Bedside manner in (pronunciation) teaching: the BATHE protocol

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Sometime the doctor-patient metaphor does work in our work!

Recovering from recent surgery here at home, and especially recalling the wonderful way that I was treated and prepared prior to the operation by the nurse in pre-op, this study, "Inpatient satisfaction improved by five-minute intervention," summarized by Augusta Free Press, published originally in Family Medicine by Pace, Somerville, Enyioha, Allen, J, Lemon and C. Allen of the University of Virginia really hit home, both as an interpersonal framework for dealing with problems in general and (naturally) pronunciation teaching!

The research looked at the effectiveness of a training system for preparing doctors better for talking with patients, bedside manner. In summary, patient satisfaction went up substantially, and time spent per patient generally went down. The acronym for the protocol is BATHE. Below is my paraphrase of what constitutes each phase of the process:

B - Start with getting concise background information with patients
A - Help them talk about how they are feeling (affect)
T - Together, review the problem (trouble)
H - Discuss how the problem is being handled.
E - Confirm your understanding of the situation and how the patient is feeling (empathy).

That is a deceptively elegant protocol. Next time you have a student (or colleague) or friend approach you with a difficult problem, keep that in mind. That also translates beautifully into pronunciation work, especially where there is appropriate attention to the body (like in haptic work, of course!) Here is how the acronym plays out in our work:

B - Start with providing a concise explanation of the target, also eliciting from students what their understanding is of what you'll be working on.
A - Anchor the target sound in a way that learners get a good "felt sense" of it, i.e., awareness and control of the sensations in the vocal track and upper body
T - Together, talk through the "cash value" and functional load of the target and practice the target sound(s) in isolation and context. 
H - Discuss how the student may be handling the problem already, or could, and what you'll do together going forward, including homework and follow up in the classroom in the future.
E - Finally, go back to brief, active, "physical" review and anchoring of the sound, also providing some realistic guidance as to the process of integrating the sound or word into their active speaking, especially the role of consistent, systematic practice.

One remarkable feature of that system, other then the operationalized empathy, of course, is the way it creates a framework for staying focused on the problem and solution. How does that map on to your own "BATHE-side manner?"

Pronunciation modelling on "cue?" You said it, MAM!

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Interesting 2010 study by Luypen at the University of Pennsylvania and colleagues on the relationship between verbal cues and visual processing. They investigated the potential impact of hearing a word before it or the object it represents appears on a screen in the visual field. In effect, hearing the name first significantly enhanced subsequent visual recognition. Somewhat surprisingly, however, they also found that, " . . . A visual preview did not make the invisible target visible. Getting a good look at the object before the experiment did nothing to help participants see it flashed." What this appears to "speak to" is how to best sequence haptic feedback with pedagogical movement patterns (PMP) in instruction. For example, when a learner produces an inaccurate pronunciation of a word, the instructor, in cueing a more appropriate model (MAM), has some options:

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(a) Verbally model the MAM.
(b) Do just the appropriate PMP, moving across the visual field.
(c) Verbalize the MAM while doing the PMP.
(d) Just provide the name of the PMP (in the case of vowels their numbers, such as "3y" or intonation contours, "Rise-fall" or rhythm grouping, "2-3"--indicating the number syllables appearing before after the prominent syllable).
(e) Ask the learner to do the PMP once and then try the MAM, speaking out loud.

And there are a few other possible combinations. The research seems to suggest that (d) might be the more efficient cue, first saying the name--which should evoke both the visual and haptic dimensions of the anchor before the instructor then provides feedback in the form of the PMP and MAM done simultaneously. Try it out with me in your classroom and report back either here on on the "data" blog! What's in a name? Possibly a great deal in this work. 

Focus on "Phon" (in integrated pronunciation instruction): Post hoc FOP

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"Focus on form" has become a basic construct of contemporary language teaching. (Wikipedia has a nice, concise definition, based on Long 1991.) Although there are several variants on this theme today, Long's key assumption was " . . . the learner must be aware of the meaning and use of the language features before the form is brought to their attention." [Italics, mine.] In other words, that would appear to exclude doing a little mini-lesson just before learners are to encounter a problematic form. (That is actually a bit extreme, but let's go with that for now.) Go a step further and focus on those situations where the learner (not just the instructor) is also aware of the "problem," perhaps based on a breakdown in communication or a very evident pronunciation or articulation difficulty--even if the task was not entirely compromised at the time. In other words, an obvious, easily recognized mis-pronunciation happens which deserves "treatment." We'll call this one "Post Hoc FOP." There are at least three other logical possibilities (my terms here): "Pre-Hoc FOP," and "Mid-Hoc FOP" and "Sub-Hoc FOP" which will be dealt with later. Those are, in a very real sense, relatively spontaneous clinical interventions based in real-time communication. So, what do you do? Here are a few to get the ball rolling (One of these, some combination of these or something else.) Instructor . . .

• Ignores it.
• Notes covertly and consults with student privately later. 
• Requests target be repeated out loud, by learner or class as a whole
• Leads learner to correct approximation of the sound.
• Models correct pronunciation once or twice without further attention.
• Passes to learner written note on "error."
• Does a quick, impromptu (probably canned) insightful explanation
• Instructs learner to "notice" something . . .
• Uses gesture signalling pronunciation issue (may be very differentiated to indicate part of speech, etc.)
• Points to Gattegno-like wall chart . . . 
• Instructs learner to put the target sound or word on personal practice list or in pronunciation diary or "log." 
• Has peer point out error. 
• Has peer makes notes to be shared later.
• (Haptic-integrated) does word or phrase with learner using appropriate pedagogical movement pattern a couple of times. 
• (Haptic-integrated) instructs learner to do word or phrase as homework. (See also earlier posts on EHIEP-based homework frameworks.) 

(SRBIIIPI) Scientific, research-based interventions in integrated pronunciation instruction - 1

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SRBI is a very catchy acronym in contemporary eduction. The 12 principles involved, which focus on system-wide design of instruction delivery, are listed on page 2 of the linked document. Very impressive sounding, especially the "scientific, research-based" qualifiers up front. So how can we be sure that we are doing SRBI in stepping in to provide feedback or correction during a speaking-oriented lesson? (The research in the field on effectiveness of such classroom interventions as "noticing," "focus on form," "uptake," "re-modeling"and a few others, especially in grammar-oriented instruction is inconclusive, at best--let alone suggestive of how to actually conduct such impromptu pronunciation interventions.)  In considering how to make such effective, on-the-spot, in process interventions in integrated pronunciation instruction, with a little of the usual "application by analogy" that happens regularly on this blog, that SRBI model is useful. Here are four relevant bullets. (Visualize this applying on a moment-by-moment basis in a conversation class, for example, where students have stumbled onto a pronunciation issue that really deserves attention immediately):

• The use of research-based, effective instructional strategies both within and across a variety of academic domains.
• Differentiation of instruction for all learners, including students performing above and below grade level expectations and English language learners (ELLs).
• Common assessments of all students that enable teachers to monitor academic and social progress, and identify those who are experiencing difficulty early.
• Early intervention for students experiencing academic and/or behavioral difficulties to prevent the development of more serious educational issues later on.

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Tomorrow's post will take those four bullets as a point of departure to consider what we might call "Experience-based pronunciation interventions," a few of the strategies (including haptic-integrated examples) that experienced instructors resort to on such occasions which address the problem, provide learners with a good anchor for remediation and practice--all without irreparably disrupting the overall flow of the class and the topic under discussion. Will, of course, invite your contributions to that discussion as well! 

Widdowson's Error II: Focus on form during "communicative" activities

Following up on the previous post, here is a 2010 study by Ellis looking at how corrective feedback and intervention happens in what he refers to as "communicative" classroom instruction. What is typical and fascinating is that at no place in the description of the study does he provide any real detail as to what was actually going on in the classroom--or whether it was being done well. We are to assume that it was, and that we all agree what we mean by communicative--and that most any type of communicative activity is, for research purposes, of equal effectiveness and impact. That is almost standard practice in research related to pronunciation teaching practices.

Widdowson
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You will rarely get much information as to what went on clinically, only pedagogically--which means just providing the name of the technique(s) used. Imagine a psychotherapist trying to convince colleagues of the efficacy of a new protocol simply by focusing on the results, not the details of the process. From that perspective, it is just as reasonable in reviewing many studies of attempts to correct pronunciation in oral communication classes to ask whether the communicative dimensions of the class were conducted well. Unless proven otherwise, we have to assume that the problem with the focus on form may have been also caused by or at least exacerbated by poor communicative instruction.

True to "form," from a HICP/EHIEP perspective, that should almost always be the case: unless the class communicative narrative is strong, haptic anchoring of pronunciation change will not work either. Maybe Widdowson was right after all.