Career Focus

Attaining competence in English

BMJ 1997; 314 doi: (Published 28 June 1997) Cite this as: BMJ 1997;314:S2-7098
  1. Jackie Cassell, specialist registrar in genitourinary medicine,
  2. Leslie Goode, teacher of English as a foreign language, Co-directors
  1. Lingua Medica.

    A doctor and teacher team of language tutors-Jackie Cassell and Leslie Goode-review the regulations, opportunities, and difficulties that confront doctors trained overseas

    The regulations for European Union nationals who have trained within the EU and those for other overseas doctors are now markedly different. Until this year the Professional and Linguistic Assessments Board examination (PLAB) was the well established first hurdle in medical English. Success in the written and spoken comprehension sections of the PLAB was required before taking the medical test. From January of this year, however, the written and spoken components of the PLAB have been superseded by the International English Language Testing System assessment (IELTS), the passing of which is now a prerequisite for taking the medical part of the PLAB. The IELTS can be taken in any of 105 countries and is often a British university entrance requirement for students of any subject whose first language is not English. Candidates must attain an overall score of 7.0 in the IELTS, with at least 6.0 in each of its four sections, in order to proceed to the medical component of PLAB.

    EU nationals trained within the EU are not legally required to take the PLAB or the IELTS, though they may be asked to do so by hospitals or trusts in order to prove that their English is adequate. It may therefore be best to take the IELTS prior to making applications. Exceptions to these general rules have always existed-for example by obtaining a sponsor. Advice on individual cases should be sought from the General Medical Council.

    Differences between the assessments

    The PLAB was developed as an examination for qualified doctors with some experience in medical practice, and it concentrates on the English which is needed for medicine. By contrast, the IELTS is taken by university candidates, undergraduate or postgraduate, from any discipline. Not surprisingly, the problems doctors are likely to face in these exams are very different. A glance at some past papers will be enough to give the reader an idea of their differing requirements.

    A selection of books and resources

    A number of useful medical English texts, with practice tapes, are available fairly cheaply. We have listed a few of general interest.

    • Parkinson J. A manual of English for the overseas doctor. London: Churchill Livingstone, 1991. (Tapes also available).

    • Glendinning E, Holmstrom B, 1987. English in medicine. Cambridge: Cambridge University Press. (Tape also available)

    • Jakeman V, McDowell C, 1996. Cambridge Practice Tests for the IELTS Cambridge: Cambridge University Press.

    • McCarter S. English for PLAB, 1995 Midlothian: Intelligene,

    • Shovel M. Making Sense of Phrasal Verbs, 1992, London: Prentice Hall.

    The requirements of the “use of English” component of the PLAB are perhaps best defined as basic literacy and spoken competence. This examination has three parts. The first is a test of comprehension of spoken English, in which the candidate answers multiple choice questions after listening to an audiotape. Next is a written English component, which asks for an essay on a general question such as “Why did you take up medicine as a profession?” followed by a medically oriented question such as “Write a letter to a young person pointing out the dangers of smoking.” An averagely literate native English speaker, medical or otherwise, could no doubt make a fair stab at these questions. The English part of the PLAB is completed by a section of the oral exam in which the emphasis is on clinical language but which also requires the candidate to discuss two pre-prepared newspaper articles. (Slightly different rules apply to those taking the medical component at the same time.)

    Providers of courses in medical English

    Institute of Applied Language Studies, 21 Hill Place, Edinburgh EH8 9DP. Tel. 0131 650 6200, Fax 0131 667 5927.

    Southwark College, The Medical English Unit, Waterloo Centre, The Cut, London SE1 8NL. Tel. 0171 815 1537, Fax. 0171 261 1301.

    Lingua Medica, 35 Spences Lane, PO Box 2644, Lewes, E. Sussex BN7 1DQ. Tel. 01273 473511, Fax 01273 473511.

    University of St Andrews (English Language Teaching), Butts Wynd, St Andrews, Fife KY16 9AL, Scotland. Tel. 01334 462259, Fax 01334 462270.

    This list is not exhaustive. Intelligene is a good source of information on further providers. We suggest you check with the organisers the following points:

    • What experience do the tutors have in medical English?

    • How large is the group?

    • How different are the levels of English within the group?

    • How many hours teaching will you get?

    IELTS would test native-speakers too

    The essay questions of the IELTS academic writing paper enter an altogether different terrain. Try this, for example: “People can no longer expect a job for life. What should individuals and governments do to prepare the current and future environments for different working conditions?” The difficulties of this kind of essay question for a candidate coming from a traditional medical education may not be immediately apparent. Medical education requires a high degree of problem solving ability of an abstract kind, together with good interpersonal communication skills. Medical aspirants may have great difficulty with such questions, compared with students of the humanities, economics, or the social sciences. The skills required to answer such a question go beyond “reading and writing.” Some of the other questions in IELTS require skills of discourse analysis akin to those required by the traditional “prŽcis” exercise, answering 40 questions on three complex and diverse texts of between 1000 and 1500 words in a time limit of one hour. A knowledge of English is, of course, required for such tests of verbal reasoning. It would, nevertheless, be interesting to look at the performance of English native speakers of equivalent educational status in these tasks. Our experience is that doctors of good fluency often have considerable difficulty with them.

    Sources of further information.

    • General Medical Council, 178 Great Portland St., London WIN 6JE. Tel. 0171 580 7642. Registration section can advise on individual cases, PLAB test section on PLAB exam.

    • National Advice Centre for Postgraduate Medical Education, (NACPME), third floor, British Council, Medlock St., Manchester M15 4AA. Tel. 0161 957 7218, Fax 0161 957 7724. Information on most aspects of training for the overseas-trained doctor, with many useful addresses.

    • Intelligene, Woodlands, Ford, Midlothian EH37 5RE, Scotland. Tel. 01875 320063, Fax 01875 320276. Publisher of excellent information on medical courses of all kinds in the UK, including medical English, in collaboration with the British Council.

    • British Medical Association (International Department), BMA House, Tavistock Square, London WC1H 9JP. Tel. 0171 383 6491, Fax 0171 383 6644.

      Useful information pack, and a comprehensive guide is in preparation for later this year.

    • IELTS Subject Officer, University of Cambridge Local Examinations Syndicate, 1 Hills Road, Cambridge, CBI 2EU. Tel. 01223 553311, Fax 01223 460278.

    English at work.

    Whether you come as a student, on a clinical attachment, or after passing your tests, there will be more to learn. The difficulties of the workplace are not those of an exam. Many doctors say that what they found hardest was the unpredictable variety of ways in which patients describe their symptoms. Medical anecdotes often result from misunderstanding between a doctor and patient who share the same language. Misunderstanding is a common fear in the first months at work, which eases with time. A number of books provide help with the oddities of patientsõ language (see Further Reading). Phrasal verbs are a constant worry to any learner of English. When you hear your colleagues giggling in the corner, you realise with a sinking heart that you have, yet again, mixed up “get on with” and “get off with.” The only remedy is a regular practice from Making Sense of Phrasal Verbs or something similar. Pronunciation is another worry. Native Britons are often caught out by the irregularities of English pronunciation, and it is therefore important to keep your ears open, though not to worry too much about mistakes. Many common medical words such as “abdomen” have more than one accepted pronunciation. The names of drugs are invented, and there is often no agreement on how to pronounce them. Listen carefully, and choose the most common version.

    Perhaps the most intimidating problems are those which face the doctor preparing for postgraduate examinations. Every student fears presenting a case on a ward round, or giving a presentation. For non-native speakers, normal anxiety during an examination is worsened by a lack of confidence in their ability to express oneõs knowledge. It is important to keep this in perspective. Exams and case presentations have a rhetoric of their own. As medical students we all had to learn to talk like a doctor. In taking a postgraduate exam, you have to learn to talk like a senior doctor. This takes practice. However, if you read the case presentations in crammer texts for examinations, it will become clear that a very limited vocabulary is used to connect up the medical terms. This vocabulary is very similar from case to case. Once you start thinking of the exam as requiring a limited area of language, you can focus on this and build it into your revision of cases and syndromes.

    Now that the IELTS is taking over from the English part of the PLAB, doctors will have to work harder at improving their general vocabulary and writing skills. Many books of IELTS papers are available, including authentic ones published by the British Council. The topics covered in the exam are often social, economic, and political issues. Much material of this kind is available in the quality newspapers. Current affairs programmes and documentaries on the radio and television will help you acquire the vocabulary needed to discuss these topics. If you are not yet in Britain, there is a great deal of relevant discussion on the BBC World Service.

    Many doctors come on a clinical attachment, in which they observe life in a British hospital. This is certainly useful. However, the language needs of overseas doctors are often overlooked and you may need to negotiate for more opportunities to practise your English. For example, doctors on attachment often observe clinics without seeing patients alone. British doctors who supervise these situations must be educated into realising that the chance to interview patients on a regular basis is an essential part of an attachment. You may need to ask for this be arranged in the clinics you observe, perhaps through the consultant responsible for you. You should read medical notes thoroughly, and practise translating the notes into what the patient might have said, and vice versa, checking things that you are not sure of with other doctors. It is useful to raise your public profile in the hospital, perhaps by offering to present a case at a meeting. This may help to provide social opportunities, in which you can practise your English. Remember, you have experience from which your British colleagues can learn.

    A number of organisations offer courses in medical English. These offer an opportunity to practise relevant areas of English with a group of other doctors or medical students. Most commercial English language schools will be able to offer preparation for the IELTS. Your choice between these types of course will depend on your exam needs as well as your personal strengths and weaknesses. Many English language schools have been inspected and approved by the British Council, including some which provide courses specifically in medical English.

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