Finnish Language Proficiency of Immigrant Physicians in Medical Licensure Examinations

Transcription

1 Finnish Language Proficiency of Immigrant Physicians in Medical Licensure Examinations Maija Tervola, MA, Researcher, Doctoral Candidate School of Languages, Translation and Literary Studies University of Tampere Finland

2 Research team Linguistics: Maija Tervola, MA, researcher, doctoral student, University of Tampere Anneli Pajunen, PhD, professor in Finnish language, University of Tampere Mari Honko, PhD, post doc researcher, University of Tampere Seppo Vainio, PhD, post doc researcher, University of Turku Medicine: Kari Mattila, PhD, professor emeritus of medicine, University of Tampere Article published in February 2015: TERVOLA et al Finnish language proficiency of immigrant physicians in medical licensure examinations. Duodecim. 131(4):

3 Medical Licensure Process for Physicians from Non-EU/EEA Countries Medical School Diploma verified by Valvira 6 month s practice Finnish language test (National Certificate of Language Proficiency, YKI ) Medical Licensure Examinations (MLE) 1. Examination, written, clinical knowledge 2. Examination, written, Finnish health care policies 3. Examination, practical, videotaped reception with a patient Licence to practice medicine in Finland

4 Medical Licencure Examinations MLE Failing rates % in (Haukilahti et al. 2012) Language of examination: Finnish (or Swedish) Organizers question candidates language skills. General concern about physicians language skills. Consequence: Re-evaluation and rearrangement of the language education and testing of immigrant physicians (MINEDU 2014)

5 Research elsewhere 1/2 USA: Spoken English proficiency assessed in clinical situation was related to TOEFL scores but in written proficiency the relation was weak. (Boulet et al. 2001) When assessing communication skills of physicians, contexts specific language tests proved to be more valid than generic tests (Baig et al. 2009) Generic language tests (TOEIC, SPEAK) were not sensitive enough to assess language skills needed in clinical environment (Eggly et al. 1999)

6 Research elsewhere 2/2 UK: Despite of the high scores in language tests, immigrant physicians had language related problems at work. (Mahajan & Stark 2007) Australia: The standardized language test proved to be a weak indicator of language skills at work. (Chur-Hansen et al. 1997)

7 Research problems What is the role of the candidates language skills in the success in medical exams? Does the lack of language skills explain the high failing rates? How is it possible to measure language skills from examination papers? What kind of problems and requirements are there, when assessing language proficiency in demanding and specific contexts?

8 Data and methods Data: 72 medical exam papers (in total words) Linguistic analysis 1) Writing skills Four-trait evaluation tool: Comprehension, coherence, word structure, syntactic relations Double-blind evaluation, agreement 90 % Five skill levels: 1=poor, 2 4=average, 5=good 2) Vocabulary (word frequency) Only the ordinary vocabulary, no medical terminology Three frequency levels: 1 3K, 4 8K, 9 11K Correlations between linguistic analyses and MLE scores

9 An example of the data kysella 68 vuotias nainen, joille on kylki kutitaa, kosketu arka, todenakoinen ds: vyöruusu (periferinen hermon vaurio, virusi aiheuttua.) Red font: morphologic / phonologic problem Underlined: problem in syntactic relations Translation: At issue is a 68 years old woman whose side is itching and sore, the most probable diagnosis: shingles (peripheral neural damage, caused by a virus.) Medical exam: passed Linguistic performance: poor

10 Results Writing skills evaluation n % 1 poor average average average good TOTAL

11 Average score out of 120 Average scores of MLE in different writing skills groups Writing skills evaluation: 1=weakest, 5=best

12 Passing rate, % MLE passing rates in different writing skills groups Writing evaluation: 1=weakest, 5=best

13 Deviation from the default value, % Word frequency with relation to the success in MLE 20% 15% 10% 5% 0% -5% -10% -15% -20% Candidates grouped by success in MLE: Best >60 % Middle % Weak <40 % Frequency level % 0.2 % 4.8 % Frequency level % 1.6 % % Frequency level % -2.6 % %

14 The role of the frequency in language learning HIGH FREQUENCY LOW FREQUENCY CHANGE kaatua to fall kompastua to trip more accurate liukastua to slip ruoka food ruokavalio a diet more abstract mennä hyvin menestyä to succeed more idiomatic to go well

15 The role of the frequency in language learning HIGH FREQUENCY LOW FREQUENCY CHANGE kaatua to fall kompastua to trip more accurate 63/million 4,3/million liukastua to slip 2,5/million ruoka food ruokavalio a diet more abstract 269/million 45/million mennä hyvin menestyä to succeed more idiomatic 1212/million, 1060/million 77/million to go well Frequencies: Finnish Internet Corpus, 119,6 million text words

16 Conclusion There are correlations between linguistic performance and MLE evaluation. Some papers did not match the minimal criteria of the mandatory language test taken before MLE. In some papers grammatical and lexical inaccuracies may occur in every other word. The mandatory language test does not serve as a valid measurement tool for immigrant physicians.

17 Discussion Health care a high risk environment High-standard and high-stakes language testing: A conflict between efficiency and accuracy (Lam 2010; Harrington & Carey 2009; Harrington & Roche 2014) How to improve efficiency and validity of testing? Context specifity (Baig et al. 2009; MINEDU 2014) Systemization of assessment (Decoo 2011; Vainio et al. 2014)

18 Systemization of assessment Basic level: Measuring phonological awareness (Lam 2010; Vainio et al. 2014) Advanced level: Measuring lexical knowledge (Harrington & Roche 2014; Lam 2006; Morris & Cobb 2004)

19 References BAIG, L. A. C. VIOLATO R. A. CRUTCHER Assessing clinical communication skills in physicians: are the skills context specific or generalizable. BMC Medical Education, 2009, 9:22. BOULET J. R. M. VAN ZANTEN D. W. MCKINLEY N. GARY Evaluating the spoken English proficiency of graduates of foreign medical schools. Medical Education, Vol. 35, 2001:8, CHUR-HANSEN, A. J. VERNON-ROBERTS S. CLARK Language background, English language proficiency and medical communication skills of medical students. Medical Education, 31, CROSSLEY, S. A. T. COBB D. S. MCNAMARA Comparing count-based and band-based indices of word frequency: Implications for active vocabulary research and pedagogical applications. System 41 (2013) DECOO, W Systemization in Foreign Language Teaching. Monitoring Content Progression. Routledge. New York. EGGLY, S. J. MUSIAL J. SMULOWITZ Research and Discussion Note The Relationship between English Language Proficiency and Success as a Medical Resident. English for Specific Purposes, 18(2), Finnish National Board of Education: Test Levels in English. HARRINGTON M. M. CAREY The on-line Yes/No test as a placement tool. System 37 (2009) HARRINGTON M. T. ROCHE Word recognition skill and academic success across disciplines in an ELF university setting. Papers in Language Testing and Assessment 3:2, 76 99

20 VAINIO, S. A. PAJUNEN J. HYÖNÄ L1 and L2 word recognition in Finnish: Examining L1 effects on L2 processing of morphological complexity and morphophonological transparency. Studies in Second Language Acquisition 2014/1: HAUKILAHTI, R.-L. MATTILA, K. VIRJO, I. 2012a. Success in licensing examinations of doctors from outside the European Economic Area experiences from Finland Education for Primary Care 2012:23(5): HAZENBERG S. HULSTIJN, J. H Defining a minimal receptive second-language vocabulary for non-native university students: An empirical investigation. Applied Linguistics, 17, HONKO, M Lexical knowledge and skills of school-age children: Finnish of second generation and the L1-peers. Acta Universitatis Tamperensis LAIPPALA, V. F. GINTER (coming). Finnish Internet Corpus (demo: LAM, Y Using vocabulary size as a placement indicator in Spanish as a Foreign Language. Report to University of Alberta Teaching Services for University Teaching Research Fund Project #03-3. LAM, Y Yes/no tests for foreign language placement at the post-secondary level. Canadian Journal of Applied Linguistics 13/2: MAHAJAN, J. P. STARK Barriers to education of overseas doctors in paediatrics: a qualitative study in South Yorkshire. Ars Dis Child. 2007; 92(3): MILTON, J Measuring second language vocabulary acquisition. SLA, Multilingual matters. Bristol, Buffalo, Toronto. MINEDU 2014 = Evaluating language proficiency and complementing language proficiency and qualifications obtained in a non- EU/EEA country in the health care sector Reports of the Ministry of Education and Culture, Finland 2014:5 MORRIS, L. T. COBB Vocabulary profiles as predictors of the academic performance of Teaching English as a Second Language trainees. System 32 (2004), TERVOLA, M. PAJUNEN, A. VAINIO, S. HONKO, M. MATTILA, K Finnish language proficiency of immigrant physicians in medical licensure examinations. Duodecim. 131(4):