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El cálculo del coste hospitalario

CONTABILIDAD DE COSTES EN LOS CENTROS SANITARIOS

4.4. El cálculo del coste hospitalario

Over the history of applied linguistics, different theories of learning have been proposed to account for how grammar is learned. During the middle of the previous century, for instance, grammar learning was thought to take place through a process of verbal ‘habit formation’. Habits were established through stimulus-response conditioning, which led to the ‘overlearning’ of the grammatical patterns of a language. In order to help students overcome the habits of their native language and inculcate those of the target language, teachers conducted pattern practice drills of various types: repetition, transformation, question and answer, etc. Teachers introduced little new vocabulary until the grammatical patterns were firmly established. Language use was also tightly controlled in order to prevent students making errors that could lead to the formation of bad habits that would later prove difficult to eradicate.

With the rise of generative grammar and its view of language as a system of rules, grammar learning was seen to take place through a process of ‘rule formation’, which itself was brought about when students formulated, tested and revised hypotheses about grammatical structures in the target language. Thus, students were seen to play a much more active role in the classroom than they had earlier.

Consistent with this perspective, students’ errors were not to be feared, but rather welcomed as evidence that students were attempting to test their hypotheses and receive feedback, with which they could then revise their hypotheses. In the classroom, students were given written grammar exercises so they could induce the grammatical rules that would allow them to generate and understand novel sentences.

With the shift toward a more communicative approach to language teaching, views of grammar learning changed once again. Some held that grammar learning took place implicitly and most effectively when students’ attention was

not on grammar at all. In other words, they said that grammar was best learned subconsciously when students were engaged in understanding the meaning of the language to which they were introduced (Krashen and Terrell, 1983). Those that adhered to a Chomskyan universal grammar (UG) perspective felt that target language input alone or input with negative evidence (that is, evidence that a particular form is ungrammatical) might be sufficient to have learners reset the parameters of UG principles in order to reflect the differences between the native language and target language grammars (White, 1987). Others felt that explicit grammar teaching had a role (Norris and Ortega, 2000), with some claiming that explicit attention to grammar was essential for older language learners whose ability to acquire language implicitly, much as children learn their native language, was no longer possible, or at least no longer efficient.

Second language acquisition (SLA) research in both naturalistic and classroom environments has informed modern perspectives of grammar learning (see Chapter 7, Second Language Acquisition). SLA research tells us that an analysis of the language that learners use, their ‘interlanguage’, reveals that grammar is not acquired in a linear fashion, one structure being mastered after another. Further, with regard to any one structure, learners use a lot of intermediate forms before conforming to what is accurate in the target language. It can easily be seen that many learners’

utterances are overgeneralizations. For example, learners of English produce

‘eated’ for ‘ate’, interpreted by some researchers as evidence for the process of rule formation in SLA. Learners also use forms that do not resemble target forms, and they do so consistently, such as using pre-verbal negation during early English language acquisition (for example, ‘no want’), regardless of the native language of learners. This behaviour explains why it has been said that the interlanguage is systematic, that is, learners operate consistently within a system, albeit one that is not consonant with the target language. New structures are not simply assimilated one by one, but rather as a new structure makes its appearance into a learner’s interlanguage, the learner’s system begins to shift. Thus, learning does not add knowledge to an unchanging system – it changes the system (Feldman, 2006).

It is also clear, however, that rule formation does not account for all of grammar learning. Indeed, some would argue that it has no role in SLA at all. Connectionist or neural network models support such a conclusion (Ellis, 1998). Repeated exposure to target language forms contributes to the strengthening of connections in neural network models. The models simulate rule-like grammatical behaviour even though no rules or algorithms are used in constructing the model. Instead, patterns are abstracted from the way structures are statistically distributed in massive amounts of input data. With the use of connectionism to simulate the way that neural networks in the brain function (see Chapter 7, Second Language Acquisition), new ways of conceptualizing grammar learning are coming to the forefront.

One method that is receiving a great deal of attention is emergentism (Ellis and Larsen-Freeman, 2006; Larsen-Freeman, 2006). Emergentists believe that rather than speakers’ performance being managed by a ‘top-down’ rule-governed system, learners’ interlanguage emerges from repeated encounters with structures and with opportunities to use them. In this way, it could be said that language learning is an iterative process, revisiting the same or similar territory again and again (Larsen-Freeman and Cameron, 2008). Thus, grammar learning is facilitated by the frequency of use of the forms in the language to which the learner is exposed. The Zipfian profile of language, in which certain forms are used very

frequently while others are used far less so, facilitates the process of abstracting the patterns (Ellis and Larsen-Freeman, 2009). The fact that frequently-occurring constructions are often semantically concrete and short in length aids the learning process (Goldberg, 2006).

Regardless of which type (or types, as is more likely the case) of process is responsible for learning, SLA research makes clear to most researchers that some attention must be given to grammar by second language learners. However, it is also clear that the attention to form should not come through the use of decontextualized drills or isolated grammar exercises. Learners will be able to complete the exercises satisfactorily when their attention is focused on the grammar, but when their attention shifts to a more communicative interaction, the grammar will be forgotten. In order for learners to be able to transfer what they have learned in the classroom to more communicative contexts outside it, pedagogical activities have to be psychologically authentic, where there is alignment between the conditions of learning and the conditions of subsequent use (Segalowitz, 2003).

Further, for new forms to be incorporated into the intermediate language, or

‘interlanguage’, that learners speak, it is thought that students must first notice what it is they are to learn (Schmidt, 1990). Until they do, the target form may merely remain as part of the ‘noise’ in the input. Then too, even when they are able to produce grammatical structures accurately, students still need to learn what they mean and when they are used. In other words, learning grammar does not merely entail learning form.

In fact, as we noted earlier, what needs to be learnt about grammar can be characterized by three dimensions: form, meaning and use. We have seen in Figure 2.1 that the dimensions are interconnected, but nonetheless can be described discretely. For example, in learning the rule of English subject–verb agreement discussed above, students would have to learn the form that an ‘s’ is added to the verb stem and that the orthographic ‘s’ may be realized in pronunciation as one of three allomorphs /s/, /z/ or /∂z/. (The slashes indicate sounds; see Chapter 9, Sociolinguistics, and Chapter 12, Speaking and Pronunciation.) They would also have to learn what it means, that is, that it signals the present tense and that the subject is third person and is conceived of as a single entity. This being the case, usually, singular subjects go with singular verbs and plural subjects with plural verbs.

However, to show that the meaning contribution is independent from form, we only have to think of a case where there is a departure from this convention. For example, a sentence such as ‘Ten miles makes for a long hike.’ shows us that even a plural subject can be conceived of as a single entity. Here again, as we showed earlier, there are times when the rule of subject–verb agreement does not apply.

Teaching students when to use it and when not to, then, becomes an essential element in grammar instruction.

The same analysis holds for a formulaic utterance. A greeting, such as ‘Good afternoon’, for instance, can be described in terms of its form, a noun preceded by an attributive adjective. Its meaning is a greeting at a particular time of day.

Learning to use it would involve, for example, students’ learning when to use it as opposed to learning to use a more informal greeting such as ‘Hi’. Another example of learning to use greetings is the need for learners of English to learn that ‘Good night’ is used only for taking leave. ‘Good evening’ is appropriate for a greeting, no matter what time of night it is. This is different from other languages in which the equivalent of ‘Good night’ is used as a greeting. This last point highlights the

influence of the L1. Because the patterns of the native language are so entrenched, many believe that grammar teaching is the only, or certainly the most efficient, way to help learners master new patterns.