This paper reports an action research project which aims to develop an English enhancement course for medical students undergoing clinical training at the University of Hong Kong, We videotaped six one-hour sessions of ward teaching and identified linguistic skills that students need in order to activate their medical learning. These skills were found to include the ability to use appropriate colloquial and technical terms in questioning and reporting case histories, to recite the chronology of a medical history, to report the results of physical examinations, and to describe the location and pathology of internal organs accurately. Based on the data analysis, we developed teaching materials which aim to raise students' awareness of the cognitive and linguistic demands of the clinical training program, and to improve their performance through various communicative tasks and through the role-play of parallel cases.

There are numerous types of English-listening problems which Hong Kong students face. These include recognized limitations in English vocabulary, as well as the problems which teachers create due to structural complexity or unfamiliar references. Students may also experience a "blur" factor in listening to English, i.e., when the combination of familiar words is merely perceived as a stream of sounds. Liu's (1998) preliminary study of the extent to which university students recognize and understand words in a short piece of English expository discourse presented on CD-ROM found that:
• Students may encounter two major difficulties: unfamiliar vocabulary and failure to segment or divide sound streams into words.
• Low proficiency students often cannot identify sounds of words that they know in writing.
• Use of English grade D and E students recognize less than 40% of the words they hear.
Apart from problems related to features of English speech, there remains a more "listener-external" problem, i.e., the intrinsic cognitive load of the lecture discourse. The nature of cognitive load is explored and examples of what might constitute high cognitive load are looked at. In what ways could teachers alleviate some of the problems associated with high cognitive load and low English proficiency?
A small trial was carried out to explore ways in which university teachers can adjust lecture-support materials in English, in order to increase student comprehension and learning. Forty-one students at Hong Kong Baptist University participated in this study. Three types of lecture support materials (knowledge map, full outline, partial outline) were used.
Although this exploratory study does not conclusively show the learning advantages (in terms of quiz scores) of one type of lecture aid over another, several important points emerge:
• the knowledge map is perceived as enhancing lecture comprehension by students, even though students are not familiar