English language requirements for foreign doctors are not fit for purpose
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Version 0 of 1. I had been teaching English to medical professionals for over a decade before Dr Ubani – the German-trained doctor whose patient died during his first shift in the UK – hit the headlines. The GMC doubted not only Ubani’s clinical competency, but also his English language skills, and he was struck off. Until June 2014, when the GMC revised its criteria, those certified in the EU had been virtually exempt from control either clinically or linguistically. Today, the International English Language Testing System (Ielts) is used as a means of ensuring fitness to practice for all overseas doctors. Much has changed since 2008 when Ubani was practising, but as I help prepare a group of overseas recruits as part of an NHS induction programme, I can’t help wondering to what extent the Ielts is actually fit for purpose. I listen while my trainees introduce themselves and I’m immediately struck by their grasp of the English language. Having scored the requisite Ielts score of 7.5, they all appear to possess the language skills necessary to function effectively in an English-speaking environment. However, as the course progresses, my doubts about the suitability of the Ielts as a means of benchmarking proficiency in any high-stress environment, least of all that of a UK hospital, are confirmed. Originally devised as a university entrance exam for overseas students, the Ielts tests proficiency in spoken and written communication. Candidates analyse data, comment on texts about topics as varied as the Titanic and greenhouse gas emissions, respond to conversations about university life and deliver a pre-prepared monologue. Aside from the obvious lack of medical-related content, the feeling among language trainers and overseas doctors alike is that the Ielts is too artificial. Far removed from the reality of a busy A&E, the listening test, for example, fails to replicate the high-pressured situations in which many of these trainees will work. These are environments where discourse is messy and where patients are distressed and vulnerable and their relatives frustrated and angry. In this fast-paced setting, trainees will be competing with background noise to understand patients and colleagues who themselves invariably speak in tones and variations of English quite unlike the clean-cut, grammatically-perfect, well-articulated dialogues presented to the Ielts candidate. The Ielts does little to prepare doctors for other aspects of communication that prove difficult, notably dialect and colloquialisms. As the group gets to grips with the course, I quickly realise their limited understanding of patient references for medical conditions, for example. Not surprisingly the local expression “mardy” (fussy) draws a sea of blank faces, but so too do euphemisms such as “spend a penny” and “pushing up daisies”. Possibly more worrying, however, is their inability to resort to communication strategies (eg “Sorry, could you just explain what you mean?”) that would no doubt enable them to repair any breakdown in communication quickly and efficiently; an automatic reflex were they communicating in their own language. Conveying meaning through intonation and tone of voice is yet another area not tested by the Ielts. Being able to read and respond effectively to such subtleties of language is imperative if a doctor is to successfully develop and maintain rapport with their patient. During the role-play section of the course all efforts to demonstrate expressions of empathy, though well-chosen and grammatically accurate, fall by the wayside the moment trainees fail to use the corresponding intonation pattern. I explain that native speakers are more likely to forgive the odd grammar mistake than a voice that lacks warmth and compassion. Complying with standards of good practice set out by the GMC is not just a question of language competency. Awareness of UK cultural norms, for example, including levels of alcohol consumption, which astound even our closest European neighbours, pose additional communication problems, the likes of which we cannot hope to evaluate via the Ielts. The GMC’s observations that, despite requisite Ielts scores, overseas doctors experience “difficulties with subtleties of language and dialect […], misunderstandings of the nuances of non-verbal communication and social and behavioural norms” (2014), bear out my own experiences as a medical English trainer. While nothing will prepare my trainees fully for a Friday night in an inner-city A&E, I am at a loss to understand exactly how the Ielts, even a score as high as 7.5, ensures fitness to practice. This begs the question: is the Ielts fit for purpose? Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views. |