Academic English aids individuals to achieve literacy competency and make progress in formal education. It is valued and learned more and more all around the world due to the spread of English and globalization (Kusumaningputri & Widodo, 2018). As planned and prearranged classroom material is an integral part of education (Dabbagh & Safaei, 2019), coursebooks have been considered as a major and rich source of learners' information for a long time (Ayu & Indrawati, 2019). Coursebooks can motivate or demotivate students' learning and can provide support, guidance, and consistency for both teachers and students (Zohrabi et al., 2014). Accordingly, English for specific purposes (ESP) is a materials-led approach in the broader domain of English language teaching (ELT) (Dudley-Evans & St John, 1998). The significance of ESP textbooks may be more apparent in countries where English is used as a foreign language, like Iran (Alemi et al., 2021). 

English plays a central role in achievements of professionals in almost all fields. As Gordin (2015) pointed out, at the same time that scientific articles became the yardstick of success and scientific productivity, English was prescribed as the language of science. With the establishment of English as the lingua franca of science, around 98% of publications in science are written in English (Gordin, 2015). In medical contexts, English has become both the international and intranational language (Dzuganova, 2002). Those who plan to join the medical or healthcare field need English to pursue their special education and work efficiently (Kourilova, 1979). English has progressively become the lingua franca of medical publications and conferences throughout the world with researchers from ‘smaller’ languages going for English because of the larger scientific effect and reputation with a great international audience (Khalili, 2021). In this regard, Ammon and Hellinger (2013) state due to the dominance of English as the international language of science, one should learn English if they desire to be discussed or read outside their country. 

Dental students are supposed to have an adequate level of English proficiency in order to meet their academic and professional needs such as reading dental sourcebooks, articles, and webpages, writing for publication in scholarly journals, taking advantage of English multimedia resources, discussing dental subjects and issues, and presenting ordered and coherent arguments.

As Robinson (1991) asserts, ESP course design is the product of a dynamic interaction between various elements, including the results of the needs analysis (NA), the course designer’s approach to syllabus and methodology, and existing materials. Though there are different views on how to design ESP courses, there is a consensus that the learners’ needs should primarily be recognized, and that the ESP course should be organized in line with those needs and requirements. These needs will, in turn, be utilized as a guide to the design of the syllabus, course materials, and teaching and testing methods. 

Regarding approaches to ESP in both teaching and learning, Hutchinson and Waters (1987) identify three major approaches, namely language-centered, skills-centered and learning-centered. Unlike the language-centered and skills-centered approaches which build the content of the course on the analysis of the target situation, a learning-centered approach goes beyond that and identifies the learning situation (Hutchinson & Waters, 1987). 

            The learning-centered approach, which was the focus of the present study, intends to maximize the potential of the learning situation. This might include considering the process of learning, learners’ motivation, and learning styles (Dudley-Evans & St John, 1998). As Hutchinson and Waters (1987) believe, the learning-centered approach considers the learner at every stage of the course design process. In the learning-centered approach, course design is a negotiated process and both the target and ESP learning situations shape the nature of the materials, syllabus, methodology, and evaluation procedures. The learning-centered approach implies that the analysis of the learning situation and that of the target situation go hand in hand. Thus, they are, in fact, complementary rather than conflicting. Bloor (1984) states that the needs of both the target and learning situations should be analyzed to create an appropriate teaching or learning syllabus. To carry out an objective evaluation of the EMP course design and the students' needs, this approach was adopted for the current study. 

2. Literature Review

2.1. Medical Students' ESP Needs

As Hutchinson and Waters (1987) point out, textbook evaluation is fundamentally a straightforward logical "matching process: matching needs to available solutions" (p.97). Some needs analysis studies in Iranian medical contexts are presented as follows. Mazdayasna and Tahririan (2008) conducted a large-scale needs analysis study of Iranian undergraduate medical students and concluded that while students need all language skills in order to cope with English tasks in their profession, they do not gain adequate proficiency after passing ESP courses. Several factors get in the way of having effective ESP courses including not considering 1) learning needs, 2) present level of foreign language proficiency, 3) objectives of the course, 4) resources available in terms of staff, materials, equipment, finances, and time constraint, and 5) the skill of the teachers and the teacher's knowledge of the specific area.

            Khorvash and Koosha (2015) examined the foreign language learning needs of Iranian students studying in medical faculties. They compared the needs of students involved in ESP courses and those who had passed these courses. The findings indicated that although the students in the “Post-study” group declared partial satisfaction with the materials, there was a great need to develop new materials and more attention was required to be paid to the course design. Finally, they concluded that some expertise should be brought to the field of medicine to make the ESP courses more consistent with the students’ needs and, consequently, more practical and fruitful.

            Nezakatgoo and Behzadpoor (2017) conducted a study to investigate ESP students' needs and the main challenges of teaching ESP in Iranian medical universities. They classified the challenges of teaching and learning EMP into 3 main themes, namely institution, learner, and teacher-related challenges. The institutional challenges were related to the curriculum, syllabus, evaluation, time, and classroom size. The learner-related challenges were low motivation, general English problems, focusing on a test, and improper needs analysis. The teacher-related challenges included teachers' poor content knowledge and general English proficiency, perception of ESP, teaching methodology, familiarity with material development, and testing skills.

In a more recent study, Khalili and Tahririan (2020) conducted a study to examine the needs and challenges of teaching EMP in Iranian contexts. They found that current EMP courses do not meet the needs of medical students for several reasons. First, while medical students preferred working on all 4 language skills, EMP courses were mainly reading-based. Second, the students were not satisfied with the presented materials and methodology. Third, areas of concern in ESP were not considered by teachers. Finally, factors including heterogeneous classes and insufficient time were found to be impeding factors in achieving ESP goals.

In this section, first some recently conducted overseas studies are reviewed. Then several Iranian studies carried out on ESP and EMP textbook evaluation are presented.

Ou (2019) evaluated three ESP textbooks for the students of computer, advertising, and logistics in China. The books were all written by Chinese authors and publications. The findings revealed that while reading and vocabulary were emphasized in these books, listening and speaking skills were not included and learning strategies were not focused on. Utami (2019) evaluated an ESP coursebook for the students of tourism in Indonesia. They concluded that in spite of the writers’ claim that the book was communicative, the evaluation result indicated that it was more structural as the exercises of the book mainly used drilling tasks. Sari and Sari (2020) carried out a study to evaluate a coursebook used in Preparation Class of Maritime English Test in one Merchant Marine Polytechnic from the viewpoints of teachers, graduates, and cadets. They found that while the book encompassed relevant vocabulary and grammar, they were not developed systematically. The physical features and illustrations were not satisfactory and needed revisions and modifications.

There is a substantial number of ESP book evaluation studies in Iranian contexts. For the purpose of the present study, however, only the EMP book evaluation literature is provided. First, Razmjoo and Raissi (2010) investigated SAMT (an Iranian organization for researching and composing university textbooks in the humanities) EMP textbooks concerning the theoretical considerations, the organizational features and practical considerations, the content, the language skills, the vocabulary, and the grammatical structure from the instructors' and students' viewpoints. They found out that both instructors and students were not content with most of the principles the SAMT ESP textbooks were expected to observe. Similarly, Ebadi and Naderifarjad (2015) compared an international EMP book with a local one entitled Oxford English for Careers: Medicine and English for medical students, respectively. The findings were suggestive of a higher level of satisfaction with the first book regarding six constructs of theoretical consideration, organizational features and practical considerations, content, language skills, vocabulary, and grammatical structures. In another study, Parsaei et al. (2017) examined learning objectives in 3 ESP books for medical, dental, and pharmacology students. The results indicated that high-level skills essential for effective autonomous and critical learning were not stressed as lower levels of learning in these books. Finally, Salehi and Khadivar (2015) evaluated a medical terminology book that is mainly used besides EMP coursebooks in Iranian medical universities. They found that the participants were satisfied with the included content, topics, and exercises, and the book could properly meet the needs of medical students in terms of terminology.

Although a great number of English courses in Iran deal with ESP, principles underlying course design, which should be viewed as an ongoing process to suit students’ interests and needs, have been overlooked and they are of limited scope (Khalili & Tahririan, 2020). Moreover, despite the fact that Iranian medical students have a general and sometimes a prerequisite English course prior to their ESP courses, their level of English proficiency is not adequate enough to meet their needs (Mazdayasna & Tahririan, 2008; Moslemi et al., 2011). ESP coursebooks have constantly been reported as a main challenge that got in the way of achieving the desired goals of ESP courses (Kaivanpanah et al., 2021; Khalili & Tahririan, 2020; Tavakoli & Tavakol, 2018).

According to Sheldon (1988), teachers frequently face complications selecting or developing classroom materials due to a load of heavy schedules and the restraining nature of most teaching conditions, which coerces them into choosing a book that is only an approximation to the context needs. This decision is not always right and is usually made hastily with a dearth of systematically applied criteria. Nevertheless, as coursebooks are considered to be the roadmap of any ELT program and as the evaluation of courses and teachers is highly affected by proper book coverage, wrong selection can be a hefty reason to rue. 

Besides, as Nation and Macalister (2010) point out, when teachers choose and introduce a coursebook and students buy the book, there is an obligation to use it even if the book turns out to be inappropriate for the course. Therefore, before recommending a coursebook, teachers should spend time evaluating the intended books systematically in order to have the right choice. As Nunan (1991) emphasizes, in order to ensure the consistency of materials with the needs and interests of the students, systematic materials evaluation can be of great help. However, systematic evaluation of coursebooks is not usually conducted for Iranian ESP courses and students' needs and preferences are passed over (Baleghizadeh & Rahimi, 2011). According to Swan (1986, cited in Robinson, 1991), several factors lead to the underdevelopment of evaluation in ESP including the shortness or even one-off nature of ESP courses, the time-consuming nature of evaluation, and the lack of any felt need for evaluation. Therefore, studies investigating the recent needs of learners and evaluating the available coursebooks can be of great value to the involved stakeholders in ESP.

The main goals of this study are to investigate the English language needs of dental students and to evaluate the most recent book published for the students of dentistry by SAMT Publication in order to see whether this book has the potential to meet the specific students’ needs and also the course objectives and goals. Therefore, the following research questions were formulated: 

1. What types of content, skills, and class activities address the needs of dental students?
2. To what extent can the latest available ESP book for the students of dentistry meet the students’ needs and course objectives?

3.Methodology

3.1. Participants

A sample of 34 participants including 22 male and female dental students and 12 ESP teachers from different cities and ethnic groups in Iran participated in the study. The students, aged between 20 and 31 (M=22.1), studied in their fourth semester. The teachers were all PhD holders including 8 teachers majored in teaching English as a foreign language (TEFL), 2 in English literature, and 2 in English translation. They were experiencing 4-20 years of their professional teaching in higher education with 35-60 age range (M=42.4). The participants were affiliated to the Isfahan University of Medical Sciences and Islamic Azad University of Khorasgan taking advantage of the availability sampling.

The intended book for evaluation was SAMT's most recent ESP coursebook for the students of dentistry entitled English for the Students of Dentistry written by Tahririan et al. and published in 2016. The SAMT organization has published 178 ESP books, 31 of which are medical. The mentioned book was chosen to be evaluated as almost all universities in Iran work on SAMT books. 

3.3. Instruments

3.3.1. Interviews

To gain an understanding of the topic, 2 sets of semi-structured interviews were formulated to find out the participants' opinions about the questions. First, the students were asked to elaborate on their strengths and weaknesses in terms of language, skills, and learning experiences (present situation analysis). Moreover, they were asked to mention their attitudes towards the course and their learning style techniques (learning needs analysis). The students were also interviewed for their preferences with respect to teaching methodology, tasks, and materials. The framework of the students' interview is presented in Figure 1.

Figure 1. Students' Interview Outline

Second, the ESP teachers were asked to share their views about the students' strengths and weaknesses in terms of language, skills, and learning (present situation analysis). They were also asked to evaluate medical ESP courses and materials and mention any related strengths and weaknesses. The outline of the teachers' interview is presented in Figure 2.

Figure 2. Teachers' Interview Outline

Following the needs analysis and the aims of the course, our second instrument, a coursebook evaluation form, was prepared. Sixteen items were developed based on the needs analysis, course aims, some guidelines for preparing teaching materials introduced by Howard and Major (2004), and some general features in materials development suggested by Nation and Macalister (2010). 

Several points were considered in the development of the form. The issue of validity was the primary concern. To ensure the validity or relevance of checklists, developers should take into account the addressed construct domain and identify the criteria for evaluation (Mukundan et al., 2011). The current form was developed according to a review of the similar former checklists to confirm its construct validity. Furthermore, eliminating large, vague, and dogmatic items in the trial stage of the developed checklist can lead to a more systematic, rigorous, and reliable evaluation. Therefore, it was attempted to design clear items that rarely tended to be interpreted differently by different evaluators. 

The design of the evaluation form was mainly taken from that of Nation and Macalister (2010). Since the items were of different importance, each item was indicated by its weighting. Then, six evaluators scored each item and multiplied the score by the weight given to that feature. Finally, an overall score out of 100 was provided. 

4. Results

4.1. Interviews

The results obtained from the interviews are summarized in the following. Major categories were generated following the data codification. The presented findings are the most representative notes and quotes by the students and ESP teachers. 

4.1.1. Students' Views

4.1.1.1.Language Skills Needs and Lacks

In terms of students' language skills needs, the findings of the interviews indicated that the majority of the students wished that all 4 language skills had been practiced in their ESP courses. Others believed that even though all language skills were significant, reading and writing had to be paid more attention to since they were essential to all medical students, while listening and speaking were required for some. On the other side of the spectrum, some students thought that listening and speaking were more important since they believed that the ultimate goal of language in medical fields is communication. 

            As far as listening is concerned, several students stated that the importance of improving listening skill is felt more than in the past. Some of the students stated that they needed to improve this skill for listening to and watching multimedia resources. They mentioned as there are valuable online conferences and educational videos for dental students and professionals, a certain level of listening proficiency is a must for them. Moreover, several students pointed out that as dental practitioners, they needed to develop their listening skills to be able to participate in international meetings and conferences. They maintained their chance of joining these events have notably increased in the post-COVID era. Finally, most of the participants declared the significance of oral skills for dental students as today more and more students intend to work or study abroad. 

            As regards speaking, a large number of the students pointed out that dentists need to practice speaking since it is needed in everyday, academic, and professional contexts. They reported that speaking skill is critical as medical professionals need it for international presentations, real doctor-patient, doctor-doctor, and doctor-staff interactions, and communication in foreign countries. In ESP courses, they stated that since speaking could not be practiced individually outside the classroom, classes had to be held in English, students had to be given opportunities to speak in English, and English speaking tasks were welcomed.

            In the case of reading, almost all students acknowledged that reading was particularly important for them. It was found that students needed to develop reading skill in order to read medical articles, medical sourcebooks, and online texts and discussions. Moreover, they believed that reading was essential for all medical students to get informed about medical innovations all around the world.

            With respect to writing, a number of students declared that developing writing skill was important to medical students due to several needs including writing emails for academic or professional purposes, writing articles for national or international journals, sharing research with the world, and writing for work settings, like taking notes and writing reports and reviews.

            In addition to the 4 macro skills, most of the students announced the important role that terminology plays in their field. They believed that a major factor that distinguishes ESP from English for general purposes (EGP) in medical fields is the practice of medical terminology. The majority commented that working on the related terminology had to be the priority in ESP courses. Some of them confirmed that working on terminology was even more critical than covering textbook reading passages.  

            In terms of students' language skill lacks, it was found that the majority of the students had problems in listening, speaking, vocabulary, and pronunciation. 

The teaching principles and methodology adopted in ESP courses were examined and the students’ preferences with respect to learning styles and methodology were inspected. 

First, several students pointed out that even though teachers had good general English knowledge, they had poor content familiarity. Second, some students believed that instead of wasting time on useless basic language principles, the English knowledge of the field had to be practiced. This indicated that genres were not sufficiently practiced in ESP courses. Third, some students reported that their course was more like a general English rather than an ESP class. The language they practiced, the tasks they were given, the methodology the teachers employed, and the materials they covered were not that much different from those they had in their previous general English course. 

Fourth, the students mentioned that methods of teaching vocabulary and terminology were inefficient. Some teachers avoided practicing terminology. Others merely mentioned the Persian equivalents of terms without elaborating on the technical definition or usage of the terms. Some nativized the pronunciation of loan words by adapting pronunciations to the sound system of Persian. A majority of teachers thought it was not their responsibility to clarify technical terms and expected the students to know the related terminology. 

Fifth, some students expressed that in their ESP courses, some teachers did not cover different parts of units fairly. One of them said that the teacher spent more time on his interest rather than the students'! Sixth, the students maintained that while group or pair work could bring about more interaction and add variety to the course, these activities were almost always passed over. Finally, the majority of the students believed that even though the time was limited, the course could be more efficient through the right methodology and materials. 

In terms of students' preferences, they mentioned that the techniques of teaching and practice were dull and different methods could be implemented to add variety to the course. Moreover, some of the students preferred to have ESP courses held in English. They stated that ESP courses would be useless if they were not held in English since the same content is taught in specialized courses in Persian by more knowledgeable teachers! Some believed that in order to have more effective ESP courses, teachers could specify more related homework. When students were not required to be prepared, they did not study. Other preferences declared by the students were practicing study skills, working on terminology, reading recently published authentic articles instead of old books, having more discussions in English, considering extra materials and exercises, paying more attention to pronunciation, and focusing on communicative skills.

Like the students, the teachers gained an understanding of the significance of practicing 4 language skills. 

Not surprisingly, the teachers gave priority to reading skills since dental students need to read plenty of English sourcebooks, journal articles, medical websites, and journal handouts. Moreover, reading is always the primary focus of ESP syllabi set by departments and examination boards.

The teachers believed even though oral skills received scant attention in ESP, they were vitally important to meet students' academic and professional needs. They stressed the importance of speaking and listening to improve students' motivation and confidence. Moreover, as more and more medical students intended to emigrate to other countries to either pursue their education or work, oral skills took on special significance. 

The ESP teachers pointed out that the practice of writing skill to some extent in ESP courses. They maintained the prominence of this skill for effective clinical practice to document medical reports and prescribe medical instructions. In addition, the teachers reported that medical students needed to get acquainted with e-mail writing in order to satisfy some academic and professional needs including applying to universities, applying for work permits, and enabling communication between professors, supervisors, journal editors, colleagues, and clients. Ideally essay writing was believed to be very helpful to medical students since they could convey intricate scientific concepts and vital clinical information through English journal articles. However, due to lack of time available in ESP courses, essay writing was mainly ruled out in ESP classes.  

Some teachers also added the effectiveness of translation skills for medical learners and professionals' success. On the other hand, they pointed out that achieving these goals was not feasible owing to some limitations, above all insufficient time.

According to the needs analysis, course aims, some guidelines for preparing teaching materials presented by Howard and Major (2004), and some general features in materials development suggested by Nation and Macalister (2010), the coursebook evaluation form was prepared and completed by 6 evaluators who had taught the target book. The mean scores of each item (out of 5) were generated and presented in Table 1.

Table 1. 

Coursebook Evaluation Form

As illustrated in Table 1, the first 2 items, the aims of the course and students’ needs, had higher weights (3) compared to the rest of the items (1). Even though all the items were significant in ESP material development, these two items were weighed 3 and the rest were weighed 1 after consulting the evaluators and ESP teachers.  Six evaluators scored the items on a scale of 1-5, and the mean was presented. Each item was multiplied by its weight given to that feature. 

Item 1 focused on the goals and objectives of the course set by policymakers and the teacher. These aims were mainly around reading comprehension techniques, medical pronunciation, dental abbreviations and acronyms, structure, synonyms and antonyms, communication, translation, and word analysis. Except for pronunciation and abbreviations, the book addressed the course aims appropriately and therefore item 1 was scored 4.25 out of 5. 

Item 2 (M: 2.75) considered the learners’ needs and wants. While the participants stated that they required to practice the 4 language skills to meet their needs, except for reading and a few speaking points, other skills were not included in the book. It contained neither guidelines in the learning of the pronunciation of dental terms nor activities for the practice of these words. The book did not even provide the phonetic transcription of the given terms. Likewise, the practice of listening and writing skills was not at all included in the book.

Next, item 3, which investigated the usefulness of the book outside the classroom, gained the score of 3.25. This item emphasized the replication of book tasks in real contexts and outside the given text. Certain activities are supposed to make students use language to exchange their own ideas, preferences, and feelings.

Item 4 examined the feature of contextualization, which means materials should be contextualized to a. the curriculum they are intended to address, b. the experiences, realities, and first languages of the learners, and c. topics and themes that provide meaningful, purposeful uses for the target language (Howard & Major, 2004). The book considered the first point well but the others to a small degree. Therefore, this item was scored 3.25. 

Item 5 measured the attractiveness of the contents. The score given for this item was 3.5. Some contents which could augment the attractiveness of the book are short interesting case studies, attractive dental facts, interesting word derivations, and some new attention-grabbing lessons such as forensic dentistry or cosmetic dentistry. 

Item 6 focused on the coverage of the 4 language skills. As mentioned before, the book mainly focused on reading skill and partly on speaking, but it did not include listening and writing skills. As a result, the book did not gain a score better than 2. 

Item 7 investigated interaction, which is based on the criterion that materials should provoke interaction and be generative with regard to language. Materials should provide situations where real communication takes place (Howard & Major, 2004, p.105). This is referred to as "learning by doing philosophy" (Nunan, 1988, p.9), which makes interaction necessary to perform activities such as information gap and information transfer. This item was scored 3 for the evaluated book.

Item 8 checked the appropriateness of the activities of the book. To evaluate this fitness, several points were considered including ensuring proper challenge and levels of success through the right level of exercises, meeting the learners' needs, involving authentic materials, changing the organizational structure of activities such as individual tasks, pair works, small groups, and whole class activities (Howard & Major, 2004). This item was scored 4.25.

Item 9 focused on how much the layout of the content could attract the learners. It also examined the cohesiveness and consistency of the layout. Here, the book gained a score of 4.25. Item 10, opportunities for self-study, analyzed the format and presentation of activities that could be used for self-study. These options are provided for work to be done outside of class time. Suggestions include using vocabulary cards, using deep processing, and practicing (Nation & Macaliste, 2010, p.13). This item was scored 4.25. 

Items 11 investigated whether the book had an appropriate number of lessons. According to Nation and Macalister (2010), the number and size of lessons should fit the length of the course and the time available. Moreover, the number of lessons should be large enough to let flexibility and variety to suit a broad range of conditions for language teaching. This item gained the score of 4.75. 

No technological features such as DVDs, i-tools, multimedia software, flashcards, digital student books, videos, or even audio files are incorporated into this book. Therefore, item 12 was scored 1.5. Item 13 examined the integration of language skills. As Howard and Major (2004) recommend, materials should provide opportunities to integrate all the language skills in an authentic way. Except for some parts where we see the integration of reading and speaking skills, the book does not integrate all four language skills and, therefore, this item was scored 2.5. 

Item 14 considered the authenticity of materials. This book takes advantage of up-to-date authentic texts, thus, this item was scored 4.5. The units of the book are rather coherent and progressive. However, since the book does not give opportunities and reinforcement for earlier learning, item 15 was scored 3.25.  By flexibility, investigated in the last item, we mean the diversity in the content, roles, and procedures for both learners and teachers. Due to the wide variety of texts and genres, this book allows teachers and learners to make choices and, therefore, item 16 was scored 4.25 out of 5. Finally, the overall score out of 100 was 69.75 for the mentioned book. 

The present study investigated the specific needs and wants of the dentistry students in its first phase and finally it evaluated the most recent book published by SAMT Publication entitled English for the Students of Dentistry written by Tahririan et al., and published in 2016. Although the book did not gain a score better than 69.75 out of 100 based on the criteria utilized in our evaluation, the participants asserted that among a few ESP books published for dentistry, this book is the most appropriate one to be used in ESP courses for Iranian dental students. However, considering the following points can surely improve our future ESP books and give the material developers a better understanding of ESP materials.  

First, while some experts believe that ESP students favor working on 1 or 2 skills, this was not the case for our participants. Our students believed that all the four skills were worth practicing in ESP classes. However, listening and writing were mainly neglected in our ESP courses and speaking was not worked systematically but the only focused skill was reading. The findings are in line with those of Khalili and Tahririan (2020) indicating that while medical students desired to work on four language skills, reading was the only skill developed in their EMP courses. Hence, as reading is a skill that is highly emphasized and dealt with in our ESP syllabi and curriculum, it is not surprising that the majority of ESP books published in Iran focus solely on reading. Four reasons can explain this overemphasis. First, our policymakers consider the mastery of reading as the ultimate goal of ESP courses and they make the instructors and learners spend the majority of class time on this skill. However, the results of our study suggest learners prefer ESP courses with an emphasis on all 4 skills. Second, developing reading materials with ready authentic materials seems simpler, cheaper, and faster. So, why bother preparing materials for other skills. Third, since our materials have been developed based on an ancient needs analysis, if any, and obsolete lesson plans, our material developers are used to the materials which mainly focus on reading. But, as it was argued before, it is maybe the time for change.

Second, based on the interviews and the second question of the questionnaire, the learners' needs in terms of speaking, listening, writing, and pronunciation were not sufficiently considered. However, the goals and objectives of the course set by policymakers and teachers were paid adequate attention in ESP courses. Consequently, it can be inferred that policymakers might not consider the needs of students in designing curricula. This might seem to be an extreme view, thus, we can assert that they do not consider the recent needs of ESP learners. Today, most people and especially the youth know that our world is developing and changing swiftly. However, while we continuously keep our smartphones and operating systems updating, we sometimes shut out updating our beliefs and human systems. Nonetheless, today adolescents seem to have begun to question the status quo. They are aware that most traditional standards no longer suit today's creative and technological age and things need to change. As Gómez-Galán (2020) concludes, we should adapt to the recent needs of learners in order to fully enjoy the benefits of quality education.

Third, except for the integration of reading and speaking skills, other skills were not integrated in the book. Since almost all our ESP books miss the opportunity for integrated language use, our material developers can be blamed. Materials should ideally provide opportunities for the learners in order to integrate all the language skills authentically (Howard & Major, 2004). In this respect, Bell and Gower (1998, p. 125) point out, “At the very least we listen and speak together, and read and write together.” 

Fourth, even though the book took advantage of authentic texts, it did not include real communications that dental students might experience in their future work setting. This is not limited to our study and due to our teachers and material developers’ lack of familiarity with the authentic language used in real situations, we rarely see materials on the language used in everyday professional contexts such as clinics and hospitals. While many Iranian dentists and physicians can participate in academic discussions, speak at seminars and presentations, and read and write in their professional journals, they can hardly communicate with patients and staff in work situations such as clinics and hospitals. One might say that they may not need English for everyday communication, but as Smith and Ashmore (2010) argue, in addition to practitioners, medical researchers have to have the ability to transfer technical concepts and terms to a "lay" audience. Unfortunately, we do not have ESP coursebooks that introduce even simple conversations between patients and doctors. 

Fifth, it was found that oral skills particularly listening were not adequately included in the book. Since it is a time-consuming, expensive, and demanding task to produce materials for speaking and listening, especially in the EFL context, material developers might elude such materials, particularly listening which is completely forsaken in our ESP books and also in our instruction and tests. However, this cannot justify this shortcoming and material developers can compile a corpus related to the language utilized in work communication.

Finally, as most of the participants asserted, the time assigned for ESP courses was not sufficient for a fruitful course. This seems sensible because two two-credit courses with thirty dental students in each class do not provide adequate time to achieve our desired goals. Still we can make our courses more efficient by adding proper technological modes of instruction (Khalili et al., 2015) and removing some unnecessary instructions and tasks such as translation activities. The dominant methods in our ESP classrooms and textbooks are mainly the insufficient ones such as the Grammar Translation Method with spending a great amount of time on explaining new vocabulary, grammar, sentence structure, and translating texts into Persian paragraph by paragraph. Although the teachers and material developers know the importance of communication in language learning, a lot of time is usually spent on translation and we rarely see meaningful communication among learners. 

Regarding translation tasks which were included in the evaluated book (and all SAMT ESP books) but not practiced well in the classes, several points are worth mentioning. First, translation activities were usually done cursorily due to lack of time. Second, because these tasks were practiced without any instructions on how to translate, the outcome was generally not satisfactory and the students usually did them reluctantly. Third, since Persian equivalents were not found for most technical words, the translated texts were usually funny ones with a large number of English words. Last but not least, since most ESP learners did not aim to become translators and needed English as a means in their profession, they would rather not spend time on translation tasks. Therefore, mainly translation tasks were done reluctantly, carelessly, cursorily, and sometimes completely passed over. Thus, we need to have a change of heart and breathe new life into our ESP books.