The evaluation of undergraduate students' written English language skills

CONTEXT: Writing is an important skill for practitioners and students, yet this is a skill rarely taught in a formal capacity at medical school. At the University of Adelaide many students are from non-English speaking backgrounds and have varying proficiencies in English. We wished to devise a method and instrument which could identify students who may benefit from formative feedback and tuition in writing. OBJECTIVES AND METHOD: Students' written account of a short clinical interview with a standardized patient was assessed using a new instrument (the Written Language Rating Scale) designed especially for this study. The assessment of writing was made by one rater with qualifications in teaching English as a second language. SUBJECTS: 127 second-year medical students enrolled at the University of Adelaide, Australia. INSTRUMENTS AND RESULTS: The scale appeared to have good internal consistency, face and construct validity, and test security was not an issue. However, it had questionable concurrent validity with a standardized language test, although this may be partly due to the period of time which had elapsed between administration of the two tests. CONCLUSIONS: This study was useful in providing a means to objectively rate students' written English language skills and to target students in need of formative feedback and tuition. However, further research is necessary for both evaluation of medical writing and interventions for its improvement.     

Language background, proficiency in English, and selection for language development

With a diverse language background profile in an Australian medical student population, teaching interventions are necessary for students whose English language proficiency is not adequate for the study of medicine. This paper describes the screening of written and aural English language proficiency in 143 first year undergraduate students using a standardized instrument. Students identified as experiencing language difficulties were subsequently assessed by interview and allocated to faculty-based Language Development Programme. Students with the greatest need for language support participated in a full 2 year programme. Those requiring less assistance were offered more limited support in the form of specific modules within the programme. Students allocated to the full programme were significantly weaker in language proficiency compared to those offered specific modules and those not offered a placement. The information gathered during the structured interview is valuable in establishing for medical educators specific areas in which language-related teaching for students who require it can be directed. Future research is required to evaluate the effectiveness of faculty-based language interventions in terms of improvement in language proficiency over time and the effect of any improvements in language proficiency on academic and clinical performance.     

Facility with the English language and problem-based learning group interaction: findings from an Arabic setting

The Faculty of Medicine and Health Sciences (FMHS), United Arab Emirates (UAE) University is in a unique position to explore issues related to English language proficiency and medical student performance. All students entering the FMHS have English as a second language. This study focused on the issues of students' proficiency in English as measured by the TOEFL test, student background factors and interaction in problem-based learning (PBL) groups. Using a modification of Bales Interaction Process Analysis, four problem-based learning groups were observed over four thematic units, to measure the degree of student interaction within PBL groups and to compare this to individual TOEFL scores and key background variables. The students' contributions correlated highly with TOEFL test results in the giving of information (range r = 0.67-0.74). The female students adhered to interacting in English during group sessions, whereas the male students were more likely to revert to using Arabic in elaborating unclear phenomena (p < 0.01). The educational level of the student's mother was highly predictive of TOEFL scores for the male students, but not for female students. Multivariate analysis was undertaken to analyse the relative contribution of the TOEFL, parental education and years of studying in English. The best predictor of students' contributions in PBL groups was identified as TOEFL scores. The study demonstrates the importance of facilitating a locally acceptable level of English proficiency prior to admission to the FMHS. However, it also highlights the importance of not focusing only on English proficiency but paying attention to additional factors in facilitating medical students in maximizing benefits from interactions in PBL settings.     

Factors determining the performance of medical students of the Faculty of Medicine, University of Kuwait

An investigation was undertaken to determine the factors influencing performance of medical students at the Faculty of Medicine, University of Kuwait. Data were collected for the first batch of 42 candidates who successfully passed the 7-year medical programme. Results showed high correlations between high-school admission grades and subsequent performance during the medical programme. Similar results were also obtained with English proficiency. A partial correlation controlling for English proficiency, however, showed a systematic decline in the magnitude of the correlations between high-school grades and performance during the medical programme. In fact the relationship between high-school GPA and clinical GPA was non-significant. A prominent influence of English proficiency on performance is indicated.     

Language background,English language proficiency and medical communication skills of medical students

Associations between language background, English language proficiency and medical communication skills were investigated in a group of 149 third year undergraduate medical students studying at an Australian university. Written and aural English proficiency were assessed with the Screening Test for Adolescent Language (STAL). Medical communication skills and the fluency of spoken language were scored during an Observed Structured Clinical Interview (OSCI), rated by a standardized patient and a clinician. An association was found between language background, performance on the STAL and spoken language proficiency. Satisfactory performance in medical communication skills was not associated with language background or overall performance on the STAL. In this study it was the global rating of unsatisfactory spoken language fluency that was associated with poorer performance in medical communication skills under examination conditions.     

Attitudes towards community medicine: a comparison of students from traditional and community-oriented medical schools

OBJECTIVE: To compare the attitudes towards community medicine of first and final year students from two Australian medical schools. METHOD: In 1995, medical students from Newcastle University (a problem-based, community-oriented curriculum) and Adelaide University (a more traditional lecture-based curriculum) were asked to complete the Attitudes to Community Medicine questionnaire. This is a valid and reliable 35 item survey assessing six key domains of community medicine. The two medical schools differ in their methods of selection and curriculum delivery, and also in curriculum content. RESULTS: Response rates averaged 95% for first year and 81% for final year students. Students selected into both medical schools were found to have positive attitudes with respect to most aspects of community medicine. However, those entering Newcastle had more positive attitudes toward community medicine overall than their Adelaide counterparts. They also scored more positively on subscales relating to holistic care and evaluation of health care interventions. Students who were older and female scored more positively on some subscales, but correction for age and gender did not change the conclusions about medical school differences. CONCLUSION: This study suggests that selection criteria, and probably curriculum style and emphasis, have an influence on the attitudes that medical students possess and later develop toward community medicine.     

Medical training and English language proficiency

Summary. Concern is often expressed about the English language proficiency (ELP) of students engaged in professional training. This report assesses the ELP of the 1990 and 1991 intakes into medicine at the University of Sydney. A quick screening test and individual in-depth tests were used in a two-stage design. Admission to the course is highly competitive and most students are selected from the top 0.75% of Higher School Certificate results but 15% and 19% of the year cohorts were found to be below average in ELP. English proficiency was found to be consistently correlated with first- and second-year university results. Initiatives taken to support students with language disadvantages and to ensure that graduates will be able to communicate effectively with patients are outlined.     

Language as a barrier to the acquisition of anatomical knowledge

The language of instruction for medical students at the University of Hong Kong is English, which is their second language. This presents a potential barrier to their academic learning. We have studied the extent of this problem by looking at the amount of terminology students have to assimilate during their anatomy course and the way in which the terminology is structured and explained (this provides, more generally, an indication of the factual loading to which medical students are exposed). We have also investigated the effect of the quality of students' language skills on their examination results in anatomy class tests and MBBS exams. It was found that students' entrance levels in English correlated well with their final examination results and that the quality and quantity of their English also correlated highly with scores in class tests. On this basis, we conclude that language is one of the most important barriers to students' academic success in the department and that current teaching materials may not be appropriate.     

Medical students'' attitude to general studies in the University of Benin, Nigeria

The academic curriculum of the University of Benin includes some compulsory courses for all students in the first year of admission. These courses, referred to as general studies, cover some aspects of English language, Nigerian history and culture, humanities, science and technology. Since the introduction in 1975 of this programme in the university various views have been expressed on the necessity, effectiveness, suitability, relevance and reaction of students to the programme. This investigation was therefore carried out to find out the views of the medical students about the programme. The results show that our medical students regard the programme as useful, effective and relevant to their medical education and should be continued. They also suggested some modifications and improvement in some aspects of the programme.     

The Significance of Bilingual Chinese, Malay and Tamil Children's English Network Patterns on Community Language Use Patterns

This study on three-generation bilingual, trilingual Chinese, Malay and Tamil families set out to observe language use patterns during interaction within familial bilingual, trilingual networks. A shift in language use patterns from community language to English has been observed in school based surveys. This study surveyed three community language groups of Chinese, Malay and Tamil families, their use of community languages or mother tongue and their proficiency in the skills of speaking, reading and writing. The analysis shows that when parents' community language proficiency in speaking is lower they tend to choose English as their preferred language. But if their proficiency is higher, they tend to choose either English or community as their preferred languages. But there are parents who tend to choose their community language in order to maintain their cultural identity. The study also provides some observations on what determines children's language choice codes. Children's confidence in their command of their community language and opportunities to use their community language has an effect on their language choice pattern. While their proficiency in English could be one of the factors, it is not the main determinant of their choice of language codes.     

Videotaped interviewing of non-English speakers: training for medical students with volunteer clients

In a multicultural society such as Australia, with over 20% of its population born overseas, interpreters are often required to facilitate medical interviews. However, where a patient has some proficiency in English, medical interviews are sometimes conducted across the boundaries of culture and language. This is a report of an educational innovation to teach interviewing skills to pre-clinical medical students with the assistance of volunteers of non-English-speaking backgrounds. Pre-clinical students interviewed community volunteers on topics of general life history in a sequence of 16 tutorials. Each student conducted two interviews. Teaching methods included feedback from the volunteers, tutorial discussion facilitated by playback of videotapes, and modelling of skills by the teachers. Evaluations by volunteers and students indicated high satisfaction with the teaching methods and outcomes. Students gained confidence in interviewing people from different cultures. Evaluation of students' pairs of videotapes by an independent rater achieved satisfactory reliabilities and indicated significant gains in inquiry skills and the communication of positive attitudes. Skills in communicating empathy and in using simple language did not improve measurably.     

Medical interviewing: initial student problems

Although every lecturer in a department of medical education would endorse the importance of sound medical interviewing the position of courses on this subject is generally unstressed. In the past few years a course has been developed in the Department of Internal Medicine at the University hospital of Utrecht in which special attention is paid to the sort of problems students experience in the initial phase of medical interviewing. Use is made of simulated patients. At the same time attention is given to both the medical and communicative aspects. This approach is specially appreciated by the students. Self assessment shows that they report a considerably enhanced proficiency. Observations and questionnaires show that the students have problems mostly on the emotional level, both in coping with their own emotions and in discussing personal and emotional topics with a patient.     

The first year at medical school: some findings and student perceptions

Summary. This paper will first summarize briefly some results from parallel studies of first-year medical students at the University of Edinburgh, Scotland and University of Houston, Texas, USA. These findings have been presented more fully elsewhere ( Surtees & Miller 1990 ; Miller & Surtees 1991 ; Miller & Lloyd 1991 ; Miller 1994 ) and here the emphasis will be on the Edinburgh results. Following this, some new material will be set down, reflecting the Edinburgh students' comments to the interviewers about their courses.     

Evaluating the spoken English proficiency of graduates of foreign medical schools

PURPOSE: The purpose of this study was to gather additional evidence for the validity and reliability of spoken English proficiency ratings provided by trained standardized patients (SPs) in high-stakes clinical skills examination. METHOD: Over 2500 candidates who took the Educational Commission for Foreign Medical Graduates' (ECFMG) Clinical Skills Assessment (CSA) were studied. The CSA consists of 10 or 11 timed clinical encounters. Standardized patients evaluate spoken English proficiency and interpersonal skills in every encounter. Generalizability theory was used to estimate the consistency of spoken English ratings. Validity coefficients were calculated by correlating summary English ratings with CSA scores and other external criterion measures. Mean spoken English ratings were also compared by various candidate background variables. RESULTS: The reliability of the spoken English ratings, based on 10 independent evaluations, was high. The magnitudes of the associated variance components indicated that the evaluation of a candidate's spoken English proficiency is unlikely to be affected by the choice of cases or SPs used in a given assessment. Proficiency in spoken English was related to native language (English versus other) and scores from the Test of English as a Foreign Language (TOEFL). DISCUSSION: The pattern of the relationships, both within assessment components and with external criterion measures, suggests that valid measures of spoken English proficiency are obtained. This result, combined with the high reproducibility of the ratings over encounters and SPs, supports the use of trained SPs to measure spoken English skills in a simulated medical environment.     

Eight years'' experience with a structured clinical examination

A structured clinical examination has been an integral component of the final-year examinations conducted by the Departments of Medicine and Surgery at the University of Adelaide for the last 8 years. It has been used as an alternative to the traditional clinical examination. This paper describes the results of ongoing student and examiner surveys carried out to determine their views and satisfaction with this new approach. It also briefly discusses the feasibility of introducing such an examination into a conventional medical school environment. The surveys showed a remarkable level of acceptance and support by both students and examiners. This positive reaction has been maintained over the 8-year period. The main reasons seem to be its perceived relevance and fairness. Students also appear to be directing their learning in a direction thought desirable by teachers. No significant problems have been encountered with the practical implementation of the method.     

The influence of English proficiency on access to care

Objective. The number of individuals with limited English proficiency in the USA is large and rapidly growing. Consequently, addressing language barriers in access to medical care is becoming increasingly important. Previous studies have reported that individuals with limited English proficiency have more difficulty gaining access to care, compared to English-proficient individuals. We assessed the impact of English language proficiency on access to medical care, accounting for health and socioeconomic status, using nationally representative data.

Design. Cross-sectional data from the 2006 National Health Interview Survey (n=29,868). The main outcome measures of interest were self-reported delayed medical care, forgone needed care, and visits to a health care professional.

Results. In unadjusted analyses, individuals with limited English proficiency were more likely to forgo needed medical care and less likely to have a health care visit, compared to individuals who were proficient in English. There was no significant association between language proficiency and reports of delayed care. After accounting for individuals’ health and socioeconomic status, only the relationship between limited English proficiency and health care visits remained statistically significant. Most associations between language proficiency and access to care did not differ across various racial/ethnic groups.

Conclusion. Results indicate that the choice of access measure may influence conclusions about language barriers in health care. Given the growing proportion of US residents with limited English proficiency, health care settings need to better address potential language barriers.     

Patient-centred consultations: a comparison of student experience and understanding in two clinical environments

OBJECTIVES: To explore students' perspectives on doctor-patient communication. DESIGN: We interviewed students in focus groups before and after their placements. In semistructured interviews they were asked about their experiences of learning through clinical contact, with particular emphasis on patient-centred consultations, on the wards and during their community attachment. Students whose clinical skills training remained hospital-based were also interviewed to compare the range of experiences. SETTING: Leeds University. SUBJECTS: Third-year medical students. RESULTS: During hospital training students are rarely introduced, either through teaching or observation, to the idea of patient-centred consultations. In contrast both the principles underpinning and/or the practice of such consultations were routinely encountered during the general practice placement. Students considered the community attachment to have helped them appreciate the value of exploring patients' concerns both in terms of enhancing the patients' overall healthcare experience and promoting effective clinical management. While they considered the nature and purpose of hospital care to be qualitatively different from that conducted in the community, the relevance of adopting a patient-centred approach on the wards was confirmed. CONCLUSIONS: Recommendations for clinical training are made. The relevance and best use of community and hospital-based attachments need to be evaluated further.     

Improving Patient-Provider Communication: Evolution of a Tool to Assess Physical Therapist Students’ Spanish-Language Proficiency

ABSTRACT

Communication is at the foundation of safe and effective health care. When patients with limited English proficiency (LEP) have healthcare providers who do not speak their language, the communication barrier can lead to poor outcomes. Responding to the high number of Spanish-speaking individuals with LEP, a Doctor of Physical Therapy (DPT) program has integrated Spanish-language training in the curriculum. This paper describes their development and pilot testing of the Physical Therapy Spanish Proficiency Measure (PT-SPM). The PT-SPM was developed for English-Spanish bilingual faculty or clinicians to assess DPT students’ clinically relevant Spanish communication. The PT-SPM has 11 total items with four subscales: verbal proficiency, aural proficiency, written proficiency, and cultural competence. Twenty-three pairs of DPT students and their bilingual clinical instructors were recruited for an interrater agreement study; each used the PT-SPM to independently rate the student’s Spanish communication with Spanish-speaking patients with LEP in clinical settings. Cohen’s weighted kappa was calculated to evaluate interrater agreement between the students and clinicians on item level, using linear incremental weights. The weighted kappa coefficients ranged from 0.35 (fair agreement) to 0.80 (substantial agreement). All weighted kappa coefficients were statistically significant. Two items had fair agreement; four items had moderate agreement, and five items had substantial agreement. These results support that the PT-SPM may have value as an assessment tool for DPT students in clinical settings. Educators in other health professions may consider adapting the PT-SPM. This paper contributes to the broader interprofessional dialogue about how to assess and improve patient-provider communication.     

Availability and Accuracy of Medical Record Information on Language Usage of Cancer Patients from a Multi-Ethnic Population

Documentation of language usage in medical settings could be effective in identifying and addressing language barriers and would improve understanding of health disparities. This study evaluated the availability and accuracy of medical records information on language for 1,664 cancer patients likely to have poor English proficiency. Accuracy was assessed by comparison to language obtained from interview-based research studies. For patients diagnosed at facilities where information on language was not abstracted electronically, 81.6% had language information in their medical records, most often in admissions documents. For all 37 hospitals, agreement between medical records and interview language was 79.3% overall and was greater for those speaking English than another language. Language information is widely available in hospital medical records of cancer patients. However, for the data to be useful for research and reducing language barriers in medical care, the information must be collected in a consistent and accurate manner.     

医学留学生诊断学中文教学效果调查及分析

目的 评估四川大学华西临床医学院针对医学留学生开展的医学中文课程（以诊断学为例）的教学效果,为课程改进奠定基础。方法 利用中、英文2种版本的临床诊断学试卷检测全体四川大学华西临床医学院2015级留学生（95人）诊断学中文课程前、后相关能力水平,同时用相同的试卷检测全体2014级留学生（90人）在完成该课程一年后的知识掌握情况,分析比较课程的教学效果。其中,2015级课前与课后中文答卷情况、2015级课前与课后英文答卷情况采用配对样本t检验分析,2015级课前不同语言的答卷情况、2015级课后不同语言的答卷情况、2014级与2015级中文答卷情况、2014级与2015级英文答卷情况采用独立样本t检验分析。结果 2015级留学生通过中文课程的学习,诊断学中文平均成绩与课前有统计学差异（P<0.001）,诊断学英文平均成绩无统计学差异（P=0.893）;课前中英文测试成绩有统计学差异（P<0.001）,而课后两者间没有统计学差异（P=0.223）。2014级留学生的中、英文诊断学知识的掌握情况和2015级留学生相比均没有统计学差异（中文:P=0.265,英文:P=0.696） 。结论 四川大学开展的医学中文课程（以诊断学为例）教学取得一定效果,对留学生掌握医学中文知识和今后的学习有一定意义,但需对教学方法不断创新以进一步提高教学效果。