An Evaluating Study on ESP Medical Textbook: Instructors and Learners’ Needs Analysis

Textbook evaluation is determining the productivity and value of textbooks with respect to stated objectives, standards, or criteria. This study was an attempt to evaluate the ESP medical textbook, which is taught at some universities in Iran. To gather the necessary data, two researcher-made questionnaires and one interview protocol were used. Iranian Medical instructors and learners answered to a 28-item questionnaire to express their attitudes towards the content, exercises, and topics of their ESP course book. In addition, some members of both groups participated in an interview to gain in depth information about the study. They were both male and female. The findings revealed that the content and the topics of the ESP medical textbook are based on the learners and instructors’ needs. The results of this study have a number of implications for medical instructors, learners, and syllabus designers.


Introduction
English is an international language and its importance causes people to use it around of the world.ESP is an abbreviation that implies English for specific purposes.The main definition of this word is to teach some of the specific English vocabularies that are related specially to the learners with specific aims, fields of study, or occupation, such as medicine, engineering, etc.We can define this word, ESP, from different aspects, but all of these definitions show that how ESP course is designed to teach its specific learner to learn English.
Based on the Conference, which is hold in Japan about English for Specific Purpose in 1997, ESP considered as a course of study that English is taught for any aims that can be specified for special needs.
To design an ESP course, four steps should be considered: needs analysis, syllabus, curriculum design, and assessment or evaluation.The core of any ESP course and in other words the heart of ESP course is need analysis.Actually, in designing any ESP course paying attention to the needs is so important (Munby, 1978;Robinson, 1991;Johns, 1991;Jordan, 1997;Dudley-Evans & St. John, 1998;Finney, 2002).
Based on Dudley-Evans and St. John (1998), the countries in which English is considered as a foreign language not as a second language, the main and the only source of English is ESP classroom.According to Riazi (2003), in second or foreign language contexts, after teachers textbook is the prominent factor.Therefore, one of the factors that can be helpful in designing ESP courses is provided by textbook analysis and evaluation.The language of the most of the educational textbooks notably in medicine or engineering in foreign language countries such as in Iran is English.Therefore, the universities of these countries in their curriculums have the ESP course as an essential course.
In the proposed study, the Medical English textbook, which is widely used as a main source in most of the Universities of Iran, is going to be evaluated.This study aimed at surveying the content, topics, and exercises of the ESP course book to examine to what extent they are based on the needs of the learners and instructors.Finally, it examined that if the textbook considers the needs of learners and if it is designed, based on the learners' needs analysis.

Literature Review
This part supplies a review of the literature regarding to the objectives of the research.This includes a brief synopsis of the notions of ESP definition, needs analysis, and a brief review of the related studies.

ESP
To introduce ESP, Tsao (2008) and Xu (2008) indicated that the need for English for specific purposes (ESP) is fast growing for people to achieve instrumental aims as English goes on to dominate in business, technology, media, education, medicine, and research.ESP has been applied since the early 1960s.
According to Evans and St. John (1998) ESP is one part of a more general notion of instructing language for specific purposes (LSP).Hutchinson and Waters (1987) believe that ESP is mostly an approach rather than a product, so it is not a particular type of language or methodology.ESP deals with a certain group of people in a specific context using specific materials in their specialized field of study.

Needs Analysis
Needs analysis is concerned with students' study or occupational needs and to what they would like to achieve from and do with the language.Besides, needs analysis, makes the teacher able to understand the abilities that the learners bring to the class and what they cannot do in English.Needs analysis is related to the activities that are concerned with collecting information that will serve as the basis for designing a curriculum that will meet the needs of a special cohort of students (Iwai et al., 1999).
The role of needs analysis in any ESP course is vital.Needs analysis is the first step in a course design as it prepares validity and relevancy for all the following course design activities (Johns, 1991)."Target situation needs analysis" is "in essence a matter of asking questions about the target situation and the attitudes towards that situation of various participants in the learning process" (Hutchinson & Waters, 1987, p.59).

Related Study
To have a good ESP course, teachers, course designers and material developers are better to know learners' requirements.As a result, Ghalandari and Talebinejad (2012) assessed, analyzed, and evaluated the medical ESP textbook that are taught in Shiraz Medical College.They investigated the ESP textbook of medical students in Shiraz according to the Hutchinson and Waters (1987) framework.They investigated the compatibility of this book with the learners' requirements.The outcomes of this study indicated that medical ESP textbooks are the right books for the purpose of medical English for Iranian physicians and in harmony with students' requirements and achievements.Baleghizadeh and Rahimi (2011) indicated that the systematic evaluation of textbooks is not often conducted and students' requirements and opinions concerning the materials developed for them are neglected in Iran.Likewise, Eslami-Rasekh (2010) pointed out that ESP textbooks developed for the students of engineering by the Ministry of Higher Education in Iran is not born out of any systematic needs analysis.In another study done by Amirian and Tavakoli (2009), they assessed and evaluated the elements of ESP textbooks for engineering students.They reported that ESP courses have been useful and successful in making background knowledge on terminology and reading proficiency of that specific field in the minds of future engineers.Finally, in an evaluation on the academic language requirements of computer science engineering students according to English for Specific Academic Purposes (ESAP) programs, Atai (2008) understood that written skills and language elements are of high value to learners.He found that the students had some problems with skills of reading, writing, speaking, and listening.

Objectives and Significance of the Study
In foreign language context such as Iran, learners do not have any contact with English language speakers, so the textbooks and ESP courses play the crucial role in this context.As a result, language instructors and designers should pay enough attention to choose a suitable textbook that can meet the needs of the learners.According to Tajalli (1998), inappropriate ESP courses result in the waste of a lot of time, money, and energy, and lead to learners and instructors' frustration.
This study intended to investigate to how extent the content, topics, and exercises of the ESP textbook are based on the instructors and learners' needs.Moreover, Examine that ESP textbook considered the learners' needs and designed based on their needs analysis.

Research Questions
More specifically, this study sought to answer the following research questions: 1) Is the ESP course book content, topics and exercises based on the Iranians medical instructors and learners' needs?
2) Does the ESP course book consider the needs of the learners and is it based on the needs analysis of the learners?

Participants
To conduct the study, 3 Iranian EFL instructors who were teaching medicine and had MA and PhD degrees in English were selected.In addition, the total number of students participating in this study was 86.They were freshman and sophomore learners of medicine who were selected randomly participating in an ESP course in two universities.Both male and female learners and instructors participated in this study.It was assumed that these groups were aware of the English learning needs of medicine because they were completely familiar with the present status of the ESP course in their field of study and had some knowledge about their lacks and wants towards their ESP course book.Especially instructors with their experiences were familiar with this ESP course book and knew its needs.
A notable point about these 86 students is that all of them were in the age range of 18 to 30.It is worth mentioning that common to all of these participants is the minimum four years of exposure to EFL instruction at high school and pre-university level.In addition, before coming to the university most of the medical learners passed an English course and to some extent, they were familiar with the English language.It was so helpful for them.

Instruments
For collecting the data of this study, researcher used two instruments.Questionnaires and interviews were used in terms of obtaining qualitative and quantitative data.Questionnaires can be regarded as one of the most useful instrument to obtain data.In addition, for gathering detailed information regarding the concepts in the questionnaires, interviews are useful for triangulating the study.

Questionnaire
The main instrument to collect data in this study was a questionnaire.Two questionnaires, one from instructors, and one from learners collected the qualitative data.These questionnaires adopted from some questionnaires, which are related to this topic and then modified by the researcher.Based on the research topic some questions that related to the research added to the questionnaire by the researcher.Those checklists which were used in designing the questionnaire including checklists of Litz (2005), Littlejohn (1998), Ur (1996), Cunnigsworth (1995), Eskey andGrabe (1988), andSheldon (1988).Common features of these checklists were selected.These two questionnaires with the reliability index of 0.78, obtained through Alpha Cronbach aimed at eliciting the instructors' and learners attitudes towards the content, topics, and exercises of the ESP textbook.
The first part of the learners and instructors' questionnaire named demographic information.Second part of the their questionnaire, included phrases to obtain some information about the content, exercises, and the topics of the textbook.Finally, some other items were concerned with learners and instructors' general attitudes towards the ESP book.All the items in the second and the last part of the questionnaire were designed on a five-point Likert scale of frequency, in which 1 = strongly agree, 2 = agree, 3 = undecided, 4 = disagree, and 5 = strongly disagree.These sections included 47 items.

Interview
The second tool to gather information of the study was an interview.The purpose of the researcher for doing the interview was to gain an insight to the research questions.Besides, the researcher could make sure that the information she gathered through the questionnaire was correct.It was conducted with two medical instructors and eight medical learners.There were seven questions regarding content and exercises, topics and their attitudes.

Materials
Medical Terminology is the name of the book this survey aims to evaluate that and consider the attitudes of medical instructors and learners towards this textbook.The book is a specialized book for medical learners in universities of Iran.Barbara Janson Cohen wrote it.Sixth edition of this book has been thought in Islamic Azad University of Najaf Abad and National University of Isfahan, Iran.This book teaches to the learners of medicine field of study in two semesters.Medical terminology: an illustrated Guide is geared to the mid-level medical terminology course, and includes moderate amount of anatomy and physiology.

Data Analysis
After collecting the initial required data for this study through the questionnaires and the interviews, the data were analyzed to find out what the learners' needs were and to how extent this textbook is designed based on their needs.To this end, descriptive statistics determining the frequencies and percentages of the learners and instructors' answers indicating their needs and lacks were conducted.
In order to analyze the results of this study, the Statistical Package for Social Sciences (SPSS) was used.Before statistical analysis, the researcher used Kolmogorov-Smirnov Test to make clear the attitudes of instructors and learners and distribution of variables.One-sample t-test was used to determine the differences between the mean of a quantitative variable with a given number.
First of the general characteristics of these two groups were presented in the following tables (Table1 & Table 2).As is shown in the table (Table 1 and 2) majority of participants in this study was women.Most of the instructors who were participating in this study were between 30-40 years old and most of the learners were between 17-20 years of old.
In following tables, the instructors and learners' attitudes towards content, topics, and exercises of the ESP course book were presented.It is apparent that instructors believed non-text content was not used accurately in this book.They were agree towards the grammatical points of the textbook, they believed that this part of the textbook was interesting, purposeful, and arranged from easy to complex ones and helped learners to use them in communication.In the direction of the content and subjects of this textbook, they believed that this book was designed based on the learners' needs and complexity from easy to difficult.They were also consent that this textbook content are interesting and challenging but its subjects were not generally realistic. .
All the instructors believed that ESP course book topics were relevant to the medical learners.However, most of them agree that it would better revise the content to become more relevant to the learners.As it is apparent from the table, most of the instructors agreed on the varieties of the ESP course book topics and the logical arrangement of the materials but believed that the topics were also difficult for learners to understand.It also should be added that instructors believed that the topics of the textbook neither can arouse the critical thinking of the learners nor helped them to expand their awareness.It is apparent from above table learners had agreement towards the general content of the ESP textbook and the material used in the course book to help understanding the content.The majority of respondents felt that the exercises and the grammar points of their textbook were not understandable concerning their needs or their level.
It is clear from the table most of the learners had agreement on the topics of their ESP course book, variety of its topics, and its relevance to their needs.In addition, this point can be added that most of them believed that its topics are difficult for them but this topics can enhanced their knowledge and experience.As is clear from the data presented in Table 3 the results of the test for the instructors attitude is 0.368 with p-value equivalent 0.999 and for learners is 0.802 with p-value equivalent 0.541.In accordance with the expressed P-value, data follow the normal distribution.The results of the Table 6 present that the learners' attitudes mean score and equality of toward the content of their textbook respectively are 3.1135 and 0.96331 and about instructors, they are 2.6364 and 0.34284.According to the instructors and learners' answers to the content and exercises part of the questionnaires, which were designed based on Likert scales from strongly disagree to strongly agree, it can be concluded that the mean scores of the instructors and learners' attitude is equal to 3, so it can effect on the content of their ESP course book.
The first part of the interview question related to the needs analysis.There are two questions concerning needs analysis in the interview protocol.First question was asked to obtain their opinion about the situation learners have to use English in future and the second one is related to instructors and learners' expectation from this course of study.Instructors believed that "Learners need to learn English language to be able to use it in future of their educations, workplace, conference, workshops, and scientific congresses".Learners were also had that same idea as the instructors and stated that" In international and Scientifics conferences and lectures, occupational field, in future of their education and in their field of study".
Towards the second question instructors averred, "We just expect them to learn vocabulary in text and memorizing them and also fluency in reading, knowing very large extent of vocabulary and medical terminology".Learners believed that this course of study should help them to get familiar with the vocabulary related to their field of study, Words and medical terminology, and those vocabularies, which are needed for medical terminology, Suffixes, prefixes, and acronyms.
Regarding to the content and exercises in these interviews, the interviewer asked just one question from the interviewees.This question investigated about the relevance of the content and exercises of the ESP course book to the needs of the learners.In respond to this question instructors stated that" This book has very brief and simple text and students get familiar with special technical terms related to their field of study.The content of this textbook is good and relevant to the needs of the medical learners additionally because this book has some exercise for reviewing vocabulary of each lesson it is helpful for memorizing them".Learners have the same idea and added that "we ourselves must study some original resources to gain more knowledge, because this book cannot be enough for our future and claimed that the content of the ESP textbook is relevant to the needs but about exercises is not true".
One of the interview questions concerned with the topics of the ESP textbook.This question was asked to make clear to how extent the topics of the ESP text relevant to the needs of the learners.Instructors regarding this question argued that," Topics of this textbook completely related to the diseases and vocabularies, which are needed for the future of the learners.However, this textbook is not enough for the learners lonely.In addition, the asserted In Isfahan University the other textbook is taught to the learners that are very more challenging.Medical terminology has very simple and easy and brief texts that are not challenging and do not force the learners to think about them very much".Learners have positive attitude towards this part of the ESP course book.

Results and Discussion
To sum up the results of this study, this study made an effort to seek answers to two questions.The questions will be restated and the answers, based on the findings of the study, will be provided below.
6.1 Is the ESP course book content, topics and exercises based on the Iranians medical instructors and learners' needs?
According to the questionnaires, the learners agreed upon the general content and the curriculum and syllabuses of the textbook and the fact that this textbook was designed based on their linguistics needs.However, there were disagreements upon the language skills.It did not pay enough attention to the four language skills.Generally, the reading parts of the textbook are enough and based on the learners' level but they are not interesting and cannot encourage them to read for comprehension.The book is somehow not motivating and the exercises and the grammar points are hard to understand.Although the topics of the textbook are difficult for them, learners agreed on its variety, and its relevance to their needs.The topics can also enhance their knowledge and experience.Learners also agreed on the effectiveness of the teaching methodology of the ESP textbook.
As for the instructors and based on the questionnaires' results, they agreed that the grammar points of the textbook were appropriate, interesting, purposeful, and arranged from easy to complex and helped learners use them in communication.However, the materials were not interesting and up to date.Although they followed the teaching syllabus, they had to prepare more materials for the learners, revise existing materials, use new methods of teaching, and prepare more exercises.They also asserted that the non-text content was not used accurately, materials were not interesting and up to date, and the topics were not generally realistic and were difficult to understand.However, they agreed on the verities of the ESP course book topics and the logical arranging of the materials.Instructors believed that the textbook can work well based with the ELT methodology.According to the instructors, the load of the ESP textbook was at an appropriate level and they were contextualized and also the reading texts of the textbook were suitable for learners' level.
According to the interviews, the content of the ESP course book was based on the learners and instructors' needs, both groups of the participants exposed that the content of the textbook centered on their needs.
6.2 Does the ESP course book consider the needs of the learners and is it based on the needs analysis of the learners?
According to both questionnaires and interviews, the ESP course book is designed based on the needs analysis of the learners.The respondents were agree upon this but cited that it was better for this book to be up to date and also some other resources ought to be introduced to the learners because some of them believed that this book was not enough for their future use.

Conclusion and Implication
In sum, the results of the resent study offered that the content, topics, and exercises of the ESP course book were mostly based on the learners and instructors' needs.Moreover, the results disclosed that the ESP course book was designed based on the needs analysis of the learners.This study has implications for medical instructors, medical learners, and syllabus designers, as it states below.
Learners and instructors' attitudes towards second and foreign language learning and teaching play a crucial role in the success of any language course.By knowing learners and instructors' attitudes towards the content of the textbooks, book editors and syllabus designers have a better understanding of what must be and not be included in the textbook and the next editions of the book will be mostly based on instructors and learners' needs and requirements.Similarly, conducting needs analysis helps book writers to improve their works and also develop and write the materials that are according to the learners' needs.Instructors can also be aware of the needs of the learners and pay enough attention to their requirements.It is also of interest to include more exercises about other language skills except for reading skills.Medical students need to get familiar with the requirements of their future job in real life situations to have professional progress.

Table 3 .
Descriptive statistics of instructors' content, exercises, and topics questions

Table 4 .
Descriptive statistics of content, exercises, and topics questions

Table 6 .
Mean group statistics