Assessing health professionals

Language tests are used in the evaluation of migrating health professionals’ readiness to practise safely and effectively. Such assessment is complex, involving policy and practice alongside questions of a moral and ethical nature. The chapter focuses on English language assessment of doctors—referred to as international medical graduates (IMGs)—to exemplify issues arising for all health professionals in any language. The initial section describes differing approaches to language assessment used in various jurisdictions internationally: the UK, Australia, and the USA. The next section links this assessment policy and practice to theoretical insights and research findings. It considers the scope of language proficiency and of what is testable in specific purpose language (LSP) tests, and describes the increased recognition in health-care contexts of the importance of effective communication for patient safety and positive clinical outcomes. Studies of the development of language tests for health professionals are cited to highlight the importance of collaboration between domain experts and test designers regarding test content, task format, and rating criteria. There is only limited evidence that LSP tests are better predictors than general purpose language tests of test takers’ ability to perform in a particular context; however, it is similarly uncertain whether general purpose tests are sufficient for such sensitive contexts as those in health care. The following section presents challenges and issues for LSP assessment for health professionals from three theoretical perspectives: authenticity, specificity, and inseparability; it also considers practical and policy constraints. The final section indicates further directions for research and wider ethical issues inherent in the global migration of health professionals.