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EALTHY Magazine

5 Questions for

5Qs for Tim McNamara

Interviewed by Ros Wright

December 2018

Attending the first OET Forum London this summer, I had the pleasure of meeting Tim McNamara, the originator of the Occupational English Test (OET). He graciously agreed to be ‘grilled’ and here shares some of the research (and research methods) that helped to shape the latest version of the OET.

For most of our readers the OET is a relatively new test and some may not be aware that it’s been around in Australia since the 80s. How did you initially become involved in English for medical purposes and then ultimately in devising the OET?

I had been living in London teaching EFL to adults and training teachers under what was the RSA Certificate scheme, now the Cambridge CELTA. When I returned to Melbourne, where I had grown up and gone to university, I worked in the equivalent of a Further Education college for three years teaching ESL to migrants and running CELTA courses. It was a time of generous funding for ESL in Australia, which had embraced multiculturalism, and at a meeting I learned that funding was available to establish English courses for migrant doctors who were trying to gain registration in Australia. My closest friend, who had been in London with me and who was now working in the same college, had done a 5-year Naturopathy course while in London which had had a strong basis in physiology, anatomy and pharmacology as well as natural medicine; I had helped her study for her qualification, and so had acquired some medical knowledge too. So we decided to apply for the funding, and got it.

The courses were a success, and we managed to get doctors we knew to come and help the migrant doctors revise and develop their medical knowledge in order to pass the clinical exams; we also managed to arrange supervised clinical placements for them. (The program went well beyond English!). At this time, the existing English test that migrant doctors and others were required to pass, which focused narrowly on medical terminology, used current but narrowly focused methods such as cloze, had no speaking component, and was not properly validated, came in for severe criticism. Eventually the Australian Government commissioned a report from a team headed by Chris Candlin and Charles Alderson at Lancaster about what should be done. (Lancaster was well known for its work on ESP in relation to dentists and doctors.) The report recommended the development of a new test which would assess the
ability of health professionals to cope with the communicative demands of the workplace. A consultancy was subsequently offered by the Australian Government, which was awarded to me, and I then devised the OET. One the basis of all this I got a job teaching Applied Linguistics at The University of Melbourne, and extended the work I had done on the test into a PhD.

Can you briefly describe the Calgary Cambridge Guide and how it impacts on the updated criteria for the OET speaking test?

Communication skills teaching has been an increasingly important feature of medical education in recent years. The most comprehensive and widely used single text guiding the provision of this teaching is the Calgary Cambridge Guide, and one of its authors, Jonathan Silverman, was engaged by Cambridge as a consultant (Cambridge had recently bought the OET in a joint venture with an Australian education provider) to evaluate the adequacy of the approach to understanding the communicative demands of the clinic implicit in the OET speaking test. The result was a three-year study funded by the Australian Research Council with support from the OET Centre to investigate what mattered to health professionals when they evaluated instances of professional-patient communication occurring naturally in work settings – for example, while supervising and giving feedback to junior or trainee practitioners. The results of the study showed that while the existing assessment criteria, fairly standard for communicative language assessments, addressed some of the things experienced professionals focused on in such feedback, there were other important dimensions which needed to be included, including the management of the interaction and engagement with the patient. The study has formed the basis for the updated criteria on the test, which now more adequately reflect what matters in communication in the clinical setting.

You carried out some extensive research in establishing the new criteria, including observation of workplace discourse. I understand the experience was a little more traumatic than you were expecting.

In the initial research on the test I spent time observing clinical communication in each of the
professions involved. As I had done quite a bit of study of medicine with my friend, as I mentioned earlier, I was excited to have access to clinical settings in hospitals and clinics, and attended ward rounds and case conferences with great interest. But what I had failed to realize was that I am squeamish. In one case an elderly woman had died unexpectedly overnight, and the case conference focused on what signs had been missed. An x-ray of her lungs showed the problem. My host clinician then said ‘We’re now going into the PMs – is that OK?’ I discovered that ‘the PMs’ was the post-mortem room, and there on a marble slab were various organs. I was still excited at this opportunity to see all this, when I suddenly realized that the organs belonged to the woman we had been discussing – and passed out on the spot. When I came round my host said ‘Oh, I should have realized… you’re just an English teacher…’. On another occasion I fainted on a ward round with students in a neurological ward, again because of the emotion of the situation – the very ill man reminded me of my father. As I came to, I heard the neurology professor saying excitedly to the students ‘Now you may have noticed that he jerked as he went under. This suggests anoxic irritation. I want you to do a differential diagnosis between fainting and epilepsy.’ I was actually helped to my feet by a patient, who got out of bed to help me! The medicos were carried away by the unexpected clinical training opportunity I had provided.

Many of our members train medical students in universities. What is the potential for the OET to be embedded into a university programme?

As the number of international students for whom English is not a first language grows, and with the growing clinical basis for medical education from even the earliest years of the medical course, it would seem that there is room for use of such a test. One good aspect of the ‘washback’ of the test is that people who are preparing for the test are also preparing for the realities of clinical communication with patients and colleagues, as the content and format of the test are based on those realities, at least to a certain extent.

As a dog lover, I’ve always been intrigued by the ‘OET Speaking Test for Vets’. Without the pet in question in the room on the day, how authentic can this particular test be? …. just a thought …. (?!)

There are severe limits to the authenticity of all language tests, even those which claim to simulate the demands of the real-world context. In the case of vets, as with other professions, the speaking test involves either eliciting from the client (in this case, the owner) the details of the presenting problem, and/or giving advice about the management or treatment of a condition. In neither of these cases is a real dog necessary! But at least the test focuses on the communication with the client. Tests which lack such a focus mean that candidates preparing for them do not focus on relevant communication tasks, but on preparing for even more artificial and less relevant tasks. This is the washback effect again – the OET has good washback, it helps direct learning and teaching in a productive direction.

Tim McNamara FAHA FAcSS
Redmond Barry Distinguished Professor Emeritus, School of Languages and Linguistics
The University of Melbourne
Immediate Past President
American Association for Applied Linguistics (AAAL)