What doctors value in consultations and the implications for specific-purpose language testing

© 2013 Dr. Thomas John Hamilton PillInternational medical graduates moving to Australia are required to demonstrate satisfactory English language proficiency as part of the process to obtain professional registration. Concerns have been raised that language tests used for this purpose – including the Occupational English Test (OET), a specific-purpose language test for health professionals – are not sufficiently aligned to the communicative demands of the contexts in which the doctors will be working. To investigate the issue, this study sought to capture those aspects of performance in the doctor–patient consultation that the profession values by applying a thematic analysis to feedback commentary given by medical educators on trainee doctors. A model of what doctors value in the doctor–patient consultation was developed from the findings of the analysis. Consideration was then given to the extent to which the valued aspects apparent in the analysis were already reflected in the assessment criteria used in the OET Speaking sub-test and whether further aspects could be included in expanded assessment criteria. The study found that, in most cases, medical professionals focus on how the clinical task is achieved rather than on the language skills involved. Nevertheless, language is shown to be essential to an effective consultation, because the interactional tools used by doctors with their patients accomplish clinical work by linguistic means. This inseparability of content and language is at the core of specific-purpose language testing. From the study’s findings, it is proposed that the existing criteria used in the OET Speaking sub-test are supplemented with two new criteria, CLINICIAN ENGAGEMENT and MANAGEMENT OF INTERACTION, which consider the ability of the health professional – through the use of language – to demonstrate his/her awareness of the patient (patient-centredness) and to gather and give information efficiently. These elements are highly valued by participants in the study. This refocusing of the OET Speaking assessment scheme extends the test’s construct beyond the language characteristics of the performance of individual test takers to include aspects of their interactional competence in a workplace setting. This has potential consequences for the way in which test results are interpreted by test users. The process used to derive test criteria from the indigenous criteria found in the data is a major contribution to the field; this data-driven approach may be applied in other testing contexts