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October 2023 - Year 25 - Issue 5

ISSN 1755-9715

Teaching Expository Writing to ESP 4th Year Medical Students

Ania Agustina Gómez Gómez. She was born on November 24th, 1968, in Santa Clara, Villa Clara, Cuba. In 1986 she started at the Pedagogical Institute Félix Varela and in 1991 she got her bachelor’s degree. In 2003 she started working at the Medical University of Villa Clara and in 2005 she became Assistant professor. Email:

Pedro Eduardo Rodríguez Rodríguez. He was born on May 5th, 1957 in Placetas, Villa Clara, Cuba. In 1977 he started at the Pedagogical Institute Félix Varela, and he got his bachelor’s degree in 1981. In 1983 he started working at the Medical University of Villa Clara and in 1994 he became Assistant professor. Email:

Sponsor institution: Villa Clara University of Medical Sciences



The observation of the student’s needs is of overwhelming importance in course planning, as well as the differentiation between what the student needs to do in the target situation and what the student needs to do in order to learn; at the time of carrying out the teaching - learning process in the target language. It is vital that the 4th year students at Villa Clara Medical University improve their writing ability, and the understanding of scientific articles, referral letters, case reports and others which are also the requirements in the target language. This work is a part of a research project where it was put into practice a practical procedure which covers two stages in order to fulfill a general objective that is to bring the medical student forward in all dimensions of language proficiency and as a specific goal - to improve the student´s proficiency in the writing of materials which are proper of the medical area.


From each according to his abilities, to each according to his needs.

Karl Marx

Introduction: Needs analysis

As the course should be based on an analysis of students need. Obviously, it is indispensable to make a distinction between what the student needs to do in the target situation and what the student needs to do in order to learn, so target need comprises a lot of important distinctions, but target situation due to necessities, lacks, and wants. As it has been posited by specialists of ESP- “Necessities, the type of need determined by the demands of the target situation, that is, what the learner has to know in order to function effectively in the target situation” Hutchinson T. and Waters A. (1996). (1)

For instance, medical students (medicos), need reading, writing and understanding; referral letters, report cases, scientific articles, medical lectures and/ or its summaries, and others proper demands in the target language.

In other words, to fulfill as a general goal - to bring a medical student forward in all dimensions of language proficiency and as a specific goal - to improve the student’s proficiency in the medical area. So, this paperwork is based on these practical needs plus the students’ weaknesses, the latter represents one of the problems to surmount by  4th year students of the Medical University.


Causes of these weaknesses

Students have weaknesses of the target language, such as, lack of habits and abilities within the language, partially, due to the differences between their vernacular languages, and the target one. It is necessary to make a remark that, not all medical students are Cubans, there are students from countries which their official languages are Portuguese, French, and the like plus the little exposure to the English language too.

As a matter of fact, most of the times when the students write in English, they do not create the text themselves, they only translate their ideas, sometimes, word by word from their mother tongue to the target language, often with grammatically incorrect results, and in other cases, they learn a text by heart.

So, in order to help the students, develop the ability to express themselves in writing, teachers must lead them. And all the more so when they have to write this kind of text (expository) in their examinations including written quizzes, final tests, etc.

Furthermore, the proposal consists of putting into practice a “Reading-Analyzing-Writing Approach”, again, to master one of the abilities regarded as an important goal of the syllabus.

This approach has been taken and adapted from Joy Reid’s work (Reid 1988), because reading is one of the most suitable ways to get information, experience, knowledge, which are of paramount importance for the future of doctors’ professional practice.

Learning to write is largely a process of learning to think more clearly, by recognizing logical thinking in what they read; students will be able to use this knowledge organizing and developing ideas in their own writing. Bossom (1979) (2).  Therefore, to accelerate language acquisition and aid the students’ writing, they must be exposed to extensive comprehensive written input, and then encouraged to employ syntactic and rhetorical pattern from these texts in their own writing (Pica 1986). (3)

Writing is a productive skill, it means the involvement of producing language rather than receiving it, it also involves communicating a message by making sings on a page, to write it is needed a message to communicate to someone and it is needed to be able to form letters and words, and to join these together to make words, sentences or a series of sentences that link together to communicate the message. The authors of TKT course (4)



Give a man a fish and you feed him for a day. Teach a man how to fish and you feed him for a lifetime.

Chinese proverb


- First thing first, select suitable adequate material.

- Choose appropriate sample materials, scientific articles closely related with their interests, needs, and knowledge. Kan Shum-min (1993). (5)

- Materials should be, firstly, short (three or four paragraphs), not longer than the composition students are expected to write, so that they will be easier for them to analyze and imitate.

- Materials (articles from scientific magazines, medical books, or the ones of their textbooks) should be at an accessible level of difficulty, including the one they can identify the important ideas and to organize their own ideas in a coherent way.

- Above all, materials should be well-constructed, illustrating principles of good organization. This makes possible the students to recognize structural and semantic clues that identify the important ideas and organize their own ideas in a coherent form.

This teaching procedure falls into two stages: language input and writing practice.

Stage 1: Language Input

The sample writings given to students must be good examples to show what an expository paragraph or essay is like and to introduce the cohesive devices employed, the overall organization, and the various methods of developing the principal idea.

Firstly, students are asked to read the model carefully and answer some comprehension questions. Then they are required to analyze its organization and content.

During the analysis of the paragraph, teachers ask students to recognize:

- topic sentence

- the supporting details

- the method of development

- the technique of support

So that, before starting the activity, teachers give students the following guidelines.

Guidelines for analysis

  • Underline the topic sentence and circle the key words that express the main idea.
  • Find the supporting details.
  • Note the important elements of the paragraph.

The sample paragraph below illustrates how a paragraph can be analyzed for teaching purposes. It is taken from the Student’s Book, English through Medicine 1 (4th year of Medicine) Unit 2 Myocardial Infarction, task 2, p. 38. It has been numbered to facilitate its analysis.

1 Blood pressure is a measure of the force that the circulating blood exerts on the wall of the main arteries. 2 The pressure wave is usually felt as the pulse; the highest (systolic) pressure is created by the heart contracting, and the lowest (diastolic) as the heart fills. 3 Raised blood pressure is almost always without symptoms. 4 HBP levels damage the arteries that supply blood to the heart, brain, kidneys and elsewhere, producing a variety of structural changes. 5 The main modifiable causes of high BP are diet, especially salt intake, levels of exercise, obesity and excessive alcohol intake. 6 Most adults have BP levels that are suboptimal for health, and this indicates that about two thirds of strokes and half of heart disease, are attributable to sub-optimal BP (systolic blood pressure>115mmH)

Students might suggest the following notes:

Sentence 1: topic sentence states the main idea

Sentences 2 - 3- 4 - 5: supporting details­ - hold up the main idea

Sentence 6: conclusion- states the consequence of having such disorder (HTN)

Method of development: cause-effect/ supporting facts

Analysis of the sample paragraph will give students a clear picture of what an expository paragraph is like and how the author develops his thoughts.

In analyzing an essay, teacher first let students know how each part contributes to the structure of the whole essay. Then teachers help students analyze the various components of the essay:

  • The overall organization and paragraph structure
  • The thesis statement or the controlling idea and the supporting details.
  • The method of development.
  • The function of each paragraph.

After analyzing various expository essays, students will learn the schematic structure of exposition is like the following, adapted from Reid`s approach (Reid 1988) (6):

Introduction: The first paragraph introduces the thesis statements.

Development / Body: This part contains several paragraphs that deals with different aspects of the subject.

Conclusion: The last paragraph restates the thesis statement or suggest new ideas to explore.

The main goal of this activity is to develop students’ discourse competence receptively and help them get a sense of organization. The conscious analysis of the models will enable students to outline and write their essays more effectively.

Stage 2: Writing practice

With the knowledge acquired from the comprehensible input, students are ready to write their own compositions. During this stage, they proceed through the following writing process: brainstorming-writing-revision.


It is an important prewriting technique. The aim of this activity is to help students generate ideas, for at the early stage of the writing process all ideas are welcome. Even silly ideas may lead the writer to an important thought about the topic (Fergenson 1989) (7). When the teachers assign their students a topic, the teachers divide them into small groups or pairs for a discussion. They discuss the topic freely, putting in paper words, facts, and ideas connected to the topic. The related information may stimulate the students’ imaginations, trigger other words and images in their minds, and provide necessary materials for their writing.


Now the students can begin to organize their ideas armed with the rough notes from the peer discussion. First, teachers ask them to formulate a supported thesis statement that is, a sentence containing the main idea with two or three supports which reflects the structure of the composition (Sullivan 1990) (8), Then teachers ask them to expand the thesis statement into several topic sentences that might begin each body paragraph of the composition. e.g.:

Title: Gestational Diabetes

Thesis: Gestational Diabetes affects not only the mother but the baby too.

Topic sentence: Gestational Diabetes (GD) is a form of diabetes that affects pregnant women who have never had diabetes before.

Conclusion refers to what the students with their knowledge summarize about GD. With this plan, which can be adapted in relation with the students’ rotation, they are ready to write their first draft. At this stage, emphasis should be focus on correct use of the language and coherence. Whereas writing, students are encouraged to use syntactic and rhetorical patterns and writing techniques learned from the written input. After the composition is done, teachers start the following activity: revision.


It provides a chance for the writer-students reviewing and assessing their work, which is an essential part of the writing process (Fergenson 1989) (7). Prior handing in their final products, they must make three revisions, (self-correction, peer evaluation, and writer’s consideration). Education is not a process of putting the learner under control, but putting the student in control of his learning.  Allison Preece (2003) (9). So, the students must make three revisions. The first revision is self-correction, the second revision is peer evaluation, and the third one is writer`s consideration.


Each student is required to read his composition a few times carefully and critically for organization, coherence, and language, as well as mechanics, making necessary corrections while reading.

To develop the activities above teachers, give a questionnaire for guiding their students as follows:

- Does your composition contain three parts: introduction, development, and conclusion?

- Is the thesis statement of your essay appropriate to the title?

- What supports have you provided for the thesis statement?

- Does the whole essay fit with the main idea and develop logically?

- Does your conclusion impress the reader with the main idea of the essay?

- Do you use grammatically correct sentence structures and correct punctuation?

Peer evaluation

It is done in pairs or in small groups. The students exchange their compositions with each other. By reading and analyzing, they evaluate one another’s work mainly on content, organization, and language, making some suggestions for later revision. Here is a checklist that the student readers can use to help each other.

Peer evaluation checklist:

  • Locate the essay’s thesis statement and the topic sentence of each body paragraph.
  • Distinguish between relevant and irrelevant information, and underline the sentences that do not support the main idea.
  • Point out grammar mistakes and misspelled words.
  • Make some comments and suggestions on a piece of paper or in the margin.

This evaluation process will give students more than one chance to perfect their work. Through evaluating each other’s work, they will become more critical and will discover their own weaknesses in writing. This will have a positive impact on the students’ writing development.

Writers consideration

The most important part of the final revision is the writer’s consideration of the readers views. The student writer should look carefully at the marks and comments made by his/her peer, but the writer has the final decision about the changes in the finished product.


Advantages provided by this approach

- The students are less dependent on their native language.

- It expands the students’ language experience, which leads them into a more meaningful cultural transference. In addition, they acquire a repertory of useful expressions, sentence structures, and other important writing elements in the English language. With this knowledge, they can express themselves more fluently.

- Above all, through adequate practice in writing, students make much progress in expository paragraph organization and essay writing. Consequently, they gain confidence in themselves and develop a positive attitude toward writing.



I hear and I forget. I see and I remember. I do and I understand.

Chinese proverb

  • It was demonstrated that the students need an appropriate tool for mastering the writing ability and the above approach has shown to be a good instrument in the hands of the medical students to help them improve this ability.
  • The use of this approach showed that through adequate practice in writing, students make much progress in expository paragraph organization and essay writing. Consequently, they gain confidence in themselves and develop a positive attitude toward writing.
  • The use of this approach has led the medical students to a more creative and better-structured writing, again, what the ESP teacher can do to improve expository writing in his/her students.



1 Hutchinson, T., Waters, A., (1996). English for Specific Purposes. Cambridge University Press. New York, USA.

2 Bossom, Richard M. (1979). English proficiency. Developing your reading and writing power. New York: McGraw-Hill.

3 Pica, Teresa. (1986). An international approach to the teaching of writing. English Teaching Forum, 24, 3, pp. 6-9.


5 Kan Shum-min (1993). A Practical Approach to teaching expository writing to ESP students, English Teaching Forum, 31, 2, pp. 32-33

6 Reid, Joy. (1988). The process of composition. Englewood Cliffs, N. J.: Prentice-Hall.

7 Fergenson, Laraine. (1989). writing with style: Rhetoric, reader, handbook. New York: Holt, Rinehart and Winston.

8 Sullivan, Kathleen E. (1990). Paragraph practice: Writing the paragraph and the short composition, 6th Ed. New York: Macmillan.

9 Preece, Alison. (2003). Communicative Approaches to Evaluation in Foreign Languages. British Columbia Teachers` Federation. Paper from a joint project with the National Union of Education, Science & Sports Workers of Cuba (SNTECD), the Cuban Ministry of Education and the British Columbia Teachers` Federation.


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