skipped B, Power Bar
and soda for L, and large dinner after practice, either pizza or burrito with teammates or balanced meal
at home with her family (meat + salad + bread + milk or water.) She has a family history of type 2 DM.
She reports not feeling hungry in the morning, but feels ravenous by dinner time and often overeats,
feeling “stuffed” by the end of the meal. She feels low in energy a lot of the time, especially at swim
practice, and worries that she is developing DM like her dad.

Intervention (Script)
REGISTERED DIETITIAN: Hi Jessica. I’m Toby. Tell me what brings you in today.
JESSICA: Well, mainly I want to improve my swimming. I have an important meet coming up and I
really want to prove myself. My times have been dropping lately even though I’ve been working
hard at practice. My coach seems to think it might have something to do with what I eat.

REGISTERED DIETITIAN: I see, so the swimming really is your primary concern. JESSICA: Yep.
REGISTERED DIETITIAN: Is there anything else that we should focus on today?

JESSICA: Um, maybe. My dad has diabetes, and I’m worried that I might be getting it too. I know
it runs in families. I feel really tired most of the time, even though I eat a lot. Do you think I might
have diabetes?

REGISTERED DIETITIAN: Wow, I can understand your concern about that. Diabetes is a big deal. I

see from your medical records here that you recently had your fasting blood sugar tested, and it
was normal. So the good news is you don’t have diabetes.

JESSICA: Oh, okay. That’s a relief.

REGISTERED DIETITIAN: There may be some other factors making you feel tired, and we should
talk about those things today. We can plan to talk more about diabetes—risks, signs and
symptoms—next time you come, if you’re interested. How does that sound?

JESSICA: Yeah, maybe we can talk more about it next time. That’s fine.

REGISTERED DIETITIAN: Great. I see you brought your three‐day food record for me, Jessica.
That’s very helpful—thanks! How about we take a look at that now?

JESSICA: Sure.

REGISTERED DIETITIAN: (Pause to look at food record.) I see there is no food until the energy bar
and soda and lunch time. Tell me about your mornings.

JESSICA: Well, I’m always super tired in the morning so I sleep until the last possible minute. When
I get up, I’m not hungry, plus I’m rushing to get to school. My mom’s always nagging me to eat
something before I go but I just don’t have time. I just throw my energy bar and soda in my bag
for later and take off.

REGISTERED DIETITIAN: I see. Hmmm. Okay, tell me about lunchtime, when you have your bar and
soda. Does that lunch satisfy you?

JESSICA: I’m usually pretty hungry by lunchtime, and I’m also busy because I’m on school council
and we meet during lunch. The bar and soda are really quick and easy, and they do satisfy my
hunger for a
while.

RD. And tell me how you feel by swim practice after school? Are you usually hungry then?

JESSICA: Yes! I’m hungry, but I’m afraid to eat right before because I might get cramps. By the time
practice is over—it’s a two hour practice—I’m always totally starving. That’s when I get the huge
burrito or eat something at home. Sometimes I get a stomach ache because I eat so much. I’m like
a bottomless pit. My friends even make fun of me for it.

REGISTERED DIETITIAN: (laughs) Well, teen athletes burn a LOT of fuel, so your hunger is not
surprising to me.

JESSICA: It’s not?

REGISTERED DIETITIAN: No, your body has a lot of demands on it, for calories, nutrients, and fluids,
and my impression is that your current food routine isn’t meeting those needs. Then, at dinner,
you’re trying to make up for it. I have some ideas that might help. Would you like to hear them?

JESSICA: Yeah, definitely.

REGISTERED DIETITIAN: First, I think you would benefit from eating more often. With your current
routine, the only thing fueling your swimming is the one energy bar and one can of soda. You
easily burn three times that many calories during your swim workouts.

JESSICA: Really?

REGISTERED DIETITIAN: Yep. So it would be great if you could find a way to shift more of your
calories to earlier in the day. I must agree with your mom on this one, Jane, breakfast would be a
great addition to your day. How would it be for you to get up 10 minutes earlier to have a bowl of
cereal with milk and a piece of fruit before your leave?

JESSICA: Well, that’s what my little sister eats anyway, so getting that would be no problem. Mom
would be happy. Waking up earlier will be a pain, but if you think it’ll help, I’ll try it.

REGISTERED DIETITIAN: That’s a good idea. You could try an experiment: for the next week, eat
breakfast before school and see how it affects your energy throughout the day. You could write it
down on the food record sheets you’ve been using. How does that plan sound?

JESSICA: That’s doable. I’ll do that.

REGISTERED DIETITIAN: Great. Now, how about lunch? The energy bar and soda are actually a
snack, not a meal. What might a more balanced lunch look like?

JESSICA: Mmmm…you mean like it would have the food groups in it? Like fruit, starch, milk,
vegetables, protein, that kind of thing?

REGISTERED DIETITIAN: That’s exactly what I was thinking. Overall, your diet does seem to be low
in some of those important food groups, especially the fruit, vegetables, and dairy groups. If you
ate a more complete lunch, you could save your snack for the afternoon to fuel your practice, and
I’m guessing you will have more energy for the day and for swimming.

JESSICA: That would be awesome.

REGISTERED DIETITIAN: What about leftovers? Your dinners at home sound balanced‐‐ with
protein, vegetables, and starch.

JESSICA: Yeah, there’s always leftovers. And there’s a microwave in the room where we meet at
lunch. And we have plenty of bag lunch ingredients at home, too, because my dad packs lunches
for my little sister. I could talk with him about getting extra for me too. So on the nights I eat out
with friends, I could still pack a lunch.

REGISTERED DIETITIAN: Those are fantastic ideas, Jessica. We have few more minutes, so I’d like
to talk about ways you could increase those food groups I mentioned a minute ago—fruit,
vegetables, and dairy. Each of those food groups provides nutrients essential to your body’s
development and health.

JESSICA: I know, I remember from health class—fruit and vegetable have antioxidants, right? And
dairy has calcium for my bones.

REGISTERED DIETITIAN: Right. Fruits and vegetables also offer fiber, and milk, yogurt, and cheese
also provide protein. Most of these foods are also a good source of carbohydrates—your body’s
main fuel source, very important for athletes like you. How could you get in more of these
particular kinds of foods?

JESSICA: Well, I love fruit, so that’s no problem. I could have fruit with my breakfast—I like banana
on my cereal—and then I could bring a fruit or juice to have with lunch. Maybe I could have the
fruit with my snack, too. I really like fruit.

REGISTERED DIETITIAN: I like those ideas. Wonderful. Next time you come, we can focus on the
other food groups we mentioned—the vegetables and dairy—but for this week, just focus on the
fruit. Okay, help me remember what your plan is…you are going to experiment with breakfast…

JESSICA: (searching her memory) Yeah, I’m going to experiment with eating breakfast, like a bowl
of cereal with milk and fruit, every morning for the next week and take notes. And for lunch, I’m
going to bring leftovers or pack a lunch, and have my bar for snack instead. And I’m going to eat
more fruit, by having it with my breakfast, lunch, and maybe with my afternoon snack.

REGISTERED DIETITIAN: That’s a great plan. Also, you could make note of your times at swim
practice this week and we can see if our plan is working. I look forward to hearing how it goes
when we meet next week. It was nice meeting you, Jessica.

JESSICA: You too. See you then.

Chapter 8 Objectives:
• Find the meaning of contextual
Morning Report
vocabulary
• Interpret information from history

taking
• Demonstrate the morning report

Skill Bank
Morning report is a case-based conference focused on clinical
teaching. As the name suggests, these sessions typically occur
in the morning, and attendance may be mandatory for all
residents and students in the program with the exception of
those caring for critical patients, managing emergencies, or on
electives outside the department. One of the sections in the
morning report, summary of database, is obtained from
history-taking. Take a look at the example of summary of
database below.

Vocabulary Bank

Asking about symptoms

Feature Typical Questions

Main Site Where does it hurt?

Show me where it hurts.

Radiation Does it go anywhere else?

Character Can you describe the pain?

Precipitating factors Does anything bring them on?

Time of onset When do they start? When do they stop?

Time of resolution How often do you get them?

Frequency Does it go anywhere else?

Aggravating factors Does anything make them worse?

Is there anything else that affects them?

Relieving factors Does anything make them better?

Associated features Do you feel anything else wrong when it's there?

Have you any other problems related to the pain?

Duration How long do they last?

Severity How bad is it?

Description of Pain Explanation
Patient’s Description
of Pain a general pain, often in muscles and joints
aching / an ache like a drill
boring with heat
burning an intermittent pain which varies in intensity, goes in waves
colicky an involuntary spasmodic muscle contraction
cramp/cramp a feeling of pressure
crushing a background pain, opposite of sharp
dull biting
gnawing a feeling of tightness
gripping like boiling water
scalding acute
sharp like a knife
stabbing

stinging sharp, burning, like an insect sting
throbbing with a pulse or beat

A Talking about pain (Case Notes)

Surname: Oates First Names: Allison

Address: Acredales, Bridgethorpe

D.O.B: 30/4/79 Sex: F Marital Status: Married

Occupation: bank clerk

Presenting complaint:

c/o severe headache, boring in nature, mainly in and around R. eye

can radiate to forehead, comes on at any time and can vary in duration 1-2 hrs. No precipitating

or relieveing factors.

Has noticed haloes around lights with some blurry vision in R eye and vomiting.

PMH:

similar headache 10 yrs, coming every 3 mths. Often premenstrual. Aggravated by eating

chocolate; relieved by lying in dark room. Can have visual aura, blurred vision, nausea + s.t.s

vomitting

B Drug History

It is essential to obtain full details of all the drugs and medications taken by the patient. Not
infrequently patients forget to mention, or forget the name of drugs they take. Some may be over-
the-counter remedies unknown to the general practitioner. The significance of others, such as herbal
remedies or laxatives, may not be appreciated by the patient.
It is necessary to determine the precise identity of the drug, the dose used, the frequency of
administration and the patient's compliance or lack of it.
It is important to ask about known drug allergies or suspected drug reactions and to record the
information on the front of the notes to be obvious to any doctor seeing the patient Failure to ask the
question or to record the answer properly may be lethal.

To find out about drug history, doctors ask:
• Details of drugs and medication:
Are you taking any medication at the moment?
Do you use any over-the counter remedies or herbal or homeophatic medicines?
Which tablet do you take?
• Frequency of administration
How many times a day?
• Compliance
Do you always remember to take it?
• Side-effects and allergies
Do you get any side effects?
Do you know if you are allergic to take it?

If the answer is YES: What symptomps do you get after taking it?

C Family History

Note the age, health or cause of death of parents, siblings (brothers and sisters), spouse (husband or
wife), and children. To find out about family history, doctors ask:

• Do you have any brothers and sisters?
• Do you have any children?
• Are all your close relatives alive?
• Are your parents alive and well?
• Is anyone taking regular medication?
• Social and personal history
• How old was he when he died?

• Do you know the cause of death? / What did he die of?
• Does anyone in your family have serious illness?

D Social and Personal History

Record the relevant information about occupation, housing and personal habits including recreation,
physical exercise, alcohol and tobacco and, in the case of children, about school and family
relationships. Typical questions in taking a social and personal history are:

• What kind of house do you live in?
• Do you live alone?
• Who shares your home with you?
• How old are your children?
• Are any of them at nursery or school?
• What's your occupation?
• Do you have any problems at work?
• Do you have any financial problems? - Do you have any hobbies or interests?
• What about exercise?
• Do you smoke?
• How many a day?
• Have you tried giving up?
• What about alcohol?
• Wine, beer or spirits?
• Can you give up alcohol when you want?
• How much do you drink in a week?
• What's the most you would drink in a week
• Are you aware of any difference in your alcohol consumption over the past five years?

E Reviewing the Systems

Once you know the main reason why the patient wants medical attention, it is to ask about the
systems to determine the patient's general state of health and to c for any additional problems. The
patient should be encouraged to describe sympto spontaneously. Initial questions should be open-
ended and as general as possible. Follow up with more specific questions if needed, but avoid
putting words in the patient’s mout.
Open-ended questions:
What's your appetite like?
How's your vision?

Closed questions:
Have you eaten today?
Is your vision ever blurry?

F Asking about the central nervous system

1. Do you suffer from headaches?
2. Have you ever had a blackout?
3. What about fits?
4. Have you had any dizziness?
5. Do you get ringing in the ears?
6. Have you ever experienced any numbness or tingling in your hands or feet?
7. Do you have any problems sleeping?

Chapter 9 Objectives:
• Use certain phrases for giving
Academic Debate
argument
• Develop an argument
• Refute an argument
• Demonstrate debate session

What is academic debate?
Academic debate is simply
defined as a debate conducted
under the auspices of an
educational institution aimed
at providing educational
opportunities for its students.
The purpose of an academic
debate is to allow evenly
matched opponents to
present balanced arguments
and evidence about critical
issues.

Skill Bank: Debate
Why Debate?
When debating, teams explore arguments for and against a specific proposition. Debating
can be an effective and practical learning tool. Debating allows several different qualities to
emerge, including:

• collecting and organising ideas,

• evaluating ideas,

• seeing logical connections between ideas,
• adapting to new situations quickly and efficiently, and

• speaking persuasively

The Audience
As the audience is acting as a judge in the debate, the debaters should remember a few
rules:
• The debater should not deliver too many facts in a short time.
• The debater should present the information to the audience as a completed work, not

short facts glued together.
• The language used in a debate must be intelligible.
• The speech must be clear, well-organised, and informative.
• Good use of transitions is the key to a good debate.

Attitude of Speakers
• Debaters should display courtesy and show respect for opponents and for the worth
of ideas at all times.
• It is not realistic to take a "right or wrong" attitude toward debate.