The corpus on which the following analysis is based consists of eight papers on the teaching of English as a foreign or second language in Medical Faculties,(17) for a total of about 115 typewritten pages and 43491 tokens.(18) The choice fell on should (one of the 5866 forms or types), with 61 occurrences in the corpus, because it is used in a variety of ways in several key-points of the text.(19) Hereafter, corpus will refer to the whole set of eight papers, while subset refers to the sentences containing the 61 instances of should. The subset is entirely reported below.(20)
A preliminary general survey reveals two types of sentences:
Let us begin with a number of instances of a heuristic-didactic type in which should is used in such expressions as it should be clear, it should be noted, etc., corresponding to Italian si noti, sia ben chiaro, occorre ricordare and the like:
From the description given above of what happens in medical congresses, it should be clear that the answer to this question must be: intelligibility, i.e. to understand others and be understood.
Second, it should be kept in mind that in a class with a shared first language teacher-led work in pronunciation will be needed even when there is mutual understanding.
The use of modals, such as may, might, and could, is another common feature of scientific prose. It should be pointed out that if the writer of a paper has an element of doubt, he/she uses the form may, might, etc., rather than commit him/herself rashly.
It should be emphasised that unlike some of the students, they [= doctors] are well aware of their need for English in their professional activities.
In all the four cases above the grammatical subject is "impersonal it".
A second group includes attitude markers, mostly in the direction of downtoning one's statements, and some transitional elements (corresponding to ora vorrei parlare di...) combining should and the verb to like:
In this paper I should like to describe a situation in which the use of popularised versions of medical articles seems appropriate...(21)
I should now like to describe one situation in which we [...] make use of popularised medical texts.
Scientific articles have become more purely scientific, in the positivistic science tradition I should add.
In the following passage we find should used to point out how a cautionary recommendation is to be interpreted:
Because discussion in this area is so dependent on clinical knowledge and experience, it has to be said that case conference material is less suitable for medical students, especially those at a pre-clinical stage. This cautionary recommendation should not be regarded as absolutely prohibitive, however, for there is some scope for adapting the use of the material to the situation of the medical student in the later years of study.
Notice it has to be said as an alternative form parallel to it should be said.
Finally, we find should in passages where the authors refer to circumstances outside the methodological discourse proper: collaborations, working conditions and possible developments. The first example duly acknowledges the colleagues' role:
I am greatly indebted to my colleagues Joan Maclean and Dr. Ron Howard [...] I should also point out that it is they who have initiated the development of many of the teaching procedures described here.
The second example expresses a wish and offer a suggestion:
It's our hope that the work that is being carried out in our Institution will be useful for other Institutions [...] . This should happen at least during this transition period which doesn't promise to be a very short one.
Then we find should after if to refer to an undesirable possibility:
The Colleagues who share my professional concern are kindly invited to share their insights and expertise as well, for it would be seriously uneconomical, and service delaying, if each of us should start from zero, multiplying efforts, mistakes and small discovery steps.
2.5 "The Medical English course should..."
Here we begin the analysis of the second type of sentences in the corpus, where deontic should is used to express ‘didactic precepts', starting from sentences where we also find other forms conveying deontic or alethic modality:(22)
A further point to be taken into account is that the lexical difficulties a learner has to face may differ in relation to their L1. [...] This supports the view currently held in wider foreign language circles in Italy that EFL textbooks should be "country specific". In other words, they should take into account the similarities and differences that exist between learners' L1 and L2 with a view to dealing more effectively with relevant problem areas.
In the example, and in several other cases that follow, a parallel alternative form of should is the verb to be + V-en: compare to be taken into account and should take into account.
Which 500 words are to be taught must be established by individual teachers, perhaps with reference to published word frequency lists, but whatever they are I recommend that as far as possible they should be grouped according to meaning, in semantic sets.
Here too we find are to be that is parallel to should be; in the next examples should is connected in various ways with need (noun or verb) and with other expressions of necessity:
Although these groups are simply mentioned, this should suffice to provide an idea of the broad, sharply diversified spectrum of curricula that need to be designed, in order to properly serve the learner population of our Institution.
A needs analysis of the students shows that at the end of the English course, they should at least be able to read a medical text.
The definition of needs and goals is central to curriculum-based teaching.
Students, at least of the lower levels, need a list of the principal false cognates, and whenever others appear in the text they should, naturally, be pointed out - if possible during the pre-reading course with elementary students.
If the language level of the group makes the use of target-level activities quite impossible, then it will be necessary to provide a series of graded activities leading up to the target activities. The target activity should then be attempted as soon as it is within reach - and that is much sooner than on a more conventional course.
Note how If...then it will be necessary parallels should then. There are interesting instances of combinations of different modalities:
[...] the cost-benefit balance dictates that the emphasis should be on the repeated meaningful practice of an essential minimum of phrases, rather than studying a rich repertoire of gambits.
The verb form dictates requires should; verbs like require and those of the group suggest, recommend, etc. behave in a similar manner
According to the Collins COBUILD English Grammar, "when someone makes a suggestion about what someone else, not their hearer, should do, you report it by using a that-clause. This clause often contains a modal, usually should: ‘He proposes that the Government should hold an inquiry.'"
The list of the reporting verbs used in this type of sentence is: advise agree ask beg command decree demand direct insist intend order plead pray prefer propose recommend request rule stipulate suggest urge, to which we now add dictate.(23)
The other words are not common in medicine and the temptation to include them for the sake of completeness should probably be resisted.
Here we find probably next to should and we can perceive how complex the discourse may become when modalities combine with hedging processes. A hedge is a word or phrase (usually adverbial) that limits and qualifies the statement where it occurs. The following two examples include theoretically and ideally:
A language teacher of the present era theoretically should not wonder whether the learners are motivated to learn a foreign language or not.
A hedge like theoretically softens the deontic modality and introduces an epistemic gradient.
Given these demands, a course of English for medical congresses should ideally aim at producing a native- speaker-like ability in speaking and listening. But this ideal is unrealistic.
Here we find an "unreal should", where ideally and unrealistic in the following sentence mark it as irrealis.
It is sometimes a main verb like suggest (corresponding to proporre, indicare) that orientates the reader as to the value to be attributed to should:
To summarise so far, I suggest that learners coming from General English classes should be systematically taught about 500 words which are more common in medicine than in general English.
It is suggested that real beginners should [...] repeat the English course in the faculty for two years, and study during their holidays or when they are free, between the first and second year.
There are cases where the objectives are linked to what students must know or must be able to do, so should co-occurs with can, be able, know how, etc.
The Advanced and Upper Intermediate level students should be able to infer or understand information not specifically stated [...]
In most examples drawn from specialist texts should is followed by be + past participle; we have already found: "The design [...] should be clearly formulated in an experimental protocol which should be transmitted..." and "Biomedical research [...] should be conducted...". More examples:
The words deleted by the teacher should, of course, be carefully chosen [...] .
Grammatical errors tend to have less effect on intelligibility than pronunciation and should be given correspondingly less attention.
Words from all three of these groups should be included in systematic vocabulary teaching.
As a noun line has at least 39 meanings [...] and a number of these are common in medicine. How many meanings should be taught?
Initially, learners should be encouraged to stick to those compound terms that are already accepted as established forms within medical discourse.
Some vocabulary, particularly the most common medical terminology, should be pretaught.
In ESP as ELT the above-mentioned skills should be integrated. What happens in reality is that, due to lack of time or facilities or appropriate materials, some are more favoured than others.(24)
The value of the phrase in reality is analogous to the use of probably, theoretically and ideally seen above.
It should be pointed out that the techniques that we automatically use in reading in our mother tongue can and should be transferred to reading in a foreign tongue (this is at least valid when the European languages are involved).
Should occurs twice in this passage (the second time it is paired with can), illustrating both its main uses (in Italian: occorre sottolineare and le tecniche... devono essere trasferite)