International Journal of Language Education, Vol. 3 No. 2, October 2019 pp. 20-26 NEGOTIATING CONFLICTS OF NEEDS IN DESIGNING TEACHING ENGLISH FOR MIDWIFERY STUDENTS I Made Sujana University of Mataram, Lombok, West Nusa Tenggara Province, Indonesia Email: madesujana@unram.ac.id Nurachman Hanafi University of Mataram, Lombok, West Nusa Tenggara Province, Indonesia Email: nurachmanhanafi@yahoo.com Sudirman Wilian University of Mataram, Lombok, West Nusa Tenggara Province, Indonesia Email: sudirman_wilian@unram.ac.id Edy Syahrial University of Mataram, Lombok, West Nusa Tenggara Province, Indonesia Email: edysyahrial@unram.ac.id Eka Fitriana University of Mataram, Lombok, West Nusa Tenggara Province, Indonesia Email: ekafitriana@unram.ac.id Abstract As an international lingua franca, English plays an important role for students of health for both academic and career success; however, it is often neglected in its planning and implementation. The present study aims at redesigning the teaching of English for midwifery students using an ESP approach by analyzing present situations (PSA), target situations (TSA), and learning situations (LSA) as the basis for designing English programs. The research was conducted at Midwifery Department, Polytechnic of Health (Politeknik Kesehatan henceforth POLTEKES) Mataram, Indonesia involving students, English lecturers, subject specialists, and management. Data were collected using triangulation techniques -- ECSCS Test, questionnaires, interviews, Focus Group Discussion (FGD), and documentation – and were analyzed qualitatively and quantitatively based on the characteristics of data. The research found that (i) the students’ level of English was still low (84.6% in Basic); (ii) the target needs (necessities) are to be able to communicate both spoken and written in carrying out the duties in workplaces and professional development; (iii) from those results mentioned above, there were conflicts among aspects of needs in designing courses, that is, the high target does not correspond to entry behavior, the number of credits allocated, and facilities. Considering the results of NA, it is suggested that the English programs can be designed using Necessities (TSA)-based Approach, PSA-based Approach, or Mixed Approach with its own advantages and disadvantages. Keywords: ESP, midwifery, need analysis, English, SKBI, syllabus, PSA, TSA, LSA opinions on the meaning of needs. Needs can be translated into target needs consisting of necessities, lacks, and wants (personal aims) and learning needs (Hutchinson and Waters, 1993), subjective and objective needs (Brindley, 1989), perceived and felt needs (Berwick, 1989). Dudley-Evans & St. John (1998) translate needs in a more elaborate way of the needs analysis by finding out 8 kinds of needs. Some translated it into PSA, TSA, and LSA. Chambers (1980) coined the terms of Target Situation Analysis (TSA) to refer to communication needed in the target situation while Richterich and Chancerel (1980 cited in Songhori, 2008) proposed the term Present Situation Analysis (PSA) to refer to what learners are like at the beginning of a course. The results of PSA and LSA become the basis to design Learning Needs or Learning Situation Analysis (LSA). LSA relates to what learners need to do and how to do it in order to enable them to reach the target needs from the present situations (Dudley-Evans & St. John, 1998; Hutchinson & Water, 1993). INTRODUCTION Needs Analysis (NA) has become a fundamental principle in designing the teaching of English using an ESP approach (Basturkmen, 2010; Dudley-Evans & St. John, 1998; Hutchinson and Waters, 1993; Iwai, et al,1999;). Even Brown (2016) claims that NA as primordial to ESP --- there is no ESP if there is no NA. Many studies all over the world have been devoted to conducting NA prior to designing ESP programs in various fields (Araminta & Halimi, 2015; Munby, 1978; Poedjiastuti & Oliver, 2017; Brown, 2016; Ulum, 2015; Sujana, Fitriana, & Syahrial, 2016). NA is defined as “a systematic and on-going process of gathering information about learners’ needs and preferences, interpreting the information, and making course decisions based on learners’ needs” (Graves, 2000:98). However, interpreting information and making course decisions from the results of NA is not a simple task due to the complexity of the meanings of needs. Different experts have different 20 I Made Sujana, Nurachman Hanafi, Sudirman Wilian, Edy Syahrial, & Eka Fitriana. Negotiating… Of various meanings of needs, following Hutchinson and Waters’ (1993) supposition in that designing courses is likened planning traveling comprising ‘starting point’, ‘destination’, and ‘route’, the needs in this context are grouped into these three categories. Dudley Evans & St. John (1998) group them into PSA, TSA, and LSA. The concept, at the same time as a framework for this research, is proposed as follows: students of POLTEKES Mataram, West Nusa Tenggara; (2) to analyze target situation (TSA) and (3) to provide recommendations for teaching of English for the midwifery students of POLTEKES Mataram. METHODS Research Protocol The needs analysis employed the protocol adapted from Hutchinson and Waters (1993) and Dudley-Evans & St. John (1998) by analyzing three areas of needs: Present Situation (PSA), Target Situation (TSA), and Learning Situation (LSA). The PSA covers students’ entry levels, perceptions of students, management and subject specialist, and English lecturers. The TSA covers necessities of learning English. These two aspects above -- PSA and TSA – becomes the basis for course recommendation of English programs at Department of Midwifery POLTEKES Mataram. Respondents The research was conducted at the Department of Midwifery of POLTEKES Mataram (D3 and D4 programs ) involving 98 students out of the total 240, three management staff who are also subject specialists, and 3 English lecturers. Data Collection and Data Analysis Data were collected by triangulation techniques in the form of ECSCS Test (English Communication Skills for Civil Service) developed by ODA-LAN-BC Project (1996), questionnaires, interviews, Focus Group Discussion (FGD), and documentation (SKBI – Competency Standard of Indonesian Midwifery). The collected data were then analyzed qualitatively and quantitatively. Diagram 1: Designing an ESP Course Comprehensive NA involves finding students’ present situation (PSA) and target situation (TSA) before designing curriculum and syllabi (learning needs or LSA). The ultimate goal of designing an English program is to bring learners from the present situation (level) to the target needs. From the theoretical point of view, NA looks simple; however, at the application level, NA often causes conflicts due to the complexity of aspects involved in the design (see for example Sujana, Fitriana, & Syahrial, 2016 for higher education contexts in Indonesia). The present research aims at redesigning the teaching of English programs for students of midwifery at Mataram Polytechnic of Health Lombok, Indonesia by employing an ESP approach. For students in the field of health (medicine, midwifery, nursing, etc.), English is urgently needed since it has ‘strong position’ in their study in the sense that they will be in trouble when they do not have adequate English proficiency (Sujana, Fitriana, Syahrial, 2016). It is due to the fact that the development of technology and science in medicine and health is very fast and massive and they are mostly written in English. In addition, for students of medicine and health in Lombok Indonesia, English plays more and more important roles along with the development of business and tourism and the opening of international hospitals. With the global competition in the coming age, English proficiency also opens opportunities for Indonesian medical personnel to work abroad. Therefore, preparing students to improve their English proficiency becomes added values in global competition. Accordingly, a thorough study needs to be conducted so that teaching and learning English can make a positive contribution to the students. It seems that the learning objectives of almost all courses, i.e. to provide students with the ability to understand textbooks in English and to prepare graduates to compete in their future careers are still very far from achievement. This study, as a series of ESP (English for Specific Purposes) studies in state and private universities, is conducted in the framework of re-design of English teaching for students of midwifery in Mataram Lombok, Indonesia using an ESP approach. Thus, the purposes of this study are (1) to analyze the present situations (PSA) of midwifery FINDINGS AND DISCUSSION Analysis of Present Situation (PSA) The data on PSA cover students’ English entry behavior, students’ perception of English needs, management, and subject specialists, and English lecturers. English Level of Midwifery Students The English level of Midwifery students of Poltekes Mataram is measured using ECSCS Test (English Communication for Civil Service) published by LAN-ODABC Project (1996). This is a placement test comprising of 15 sections with each section consisting of 10 cloze procedure types to be completed by the test-takers. The following is the result of the test from 98 students. Table 1. Results of Placement Test of Midwifery Student (N = 98) Ecscs Score Freque % Level level ncy 6 (+) 135-150 Post-Intermediate 5 111-134 Upper-Intermediate 4 87-110 2 2.0 Intermediate 3 63-86 2 2.0 Pre Intermediate 2 37-62 14 14.3 Elementary 1 00-36 80 81.6 Foundation The table above shows that the English language ability of midwifery students in POLTEKES Mataram is still low. The scores range from 5 to 81 out of 150 questions given. In general, the average ability of students is at the Basic/Foundation level. It is found that 80 students (81.6%) 21 International Journal of Language Education, Vol. 3 No. 2, October 2019 pp. 20-26 of the 98 respondents are in Basic/Foundation level; Fourteen students (14.3%) are in Elementary Level, and 2 students each (2.0%) are at a Pre-Intermediate and Intermediate Levels. Given the fact of students’ English entry behavior above, it is difficult to design effective language programs using an ESP approach. Three aspects need to be considered in designing language or other education programs are ‘where to go’ (goals), ‘where to start from (entry/starting points), and ‘which way to take’ (process/route). With such current levels of English, is it possible to achieve the expected goals? for D4 program), the management emphasizes on improving grammar mastery in English 1 and on improving communication skills in English 2. The institution expects that English in the future is directed to the improvement on students’ communication ability (both oral and written) such as an ability to understand simple communication on obstetrical topics and to read journals written in English to anticipate various global issues and development of tourism in Lombok, Indonesia. To meet these demands, the institution plan to extend to an extra English program on English journal analysis in the 7th semester. In terms of curriculum issues, the problems are the Midwifery Department of POLTEKES Mataram has no course description as a guide for developing Semester Lesson Plan which leads to different interpretation among lecturers of English [interview with the secretary of the department and the Program Coordinator of D3 POLTEKES Mataram]. This statement is supported by English lecturers [interviews and questionnaires]. From the interview above, it can be concluded that the management and subject specialists expect that students have active mastery on English both oral and written language to cope with their study (reading textbooks) and with their jobs (oral communication). Putting together, the management, subject specialists, and students have the same directions and language proficiency. All expect that students have functional ability to be able to use English for written and spoken communication for their future career (job) and academic life (as students). However, various obstacles hinder the goals. Needs Perceived by Students The purposes of learning English. From the questionnaires distributed to 49 midwifery students of Poltekes Mataram, it is found that 42.8% of the students wanted to improve communication skills (Speaking); 26.5% wanted to increase the ability of reading textbooks; 12.2% expected to increase their translation capability; and only 6.1% of students intend to prepare themselves for future career. From the analysis of the top three options of the students, the finding is quite the same as the results mentioned above. The main goal is to increase the ability to speak (24.0%), followed by the goal to increase reading comprehension ability (22.1%) and the ability to translate (13.9%) and prepare for the future career (13.9%). Accordingly, the English training program should be designed and directed to improve the ability to speak and read. In other words, since the institutional purpose of learning English is to improve students’ ability to read textbooks, the materials must involve activities in which students have the opportunities to express themselves in English. Skills to be Developed. The objective above is in line with the midwifery students‘ responses to the question of what skills they want to develop in learning English. From data on preferences of skills to be learned, it is revealed 46.9% of respondents focused more on Speaking, and 30.6% on Reading. In terms of English sub-skills, increasing vocabulary is favored by 35 respondents (71.4%) followed by the development of pronunciation (7 students, or 14.2 %) and grammar mastery (7 students or 14.2 %) Needs Perceived by English Lecturers From the results of questionnaires, interviews, and discussions with the English lecturers and subject coordinator, it is found that the direction of English learning is different from one lecturer to another. This difference in purpose leads to the difference in teaching materials and methods. In parallel classes of the same subject and credits, the emphasis of each class is different: one class is geared to reading comprehension while another emphasizes on communication skills; meanwhile, the management, as admitted above, suggest on the improvement of English Grammar in English 1, and on the improvement of communication skills in English 2. To overcome these differences, the teaching team and the program management need to determine the direction together so that the parallel classes will have the same learning objectives and materials. They need to agree on the learning outcomes of the courses, the expected competency, and the materials coverage Preferences in English Learning Activities Of the three priorities of the preference on learning activities by the Midwifery students in POLTEKES Mataram, no trend of preference is reflected: students’ choice among nine preferred learning activities ranged between 12.2% to 13.0%. This indicates students’ preferences vary widely. It is also found that the students favor activities that involve others in learning: small-group activities (46, 9%) and pair work activities (32.6%). Large group activities and individual activities are favored respectively by 8.1% and 12.2%. Thus, it is necessary to design activities that allow students to interact in pairs and small groups. Analysis of Target Situation (TSA) Analysis of Duties and Responsibilities of Midwives as Professionals. As explained in the methodology section, the English language needs analysis for midwifery students was performed through analyzing the responsibilities/tasks usually performed by professional midwives. In this study, the responsibility of a professional midwife is analyzed from the documents containing competencies and responsibilities of the midwife with the reference of Indonesian Midwives Competency Standards (Standar Kompetensi Bidan Indonesia – SKBI, DIKTI, 2012). According to the SKBI, the Needs Perceived by Management and Subject Specialists The management and subject specialists (lecturers) of Midwifery Department of POLTEKES Mataram acknowledged the needs for improvement of English learning to produce students who are able to use English to communicate about obstetrical topics. However, with the limitation of credits allotted (i.e. only 2 for D3 program and 4 22 I Made Sujana, Nurachman Hanafi, Sudirman Wilian, Edy Syahrial, & Eka Fitriana. Negotiating… as students' and providing skills for future career and professional development. However, from data collected above, the design of the teaching English program will be difficult due to the conflicts among aspects of needs (necessities, lacks, and wants). competence of Indonesian midwives covers seven areas of competence: (1) legal conduct and patient safety, (2) effective communication, (3) personal development and professionalism, (4) the scientific base of midwifery practice, (5 ) clinical skills in midwifery practice, (6) health promotion and counseling, and (7) leadership and entrepreneurship management. In the analysis of midwifery students’ needs of the English language, what is required is the breakdown of sub-competencies related to the purpose of the use of language (English). From the SKBI documents, the required tasks and responsibilities (competencies) associated with language can be summarized as follows: a. Capable of exchanging information verbally or nonverbally with the patient/female, the family, female environment, obstetrics professionals, other health professionals, and stakeholders. b. Capable of developing themselves by following the developments of science and the latest technology, as well as self-awareness of the limitations associated with the practice of obstetrics, and uphold the commitment to the profession of the midwife. c. Having knowledge and skills on obstetrics, neonatology, social sciences, public health sciences, ethics, culture, and proper care for women, newborns, childbearing women, and families. d. Conducting health promotion and counseling about public health in general and women's health in accordance with the development stage of the reproductive cycle. e. Planning and managing resources with the aid of science and technology to produce strategic steps of organizational development. From descriptions of the language-associated competencies mention above, midwives and students of midwifery are demanded to have high levels of English proficiency. They are required to have (a) ability of oral communication (speaking and listening) in the field of obstetrics and health with various levels of difficulty; (b) ability to read English texts with varying complexity (simple to complex); (c) ability to write simple texts up to writing reports and scientific journals; (d) the ability of vocabulary, pronunciation and grammar with varying complexity which is presented in an integrated and contextual way; and (e) the mastery of cross-cultural understanding in midwifery-patient communication. Based on the data obtained from various sources, the ideal English learning for midwifery students can be categorized into two major parts, namely preparing ‘students Justification of the design of ELT Referring to the theoretical framework used in the design of the ESP approach, namely the design of the curriculum should be based on the entry behavior and the goals to be achieved (the target needs). Both of these concepts will show the gap to be filled with the curriculum (learning needs). The data collected from various sources (students, faculty subject areas, management of institution) involving various data collection techniques (test of English, questionnaires, interviews, and FGD) illustrate that the English proficiency of midwifery students in Mataram city is averagely still at the 'basic' level (81.6%). Furthermore, the analysis of the tasks and responsibilities of midwives indicates that midwives are required to have high levels of language skills to carry out the duties and functions as a midwife and a student of midwifery. It means that the teaching English should be directed to the achievement of all aspects of language proficiency at high levels in their own field. A midwife (and midwife students) is required to have the followings: a. Verbal communication skills (speaking and listening) from simple activities (welcoming and patient registration, patient history record, etc.) to complex ones (discussion, presentation of the findings in the field of health). b. Ability to read English from simple manual/information to reading journals and scientific publications. c. Ability to write simple memos, announcements, etc., to writing reports and scientific articles. d. The mastery of related vocabulary, pronunciation, and grammar presented in an integrated and contextual way. e. Mastery of cross-cultural understanding (CCU) underlying communication in English. Of the two data described above --- students’ English levels and the target needs (necessities) --- it is clear that the gap between target needs and the English entry behavior of midwifery students is very large. According to Dudley-Evans & St. John (1998), the ESP program can be implemented to students at the minimum level of Intermediate. The hierarchical arrangements in the context of the ESP can be described as follows: 23 International Journal of Language Education, Vol. 3 No. 2, October 2019 pp. 20-26 ESP: Academic Reading ESP: English for Jobs Interm ediate Pre-Intermediate Elementary Basic Figure 3. Levels of English Courses Recommendations for English Programs at Midwifery Department Recommendations of ELT programs for students of midwifery are based on theories or concepts of Needs Analysis proposed by Hutchinson and Waters (1993) and Dudley-Evans and St. John (1998) and on the results of NA conducted at Poltekes Mataram. As seen in Diagram 1 above, three main areas in syllabus designs are the analyses of target situations (TSA), of present situations (PSA), and learning situations (LSA). The LSA will be based on the gap between TSA and LSA. Based on the findings mentioned above -- students’ low level of English (entry behavior), high demand, limited number of credits, big number of students in one class, and other factors, it is difficult to design ELT programs for midwifery students, which is ideally based on the necessities (TSA) as the main target of learning English. From various analyses of needs mentioned above, the target needs are categorized into short-term targets (to be able to read academic publication) and long-term targets (to use English for jobs). With present situations, both of them are hard to achieve. Therefore, it is difficult to redesign the ELT program, whether it is based on the necessities (TSA) or on current situations (PSA). In such complicated situations, this research recommends some alternatives or choices. In the design of English learning, proficiency is acquired gradually. According to Krashen (1982), learning will run smoothly if the objectives are at one level above the current capabilities; this is known as an i+1 concept (i is the current capability, 1 is the ability acquired one level above the current capability). It is also in line with Vygotsky’s (1978) Zone of Proximal Development (ZPD). The picture above shows that the gap is too high between the students’ current level of English and the goals to be achieved. The situation is worsened by the number of credits allocated to achieve the goals (2 credits for the D3 program and 4 credits for the D4 program). As seen in the picture above, it is required to go through, at least, 4 levels to accomplish learning Academic Reading (reading scientific journal). If one level takes 60 hours (± 4 credits), it takes quite a long time (240 hours / ± 16 credits) to achieve the desired goals. That required time for class meetings can be made shorter by providing a selflearning program, the participation of lecturers to encourage students to use English or by requiring certain certificates for graduation. These will be able to motivate students to study harder. In addition to the problems mentioned above, teaching English becomes more difficult due to other obstacles such as the big class size, the absence of clear and standardized program/syllabi/materials, and the weak teamwork among teachers. From the analysis of information related to English language learning targets (target needs), the direction of teaching and learning English can be grouped into short-term goals and long-term goals. In the short term, the goal of learning English in the Department of Midwifery Poltekes Mataram is to prepare ‘students’ to become ‘students’. English is needed as a means to study (that is, reading textbooks/journals in the own field). In the long term, English is needed to prepare students as ‘job seekers’ who need English to carry out jobs as midwives. Again, it needs to be reminded that to be able to achieve those goals requires high levels of English. Given the data above, is it possible to achieve those goals? If not, what are the strategies or actions need to be taken by the Department to equip their students and/or graduates with adequate levels of English for global competitions? Recommendation #1. Necessity (TSA)-Based Program Design Since the purpose of teaching English in an ESP context is to be able to use the language professionally in the targeted contexts, the ESP programs are ideally designed based on the necessities (i.e. where the language will be used). Therefore, the ideal learning outcomes of teaching English at the Midwifery Department are to be able to read academic publications to support their study and to able to use English for employment (job). Thus, the language programs are English for Academic Purposes (EAP) and English for Occupational Purposes (EOP) in midwifery. It means that the ELT programs will contain high levels of English. In EAP, the teaching will be directed to the achievement of reading academic publications written in English. Academic reading requires learners to be effective, active, and critical readers (Kocukoglu, 2011). In EOP the teaching will be directed to the use of English for communication (spoken and written) in a workplace. 24 I Made Sujana, Nurachman Hanafi, Sudirman Wilian, Edy Syahrial, & Eka Fitriana. Negotiating… However, the problem with EAP and EOP programs is that both need an adequate level of English to start. Dudley-Evans & St. John (1998) suggest that ESP programs ideally start at least from an intermediate level. With the current level of English (81.6% at the basic level), the program will need a lot of credits and support (such as facilities, human resources, students’ readiness, etc.). [see leveling in Figure 3 - Levels of English Courses above]. and has the ability to professional development; (d) limited number of credits, and (e) class size. Based on the data given above, the course designer can choose Necessities (TSA)-Based Design, PSA-Based Design, or Negotiated English Program with their own strengths and weaknesses in the application. Considering the conditions mentioned above. it is necessary for the policymakers at the Department to consider other supporting programs to support class meetings. Recommendation #2. PSA-Based Program Design The design recommended above will raise a number of problems especially related to the number of credits allocated to English subjects. The second alternative of program design for teaching English for Midwifery students is based on the current level of English, considering Krashen’s comprehensible input (Krashen, 1982). Since most of the students are at the Basic level (81.6%), the ELT program must be designed to achieve one level above (Elementary level). 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