Medical case reports in English and Vietnamese - A genre-based analysis.pdf

VIETNAM NATIONAL UNIVERSITY, HANOI
UNIVERSITY OF LANGUAGES AND INTERNATIONAL STUDIES
*****
NGUYEN THI TUYET MAI
MEDICAL CASE REPORTS IN ENGLISH AND VIETNAMESE:
A GENRE – BASED ANALYSIS
(Các báo cáo trường hợp lâm sàng tiếng Anh và tiếng Việt:
Phân tích dựa vào thể loại)
A dissertation submitted in partial fulfilment of the requirements for the
degree of Doctor of Philosophy in Linguistics
HANOI – 2019

VIETNAM NATIONAL UNIVERSITY, HANOI
UNIVERSITY OF LANGUAGES AND INTERNATIONAL STUDIES
*****
NGUYEN THI TUYET MAI
A GENRE – BASED ANALYSIS
(Các báo cáo trường hợp lâm sàng tiếng Anh và tiếng Việt:
Phân tích dựa vào thể loại)
MAJOR: ENGLISH LINGUISTICS
CODE: 9220201.01
A dissertation submitted in partial fulfilment of the requirements for the
degree of Doctor of Philosophy in Linguistics
Supervisor: Assoc. Prof. Dr. Le Hung Tien
HANOI – 2019

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DECLARATION
I certify my authority of the study project report submitted entitled:
A GENRE-BASED ANALYSIS
In fulfilment of the requirements for the degree of Doctor of Philosophy in
Linguistics at Vietnam National University, Hanoi
Except where the reference is indicated, no other person’s work has been used
without due acknowledgement in the text of the dissertation.
Hanoi,2019
Signature
Nguyen Thi Tuyet Mai

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ACKNOWLEDGEMENTS
Firstly, I would like to express my deep gratitude to my supervisor,
Associate Professor Doctor Le Hung Tien, for his continuous constructive
suggestions, guidance, help and encouragement over the last few years. Thanks to
his constant presence and aid, I can overcome many obstacles and hurdles along the
stressful writing stages of this dissertation and find the motivation to keep moving
on my own work.
Secondly, I would also like to thank Doctor Huynh Anh Tuan from VNU, Hanoi
University of Languages and International Studies, Faculty of Post Graduate Studies and
Doctor Pham Hien from Vietnam Institute of Lexicography and Encyclopaedia who
contributed to this dissertation. Their valuable and thought-provoking comments and
feedback have helped me to enhance this work in its style and content.
Thirdly, I would like to give many thanks to all the professors and teachers
from the VNU, Hanoi University of Languages and International Studies whom I
had during my coursework years for acting as members of the examination
committee and for their constructive questions, suggestions and comments about
this research.
Next, I express my sincere and deepest gratitude to my friends and
colleagues from Faculty of Foreign Languages, Vietnam Military Medical
University who has patiently listened to all my problems and helped me at different
stages of this research over the last few years. Thank them for all the vivid
discussions we have had.
Most importantly, I would not have been able to complete this work without
the support of my family; Many thanks to my parents, my mother-in-law, my
sisters, my brothers and my lovely children who have always been there for me and
supported me in all of my decisions. I would like to thank them for their
unconditional, unselfish love and support. I also would like to give special thanks to
my big friend, my husband who even not knowing anything about this research, has
motivated me endlessly.

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ABSTRACT
The current study used ESP approach to genre analysis with the emphasis on
move analysis based on Swale‟s theory (then developed by Nwogu 1997 Hylan
2002 and Mend z-Ced n 2009) to analyze English and Vietnamese medical case
reports (MCRs) encompassing Abstract, Introduction, Case presentation and
Discussion sections. The study was carried out with two main aims: (i) to explore
how the moves and lexical signals of the moves work in English and Vietnamese
MCRs and (ii) to compare these moves to establish the similarities and differences
between the two corpora. The moves were analyzed in terms of frequency, length
and steps while the lexical signals were examined concerning typical linguistic
features such as words, phrases and reporting verbs (RVs). The study was designed
as a descriptive, qualitative, quantitative and comparative study. The results
obtained from the analysis of 80 MCRs in English and Vietnamese published within
2010 and 2015 lent weight to the following general conclusions: First, the genre of
the MCRs was made up of twelve conventional moves with 22 steps. Second, the
Vietnamese MCRs were longer because of the amount of the information presented
in the reports. Third, the typical phrases used in the Vietnamese MCRs were not as
diversified as in the English MCRs due to a repetitive use of the same expressions
in the reports. Finally, more reporting verbs were used in the English MCRs
because the writers may lack judicious use of the RVs, efficiency in using the verbs,
or creativity of successful academic discourse. The study acknowledged some
limitations: First, the order of the moves was still neglected and second, it would be
better if the thesis dealt with reporting verbs in some depth, taking into
consideration the interpersonal function of language. Despite these limitations, the
study is hoped to provide some pedagogical implications for teaching ESP in
Vietnamese settings to help students to be aware of the moves and steps when
writing a MCR.

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TABLE OF CONTENTS
DECLARATION....................................................................................................... i
ACKNOWLEDGEMENTS..................................................................................... ii
ABSTRACT.............................................................................................................. iii
TABLE OF CONTENTS.......................................................................................... iv
ABBREVIATIONS.................................................................................................. vii
LIST OF TABLES ................................................................................................ viii
CHAPTER I: INTRODUCTION ............................................................................1
1.1. Rationale for the study .........................................................................................1
1.2. Scope of the study................................................................................................3
1.3. Aims and research questions................................................................................3
1.4. Research methods.................................................................................................4
1.5. Significance of the study......................................................................................5
1.5.1. Theoretical significance ....................................................................................5
1.5.2. Practical significance ........................................................................................5
1.6. Structure of the thesis...........................................................................................5
CHAPTER II: LITERATURE REVIEW ...............................................................7
2.1. APPROACHES TO GENRE ANALYSIS ..........................................................7
2.1.1. The Systemic Functional Sydney School approach to genre analysis..............8
2.1.2. North American New Rhetoric tradition approach to genre analysis.............10
2.1.3. The ESP Approach to Genre analysis.............................................................12
2.1.4. Summary of the approaches to genre analysis................................................16
2.1.5. Distinction between genre analysis and register analysis ...............................18
2.2. MEDICAL CASE REPORTS AS A GENRE ...................................................20
2.2.1. Definition of a medical case report.................................................................20
2.2.2. MCRs and other research methods in clinical settings ...................................21
2.2.3. Limitations and merits of MCRs.....................................................................22
2.2.4. Structure of a medical case report...................................................................25

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2.3. PREVIOUS STUDIES OF MCRs .....................................................................26
2.4. THEORETICAL FRAMEWORKS OF THE STUDY......................................29
2.4.1. Theoretical framework for move analysis ......................................................29
2.4.1.1. The notion of move analysis ........................................................................29
2.4.1.2. Swale‟s move analysis .................................................................................30
2.4.1.3. Major studies based on Swale‟s move analysis ...........................................33
2.4.1.4. The rationale for adapting Hyland (2000), Nwogu (1997) and M ndez-
Cend n (2009) models of move analysis..................................................................41
2.4.2. Contrastive framework....................................................................................42
2.5. CONCLUDING REMARKS.............................................................................43
CHAPTER III: METHODOLOGY......................................................................45
3.1. THE DESCRIPTION OF THE DATA..............................................................45
3.1.1. The description of the chosen MCRs..............................................................45
3.1.2. The description of sources ..............................................................................46
3.1.3. Criteria for collecting the data ........................................................................48
3.1.4. English and Vietnamese MCRs ......................................................................49
3.1.5. Data entry........................................................................................................53
3.2. DATA ANALYTICAL TOOLS........................................................................56
3.3. DATA ANALYTICAL FRAMEWORK...........................................................57
3.3.1. The modified model of move analysis............................................................58
3.3.2. The analysis procedures ..................................................................................60
3.4. CONCLUDING REMARKS.............................................................................64
CHAPTER IV: DEPLOYMENT OF MOVES IN ENGLISH AND
VIETNAMESE MCRs............................................................................................65
4.1. DEPLOYMENT OF MOVES IN ENGLISH MCRs.........................................65
4.1.1. Deployment of moves in English MCR abstracts...........................................65
4.1.2. Deployment of moves in English MCR introductions....................................78
4.1.3. Deployment of moves in English MCR case presentations............................84
4.1.4. Deployment of moves in English MCR Discussions......................................92

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4.2. DEPLOYMENT OF THE MOVES IN VIETNAMESE MCRs .......................99
4.2.1. Deployment of the moves in Vietnamese MCR abstracts ..............................99
4.2.2. Deployment of moves in Vietnamese MCR introductions...........................108
4.2.3. Deployment of moves in Vietnamese MCR case presentations ...................114
4.2.4. Deployment of moves in Vietnamese MCR Discussions.............................118
4.3. CONCLUDING REMARKS...........................................................................123
CHAPTER V: SIMILARITIES AND DIFFERENCES BETWEEN MOVE
DEPLOYMENT IN ENGLISH AND VIETNAMESE MCRs..........................126
5.1. COMPARISONS OF MOVE DEPLOYMENT BETWEEN ENGLISH AND
VIETNAMESE MCRs............................................................................................126
5.1.1. Comparisons of move deployment between English and Vietnamese MCR
abstracts...................................................................................................................126
5.1.2. Comparisons of move deployment between English and Vietnamese MCRs
introductions............................................................................................................133
5.1.3. Comparisons of move deployment in English and Vietnamese MCR case
presentations............................................................................................................137
5.1.4. Comparisons of move deployment in English and Vietnamese Discussions......142
5.1.5. Comparisons of move deployment in English and Vietnamese MCRs as a whole147
5.2. SUMMARY .....................................................................................................156
CHAPTER VI: CONCLUSIONS........................................................................158
6.1. SUMMARY OF THE FINDINGS ..................................................................158
6.2. PEDAGOGICAL IMPLICATIONS................................................................163
6.3. LIMITATIONS OF THE STUDY...................................................................164
6.4. SUGGESTIONS FOR FURTHER RESEARCH ............................................164
THE AUTHOR’S PUBLICATION RELATED TO THE DISSERTATION.166
REFERENCES......................................................................................................167
APPENDICES ...........................................................................................................I

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ABBREVIATIONS
EAP: English for Academic Purposes
EMP: English for Medical Purposes
ESP: English for Specific Purposes
ICD: International Classification of Diseases
IMRD: Introduction – Methods – Results – Discussions
M1: Move 1
M2: Move 2
M3: Move 3
M4: Move 4
M5: Move 5
M6: Move 6
M7: Move 7
M8: Move 8
M9: Move 9
M10: Move 10
MCR: Medical Case Report
MRA: Medical Research Article
RCT: Randomised Controlled Clinical Trials
RGS: Rhetoric Genre Studies
RV: Reporting verb
SFL: Systemic Functional Linguistics
VMMU: Vietnam Military Medical University
VNU: Vietnam National University

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LIST OF TABLES
Table 1. Three approaches to genre analysis ............................................................16
Table 2. Ten common pitfalls of MCRs ...................................................................22
Table 3. The individual sections and their contents of a medical case report ..........25
Table 4. The CARS Model........................................................................................31
Table 5. The model of abstract move analysis by Hyland........................................36
Table 6. The model of move analysis of whole article by Nwogu ...........................38
Table 7. The modified model of move analysis of case presentation section...........40
Table 8. A Corpus of English MCRs ........................................................................50
Table 9. The domestic journals rankedby the Council of Vietnamese Medical
Professors ..................................................................................................................51
Table 10. A Corpus of Vietnamese MCRs ...............................................................53
Table 11. Classification of the 11 disease groups with the codes based on ICD 10.54
Table 12. The modified model of move analysis of a MCR as a whole...................60
Table 13. The data of the moves in English abstract section....................................66
Table 14. An example of English M1 abstract..........................................................69
Table 17. The use of RVs in English abstracts .........................................................75
Table 18. The data of the English introduction moves .............................................78
Table 19. An example of English M6 introduction with two steps ..........................79
Table 20. The use of RVs in English introductions ..................................................82
Table 21. Data of the English case presentation moves............................................84
Table 22. An example with two steps in M9 case presentation section ...................86
Table 23. The use of RVs in English Case presentation section ..............................90
Table 24. Frequency of the occurrence of moves in English discussion section......93
Table 25. An example of M14 in English MCR discussion section.........................95
Table 26. The use of RVs in English discussion section ..........................................97
Table 27. The data of moves in Vietnamese MCR abstracts..................................100
Table 28. An example of Vietnamese M1 abstract (1) ...........................................102

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Table 32. The use of RVs in Vietnamese abstracts.................................................106
Table 33. The data of the Vietnamese introduction moves ....................................109
Table 34. An example of Vietnamese M6 introduction with two steps..................110
Table 35. An example of Vietnamese M7 introduction with two steps..................110
Table 36. The use of RVs in Vietnamese introductions .........................................112
Table 37. Data of the Vietnamese case presentation moves...................................114
Table 38. The use of RVs in Vietnamese case presentation section.......................117
Table 39. The data of the moves in Vietnamese discussion section.......................119
Table 40. The use of RVs in Vietnamese discussion section .................................122
Table 41. Frequency of the occurrence of the abstract moves................................127
Table 42. The number of tokens, types and sentencesin English and Vietnamese
MCR abstract moves...............................................................................................127
Table 43. The RV use in English and Vietnamese abstracts ..................................131
Table 44. Frequency of the occurrence of moves in the introduction section ........133
Table 45. The number of tokens and sentencesin English and Vietnamese MCR
introduction moves..................................................................................................134
Table 46. The use of RVs in English and Vietnamese introduction section...........136
Table 47. Move frequency in English and Vietnamese Case presentation section......138
Table 48. The number of tokens and sentencesin English and Vietnamese MCR case
presentation moves..................................................................................................138
Table 49. The RV use in English and Vietnamese Case presentation section........141
Table 50. Move frequency in English and Vietnamese discussion section ............143
Table 51. The number of tokens and sentencesin English and Vietnamese
discussions...............................................................................................................143
Table 52. The RV use in English and Vietnamese discussion section ...................145
Table 53. The RV use in English and Vietnamese MCRs......................................151
Table 54. A model of move analysis of a medical case report ...............................162

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LIST OF FIGURES AND CHARTS
Figure 1. Metafunctions in relation to register and genre.........................................19
Figure 2. Categories of Reporting Verbs ..................................................................62
Figure 3. An example of a longer concordance ........................................................64
Chart 1. The move frequency of occurrence in English and Vietnamese MCRs ...147
Chart 2. Number of tokens in English and Vietnamese MCRs ..............................148
Chart 3. Number of sentences in English and Vietnamese MCRs .........................149

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CHAPTER I
INTRODUCTION
1.1. Rationale for the study
Medical case reports (MCRs) serve as “primers” leading to discoveries of new
diseases or disease pathophysiology as well as development of new preventive and
therapeutic measures. According to Li et al. (2013), MCRs are employed as a
platform for the training of medical students and resident doctors in scientific
writing and critical thinking. MCRs are also an excellent means of describing
important adverse drug effects and for postulating links between previously
unrelated symptoms, signs and syndromes. In addition, they can and should suggest
new hypotheses and stimulate further studies. However, compared to other research
in clinical settings such as overviews, randomised controlled clinical trials, cohort
studies, case-control studies and cross-sectional surveys, MCRs have not received
much consideration and are under-represented in genre studies since they are
seldom definitive and can rarely prove causation.
In Vietnam, the limited amount of research about MCRs has lead to a limited
understanding in describing this structured writing and the understanding of
scholars in the medical field trying to publish their research into international
journals. Almost all linguistic research concerning with the biomedical field has
focused on finding the ways of translating medical terms from English to
Vietnamese in order to standardize the system of Vietnamese medical terms and to
propose concrete direction and solutions to designing a textbook for medical
students. For example “Examining English medical terms and the way of
translating them into Vietnamese” by Minh (2005) and “English – Vietnamese
methods of medical translation” by Huong (2008). In addition, there have been
some studies mapping and describing the generic characteristics of the biomedical
texts including “A study on the meaning and structure of a biology text: A System
Functional Grammar” by Mai (2008) and “Lexical and morphological
characteristics of medico-pharmaceutical texts” by Hanh (2008).

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In the world, in recent years, MCRs have been studied more extensively, such
as “Medical Case Reports and Scientific Thought-styles” by Taavitsainen (2011),
“Case Report writing in a Doctor of Physical Therapy Education Program: A Case
Study. Journal of Scholarship of Teaching and Learning” by Fillyaw (2011),
“Analysis of Published Medical Case Reports: Genre-Based Study” by Helán
(2012), etc.Each discipline has fore-grounded or back-grounded certain aspects of
medical language due to different theoretical perspectives, different analytical
methods, or different research emphases. Nevertheless, so far, no reported research
has been devoted to the contrastive analysis about the genre of MCRs in English
and Vietnamese. The issue thus has been an uncultivated land within Vietnamese
applied linguistics.
To fill the gap, the author of this paper, thus, desires to carry out a study titled
“Medical Case Reports in English and Vietnamese: a Genre-based Analysis” with
the emphasis on moves of the MCRs in both languages. The important role of move
analysis when analyzing a genre is emphasized by many linguists. Bonyadi (2012),
for example, agreed, “The central to the analysis of a certain genre is the
identification of the moves in a text based on the conventions set by the discourse
community” (p.7). Similarly, Biber et al., (2007) claim that move analysis is a
subset of genre analysis that examines discourse by concentrating on its
organization. In their opinion, moves are considered as functional units in a text,
together fulfilling the overall purpose of the genre and “moves of genre are
considered as an inherent part of the genre”. (p. 32)
Hopefully, the thesis would help the novice researchers, who begin their study
as outsiders in the academic community “unfamiliar with the rules of the game”
(Gosden, 1995) of academic research deal with serious problems when they attempt
to publish their research articles in international journals. Firstly, they can
understand how to conform to the overall organization as well as how to use certain
expressions and vocabulary commonly employed in their respective discourse
communities and academic disciplines. Secondly, they can read and write a medical
research article in general and a medical case report in particular in English with the

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least challenges and they can handle academic writing tasks encountered in a higher
education setting.
1.2. Scope of the study
The moves are analyzed in terms of their frequency, length and steps while the
lexical signals are analyzed regarding words/phrases and reporting verbs.
(Reporting verbs are known as one of the explicit ways for writers to establish the
credibility of the reported claims and considered as one of the lexical devices that
writers need for both expressing a stance and connecting or aligning themselves
with the readers in scientific articles). In clinical settings, medical research papers
are considered as persuasive texts by nature, and in reporting work by others, their
authors need to show how their work is in agreement with a previous study or how
it is different, and must evaluate previous work accordingly, thereby presenting an
evaluative stance. The current research studies how the reporting verbs work in the
moves and how a researcher can use the verbs in a specific context to show
disagreement or agreement with the findings of others. During the analysis, the
taxonomy suggested by Hyland‟s (2002) including Research Acts Cognition Acts
and Discourse Acts is referred.
1.3. Aims and research questions
According to Swales (1990 & 2004), two levels of move analysis are the study
on moves and the lexical signals of the moves. In the current study, Swale‟s theory
(then developed by Hyland, 2002, Nwogu, 1997 and Mend z-Ced n, 2009) is used
with the focus on move analysis to analyze the moves in English and Vietnamese
MCRs with the following aims: (1) to explore how the moves and lexical signals of
the moves work in English and Vietnamese MCRs and (2) to compare these moves
to establish the similarities and differences between English and Vietnamese MCRs.
To reach the aims, the current study seeks the answers to the following research
questions:

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1. How do moves work in English and Vietnamese medical case reports?
1.1. What are the frequency and length of moves in English and Vietnamese
medical case reports?
1.2. How do the steps of moves operate in English and Vietnamese medical
case reports?
1.3. How do the lexical signals of moves operate in English and Vietnamese
medical case reports?
2. What are the similarities and differences between English and
Vietnamese medical case reports regarding the identified items?
The first research question identifies the moves in English and Vietnamese
MCRs regarding their length, frequency, steps based on the modified models
adopted from Hyland (2000), Nwogu (1997) and M ndez-Cend n (2009). To
explore the lexical signals of moves, the typical words/phrases and RVs are picked
up and examined.
The second research question attempts to find out the similarities and
differences between English and Vietnamese MCRs in terms of the identified items.
The comparison of the two sources of MCRs can provide with an understanding of
how the English and Vietnamese researchers arrange moves in their writing.
1.4. Research methods
The study is designed as a descriptive, qualitative, quantitative and comparative
study that allows the researcher of the current study to analyze, describe and
compare analyses the moves used in English and Vietnamese MCRs. In particular,
the analytical approach of comparative method is used to compare the shared and
unshared identified items in English and Vietnamese MCRs. The current study thus
is a Mixed Method Research Design. According to Lazaraton (2005, p. 219 cited in
Angouri, 2010, p. 32) combining approaches is not only feasible but also beneficial
in revealing different aspects of „reality‟. Angouri (2010 p. 41) shared the same
idea when claiming that mixed method “can provide rich datasets and enhance our
understanding of complexities in most research areas in linguistics”. In the current
study, the quantitative data reveal different frequencies of moves and lexical signals

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used in MCRs. At the same time, the closer qualitative analysis of discourse data
shows how the moves and lexical signals are used by English and Vietnamese
writers to achieve the goals.
1.5. Significance of the study
1.5.1. Theoretical significance
The study provides an in-depth and detailed description of MCRs in English and
Vietnamese not only of the surface linguistic features but also of the discourse
conventions and underlying socio-cultural values. In addition, it equips medical
staffs with basic knowledge of English cultural background and understanding of
the specific genre in both languages.
1.5.2. Practical significance
The findings of the study help the lecturers develop pedagogical strategies and
address problems in the context of a process-oriented writing course with the
evidence of cross-linguistic influence and differences in discourse. Moreover, they
support students, doctors, researchers and medical staffs in studying, translating and
writing MCRs in Vietnamese and English in social contexts relevant to their
educational, social and cultural needs. More importantly, the results make
contribution to promoting and popularizing the medical achievements of training,
scientific research and treatment of Vietnamese medicine in general and Vietnam
Military Medical University where the author has been working as a teacher of
English for over 20 years in particular.
1.6. Structure of the thesis
This thesis includes six chapters. After CHAPTER I - Introduction to the study
including the rationale to the study, aims and research questions, scope of the study,
significance of the study, research methods, research data and structure of the thesis,
the thesis is continued with the following chapters:
CHAPTER II – Literature Review – is concerned with presenting different
linguistic approaches of previous studies on the theme of genre analysis. It is
designed with the following main sections. The first section deals with a critical
review on different approaches of genre analysis in order to show the contributions

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of the previous studies and to establish the gap that needs to be filled in the studied
issues. It also gives the reasons for the use of the appropriate approach in the current
research. The next section concentrates on the genre of MCRs and the last section
focuses on the description of the move analysis as the theoretical framework for the
current study.
CHAPTER III - Methodology – provides a detailed research design, and
methodology for the current study in which the description of data set, the modified
model, the analytical framework and the procedures of the moves analysis are
given.
CHAPTER IV – Deployment of moves in English and Vietnamese MCRs –
presents the main results of move analyses of English and Vietnamese MCRs
regarding the move frequency, length, steps, typical phrases and reporting verbs.
The analyses are carried out section-by-section (Abstract, Introduction, Case
presentation and Discussion).
CHAPTER V – Similarities and differences between move deployment in English
and Vietnamese MCRs – is provided with two purposes. Firstly, it compares and
discusses the similarities and differences of the moves in terms of the identified
items English and Vietnamese authors used in their papers. During the analyses, the
possible reasons for the similarities and differences in English and Vietnamese
MCRs are discussed.
CHAPTER VI – Conclusions is the final part of the study. First, the prominent
findings of the study are summarized and it is followed by the pedagogical
implications, contribution and limitations of the study. It closes with some
suggestions for further studies.

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CHAPTER II
LITERATURE REVIEW
This chapter encompasses a literature review of the following issues. First, three
broad schools of genre analysis are reviewed in terms of their different conception
and pedagogical approaches: Systemic Functional Linguistics (also known as the
Sydney School), North American New Rhetoric studies, and English for Specific
Purposes (ESP) tradition. In addition, the distinction between genre analysis and
register analysis is also discussed to draw a clear picture of why the ESP approach
to genre analysis should be used in the current study. Second, the chapter concerns
with the general understanding about the genre of medical case reports (MCRs)
such as the definition, their benefits and limitations and the structure. The genre is
compared to other kinds of genre used in clinical settings. The chapter then
examines the previous research of the different sections of MCRs and discusses
their limitations that the current study may do to fill the gaps. Finally, it establishes
the theoretical framework that guides the research.
2.1. APPROACHES TO GENRE ANALYSIS
Henry and Roseberry (2001)stated that the general aim of genre analysis was to
identify the moves and strategies of a genre, the allowable order of the moves, and
the key linguistic features. The next step was to explain why these features were
chosen by expert users of the genre to achieve their communicative purpose. The
similar idea was also given by Quin (2000) who stated that the fundamental aim of
genre analysis was to “study the communicative purposes of a discourse and the
language use strategies” (p. 42).
That is why genre analysis has been a useful method for the description of
different text types. According to the father of genre, Swales (1990), genre analysis
was the study of how language was used within a particular setting. Rhetorical
styles and discourse types were the issues that genre analysis may focus on. The
idea was also shared by Barron (2012) that this approach is “concerned with the
question as to how members of a specific community use language to get things

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done” (p.7). He added that genre analysis was widely used and recognized
internationally by three schools, namely: (i) Australian genre-based educational
linguistics (also referred to as the Sydney School) drawing on Systemic Functional
Linguistics (SFL), (ii) Rhetorical Genre Studies (RGS, also known as North
American Genre Theory) drawing on and contributing to New Rhetoric and (iii)
English for Specific Purposes (ESP) – an umbrella term for areas of English study
such as academic English, medical English, legal English or business English. The
following subsections discusses in details the three approaches.
2.1.1. The Systemic Functional Sydney School approach to genre analysis
The Systemic Functional Sydney School approach to genre (known as
Systemic-Functional Linguistics approach) was founded by a British-born scholar
Halliday with the focus on the relationship between language and its functions in
society. The approach attempts to explicate why and how people in social contexts
used the language it thus “is more closely aligned with Sociology: it explores how
language is used in social contexts to achieve particular goals” rather than
concerning with “language as a mental process”. (O‟Donnell 2012). It does not
study language for the sake of language alone but seeks to contribute to educational,
economic and political processes. It means that the approach understands the
language as belonging to one of the semiotic systems constituting a culture.
Consequently, the language can be interpreted in the context of culture and the
structure of language is inextricably linked to social function and context.
Instead of viewing texts in relation to communities like Swales (1990, 2004),
the SFL approach analyzes three meta-functions of meaning-making known as the
ideational, interpersonal, and textual. Ideational metafunction deals with how the
language is used to represent our experiences of the physical, the psychological and
the social world. They can be realized through the „system of transitivity‟ with the
focus on „a process‟ (realized by a verbal group) „the participants‟ involves
(realized by nominal groups) and their „circumstances‟ (realized by adverbial
groups). Interpersonal metafunction is realized by the „systems of mood‟ and
„modality‟. The former concentrates on the exchange of information and of goods

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and services while the latter is used to show the relationship between the text‟s
authors and their representations. Textual metafunction expresses how the text is
organized in relation to its context and its message through the „system of
Theme/Rheme‟. Theme is related to the message‟s point of departure and Rheme‟ is
concerned with its continuity in the clauses‟ syntactic organization.
From a systemic point of view, the choice of the distinct metafunctions can
create the context of a text and the register elements can activate different areas of
semantics and grammar (Figueiredo, 2010). The register realizes genre by three
variables: field, tenor and mode. Field is recognized in the culture, within which the
language is playing some part or the total event (Halliday & Hassan, 1985:45-46). It
refers to what is happening, to the nature of the social action that is taking place.
Tenor refers to who is taking part in the text and to the nature of the participants‟
status and roles, kinds of relationship obtained among the participants. Mode refers
to what part of the language is playing (prototypically speech or writing). The
register can be understood as the context that is constituted by texts. Consequently,
register known as functional language variation, is a “contextual category
correlating groupings of linguistic features with recurrent situational features”
(Gregory & Carroll, 1978:4).
In “An Introduction of Functional Grammar” Halliday (1994) concluded that in
any piece of discourse, there were always two possible levels of achievements to
aim at understanding and evaluating the text. The former “enables one to show how,
and why, the text means what it does”. It means that the linguistic analysis related
the text to general features of the language, especially grammar. The later “enables
one to say why the text is, or is not, an effective text for its own purposes – in what
respects it succeeds and in what respects it fails, or less successful”.
Talking about this approach, Bawarshi and Reiff (2010) gave the summary of
the theory by pointing out that according to this approach,
“… language is organized the way it is within a culture because such an organization
serves a social purpose within that culture. „Functional‟ thus refers to the work that
language does within particular contexts. „Systemic‟ refers to the structure or organization
of language so that it can be used to get things done within those contexts. „Systemic‟ then

10
refers to the „systems of choices‟ available to language users for the realization of
meaning” (original emphasis). (p. 29-30)
By giving the explanation of the terms such as “Function” and Systemic” the
summary makes the SFL theory clearer.
The SFL theory of Halliday‟s work (2006) has attracted much attention from
some researchers. (Eggins, 2004), for example, provided an accessible first step into
systemic for those who wish to equip themselves with the conceptual and practical
tools to analyse and explain how people make meanings with each other in
everyday contexts. (Martin & Rose, 2008), on the other hand, introduced our
general orientation to genre from the perspective of system and structure, and places
genre within our general model of language and social context. In “The language of
schooling. A functional linguistics perspective” Schleppegrell (2004) built on
current sociolinguistic and discourse-analytic studies of language in school. She
added a new framework of functional linguistic analysis focusing not only on the
structure of words and sentences, but also on how particular grammatical choices
created meanings in the different kinds of texts students were asked to read and
write at school.
In short, genre can be understood in simple and easy way from SFL approach
by the summary of Imtihani (2010) that the concept is used to “describe the impact
of the context of culture on language, by exploring the staged, step-by-step structure
cultures institutionalize as ways of achieving goals” (p. 92). The SFL genre analysis
concentrates not only on its situational contexts including field, mode and tenor, but
also on its structure and the realizational patterns in the texts.
From pedagogical perspective, Gebhard & Harman (2011) stated that “SFL
scholars have focused their research agendas on supporting the academic literacies
of non- dominant students in elementary and secondary schools” and that “teaching
academic literacies involves apprenticing English language learners to using
school-based genres and registers”. (p.48-49)
2.1.2. North American New Rhetoric tradition approach to genre analysis
The principle for this approach is originated from the essay "Genre as Social
Action" by Mille & Miller (1994) who examines genre as typified social action, as

11
ways of acting based on recurrent social situations. In other words, the discourse
performs the rhetorical action as pragmatics, the genre thus must focus on the action
not on the substance or the form of discourse it was used to accomplish. The
understanding of genre in her work in 1984 can be summarized as follows:
- a typified rhetorical response to (uptake of) a recurrent rhetorical situation
- pragmatic not formal or substantive; a “macro” speech act
- a significant social action, which created meaning
- a mediation between private intentions (purpose) and socially objectified
needs (exigence)
Some further entailments of genre as social action include these
considerations:
- Genres are categories, or types, of social action.
- Typification is culturally dependent.
- “De facto” genres are culturally important because they marked cultural
categories; as such genres collectively help to “constitute” society in
Giddens‟s sense. (Giddens 1984)
- Genres are recognized by those who use them, as opposed to those who
study them
- Rhetorical genres are an open, evolving class and as such, genres do not
constitute a neat, mutually exclusive taxonomy. (Miller, 2015)
According to Coe and Freedman (1998), the theory studied how particular
discourses were socially motivated, generated, and constrained. It thus put the
answer to the question “as what it means to say that an individual (or small group
of collaborating individuals) wrote a particular memo, article, or novel and what it
means to say that we not only write but are written”. (p. 41). When comparing this
approach with other traditional theories they claimed while “traditional theories of
genre focused primarily on discursive form, the new theories explain the discursive
structures of a genre functionally, as standard responses of a recurring type of
rhetorical situation”. (p. 41).

12
The difference was also shown by Bawarishi & Reiff (2010) who said that
instead of studying the context when analyzing the text, the North American New
Rhetoric Approach “viewed context as an ongoing, inter-subjective performance,
one that is mediated by genres and other culturally available tools”.
Although this new approach to genre constitutes a particularly powerful and
promising approach to writing as social process and “provides a basis for
teaching/learning methods that could prepare students to handle the social
constraints they will face in practical writing tasks” (Coe & Freedman, 1998), some
linguists have been concerned about the pedagogical implications that this approach
brought to education. Bawarshi & Reif (ibid.), for example, wondered what the
pedagogical quandary that this approach has faced. To illustrate the idea they gave
an example situation where students would be asked to perceive a task as serving a
certain function within an activity system. In this case, they would likely select a
mediational means (a genre or set of genres) that is appropriate to their
understanding of the objective. Subjectivity compatible with that understanding
could be unavoidable because although some students may recognize the
object/motives, they may not have accessed to the appropriate mediational means.
According to them, how we used the mediational means depended on how we
understand the object and outcomes.
Miller (2015) did a new research to revisit her work in 1984 and concluded that
the genre in recent years has become much more complex. It has been not only a
multidimensional social phenomenon but also a “structurational nexis between
action and structure, between agent and institution, between past and future”.
Consequently “we can continue to learn from the diversity of recurrent categories
that structure our social worlds”. (p. 69).
2.1.3. The ESP Approach to Genre analysis
The ESP approach to genre subsumes areas of language study such as English
for Academic Purposes (EAP), English for Business and Technology (EBT),
English for Medical Purposes (EMP) and English for Professional Communication
(EPC). In ESP genre analysis, the work of ESP researchers is based on the study of

13
the occurrence or absence of certain linguistic features such as hedges (Hyland,
2006), addresses features (Hyland, 2001a), imperatives (Swales & et.al., 1998),
passive voice versus metonymy (Rundblad, 2007), self-mention Hyland (2001b),
the expression of stance (Charles, 2003), collocational frameworks (Marco, 2000).
In the above work, formal and academic genres utilized by academic and
professional discourse communities are the principal research objectives.
From a pedagogic perspective, the description of ESP genre may be useful in
instructing ESP learners. In ESP, language analysis tasks help learners gain
awareness of the communicative purposes and linguistic features of texts that they
need to read and write in their disciplines and professions. The analysis is believed
to help English as a Second/Foreign Language (ESL/EFL) learners deal with the
nature of writing, understand and master the organizational and stylistic features of
professional and academic genres.
In ESP genre analysis “move” and “step” are the central recognition that have
been given different meanings. For example, Bhatia (1993:30) considered moves as
“discriminative elements of generic structure”. Yang and Allison (2003) stated that
a move was a semantic unit of text achieving a unified purpose in ESP genre
analysis. Moves served the function and purpose of a segment of text at a more
general level and step provided a more detailed rhetorical means of realizing the
function of a move.
The ESP approach is associated predominantly with the names of Swales
(1990) with three central terms: discourse community, genre and language learning
task.
 Discourse community
According to Swales (1990), there were two different types of community:
speech and discourse. The former “was seen as being composed of those who share
similar linguistic rules” (p. 23) while the later was identified by six following
characteristics:
1. A discourse community has a broadly agreed set of common public goals
2. A discourse community has mechanisms of inter-communication among its members.

14
3. A discourse community uses its participatory mechanisms primarily to provide
information and feedback.
4. A discourse community utilizes and hence possesses one or more genres in the
communicative furtherance of its aims.
5. A discourse community has acquired some specific lexis.
6. A discourse community has a threshold level of members with a suitable degree of
relevant content and discoursal expertise. (p. 24 – 27)
When describing these characteristics, Swales noted several things. Goals can
be published in documents or be implicit; high level or abstract. Communication
can be through text or confrontation. Information exchange is relative to the
common goals. Discourse communities develop around the genres upon which it
establishes itself. Lexis is essentially a compilation of vocabulary, so each
community has its own terminology specific to that group. There should be a
reasonable ratio between experts and newcomers.
The term discourse here refers to language with a specific communicative
purpose used in a given social context, and discourse community represents the
users of that particular discourse. According to him, the experts in the discourse
community are able to recognize the purposes of a genre. As a rule, the people who
have just been initiated into the discourse community are less capable of doing.
The main difference between discourse and speech communities is that
discourse communities separate the existing people into groups whereas speech
communities are looking to include outsiders. In other words Swales‟ discourse
community here is distinguished from speech community in sociolinguistics. In
sociolinguistics, the main objective of the community is in the socializing of its
members whereas in Swales the main objective of the discourse community is in its
members‟ sharing of the same interest either social or academic.
 Genre
Swale‟s (1990) definition of genre attempts to capture how writers achieve their
social purposes by using various structural forms, constructing different focuses and
manipulating topics. According to him, genre was determined by the actions they

15
help accomplish (communicative purpose) and the people interacting through them
(discourse community) as follows:
“a class of communicative events the members of which share some sets of communicative
purposes. These purposes are recognized by the expert members of the parent discourse
community, and thereby constitute the rationale for the genre. This rationale shapes the
schematic structure of the discourse and influences and constrains choice of content and style.
Communicative purpose is both a privileged criterion and one that operates to keep the scope
of a genre as here conceived narrowly focused on comparable rhetorical action. In addition to
purpose, exemplars of a genre exhibit various patterns of similarity in terms of structure, style,
content and intended audience. If all high probability expectations are realized, the exemplar
will be viewed as prototypical by the parent discourse community but typically need further
validation.” (p. 58)
In his definition of genre, the communicative event was a complex notion,
comprising not only of the discourse itself but also of the role of the discourse and
the environment and culture surrounding it. However „communicative purposes‟
were claimed for the challenges and difficulties. As he put it: “… the fact that
purposes of some genres may be hard to get at is itself of considerable heuristic
value. Stressing the primacy of purpose may require the analyst to undertake a fair
amount of independent and open-minded investigation, thus offering protection
against a facile classification based on stylistic feature and inherited beliefs, such
as typifying research articles as simple reports of experiments”. (p. 46). However
there have been also some cases in which “identifying purposes may be relatively
easy” (p. 46). Recipes and political speeches were obvious examples.
In short, what adopted from his definition of genre are the use of language in a
conventionalized setting and the structure. The former reflects the communicative
purpose and the latter is determined by smaller parts called "moves" by Swales
(1990). Every move is characterized by its own specific purpose, which is reflected
in the subject matter. For that reason, the generic structure is considered as one of
the major representatives of the purpose of genre. In other words, this approach to
genre analysis is characterized by identifying a set of „moves‟ and „steps‟,
embedded in a spoken or written discourse, which realizes the communicative
purpose(s) of a member of a discourse community.

16
 Language Learning Task
The third concept of Swales‟ (1990) genre analysis is language learning task.
Swales defined the concept as “one of a set of differentiated, sequenceable goal-
directed activities drawing upon a range of cognitive and communicative
procedures relatable to the acquisition of pre-genre and genre skills appropriate to
a foreseen or emerging sociorhetorical situation”. (p. 76)
Swales recommends performing a number of language-learning tasks to help
students come closer to understanding the role of genre in their discourse
communities. For example, Swales provided three short request letters for papers.
He designed critical thinking and reference questions to ask the students to perform
his requested tasks. His conclusion is that “a genre-centred approach is likely to
focus student attention on rhetorical action and on the organizational and linguistic
means of its accomplishment” (p. 82).
2.1.4. Summary of the approaches to genre analysis
Table 1 summarizes the general features of the three approaches to genre
analysis have been discussed above.
Approaches Settings Text analysis Theories
ESP EAP, L2 tertiary
education
Structure move
analysis
“A genre comprises a class of
communicative events, the members of
which share some set of communicative
purposes.” (Swales, J., 1990)
SFL
primary and secondary
education and adult
migrant education
Analysis of linguistic
features
“A genre is a staged, goal-oriented,
purposeful activity in which speakers
engage as members of our culture”.
(Martin, J. R., 1984)
New Rhetoric L1 tertiary education Text analysis based on
ethnographic methods
“Genre as Social action” with social
purposes (Miller, C.R. 1984)
EAP: English for Academic Purposes; L1/L2: first/second language
Table 1. Three approaches to genre analysis (adopted from Kobayashi, 2003, p. 7)
As can be seen in Table 1, there are several ways in which these three genre
approaches differed from one another. The idea is shared in the work named Genre
– An Introduction to History, Theory, Research, and Pedagogy by Bawarshi and

17
Reiff (2010). According to them, although SFL and ESP genre approaches both
agree that linguistic features are connected to social context and function, they
differ in their applied target audience, theory behind them and the methods of text
analysis. In the SFL approach, the definition of genre is based on Hallidayan theory
of systemic linguistics, the analysis is thus within the systemic functional approach.
The North American new rhetoric approach focuses on social purposes of genre (the
study of genre involves an ethnographic study of the surrounding social context). In
this approach, the analysts try to analyze a genre through the study of the society in
which the genre is used. Therefore, the method of analysis is more akin to that of
ethnomethodology. In the ESP approach, genre is defined as a class of
communicative events. The analysts look for textual patterns common in a genre by
analyzing the moves. The level of analysis is not only look at the level of text but
also the lexico-grammatical level. The analysts look at the use and the meaning of a
particular word or phrase in a particular genre.
In addition, Flowerdew (2013) found that the ESP approach was rather eclectic
in its approach, while the Sydney school worked with well-developed linguistic
theory and descriptive model. In addition, the ESP approach is easy to apply while
the SFL school is more detailed and requires training in the theory and analysis. On
the other hand, RGS school does not have a model of language perse. This research
is in support of this idea and choose the ESP approach to genre analysis, especially
Swales‟ theory to apply to the current study. It is relevant to the purposes of this
study for the following reasons. First, it gives priority to EAP, particularly to EMP
(English for Medical Purposes). Second, it gives the application of discourse
community through written communication (specialized texts known as MCRs)
among healthcare professionals who use highly specialized terminology, specific
abbreviations and acronyms that can be easily recognized by fellow community
members. Lastly, Swales‟ model not only focuses on rhetorical organization but
also suggests the lexico-grammatical signals of each move and steps that are similar
to the purposes of the current study.

18
2.1.5. Distinction between genre analysis and register analysis
The terms genre and register are the most confusing because they overlap to
some degree, they both apply to analyzing characteristics of varieties of texts and
“involve the adaptation of linguistic and discourse structures to a situation defined
by a complex of social, cultural, and communicative factors” (Ravid & Tolchinsky
2002, p. 424). Consequently, they are often used interchangeably by the linguists
such as Biber (1995), Guenthner and Knoblauch (1995).
However, it is worth noting that, despite the similarities between the two terms,
there are considerable differences between them that should be emphasized.
Couture (1986), for example, offered an alternative explanation to avoid the
conflation of genre and register by claiming that registers are constrained at the
linguistic levels of vocabulary and syntax, whereas genre operates at the level of
discourse structure. Further “Unlike register, genres can only be realized in
completed texts or texts that can be projected as complete, for genre does more than
specify kinds of codes extant in a group of related texts; it specifies conditions for
beginning, continuing, and ending a text” (p. 82). In his opinion genres such as
research reports, business reports, and newspaper articles are compleTable
structured texts, while register including language of scientific or newspaper
reporting and bureaucratic language is more generalizable stylistic.
Nunan (2008) also distinguished genre and register by saying that while genre
related to the context of culture, register related to the context of situation. Register
analysis thus examined the relationship between a text and the situational context
surrounding the creation of the text. (p. 58).
Similarly, Lee (2001) claimed one difference between the two terms was that
“genre tends to be associated more with the organisation of culture and social
purposes around language” and “is tied more closely to considerations of ideology
and power, whereas register is associated with the organisation of situation or
immediate context” (p. 41-42)
Martin (2001) had a harmonious view by claiming that genre was realized
through registers and registers in turn “are realized through language”. The

19
relationship between them can be illustrated in Figure 1 that illustrates how genre
(context of culture) related to register (context of situation) as realized through the
metafunctional diversity of language.
Figure 1. Metafunctions in relation to register and genre
(Adopted from Martin, J. R., 2001, p.52)
In short, register corresponds to the context of situation, and genre to the
context of culture. According to Swales (1990), the emphasis of genre studies falls
into three following criteria:
- Genres as a types of goal-directed communicative events
- Genres as having schematic structures; and most strikingly
- Genres as disassociated from registers or styles (p.42)
Unsurprisingly register analysis thus “focuses mainly on the identification of
statistically significant lexico-grammatical features of linguistic variety” (Bhatia
1993, p.5). In other words, special importance to register analysis is the case of
“above-average incidence or even a lack of certain linguistic features, be they
lexical, grammatical or even discoursal / rhetorical, in the text under study” (p. 17).
Although register analysis has common important aim with genre analysis - that it
to “characterize typical or conventional textual features of any genre-specific text”
(p. 16), it possesses some limitations discovered by Bhatia (1993). First, the
findings from register analysis do not provide adequate insights about the way
information is structured in particular variety since it emphasizes on surface
features. Consequently, it is difficult to explain why a particular variety takes the

20
form that it does.... Second, the focus on surface-level description from the register
analysis fails to yield appropriate “insights into the rationale underlying selection
and distribution of surface linguistic features”. (p. 6).
In contrast, in his opinion, another aim of genre analysis is to “identify […]
form –function correlations” and to “explain such a characterization in the context
of the socio-cultural as well as the cognitive constraints operating in the relevant
area of specialization, whether professional or academic” (p.16). In other words, it
attempts to go beyond “a surface level description to a more functional and
grounded description of language use” (p. 5) taking into consideration “not only
socio-cultural but psycholinguistic factors too” (p. 39). Thick description taken
from genre analysis helps to clarify not only “the communicative goals of the
discourse community in question, but also the individual strategies employed by the
members to achieve these goals” (p. 39 - 40). According to him, “a genre is a
recognizable communicative event characterized by a set of communicative
purpose(s) identified and mutually understood by the members of the professional
or academic community in which it regularly occurs” (p.13). Thus, both authors
emphasize the communicative purposes of the text are the most important features
related to genre, shapes the genre and gives it internal structure.
Since genre analysis involves not only the analysis of lexico-grammatical
features but also the analysis of text-patterning or textualization and structural
interpretation of the text – genre, it becomes possible to justify the use of the term
genre analysis for the analysis undertaken in this dissertation.
In this study, the genre chosen to study is from the field of professional medical
writing known as Medical Case Reports (MCRs). This genre is carried out as part of
the everyday routine in hospitals and other health-care facilities and has received close
attention. The following sub-section gives more information about this kind of genre.
2.2. MEDICAL CASE REPORTS AS A GENRE
2.2.1. Definition of a medical case report
MCRs play an important role in the decision-making process regarding the
steps in the management of pathological conditions. They are “a time-honored,

21
important, integral, and accepted part of the medical literature”. (Rison, 2013). A
Case report is a “report of a single case of a disease, usually with an unexpected
presentation, which typically describes the findings, clinical course, and prognosis
of the case, often accompanied by a review of other cases previously reported in the
biomedical literature to put the reported case in context”. (Segen's Medical
Dictionary, 2011). Similarly, (Kirthi, 2011) from Royal College of Physicians also
defined MCRs as “a means of communicating something new that has been learnt
from clinical practice. It could be about an unusual or previously unknown
condition, a rare presentation or complication of a known disease, or even a new
approach to managing a common condition”. In shorts the MCRs in this study can
be understood as a medical recount of a rare pathological condition in a single
patient.
2.2.2. MCRs and other research methods in clinical settings
According to Greenhalgh (2001: 39 – 55), clinical decisions about interventions
in the treatment of patients made by medical professionals can be ranked from the
most objective, statistically and reliable studies to the most subjective.
1. Overviews: They are statistical syntheses of the results of several clinical trials
addressing the same medical question. The research tends to be more reliable,
accurate conclusions, more generalizable findings and more consistent results
because it can identify weak studies and limit bias.
2. Randomised controlled clinical trials (RCTs): The participants are randomly
selected and offer a medical standard intervention. RCTs are the gold standard in
medical research because their aims are to reduce bias when testing a new
treatment and they allow rigorous evaluation of a single variable in a precisely
defined patient group. However, RCTs are claimed to be expensive and time
consuming.
3. Cohort studies: two (or more) groups of people are selected on the basis of
differences in their exposure to a particular agent (such as a vaccine, a medicine)
and follow up to see how many in each group develop a particular disease or
other outcome. Cohort studies may take years or even decades to measure.

22
4. Case-control studies: Case-control studies are generally concerned with the
aetiology of a disease (i.e. what causes it), rather than its treatment. The studies
find out what might have caused a specific pathological condition in a group of
patients. The results of analysis of the patients‟ past medical records are then
compared to a control group of patients.
5. Cross-sectional surveys: In this type of research, the opinions, behaviour, habits,
etc. of a representative sample of randomly selected patients are collected by
interviewing or using questionnaires.
6. Case reports: “Case reports are often run together to form a case series, in
which the medical histories of more than one patient with a particular condition
are described to illustrate an aspect of the condition, the treatment or, most
commonly these days, adverse reaction to treatment”. (p. 53).
Among the research methods in clinical settings, MCRs are considered as
relatively weak scientific evidence and (RCTs) are believed to be the most useful
method for confirming a specific treatment option. However, MCRs play an
important role in recognizing adverse outcomes because every patient responds to a
treatment in a different way. In addition, as highlighted above, MCRs are the first
indications of rare adverse reactions among the other methods in clinical settings.
(Greenhalgh, 2001). To understand the more about MCRs, the following sections
focus on some key issues relating to this kind of genre.
2.2.3. Limitations and merits of MCRs
Due to relatively weak scientific evidence and focusing mainly on the
development of a pathological condition, its diagnosis and treatment in a single
patient, MCRs have not been appreciated as highly as the genre of medical research
articles that are predominantly based on randomized clinical trials. Pierson, D. J.
(2004) presented a Table involving 10 pitfalls of MCRs:
1. Inexperience
2. Insufficient documentation
3. Tunnel vision
4. Bad care
5. Bad idea
6. Inadequate focus
7. Inappropriate format
8. Poor writing
9. Ineffective illustrations
10. Poor use of references
Table 2. Ten common pitfalls of MCRs (Adopted from Pierson, 2004, p.1190)

23
To overcome the problems, according to him, the researchers should be aware
of common mistakes in case report writing and take deliberate measures to avoid
them. In addition, they should focus on new syndromes, manifestations,
associations, complications, or outcomes.
Despite the limitations of MCRs, many researchers have acknowledged their
merits. Smith (2008) argued that every medical case containing a significant piece
of clinical information played an important role in teaching the medical
professionals about something new or important. The idea is presented clearly by
him as follows:
“Health care is in some ways nothing more than an accumulation of case reports just as a
population is a collection of people. And just as every person is important and different so
is every case – even when „it‟s just another sore throat”
Similarly, Vandenbroucke (2001) highly evaluated the potential roles of case
reports in clinical medicine. According to him, MCRs recognized and described
new diseases or rare manifestations of disease, detecting side effects of drugs, and
medical education and audit. In physical therapy, on the other hand, Fitzgerald
(2007) claimed that they provided detailed descriptions of how therapists meet
clinical, managerial, and educational challenges. As Nissen and Wynn (2014) put it:
“the case report is the only one that presents day-to-day clinical practice,
clinicians‟ diagnostic reasoning, disease management, and follow-up” (p. 3) and
“The major advantages of case reporting are the ability to make new observations,
generate hypotheses, accumulate scientific data about rare disorders, do in-depth
narrative studies, and serve as a major educational tool” (p. 6). From pedagogical
perspective, MCRs have been considered as ideal vehicles for teaching scientific
writing (Neely, et. al. 2008). The idea was proved by Fillyaw (2011) who described
the implementation of two courses that prepare physical therapy students to write
and disseminate a patient/client-centered case report. He concluded that by writing a
case report, students were able to exemplify evidence-based practice.
First they define their need for information about the patient/client‟s examination
diagnosis, prognosis, or treatment into an answerable clinical question. Second, they search
the peer-reviewed medical literature for the best evidence to answer the clinical question.

24
Third, they appraise the evidence for validity, impact, and applicability to their patient.
Fourth, they integrate the research evidence with their clinical expertise and experience
along with the patient‟s circumstances and preferences to develop a patient/client care plan.
(p.148)
Consequently, the current research is in line with Greenhalgh (2001) who
voiced the support of the MCRs that “a vocal pressure group within the medical
profession calling for the reinstatement of the humble case report as a useful and
valid contribution to medical science”. (p.53)
Modern life has brought many benefits to human beings, it is, however
responsible for life-threatening risks, especially diseases. Many new medications
have been launched into the general community every year. However, the discovery
of their rare side effects or negative interactions between various medications taken
together is revealed only when the study results of some MCRs came out. Moore
(2007) reported that thanks to MCRs, some specific drugs that caused rare side
effects have been removed from the market such as the use of Zomax causing
anaphylactic shock ultimately led to the withdrawal of the drug from the
pharmaceutical industry.
Concerning with the potential motives for publishing case reports in medical
journals, Green and Johnson (2000) presented 16 reasons for submitting case
reports for publication. Helán (2013) then summarized this ideas and suggested
three main aims for publishing contemporary MCRs including “to advance the
knowledge about pathologies and their treatments (i.e., research aims), to
demonstrate best practices helping physicians in their daily work (i.e., clinical
aims) and to teach lessons through clinical successes and failures (i.e., educational
aims).”
The current study thus is in support with the idea of Vandenbroucke (2001) who
states that a case report teaches us what is „un-known‟ or „un-recognized‟ either
what medicine does not know yet („progress‟) or what individual doctors have not
yet recognized („education‟). Usually there is „the element of surprise‟“. In other
words “un-known” and “un-recognized” are two main features that MCRs brought
us. The former refers to progress and the latter is concerned with education. The

25
language of MCRs is thus concerned with lexis of description and explanation.
Although there have been clear limitations to the methodology of case studies in
determination of treatment and establishment of new tests, the understanding of
particularly rare diseases in terms of etiology, pathogenesis, natural history, and
treatment could make contribution to the training of potential junior investigators.
2.2.4. Structure of a medical case report
The layout (superstructure) of a medical case report may differ widely
according to policies of Journals. According to Rison (2013), individual sections of
an actual case report in a sequence that matches the requirements of the specific
journals as in Table 3:
The Medical Case Report
Abstract
“Background, an introduction about why this case is important and needs
to be reported”
Introduction
(background)
“The background of the case, such as the disorder, usual presentation
and progression, and an explanation of the presentation if it is a new
disease”
Case
presentation
“A description of the patient‟s relevant demographic information, any
relevant medical history of the patient; the patient's symptoms and signs;
any tests that were carried out and a description of any treatment or
intervention”
Discussion
“An evaluation of the patient case for accuracy, validity and uniqueness;
comparison and contrast of the case report to the published literature”
Conclusion
“Information on how it will significantly advance our knowledge of a
particular disease etiology or drug mechanism (if appropriate)”
Table 3. The individual sections and their contents of a medical case report
(adopted from Rison, 2013, p. 4-5)
Rison concluded that the “Discussion” section might be optional for the above
journals. However, many researchers, such as Aitken and Marshall (2007), argued
that the discussion section was the most important component for medical readers
because they put the case into the right context with explanation of treatment
decisions and giving an outline of the importance of the case and its future use in
everyday medical practice. Similarly, Cohen (2006) also agreed that among five

26
sections, the discussion section was the most important because it evaluated the
patient case for accuracy, validity, and uniqueness.
Some researchers, for example Nissen and Wynn (2014) stated that the general
standard medical case report in the 20th century was towards neutralization of the
authors and conventionalization of the textural structure that started with an
introduction (usually without a heading) followed by the „case report‟ and the
„discussion‟ sections. The conclusion section was considered as optional Helán
(2012) because the discussion and conclusion sections were sometimes conflated
into a single heading in articles (Adel & Moghadam, 2015). They also concluded
that this standardization seemed to be an equivalent to the development of the
IMRAD-norm for the quantitative research articles.
The overall format of a medical case report in some ways thus resembles the
research article. However, some medical journals may have their own unique
additional technical and orthographic requirements. Therefore, the researchers need
to consider when writing medical research articles in general and medical case
reports in particular.
The MCRs chosen to study in this dissertation are based on general format of
MCRs suggested by Rison (2013) including Abstract, Introduction, Case
presentation and Discussion. (More details can be seen in appendices 2.1 and 2.2).
Although conclusion section is seen in some MCRs, it is not put under investigation
since they are considered as optional based on the view of Helán (2012) and Adel &
Moghadam (2015).
2.3. PREVIOUS STUDIES OF MCRs
Recently, a number of studies have been done in the area of writing in academic
and research settings for specific purposes. MCRs, ones of the central mechanisms
for the exchange of information, also received attention from international linguists.
Many researchers made an effort to report the discourse structure of MCRs from
individual to complete sections.
Having seen MCRs as the most narrative (i.e., the least argumentative) and the
ones that presented the lowest level of scientific claim, Salager -Meyer (2001)

27
concluded that introduction academic conflict in MCRs “generally refer to a given
disorder that has never been reported in certain contexts or to the literature that so
far has not provided enough information on a particular issue”. In addition
academic conflict in the 'comment section was either quite direct and personal or
indirect.
Since case presentation plays an important role in a MCR, it has attracted
much attention from linguists. Hsuan Hung, et. al. (2012) identified the rhetorical
structure and linguistic features of case presentations to draw out the differences in
the linguistic features of case presentations between international and Taiwanese
medical journals written in English. Anspach (1989) examined a significant
segment of medical social life: formal presentations of case histories by medical
students, interns and residents. The analysis focused on the four features: (i) the
separation of biological processes from the person; (ii) omission of the agent; (iii)
treating medical technology as the agent; and (iv) account markers such as “states”
“reports” and “denies”. He concluded that “It is arena in which claims to
knowledge are made and epistemological assumptions are displayed, a linguistic
ritual in which physicians learn and enact fundamental beliefs and values of the
medical world” (p.1).
M ndez-Cend n (2009) focused on combinatorial patterns in case presentation
section of MCRs. The linguistic features in her study were phraseological and
rhetorical structures. Corpus-based approach was proposed to retrieve the
phraseology specific to medical case reports. Her model of move analysis of this
section will be applied to the current study. It thus will be presented and explained
clearly in the chapter II: Theoretical framework.
Murawska (2010) has analyzed a corpus of fifty-six medical case reports to
reveal how particular linguistic choices (the grammatical, rhetorical, and lexical
configurations of texts) the authors made when writing about patient diagnosis and
treatment contributed to various spatial configurations in patient imaging. Using
the figure/ground distinction or “segregation” and the metaphor of a container led
him to the conclusion that what medicine focuses on was the patient as a case of a

28
given disease and not the whole person experiencing illness. The results from
figures and grounds convinced that the authors seemed to have chosen the patient‟s
perspective for the description of the situation because of the fact that the patients
were referred to as whole persons and they could be treated as the grounds as well.
While “patients as containers” showed that the readers‟ paid attention to the
diseases examined and the treatment performed rather than to the patients
themselves. In other words, although the patients were textually presented, they did
not hold sententially prominent positions.
Being interested in the whole section of MCRs in “Hedges and Textual
Communicative Function in Medical English Written Discourse”, Salager-Meyer
(1994) stated from the study of hedges used in both medical research papers (RP)
and case reports (CR) that:
“The Discussion (RP) /Comment (CR) sections are the most heavily hedged sections,
whereas the Methods (RP) and the Case Report sections (CR) are the least-hedged
rhetorical divisions (p=.001 and .071 respectively). The Introduction section of both RP
and CR favors shields (mainly epistemic verbs) as a hedging convention followed by
approximators (negative or quasi negative expressions in RP Introductions, and adaptors of
frequency in CR Introductions). In the Introduction hedges allow researchers to establish
an "early niche" for their research”. (p. 149)
According to him, to evaluate, interpret and comment on the findings of the
research being reported researchers used shields (mostly modal verbs) in result
section of RP. However, in the Discussion/Comments sections of both RP and CR,
the researchers tended to use compound-hedges devices.
Helán (2012) used structural move analysis method of English for Specific
Purposes (ESP) genre research to examine medical case reports published in on-line
medical journals and present-day medical case reports. Specific textual aspects
deemed important for the investigation have been selected such as biomedical
rhetorical features and conventionalized lexis characteristic of this written medical
discourse. After attempting to explain the key differences between the three
established genre research traditions, she used the ESP approach to genre analysis to
explain the specific conventions of the medical discourse community, the SFL

29
method of register analysis to investigate the context and the method of structural
move analysis to describe the structural description of MCRs. Her study revealed
that the structural organization of the two genres (by means of their moves) differed
substantially in the methods and results sections of research articles/case
presentation sections of MCRs, and their discussion/conclusion sections. MCRs
could be considered a hybrid genre, comprising features of academic writing and
professional writing. However, this study utilized only the method of move
analysis, disregarding the steps or strategies.
All the above previous studies have been explored from different viewpoints.
Many of these studies focused on the linguistic use and move analysis of a single
section and few studies have investigated all sections of MCRs. However, we
should be cautious with these findings. First, the discourse structure is not analyzed
on the basis of a representative corpus because of limitations of corpus size. For
example, Hsuan Hung et. al. (2012) and Helán‟s (2012) corpora consist of 40 RAs
and MCRs, respectively. Therefore, the sampling might reflect the subjectivity.
Furthermore, different genres (such as clinical reports and experimental articles) are
included in the same corpus (e.g. Salager-Meyer, 1994).
The present study not only explores the moves but also examines the lexico-
grammatical features of the moves in the MCRs as a whole. More importantly, it
discovers the relationship between the socio-cultural reasons for the features found
at the discoursal level by employing the „same‟ analytical framework for examining
the same genre realized in the two different languages and cultures.
2.4. THEORETICAL FRAMEWORKS OF THE STUDY
2.4.1. Theoretical framework for move analysis
2.4.1.1. The notion of move analysis
Nwogu (1997) defined a move as “a text segment made up of a bundle of
linguistic features (lexical meaning, propositional meanings, illocutionary forces
etc.) which give the segment a uniform orientation and signal the constituent
elements or slots which combine in identifiable ways to constitute information in the
move.” (p. 122).

30
Move analysis is definitely important in genre analysis because this “is a helpful
tool in genre studies since moves are semantic and functional units of texts, which
can be identified because of their communicative purposes and linguistic
boundaries” (Ding 2007 p. 370). Moves organize the flow of information within a
text and “each move has its own communicative purpose, which, together with the
other moves, contributes to the general communicative purpose of the text” (Pho,
2009, p. 17). Samraj (2009) added, each rhetorical move can be realized by one or
more steps and both of them can be optional or obligatory in a genre. Generally, the
moves and steps that occur regularly in the texts can be considered as obligatory or
conventional, otherwise they can be defined as optional. The moves are held to be
optional or conventional by the different authors. According to Kanoksilapatham
(2005), an arbitrary cut-off point set to assign a category for each move is that if a
move occurs in 60% or more of the particular section in different articles, then it
can be labelled conventional, or if less, optional. Skelton (1994) set the threshold of
obligatory to optional at a frequency of 65% for a Move, while Nwogu (1997), Li
and Ge (2009) saw the move as optional if it occurred in less than 50% of the
articles in their corpora. This study bases on Kanoksilapatham (2005) to define the
conventional and optional moves. Having a 40%-50% omission cut-off for
conventional moves may seem a bit high. However, given the fact that this study
aimed to establish which rhetorical moves are more conventional than the others,
the rather high cut-off frequency would be beneficial in enhancing the distinction
between the two categories of moves. Moreover, this study is in support of her idea
in the point of view that in order to “establish which Rhetorical Moves are more
conventional than the others, the rather high cut-off frequency would be beneficial
in enhancing the distinction between the two categories of Moves”.
2.4.1.2. Swale‟s move analysis
As mentioned above, among the three approaches of genre analysis, the English
for Specific Purposes (ESP) approach will be employed in the present study to
determine the general structure of MCRs with the emphasis on move analysis.

31
Kanoksilapatham (2005) claimed that Swale‟s main aim of move analysis was
“to address the needs of advanced non-native English speakers (NNSs) learning to
read and write research articles, as well as to help NNSs professionals who want to
publish their articles in English”. (p. 25). The analysis can be considered as one of
the most common examples of a text-level analysis of discourse structure. In other
words, move analysis is developed by Swales to analyze the discourse structure of
texts from a genre; the text is described as a sequence of „moves‟ that represents a
stretch of text serving a particular communicative function. Swales‟ move analysis
not only looks at the moves through steps but also studies the lexical signals of
moves.
- Move Analysis:
The ESP genre analysis model used most widely has been Swales‟ structural
moves analysis known as the top-down four-move model (Swales, 1981) that is
upgraded to the Create a Research Space (CARS) model (Swales, 1990, 2004),
identifies a series of moves common to specific genres. These moves, defined as
“discoursal or rhetorical units that perform a coherent communicative function in a
written or spoken discourse” (p. 228) and thus help ESL/EFL students understand
and master the organizational and stylistic features of professional and academic
genres. This analytical framework is used to identify and describe the move types
that can occur in this genre (the functional/communicative distinctions that move
types can serve in the target genre).
Move 1 Establishing territory
Step 1 Claiming centrality and / or
Step 2 Making topic generalization(s) and / or
Step 3 Reviewing items of previous research
Move 2 Establishing a niche
Step 1 A Counter-claiming or
Step 1 B Indicating a gap or
Step 1 C Question-raising or
Step 2 Continuing a tradition
Move 3 Occupying the niche
Step 1 A Outlining purposes or
Step 1 B Announcing present research
Step 2 Announcing principal findings
Step 3 Indicating RA structure
Table 4. The CARS Model (Swales, 1990, p. 141)

32
Swales (1990) proposed CARS Model in fact is a revised version of his earlier
CARS Model (1981). In the 1990 version of the CARS Model, Move 1 has a
“narrowing” effect which is called “claiming centrality” Move 2 the other
important issue is “cyclicity” and the last move in the CARS Model, is labelled as
“occupying the niche”. The CARS model shows that the organization of texts
consists of moves and each move contains one or more steps. That is why
Kanoksilaptham (2005) stated that “Move analysis, as articulated by Swales,
represents academic RAs in terms of hierarchically organized text made up of distinct
sections; each section can be subdivided into moves, and each move can be broken
into steps”. (p. 271). The recognition of “move” and “step” is central to ESP genre
analysis. Moves are functional rather than formal units (Swales, 2004, p. 229).
- Lexical Signals
Since the Moves and Steps have their own linguistic exponents or signals,
Swales defines the lexico-grammatical features of each move to identify the move.
Some typical examples of linguistic components – and signals – of centrality claims
are picked out from Move 1 by him as follows:
Recently, there has been a spate of interest in how to …
In recent years, applied researchers have become increasingly interested in….
The possibility...has generated interest in …
Recently, there has been wide interest in …
The time development… is a classic problem in fluid mechanics.
The explication of the relationship between…is a classic problem of …
The well-known ... phenomena … have been favorite topics for analysis both in …
Knowledge of…has become an important aspect of …
The theory that ...has led to the hope that …
The effect of…has been studied extensively in recent years.
Many investigators have recently turned to…
The relationship between…has been studied by many authors.
A central issue in…is the validity of ... (Swales, 1990: 144)
The centrality claims in the introduction‟s outset can be made based on these
above list to emphasize the interest importance and to claim that “there are many
other investigators active in the area”. (p. 144). He also discovered that centrality

33
claims could be communicated in a single sentence or extended over two or more
sentences. In addition “Move 2 is said to be signalled, in an order of decreasing
frequency, by (1) negative or quasi-negative quantifiers, (2) lexical negation. (3)
negation in the verb phrase, (4) questions, (5) expressed needs/desires/interests, (6)
logical conclusions, (7) contrastive comment and (8) problem-raising” (Yang 2010).
However Holmes (1997) conceded that in describing a text‟s rhetorical
movement, a degree of subjectivity is perhaps unavoidable. Hopkins & Dudley-
Evans (1988) thus were reasonable to reject the linear progression of moves
described by Swales (2004) in academic research articles. According to them,
Swales‟ definition of move as “discoursal or rhetorical units that perform a
coherent communicative function in a written or spoken discourse” in somewhat
may be vague (p. 228). Despite the criticism, the framework of genre analysis
introduced by Swales can be considered as solid basis for researchers to define the
move structure and the role of each move in the text. However, since the CARS
model was created for only introduction section, the current study will base on some
other models of move analysis (developed from Swale‟s CARS model) to analyze
the moves of the MCRs as a whole.
2.4.1.3. Major studies based on Swale‟s move analysis
A glimpse at review literature reveals that different sections of a medical
research article have been investigated by several scholars based on Swale‟s model
of move analysis. However, the current research focuses only on the three main
studies in which the model of move analysis will be adapted and applied including
Hyland‟s study of abstract section Nwogu‟s study of introduction and discussion
sections and M ndez-Cend n‟s study (2009) of case presentation section. The
sections in the studies are also the main structure of a MCR.
An abstract is one of the most important sections of the research article; it can
determine the acceptance or rejection of an article for conferences, and its selection
by readers. (Marefat & Mohammadzadeh, 2013). An abstract was defined by Lor s
(2004) from The American National Standards Institute as "an abbreviated,
accurate representation of the contents of a document, preferably prepared by its

34
author(s) for publication with it". (p. 281). In other words, the main objective of an
abstract is to summarize the precise information and comprehensive reflection of
what is in your article.
The introduction section leads the reader from a general research issue or
problem to your specific area of research. According to Swale (1990), introductions
of research articles were the most difficult part for writers since they were “forced
with numerous options and decisions such as the amount of background knowledge,
the authoritative versus sincere tone, the winsomeness of the appeal to readers and
directness of the approach they should incorporate into their writing”(Mahzari,
2007). That is why “the introduction outlines the subject but does not develop it.
The aim of the introduction is to gain the reader‟s attention by giving sufficient
information to outline the problem or matter of the article” (Ahmed, 2013).
A case presentation (case report or case prescription for other names) is a
central part of a medical case report (McCarthy & Reilly, 2000). Cohen (2006)
added that when writing a case presentation section, a writer “should describe the
case in chronological order and in enough detail for the reader to establish his or
her own conclusions about the case‟s validity” (p.1888). According to this author
there is some important information about the patient should be included in this
section such as patient‟s demographics and history (age height weight sex race
and occupation) Patient‟s laboratory and diagnostic data (Pertinent positive or
negative laboratory results diagnostic procedures) patient‟s medication history (the
medication‟s name strength dosage form route and dates of administration) and
patient‟s diet. Rison (2013) put a similar idea by saying that “one should usually
begin with the primary complaint, salient history (including significant family,
occupational, and other social history along with any significant medications taken
or allergies), followed by the physical examination, starting with the vital signs
presented at the examination, along with pertinent investigations and results” (p.5).
Basturkmen (2012) stated that the discussion section was used to talk about how
the results of the research integrated with and contribute to disciplinary knowledge.
In other words, Discussion section suggested the credibility, asserted the lucidity

35
and appropriateness of the approach to the problem, and advanced the correctness of
the solution of the researchers. That is why when presenting the Discussion section,
the writer should take a broad look back at the findings as a whole and try to guide
the readers back from the specific information to a more general view of how the
findings should be interpreted.
Generally, the main purpose of the discussion section is to explain what your
results mean and what contribution your paper makes to the field of study because
for many readers the most important information is not what your results show but
what your results mean. Since the differences of the structure of discussion sections
between MCRs and other medical research articles, the function of discussions in
MCRs is “to contextualize the case by referring to other similar cases (by way of a
review of relevant literature) and highlighting salient characteristics and special
significance of the case which distinguish it from the other cases mentioned in the
report” (Helán 2012 p. 150).
However, many researchers share the same ideas that writing a discussion
section has never been an easy task for both native and non-native speakers
(Jaroongkhongdach, 2013; Swales J., 1990; Swales & Feak, 2004). One of the
reasons may be that when writing the section, writers have to satisfy the cognitive
demands of the discussions and have skills for writing in the persuasive and
argumentative styles (Pojanapunya & Todd, 2011). The following subsections gives
in details how the sections are investigated through the method of move analysis.
- Hyland’s move analysis of abstract section:
According to Hyland (2000), abstracts played a pivotal role in academic
knowledge-making and their function could be considered as the first introducing
new research to readers. Thus, abstracts possessed both the informative and
persuasive functions that closely connected with disciplinary conventions. To
explain the idea he claimed “To gain readers‟ attention and persuade them to read
on, writers need to demonstrate that they not only have something new and
worthwhile to say, but that they also have the professional credibility to address
their topic as an insider” (p. 63). In the line of Swales (1990) Hyland‟s (2000)

36
model based on a thorough study of 800 abstracts in eight science domains includes
five moves such as „introduction‟, „purpose‟, „method‟, „product‟ and „conclusion‟.
Move 1 (M1), Introduction, established the context of the paper and motivated the
research or discussion. Move 2 (M2), Purpose, indicated purpose, thesis or
hypothesis, outlined the intention behind the paper. Move 3 (M3), Method provided
information on design, procedures, assumptions, approach, data, etc. Move 4 (M4),
Product stated the main findings or results, the argument, or what was
accomplished. Move 5 (M5), Conclusion, interpreted or extended results beyond the
scope of the paper, draw inferences or pointed to applications or wider implications
(Hyland, 2000, p. 67). The functions of the moves and their constituent steps are
indicated in Table 5:
Moves Steps
M1 - Introduction (Establishes
context of the paper and motivates
the research.)
Step 1. Arguing for topic prominence,
Step 2. Making topic generalizations,
Step 3. Defining terms, objects, or processes,
Step 4. Identifying a gap in current knowledge
M2-Purpose (Indicates purpose,
thesis or hypothesis, outlines the
intention behind the paper)
Step 1. Stating the purpose directly
M3-Method (Provides information on
design, procedures, assumptions,
approach, data, etc.)
Step 1. Describing the participants
Step 2. Describing the instruments or equipment
Step 3. Describing the procedure and conditions
M4-Product (States main findings or
results, the argument, or what was
accomplished.)
Step 1. Describing the main features or properties
of the solution or product
M5-Conclusion (Interprets or extends
results beyond the scope of the paper,
draws inferences, points to
applications, or wider applications.)
Step 1. Deducing conclusions from results,
Step 2. Evaluating value of the research,
Step 3. Presenting recommendations
Table 5. The model of abstract move analysis by Hyland (2000)
Compared with the IMRD model this framework distinguishes the abstract‟s
purpose from the introduction since it has a different role from the introduction‟s

Medical case reports in English and Vietnamese - A genre-based analysis.pdf

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