THE INFLUENCE OF THINK PAIR SHARE (TPS) AS A COOPERATIVE LEARNING MODEL IN IMPROVING HEALTH INFORMATION MANAGEMENT STUDENTS’ SKILL AT DELI HUSADA DELI TUA HEALTH INSTITUTE ON TOEFL TEST

TOEFL is categorized as a Norm-Referenced Test because scores are associated based on tiered counts or has percentage stages. Based on an initial survey, the biggest difficulty of TOEFL is known having high difficulty level. Think Pair Share (TPS) as a cooperative learning model for more effective learning system in providing and improving communication skills both orally and written within the scope of academic understanding through TOEFL. The application of TPS is expected to increase student's TOEFL score, learning quality and provide the opportunity to find out strategies on TOEFL success and further develop students’ skill. TPS is a type of cooperative learning designed in the form of discussion that can improve thinking skills, communication skills and encourage student participation in class. This research is aimed to improve the ability of Health Information Management students in facing TOEFL test by applying the cooperative learning model Think Pair Share (TPS). After applying the model, it found that the average score of students' TOEFL scores as well has increased from previously 56.93 to 83.68. This can be seen during the English learning process in the classroom. In learning by using Think Pair Share (TPS) model, students are required to discuss simple and effective ways to solve TOEFL questions with their friends by expressing the result of his thoughts.


Introduction
TOEFL (Test of English as a Foreign Language) is a test used to determine a person's skill in English. In education field, TOEFL is becoming popular because almost all universities in world apply TOEFL score requirements for magister and doctoral students. Not only that TOEFL score also apply as entry requirements for prospective civil servants and private employees. In recent developments, many universities have required undergraduate candidates to have TOEFL score. This regulation is not yet in effect for Health Information Management study program in Deli Husada Deli Tua Health Institute at this time, but TOEFL course is already included in curriculum because as it is known all books regarding teaching materials are in English. Even though the current graduation requirements do not require passing TOEFL with a minimum score, students have to prepare grab TOEFL score of 450 because of demands in medical record field.
It is not easy to get a sufficient TOEFL score for most students. They do not have skills to discuss grammar, listen to long conversations or read articles on scientific topics that are very academic specifically for TOEFL content. Think Pair Share (TPS) is a cooperative learning model that allows students to complete three stages of academic assignments in pairs, namely thinking, pairing and sharing. First of all, they have to think about TOEFL questions themselves, provide opportunities for students to discuss with their pairs to find the best answers and provide feedback to respond and opportunities to help each other.
Based on above description, there are several problems in this study namely the lack of Health Information Management students' skill on TOEFL and there are many English lecturers who haven't innovated in providing learning models. The study reasons are firstly, the researchers want to applying TPS in improving the ability in the scope of academic understanding through TOEFL whereas TPS can increase student activity, thinking power and longer memory due to mutual arguments in solving TOEFL. Secondly, TPS that performed to improve students' skills on TOEFL never do by other researchers.
Based on the background, researchers formulate study problems. They are how to describe Health Information Management students' skill on TOEFL before being given TPS, how to describe students' skill on TOEFL after being given TPS and How can students' skill on TOEFL be improved through TPS?
The study objectives are to derive Health Information Management students' skill on TOEFL before being given TPS, observe an overview of students' skill on TOEFL after being given TPS and analyze the influence of TPS as a cooperative learning model in improving students' skill on TOEFL.
The research urgency is academically, it is expected to provide scientific contribution in TEFL (Teaching English as Foreign Language) study and practically, the special specification it is expected to provide benefits through the analysis that is presented to obtain preliminary data for the development of English learning strategies especially success on TOEFL for health students.

Literature Review
According to Rizka & Lismalinda (2021:16) that several indicators of learning effectiveness, namely: (a) Achievement of learning completeness, (b) Achievement of the effectiveness of student activities (namely the achievement of the ideal time students use to carry out each activity contained in the learning plan), (c) Achievement of the effectiveness of the ability of educators to manage learning, and student responses to positive learning. The effectiveness of learning is a measure related to the level of success of a learning process. The indicator of effectiveness in this study is an influence in student learning outcomes which statistically shows a significant difference between before and after the application of the learning approach.

Cooperative Learning
Cooperative learning is a system in which there are elements that are interrelated. The various elements in cooperative learning are: (1) positive interdependence; (2) face to face interaction; (3) individual accountability, and (4) skills to establish interpersonal relationships or deliberate social skills taught.

Think Pair Share (TPS)
TPS strategy is a part of cooperative learning. To make a case for collaborative learning seems easy. Research on learning in small groups exists than on any other instructional method, including lecturing. There are five steps in TPS: Bukit, H. P-ISSN: 2723-0961 E-ISSN: 2775-1317 4. Asking students to discuss with their partner and share their thinking. In this section, each students share his or her own answer to his or her partner in pairs to find the best answer. 5. Calling on a few students to share their ideas with the rest of the class and the others can give their opinion or other answers.
It can be concluded that steps of TPS that will be given on TOEFL discussion as follows: a.
Step 1 -Thinking, Lecturer gives TOEFL questions and students are given one minute to think for themselves regarding the answer or issue. b.
Step 2 -Students in pairs. In pairs discussing what had been thought. c.
Step -3 Sharing. Each of pairing group are sharing for cooperate with the whole class in a way about what that has been talked about TOEFL answers and the reasons why they choose it. d.
Step -4 Decisions. The lecturer listens to all of arguments from each pairing group then makes a decision on the correct answer to TOEFL question by giving correct reason. e.
Step -5 Appreciations. The lecturer gives an award to pairing group who always answered TOEFL questions correctly in the form of good scores.
These are some advantages of TPS technique: a. The notion of the positive effects of "wait time" upon the quality of student responses in the classroom. b. Non-native speakers must first linguistically decipher the question itself and then cognitively from a response to it c. Wait time not only offers time for linguistic interpretation of the question but also response formation. d. Pairing with another student gives an opportunity to orally share their response with a classmate and receive valuable feedback. b. The TPS technique also has some disadvantages as follows: c. Not all students focus on the topic given, because they can share everything with their partner out of the topic (question) given. d. There is a possibility that the students who have low understanding about the topic given likely chat to the other pairs

TOEFL
According to Muliawati et al (2020:201) there are three sub-categories of test anxiety typically experienced by test takers; cognitive, emotional, and physical symptoms. In this case, the symptoms of cognition constitute self-comparison to others; thinking that others might perform better than him/her and blanking out due to the struggle to concentrate. Later, emotional symptoms prompt some excessive negative feelings towards the test such as fear of failure, nervousness, shame, and helplessness. The latter is physical symptoms characterized by increasing heartbeats, having sweaty palms, and having a headache.
In sum, test anxiety brings a negative impact on the test outcomes since it can interfere with the test takers' cognition, emotion, and physical state while preparing for the examination, taking the examination, or both. The foreign language test is one of the anxiety sources for EFL learners because it examines their proficiency in a non-native language.
TOEFL or Test of English as a Foreign Language is a standardized test that evaluates the English proficiency of people whose native language is not English. The TOEFL test is an internationally accepted standard of English that measures the academic English proficiency of a non-native speaker of English. The TOEFL test is required by more than 7,000 colleges, universities and licensing agencies in 110 countries throughout the world. The TOEFL test is only to test your English proficiency. A high score alone does not translate into an admission offer from a great school. But the test is mandatory and cannot be overlooked. Students' difficulties in doing the TOEFL were found in three categories of understanding, namely Listening, Structure and Written Expression, and Reading. In Listening, students must have the ability to do "Structure for Restatements", understand the conversations types and topics for mini-talks. In Structure and Written Expression level, there is a detailed and comprehensive discussion of grammar starting with a discussion of verbs to vocabulary. This part is as difficult as the third category, which is about Reading. In Reading, students must be able to master vocabulary, and must able to analyze through the stages of 'previewing, reading for Main Ideas, scanning, inference, restating, and other factors.
The strategies in teaching TOEFL in the classroom as follow:

Research Method
According to Tanner (2018) in Sabrina et al (2020:79) explain that an experiment is a research situation in which at least one independent variable, called the experimental variable, is deliberately manipulated or varied by the researcher, while quantitative research is the collection and analyses of numerical data in order to explain, predict, or control phenomena of interest.
This research is conducted by quasi experiment by using pre and post-test. Pretest-posttest design in this research is a quasi-experiment where students are studied before and after the experimental manipulation. Quasi-experimental simply means students are not randomly assigned. It is possible to have a control group, or a group who doesn't receive the manipulation. In a pretest-posttest design, there is only one group and all of them are in the experimental condition. The reason to choose pretest-posttest experiment is to see the manipulation, has caused a change in the students. It means researcher test them before doing the experiment, then run experimental manipulation, and then test them again to see if there are any changes.
The data were TOEFL score that are resulted from pre and post-test. The populations in this study were all Health Information Management students grade 4 totaling 145 students. Health Information Management students' grade 4 divided into 3 classes namely A, B and C group. The samples in this study were 3 classes with a total of class A as many as 50, class B 50 and class C 45 students. Students at this grade have different intelligence, talents, interests, and economic levels. These individuals have different experiences, parenting styles and environmental conditions. Data Sources were primary and secondary data. Primary data was student's grade 4 in 2020/2021 academic year. The data is obtained from students' TOEFL score. Secondary data was the result of English learning obtained from English lecturers, learning methods and student motivation.

Results and Discussion
Based on the results of research during two data, the TPS model has been applied through the following steps: a) The lecturer explains in outline Materials on TOEFL b) The lecturer divides the students into 3 classes c) The lecturer gave TOEL Test to students then students are given time to think. d) Students think to get answer. e) Students are asked to pair up with his friend © JETLi: Journal of English Teaching and Linguistics Bukit, H. P-ISSN: 2723-0961 E-ISSN: 2775-1317 14 f) Students discuss with their partner to solve the TOEFL questions, researchers guide students in working on the problem. g) Students present the results of their discussion in front of the class, h) The lecturer gave a conclusion and straightens student answers and adds student answers.
Data analysis in this study, namely by applying the cooperative learning model Think Pair Share (TPS) in improving the ability of Health Information Management students in facing TOEFL test, it showed that there are increased activity and learning outcomes students. In applying this TPS model, activity was observed lecturer and student activities.
Based on the research results, there are found that the average score of students' skills on TOEFL before being given TPS were 56,93. Similarly, the average score of student activity experienced before being given TPS were 6,71. Then it was an increase about the average score of students' skills on TOEFL after being given TPS become 84.17. Similarly, it was an increase from pre-test to post-test about the average score of students experienced after being given TPS become 35.85. There has been an increase in the discussion activity about TOEFL, this is indicated by the N Gain value of 0.57 which is included in medium category and students' learning outcomes are obtained the value of N gain of 0.63 which included in the medium category.
Based on the increasing above, it can be described that TPS is so influencing as cooperative learning model in improving students' skill on TOEFL. It can be explained that at the beginning the implementation of the TPS model, some students still unable to answer the TOEL practice questions independently with the group and some students are still lacking pay attention during learning activities takes place. Based on the results of data analysis, during the activity students are more actively involved in learning activities than before the TPS model was applied. Based on data analysis results, students' scores have increased which previously became 44.57. Other than that, the average score of students' TOEFL scores as well has increased from previously 56.93 to 83.68. Student's TOEFL score has increased. Based on the value of N-gain that obtained for the results of TOEFL score 0.62. These yield improvements include in the moderate improvement category.
Based on the initial description about English learning, especially the discussion of TOEFL questions for health students, it was found the problem of low student achievement and interest in English learning. It is supported with the teaching and learning process in the classroom. Students tend to hear and take note of the important things delivered by the lecturer so it is impressed passive. Likewise, fewer lecturers provide a stimulus that involves students in the process of thinking and cooperate. Giving good stimulus is recommended in English learning activities because it can improve knowledge and attitudes of children towards question discussion.
The achievement of Health Information Management students' ability in facing TOEFL test is also consistent with improvement activities of lecturers and students in class. The learning process does not seem unidirectional again, but going both ways between students and lecturer. This is observed in the acquisition percentage of lecturer and students' activities.

Conclusions
This research is aimed to improve the ability of Health Information Management students in facing TOEFL test by applying the cooperative learning model Think Pair Share (TPS). After applying the model, it found that the average score of students' TOEFL scores as well has increased from previously 56.93 to 83.68.
This can be seen during the English learning process in the classroom. In learning by using Think Pair Share (TPS) model, students are required to discuss simple and effective ways to solve TOEFL questions with their friends by expressing the result of his thoughts. It is different from the conditions a class where students only listen the lecturer explains the material in front of the class. In conventional learning, students are not required to communicate with their friends during the process of discussing the TOEFL questions. As for in this study, researchers provide the suggestions so that the TPS learning model can applied as a learning innovation in improving students' ability to solve TOEFL questions well and get a high TOEFL score. In addition, this research should be carried out in a longer time and better preparation. And it is better to be able to research with other learning models.