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Vol 34 No 2, April - June 1996
Page 22

A Useful Device
by Clara Perez Fajardo

Has it ever happened that you read or listen to something, and shortly afterwards when you want to recall it, you can only remember a small part? Have you ever thought of how many interesting ideas you have missed, just because you have not taken a few seconds to note them down as they occurred to you? Everyday happenings pass through time and can never be recalled again if they are not recorded either on a tape or with a video camera. But, not many of us have these devices always handy. What we do have available is a simple sheet of paper, a pencil, and our five senses. Taking notes on what takes place not only permits us to remember but also facilitates our oral and written communication.

Regardless of their age or level, students tend to rely too much on their memory, instead of taking notes. For this reason, I began devising different tasks which demand the recall of facts that the students would have only if they had taken notes. The results have motivated me to do further research on the topic through interviews, reading, and analysis-all the time noting down the information I was obtaining.

The note-taking process

In order to reconstruct a complete account of what one perceives through listening, reading, observing, discussing, or thinking, it is necessary to take notes either simultaneously with the act of perception or after an interval of just a few seconds. We cannot expect to remember everything we perceive, and despite the advantages of training our memory, it is better to have notes taken at the moment things happen.

Language educators have approached note-taking from different perspectives. McKeating (1981) sees note-taking as a complex activity which combines reading and listening with selecting, summarizing, and writing.

Grellet (1986) advises helping students to establish the structure of a text so they can pull out the key ideas and leave out nonessential information. Nwokoreze (1990) believes that "it is during the note-taking stage that students reach the highest level of comprehension."

These authors agree about two main aspects concerning note-taking:

  • It involves the combination of different skills, i.e.; listening or reading, selecting, summarizing, and writing.
  • It requires the selection of relevant information from the nonessential.

Moreover, most authors see note-taking as a complex activity which must be approached gradually. When teaching the skill, Raimes (1983) suggests that elementary-level students can be given a skeleton outline to work with when they take notes, so that their listening is more directed. Advanced students can listen to longer passages and make notes as they listen.

Gilbert (1989) observes how difficult it is to take notes from a lecture in a foreign language. If one tries to write every word the professor says, then s/he is writing at the same time the professor is lecturing. Nwokoreze calls this form of taking notes "the verbatim transcript," and he does not recommend it.

Murray (1982:34) refers to a "rehearsal for writing," which begins as an unwritten dialogue within the writer's mind: what the writer hears in his/her head evolves into notes. This may be simple brainstorming-the jotting down of random bits of information which may connect themselves into a pattern later on.

Note-taking involves putting onto paper the data received through any of our senses. These data could range from simple figures, letters, symbols, isolated words, or brief phrases to complete sentences and whole ideas.

Most teachers instruct students to take notes while perceiving . However, Nwokoreze insists on the need for first listening long enough to make sure the essence of the information is perceived before taking notes. The decision on whether the notes are to be taken at the moment of perception or shortly afterwards depends on the complexity of the task and the ability of the note-taker. Consequently, if we are to take notes with figures, letters, or single words to fill in a pre-designed skeleton, we can do it at the same time we receive the information; whereas notes which require selection, summarizing, and organization ought to be taken later.

How to take better notes

Regardless of the degree of complexity of note-taking, there are certain requirements to fulfill if we wish to take faster and more effective notes. First, we should have our own set of meaningful abbreviations and symbols. Second, whenever possible, we need to anticipate the sort of information we are going to receive and be ready to write what is really new and important.

Third, when listening to a lecture or recorded material, or when reading, discussing, or observing a process, we need to have a clear purpose and a definite sense of organization for the notes to be taken.

Nwokoreze recommends using two methods while listening to a lecture-both are adaptable to other activities as well. These methods are: "Heading and Statements" and the "Pre-class Outline". Regarding the former, Nwokoreze points out: "You do not quote the speaker. You condense the message into a brief and meaningful statement. In this way you are assured that you understand the lecture" (1990:40). Since the topic of the lecture is known beforehand, Nwokoreze stresses that it is possible to prepare a pre-class outline which will serve as a skeleton to be filled in during the lecture.

Both Nwokoreze and Wallace (1980) agree that "positive" note-taking starts before a lecture. The teacher encourages anticipation before the lecture so that students do not receive the information "cold." If the topic of the lecture is unknown, students may use what Wallace calls "branching notes." The topic of the lecture, or the first topic stated by the lecturer is placed in the center of the page and the rest of the topics branch from it or from one another. Arrows may be used to show interrelations between sub-topics. There is no single way of doing this, so students may have branches going in different directions.

A fourth requirement is that students must have a reason for taking notes. There are various types of follow-up activities that the teacher can construct which demand using notes in a meaningful way.

The fifth requirement is to be alert to those cues that precede the information that should be noted down. Both Raimes and Gilbert identify certain cues that speakers use to point out significant new information. For Gilbert, these cues may be the focus of intonation, and a pitch change. Raimes calls attention to other signals like pauses, raising of the head or the voice to make an important point, or using words like first, most important , etc. (1983:78).

The last requirement for achieving better notes is to speculate and predict what will be heard or read. These strategies pave the way for clearer note-taking.

Note-taking vs. note-making

Although some authors use the terms of note-taking and note-making indiscriminately, Grellet makes a clear distinction between them in connection with summary writing.

In summary writing, minor details must be deleted, but the summary must be an accurate and objective account of the text without the reader's reaction to it. By contrast, note-taking can be supplemented by note-making, i.e., briefly jotting down one's reactions (1986:23).

We can say that when we make notes, we write our reactions to what we perceive; and when we take notes, we record the information as we perceive it. Notes made at a given moment will vary from one person to another and even within the same person at different moments. But notes taken of the facts presented are more likely to be similar in content-though different note-takers may vary in their perceptions.

Guided note-taking

As teachers, we must decide what sort of help our students need for every task we assign. The guidance we give for taking notes will depend on various aspects. One of them is language level. Raimes suggests providing beginners with a skeleton outline to fill in or expand to make their listening more directed. She also proposes letting the advanced students listen to longer passages and make notes as they listen.

Gilbert observes that students will develop their own method of taking notes and use their own judgement as to what material to record. Therefore class discussion of notes should not have a correct/incorrect emphasis (1989:47).

Guidance provided will depend on the degree of difficulty of the task involved. The reasons for taking notes and the follow-up activities are also important. If the students only take notes of simple figures, letters, or single words as the basis for a discussion to take place immediately, they will not need much guidance. But if they are supposed to take notes of a higher complexity to use in writing a report for homework, they will need more preparation.

Using note-taking in our classes

Assuming an extreme position when defining the concept of note-taking, we can say that even checking or ticking items on a list is a form of note-taking, as long as what students have to "tick" represents the content of the reading or listening passage. If we give students a multiple-choice exercise, a list, or Yes/No questions, and ask them only to tick the correct answer, they will be taking notes. This could be considered the most basic form of note-taking. Nevertheless, if we analyze the task in detail, we find it is not as simple as it seems. To answer accurately, the students will first have to understand the statements and determine whether their choices are correct or not. Furthermore, they have to predict and speculate about what they are going to perceive.

When teaching technical texts written in English to Cuban medical students, there are many instances where note- taking can be encouraged. Since it takes several class periods to teach each unit, the students need to recall information long after it was first presented. Therefore it is useful if they take notes as they study each case. In that way, they can express themselves accurately in subsequent classes.

The lexical items introduced in these cases may be known to the students in Spanish, but they are difficult to master in English because of their spelling or pronunciation. If, we provide multiple- choice exercises, or questions in which these terms appear, the students can tick the correct answer as they listen. As a result, they become familiar with the new lexicon and master grapheme-phoneme correspondences.

When teaching the first unit in ~!#PARAGRAPH Practical Medicine we may use this technique giving students a skeleton to fill in while listening. Example:

Unit One. "Hypertension". Lessons 1-2 pp. 11- 14.

Listen to the interview with the patient and tick (v) the correct answer:
Patient's name: Mrs. Kelly.
Main Symptoms: high blood pressure____ headache____
dizziness ____
Other Symptoms: obesity ____ blurred vision ____
trouble breathing ___ swollen ankles ____
urinary problems ___ pain in the back ____
chills and fever ____
Past History: heart disease ____ chest pain ____
kidney infection ____
Family History hypertension ____ diabetes ____
kidney disease ____ stroke ____
heart attack ____

Although students are not familiar with this vocabulary in English, most are cognate words and can be easily identified. Based on this skeleton and on the data they have from listening, students are able to speak about the case.

Once students know the technical language, they can be helped to devise a skeleton which requires them to write down new information. For example:

Unit One. "Hypertension". Lessons 3-4 pp. 16- 17.

Listen to the case report and tick (4) or fill in the information
the intern gives:
Note:(-) = Symptoms or diseases the patient denies
(+) = Symptoms or diseases the patient has or has had
Main complaint: Respiratory problems:
Other symptoms: (-) (+) -PND: ____ -Dyspnea: ____
-Dyspnea on exertion ____
Past history:(-) (+) Family history:
Physical findings:
-Ankle edema ____ -Bilateral Costovertebral ____
-Hepatomegaly ____ -Angle Tenderness ____
-Retinopathy ____ -Blood Pressure ____
Any other information?

With this last question, we are prompting the students to note down other information, not limiting them only to what the chart asks for. Not all the students will be able to take further notes, but the most skilled will not get bored while their classmates are engaged at a more elementary level.

Another instance that calls for note-taking is reporting on medical cases. To do this, the class may be divided into teams of three or four students. Each team prepares a case for the others to analyze. One variant would be having each team first brainstorm, then prepare a skeleton outline with the sort of information they need the other team to provide in order to write a full case report. Once ready, they exchange skeletons, brainstorm again, and note down the information the skeleton forms ask for. The teams should give neither the diagnosis nor the treatment. As soon as they finish, they swap these "problem-cases," analyze them, and confer on the diagnosis, treatment, and prognosis of the patient. Next, they write a full case report that everyone reads and discusses. The class then moves around, reads, and comments on them. Finally, they decide which of the skeleton forms are better and which reports are the most coherent and faithful to the information provided.

A simpler variant would be having each team ask for the information orally from one another, take notes on it and then report on the case orally or in writing.

If the case report has been assigned as a course project, students can take notes both when gathering information for their paper and when listening to their classmates' reports (See Appendix ).

After the first two or three units in Practical Medicine , students have enough language background to be sent to the ward to observe a specialist as s/he examines a patient. They will have to take notes in English about the whole procedure. Later in the classroom they will give a full account of what was observed in the ward based on these notes.

In teaching Medically Speaking , I suggest taking notes while listening to the dialogues or reading the case studies given in the text. The table in Unit 5, "Colitis," is a good example of how to get students to focus on specific information while listening. Instead of having the students take down all the information, teams are formed to take notes on specific parts.

The following table is on the board and copied in the students' notebooks:

Unit Five. "Colitis". Listening Practice A pp. 62

Teams 1, 2, 3, 4
Books closed. Listen and take notes to fill in the table below:
Team 1: Sigmoidoscopy
Team 3: Plain X-rays
Team 2: (Second Test)
Team 4: Physical Exam
When you are ready, go to the board and fill in your part of the table. Then check your answers with team 5. Afterwards write a report on your portion of information. Share your report with the other teams.
Team 5:
Books open, Listen to and read the dialogue in your books. Take notes on all the information required in the table. Be ready to help the teams. Close your books and report to the whole case.
(*)= Included or excluded items.












*Not performed

Plain X-rays


* U. K.


*Physical Exam



*Emaciated and drowsy.

Table for student notebook


As we have seen, there are numerous opportunities to help students develop the skill of note-taking. Note-taking assists the listener, reader, or observer in achieving a better understanding of what is presented, and it facilitates recall of facts as well as oral and written expression. The student's language level and the purpose which the notes are to serve will determine the type of guidance the teacher must provide to help them to take notes in class and later on the job.

Clara Perez Fajardo is an assistant professor at the Instituto Superior de Ciencias Medicas de la Habana. She has also been teaching ESP to medical students at the Facultad Finlay-Albarran.



  • Abbott, G., D. McKeating, J. Greenwood, and P. Wingard. 1981. The teaching of English as an international language. A practical guide. London: Collins.
  • Berman, H. S. (n.d.) Medicine. Practical Surgery. London: Macmillian.
  • Gilbert, J. B. 1989. Clear speech. New York: Cambridge University Press.
  • Grellet, F. 1986. Developing reading skills: A practical guide to reading comprehension exercises, new direction in language teaching. New York: Cambridge University Press.
  • Murray, D. M. 1982. Learning by teaching: Selected articles on writing and teaching. Portsmouth, NH: Boynton Cook Publishers Inc.
  • Nwokoreze, U. N. D. 1990. Note-taking. English Teaching Forum, 33, 2, pp. 39-40.
  • Raimes, A. 1983. Techniques in teaching writing. New York: Oxford University Press.
  • Sandler, P. L. and I. G. Barrison. 1987. Medically speaking, English for the medical profession. Havana, Cuba: Edicion Revolucionaria.
  • Wallace, M. J. 1983. Study skills in English. 2nd. Printing. Cambridge: Cambridge University Press.

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Vol 34 No 2, April - June 1996
Page 22


Instructions for preparing and presenting a case report
First think of an interesting case you would like to report on and discuss with your classmates. Consult your professors, look for information about your case and associated diseases or cases in magazines, books, journals, etc. Note down this information. Then make an outline of the elements you need in order to report on a case
1. Patient's
Age: Sex:     Race:
Weight: Height:
2. Main symptom:  8. Physical findings
3. Other symptoms:  9. Diagnostic procedure:
4. Past history: 10. Differential and definitive diagnosis:
5. Family history: 11. Therapeutic procedures:
6. (Toxic) habits: 12. Possible complications
7. Medications: 13. Prognosis
Note down the data you have from your patient and write your case report:
    I. Introduction:
    a) Global outlook about the disease.
    b) Objectives
    II. Development: the case itself
    III. Conclusion: based on the case compared with the
    information you gathered from the bibliography and the
    specialists as well as your own experience
    IV. Bibliography:
Before presenting your case orally, copy the outline on the board, ask your classmates to also copy it in their notebooks. You will all follow this order for the presentation and discussion of your case. Your classmates will ask you for the data they need to complete their outlines and discuss the case. Once the discussion is over, they will use their notes to write a report on the case you presented.
Patient's characteristics: Age: 22 Race: white Sex: M

Weight: 70 kg.

Height: 1.70m.
Main symptom: pain in the right lower quadrant (sporadic and colicky in nature)
*began in epigastrium two days ago
*moved to periumbilical region and right lower quadrant
Other symptoms: fever, vomits (3), anorexia, constipation for two days (no bowel movement). No diarrhea
Past history: -none
Family history: -none
Toxic habits: -none
Medications: -none
Physical findings: -patient well oriented as to time, place and
-well nourished
-extreme tenderness to palpation mainly
over McBurney's point
-guarding, muscle rigidity, rebound
-difference: axillary & rectal temperature
-bowel sounds: absent
Diagnostic procedures: urinalysis (-)
Sed rate: ^

Hg. & ht.: normal

Differential diagnosis: acute pancreatitis, acute cholecystitis, myocardial infarction, gastroduodenal ulcer, perforation of an ulcer
Definitive diagnosis: acute appendicitis
Therapeutic procedures: appendectomy
Possible complications: perforation, necrosis, peritonitis
Prognosis: Anceps
Today we discussed the case of a 22-year-old white man who was in good health prior to two days ago, when he began to have an abdominal pain. This pain was sporadic and colicky in nature. It began in the epigastrium and has since migrated to the right lower quadrant. The patient has had three episodes of vomiting associated with the pain. He has been anorectic and feverish. He has had no bowel movements for two days. He reported no diarrhea, coughing with expectoration or shortness of breath. He has no past history or family history of abdominal pain or any other disease. The pertinent physical findings are related to the abdomen. There is extreme tenderness to palpation, especially over McBurney's point. Guarding, muscle rigidity and rebound tenderness are all present. Bowel sounds are absent. There is a difference between the axillary and the rectal temperature. His urinalysis, hemoglobin and hematocrit are within normal limits. Nevertheless, both white blood count and red rate are elevated. His chest film is clear, but in the abdominal film we observed the psoas line is absent.

We established the differential diagnosis with acute pancreatitis, acute cholecystitis, myocardial infarction, gastroduodenal ulcer and perforation of an ulcer. Finally, we decided the definitive diagnosis is acute appendicitis. Among the possible complications to consider are perforation, necrosis and peritonitis. Therefore, the prognosis is anceps. The only possible treatment is surgical: appendectomy.

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