jircd (print) issn 1742–2906jircd (online) issn 1743–1662.docx

jircd (print) issn 1742–2906
jircd (online) issn 1743–1662
lhs vol 4.1 2008 67–89
©2011, equinox publishing
doi : 10.1558/lhs.v4i1.67
Article
‘The foreign teacher is an idiot’: Symbolic
interactionism, and assumptions about
language and language teaching in China
Phiona Stanley
Abstract
This paper examines Western teachers’ and Chinese students’
assumptions about
second language acquisition and the nature of language itself. It
explores the interac-
tion of outward classroom behaviours derived from these
assumptions as symbols
that may be misunderstood across cultures, using symbolic
interactionism as a theo-
retical framework. Said’s Orientalism, and its mirror image,
Occidentalism, inform
the intercultural (mis)communication in this context, which is a
public university in
Shanghai.
The study found that the student participants conceptualized

language as a
set of discrete, quantifiable items. In this view, language is
learned by acquiring
more items rather than by developing discourse and other
competences. Students’
beliefs are at odds with the theories of language and language
learning implicit in
the (weak) communicative methodology used by the Western
participant teachers.
However, students perceived their teachers’ classroom
behaviours as indicative of
their ineffectiveness rather than as indicative of differences in
underpinning theo-
retical models.
Keywords: theories of language, theories of language learning,
oral
English, Occidentalism, communicative language teaching
Affiliation
Monash University, Australia.
email: [email protected]
68 ‘The foreign teacher is an idiot’
Introduction
Much has been written about language theory and second
language acquisi-
tion (e.g. Ellis, 1985; 1994; 2002; Gardner, 1991; Richards and
Rodgers, 2001;
Tomasello, 2005; McLaughlin, 2006), and it is not my intention
to add to these
discussions. Instead, I am interested in what happens when

Western teachers’
and Chinese students’ implicit theories in these areas differ,
when this affects
what they do in language classrooms, and when both sides
neither realize that
their expectations are different nor necessarily understand that
these expec-
tations might stem from different underpinning theories of
language and
learning. The framework I use to analyse this contact situation
is symbolic
interactionism.
The research context is oral English teaching to non-English
major students
at a publicly funded university administered by Shanghai
Municipality. It is
considered a ‘second tier university’ as it is not administered
directly by the
national Ministry of Education, although it ranks in the top
hundred of 1700
tertiary institutions nationally on the list compiled by the
Chinese Academy of
Management Science (2009). Its pseudonym here is People’s
Square University
(PSU). Western teachers teach oral English at PSU.
This paper reports on findings from qualitative case study
research (Stake,
2005) drawing upon data collected over two years (2007–2009)
and three
visits to Shanghai, totalling four months; its research methods
and epistemo-
logical tensions are described below. The teachers were Western
university
graduates from Australia, Belgium, Canada, the UK, and the
USA, and all are
qualified and/or experienced in English language teaching, with

most having
taught previously in Western and/or other Asian contexts. The
teachers are
aged 23–42, with a mean age of 29. The students are Chinese
undergraduates
in their early 20s; most were in their third year of study and all
were from
Shanghai. All participant names in this paper are pseudonyms
and all quotes
in this paper are taken from interviews and focus groups.
As described above, the question discussed in this paper is not
which
theory of language or language learning is better. Instead, I will
discuss inter-
cultural miscommunication experienced by students and
teachers whose
underpinning theoretical constructions of learning and language
are different
from each other. This appears to result in students discursively
misconstru-
ing the underlying significance of the outward signifying
behaviours of their
teachers, and to interpret these through a framing discourse of
Occidentalism.
The question addressed in this paper, therefore, is ‘what do the
students think
about their Western teachers, and why?’ My focus in this paper
is on the stu-
dents’ constructions of their Western teachers, although some of
the Western
teachers in this study also misconstrued their students’ outward
signifiers; this
is a separate discussion. As oral English is, for many Chinese
students, a first

Phiona Stanley 69
encounter with the Western Other, such miscommunications
may have an
impact beyond the classroom door, as they would serve to create
and perpetu-
ate negative stereotyping about Western Others more generally.
Locating the study
Richards and Rodgers (2001: 20–22) identify three distinct
theories of lan-
guage; the structural, the functional, and the interpersonal. The
structural
view regards language as a system of elements including
grammatical, lexical
and phonological elements. The functional view sees language
as a vehicle
for communicating meanings. The third model is the
interactional view,
in which language is seen as a way of realizing social relations.
A theory
of language, then, describes what language is and what it does;
it seeks to
explain what language competence might entail rather than how
it might be
acquired. A theory of language learning, in contrast, refers to
how languages
are learned (Richards and Rodgers, 2001: 22–24). These
theories may be
process-oriented or condition oriented, with the former
describing language
acquisition models such as hypothesis testing and generalization
or habit
formation. Condition oriented theories stress surrounding
factors, such as

motivation or learner affect, as determiners of language
acquisition. Thus
theories of language and language learning underpin language
classroom
practices.
Another key term that needs discussion is the notion of
‘Western’ teachers.
The ‘West’ is an imagined place; no person carries a passport
with ‘Western’
as his or her nationality. Nevertheless, the ‘West’ exists in the
minds of those
people in this study who refer to their ‘Western’ teachers of
English or to
themselves as ‘Westerners’ in China. Zheng writes:
[T]he West does not denote a geographic region but rather a
field of meanings. Local
and global media, such as pirated Western … DVDs, form the
basis on which Chi-
nese conceptions of the West are based. These raw cultural
materials are refined into
complex concepts. The final product is only tangentially related
to the raw materials
themselves. Thus, the process is better described as the creative
use of foreign cultural
products rather than the direct impact of Western culture on
Chinese society. … In
this sense, the West is ‘(re)made in China’. (Zheng, 2006: 170)
This is similar to the notion of the ‘Orient’ as an ‘experiential
entity’ that
exists as a figment of the Western imagination (Balagangadhara
and Keppens,
2009). Clearly, places in the ‘West’ and the ‘Orient’ exist, but
the West and
the Orient are fictions constructed and used in identity work,

often to create
a coherent Other as a foil against whom to define the Self (Said,
1979; 1986;
Gries, 2006; Suzuki, 2007).
In the case of Western Orientalism, this is a hegemonic
discourse in which
non-Western cultures are positioned as ‘pale (or erring)
imitations of the great
original [Western culture]’ (Balagangadhara and Keppens,
2009: 55). This
is the basis of the modernist, (post)colonial, linear model that
conceives a
hierarchy of cultures and positions the West as more advanced
along a single
(Western) path of development. This is different from a
postcolonial model in
which there are myriad routes to ‘development’ (Escobar,
1995).
Sojourning English teachers have been framed as agents of neo-
colonial-
ism (e.g. Phillipson, 1992; Kelly, 2008), and their presence in
Shanghai echoes
the city’s semi-colonial history. However, the presence of
Western teachers
can nowadays be attributed more to China’s scramble to
implement a mas-
sive English teaching programme (Graddol, 2006) beyond the
capabilities of
a home-grown teaching cadre whose own English may lack
communicative
competence (Hu, 2005) and in which communicatively

competent, pedagogi-
cally skilled local English teachers may be lured away from
teaching by higher
salaries in other industries (Jin and Cortazzi, 2003).
But a mirror-image Occidentalism also exists. This serves both
as resist-
ance to foreign imperialisms and as a foil against which to
depict the Self; in
China, foreign Others are constructed as very different from the
Chinese (Cai,
2003). Occidentalism has been variously defined (Conceison,
2004: 40–67)
but its central tenets are the discursive construction, and
reduction, of the
West by the East. This occurs in various spheres, and the
examples here come
from both China and Japan. In the context of Westerners being
‘Othered’ in
Japanese advertising, Creighton (1995: 155) explains: ‘they are
often stripped
of individual identity and their own personalities, encountered
and experi-
enced as representative gaijin [foreigners] rather than real
individuals’. Simi-
larly, H. Li (2008) and Conceison (2004), respectively, examine
the ways in
which Westerners are caricatured in Chinese advertising and
Chinese theatre.
Imagined ‘Western’ qualities may thus be attributed to those
displaying char-
acteristics constructed as prototypically Western:
In Japan there is a rigidity of attachment of ethnicities and
nationalities to physiog-
nomies; in Japanese popular culture foreignness, gaijinness,
Whiteness and English

ability are mapped in a one-to-one correspondence. In this
environment, Whiteness
cannot be apprehended without, for example, the expectation of
a complete lack of
skill in using chopsticks; nor can the identity of those with
white skin be compre-
hended if they do not speak English. (Bailey, 2007: 589)
The ‘Western’ teachers in this study are ‘Western’ to the extent
that their iden-
tities ‘fit’ the imagined construct. Not all are White, not all are
native English
speakers; but all are sufficiently ‘Western’ to be considered and
constructed as
such. For example, Mike, a teacher quoted in this paper, is from
London and his
Phiona Stanley 71
parents are Chinese. While he is ethnically Chinese, he is
considered ‘Western’
in that he has a London accent, speaks little Chinese, associates
mainly with
White people, and behaves in ways constructed in China as
stereotypically
‘Western’, e.g. he portrays outward self-confidence. Another,
comparable, term
is ‘foreign’ or ‘foreigner’; these are translations of the Chinese
terms waigu-
oren, and laowai. These lack the negative connotations of
‘foreigner’ but do
connote Western foreigner rather than merely ‘non-Chinese’.
These are all
terms the participant teachers and students use to describe

themselves and
their teachers.
Orientalism and Occidentalism are important in this study
because these
are frameworks of representation in which intended meanings
are altered by
those interpreting outward signifiers across cultures. When we
communicate,
we encode meaning into signs (words, images, performed
behaviours, etc.)
so as to represent those meanings. Signs unite two concepts: the
signifier (the
sign) and the signified (the intended meaning). Such signs are
arbitrary, and
the same sign may have different meanings in different contexts
(Barthes,
1967). This has important consequences for symbolic
interactionism, the the-
oretical framework used in this study. Blumer (1969) proposed
three premises
of symbolic interactionism. First, people act towards things on
the basis of
the meanings that those things have for them. Second, the
meanings of things
are derived from social interaction. Third, those meanings are
negotiated and
modified through individuals’ interpretive processes as they
deal with the
things they encounter.
This means that, for example, the expected behaviours of a
‘teacher’, which
are socially constructed, may differ across contexts. Jin and
Cortazzi describe
teachers’ and students’ cultures of learning, defining these as:
[T]aken-for-granted frameworks of expectations, attitudes,

values and beliefs about
how to teach or learn successfully.… A culture of learning
frames what teachers and
students expect to happen in classrooms. (Jin and Cortazzi,
2006: 9)
Thus the teacher role of a ‘teacher’ in a Chinese university may
not be the same
as the notion of a ‘teacher’ that Western teachers bring with
them to China.
Western teachers whose behaviour does not ‘fit’ the role as it is
constructed
may be deemed sub-standard. Similarly, students whose outward
behaviours
do not ‘fit’ the expected role of ‘student’, as it is constructed by
foreign teachers,
may be poorly evaluated.
Symbolic interaction, then, investigates the interpretation of
meaning
through social interaction. This includes the extent to which our
performed
behaviours correspond with the expected behaviours of our role.
Central is
the idea that people respond to others’ outward performances
(i.e. behav-
iours and other signs) according to what those signs mean to
them, and not
necessarily the intended meanings. Herein lies one source of
intercultural
miscommunication.

Research methods
I began this project by problematizing the praxis of English
language teach-
ers who had been trained in communicative language teaching
in Western
contexts and who then found themselves working in teaching
contexts where
communicative methods are not widely used. I wondered
whether they might
experience ‘teaching shock’, akin to culture shock, and, if so,
how they might
respond. From this question grew a study of the roles, identities
and training
needs of transnational teachers in China. The present paper is
part of that
larger study, and it considers the causes and implications of
methodological
and language-theory misunderstandings between Chinese
students and their
Western teachers.
In total, I interviewed 37 Western and Chinese teachers of
English and
42 Chinese students, and I gathered and transcribed more than
200 hours
of audio- and video-recorded data. The teachers cited in this
paper were all
‘participants’ (as opposed to ‘informants’ who provided one-off
interviews);
they were the focus of my study and I charted their stories
throughout two
years. The students I interviewed volunteered to take part in
group inter-
views; they may be unrepresentative of the student body more
generally
but their interviews were triangulated against my own and the
participants’

classroom experiences and so I am confident that the views they
express in
this paper are sufficiently typical of the context to be valid.
However, this a
qualitative study and the people I interviewed represent only
themselves;
this study is not a census of all Western teachers and Chinese
students. My
aim is to illuminate the field rather than to map the terrain, and
I do not
infer from sample to population. That said, when I have
presented at confer-
ences and research seminars my findings have often resonated
strongly with
Western and Chinese people familiar with comparable contexts.
But this is
a bounded case study (Stake, 2005) of individuals within a
single university
context in Shanghai.
Admittedly, it is a rather large context: the foreign teachers in
this study
teach, between them, more than 6500 students per year, and the
programme is
now in its fifth year of operation. So for a large number of
Chinese students the
oral English programme described here is their first, and
perhaps their only,
contact with the foreign Other as represented by their oral
English teacher. So,
in itself, this is an important study. Additionally, this case study
does not stand
entirely alone; I have incorporated information from informants
in other
teaching contexts in Shanghai.

Phiona Stanley 73
As little is known about transnational teachers’ lives (e.g.
Green, 2005), a
hypothesis-testing approach would be impossible: there are few
hypotheses
to test. Instead, I used grounded theory (Charmaz, 2006), going
into the field
with the aim of constructing knowledge about what was
happening in this
context. Grounded theory is an inductive method in which
emergent data
informs the research direction. Thus, it was impossible to go
into the field with
pre-conceived ideas of how the research would progress.
Instead, I allowed for
a relatively long period in the field (four months, over three
visits spread over
two years) during which I could get a feel for what was going
on and could
cycle through my data gathering and initial analysis phases in
order to inform
subsequent data construction. Sampling in grounded theory is
theoretical,
meaning that cases are selected according to new insights that
they permit.
I used mixed data-gathering methods, of which Patton (2002:
248) writes:
[S]tudies that use only one method are more vulnerable to errors
linked with that
particular method than studies that use multiple methods in
which different types of
data provide cross-data validity checks.

My data collection included: audio-recorded, semi-structured
individual
and group interviews, video-recorded classroom observations,
stimulated
recall, document analysis, and participant research (i.e. working
as a teacher
among the participants so as to engage with their everyday
experiences). I
visited and revisited the research site three times over the two
years, each time
interviewing teachers and students and showing them their own
previous data
and my theorizing on it, asking them to comment further. This
allowed for
‘thick’ description (Geertz, 1973), for the documenting of
change over time,
and the quoting of participants’ own words so as to remain truer
to their own
understandings. I showed teachers their own classroom videos
so as to access
their thinking about their rationale rather than relying on
observations alone
(Borg, 2003; 2006). This research process raises another
question, however, of
my own objectivity.
Early ethnographical studies (e.g. Malinowski, 1922) assumed
the neu-
trality of the researcher, who was thought to be able to observe
and record
objectively the lives, beliefs, rituals, and practices of others.
This type of ‘objec-
tive’ research has since been discredited, as it has been
recognized that these
early ethnographies reflected as much about the writers’ own
norms of life,
beliefs, rituals, and practices as they did about the subjects’. I

therefore do not
claim objectivity. Modern ethnographic research admits to the
researcher’s
own cultural, social, and political positioning, and instead of
pretending that a
researcher can be all-seeing/all-knowing, or objective,
ethnography has sought
to recognize and manage the researcher’s own role in the social
construction
of knowledge (Bogdan and Taylor, 1998).
Reflexivity allows researchers to manage their influence on the
text (Pillow,
2003). This is necessary as two different researchers viewing
the same con-
struct may record it in very different ways, a product not of
construct differ-
ences but of the different ‘lenses’ through which they view the
world (Stronach
and Maclure, 1993). Additionally, interviews involve the
researcher much more
than simple observation. The co-construction of data allows
interview partici-
pants, including the interviewer, to ‘discover, uncover or
generate the rules by
which they are playing this particular game’ (Blaxter et al.,
2001: 171). This
forms part of the larger discourses through which identities are
constructed
and maintained (Sarup, 1996: 17). But there is a tension here. In
co-creating
the data, might the interviewer’s own subjectivity guide

participants to repro-
duce the interviewer’s intended interpretations? I have tried to
mitigate this
by member checking, triangulating interview data against other
data sources
including further interviews with the same people, and by
letting the partici-
pants’ own voices tell their stories to preserve the how as well
as the what. I
also used group interviews as these allowed access to
unarticulated normative
assumptions (Kamberelis and Dimitriadis, 2005: 903). In
addition, Bourdieu
and Wacquant (1992) argue that we must be aware of possible
distortions to
our own objectivity through awareness and vigilance as to our
own paradigm
and its likely effects. I thus reflected upon my own positioning,
and before
going starting my fieldwork I wrote extensively about my
expectations so as to
be able to check my findings against the ‘scratches’ on my own
lens.
Having gained access to the research site, I recruited study
participants
by being around at teachers’ meetings and in the staffroom,
getting to know
the students in my classes, and by talking about my desire to
understand the
situation better. Once I had become accepted, I sought out
participants and
informed them about my research. Teacher participants filled
out consent
forms and were interviewed, observed, and re-interviewed, as
follows. I
began with initial interviews, in which I interviewed each

participant teacher
and invited them to describe their own educational backgrounds,
reflections
on teaching in China, and their perceptions of the learning
outcomes from
their teacher training. These initial interviews lasted 80–120
minutes each
and were semi-structured around a series of prompts and
guiding ques-
tions. This allowed for participants to describe their own
circumstances
and issues as they saw fit. The teachers were then observed
teaching, and
the lessons were videotaped. Then the teachers were
interviewed again, as
soon as possible after the lesson, with the follow-up interview
consisting of
the teacher and me watching the lesson together and discussing
what had
happened, and why, and how the teacher felt about classroom
events and
stages as they had taken place. The follow up interviews were
longer than the
initial interviews, averaging 120–180 minutes. Teachers were
then given the
Phiona Stanley 75
opportunity, without obligation, to repeat the observation/video-
watching
cycle with another class or lesson and/or to be interviewed
again. Most of
the participants were thus observed and interviewed many times
over the

two-year period.
The students were mostly interviewed in groups, although a
few, including
Xiaoli who appears in this paper, were interviewed individually
at their own
request. In these interviews I presented initial findings from my
research
among the teachers and findings from my own teaching with
which to elicit
participants’ reactions. For example, I put it to the students that
the teach-
ers felt they struggled to get the students to contribute in class,
and asked
them what they thought about it. I started these conversations
by asking
the students to talk about their own experiences of learning
English and of
Western English language teachers. I conducted the interviews
mainly in
English but the presence of a bilingual Chinese friend (who was
neither a
teacher nor student, but a former PSU student) also allowed the
students
to explain themselves in Chinese. All quotes in this paper were
originally
recorded in English.
In addition, some participants provided additional data on e-
mails, often
in response to transcripts of their previous interviews or to
inform me about
events at the university in between my visits. I was also lucky
enough to have
access to about 5000 anonymous written student evaluations of
their foreign
teachers. And I gathered data about my own teaching,
comprising lesson

plans, classroom activities, and video recordings of my own
lessons.
Theories of language
In Chinese popular culture, Chinese language appears to be
counted quan-
tifiably; for example, it is an oft-quoted statistic that it takes a
knowledge of
about 2000 characters to read Chinese newspapers. In keeping
with this quan-
tifiable view of language, the Chinese College English
Curriculum includes a
156-page list of the words and phrases a graduating student is
expected to
‘know’ (Chinese Ministry of Education, 2007: 60–228).
Language, including
English, appears to be seen as a series of discrete items that can
be measured
and counted in curriculum documents, test preparation word
lists, and in
assessment. Implicit in this is a view of language in which
‘knowing’ a lan-
guage means knowing its discrete parts, that is, a view of
language as words
and structures rather than as discourse in contexts.
This may be explainable by the largely discrete-item testing
encountered
in the College Entrance Exam (CEE) and the College English
Test (CET). As
a result, students may struggle to speak and understand English
because of
insufficient skills development. Two PSU students give their
views:

The Chinese English teacher, he will stress on the grammar, the
words, and not the
accent, the speaking, so we learn English just to prepare our
test, not practising our
oral exercising. So this is why we are eager to meet a foreign
teacher because we want
to learn some native accent. (Huang, PSU student, 2009)
If you just learn from [a] book, or class you cannot understand
the native speaker.
English is changing quickly, for example the slang, you
couldn’t understand the slang,
and it is different from what you learn from book[s], so I think
it is very important to
study oral English. You need to learn from native speaker. (Lili,
PSU student, 2009)
To Huang and Lili, the problem seems to be a lack of language
items,
whether a ‘native accent’ or ‘slang’ words. While the barrier to
comprehension
may be accent or slang, another explanation here might be the
lack of recep-
tive skills for making meaning from discourse. Metaphorically,
Huang and Lili
seem to assume that the jigsaw is missing vital pieces, rather
than that they
lack skill in putting together jigsaw puzzles. Both students here
do say they
perceive the need to learn from native speakers and not just
from books and/
or to pass tests, and so it may be that a purely quantifiable view
of language
is an overly simplistic rendering of their viewpoints. However,

in both cases,
contact with native speakers is perceived to confer the missing
pieces rather
than more intangible skills development or language practice
from which pro-
ficiency might derive without further ‘pieces’ being added.
The assumption of language as quantifiable also allows for a
correct/incor-
rect binary to inform teaching. As a result, Xiaoli complains:
English people don’t care too much about the words, don’t care
the tense. Because
you have to take written tests including the grammars and the
words so you have to
master the language from a second language teacher. … Native
speakers, yes, they
make mistakes, but it’s OK because I can understand them.
(Xiaoli, PSU student,
2007)
Xiaoli appears to be assuming a Chomskyan model of
underlying linguistic
competence and observable language performance, equating the
latter with
native speakers’ use of language and the former to the language
competence
students may need to acquire in order to be successful at CET-
type exams.
In this model, language is a set of discrete, prescriptive
variables that may
be correct or incorrect; contextual differences are seemingly
discounted in
explaining language variance, including whether language is
written or oral.
As Xiaoli demonstrates, Chinese students and teachers may
value this model

of language not least because of exam backwash, but also
perhaps because a
learnable, correct/incorrect binary would allow teachers to ‘save
face’.
Language quantifiability contrasts with the view of language
assumed
by most of the teachers in this study, whose English teaching
training was
Phiona Stanley 77
undertaken in contexts in which communicative language
teaching (CLT) is
the norm. CLT is defined by Hiep (2007), as comprising three
tenets: first,
an understanding of language competence as communicative
competence
(including discourse competence); second, a set of views about
second lan-
guage acquisition/learning, in which communicative competence
develops
through learners using the language meaningfully as opposed to
learning
about language or manipulating its form; and, third, a certain
‘communicative
approach’ to classroom teaching, including, for example, pair
work and group
work activities in which students negotiate meaning and
produce language
output. Discussing error correction, Karen exposes her assumed
model of lan-
guage as a system for communicating:
If the students are telling me about their weekend or something

and they’ll say some-
thing and I’ll be like ‘sorry? I didn’t understand that’. … I
mean if it’s only a small
thing and they haven’t got very much confidence anyway then I
won’t pick up on it.
But, yeah, I focus on where it’s causing a breakdown of
communication. (Karen, Brit-
ish teacher, 2007)
While neither group is entirely uniform in its understanding,
the Western
teachers and Chinese students in this study appear to assume
discernibly dif-
ferent underlying theories of language, with the students taking
a structural
view and the teachers a functional/interpersonal view. These
inform their
language-classroom cultures of learning, to which I turn next.
Theories of language learning
A quantifiable view of language appears to translate to
classrooms as an expec-
tation that students will learn more lexical and grammatical
items as they
progress through the years of English language teaching in
school and univer-
sity, with testing at each stage comprising testing of the items
learned rather
than testing of language proficiency across macro-skills. This
culminates, in
the third year at PSU, in oral English as a capstone course
designed to ‘activate’
language already learned ‘in theory’.
I asked some PSU students for metaphors of how they
understand the
language learning process, and two are particularly vivid in

understanding
students’ conceptualizations of the process. The first is that
language is first
downloaded through years of learning English ‘in Chinese’. It is
then installed
through the oral English course, which activates English. The
second meta-
phor is that of Frankenstein’s monster. English is gradually and
lifelessly built
before being sparked to life through oral English. These
metaphors have in
common the idea that English needs to be first learned, then
used, rather than
learned through use.
This may be explainable as a fear of error fossilization, as Ping
explains:
You have to know some grammars … because [if ] you doesn’t
know any grammars
and your English just poor, and you speak wrong English, [then,
as a result] you
speak like that again. And you form wrong ways, the wrong
habit, not good habit,
and after you have formed this habit you have, maybe you have
to do a lot of things
to rid of this habit. … First you have to learn from the book,
then you use. (Ping,
PSU student, 2009)
Ping’s repeated use of ‘habit’ to describe language acquisition
is evocative

of drill-based pedagogy aimed at the acquisition of language
habits; this is
the theory of learning behind language-teaching methodologies
such as the
audio-lingual method (Richards and Rodgers, 2001).
This implicit theory of learning may explain Feng’s concern;
Feng was one
of my Chinese colleagues at PSU who observed me teach. She
was worried
that students in my class were making mistakes in oral fluency
exercises. To
Feng, this was problematic and unintended; she explained that
students’ errors
are evidence that learning has not succeeded. As someone who
believes that
languages are acquired through hypothesis testing and
generalization, I think
the opposite; for me, learners’ errors are evidence of
interlanguage progres-
sion. Dan, a PSU foreign teacher participant, described a similar
discord with
another Chinese colleague, in which she made use of some of
the communica-
tive activities he had suggested, but used them as controlled
practice following
a thorough explanation of the language items, so as to ‘prevent
the students
from making mistakes’. Dan described this situation as:
She seemed to think the activities … were some kind of break
from learning … not
that an activity can actually be the learning. … For her, the
activity is the dispensable
bit if she’s running out of time. For me, it’s the explaining bit
that’s dispensable. (Dan,
American teacher, 2009)

These discords indicate different views of oral English
teaching. Dan and
I conceive of our task as providing opportunities for students to
use language
meaningfully so as to ‘activate’ students’ latent knowledge and
to improve stu-
dents’ discourse skills so as to enable them to use language
meaningfully. Feng
and her colleague, in contrast, appear to teach rules and then
provide practice
exercises, so as to increase students’ accuracy and stock of
language items.
This is not to say that all Western teachers hold view X and that
all Chinese
teachers hold view Y; clearly this is an oversimplification.
However, I found
sufficient difference between my Chinese and Western
interviewees to be able
characterize their different implicit theories of language and
language learn-
ing. While Feng and Dan are not ambassadors for their cultures
of learning,
they represent the divide that I noticed in many other
interviews.
Phiona Stanley 79
Different implicit theories of language learning were also
evident in other
lessons ostensibly aimed at macro skills development (listening,
speaking,
reading and writing skills). Although College English is
organized around

macro skills, which are taught separately, examination
backwash may create
the pressure for quantifiable, discrete-item teaching. As a
result, the ‘reading
skills’ lessons I observed at PSU, for example, featured texts on
clickable
PowerPoint presentations. The (Chinese) teachers explained the
texts word-
by-word, clicking through from each word or phrase to a
different slide in
which examples and (Chinese and English) definitions were
given. Each par-
agraph took half an hour to ‘read’ in this way. This type of
‘reading’ teaching
is entirely different from that assumed by communicative
language teach-
ing, in which reading micro-skills (scanning, skimming,
deducing unknown
meaning from context, etc.) are developed. Thus, although
Chinese teach-
ers may ‘teach reading’ their classroom practices may be
entirely different
from ‘teaching reading’ in communicative classrooms, where
the object is to
engage with the text to extract meaning.
These very different views of classroom practice appear to
indicate very dif-
ferent models of language acquisition. Xiaoli, a PSU student,
summarizes her
expectation about language learning; ‘the teacher is teaching to
the students,
the students are receiving information from the teacher’ (2007).
Although
Beth notes that ‘content subjects’ are often taught via lectures
in Western edu-
cation, she describes languages at her university in the USA as

taught in small
tutorials focused on meaningful student output. These are:
More holistic, so you did get up some level of fluency. …[At
PSU], students give back
only the same output they‘ve received, so they don’t need to
manipulate the language.
(Beth, American teacher, 2007)
The sequential learning of tangible facts contrasts with skills
develop-
ment inherent to communicative language teaching, which
assumes that
languages are learned through use and that errors are evidence
of learn-
ing (Richards and Rodgers, 2001). Zoe, the manager of language
teaching
programmes at a multinational company, explains that she often
deals with
complaints about Western teachers whose teaching is too
‘nebulous’ for
Chinese students:
There’s pressure on teachers to make it explicit and measurable,
to build in reviews.
The students want to be tested, they want to have lists, and they
want to count the
number of things they’ve learned. (Zoe, American educational
manager, 2007)
This contrasts with the aim of oral skills development in which
the objective
is not the acquisition of new language items but instead the use
of students’
existing store of language. However, those students whose
culture of learning

assumes a knowledge acquisition model of language learning
may struggle to
see the purpose of skills development. This may result in the
type of complaint
that Zoe describes.
Crossing cultures of learning
Oral English is ostensibly a capstone course to ‘activate’
students’ existing
English, but it may feel redundant to the students. Mike
identifies listening
and speaking macro skills development aims of oral English:
For me, being effective is to have them speak English and to
have to use something
they’ve learned rather than to walk out with this new grammar
structure, or ‘I’ve
learned this new word today’ … I don’t want to teach, like, a
new dance move, I just
want them to get better at what they’re doing already. … These
guys have been taught
English for, like, ten years, and they’ve got loads of vocab,
[but] they haven’t had to
use it. (Mike, British teacher, 2007)
However, skills development may appear intangible to students,
and this may
be problematic in an environment where students expect
quantifiable learn-
ing outcomes. Phil and Ryan describe the problem of trying to
get students to

practise existing language items that they may perceive they
already ‘know’.
[Oral English] turns the students off because [the students] they
think they know it,
they feel like they’ve already ticked that box, they’ve closed
that page in the book …
they haven’t necessarily internalized it but they’ve seen it, so
they perceive they’ve
learned it. (Phil, British teacher, 2009)
[The students] look at the book and see ‘maybe you could plus
verb’, and they think
‘I know those words, that’s not new, I already know that’, and
even though there’s
no possible way that person would ever use that in a
conversation they’ll dismiss it
and go ‘boring’, [and put their] head down on the desk. And
then you ask them, like,
‘what would you say: you just killed a friend and you don’t
know what to do with the
body?’ And they’ll be like ‘uhhh, I say go to police’. … So
they’re not using it at all.
You’ve just taught it, you’ve just reviewed it … and you know
that person’s just com-
pletely tuned out … they don’t get it, like, you’re supposed to
be practising it. We’re
not teaching you anything new. (Ryan, Canadian teacher, 2009)
One origin of students’ resistance may therefore be a
perception that, in
practising ostensibly ‘known’ language items through
communicative activi-
ties, the teachers appear to be pitching the level of the material
too low, as
students may perceive they have already learned the language

items contained
in texts. This may cause the students to resist.
But students’ resistance, that Ryan describes as students’
putting their heads
down on the desk and ‘tuning out’ may cause the teachers to
reduce the level
Phiona Stanley 81
of challenge further so as to elicit a response, as their own
cultures of learning
would lead them to expect this. Claire explains:
It’s so hard to get them to talk. You know when you sort of say
‘what did anyone
think? Can anyone tell me what this means?’ and, you know,
you’ll have people sit-
ting there looking away. … It could be that maybe I’m speaking
too quickly or maybe
they don’t understand the question. So I try to make it easier
and I ask again. (Claire,
British teacher, 2008)
This problem seems to be caused by the inert knowledge
problem, where
students have a large passive knowledge that oral English is
supposed to
‘activate’. Teachers may erroneously interpret students’ silence
as incompre-
hension, and, as their own cultures of learning expect students’
participation
in class, may pitch their lessons too low. This problem is then
cyclical, as
shown in Figure 1.

Figure 1: Conceptual model of a source of misunderstanding in
oral English
Students may use the seeming intangibility of oral English and
their percep-
tion of its low-level objectives as evidence for their foreign
teachers’ incom-
petence. As discussed above, symbolic interactionism theorizes
that people
respond to things on the basis of the meanings those things hold
for them. As
a result, PSU students may, quite naturally, judge foreign
teachers from within
their own symbolic paradigm, in which the foreign teachers do
not appear to
‘fit’ the students’ constructed notion of a ‘teacher’. From this, it
may be that
the students judge foreign teachers negatively, or as less than
‘teachers’. Three
students explain:
[Foreign teachers] sit on the tables, and you never see a Chinese
teacher sit on the
tables, never. So maybe the Western teachers give us the
impression they are fun and
we have highly expectation of them, be the foreign friends. A
different expectation
for the foreign teachers. (Chao, PSU Student, 2009)
We see the TV dramas, we see Western teachers always willing

[to] communicate
with students. … But I don’t understand. In the Western
education is talk, talk, talk,
and so how someone will learning? (Lili, PSU Student, 2009)
The foreign teachers, they don’t bring books to class and the
students think the
teacher don’t bring books and seems doesn’t have a lot of plans,
they just pick a topic
and write on the board and say ‘this class we just talk a topic’.
This is not a way Chi-
nese teacher do a class, so this is not a good teacher. … We
think the foreign teacher
is an idiot. (Huang, PSU Student, 2009)
It may be that teachers’ intended meanings are being
(mis)understood through
(mis)interpretations of their outward signifiers and what these
mean to the
students.
To Chinese students, a teacher who sits on the tables may be
seen as less than
a ‘proper’ teacher. But the teacher’s purpose may be to reduce
negative affect
by appearing approachable. This is an example of how the same
outward signi-
fier (sitting on a table) may be intended one way and interpreted
in another.
Similarly, the learning outcome of students acquiring language
by using it may
not be clear in the setting up of group-based oral fluency
activities. Instead, to
students, it may look like the teacher cannot, or is too lazy, to
teach ‘properly’
(at the front of the class, with the teacher doing most of the
talking, as Xiaoli

described above). The same may be true for seemingly
intangible discussion
activities perhaps based on textbook topics, in which the
students’ language
output may not be systematically corrected for accuracy and in
which there
are no ‘correct’ answers. To the teacher, this may be a good
way to adapt text-
book material to practise oral fluency, whose products (the
‘answers’) are less
important than the process, and whose aim is not accuracy. But
to the students
this may seem to be an avoidance of teaching the grammar in
the textbook
(because the teacher cannot? Or does not realize s/he is
supposed to? Or is
too lazy?) In this interpretative paradigm, not correcting and
apparently not
knowing the ‘correct’ answers may add fuel to the fire: as
Huang says, ‘the
foreign teacher is an idiot’.
Making fun of foreign teachers
These misunderstandings of teachers’ intended meanings may
lead students to
the conclusion that foreign teachers are incompetent, and to
therefore expect
little of them. Beth reports:
Phiona Stanley 83
My engineering students have the opportunity to go to America
at the end of their
junior year. … They didn’t tell me at first, I found out a little

over half way through.
And I asked, ‘Why didn’t you tell me earlier? This class would
have been completely
different if I’d have known. I would have structured it to make
it more useful for
you going abroad.’ And they’re ‘oh, well, you know, it’s just
our English class’. … It
just hadn’t occurred to them … they have all of their real
classes and then they just
get to come to our class and goof around and have fun. (Beth,
American teacher,
2008)
This conception of foreign teachers as less competent and more
‘fun’ than
Chinese teachers may be triangulated, for students, by the
Occidentalist con-
structions of foreign ‘Others’ that they bring to the situation.
Leo, a Chinese-Canadian teacher whose Chinese is fluent and
who has
lived in Shanghai for seven years explains his understanding of
the students’
construction of Westerners, framed by an Occidentalism in
which the ‘West’
is contrasted to the Chinese Self:
[The students] perceive Westerners as ‘open’. … Open means
open-minded, it
also means warmth, it also means friendly. But I think the
reason why they use
the word ‘open’ is ... because they’re seeking, they’re
identifying any foreigners as
someone opposite from them, doing everything that is opposite
from what they are
allowed to do. It’s almost a rebellious thing, for a lot of our
students, they sort of

look up to a Westerner because they feel a Westerner is allowed
to do a lot of things
that they’re not allowed to do. … I think they [the students]
already came in with a
perception of what Westerners are like. … [They think] we’re
lively, warm, optimis-
tic, energetic, fun … not as serious as Chinese teachers. (Leo,
Chinese-Canadian
teacher, 2009)
Some PSU students triangulate this view:
[Western] foreign teacher you respect from your heart because
you have the happy
time. Chinese teacher you respect, maybe, from head … they
treat me like [they’re a]
teacher. (Ping, PSU Student, 2009)
If the teacher will be cheerful I will pay more attention … I like
foreign teacher to
be fun, like actor, could told you about anything. … I want to
see he is very nice.
Easy going, funny, can share the different ideas, don’t have the
distant … humorous,
arouse our interest in learning English, you feel flexible. … In
the foreign teacher
class you can do whatever you like, you can do more
communication with him. …
He must be fun, yes, and vividly. (Guo, PSU Student, 2009)
Students’ view that Western teachers are, or should be, ‘fun’
may thus be
because of stereotyping about Western foreigners more
generally. Leo con-
nects this to the American television series ubiquitous on DVD
in China,

saying that for students lessons with a foreign teacher seem ‘as
if they’re
watching Friends and one of the characters pops out of the TV
and they get to
talk to them’ (Leo, 2007). This is the view of the West as
‘(re)made in China’,
based on Hollywood and other sources, that Zheng (2006)
described above.
Xiaoli explains her perception:
[Western] foreigners are kind of very hot and very friendly. …
Hot is kind of, they’re
always laughing [and] even [though] they don’t know you they
will smile at you, you
will feel, when you are with them, you won’t feel cold. Your
mind is always running.
(Xiaoli, PSU Student, 2007)
However, while this may describe students’ constructions of
foreign teachers,
it also puts pressure on the teachers to live up to these
constructed identities
by being ‘fun’. Beth explains:
They expected me to get up there and be the funny, foreign
monkey. Let them play
fun games, tell funny jokes, clown a bit, and then they’d get to
go home … it’s so easy
at this university to let yourself slip … To just go into class, get
through the 80 min-
utes, and move on. And there’s definitely been weeks where

I’ve done that … because,
[there’s] the pressure from the students, and the pressure from
management to amuse
the students so they don’t complain. … It’s absolutely just like
pulling teeth otherwise.
It’s just so slow, if you don’t do something to force the students
to engage, if you don’t
make it fun, then it’s just absolutely horrible. You have 80
minutes of ‘say this, say
this’. (Beth, American teacher, 2008)
This is a circular problem, and a conceptual model of this
appears in
Figure 2. Students pressure teachers to be fun, using resistance
in class as
Beth described. Another way in which students at PSU pressure
their foreign
teachers to conform to ‘fun’ expectations is through their post-
course evalu-
ations. These post-course evaluations are the only measure of
foreign teacher
work at PSU, and several teachers described them as a
‘popularity contest’. Phil
expands on this point:
I’ve done three or four semesters’ worth of feedback and this
word pops up all the
time for the students, ‘fun, fun, more interesting, more fun, we
want more fun’ … it is
quite sobering. I sincerely believe that I delivered probably
some of the better classes
last semester but I was probably one of the lower-scoring
teachers because I didn’t
make it a game show. (Phil, British teacher, 2007)
Because Westerners are constructed as fun there is pressure on

Western teach-
ers to be fun. This then reinforces students’ perceptions. While
there is nothing
wrong with ‘fun’, the teachers in this study experienced
pressure to be fun
rather than effective as teachers. This meant that many of the
participant teach-
ers felt disinvested professionally, and perceived that they de-
skilled because
their working lives consisted of providing ‘fun’.
Phiona Stanley 85
Figure 2: A conceptual model of the cycle of Occidentalist
constructions of ‘Western-
ers’, pressure to conform, and subsequent evidence supporting
these constructions.
Conclusion
The situation in oral English teaching at PSU is erecting
barriers to intercul-
tural communication rather than allowing for cross-cultural
understanding.
This problem derives from Chinese students’ and their Western
teachers’ dis-
tinct, although largely implicit, theories of language and of
language learn-
ing. While Western teachers’ and Chinese students’ views may
not always be
as starkly differentiated as I have described, there is still a
tangible schism
between the two sides’ understandings in the context under
examination.

The teachers’ practices and underpinning methodological
paradigms are
based on assumptions about language and language learning in
which lan-
guage is a holistic system that can be acquired through use as
well as some
‘learning-about’. The students, in contrast, are experienced in a
Confucian-
heritage educational system in which discrete-item language
assessment is
of vital importance as an educational and societal gatekeeper,
and in which
local English teachers’ practices may be constrained by class
sizes, the teach-
ers’ own apprenticeships of observation and resultant cultures
of learning, and
the pressure they experience to cover a very full curriculum.
This results in
a system where language learning comprises learning ever more,
and more
complex, ‘pieces’ of language. When the students experience
difficulty in using
the English they have ‘learned’, some conclude that they must
be missing some
of the ‘pieces’ of the puzzle rather than questioning whether
there is also a
need for macro-skills development and discourse competence.
Oral English is therefore a peculiar orphan of a course.
Sidelined by
backwash from discrete-item examining, it appears to the
students to be a

rehashing of already ‘known’ language items; understandably,
they may fail
to engage. Into this context come Western teachers, like bulls in
a china shop.
They bring with them their own ways of teaching, and in some
cases what Bax
(2003) describes as the ‘CLT attitude’. They may be unable
and/or unwilling to
modify their praxis in the face of a quite different culture of
learning. Addi-
tionally, they may struggle to understand the purpose of oral
English, whose
existence is attributable to a highly questionable ‘download and
install’ model
of language learning.
Within this confusion, the teachers gamely try to engage
students in
communicative-style teaching. To attract students’ attention
they make it
more ‘fun’. However, the students are also operating within
their own set of
understandings, interpreting their experiences of oral English as
indicative of
Western teachers being ‘fun but ineffective’. This ties neatly
into an Occiden-
talist view of Westerners more generally, and the ‘evidence’ of
foreign teachers’
behaviours at PSU may compound some students’ previously
held stereotypes
about Western foreign Others. So a notion of ‘fun but
ineffective’ Westerners
may be reified into an experience of ‘fun but ineffective’
Westerners. This does
not bode well for cross-cultural understanding.
About the author

Dr Phiona Stanley is a TESOL teacher educator who has taught
in six countries
including China. She has just completed a PhD in Education at
Monash University,
Australia. Her thesis was on transnational teachers’ roles,
identities, and training
needs at a Chinese university, and her research interests include
higher education
teaching, identity, and transnationalism.
References
Bailey, K. (2007) Akogare, ideology, and ‘Charisma Man’
mythology: Reflections on ethno-
graphic research in English language schools in Japan. Gender,
Place and Culture 14 (5):
585–608. doi:10.1080/09663690701562438
Balagangadhara, S. N. and Keppens, M. (2009)
Reconceptualizing the postcolonial proj-
ect: Beyond the strictures and structures of Orientalism.
Interventions 11 (1): 50–68.
doi:10.1080/13698010902752731
Barthes, R. (1967) Elements of Semiology. London: Cape
Publications Ltd.
Bax, S. (2003) The end of CLT: A context approach to language
teaching. ELT Journal 57 (3):
278–287. doi:10.1093/elt/57.3.278
Phiona Stanley 87
Blaxter, L., Hughes, C. and Tight, M. (2001) How to Research.

Maidenhead, Berkshire:
Open University Press.
Blumer, H. (1969) Symbolic Interactionism: Perspective and
Method. Berkeley, CA: Univer-
sity of California.
Bogdan, R. and Taylor, S. J. (1998) Introduction to Qualitative
Research Methods. New York:
Wiley.
Borg, S. (2003) Teacher cognition in language teaching: A
review of research on what
language teachers think, know, believe and do. Language
Teaching 36 (2): 81–109. doi:
10.1017/S0261444803001903
Borg, S. (2006) Teacher Cognition and Language Education.
London: Continuum.
Bourdieu, P. and Wacquant, L. J. D. (1992) Invitation to a
Reflexive Sociology. Chicago, IL:
University of Chicago Press.
Cai, R. (2003) Problematizing the foreign Other: Mother, father
and the bastard in Mo Yan’s
‘large breasts and full hips’. Modern China 29 (1): 108–137.
doi:10.1177/0097700402238598
Charmaz, K. (2006) Constructing Grounded Theory. London:
SAGE Publications.
Chinese Academy of Management Science (2009) Chinese
university ranking.
Chinese Ministry of Education (2007) College English

Curriculum Requirements. Shanghai:
Shanghai Foreign Language Education and Research Press.
Conceison, C. (2004) Significant Other: Staging the American
in China. Honolulu, HI: Uni-
versity of Hawai’i Press.
Creighton, M. L. (1995) Imagining the Other in Japanese
advertising campaigns. In J. G.
Carrier (ed.), Occidentalism: Images of the West 135–160.
Oxford: Clarendon Press.
Ellis, R. (1985) Understanding Second Language Acquisition.
Oxford: Oxford University
Press.
Ellis, R. (1994) The Study of Second Language Acquisition.
Oxford: Oxford University Press.
Ellis, R. (2002) Grammar teaching: Practice or consciousness-
raising? In J. C. Richards and
W. A. Renandya (eds), Methodology in Language Teaching
167–174. New York: Cam-
bridge University Press.
Escobar, A. (1995) Encountering Development: The Making and
Unmaking of the Third
World. Princeton, NJ: Princeton University Press.
Gardner, R. C. (1991) Attitudes and motivation in second
language learning. In A. G.
Reynolds and W. E. Lambert (eds), Bilingualism,
Multiculturalism, and Second Language
Learning 43–63. Montreal: McGill University Press.
Geertz, C. (1973) The Interpretation of Cultures: Selected

Essays. New York: Basic Books.
Graddol, D. (2006) English Next: Why Global English may
mean the End of ‘English as a
Foreign Language’. London: British Council.
Green, T. (2005) Staying in touch: Tracking the career paths of
CELTA graduates. University
of Cambridge ESOL Research Notes 19: 7–11.
Gries, P. H. (2006) China and Chinese nationalism. In G.
Delanty and K. Kumar (eds),
The SAGE Handbook of Nations and Nationalism 488–499.
Thousand Oaks, CA: SAGE
Publications Inc.
Hiep, P. H. (2007) Communicative language teaching: Unity
within diversity. ELT Journal
61 (3): 193–201. doi:10.1093/elt/ccm026
Hu, G. (2005) English language education in China: Policies,
progress, and problems. Lan-
guage Policy 4 (1): 5–24. doi:10.1007/s10993-004-6561-7
Jin, L. and Cortazzi, M. (2003) English language teaching in
China: A bridge to the future.
In H. W. Kam and R. Y. K. Wong (eds), English Language
Teaching in East Asia Today
131–145. Singapore: Times Academic Press.
Jin, L. and Cortazzi, M. (2006) Changing practices in Chinese
cultures of learning. Lan-

guage, Culture and Curriculum 19 (1): 5–20.
doi:10.1080/07908310608668751
Kamberelis, G. and Dimitriadis, G. (2005) Focus groups:
Stategic articulations of pedagogy,
politics, and inquiry. In N. K. Denzin and Y. S. Lincoln (eds),
The SAGE Handbook of
Qualitative Research Thousand Oaks, CA: SAGE Publications,
Inc.
Kelly, W. (2008) Applying a critical metatheoretical approach
to intercultural relations: The
case of US-Japanese communication. In M. K. Asante, Y. Miike
and J. Yin (eds), The
Global Intercultural Communication Reader 263–279. New
York: Routledge.
Li, H. (2008) Branding Chinese products: Between nationalism
and transnationalism.
International Journal of Communication 2: 1125–1163.
McLaughlin, B. (2006) The monitor model: Some
methodological considerations. Lan-
guage Learning 28 (2): 309–332. doi:10.1111/j.1467-
1770.1978.tb00137.x
Patton, M. Q. (2002) Qualitative Research & Evaluation
Methods. Thousand Oaks, CA:
SAGE Publications, Inc.
Phillipson, R. (1992) Linguistic Imperialism. Oxford: Oxford
University Press.
Pillow, W. (2003) Confession, catharsis, or cure? Rethinking
the uses of reflexivity as meth-
odological power in qualitative research. International Journal

of Qualitative Studies in
Education 16 (2): 175–196. doi:10.1080/0951839032000060635
Richards, J. C. and Rodgers, T. S. (2001) Approaches and
Methods in Language Teaching.
Cambridge: Cambridge University Press.
doi:10.1017/CBO9780511667305
Said, E. W. (1979) Orientalism. New York: Vintage Books.
Said, E. W. (1986) Orientalism reconsidered. In F. Barker, P.
Hulme, M. Iversen and
D. Loxley (eds), Literature, Politics, and Theory 210–229.
London: Methuen.
Sarup, M. (1996) Identity, Culture, and the Postmodern World.
Athens, GA: University of
Georgia Press.
Stake, R. E. (2005) Qualitative case studies. In N. K. Denzin
and Y. S. Lincoln (eds), The
SAGE Handbook of Qualitative Research 443–466. Thousand
Oaks, CA: SAGE Publica-
tions, Inc.
Phiona Stanley 89
Stronach, I. and Maclure, M. (1993) Jack in two boxes: A
postmodern perspective on
the transformation of persons into portraits. Interchange 24 (4):
353–380. doi:10.1007/
BF01435194
Suzuki, S. (2007) The importance of ‘Othering’ in China’s

national identity: Sino-
Japanese relations as a stage of identity conflicts. The Pacific
Review 20 (1): 23–47.
doi:10.1080/09512740601133195
Tomasello, M. (2005) Constructing Language: A Usage-based
Theory of Language Acquisi-
tion. Boston, MA: Harvard University Press.
Zheng, T. (2006) Cool masculinity: Male sex clients’ sex
consumption and business alli-
ance in urban China’s sex industry. Journal of Contemporary
China 15 (46): 161–182.
doi:10.1080/10670560500331815
Copyright of Linguistics & the Human Sciences is the property
of Equinox Publishing Group and its content
may not be copied or emailed to multiple sites or posted to a
listserv without the copyright holder's express
written permission. However, users may print, download, or
email articles for individual use.
Journal of Broadcasting & Electronic Media/March 2009
The Effects of Viewing Grey’s Anatomy
on Perceptions of Doctors and
Patient Satisfaction

Brian L. Quick
The present investigation applies cultivation theory to describe
the role of
viewing Grey’s Anatomy on patients’ predispositions. Results
demonstrate
that heavy viewers of Grey’s Anatomy perceive this program to
be credible.
Credibility was positively associated with a perception that
real-world doctors
are courageous. A direct association did not emerge between
Grey’s Anatomy
viewing and a perception that doctors are courageous, although
an indirect
effect emerged, mediated through credibility. A positive
association emerged
between perceptions that doctors are courageous and patient
satisfaction.
Results are discussed with an emphasis on the role of
entertainment programs
in cultivating patients’ predispositions about medical doctors.
Until recently, a shortcoming within the doctor-patient
literature was a dearth of
theoretical models to explain the complexities that underlie this

unique relationship.
The doctor-patient relationship does not occur in a vacuum,
thus, attention to envi-
ronmental factors influencing this relationship is of interest to
health communication
research. Street’s (2003) ecological model takes a step in this
direction by advancing
an approach that takes into account multiple contexts impacting
the healthcare
provider-patient relationship. In doing so, the model illustrates
how the media,
organizational, cultural, and political-legal contexts each impact
the doctor-patient
relationship, which has received a wealth of coverage during the
past 30 years. At
the heart of the concept is the relationship between the
healthcare provider and
patient. In examining the interpersonal context in which this
relationship occurs,
Street identifies partner and relationship perceptions as
cognitive-affective influences
for both doctors and patients.
In applying the ecological model to patients’ perspectives of
doctors, the focus of

this investigation concentrates on the media context. Research
examining television
representations of doctors is not new to the literature (Chory-
Assad & Tamborini,
Brian L. Quick (Ph.D., Texas A & M University) is an Assistant
Professor in the Department of Communi-
cation at the University of Illinois at Urbana-Champaign. His
research interests include message processing
of persuasive health messages and the effects of media coverage
of health issues.
This article was submitted and accepted under the editorship of
Donald G. Godfrey.
© 2009 Broadcast Education Association Journal of
Broadcasting & Electronic Media 53(1), 2009, pp. 38–55
DOI: 10.1080/08838150802643563 ISSN: 0883-8151
print/1550-6878 online
38
Quick/ECOLOGICAL MODEL 39
2001; Pfau, Mullen, & Garrow, 1995; Turow, 1989; 1996;
Turow & Coe, 1985;
Volgy & Schwarz, 1980). Extant research successfully traced
historic portrayals
of television doctors (Turow, 1989; Turow & Coe, 1985), while
others performed

systematic content analyses to examine doctor portrayals on
television (Chory-Assad
& Tamborini, 2001; Pfau et al., 1995); however, less is known
about the influence
of television in shaping patient perceptions of doctors (Chory-
Assad & Tamborini,
2003; Pfau et al.; Volgy & Schwarz, 1980), particularly within
the context of a single
medical drama.
This investigation extends this line of research by examining
the influence of
exposure to Grey’s Anatomy, spanning Season 2 and the first
five episodes of
Season 3, on viewers’ perceptions of real-world doctor’s
courage along with how
this perception is associated with patient satisfaction. Grey’s
Anatomy was selected
due to its popularity and uniqueness. Nielsen Media Research
rankings 2005–
2006 indicate that Grey’s Anatomy (Season 2) had an average of
19.9 million
viewers per episode, giving it a #5 overall ranking. Perhaps a
major reason for

the show’s popularity among viewers rests in the diversity of
the cast (Deimen,
2006; Reddy, 2007). The surgical interns and staff at Seattle’s
Grace Hospital are
ethnically diverse, which is in stark contrast to most television
shows that do
not adequately represent minorities (Deimen). Another factor
that makes Grey’s
Anatomy different is the constant depiction of risky and
complicated surgeries.
Deimen writes, ‘‘Due to the nature of their internship, they
[surgical interns] are
constantly pitted against each other for the juiciest and most
complicated surgeries’’
(p. 2). While the ecological model identifies the influence of the
media within the
healthcare provider-patient relationship, the manner in which
this occurs is not
explicated. Prior to making an argument for applying cultivation
theory within the
context of a single program across 32 episodes, a brief history
of television portrayals
of medical doctors is provided.
Television Portrayals of Doctors

The portrayal of doctors on television has shifted significantly
during the past
60 years (Chory-Assad & Tamborini, 2001; Turow, 1989, 1996;
Turow & Coe,
1985; Volgy & Schwarz, 1980). City Hospital, the initial doctor
show launched
in 1952, portrayed doctors as omnipotent healers who
represented the author-
ity within the hospital. Doctors throughout the 1950s and 1960s
were charac-
terized as compassionate heroes dedicated to their patients
(Turow, 1996). Au-
diences followed the likes of Dr. Ben Casey and Dr. James
Kildare as they regularly
beat the odds and triumphed over illness to save patients. The
1970s introduced
doctors such as Dr. Marcus Welby who were on the cutting edge
of medical
advances and, like their predecessors, always succeeded in
improving the lives
of their patients. Volgy and Schwarz’s content analysis across a
4-week period
found that ‘‘not a single reference to physicians which could be
described as a

negative statement toward the medical profession’’ occurred
(1980, p. 152). At
40 Journal of Broadcasting & Electronic Media/March 2009
the end of the 1970s, the focus switched from patient illness to
the difficulties
that come with being a doctor (Turow & Coe, 1985). Shows
such as St. Else-
where and Northern Exposure, among others, began showing the
stress and strain
of being a doctor (Pfau et al., 1995). By giving attention to the
often unfavor-
able dispositions of doctors, media scholars feared that negative
portrayals may
lead to doctor distrust (Pfau et al.). Although medical shows
had begun to de-
pict doctors’ struggles, for better or worse, the majority of
coverage remained
positive.
Most recently, Chory-Assad and Tamborini’s (2001) content
analysis of 229
television physicians discovered that portrayals of doctors
remained largely positive,

although these depictions were less favorable than portrayals a
decade earlier
(Pfau et al., 1995). Specifically, Chory-Assad and Tamborini
wrote that prime-
time fiction doctors ‘‘were often mean, unethical, incompetent,
insubordinate,
and sometimes even criminal’’ compared to non-fiction
portrayals within the
media (i.e., news broadcasts, magazines) (p. 514). ABC’s
Grey’s Anatomy con-
tinues in this tradition by showing both positive and negative
characteristics
of medical doctors. With that said, consistent with previous
decades of doctor
portrayals on television, courageous acts performed by doctors
on Grey’s Anatomy
abound in which they are forced to make critical decisions that
determine
the fate of their patients. To provide illustrations of these
valiant acts, two
episodes were randomly selected from Season 2 and the first
five episodes of
Season 3.

In the episode entitled ‘‘Deterioration of the Fight or Flight
Response,’’ three
courageous acts are performed simultaneously. First, Dr. Burke
was shot outside of
the hospital. While treating Burke, viewers watch as Dr.
Shepherd struggles with
the delicacy of dislodging a bullet from a friend, while at the
same time performing
the surgery without damaging nerves that would prevent Burke
from performing his
duty as a surgeon. While viewers witness this struggle, Dr.
Addison has the daunting
task of telling Dr. Richard that his adolescent niece’s ovarian
cancer has returned.
Meanwhile, viewers watch as interns Izzy, Cristina, Meredith,
and George struggle
to keep a patient, Denny Duquette, alive after Izzy intentionally
cut his LVAD
wire in attempts to improve the likelihood of him receiving a
much-needed heart
transplant. In short, within a single episode, viewers see the
courage needed to be
a medical doctor.
In another episode, ‘‘Raindrops Keep Falling on My Head,’’

viewers watch as Dr.
Addison Forbes Montgomery and intern Meredith Grey see
Julie, a patient with twin-
twin transfusion syndrome (two twins connected by blood
vessels in the placenta).
Addison performs surgery after she detects beginning heart
failure in the twins.
After the surgery, viewers learn that the babies and Julie turned
out fine. In the
same episode, viewers watch as Joe, the owner of a bar across
from the hospital,
suffers from an aneurysm. In order to correct the problem, the
doctors must perform
courageous acts (e.g., freeze his body, drain his blood, and stop
his heart) within
45 minutes to save Joe. Joe survived the procedures. Despite
their courageous acts,
the doctors on Grey’s Anatomy do not always succeed. In fact,
often their patients
die. Although there is not always a happy ending, the doctors’
courageousness is

rarely questioned. In order to provide a theoretical framework
to understand media
influence, cultivation theory is employed to address the
underlying process in which
heavy viewers of Grey’s Anatomy develop beliefs and
perceptions consistent with
television portrayals of doctors.
Cultivation Theory
Perhaps no theory has been as instrumental as cultivation theory
in explaining the
long-term effects of repeated exposure to television images
(Gerbner & Gross, 1976).
Cultivation theorists assert that over time, social reality and TV
reality are blurred
among heavy television viewers (Gerbner & Gross, 1976;
Gerbner, Gross, Morgan,
Signorielli, & Shanahan, 2002). The theory suggests that
specific themes (e.g., crime)
cut across genre boundaries and pervade all programs. In
making the case for
cultivation theory, researchers frequently compare perceptions
between heavy and
light viewers. The preponderance of cultivation research
suggests that heavy viewers

maintain perceptions that mirror television compared to light
viewers in general. In
fact, the validity of cultivation research has been bolstered by
meta-analytic research
that suggests Gerbner and colleagues’ prediction holds true
(Morgan & Shanahan,
1996).
Despite evidence in support of cultivation, the theory has
endured its share of
criticism (see Hawkins & Pingree, 1980; Potter & Chang, 1990).
The assumption
that television viewing impacts perceptions is not disputed;
however, the under-
lying assumptions of cultivation remain debated (for a review of
these criticisms,
see Shanahan & Morgan, 1999). A major criticism of cultivation
research rests in
Gerbner and colleagues’ belief that television messages are a
cumulative mass of
messages with consistent storylines. That is, cultivation treats
television messages as
a coherent system of stimuli spanning all genres and programs
(Gerbner & Gross,

1976; Gerbner et al., 2002). As a result, cultivation researchers’
interests are in the
impact of total television viewing as opposed to genre-specific
or program-specific
effects. While treating television messages as a coherent system
was legitimate for
the late 1960s, the spawn of cable and satellite programming, an
influx of programs
aimed at specific target audiences, along with technologies such
as television digital
video recordings during the past four decades have certainly
challenged cultivation’s
notion of a uniform storyline across genres and programs.
Content analyses have
disputed the belief that television messages are uniform across
genres and programs
(Hawkins & Pingree, 1980; Potter & Chang, 1990). In fact,
Segrin and Nabi’s (2002)
study examining marital expectations found that relationship
genre explained more
variance in eros and expectations for intimacy than total
television viewing. Both
relationship genre and total television viewing explained a
significant portion of

variance in fantasy rumination or marital intentions. Similarly,
research found that
heavy viewing of TV news is associated with concerns about
violent crimes (Romer,
Jamieson, & Aday, 2003), while others discovered that parents
attending to media
stories about child abduction cases experience more fright-
related feelings than
light viewers (Wilson, Martins, & Marske, 2005). Wilson et al.
also found that heavy
exposure to TV reality/dramas and attention to media stories
about child kidnappings
are positively associated with concerns about a local threat.
Finally, within the
context of doctor portrayals on television, Chory-Assad and
Tamborini (2001) found
that visual and non-visual doctor portrayals varied in physical
attractiveness and
interpersonal style across prime-time fiction, daytime soaps,
network news, news
magazines, and daytime talk shows, although doctor
competence, ethical character,

regard for others, and power did not vary significantly.
Together, these studies
support the possibility of extending cultivation theory to
examine effects within
specific television genres.
Although research supports the cultivation hypothesis with
respect to total televi-
sion viewing (Morgan & Shanahan, 1996) and genre-specific
programming (Chory-
Assad & Tamborini, 2003; Romer et al., 2003; Segrin & Nabi,
2002; Weaver &
Wakshlag, 1986; Wilson et al., 2005); however, examining
cultivation within the
context of a single program (e.g., Grey’s Anatomy), albeit over
32 episodes, remains
uncharted territory. In fact, in several of the aforementioned
studies, support for the
cultivation hypothesis was more robust for genre-specific
compared to total televi-
sion viewing (Chory-Assad & Tamborini, 2003; Segrin & Nabi,
2002; Wilson et al.,
2005). Specifically, Chory-Assad and Tamborini found that
exposure to prime-time

medical dramas among others predicted physician perceptions,
but total television
viewing did not. Similar results were found by Wilson et al.,
although within a
different context, who found child news viewing to explain
more variance than
TV viewing when it comes to fright-related feelings and
concern for one’s safety.
Perhaps increasing the specificity of the cultivation hypothesis
into a particular pro-
gram, over multiple episodes and seasons, will also support
Gerbner’s hypothesis.
After all, Gerbner’s assumption about the nature of cultivation
seems logical within
the context of Grey’s Anatomy. That is, heavy viewing of this
program over the
course of 32 episodes would likely impact perceptions of real-
world doctors among
heavy viewers of this medical drama.
Greenberg’s (1988) drench hypothesis is a competing
framework to cultivation
theory. The drench hypothesis asserts that exposure to a
dramatic program or
narrative can generate a significant impact on an audience.

Whereas cultivation
can be characterized by a drip-drip-drip effect over a long
period of time, the
drench hypothesis is depicted as an intense, immediate effect
(Reep & Dambrot,
1989). Recently, Bahk (2001) applied the drench hypothesis to
the movie Outbreak.
Bahk’s findings supported the argument that exposure to a
dramatic stimulus can
elicit changes in health beliefs. While both frameworks offer
insight into the present
study, examining the effect of Grey’s Anatomy viewing on
perceptions of medical
doctors over 32 episodes better lends itself to cultivation than
the drench hypothesis
for a number of reasons.
The present investigation is concerned primarily with how
repeated exposure to
patterns communicated within a medical drama can impact and
shape viewers’
perceptions of medical doctors. Arguably cultivation is not
concerned with the

effects of a single program or particular genre, yet cultivation
research is interested
in patterns and representations over an extended period of time
(Gerbner & Gross,
1976; Gerbner et al., 2002). Grey’s Anatomy viewers have
watched the everyday
operations of a teaching hospital unfold on their television sets.
Exposure to pat-
terns of courage by these medical doctors may have cultivated
similar perceptions
among viewers, but how these perceptions impact viewers over
time is worthy
of consideration within a cultivation framework. Cultivation
also acknowledges
that exposure impacts the cultivation effect. Specifically, heavy
viewers are hy-
pothesized to provide answers consistent with television reality
when asked about
real-world reality (Gerbner & Gross, 1976). Although this
hypothesis rings true
for total television viewing (see Gerbner et al., 2002) and
genre-specific view-
ing (Chory-Assad & Tamborini, 2003; Romer et al., 2003;

Segrin & Nabi, 2002;
Wilson et al., 2003), conceivably cultivation theory is an
appropriate framework
for a single show spanning 32 episodes. Therefore, portrayals
presented across
32 Grey’s Anatomy episodes will likely impact viewers’
perceptions of real-world
doctors.
From a cultivation perspective, it is assumed that heavy viewers
of Grey’s Anatomy
will maintain perceptions of doctors that are consistent with
depictions of television
doctors on this television program. Moreover, cultivation
researchers have argued
that a cultivation effect is most likely in medical contexts where
viewers often have
limited experiences (see Gerbner & Gross, 1976; Morgan &
Signorielli, 1990; Pfau
et al., 1995). Not surprisingly, media scholars have found that
television viewing of
medical shows impacts patient perceptions of doctors (Chory-
Assad & Tamborini,
2003; Pfau et al., 1995). Additionally, limited experience inside
a teaching hospital

will likely enhance the credibility of the program, which can
impact one’s social
judgments (Busselle, 2001; Busselle & Greenberg, 2000). For
instance, perceiving
television to be realistic enhances the accessibility of television
images in audiences
(e.g., shootings, Americans having extramarital affairs)
(Busselle). In this same man-
ner, perceiving Grey’s Anatomy to be realistic will likely make
television depictions
of doctors on this program more accessible to viewers and
subsequently impact
viewers’ perceptions of real-world doctors. Medical dramas
such as Grey’s Anatomy
can shape perceptions about doctors by giving viewers insight
into the behind
the scenes and day-to-day operations of a teaching hospital,
which few patients,
particularly college students, have experienced first hand. Put
another way, average
college students presumably have little experience inside
emergency rooms and
thus, are likely to perceive Grey’s Anatomy depictions of
surgeons operating in this

environment as accurate due to their inexperience in this
context. With that said,
the first hypothesis is advanced,
H1: The viewing of Grey’s Anatomy is positively associated
with perceived cred-
ibility of this program.
As alluded to earlier, cultivation research asserts that a
cultivation effect is most
pronounced in contexts in which the audience is unfamiliar (see
Gerbner & Gross,
1976; Morgan & Signorielli, 1990; Pfau et al., 1995). That said,
studying the culti-
vation effects of a program such as Grey’s Anatomy, which has
attracted a college-
student audience, is reasonable. Few students have spent
extensive time in a teach-
ing hospital. Not surprisingly, media scholars have found that
television viewing of
medical shows impacts patient perceptions of doctors (Chory-
Assad & Tamborini,

2003; Pfau et al., 1995). With inadequate examples to compare
the validity of the
programs’ everyday portrayals, audiences are likely to perceive
the depictions on
Grey’s Anatomy to be realistic. Following these surgical interns
as they seek out
the most daring and complicated surgeries, audiences are likely
to perceive these
doctors to be courageous. In turn, if viewers of Grey’s Anatomy
perceive these TV
doctors as courageous, then they will also perceive real-world
doctors as being
courageous. After all, research indicates that perceiving a
message to be credible
can make television images more accessible and ultimately can
impact one’s social
judgments (Busselle, 2001; Busselle & Greenberg, 2000). With
this in mind, the
second hypothesis is advanced.
H2: Perceived credibility of Grey’s Anatomy is positively
associated with per-
ceived courageousness of real-world doctors.
Reviews of doctor portrayals on television demonstrate that TV
doctors are coura-

geous. Consistent with depictions of TV doctors on other
medical dramas over
the years such as Dr. James Kildare, Dr. Ben Casey, and Dr.
Marcus Welby, the
cast of Grey’s Anatomy display their bravery through their
courageous maneuvers
in difficult situations. For these reasons, to provide a direct test
of the cultivation
hypothesis, a positive association is expected to emerge
between exposure to Grey’s
Anatomy viewing and a belief that real-world doctors are
courageous.
H3: The viewing of Grey’s Anatomy is positively associated
with perceived coura-
geousness of real-world doctors.
In addition to testing for a direct effect between Grey’s
Anatomy viewing with
perceived credibility and perceptions that doctors are
courageous, an indirect effect
connecting Grey’s Anatomy viewing and perceptions that
doctors are courageous
through the program’s perceived credibility is examined. Media
effects researchers

have encouraged research to examine both direct and indirect
effects (Holbert &
Stephenson, 2003; McLeod, Kosicki, & Pan, 1996). Inadequate
attention to indirect
effects could certainly camouflage the relationship between two
variables of interest.
In this spirit,
RQ1: Does perceived credibility of Grey’s Anatomy mediate the
relationship
between Grey’s Anatomy viewing and perceived courageousness
of real-
world doctors?
Research argues that glamorizing the profession on medical
dramas is a contribut-
ing factor to increases in applications to medical resident
programs, which increased
from 4% in 1994 (the year ER began) to 5.2% in 1997
(O’Connor, 1998). In essence,
O’Connor argued that students watching weekly episodes of ER
over 4 years is com-
parable to a medical student’s time spent in a typical emergency

medicine rotation.
Taking into account television depictions of physicians along
with physicians’ and
public perceptions of physicians, Pfau et al. (1995) found that
television portrayals
and public perceptions of doctors’ interpersonal style and
physical attractiveness
were more favorable than physician perceptions. Interestingly,
network television
depictions and public perceptions toward doctors’ character and
power were more
negative than physician perceptions. These studies suggest that
viewing medical
dramas can impact perceptions. Within the doctor-patient
literature, a commonly
employed measure for patient outcomes is satisfaction (Brown,
Stewart, & Ryan,
2003).
Research has found that patients satisfied with their interactions
with doctors are
more likely to adhere to a prescribed treatment regimen (e.g.,
Brown et al., 2003).
Patient satisfaction has received extensive attention in the
literature. For example,

Roter et al. (1997) conducted an extensive analysis of patient
satisfaction across 13
locations within North America. Their team found that patients
were most satisfied
when the doctor discussed biomedical and psychosocial issues
equivalently. Per-
ceptions that a doctor will perform courageous acts in order to
save or significantly
improve the quality of life for a patient will reasonably be
positively associated with
patient satisfaction. Thus,
H4: Perceived courageousness of real-world doctors is
patient satisfaction with their real-world doctors.
In sum, H1 through H4 present a structural model featuring both
direct and
indirect effects between Grey’s Anatomy viewing, an evaluation
of the credibility of
this medical drama, patients’ perceptions that doctors are
courageous, and patient
satisfaction. Specifically, heavy viewers of Grey’s Anatomy are
hypothesized to
believe the show is credible (H1 ). A belief that Grey’s

Anatomy presents a credible
portrayal of doctors is hypothesized to be positively associated
with a perception that
real-world doctors are courageous (H2 ). To provide a direct
test of the cultivation
hypothesis, Grey’s Anatomy viewing is hypothesized to be
perceived courageousness of real-world doctors (H3 ). Along
with testing a direct ef-
fect between Grey’s Anatomy viewing and perceptions of real-
world doctor courage,
an indirect effect between these variables was assessed as
mediated through program
credibility (RQ1). Following extant research on doctor-patient
communication, a
positive association between perceiving a doctor to be
courageous and patient
satisfaction was hypothesized (H4 ). The hypothesized
structural model is depicted
in Figure 1.
Figure 1

Hypothesized Structural Model
Method
Participants and Procedures
Students in a communication class at a large Midwestern
University recruited five
students to complete the paper and pencil survey for extra
credit. This recruitment
strategy was employed because it offers a broader range of
participants than limiting
a sample to students enrolled in communication classes (see
Kramer & Hess, 2002).
Students returned the survey to the principal investigator within
1 week. Participants
(N D 269) ranged in age from 18 to 46 (M D 20.72, SD D 2.04).
The majority of
participants, 95.5%, identified themselves as White or
Caucasian, while 1.1% were
African American, and 3.4% were other. Most participants were
female (65.1%). In
terms of watching Grey’s Anatomy during Season 2 and part
way through Season 3,
a total of 32 episodes, the majority of participants watched
several episodes (M D

12.77, SD = 14.25). In fact, 78 participants reported watching
all 27 episodes from
Season 2 and the first five episodes of Season 3, while 95 had
not seen one episode.
Measures
In order to prevent the likelihood of an ordering effect,
participants first completed
a series of items pertaining to their perceptions of real-world
doctors’ courageous-
ness and patient satisfaction among others. To avoid an ordering
effect, participants
indicated their television viewing habits along with their
perceived credibility of
Grey’s Anatomy at the end of the survey. Additionally, given
the nature of the
recruitment strategy, it was important to limit the number of
survey items in or-
der to increase the validity of the responses. As a result, scales
to assess Grey’s
Anatomy viewing, perceived Grey’s Anatomy credibility,
doctors’ courageousness,
and patient satisfaction were developed.
To ensure that these measures empirically held together, an

exploratory factor
analysis with principal axis factor extractions, promax rotations
with Kaiser normal-
izations, and a convergence rotation set at 25 iterations was
performed. Five factors
emerged with eigenvalues of greater than 1. Specifically, the
following eigenvalues
were obtained: perceived doctor courageousness (4.39),
perceived Grey’s Anatomy
credibility (2.29), and patient satisfaction (1.08).1
Grey’s Anatomy Viewing. In determining how frequently
participants watched
Grey’s Anatomy, participants were asked, (a) ‘‘During the
second season of Grey’s
Anatomy, how many episodes did you watch on TV?’’, and (b)
‘‘So far this season,
how many episodes of Grey’s Anatomy have you watched on
TV?’’ The sum of both
items resulted in the Grey’s Anatomy viewing variable (M D
12.77, SD D 14.25).
Grey’s Anatomy Perceived Credibility. To determine the

perceived credibility
of Grey’s Anatomy, the following stem was used, ‘‘In general,
images and story-
lines communicated in medical dramas like Grey’s Anatomy are
.’’
Three semantic differential scales with the endpoints not
realistic/realistic, not cred-
ible/credible, and not believable/believable were used on a 5-
point scale. The three-
item index was reliable (˛ D .88, M D 2.75, SD D .94).
Perceived Doctor Courageousness. Perceptions that doctors are
courageous was
measured on a Likert scale ranging from 1 D Strongly disagree
to 5 D Strongly agree,
participants responded to the following seven items: (a) In
general, physicians are
heroic; (b) In general, physicians are brave; (c) In general,
physicians are daring; (d)
In general, physicians are courageous; (e) In general, physicians
are superhuman;
(f ) In general, physicians are brilliant; and (g) In general,
physicians are clever. The
7-item scale was reliable (˛ D .84, M D 3.25, SD D .64).

Patient Satisfaction. On a 1 D Strongly disagree to 5 D Strongly
agree Likert
scale, participants indicated their overall satisfaction with
doctors in general by
responding to two items: (a) ‘‘In general, I am satisfied with my
physician,’’ and (b)
‘‘On average, my physician satisfies my health needs.’’ This 2-
item index formed a
reliable measure (˛ D .79, M D 3.99, SD D .78).
Results
Structural equation model (SEM) using EQS 6.1 was employed
to test the fit of the
hypothesized model. In testing the hypothesized model, Grey’s
Anatomy viewing
was specified as a single-item observed variable, while
perceived credibility, doctor
courageousness, and patient satisfaction were each treated as
latent composite vari-
ables (see Holbert & Stephenson, 2002; Stephenson & Holbert,
2003). To determine
the adequacy of the hypothesized model, the Chi square
goodness-of-fit test (�2 ),
Comparative Fit Index (CFI), Standardized Root Mean Squared
Residual (SRMR),

and Root Mean Square Error of Approximation (RMSEA) were
used as indicators.
To provide a conservative test of cultivation theory, it was
decided that total
television viewing, which represented the sum of hours watched
on the average
weekend and weekday, along with participants’ biological sex
and the number
of doctor visits during the past year should serve as covariates
while testing the
Table 1
Means, Standard Deviations, and Correlations for Variables
(N D 269)
Variables 1 2 3 4
1. GA Viewing 1.0
2. GA Credibility .33 1.0
3. Courage .13 .25 1.0
4. Satisfaction .02 .08 .27 1.0

Mean �.02 �.01 .00 .00
Standard Deviation 14.16 .93 .63 .78
Note. GA D Grey’s Anatomy.
hypothesized model. In doing so, Grey’s Anatomy credibility,
doctor courage, and
patient satisfaction were regressed on each of the covariates
using SPSS software.
Then, the unstandardized residuals for these variables, which
represent the variance
not explained by the covariates, were saved and transferred to
EQS for the structural
equation analyses (e.g., Stephenson & Palmgreen, 2001). In this
way, the variables
depicted in the structural model are not affected by any
systematic effect due to the
covariates.
The Mardia’s normalized estimate was examined and was not
determined to be
problematic at .80. The results indicated that the hypothesized
structural model was
consistent with the data, CFI D 1.0, SRMR D .01, RMSEA D
.00 (CI: .00, .05), �2
(2, N D 269) D .19, p D .91. See Table 1 for correlations,

means, and standard
deviations (after controlling for the covariates) for this model’s
variables and Figure 2
for path coefficients.
The first hypothesis predicted that viewers of Grey’s Anatomy
would be likely
to perceive the show as credible. Following cultivation theory
(Gerbner & Gross,
1976; Gerbner et al., 2002), heavy viewers of television are
more likely to adopt
worldviews that mirror those portrayed on television. A positive
association was
anticipated and found between exposure to Grey’s Anatomy and
perceptions of this
show’s credibility, ˇ D .35, p < .001.
Figure 2
Structural Model
Note. *** D p < .001.
A cultivation effect is believed to be most pronounced within
contexts where

viewers are unfamiliar with the content being portrayed on
television (see Chory-
Assad & Tamborini, 2001; Gerbner & Gross, 1976; Morgan &
Signorielli, 1990; Pfau
et al., 1995; Volgy & Schwarz, 1980). Due to the unfamiliarity
of life inside a teach-
ing hospital, it was hypothesized that for viewers perceiving the
presentations on
Grey’s Anatomy to be credible, a perception that real-world
doctors are courageous
would follow. Hypothesis 2 received empirical support, ˇ D .28,
p < .001.
Following the frequent portrayal of doctors performing heroic
acts throughout
Grey’s Anatomy, it was hypothesized that heavy viewers of
Grey’s Anatomy would
likely perceive real-world doctors to be courageous. Hypothesis
3 did not receive
empirical support, ˇ D .04, p > .05.
A positive association was hypothesized between perceived
real-world doctor
courageousness and patient satisfaction. Patients want doctors
that are willing to do

whatever it takes to improve their health. Hypothesis 4 received
empirical support
in the hypothesized direction, ˇ D .33, p < .001.
Although a direct effect for Hypothesis 3 was not found, an
indirect effect con-
necting Grey’s Anatomy viewing and perceived doctor
courageousness as medi-
ated through perceived Grey’s Anatomy credibility was
examined. Media effects
researchers have encouraged examining indirect effects to get at
the why question
in quantitative research (Holbert & Stephenson, 2003; McLeod
et al., 1996). In
response, a product of coefficient test for mediation was
performed (MacKinnon,
Lockwood, Hoffman, West, & Sheets, 2002). In doing so, a z-
score product for the
mediation of Grey’s Anatomy viewing on Grey’s Anatomy
perceived credibility and
doctor courageousness was computed, (.02/.004) � (.18/.05) D
18. After consult-
ing Craig’s (1936) normally distributed variable table, Grey’s
Anatomy perceived
credibility was determined to mediate Hypothesis 3 at p < .001.

Discussion
Street (2003) advanced the ecological model to provide a
systems framework to
the healthcare provider-patient relationship. Within the model,
Street acknowledged
the media as an environmental factor that influences patient
predispositions prior to
an appointment with a doctor. Although the present
investigation was not a formal
test of the ecological model, it applied cultivation theory to a
single program across
32 episodes as opposed to total television viewing (Gerbner et
al., 2002; Morgan
& Shanahan, 1996) and genre-specific programming (Chory-
Assad & Tamborini,
2003; Romer et al., 2003; Segrin & Nabi, 2002; Weaver &
Wakshlag, 1986; Wilson
et al., 2005), and advanced cultivation theory by providing
partial evidence that
this framework can be applied to a single program over an
extended period of
time. Results from this investigation are discussed below with
an emphasis on how

these findings bolster Street’s ecological model, advance
cultivation theory, and to
a larger extent, provide a linear framework from which to
understand antecedents,
within a media context, to patient satisfaction.
A research line that emerged more than four decades ago sought
to understand
media portrayals of doctors (Chory-Assad, & Tamborini, 2001;
Pfau et al., 1995;
Turow, 1989, 1996; Turow & Coe, 1985; Volgy & Schwarz,
1980). From this
research, readers learn that doctors historically have been
portrayed on television
as omnipotent healers who overcome adverse conditions to
triumph in the face of
adversity (O’Connor, 1998). Although content analyses of these
medical portrayals
abound (Chory-Assad, & Tamborini, 2001), less is known about
how these portrayals
impact patient perceptions (Chory-Assad & Tamborini, 2003;
Pfau et al. 1995;

Volgy & Schwarz, 1980). Cultivation researchers argue that
heavy viewers are
likely to perceive the world as it is depicted on television more
than light viewers
(Gerbner & Gross, 1976; Gerbner et al., 2002). Although the
bulk of research
favors a cultivation effect (see Morgan & Shanahan, 1996),
Gerbner and colleagues’
hypothesis is stronger when audiences have little experience or
exposure to the
phenomenon depicted on television (Gerbner & Gross, 1976;
Pfau et al., 1995). For
these reasons, it was hypothesized that a positive association
would emerge between
Grey’s Anatomy viewers and show credibility. The first
hypothesis was supported,
which predicted that the number of Grey’s Anatomy episodes
viewed would be
positively associated with the perceived credibility of the show.
In other words, the
more people watched the show, the more realistic they
perceived the program. This
finding was not surprising given the limited exposure that has
been given to day-

jircd (print) issn 1742–2906jircd (online) issn 1743–1662.docx

jircd (print) issn 1742–2906jircd (online) issn 1743–1662.docx

Recommended

Recommended

More Related Content

Similar to jircd (print) issn 1742–2906jircd (online) issn 1743–1662.docx

Similar to jircd (print) issn 1742–2906jircd (online) issn 1743–1662.docx (20)

More from christiandean12115

More from christiandean12115 (20)

Recently uploaded

Recently uploaded (20)

jircd (print) issn 1742–2906jircd (online) issn 1743–1662.docx