By Robert Oliphant
Columnist EdNews. org

Medical terminology is serious business today.The University of Maryland Medical Center now offers its patients and their families an impressive online glossary of medical terms to learn, paralleling the glossary in the Mayo Clinic Family Health Book.The University of Hong Kong even offers an online program in English as an indication of how globally pervasive our Graeco-Latinate English technical vocabularies have become in international science, industry, and trade.In a health-conscious planet like ours all of us, not just professionals, face the challenge of acquiring higher levels of medical literacy.

The most striking feature of medical literacy is its measurability. How we pronounce ERYTHEMA, for instance, immediately tells our physician what our literacy level is. The same is true, though more cumbrously, of our spelling-bee ability to identify the noun whose definition is “the muscular substance of the heart” and whose pronunciation can be represented as /muy’euh kahr"dee euhm/. This measurability is what equips us to learn medical terms on our own — just like going to a gym and keeping track of our personal-best day to day progress.

Spongers and dot-connectors. . . . There are different styles of personal-best learning. Some of us can fairly be called “sponge” learners, which is to say that we simply soak up what we need quickly and retentively, whether it be a set of vocabulary flash cards or a memorization target like William Blake’s “The Tiger.” Others can learn best by establishing external connections like the rhythmic structure of a word or the rhyming patter of a poem and can therefore be called “connect the dot” learners. Overall, sponging works best for us, though we usually lose the knack of it after adolescence.

Steadman’s Medical Dictionary, designed as it is for serious students, is filled with connect-the-dots help for older learner. Now in its 28th edition, Steadman consistently presents four key elements for each of its headwords: pronunciation, etymologies (word histories), definitions, and roots, noting that 1,200 of these vocabulary roots appear — directly or indirectly — in 80% of its 170,000 headwords. With this kind of emphasis in their training, it’s not surprising that most physicians enjoy telling their patients that MYO- (of ) literally means “muscle” and that the Greek root of ERYTHEMA means “red.”

Glossary-based learning versus dictionary-based learning. . . . Be it technical or foreign-language textbook, a glossary is what we might call a “two dot” form. This is to say it saves space by presenting only a target word (headword) followed by a single definition. In contrast a standard-size American dictionary presents, for example, four definitions for METASTASIS, along with the word’s pronunciation, its etymology, cross references to related word elements (meta- and –stasis), and related words like .

Where glossary entries work well for young spongers, it’s the richness of dictionary entries that offers dot-connectors their best chance of learning quickly and retentively, enough so that a strong case can be made for simply offering dot-connectors a bare-bones list of medical terms that can be found in a college-size dictionary like American Heritage, Merriam Webster, Random House, and Webster’s New World.

A personal-best comparison framework for global Englishers. . . . As indicated by our University of Hong Kong example, English is now a world wide language. Time Almanac 2007 lists English as an “official” language for 35 nations (1.7 billion human beings) and as an “alternate” language for 1.5 million more. These figures, of course, do not mean that over three billion people currently speak fluent English, but they certainly indicate that most of them are aspiring “global Englishers” who for career purposes who need a productive learning strategy for mastering a vocabulary (80% Graeco-Latinate) that is just as mysterious to them as it is to us.

As indicated earlier, our sponger and dot-connector categories represent extremes, not the wide variety of learning styles that actually exists among human beings. Our appendix therefore offers a personal-best comparison framework, including Scripps-style spelling bee test questions, for use in choosing between two basic alternatives: (a) glossary-based learning of medical terms, and (b) dictionary-based learning via a glossary-based access list.

As will be apparent, this comparison framework can be used with larger groups for more ambitious purposes. But learning is a personal-best adventure, after all, especially where vocabulary improvement is concerned. Hence the desirability of starting with individual participants and their reactions.

TO CONCLUDE. . . . I believe it’s fair to say that the future of vocabulary improvement tools is a bright one. One reason is the growth of senile dementia among the elderly, as indicated by going blank on ordinary words (far more frightening than going blank on proper names). Another is the increasing use of high stakes externally administered tests, most of which emphasize vocabulary-skill challenges. Still another is the development of global English as an international communications tool — including American pronunciation with its “flat A” and its crystal clear phonemically distinct range of front vowels, as in .

But the most powerful source of energy for vocabulary improvement can be summed up in the phrase Personal Best. It’s a phrase which translates winners-and-losers zero sum games into more delicate individual computations that involve personal capability (e.g., age and sex in the Iron Man triathlon) and even personal history (one’s previous score on the GRE). Consequently, just as in day-to-day exercise, many human beings today have good reason to challenge themselves intellectually in a constant quest for personal growth and satisfaction — a Conquest of Inner Space, we might call it.

Here’s hoping our makers of glossaries and dictionaries will give our new vocabulary conquistadors plenty of encouragement and better tools to work with.
*

APPENDIX. . . . Mayo Clinic medical terminology — a personal-best comparison of glossary-based learning with dictionary-based learning

DEAR PARTICIPANT. . . What’s here is meant to help you decide which of two general learning styles will best fit your own personal needs in your future career as a learner. One style, as represented by glossary-based learning is a simple matter of reading and remembering what you have read. The other style, as represented by dictionary-based learning, is a process of establishing several linking connections in your memory between a medical-term target and its definition.

Materials. . . . Our glossary-based materials appear in Attachments A1 and A2. Attachment A1 presents 20 medical terms and their definitions selected from those in the Mayo Clinic Family Health Book glossary of terms. Attachment A2 presents 20 test questions based upon the contents of A1.

Along the same lines, Attachment B1 presents a list (no definitions, though) of 20 Mayo Clinic terms, and Attachment B2 presents 20 test questions based on B1.

Activities. . . . Since this is a personal-best comparison, you can pretty much set your own rules, including taking a preliminary look at our four attachments. If you want to limit yourself to a five-item comparison, that’s fine. If you want to go after the full 20-item-times-2 challenge, you should be very proud of yourself.

The only requirement can be summed up in one phrase: Equal Time. This simply means that you should spend an equal amount of time on each activity. If you spend 15 minutes on the first five words of A1, wait an hour, and then spend 5 minutes on the first 5 test question in A2, you should do the same with B1 and B2. Personally considered, after all, your primary concern in making this comparison is with which style — glossary or dictionary — gives you the most learning value for the same time investment.
*

ATTACHMENT ONE-A. . . . A traditional-focus glossary-style list of 20 medical terms accompanied by definitions

Traditionally, materials for vocabulary study present only the target word followed by a definition. The University of Maryland Medical Center offers its patients and their families such a listing, and so does the Mayo Clinic Family Health Book (2nd. ed., pp. 1356-72). Here by way of illustration is a 20-item sample of terms, each of which has 8 letters or more.

1) aldosterone. . . . adrenal hormone that affects the body’s handling of sodium, chloride and potassium.
2) anaphlaxis. . . . an immediate and sometimes life-threatening allergic hypersensitivity reaction.
3) angioedema. . . . allergic swelling of the mucous membranes, tissues beneath the skin, or an internal organ.
4) arthroplasty. . . . surgical replacement or repair of a joint.
5) atherosclerosis. . . . condition in which fatty deposits accumulate in the lining of the arteries, resulting in smaller, less flexible pathways for the blood.

6) bilrubin. . . . orange or yellowish pigment in bile that is the result of breakdown of hemoglobin; an exess of bilrubin produces jaundice.
7) calcitonin. . . . a hormone produced by the thyroid gland that affects the amount of calcium in the blood.
8) carcinogen. . . . potential cancer-causing agent.
9) cerebrovascular. . . . pertaining to the blood vessels of the brain.
10) cholesterol. . . . fat-like substance synthesized in the liver and found in the blood, brain, liver, and bile and as deposits in the walls of blood vessels; essential to the production of sex hormones.

11) claudication. . . . pain in muscles during exercise, produced by inadequate arterial blood flow.
12) corticosteroids. . . . hormones produced by the cortex of the adrenal glands; also, a class of such hormones used as medications.
13) dermatitis. . . . inflammation of the skin, often characterized by itching and redness.
14) diaphragm. . . . muscle that separates the abdomen from the chest; or, a rubber or plastic device that fits over the cervix to help prevent conceptions.
15) dysplasia. . . . abnormal development of tissue.

16) endocardium. . . . the thin, inner membrane that lines the cavities of the heart.
17) epiglottis. . . . flap of cartilage that covers the larynx.
18 erythema. . . . area of reddened skin due to dilation of capillaries beneath the skin.
19 erythrocytes. . . . red blood cells; they transport oxygen.
10) esophagus. . . . the muscular tube that connects the throat with the stomach.
*

APPENDIX ONE-B. . . . A 20-question test based on Appendix ONE.

Preliminaries. . . . The format for each question, spoken or written, calls for a pronunciation clue followed by a part-of-speech clue and a definition clue as in, “Please identify the dictionary head word whose dictionary pronunciation is /euh neem”ee euh/, which is a noun (n.), and whose dictionary definition is .” The answer format requires the word, in this instance ANEMIA, to be spelled aloud (as in the Scripps contest) or written out, as in some current online web site “daily word” challenges. A correct answer must match the headword perfectly.

The test can be administered very easily in spoken form via pronunciation of the target word followed by a slow, clearly articulated reading of the definition, after which the test taker must spell out the word letter by letter. In written form the target word must be written out. With large groups a multiple-choice version wo uld ask for the “second spelling vowel and offer five alternatives: (a) A; (b) E; (c) I; (d) O (e) U, or “none of these.

”

INSTRUCTIONS. . . . Paralleling the Scripps National Spelling Bee, please spell the word which corresponds to the three clues that follow it: pronunciation (via phonetic transcription) part of speech (n = noun, v = verb, adj = adjective), and definition.

1) /al'doh sti rohn"/ (n.) . . . adrenal hormone that affects the body’s handling of sodium, chloride and potassium.

2) /an’euh flak”sis/ (n) . . . . an immediate and sometimes life-threatening allergic hypersensitivity reaction.

3) /an’jee oh dee meuh/ (n). . . . allergic swelling of the mucous membranes, tissues beneath the skin, or an internal organ.

4) /ahr"threuh plas'tee/, (n). surgical replacement or repair of a joint.

5) /ath'euh roh skleuh roh"sis/ (n)condition in which fatty deposits accumulate in the lining of the arteries, resulting in smaller, less flexible pathways for the blood.

6) /bil”euh rooh’ bin/ (n). . . . orange or yellowish pigment in bile that is the result of breakdown of hemoglobin; an exess of bilrubin produces jaundice.

7) /kal’ si toh” nin/ (n). . . . a hormone produced by the thyroid gland that affects the amount of calcium in the blood.

8) /kahr sin"euh jeuhn/ (n). . . . potential cancer-causing agent.

9) /se ree'broh vas"kyeuh leuhr/ (adj). . . .pertaining to the blood vessels of the brain.

10) /keuh les"teuh rohl'/ (n). . . . fat-like substance synthesized in the liver and found in the blood, brain, liver, and bile and as deposits in the walls of blood vessels; essential to the production of sex hormones.

11) /klaw'di kay"sheuhn/ (n). . . . pain in muscles during exercise, produced by inadequate arterial blood flow.

12) /kawr'teuh koh ster"oyd/ (n). . . . hormones produced by the cortex of the adrenal glands; also, a class of such hormones used as medications.

13) /derr'meuh tuy"tis/ (n). . . . inflammation of the skin, often characterized by itching and redness.

14) /duy"euh fram'/ (n). . . . muscle that separates the abdomen from the chest; or, a rubber or plastic device that fits over the cervix to help prevent conceptions.

15) /dis play"zheuh/ (n). . . . abnormal development of tissue.

16) /en'doh kahr"dee euhm/ (n). . . . the thin, inner membrane that lines the cavities of the heart.

17) /ep'i glot"is/ (n). . . . flap of cartilage that covers the larynx.

18) /er'euh thee"meuh/ (n). . . . area of reddened skin due to dilation of capillaries beneath the skin.

19) /i rith"reuh suyts'/ (n). . . . red blood cells; they transport oxygen.

20) /i sof"euh geuhs/ (n). . . . the muscular tube that connects the throat with the stomach.
*

ATTACHMENT TWO-A. . . . A dictionary-based study list of 20 medical terms from the Mayo Clinic glossary.

In this list the definitions have been omitted in favor of direct study of the full dictionary entry, as in our ANEMIA example. The specific dictionary used for this study list in the Random House Webster’s Unabridged Dictionary – CD ROM version (WordGenius). But any college-size or unabridged American dictionary is appropriate as a source as long as subsequent test questions are based on it.

In either printed or electronic form, that study can include attention to the term’s pronunciation, its definition or definitions, its etymology, cross references to combining elements (roots, suffixes, etc.), and additional cross references cited in those cross references. Here’s a sample entry

myocardium. . . . —myocardial, adj. . . . /muy'euh kahr"dee euhm/, n., pl. myocardia /-dee euh/. Anat. . . . . the muscular substance of the heart. . . . [1875-80; MYO- + -CARDIUM]/

COMMENT. . . . Like many words, our target word can also turn up as an adjective, which means we’re in effect learning two words simultaneously. Here are some other entry features.

Pronunciation. . . . This appears between slanted lines (virgules). The symbols used may seem strange, but they’re consistent and will help you to sound the word out and learn it in your “mind’s ear,” especially the stress indicators (“ and ‘). Even without checking the symbols we can see and hear the sound of this word as “¬my o CAR di um.,”

Part of speech. . . . The abbreviation (n) identifies our target as a noun. Most of the time we can guess this from how a word is used or from its ending. The –IUM marks other nouns like STADIUM, EQUILIBRIUM, etc.

Definition(s) . . . This will be your main question clue, just like knowing what you want to say and searching for the “right word.”

Etymology. . . . This tells us when the target word came into the language and via cross referencing what its combining elements are. The fact that these combining elements, or roots, are capitalized invites us to check them out as cross references. If we do, we learn that MYO- comes from Greek and originally meant both “mouse” and “muscle,” while CARDIUM- takes us to PERICARDIUM (membrane “around” the heart), which takes us to native English HEART, which turns out to be related to CORDIAL, COURAGE, and (as we might expect) Greek , the source of CARDIUM. . . . All this in a few movements of the eye and a couple of clicks with the mouse, or page-turnings with a print dictionary.

Pronunciation, definitions, etymology, cross references — simply notice these and they’ll sink into your awareness, especially if you “trust your body,” which means using your organs of speech silently or out loud to take possession of your target as a physical object. Also, don’t be afraid to “trust your memory.” This means your memory will in effect “decide” what to emphasize and what to downplay, enough so that you can’t expect total mastery from yourself the first time through a list of words or a set of flash cards.

Study list of medical terms. . . . The number of the specific definition used in a question will appear in parentheses when the entry for a term lists more than one definition.

1) fibrillation (2)
2) fontanel
3) gastrointestinal
4) globulin (2)
5) glomerulus (1)

6) glucagon
7) granulocyte
8) hirsutism
9) hydrogenate
10) hymenopterous

11) hyperplasia (2)
12) hypothalamus
13) ischemic
14) lithiasis
15) lymphocyte

16) macrophage
17) metastasis
18) micturation
19) myocardium
20) nephritis
*

ATTACHMENT TWO-B. . . . . A 20-question test based on Appendix 2A

Preliminaries. . . . The format for each question, spoken or written, calls for a pronunciation clue followed by a definition clue as in, “Please identify the dictionary head word whose dictionary pronunciation is /euh neem”ee euh/ and whose dictionary definition is .” The answer format requires the word, in this instance ANEMIA, to be spelled aloud (as in the Scripps contest) or written out, as in some current online web site “daily word” challenges. A correct answer must match the headword perfectly.

The test can be administered very easily in spoken form via pronunciation of the target word followed by a slow, clearly articulated reading of the definition, after which the test taker must spell out the word letter by letter. In written form the target word must be written out. With large groups a multiple-choice version would ask for the “second spelling vowel and offer five alternatives: (a) A; (b) E; (c) I; (d) O (e) U, or “none of these.”

INSTRUCTIONS. . . . PLEASE SPELL THE WORDS WHICH CORRESPOND TO THE FOLLOWING PRONUNCIATION AND DEFINITION CLUES.

1) /fib'reuh lay” sheun-/, n. . . . 2. uncontrolled twitching or quivering of muscular fibrils.

2) /fon'tn el"/, n. . . . one of the spaces, covered by membrane, between the bones of the fetal or young skull.

3) /gas'troh in tes"teuh nl/, adj. . . . of, pertaining to, or affecting the stomach and intestines.

4) /glob"yeuh lin/, n. . . . 2. any of several groups of blood plasma proteins, divided into fractions, as alpha, beta, or gamma globulin, depending on electrophoretic mobility.

5) /gloh mer"yeuh leuhs/ n. . . . 1. a compact cluster of capillaries.

6) /glooh"keuh gon'/, n. . . . a hormone secreted by the pancreas that acts in opposition to insulin in the regulation of blood glucose levels.

7) /gran"yeuh loh suyt'/, n. . . . a circulating white blood cell having prominent granules in the cytoplasm and a nucleus of two or more lobes. Also called polymorph.

8) /herr"sooh tiz'euhm, n. . . . excessive hairiness, esp. in women.

9) /huy"dreuh jeuh nayt'/, v. . . . to combine or treat with hydrogen, esp. to add hydrogen to the molecule of (an unsaturated organic compound).

10) /huy'meuh nop"teuhr euhs/, adj. . . . belonging or pertaining to the Hymenoptera, an order of insects having, when winged, four membranous wings, and comprising the wasps, bees, ants, ichneumon flies, and sawflies.

11) /huy'peuhr play"zheuh/, n. 2. enlargement of a part due to an abnormal numerical increase of its cells.

12) /huy'peuh thal"euh meuhs/, n. . . . a region of the brain, between the thalamus and the midbrain, that functions as the main control center for the autonomic nervous system by regulating sleep cycles, body temperature, appetite, etc., and that acts as an endocrine gland by producing hormones, including the releasing factors that control the hormonal secretions of the pituitary gland.

13) /i skee"mee euh/, n. . . . local deficiency of blood supply produced by vasoconstriction or local obstacles to the arterial flow.

14) /li thuy"euh sis/, n. . . . the formation or presence of stony concretions, as calculi, in the body.

15) /lim"feuh suyt'/, n. . . . a type of white blood cell having a large, spherical nucleus surrounded by a thin layer of nongranular cytoplasm.

16) /mak"reuh fayj'/, n. . . . a large white blood cell, occurring principally in connective tissue and in the bloodstream, that ingests foreign particles and infectious microorganisms by phagocytosis.

17) /meuh tas"teuh sis/, n. . . . 1. the transference of disease-producing organisms or of malignant or cancerous cells to other parts of the body by way of the blood or lymphatic vessels or membranous surfaces.

18) /mik"cheuh rayt'/, v.i. . . . to pass urine; urinate.

19) /muy’euh kahr"dee euhm/, n. the muscular substance of the heart.

20) /neuh fruy"tis/, n. . . . inflammation of the kidneys, esp. in Bright's disease. ]

A FINAL COMMENT. . . . My experience indicates that third graders handle these keyboard-friendly phonetic transcriptions very well, enough so that some of these terms are accessible to them, along with definition-first test questions. . . . Right now many Americans are scrutinizing our No Child Left Behind program very carefully with particular attention to its tests of reading comprehension. These tests are available for inspection via the National Assessment of Education Progress (NAEP) web site.

I urge concerned Americans to inspect these reading comprehension tests. On every level they follow the same pattern of presenting a longish passage followed by questions that measure the test taker’s memory of what was in the previously read passage. The questions therefore measure short term memory, not reading comprehension, e.g., vocabulary meaning in context, and they embody the same assumption as do our vocabulary glossaries, namely, that good readers “remember” what they read in detail.

As indicated earlier, the focus of this article is upon vocabulary growth, not United States educational policy. But I feel the NAEP reading comprehension questions are unduly worrisome to many parents and deserve to be defended far more explicitly and vigorously than they have been so far.

Published April 9, 2007