Health Professionals' Views of Communication: Implications for Assessing Performance on a Health-Specific English Language Test

The gap between linguistic and professional criteria is a widely acknowledged but unresolved issue in the teaching and assessment of languages for specific purposes (LSP). In the teaching of professional writing, language experts and workplace professionals have been characterized as living worlds apart with respect to their views of communication. Likewise, in testing contexts, a number of studies have shown significant divergence in judgements between the language experts who traditionally assess performance on LSP tests and those with experience of the relevant professional context. It has been argued that if LSP tests are to act as proxies for the demands of communication faced by candidates entering the workforce, then the judgements of such professionals should not be ignored. The preliminary study reported in this article is part of a larger research project relating to a specific-purpose English language test for overseas-trained health professionals (HPs): the Occupational English Test (OET). The larger project is designed to validate both the criteria against which candidates are assessed on this test and the performance standards required for registration. The OET, a four-skill test, is recognized by 12 health professions as a mechanism for ensuring adequate language skills for nonnative-English-speaking applicants for entry to the profession. Test performances on the OET are currently rated against a common set of essentially linguistic criteria: (1) intelligibility; (2) fluency; (3) appropriateness of language; (4) resources of grammar and expression; and (5) overall communicative effectiveness. These criteria, although applied by highly trained language specialists, may nevertheless differ from those which HPs see as essential for effective healthcare communication. Moreover, the appropriateness of the passing standards on the OET required in terms of these criteria are the subject of ongoing debate, with concerns that HPs with a non-English-speaking background may pass the test but nevertheless struggle with interactions in the clinical setting. Tests like the OET thus bear a heavy burden of responsibility for making decisions affecting the careers of candidates and the people for whom they are subsequently responsible. Further investigation of the test's claim to form a valid basis for determining professional entry could therefore be seen as an ethical imperative. This report focuses on findings from the first phase of the project designed