D. E. Ingram and Masako Sasaki

This is a modified version of a talk originally presented to health professional students at Hondo Campus, Akita University, Akita, Japan, on Tuesday, 10 December, 2002 by David Ingram and subsequently edited by Masako Sasaki.

Abstract
The paper argues that language learning is one of the most important components of a good education. The Australian situation is given as an example of the universal need for language skills. Not least, it is emphasised that the world has changed dramatically as a result of improved telecommunications, rapid transport and the increasing movement of people around the globe as a result of migration and tourism. The Australian multicultural society presents in microcosm the racial, cultural and linguistic diversity that increasingly characterises all societies. International treaties and education policies are cited that endorse the importance of language learning. It is also vital that workers in medicine and other health sciences be proficient in more than one language and have experienced good language learning. English is of particular importance as the dominant international language. The paper goes on to advise on how best to learn English (or other languages) and discusses the value of academic exchanges and "study abroad" programmes for those learning English in Japan.

THE IMPORTANCE OF LANGUAGE LEARNING
Learning another language is one of the most important and valuable parts of any person's education but it is especially important for people working in the field of medicine. There are many reasons for this but, here, we will mention just five.

First, where people are in daily contact with speakers of another language, there is obvious value in being able to speak to them. However, the need is, if anything, even greater where the people have no contact with other languages or cultures and are in danger of being locked in their own ethnocentric shells. Learning another language helps people to break out of those shells. Learning a language introduces the learner to another culture, another way of thinking: languages widen horizons.

Second, there is strong evidence, not least from research in Canada and Australia, that learning a language benefits learners intellectually, in educational attainment, in achievement in their first language, in attitudes to other people, in creativity, and in many other ways relevant to intellectual and affective development and to educational attainment. In particular, the experience of learning another language, striving to communicate in another language, and moving into another culture can sensitise learners so as to be able to move across cultures with enough sensitivity that they neither cause offence inadvertently nor feel offence when it is not intended.

Third, for many reasons, language skills are beneficial to and facilitate the conduct of trade. Ingram has written extensively on this theme and, in particular, has a book currently in preparation on the benefits that language skills can bring to Australian industry 1. Fundamentally, the better one can understand the market, the more likely it is that the products will suit the market; the more effectively one can communicate with and understand the market or one's trading partners, the more convincing one is likely to be and the better the deals made are likely to be. Indeed, the practical experience is that, where business enterprises have been given access to language skills (e.g., through the AT&T Language Line Services in the United States 2), their use of those language services continues to escalate - a clear reflection of the benefits that accrue to the companies' financial success.

Fourth, the world is culturally, linguistically and racially diverse. There are between 6000 and 7000 languages plus additional dialects in the world. In many countries, several languages are spoken everyday and, in some countries, there are literally hundreds of languages spoken. In Papua New Guinea, there are over 800 indigenous languages, Indonesia has over 700, Australia has about 150 indigenous languages plus another 150 or 200 languages that were brought to the country by immigration and are still spoken by the people. Australia is not unique in this: as a result of rapid transport, efficient telecommunications, tourism and migration, this is increasingly characteristic of all parts of the world, and of the world itself. In fact, Japan has long recognised the importance of language skills if it is to trade effectively with the rest of the world and its major companies have commonly offered training in other languages to their employees to enable them more effectively to trade with other countries.

Fifth and in summary, no nation that wants to deal with the rest of the world can rely on just one language - the world is not like that. The world is diverse, varied, and, to understand the world, to relate to it, and to survive in it, especially as educated people, we must learn to understand and deal with that diversity. We have to learn to deal with, understand and accept people of diverse cultural, racial and linguistic origins

Australia provides a good example of why it is not enough just to rely on the national language, even when, as in Australia's case, that language is English. It also illustrates the changes that are occurring all over the world and that are increasingly impacting on every country. Traditionally Australia was most closely linked in trade, sport and international relations with Britain and the United States. Now, Australian trade is predominantly with non-European, non-English speaking countries: in 1997-98, for example, 85% of Australia's export merchandise went to countries other than the United States and New Zealand, about 55% went to East Asia (especially Japan, Korea, China), and 70% went to countries whose populations are predominantly non-European 3. There are also very large numbers of foreign tourists and overseas students in Australia: in 1999, approximately 3.4 million foreign tourists visited Australia (equal to about 18% or one in six of the Australian population) and the numbers have increased greatly since then 4. Australia is now the third largest destination for overseas students in the world after the United States and Britain. In the year 2000, some 185,000 overseas students were studying in Australia and that number is continuing to grow rapidly. Indeed, worldwide, the number of people studying as "international" or "overseas" students is growing rapidly: the OECD's figures show that there were some 80 million international students worldwide in 1995 but this is projected to grow to 150 million by 2025. The provision of education for overseas students has become a major industry in many countries: in Australia, it is already the third largest service industry (after tourism and transportation), the eighth largest export industry overall, and is growing faster than most other export industries.

Australia has also changed dramatically internally in ways that also reflect (though possibly more intensely) changes that migration, tourism, and world political unrest with the consequent increase in refugee numbers are bringing worldwide. Traditionally, "Australians" have been thought of as predominantly white, English-speaking people descended from British settlers who were sent or migrated to Australia during the 200 hundred years from 1788. The reality today is, in fact, very different and, ethnically, Australia is now very diverse: 22% of the Australian population were born overseas and another 27% have at least one parent born overseas. This diversity has increased through the last 50 years (reflecting the worldwide pattern of human movement and the growing worldwide diversity): in 1947, only 10% of the Australian population was born overseas and 81% of those came from English-speaking countries whereas, in 1998, only 39% of the overseas born had come from English-speaking countries. This also has changed the language pattern in Australia from what used to be seen (even if not quite accurately) as an English-monolingual country to one where certainly English predominates but many other languages are also spoken. Some figures were cited earlier but, in addition, census figures show that, in 1996, 15% of the population spoke a language other than English at home while, at most, 81% spoke only English (though the wording of the question on the census forms meant that the number who know another language and may use it outside of the home was seriously under-estimated).

Such changes as have occurred in Australia are not just abstract demographic statistics and do not just affect "industry" or "international trade". They impact on everyone's everyday life as Ingram illustrated when he spoke on this topic to student and staff at Akita's College of Allied Medical Science in December 2002. He said:

The changes in my own life reflect what is happening worldwide. Even just 50 to 60 years ago, when I was a boy growing up in outback Australia, we could live as though there was no other group of people on the earth: we knew there were but we had no contact with them and we could ignore them: we thought of ourselves as Australian, white, English speaking and British. That is no longer the case. My wife is from Papua New Guinea. My children are mixed-race with light brown skins rather than white. We have a Japanese boy staying with us while he studies at our local High School along with students from around the world. In my extended family and amongst our closest friends, I can think of people who have themselves or their recent ancestors come from Papua New Guinea, China, Afghanistan, Taiwan, Britain, France, South Africa, India, Cambodia, New Zealand, Indonesia, Korea, Italy, Greece, Germany, Iran, and many other countries. While I am here in Japan, my son is playing soccer in Brazil. This year, my work has taken me from Australia, to Singapore, Thailand, China, Korea and Japan: I can no longer think of myself as just working out of an office in Brisbane but my "office" stretches around the world. When I retire from my present position at the end of 2003, I have already been offered jobs in China, Korea and Thailand and reasonably expect that I might be involved in other countries as well. My normal day's activities involve corresponding via email with people in many different countries everyday and often I will write to someone on the other side of the world and, within minutes if they happen to be at their computers, I will have a reply - even more quickly than if I walked down the corridor to speak to one of my own staff.

My life is not exceptional in this: it merely reflects the way the world has changed and it is essential that we all learn to understand, communicate with, and accept people of many different cultures. Indeed, if we don't learn to do so, the world will collapse into chaos and strife.

The result of these changes in the demographic pattern of Australia, caused by the massive mixing of the world's population that is seen in most, if not all, countries worldwide, is that the very concept of what it is to be "Australian" has changed and is well reflected in a popular national song, entitled "I am Australian", the opening lines of which go:

• We are one, but we are many,
• And from all the lands on earth we come.
• We share our dream
• And sing with one voice:
• I am, you are, we are Australian.

The linguistic result of these changes leading to the diversification of the Australian population is that the number of languages spoken daily in Australia has increased dramatically (as the figures cited earlier show) but, in addition, the demand for people with language skills by Australian industry, as shown in job vacancy advertisements, grew equally dramatically by approximately 4000% from 1982 to 1992.

The consequence of these trade, demographic and linguistic changes for Australian education have been dramatic. Throughout much of the twentieth century, Australian education was almost (though not quite) English-only but, during the latter part of the twentieth century, successive national and State language education policies were adopted in an attempt to raise the level of skills in other languages amongst Australian children 8. The national policy on the teaching of Asian languages and cultures, for example, states:

… it is critical that Australia attaches the highest priority to the adoption and implementation of a long-term strategy to ensure that the Australian workforce of the future is equipped with language skills, and associated skills of cultural awareness, of direct relevance to our national economic interest.

Recently, the Chief of the Australian army, Lieutenant General Peter Cosgrove, spoke about how he believed Australia could best secure the future. It was not, as one might expect from a soldier, by building stronger armies. Rather, he said:

Commercial links, alone, will never render war unthinkable. What will, however, are mutual understanding and respect and the banishing of prejudice. …

If [our] future is to be one of peace and prosperity our kids will need the capacity to engage in dialogue with others of different cultures and creeds. And that applies both within Australia and abroad.

Earlier in his speech, Cosgrove commented:

Language skills and cultural sensitivity will be the new currency of this world order. Along with computer literacy they will provide the keys to participation in the global economy. …

Our future prosperity and security will depend on our ability to understand these cultures [with whom we trade and have other links] and to build bridges to the citizens of these nations and all our immediate neighbours. …

It is impossible to overstate the case for expanding our collective knowledge of the languages and customs of our neighbours.

It is not only in Australia that this diversification has occurred and where it has been recognised that, to cope with the national and international diversity, it is necessary to upgrade and diversify the nation's language skills and try to ensure that the people learn to understand and accept other races and cultures. There are, in fact, many international treaties that recognise the value of learning other languages, especially in order to break down prejudice and increase intercultural understanding. The UNESCO Position Paper, October 2002, Education in a Multicultural World (draft), for example, states:

Learning another language opens up access to other value systems and ways of interpreting the world, encouraging intercultural understanding and helping to reduce xenophobia.

The 1995 (UNESCO) Declaration and Integrated Framework of Action on Education for Peace, Human Rights and Democracy promotes foreign language learning in order to foster understanding between communities and nations (Article 29). The 1998 World Declaration on Higher Education for the 21st Century stresses the importance of multilingualism in order to encourage international understanding and asks for student exchange programmes to be an integral part of all higher education. The Council of Europe has always strongly supported language learning as a means to fostering understanding between the countries of Europe, to facilitate trade, and to enable Europeans to work anywhere in Europe. In its Recommendation R(82) 18, it stated:

… it is only through a better knowledge of European modern languages that it will be possible to facilitate communication and interaction among Europeans of different mother tongues in order to promote European mobility, mutual understanding and cooperation, and overcome prejudice and discrimination.

Similarly, most education systems around the world see an important role for language learning and generally recognise three important goals: to develop language proficiency for practical purposes (including international relations and trade), encouraging intercultural understanding, and fostering positive cross-cultural attitudes. In Britain and elsewhere in Europe, for example, strong policies have been developed and adopted to encourage the learning of languages to facilitate trade, to enable Europeans to work anywhere in Europe, and to foster mutual understanding. In Britain, for example, the 1990 National Curriculum stated that one of the aims of foreign language teaching was:

… to encourage positive attitudes to ... speakers of foreign languages and a sympathetic attitude to other cultures and civilisations.

A "group of experts" mandated by the Swiss General Education Commission to develop a language education policy also stated:

La connaissance des langues voisines ou partenaires permet non seulement une communication transfrontaliere, mais contribue aussi et surtout a une comprehension mutuelle at a une attitude de tolerance a l'egard d'autres cultures.

In Australia, successive national policies have sought to increase the learning of languages for economic reasons and to encourage more favourable cross-cultural attitudes and intercultural understanding. The Australian Language and Literacy Policy, for example, states:

Language and literacy issues are central to the reshaping and the improved performance of our education and training systems. …

Global economic forces are demanding changes in the structure of Australian industry, in our ability to compete in world markets …

… language proficiency improves social cohesion, communication and understanding throughout the Australian community .

As was noted earlier, Australia's national policy on Asian languages is based on a recognition of

… the importance of the development of a comprehensive understanding of Asian languages and cultures through the Australian education system if Australia is to maximise its economic interests in the Asia-Pacific region.

In brief, in today's world it is important to develop skills of communication with other people. No one language is sufficient, whether that be English or Japanese or any other language. We cannot learn all languages but we can learn at least one other language which will help us to communicate with and understand other people, and, most of all, help us to understand and accept the nature of racial, cultural and linguistic differences. For speakers of other languages, English has some advantages. Not least, for largely accidental historical reasons, English has become the major international language and serves as a medium for communication not only with native English speakers but English, taught and learned as an international language, has become an important medium for communication between speakers of other languages. In fact, there are probably at least twice as many people who use English as a foreign or second language for daily communication as use it as a first language

Most fundamentally, however, all people, not least people in all professions such as medicine or education that deal with other people, must learn to understand, accept, and interact harmoniously with other races and cultures, that is, it is vital that both general education and professional training encourage intercultural understanding and acceptance amongst all people, and, not least, amongst all people working in the "human" and "humanistic" professions. People of all races and cultures need to understand and be able to communicate with each other but, in particular, they need to grasp two basic principles: first, underlying the differences in language, culture and races are the same basic human features, the same fundamental human needs that exist across cultures and races: people are different but humanity is the same. Those basic needs, wishes and characteristics are expressed differently through different customs but these differences, for the most part, reflect the same underlying needs. Hence we need to recognise, understand and accept the universal that exists across the diversity of languages and cultures. Second, we can identify national, racial or ethnic groups that speak particular languages and have certain cultures; so there are Japanese or Australians or Germans or Koreans but the differences within any group or race or ethnic community are just as great as the differences between ethnic groups. It is easy to "stereotype" people in a group but stereotypes don't exist, only individuals exist. Hence, we need to recognise the individuality that exists within the universality of a culture.

II WHY IS THIS RELEVANT TO STUDENTS IN THE FIELD OF MEDICINE?
The reasons just discussed are equally applicable to people working in the field of medicine as they are to anyone else but there are several factors that make the experience of learning another language and having skills in at least one other language (especially English) of particular importance to medical personnel.

First and very fundamentally, most people working in the various fields of medicine are well educated, for many, highly educated. The very concept of an educated person is very relevant to them and they should exemplify what we understand to be the characteristics of an educated person. In particular, an "educated person" is one who has vast knowledge but also has equally vast understanding and tolerance, one who acts and believes on the basis of reason and not prejudice, one who, through training and intellect, is able to treat all people, meet all situations, respond to all challenges rationally, in a disciplined manner, with understanding, and, not least, with self-understanding. Language learning is especially appropriate to these goals. The systematic, long-term nature of language learning encourages a disciplined approach to achieving goals; there is strong evidence (referred to earlier) that language learning benefits general intellectual development as well as educational attainment; and there is strong evidence that good, well designed language learning can have a positive effect on attitudes to, and understanding of, other people, especially on cross-cultural attitudes

Second, the best and most successful medical practitioners do not just treat bodies: they relate to and treat people. Undoubtedly bodies are predominantly chemicals and their well-being can be influenced by chemicals but the practice of medicine is not just chemistry. As important as medicines or pharmaceuticals might be in treating illness, the art of medicine rests not just in the mixing of chemicals but medicine is about treating people: workers in the various fields of medicine need to understand and accept people. Some of this understanding can come from "book learning", from the study of psychology, for example, but most of all and certainly most sensitively and most intuitively, it comes from meeting and interacting with a diverse range of people of different personalities, cultures and races. The wider and more diverse one's experience of people and of what it is to be human, the more sensitive, alert and aware one is likely to be. Language learning, especially of the form to be described shortly, most effectively develops this awareness and sensitivity.

In this context, it is worth remembering the words of the French philosopher-writer, Antoine de Saint-Exupery. Saint-Exupery was a writer of children's books but he fills his books with perceptive insights into the human condition. In one, where he considers the nature of friendship and human relationships, he says:

Il est tres simple: on ne voit bien qu'avec le coeur. L'essentiel est invisible pour les yeux.

And elsewhere, he wrote:

Connaitre, ce n'est point demontrer, ni expliquer. C'est acceder a la vision. Mais, pour voir, il convient d'abord de participer. Cela est dur apprentissage.

To understand people, to know humanity, it is not enough just to study the make-up of their bodies, it is not enough to learn about their minds, one must first meet them, interact with them, experience them; one can understand only "with your heart", one must have a vision of what it is to be human and that can be acquired only by interacting with people and gradually gaining insight into the human condition. Learning another language, stepping into another culture, and interacting with people in different cultural contexts lets one broaden one's vision of what it is to be human and sensitises one to other people, to their ideas, their customs, and their modes of acting and expression.

Third, and on a more practical level, medical discoveries and developments occur all around the world, medical conferences occur all around the world, and the main language in which the research findings are published and the main language of the conferences that are held is English: without English a medical worker's access to the latest medical information is severely limited or, at best, delayed. Three examples from Australia24 will suffice to make the point. In 1996, the Nobel Prize for Medicine was awarded to an Australian medical researcher who investigated the body's immune response and, in particular, how the body eliminates viruses by T-cells. Inevitably, his papers were written in English. Somewhat earlier, in the 1960s, the Nobel Prize for Medicine was awarded to another Australian scientist, McFarlane Burnett, who investigated the body's immune response and discovered how the body identifies the self and the non-self, i.e., how it recognises cells that are its own or different. His discovery is vital to such subsequent developments as transplants, which are so important today in advanced medical practice. Again, his papers were written and published first in English. Another and on-going example is that of the work of the Queensland Institute for Medical Research (QIMR) in Brisbane. QIMR is one of the most important medical research institutes in the world. Amongst its recent discoveries has been identification of the genes associated with breast cancer, it has developed and is trialling a vaccine for the prevention of malaria (a disease that kills hundreds of thousands of people around the world each year), and it has carried out major research into Japanese encephalitis. Again, the QIMR's publications and conferences are all in English and, for anyone without English, access to those findings will, at best, be delayed.

Fourth, there are important cultural issues involved in dealing with people, especially in the intimate ways that medical practitioners do. Just a few of the critical issues in doctor-patient or nurse-patient relationships include, for example, how a medical person deals with a patient, the personal distance between the doctor or nurse and the patient both in conversation and in treatment, whether it is necessary to have a third person present during treatment or interviews, how to handle communication where an interpreter is required, who is qualified to act as an interpreter or can reasonably be used as an interpreter for medical purposes, and how to give instructions to people of different cultures [see the research by Masako Sasaki].

Fifth, one cannot learn closely all the cultures with which one may have to deal but one can learn to understand the main international language and its associated culture (i.e., English) but, even more importantly, if one goes about it the right way, the language learning experience itself can sensitise learners to other people, to other cultures, and can make them culturally aware: one cannot learn every culture but one can learn to "tread warily" so that one neither causes nor feels inadvertent offence.

Sixth, there is a very fundamental way in which English is important, not only to medical practitioners, but to all professionals: as a professional, one needs to be able to identify with one's fellow professionals, for medical personnel, with one's fellow medical practitioners and researchers around the world. For this, it is vital that one participates in conferences, reads the journals and books in one's field, and keeps up to date. Most of that worldwide interaction will be carried by English and, without English, one would be denying oneself a sense of profession and, even more importantly, access to current knowledge.

III WHY ENGLISH?
Some reasons for the importance of English to medical workers have already been given: in particular, it is the principal language in which medical research findings are published, in which international medical conferences are held, and through which workers in the field of medicine interact with their international colleagues.

The simple fact is that English has become the main international language. The reasons for English to have become so dominant are various: colonialism, military power, commerce, industry, trade, technology, media, the cinema and other arts, popular music, while, more recently, English has become the predominant language of the internet with some 80% of the net being conducted in English

However, the reasons why English has assumed this significance don't matter so much as the fact that English is the most widely spoken language in the world. It is hard to estimate how many speakers of English there are in the world. Crystal, in 1987, estimated that there were 350 million native speakers but another 1400 million people who spoke it regularly as a second or foreign language 26. More recent figures frequently quoted at the 2002 RELC Seminar in Singapore suggested there are 700 million English-L1 speakers, 700 million ESL speakers, and 700 million EFL speakers. Such figures confirm that English has the strongest claim to being the principal international language, and therefore, for international communication, it is the most useful.

Granted the importance of language learning and of learning English in particular, it is worth considering how learners should go about learning it so as to maximise both their proficiency and their intercultural understanding and cross-cultural attitudes.

IV HOW CAN YOU BEST LEARN ENGLISH?
Research shows that the things that learners can do that are most important in developing language proficiency are also those that are most important in developing cultural understanding and positive cross-cultural attitudes. The design of language teaching/learning methodology to maximise proficiency development and foster positive cross-cultural attitudes has been discussed at length in other papers 27 but here, in summary, are some basic principles and practical advice:

First, language is best learned by using it: use it, use it, use it. In particular, continually put yourself in situations where you need to use English to communicate.

Second, language is based on grammar: grammar is the system by which words are put together to convey meaning. In learning a language, it is necessary to acquire the grammar and so it is appropriate to study the grammar but, most of all, use the grammar, use the language, and let your own mind develop the grammar as you use the language.

Third, language is best learned when you use it actively to communicate. Take every opportunity there is to use the language to communicate: with your teacher, with your friends, with work colleagues, with other speakers, and especially with English native speakers. Use it to speak, to listen, to read, and to write.

Fourth, language learning is greatly helped by wide and varied experience of the language in all its forms: speak, read, watch movies, use it on the internet, listen to English spoken on the radio, on TV, in videos, in the cinema - in as many and varied places and forms as is possible to find or do. Even English songs can help one learn though they are less useful than hearing the language spoken, using it to read, and trying to speak and write.

Fifth, culture is important both for language development and to learn to understand other people: culture gives the words meaning. In learning the language, it is essential also to learn the culture (see below).

Sixth, learn how to learn: it is not enough just to attend English classes and to depend on the teacher. Language is learned, not taught. Even though a teacher can help you learn, it is by studying the language and, most of all, by struggling to use it in communication that it is learned. In any case, developing high levels of proficiency is a long-term activity, most language courses are finite, and, if one is to develop a high level of proficiency, it is essential to be able to go on learning beyond the end of the set courses. In other words, it is essential to learn how to learn and, in particular, to learn how to use the community of speakers and other resources to enable you to continue to develop your language when you have finished with formal courses.

Seventh, language is best learned in the course of social interaction both face-to-face and through reading and writing. Meet with English speaking visitors to your country, your community, or your institution; act as a guide to visitors so that you are using English to talk about the things around you with which you are familiar; try to participate in any conferences or other meetings in your professional field where English is spoken; form university, professional or community clubs or associations (either for general or in your professional purposes) and make English the principal means of communication; seek out on the internet chatrooms and other places of interaction with people in the medical area; and, similarly, seek out links with student or professional associations in English-speaking countries and either visit them or interact with them over the net in English. Nowadays, with the ready availability of the internet, there are also many excellent and low-cost opportunities to read and write English while seeking information for oneself or in interacting over the net with other people (e.g., using the internet to search for information, reading relevant webpages, interacting with other professionals in chatrooms, exchanging email, and so on - the list of possibilities is endless).

Eighth, take every possible opportunity to interact with native speakers: not just reading out written questions or memorised texts but by engaging in conversation. While there is particular value in interacting with native speakers who can model the language, the main thing is to interact, to use the language for communication whether with native speakers or with other learners of English.

What has just been said about how best to develop your language also applies to how to develop better understanding of the other culture and more positive attitudes towards people of other cultures and races. In other words, the same principles apply to developing intercultural understanding. In particular, use the language for interaction with other speakers of English, do this in as many and varied but authentic cultural contexts as possible, and, most of all, interact with native speakers of English. In this way, you learn spontaneously the culture of the other people but, in particular, you learn to recognise the individual that exists in the universal of a culture (as discussed above). You also learn that the other people are, basically, like you despite the language and culture differences; in other words, you learn to recognise the basic universal needs, ideas, and values that exist across the different cultures (as discussed earlier). Not least, you start to become sensitive to the real cultural differences and learn how to move across cultures without feeling or causing inadvertent offence.

Often when people first meet with people from other cultures or when people first enter another culture, they suffer "culture shock". Culture shock is a normal experience and arises from the differences between one's own culture and the other culture encountered for the first time. In fact, culture shock plays an important part in the development of understanding of other cultures and in the development of positive attitudes and intercultural understanding28. The value of culture shock lies in the fact that it can be used to encourage people to think about their cross-cultural experiences, to think about why they react as they do, to understand their reactions, to understand why the other people act as they do, and, eventually, to rationally alter their own reactions.

At the practical level, here are seven suggestions of useful things to do in order to maximise the development of your language skills, to enhance your understanding of the other culture, and to facilitate the development of positive and balanced cross-cultural attitudes (especially towards speakers of English):

First and, perhaps, most importantly, meet as often as possible with native (or other fluent) speakers of English: have a project or a topic to explore with them and report back to your class or group to discuss it with your colleagues as well (in English, of course).

Second, act as a guide for tourists, professional colleagues, or other visitors who speak English or whatever language you are learning.

Third, participate in language evenings and language camps where you interact in English (or whatever the target language is). They should be set up so that the context or environment is as Australian, as English, or as American as possible so as to create an appropriate atmosphere. Invite English native speakers or other fluent speakers to be present.

Fourth, have professional evenings, clubs, or other organisations where you meet to discuss professional matters in English: at first this may be difficult and you will struggle with the language but it is that struggle that promotes language learning and the more you persevere, the more rapidly your English will develop. Seek out and join a professional association where English is used either all the time or with professional and other visitors; if there isn't one, form one.

Fifth, use the internet and email as much as possible: correspond by email with your lecturers, with colleagues, and with friends using English; correspond with colleagues in Australia or other English-speaking countries; correspond in English with colleagues elsewhere in Japan; use chatrooms and try to find ones devoted to medical issues; use the internet in English to research information for your studies, research, or professional development; and link up with colleagues in English-speaking countries using webcameras or videoconferencing.

Sixth, travel in English-speaking countries is especially useful and brings together in one short experience many of the activities referred to above. Such travel may be to undertake short or long-term English language courses, to undertake study tours in which English is learned but also other activities (medical studies, tourism, or work experience and observation) are undertaken. Often the people who organise English courses and study tours will arrange homestay, which enables the visitor to experience English-speaking culture in real-life situations and provides the opportunity to use English for everyday purposes with the host family. Tourism can also give opportunities to experience the culture and to use English but it is important that tours not be taken in home language groups or the opportunities to practise English will be much reduced.

Finally, there are many activities similar to those outlined above that language learners or people wishing to improve their proficiency in a second or foreign language can undertake. Whatever activities are used, three basic principles should always be remembered and used to test the suitability of the activities: first, use the language as much as possible; second, learn about the culture both in formal classes and study and through interacting with native speakers; and, third and most importantly, interact with native and other speakers of the language both face-to-face and through writing, the internet, videoconferencing, and by any other means that facilitates interaction.

V ACADEMIC EXCHANGES OR STUDY ABROAD
From what has been discussed above, clearly there is great benefit both for language development, for intercultural understanding, and for the development of medical expertise if students or professionals in the field of medicine spend some time abroad, both to learn and experience the English language and culture and to broaden one's medical experience.

Many universities actively encourage their students to spend time abroad for these purposes. Many Japanese universities actively participate in programmes that assist their students to spend time abroad learning English and furthering their studies and experience in their vocational field. Many English-speaking universities encourage their students to spend time in foreign universities as part of their degree programmes.

In fact, this is not a modern phenomenon. Travel from place to place and country to country to learn from other experts and to experience other cultures, other forms of knowledge, and to broaden one's own experience is a very long academic tradition, going right back, in the western tradition, to the earliest days of universities when medieval students travelled around Europe to "sit at the feet of the masters". This tradition continues today as thousands of students travel abroad to study (see the figures quoted earlier). Worldwide, many universities are re-developing their teaching programmes to cater for overseas students and, in English-speaking countries, many universities have specialised units to provide high quality English language courses to overseas students. One example of such a unit is the Centre for Applied Linguistics and Languages in Griffith University, Brisbane, Australia

VI CONCLUSION
The experience of learning another language has a major contribution to make to the education of all people. It is especially relevant to people, such as those in the various fields of medicine, who deal professionally with other people. English, which has become, for historical and practical reasons, the major international language, is especially relevant to speakers of other languages since it is most widely spoken, it is the medium for the initial publication of much of the world's research, and, globally, it is the principal medium for international conferences, negotiations and other events. Modern approaches to methodology for the teaching and learning of English (and other languages) are able to develop high levels of practical language skills or proficiency, they can foster a realistic and balanced understanding of English-related culture, and they encourage the development of positive cross-cultural attitudes that are vital in today's globalised world where, as a normal part of everyday life, people intermingle with people of different races, cultures and languages.

REFERENCES

1. See Ingram, D. E. in preparation. Languages in Australian Industry. Mimeograph.
2. See Ingram, D. E. 1997. "Service, Profits and Stimulus: A Case for a 'Language Line' in Australia". In Babel, Vol. 32, No. 1, April-June 1997, pp. 8 - 15. Also in the New Zealand Language Teacher, Journal of the New Zealand Association of Language Teachers, Volume 24, November 1998, pp. 48 - 59.
3. Market Development Task Force Secretariat and the Trade and Economic Analysis Branch. 1998. TradeWinds: Trading with Asia in Difficult Times: Australia Rises to the Challenge. Canberra: Department of Foreign Affairs and Trade.
4. Market Development Task Force Secretariat and the Trade and Economic Analysis Branch. 1999. TradeWinds: East Asia - Recovery Underway. Canberra: Department of Foreign Affairs and Trade: 32.
5. See English Australia News, October 2002: 5.
6. See the website of the Australian Bureau of Statistics at www.abs.gov.au.
7. See Australian Language and Literacy Council (ALLC). 1994. Speaking of Business. Canberra: Australian Government Publishing Service: Appendix 3.
8. These policies are briefly discussed subsequently but, for more extensive information, see Ingram, D. E. 2002. "Language and Culture Policy in Multicultural Australia". Paper to the Annual Convention of Oceanian Education Studies, Akita University, Akita, Japan, 7 December, 2002.
9. Council of Australian Governments Working Group (COAG). 1994. Asian Languages and Australia's Economic Future - A Report for the Council of Australian Governments on a Proposed National Asian Languages/Studies Strategy for Australian Schools: 14.
10. Cosgrove, Peter J.. 2002. "Address by the Chief of Army, Lieutenant General Peter J. Cosgrove AC, MC to the Australian Principals Association Professional Development Council (APAPDC)". Melbourne, 30 May, 2002. Mimeograph: 10.
11. Cosgrove, Peter J.. 2002. "Address by the Chief of Army, Lieutenant General Peter J. Cosgrove AC, MC to the Australian Principals Association Professional Development Council (APAPDC)". Melbourne, 30 May, 2002. Mimeograph: 6 - 7.
12. Cited in Morgan, Carol. 1993. "Attitude change and foreign language culture learning". In Language Teaching, Vol. 26, April 1993: 63.
13. Conference suisse des directeurs cantonaux de l'instruction publique. 1998. Quelles langues apprendre en Suisse pendant la scolarite obligatoire? Rapport d'un groupe d'experts mandate par la Commission Formation Generale pour elaborer un "Concept General pour l"Enseignement des Langues". Berne, Switzerland: Conference Suisse des directeurs cantonaux de l'instruction publique: 4.
14. In translation: Knowledge of the languages of our neighbours or partners, not only allows cross-border communication but also and especially contributes to mutual understanding and to an attitude of tolerance towards other cultures.
15. Department of Employment, Education and Training (DEET). 1991. Australia's Language: The Australian Language and Literacy Policy. Canberra: Australian Government Publishing Service: 1
16. Department of Employment, Education and Training (DEET). 1991a. Australia's Language: The Australian Language and Literacy Policy - Companion Volume to the Policy Paper. Canberra: Australian Government Publishing Service: 62
17. Council of Australian Governments Working Group (COAG). 1994. op. cit.: 1.
18. cf. ALLC 1994, op. cit.: 9 citing Crystal, David. 1987. The Cambridge Encyclopedia of Language. Cambridge University Press.
19. See Ingram, D. E. 2000/2001. "The Enigma of Cross-Cultural Attitudes in Language Teaching, Parts 1 and 2". In Babel, Vol. 36, No. 2, Spring 2001: 12 - 18, and Babel, Vol. 36, No. 3, Autumn 2002: 17 - 22, 37 - 38; Ingram, D. E. 1999. "Cross-Cultural Attitudes in Foreign Language Programmes". In PASAA: A Journal of Language Teaching and Learning in Thailand, Vol. 29, December 1999, pp. 1 - 32; Ingram, D. E. 1980. "Aspects of Personality Development for Bilingualism". In Afendras, E. A. 1980. Patterns of Bilingualism. RELC Anthology Series, No 8. Singapore: RELC/University of Singapore; Ingram, D. E. 1980a. "To See, To Speak: Participate! Community Involvement in Language Teaching". In Unicorn, Vol. 6, No. 3, August 1980, pp. 276-283; Ingram, D. E., Shirley O'Neill and Kerry Townley-O'Neill. 1999. "The Effect of Language Learning on Cross-Cultural Attitudes". Report of a project funded under the Griffith University Research Grants. Mimeograph, 1999.
20. Saint-Exupery, Antoine de. 1958. Le Petit Prince. Paris: Gallimard: 72.
21. In translation: It is very simple: you can see clearly only with your heart. The essence of things is invisible to your eyes.
22. Saint-Exupery, Antoine de. 1942. Pilote de Guerre. Paris: Gallimard: 54.
23. In translation: Knowing is neither showing nor explaining. It is yielding to a vision. But, to see, you must first participate. That is the hard lesson.
24. Examples kindly provided by Dr Lawrie W. Powell, retired director of the Queensland Institute for Medical Research.
25. Graddol, David. 1997. The Future of English? London: British Council: 50.
26. Crystal 1987, op. cit.: 438.
27. Ingram, D. E. 2002. "The Effect of Foreign Language Learning on Cross-Cultural Attitudes: Effecting Change and Promoting Proficiency". Paper to the Annual Convention of the Association of Akita English Studies in conjunction with the Tohoku Chapter of the Japan Association of College English Teachers, Akita University, Akita, Japan, 30 November, 2002; Ingram 1999, op. cit.; Ingram, D. E. 1999a. "Cross-Cultural Attitudes as a Goal of Language Teaching in the Global Context". Keynote paper to the RELC Seminar 1999, Language in the Global Context: Implications for the Language Classroom, Regional Language Centre, Singapore, 18 - 22 April, 1999 and to the Post-RELC Seminar, Chulalongkorn University, Thailand, 26 - 27 April, 1999. Reprinted in Ho Wah Kam and Ward 2000: 104 - 163. Reproduced in the ERIC Clearinghouse on Languages and Linguistics (1999), ED430 398/FL025 833; Ingram, D. E. 1978. An Applied Linguistic Study of Advanced Language Learning. Thesis for the degree of Doctor of Philosophy, University of Essex, Colchester, England. Reproduced in ERIC Clearinghouse on Languages and Linguistics, ED168 359; Ingram et al 1999, op. cit.
28. See Ingram 2002, op. cit.; Ingram 2000/2001, op. cit.; Ingram 1999, op. cit.; Ingram 1999a, op. cit.; Ingram 1980, op. cit.; Ingram 1980a, op. cit.
29. See Ingram, D. E. 2001. Language Centres: Their Roles, Functions and Management. Amsterdam: John Benjamins Publishing Company, especially Chapter 6, for a more detailed discussion of this Centre. See also the Centre's webpage at www.griffith.edu.au/call .