There has long been evidence that a failure to communicate between medical staff, emergency services personnel and patients, can lead to the provision of inappropriate or even harmful treatments. Flores et al. (2003) and Flores (2005) summarize some of the research in this area. There are two separate contexts of interest in the current debate. First is the need to ensure that medical or emergency staff who do not speak the primary language of the country in which they are seeking to work have adequate command of that language to function safely. Second is the concern to provide patients who do not speak the language used by the health services with interpretation facilities. We will look at the first context, and then go on to consider medical interpretation.

Most medical language testing concerns English. Whenever misdiagnosis, mistreatment, or even fatalaties occur there is an outry. This Newspaper Report that blames a death on both language and clinical skills is not untypical. There are also reports like this one that suggest large numbers of other medical staff do not have the language skills to operate safely in hosopitals, which lead to calls for compulsory language classes and assessment.

There are a number of medical interpretation tests available on the market, including this one, which has a YouTube Video explaining the component sub-tests that make up the instrument, and its intended uses. However, most of these tests have been developed for use in the United States, and many countries around the wrold do not provide any kind of interpreter services. Why is this the case?

For Discussion

1. The provision and testing of medical interpreters is not universal. If you are working in a multinational group, which countries represented do and do not make such provision? Is there a problem in countries that do not (for example, when tourists who do not speak the language are taken ill)?
2. Make a list of problems that might occur if a patient cannot communicate with emergency or medical staff (a) on first contact, and (b) during treatment.
3. If you were asked to design a language test for doctors wishing to work in a second language, what constructs would you test, and what task types might you include on your test?
4. If you were asked to design a language test for medical interpreters, what constructs would you test, and what task types might you include on your test? You may wish to look at the MITI Medical Interpretation Test Video before you do this activity.
5. Look at the links on the right side of this web page. Choose one that looks interesting to you. What issues does it raise for the language training and testing of medical staff or medical interpreters?
6. Search for language tests that claim to be useful for making decisions about ability to communicate in medical settings, such as the IELTS. Look at the sample materials online. From a content perspective, do you think the tests are likely to be content relevant to this particular domain?
7. Open your favourite search engine and type in 'medical English courses'. Select one or two. Who is the course targetted at? Do you think it would meet their needs? If the learners are assessed, how are they assessed?

Latest Medical Language Assessment Links

Websites

• Occupational English Test
• Language Interpretation (Wikipedia)
• International Medical Interpreters Association
• The MITI Medical Interpretation Test Video
• Language Access Network

Researching Medical Communication

Conversation analysis and discourse analysis has been used extensively to study communication in a medical setting, often with the intention of improving medical communication education as well as test design. Here are additional references that may help with getting started in analysing medical discourse. There are many more articles and books available, so you should conduct a schoolar.google.com search on relevant keywords.

• Conversational analysis, doctor-patient interaction and medical communication.
• Conversation analysis: a method for research into interactions between patients and health-care professionals.
• Davidson, B. (2000). The interpreter as institutional gatekeeper: The social-linguistic role of interpreters in Spanish-English medical discourse. Journal of Sociolinguistics 4, 3, 379 - 405.
• Williams, S., Winman, J., and Dale, J. (1988). Doctor-patient communication and patient satisfaction: a review. Family Practice 15, 5, 480 - 492.
• Wodak, R. (1997). Critical Discourse Analysis and the Study of Doctor-Patient Interaction. In Gunnarsoon, B. L., Linell, P., and Nordberg, B. (Eds.) The Construction of Professional Discourse. London: Longman, 173 - 200.

References

• Bachman, L. F. (1990). Fundamental Considerations in Language Testing. Oxford: Oxford University Press.
• Flores, G. et al. (2003). Errors in Medical Interpretation and Their Potential Consequences in Pediatric Encounters . Pediatrics 111(1), 6 - 14.
• Flores, G. (2005). The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review. Medical Care Research and Review 62(3), 255 - 299.
• Fulcher, G. and Davidson, F. (2009). "Test Architecture, Test Retrofit." Language Testing 26(1), 123 - 144.
• Hawthorne, L. and Toth, J. (1996). The impact of language testing on the registration of immigrant doctors. People and Place 4(3).
• McNamara, T. (1996). Measuring Second Language Performance. Harlow: Longman.
• McNamara, T. (1997). "Problematising content validity: the Occupational English Test (OET) as a measure of medical communication." Melbourne Papers in Language Testing 6(1) 19 - 43.
• McNamara, T. and Lumley, T. (1997). "The effect of interlocutor and assessment mode variables in overseas assessments of speaking skills in occupational settings." Language Testing 14(2), 140 - 156.
• O'Neill, T. R., Buckendahl, C. W., Plake, B. S. and Taylor, :. (2007). "Recommending a Nursing-Specific Passing Standard for the IELTS Exmination." Language Assessment Quarterly 4(4), 295 - 317.