PUBLIC HEALTH Specialist English as a foreign language for European public health: evaluation of competencies and needs among Polish and Lithuanian students

mean scores provided by respondents changed from B1 level to B2 level. Respondents gave priority to less formal and practice-based interactive English teaching methods (going abroad, contacts with native speakers) in comparison with theory-oriented methods of learning (self-studying, Internet courses). Conclusions. Similar levels of English language in all five areas of language skills were established in Polish and Lithuanian university students. Respondents gave more priorities to less formal and practice-based interactive English teaching methods (going abroad, contacts with native speakers) in comparison with theory-oriented or classroom-based methods of learning (self-studying, Internet courses). Survey showed a growing interest of students in improving English language in the future in Poland and Lithuania.


Introduction
Globalization and the expansion of the European Union (EU) have a significant effect on the free movement of workforce. Changes in European politics, economy, and environment have influenced significantly the role of public health practice and training. Foreign languages are becoming an essential prerequisite for a successful carrier among all professions including public health professionals in many countries (1,2). The English language is used more frequently in the expanded EU and other countries worldwide. Growth of English as a leading language for dissemination of academic knowledge has a major impact on careers of university graduates (3). Therefore, the role of this lingua franca is increasing especially in the area of public health teaching. Its dominance Adresas susirašinėti: L. Šumskas, KMU Profilaktinės medicinos katedra, A. Mickevičiaus g. 9, 44307 Kaunas. El. paštas: linas.sumskas@kmu.lt in the area of public health teaching and terminology has also become evident. Such move toward Englishmedium education is mainly a result of economic factors (4,5). On the other hand, a need to develop national public health terminology is felt among public health communities in European countries and particularly in the new independent states, mainly in the countries of Central and Eastern Europe. Recent development of public health professionalization corresponds with the European Commission Action Plan for languages, which projects functional proficiency of each citizen in their mother tongue plus two foreign languages as a main goal (6). Universities are considered as key institutions in promotion of this concept of societal and individual multilingualism. This trend could be accelerated in Europe through the implementation of the Bologna declaration, which aims two-phase higher education model, harmonization and transparency of education qualifications. The new Life Long Learning initiative for 2007-2013 integrates ERASMUS and Leonardo da Vinci programs and covers higher education and professional teaching areas (7). These international activities also facilitate the implementation of multilingualism and cultural integration into European higher education community.
However, we are still lacking more detailed comparative research on the need of this language among the students who study public health at the universities of Central and Eastern Europe. Despite the availability and popularity of the English language, there is a need to develop courses, which combine content and language learning to support higher education curricula and meet the demand of the future employers of the graduates. The European Leonardo da Vinci project "Specialist English as a foreign language for European Public Health" is an exemplification of such an approach.
The project combines the expertise of both public health and English language experts. The project is being carried out in three phases: firstly, an analysis of specialized English needs; secondly, development of learning environment, supporting glossaries and teaching material; and thirdly, piloting of the developed course and students' self-assessment.
The aim of our study was to get a deeper insight how the English language is perceived as a foreign language by Polish and Lithuanian students. One of our objectives was the assessment of English language competence, another important objective -to evaluate the perceived need to study professional English and use this language in the future.

Study design and samples
The study was conducted in the framework of the EU Leonardo da Vinci project "Specialist English for European Public Health," which was carried out by four EU universities: Jegiellonian University, Krakow, Poland; Kaunas University of Medicine, Kaunas, Lithuania; Maastricht University, Maastricht, Netherlands; and Sheffield University, Sheffield, England, the United Kingdom. Samples of the respondents were selected at Jegiellonian University and Kaunas University of Medicine in autumn 2005 from the currently studying students of public health. First-second-year public health Bachelor students and first-second-year Master students at Kaunas University of Medicine were enrolled; first-fifth-year public health Diploma students at Jegiellonian University also were selected as respondents.

Instruments and procedures
A special questionnaire for the students, which contained 14 both quantitative and qualitative questions, was developed by the international team. The questions presented for analysis in this paper were as follows: A. Personal data about the respondent ( For evaluation of English competences, we have adopted already existing and widely used evaluation instrument -the Language Passport -Common European Framework of Reference for Languages of Council of Europe (8). This evaluation tool distinguishes six levels (A1, A2, B1, B2, C1, and C2) of language skills. Five areas of language skills were self-evaluated: listening, reading, spoken interaction, spoken production, and writing. Level A1 is considered as an initial level of skills and level C2 as the most advanced level. Self-assessment grid, which allowed identifying their own perceived skills, was presented for respondents.
We have rated each level of skills by separate scores as follows: A1-1, A2-2, B1-3, B2-4, C1-5, and C2-6. It allowed making calculation, drawing, and comparing the profile of language skills between the groups of respondents.

Statistical analysis
Data analysis was performed by the statistical package SPSS 12. Descriptive statistics, such as mean (m), standard deviation (SD), and proportions were calculated to describe measures of central tendency, dispersion, and distribution. Differences of quantitative data distribution between groups were tested using the nonparametric Mann-Whitney U test. Differences of qualitative data distribution among groups were tested using chi-square test. The z test was applied for evaluation of differences between proportions in two groups. The significance level was set at <0.05.

Demographic and other personal characteristics of the respondents
A total of 246 respondents were questioned in Lithuania and Poland under the framework of our questionnaire survey. Table 1 summarizes the demographical characteristics of students involved.

Previous experience of the students in learning the English language
Respondents were asked to summarize the number This question covered seven modes of English learning: 1) in primary/secondary or vocational school; 2) during higher education period; 3) during adult education courses; 4) during other courses; 5) during regular use in the workplace; 6) during regular contacts with native speakers; 7) during other modes of education.
Results of statistical analysis indicate that learning in primary/secondary or vocational school and studying English at the university were two main modes of learning English for public health students in both countries. Fig. 1 shows that majority of the examined Lithuanian students (88.3%) reported learning English in primary/secondary school for more than 5 years. A smaller proportion of Polish respondents (41.4%) were exposed to more than 5-year English teaching, according to their answers (P<0.05).

Years learned English at university
Majority of the participants in both countries (71.7% of Lithuanian and 69.0% of Polish) studied English at the university level up to 3 years (P>0.05). Only 7.1% of Lithuanian and 26.9% of Polish students reported that they had English classes for more than 3 years at the university (Fig. 2) Table 2 presents the percentages of respondents who reported other 5 less prevalent modes of English learning: learning during adult education courses; during other courses; during regular use in the workplace; during regular contacts with native speakers; and during other modes of education.

Other modes of learning English
These data indicate that Polish students were more exposed for "adult education courses" and "other courses" of training. Lithuanian respondents used opportunity to learn English in outside courses: "use English in the workplace," to have "regular contacts with native speakers," and use of "other methods of education."

Current and future projected levels of the English language skills
Perceived level of English proficiency in selected language skills was also self-evaluated in our survey. The evaluation was based on the Language Passport (Common European Framework of Reference for Languages of the Council of Europe). Five areas of language skills were self-evaluated: listening, reading, spoken interaction, spoken production, and writing. Respondents were asked, "What is your perceived level of English for specified areas of skills?" Table 3 presents the mean scores of language proficiency in five areas of English skills. The mean scores of language skills were highest for listening and reading for both Lithuanian and Polish respondents. Spoken production and writing were considered as less proficient English language skill areas among Lithuanian students. Spoken interaction had the lowest self-rating among Polish respondents. Statistical analysis showed that there was no significant difference established in any area of skills between Lithuanian and Polish respondents.

Current self-rated proficiency of the English language
Normal distribution curves were established in all five areas of the language proficiency mentioned above -majority of respondents have evaluated their skills as medium (level B1 and B2 of proficiency). For example, the highest percentage of participants in both countries (in Lithuania, 58.8%; in Poland, 71.8%) reported that their listening skills are medium (level B1 or B2). Furthermore, level A1 or A2 was reported by 11.8% of Lithuanian and by 10.3% Polish respondents, C1 or C2 level by 29.4% and 18.1%, respectively. The spoken interaction skills were self-evaluated quite similarly: 58.8% of Lithuanian and 65.1% of Polish students rated these skills as level B1 and B2.
Only 7.8% of Lithuanian and 6.3% of Polish respondents pointed out the lowest level A1 and very few -6.9% of Lithuanian students -the highest level C2.

Future projected self-rated proficiency of English language
Respondents were asked, "What level of English do you think you will need for your professional future (nine areas of professional English skills were included)?" Table 4 summarizes the results of Lithuanian and Polish respondents and provides comparison between current and future projected levels of the English language competencies. Reading scientific literature (mean score, 4.72) was the first priority for Lithuanian students for the future. Negotiations (mean score, 4.79) were the most common priority among Polish respondents. Lithuanian and Polish students had the lowest preference for social interaction (mean scores of 4.04 and 4.29, respectively). Table 4 also shows that a significant gap exists between current self-evaluated and future-projected mean scores of language skills among both Lithuanian and Polish students.

Current importance of the English language skills as the study tool
Respondents were asked, "How important are English language skills currently for the following study-related activities (nine areas of professional English skills were included)?" ( Table 5). Reading of scientific literature was reported as the most important current activity (mean scores of 3.51 and 3.80 for Lithuanian and Polish respondents, respectively; P>0.05). The least importance was given for writing essays/reports (2.57 and 2.99 for Lithuanian and Polish respondents, respectively; P<0.01). Polish students provided significantly higher ratings of importance for 7 out of 9 English language application areas. Total mean score also was significantly higher for Polish students.

Frequency of use of the English language for learning public health subjects
Current use of the English language for the studies at the university. Respondents were asked, "Are you using the English language for your studies?" Majority of respondents (63.8% of Lithuanians and 78.6% of the Polish) have reported that they used English "sometimes" for their studies. However, a significantly smaller percentage (24.8% of Lithuanian and 9.3% of Polish students) indicated frequent use of English for their studies (Fig. 3).  Values are expressed as mean±SD. Table 5. Mean scores on self-rated importance of English language skills for the current study-related activities

Preferred methods of learning English by the students
The questionnaire included a question about preferred ways of the improvement of English learning. Five options were asked to rate: Internet courses, learning abroad, learning through regular contact with native speakers, and individual learning (rating scale from 1 to 5).
The highest priority according to the calculated mean score was given for "going abroad" as the most acceptable method of improving English proficiency, lowest -to "access Internet courses" (Fig. 4). Contact with the native speakers was the second most preferred option for respondents. Course with a tutor was  selected as the third choice. Polish respondents gave higher preference to self-studying and the courses with a tutor than Lithuanian students (P<0.05).

Discussion
Our study was conducted in the framework of Leonardo da Vinci project, which plays an important role in preparing European citizens for entering the labor market. Multilingualism and cultural integration are essential ideas in this program (9). It promotes mobility, innovation, and quality of training through international partnership -cooperation among various players in vocational training, such as training bodies, vocational schools, universities, and business institutions.
It was considered that a higher necessity to conduct a questionnaire survey among students exists in Poland and Lithuania, countries that joined the EU in 2004. The project partners from the Netherlands tended to conduct a qualitative survey among the students rather than to conduct a full-scale quantitative survey. It was agreed not to conduct any survey in England as a native country of English speakers.
We made a few working hypotheses before doing research analysis. One of our hypotheses was that English competences, attitudes for learning should not differ significantly between students from "new European" countries. Poland and Lithuania have had historical, geographical, and linguistic relations over centuries. Such context could result in smaller differences between the neighboring countries. Another but more recent historical similarity for both countries concerns transition of public health training in Poland and Lithuania from purely medical domain of biomedical sciences toward multidisciplinary fusion, which involves social, behavioral sciences and also humanitarian teaching subjects (10).
Another research hypothesis was as follows: the students from "new EU countries" (e.g. Lithuania and Poland) should be increasingly interested in learning English and should project higher future language competences due to their expanding employment opportunities abroad and increasing possibilities for use of foreign languages inside and outside the home countries.
Two comparable specific groups of respondents were involved in our study: bachelor's and master's level students of public health programs. These samples do not represent the whole population of students in two countries. However, both samples could be compared with other samples of full-time students from public health study programs at other universities.
An instrument of this survey (questionnaire) was developed by the international team from the United Kingdom, Lithuania, Netherlands, and Poland. For language proficiency evaluation, the Language Passport as an internationally approved instrument was used. That makes our data comparable with other similar studies. Other questionnaire items were constructed in context related to public health and language teaching areas and also were analyzed by the approved methods.
Over the past 30 years, the use of English for medical purposes has been analyzed in the different contexts. Research on evaluation of needs for specialized English learners has ranged from variety of studies including overcoming language barriers with foreign-language speaking patients (11), the role of computers in supporting access to the curriculum (12,13), the perception of English needs among medical college students (14,15), the assessment of English proficiency and success in medical staff (16,17). Some studies have focused their scope on the recommendations for development of the language courses and on identification of the teaching area gaps (18,19). Lapetit and Cichocki (20) in their study of American students studying in health area noticed that oral communication skills were among most expected to gain in language courses. Although these authors examined the needs of English learners from different frames of reference, all agree that professional knowledge is a priority for students' academic studies and their future work. Current and future importance of English language was also investigated among medical college students in Taiwan (14). More than half (58.8%) of respondents have reported that English language currently was very important or important for their studies; 93.8% answered about its importance for the students' future career. Our study of public health students also involved items on current and future importance of English, but another format of questions and answers was used. In addition, our students have rated more practice-based study methods related activities (reading scientific literature, daily communication; presentations, etc.) by a 5-point Likert scale. Reading scientific literature was reported as the most important language competence (mean score, 3.68±1.16), writing essays/reports was evaluated as the least important language competence (mean score, 2.82±1.20).
Identification of preferred methods of learning English by the students was one of our study objectives. We investigated in our survey to what extent Internet and other modes of learning English were accepted by public health students. Only a smaller proportion of respondents selected Internet-based methods. In a similar questionnaire survey carried out among students of Manchester University, 13% reported that they were not using Internet for learning (12). Other researchers (21)(22)(23) also showed that respondents favor a variety of traditional (e.g. wordfor-word, translation, memorization) and contemporary methods (distance learning, computer-assisted language learning). This is why it could be stated that this relative skepticism concerning conflict of modern technologies and traditional teaching tends to melt. Also all mentioned above let us conclude that traditional methods of teaching also should be applied in combination with website technologies in modern teaching of English for special purposes.
Implications for teaching. The scholars in the Central and East European countries (this is also a global trend) seek to publish "their best publications in the West" (3). The expanding role of English as a mode of communication allows for our graduates to project and to seek the career in English-speaking countries. Results of our study show a high interest of university students to use English.
The study suggests that resent historical and cultural relations between Poland and Lithuania, very close mentality, and similar social context during postwar period, resent integration of both nations in the EU have resulted in similarities of attitudes toward the need of learning a second or third language, which is often English. It means that common methods of teaching as well as similar types of teaching materials could be developed for public health in both countries. It is evident that after deleting the clear borders between the EU countries and with increased labor migration from Central and Eastern European countries to the United Kingdom, Ireland, TV, newspapers, textbooks, professional papers in English should become as the main source of informal teaching materials during English learning. This should result in attempting to combine traditional and modern, less formal teaching methods by the language teachers at the university.
Our study also suggests that content and language teaching should be implemented. Study domain (subject)-specific public health teaching texts, materials, glossaries should be used for successful teaching of professional language. In our Leonardo project, we have defined seven public health domains (epidemiology and biostatistics; health care management; environmental and occupational health; health policy; health promotion; health ethics and law; health economics) and developed domain-specific dictionaries for students. Teaching texts with exercises are another teaching aid elaborated by our international team. Our teaching materials should satisfy educational needs for public health students and professionals who are learning professional English as independent learners or learning language in small groups in the classroom. Mentioned teaching materials will be published in the paper format and placed on the websites of our universities. Distance learning courses will be developed for a specific group of students too (in continuing education programs, for field public health professionals, etc.).

Conclusions
The study showed that the length of study period did not differ for both national groups at the university level. Lithuanian students have reported longer exposure to the English language learning than Polish students in primary and secondary school. Polish students were exposed more frequently to learning at "adult education courses" and "other courses." Lithuanian respondents used opportunity to learn English outside formal teaching courses: "in the workplace" and "regular contacts with native speakers." Current self-rated proficiency of the English language did not differ between Lithuanian and Polish respondents in all five Language Passport proficiency areas. Current importance of the English language skills for their studies was rated by higher mean scores by Polish respondents in 7 out of 9 English language application areas and for overall rating results. Majority of respondents (88.6% of Lithuanian and 87.8% of Polish) reported as using the English language for their studies. A higher percentage of Lithuanian students than Polish were using English on the regular basis. Respondents have predicted a significant increase in necessity for higher level of English proficiency in future: mean scores provided by respond-ents changed from B1 level to B2 level (an increase by 0.93 and 1.27 scores for Lithuanian and Polish respondents, respectively). Respondents were giving more priorities to less formal and practice-based interactive English teaching methods (going abroad, contacts with native speakers) in comparison with theory-oriented methods of learning (self-studying, Internet courses). 1 Kauno medicinos universiteto Biomedicininių tyrimų institutas, 2 Kauno medicinos universiteto Profilaktinės medicinos katedra, 3 Mastrichto universiteto Tarptautinės sveikatos katedra, Nyderlandai, 4 Kauno medicinos universiteto Kalbų ir edukacijos katedra, 5 Lenkijos mokslų akademijos Antropologijos institutas, Vroclavas, Lenkija Raktažodžiai: anketinė apklausa, visuomenės sveikatos fakultetų studentai, kalbų pasas, kompetencija, mokymosi poreikiai.
Needs for professional English in public health