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It has become a bit of a cliché in OET circles that students and teachers alike face a lack of high-quality preparation materials; a new title by a well-respected author in the field is therefore bound to cause excitement. OET Speaking and Writing Skills Builder (Nursing and Medicine) by Ros Wright is aimed at both self-study and classroom settings and with its focus on the development of techniques required for the speaking and writing OET sub-tests (nursing and medicine)will be welcomed by both independent learners and classroom teachersIt is the companion title to OET Reading & Listening Skills Builder (All Professions), which I have reviewed separately, and this review looks both at the print and the Digibook editions of the book. Like the Reading and Listening book, OET Speaking and Writing Skills Builder was written with input from two medical advisers, who are credited on the front covers.  

As companion texts, it is perhaps surprising that the organisation of the Writing and Speaking book differs from that found in the Reading & Listening textIn OET Speaking & Writing Skills Builder, there are eight rather than ten topic-focused units, such as respiratory (covered in Units 1 & 4), endocrinology and psychiatry. There is no cross over with the Reading and Listening book in terms of unit topics, meaning autonomous learners and students on a long-stay exam preparation course using the books side by side may find themselves dealing with two distinct topics at the same time. However, this does mean that they also gain exposure to a greater range of topics.  

Each unit opens with an OET Speaking section, which looks at the skills required to meet the clinical communication aspects of the Speaking sub-test and patient-centred care in the workplace. There is then a Medical Focus section linked to the unit’s topic, sections dealing with Grammatical Expression and Lexis and finally OET WritingThis final section makes significant use of the SBAR framework and also helps students to make principled choices when selecting which information to include in an OET letter. The grammar and lexis areas are largely well chosen, covering the language which many OET candidate struggle with such as articles, softening questions and asking for consent; four sections on dependent prepositions out of eight for Lexis does feel a little imbalanced, notwithstanding the issues many learners face with this language point. Additionally, given the C1 level of OET, the tense review sections seem pitched a little low. 

The book is rich in additional resources, audio scripts and answer keys, including some very useful case notes, sample letters and speaking role play cards and a grammar reference, making the book ideal for self-study. I particularly liked the sample letters with their detailed annotations highlighting good practice and the additional further commentaries although I was surprised to see one sample letter of 221 words described as being of an appropriate length given that OET asks test takers write a letter of between 180 to 200 words 

The print edition is attractively laid out in full colour and the pages breathe well thanks to plenty of white space. Additional bite-size hints about exam strategies are presented in the frequent blue Test Tip boxes and are a strength. Learning objectives for each of the five sections are given at the beginning of each unit; the addition of some kind of review activity or reflective task at the end of each unit or cycle of three units would have been a welcome addition.  

All of the book’s contents can be accessed through Express Publishing’s own online platform and Digibooks app. Pleasingly, the code for this online version is provided at no extra charge, bound in with the hard copy edition, and for student accounts is valid for 15 months from the activation date; teachers on the other hand can re-activate the apps for free. CD recordings of the audio tracks are available separately for a small charge of just under 8 Euros. A stand-alone digibook edition is available, with a 15% reduction on the price of the printed edition.  

The user experience for students is mixed. Students who are studying on their own will welcome the opportunity to access the whole book, including the audio recordings, on a PC or a mobile device at no extra charge and the flexibility this offers is clearly welcome. The digibook edition has flexible navigation, with each activity on its own page. These are accessed linearly using back and forward arrows or via a drop-down menu which makes it easy to jump to a specific exercise anywhere in the book. However, as these pages are labelled with the exercise number only (e.g. Exercise 6.2), it is not self-evident how each activity relates to the five parts of the unit (Speaking, Medical Focus, Grammatical Expression, Lexis and OET Writing). Also, the first number does not correspond to the unit number, making quick navigation difficult. Hopefully, this is an issue that the digibook team can address easily in the future. The serif font used looks dated and the non-responsive nature of the page frame means there is often a lot of empty white space in shorter exercises, giving a rather dated user experience.  On a mobile phone, this lack of non-responsive design meant that I had to place my device on its side to fit the page on screen: holding the phone normally meant constant scrolling left to right. Answers requiring me to type in a word were also problematic: many mobiles default to capitals for the first word in a new field, but the system automatically marks as wrong a correctly spelled word with an erroneous first capital letter.  

Teachers using the digibook to project via a projector or an interactive board/panel will welcome the opportunity to project these unit segments and this will work equally well in face-to-face, online or in hybrid classes. However, the publisher seems to have overcomplicated its LMS, with a hierarchy of users (student, teacher, school manager, school master and parent), each with its own lengthy user manual. I have not been able to trial this with a group of students, but there are options for progress reporting, homework and assignment setting and even attendance checking 

OET Speaking & Writing Skills Builder (Nursing and Medicine) is a welcome addition to the slowly growing choice of materials available to teachers and students who are studying independently. Its focus on speaking and writing skills development meets the needs of candidates who are not familiar with the requirements of the relevant OET sub-tests and while the middle sections are sometimes pitched low, they are described as optional. As I wrote for my review of the companion Reading and Listening book, many students preparing for OET fall into the trap of thinking that exam practice alone is the key to exam success and this book provides something different and for that it deserves praise and success.  

Published 2020, Express Publishing.

160 pages; 31,79 Euros for print book and digital access currently reduced to 25,43 Euros (or 25,43 Euros currently reduced to 20,34 Euros for the digibook only); Audio CDs 7,95 Euros 

ISBN-10:  1-4715-8694-1 

ISBN-13:  978-1-4715-8694-1 

Until recently, candidates preparing for the Occupational English Test, plus the teachers supporting them, have faced a relative lack of high-quality published preparation materials. OET Reading & Listening Skills Builder, written by Tom Fassnidge, will therefore be a welcome addition to the growing array of OET materials, as will its companion title, OET Writing & Speaking Skills Builder (Nursing and Medicine).

Tom is an experienced OET teacher and materials writer who has worked for one of the UK’s leading OET Premium
Providers; this new title provides candidates with the techniques required for the reading and listening (all professions) sub-tests and is suitable for either self-study or classroom use.

OET Reading & Listening is divided into ten units which are organised by topic. Besides the usual clinical areas (lifestyle issues and infectious diseases), the topics also include wider issues such as training and best practice plus technology and social issues. Each unit includes a reading and listening focus plus a language/skills
focus. Beginning in Unit One with an overview of the types of texts and questions found in the reading and listening sub-tests, the reading and listening focus sections then look at each part of the reading and listening sub-tests in turn and repeat this structure throughout the remaining nine units. The language/skills focus cover the many sub-skills required for success in OET, including gist, detail and purpose and useful language such as collocations, modals, and semi-modals plus a very useful section on identifying and avoiding distractors. In total, the book provides the
equivalent of more than two complete OET Reading and Listening sub-tests. Of note is the author’s comment in the introduction that the texts and exercises are designed to be “a little easier than the real test” to help students to focus on the development of the techniques required for OET success. This reflects nicely the book’s title, although it is perhaps a little disappointing that there are no complete practice tests at the C1 level provided at the back of the book for students to gauge their level on completion of the book.

Like the Speaking & Writing volume, the hard copy edition of OET Reading & Listening Skills Builder includes additional resources, audio scripts and answer keys, making the book ideal for self-study. Furthermore, all of the book’s contents can also be accessed through Express Publishing’s own online platform and the Digibooks app. Unusually, the code for this online version is provided at no extra charge, bound in with the hard copy edition, and for student accounts is valid for 15 months from the activation date; teachers on the other hand can re-activate the apps
for free. CD recordings of the audio tracks are available separately for a small charge of just under 8 Euros.

Unfortunately, the digibook edition of OET Reading & Listening Skills wasn’t ready at the time of writing this review but the publisher states that the online/app edition will be highly interactive. The teachers’ guide for Express Publishing’s online platform is very comprehensive and perhaps almost overwhelming in its detail, while the platform itself allows students who are part of an taught group to check what has been assigned to them as homework, complete it online, have their answers automatically corrected and see their progress. Individual learners are also well catered for, being able to complete all of the book’s activities (including listening ones) online and receive instant feedback.
The book is attractively laid out in full colour, with plenty of white space on the page for the contents to breathe. Frequent blue Test Tip boxes, presented as speech bubbles, provide additional bite-size hints about exam strategies and are a strength. It was good to see learning objectives for Reading, Listening and Language and Skills presented at
the beginning of each unit; the addition of some kind of review activity or reflective task at the end of each unit or cycle of three units would have been a welcome addition.

I am very happy to recommend this and its companion Speaking and Writing volume to teachers and students who are studying independently. The focus on skills development will be particularly welcome to teachers and students who value a focus on developing their skills. Many students preparing for OET fall into the trap of thinking that exam
practice alone is the key to exam success and this book is brave in providing something quite different and for that it deserves praise and success.

Published 2020, Express Publishing.
158 pages; 31,79 Euros for print book and digital access (or 15% discount for digibook
only), currently reduced to 25,43 Euros; Audio CDs 7,95 Euros
ISBN-10: 1-4715-8693-4
ISBN-13: 978-1-4715-8693-4

A new title for candidates aiming to pass OET Nursing, the Cambridge Guide to OET Nursing assumes that candidates have reached the appropriate level of language competence and does not attempt to introduce or revise lexis or structure. Rather, the title prepares candidates for the exam by presenting what the publishers refer to as ‘extensive task-based learning and practice’ for the four parts of the exam along with strategy and tips 

The Reading and Listening chapters are broken down into the three sections of each paper, with plenty of opportunity to get to grips with the skills necessary to succeed.  This is particularly important as each section demands different skills and do not all pose the same level of difficulty. Part C in both sections can be particularly challenging for candidates – distinguishing between opinion and fact is no easy matter, even for native speakers.  

The chapters dedicated to the Speaking and Writing part of the test follow the same format: an explanation of the sub-test ( which includes the criteria and level descriptors) is followed by a detailed preparation chapter, with plenty of explanations of the skills required to achieve a good pass, along with relevant practice tasksThe Speaking chapter focuses on such skills as using suitable question types, organising information when explaining things to the patient, checking for understanding and communicating with empathy. There is, in my view, a good balance between the professional skills needed for nursing in English and the linguistic skills needed to speak intelligibly and appropriately – which involves an understanding of the role of intonation. Of course, speaking practice can’t effectively be done alone and with just a textbook for company – candidates are strongly advised to get live practice before they sit the test – but what the book presents is highly useful. 

The book includes two practice tests, with all audio recordings and answers available on an online platform. In terms of look and ease of use – well, like a lot of titles these days, there’s a fair amount of text but the font size is good, blue is used throughout to highlight box-outs, etc and there’s also enough white space so that eyesight isn’t strained. While many books try to work as both self-study and class texts, they don’t all succeed. This does and would work very well in both contexts in my view. In factone of the things I liked about the title was the ‘voice’ behind the text felt like that of a teacher. For this reasonthe book could be useful for a less experienced teacher, or one who was less familiar with the OET exam. 

All too often what is being taught and tested on ESP courses is specific vocabulary – though not necessarily that needed to perform specific communicative tasks in the workplace. Throughout The Cambridge Guide to OET Nursing, reference is made to the professional skills being tested which serves as a constant reminder of the focus of the OET exam, and of the utility of this book.

I highly recommend the book for candidates (with a B2+) and their teachers. 

Approx €45

ISBN-10: 1108881645

ISBN-13: 978-1108881647

What’s the position of medical communication skills training in India?

Medical communication skills training in India is still in infancy. Before 2019 there wasn’t any formal curriculum though in that year the Medical Council of India revised the medical curriculum and introduced the AETCOM module (Attitude, Ethics and Communication module). Spread over five years of medical school, the module covers skills around attitude, ethics and communication. Since 2019, communication has been taught in all  medical schools in a staged manner.

In the absence of any regular programs, I have conducted more than 1500 both short and long programs for multiple medical schools and hospitals across the country in the last 10 years. These programs are specifically focused on clinical communication including topics like conducting patient interview and information sharing (based on the Calgary Cambridge guide), handover tools, understanding patient’s expectations, breaking bad news etc.

Do you teach medical communication as a skill, independent of the language being used? Or are your programmes about communication in English only?

All programs in the medical schools are in English. Other programs for residents and nurses across the country are conducted as per the preferred language of the audience. It is mostly English or Hindi.

Are your programmes specifically aimed at medical professionals looking to work an English-speaking culture? Do you work with a range of healthcare professionals, including nurses?

Although most of the programs are conducted in English they are not meant to only prepare professionals for working with an English speaking culture. Rather, I have designed my programs to meet the communication needs of my country. The programs are designed to suit the healthcare delivery system specific to my country. I do work with a range of healthcare professionals including nurses and paramedics. Selection of the language is done based upon the audience and their preferred language.

Medical culture varies quite a bit from country to the next, particularly in how patriarchal the culture is and in the expected roles of doctors and patients. How does this variation affect how and what you teach? Or how the programme is received by participants?

Doctor-patient communication in our country is very peculiar and has changed drastically over the last few decades. Patients, who never asked anything, now wish to ask questions and be informed about their illness and the options available to treat a medical condition. This comes as a shock to some of the doctors, who are not used to this kind of communication expectation. As a result, many are not receptive to communication skills programs. They feel they are being forced to learn communication skills. Many of them also are resentful of the fact that poor communication is leading to lots of violence against doctors and they put the blame on patients for being too demanding.

Keeping this in the background, I design my programs very carefully. Through my programs I help them see the changing doctor-patient relationship. I also help them see the benefits of communication in terms of a better doctor- patient relationship, reduced errors in patient care leading to ensured patient safety, continuity in patient care and better health outcomes. Without offending anyone, I help them understand the need for these programs.

I have attended lots of communication programs in US and India, but I do not try to transfer all the learning as is. It’s important to generate genuine understanding for the subject rather than loading them with everything in one go. Some of the communication practices I learnt abroad are practically too difficult to be implemented immediately.

I have customized the programs based on my experience of working with Indian healthcare industry for the last 30 years and my learning at various institutes. I have made an amalgam of the same and move from basic to advanced level depending upon the training needs of the specific healthcare facility and receptivity.

How does your background as a psychologist inform your work in the field of medical communications?

My background as a psychologist helps me greatly in the field of medical communication programs. There are lots of soft skills trainers in India trying hard to work on medical communication programs but my background as psychologist and having had worked in healthcare greatly helps me quickly develop rapport with my audience. I am able to bring lots of examples from healthcare to help them relate with the content I deliver. Being a psychologist also helps me design and deliver my program in a manner that highlights the benefits of medical communication to the audience. They are able to see what is in it for them.

My understanding of adult learning helps me design the delivery of the program, which is based on adult pedagogy. Most of the content is delivered through hands on training, including role plays and videos followed by discussion, self- introspection questionnaires leading to self- reflection and discussion. I also make use of the professional skills I’ve developed as a psychologist, skills such as being non-judgemental, being accepting, empathetic and being receptive without blaming or complaining. It helps me develop wonderful rapport with my audience and makes them receptive to my programs.


Dr Indu ArnejaDr Indu Arneja, Director of the Indian Institute of Healthcare Communication, holds a PhD in Psychology and an MBA in Hospital Administration. She is a visiting professor at a number of universities in India and is a member of the advisory board of the National Human Rights Commission.



A lesson for online or the classroom based on a TED presentation by biochemist Gregory Petsko who convincingly argues that unless we take action, in 30 years most of the world will be experiencing an epidemic of neurological diseases.

Language work, video comprehension and communication activities. Level B2



Targeted at students for clinical practice and for those preparing for the Writing component of the Occupational English Test, this is a useful and affordable book written by a former GP and an ESL teacher/writer. It’s A4 in size, with 12 units, all following a similar format: case notes are followed by an OET-type letter writing task, with model letters for each task. Each unit contains language work focusing on grammar or lexical aspects of use for the OET candidate and a ‘Writing Clinic’ which focuses on the nuts and bolts of letter writing such as paragraphing, organisation of information, punctuation and common spelling errors.

As the title suggests, the book is very much aimed at doctors, though clearly much is of use to any professional needing to practice professional letter writing, while an experienced teacher will be able to adapt and substitute tasks that are more suitable for other professions, particularly nurses, looking to sit the OET exam (the writing task is profession-specific).

The book was independently published which means it hit the shelves a lot faster than if it had been traditionally published, i.e. with a publisher.  It also means that some of the niceties of traditional publishing are absent: colour, graphics, fancy fonts and images are entirely absent. While these aspects may be of little concern to some teachers and students, it does mean that this is a very text-dense book. In my experience, text-dense language books work better when study is teacher-led. Had there been an editor involved, the book would also have contained more succinct, less wordy language explanations. This is an important point when attempting to target the book at a learner with a B1 in English. That being said, most of these are aspects that can easily be improved upon for the 2nd edition.

This is a very useful text, it’s fairly priced and – a nice touch this – half of its profits are going to the Refugee Council in the UK. It would certainly be of great use for doctors looking to improve their clinical writing skills for work in the UK and for those looking to sit – and pass – the Occupational English Test.

Published 2019; independently published/available on Amazon

119 pages; £15



I arrived back in a rain-washed Gatwick last night, reflecting on a diverse, interesting and rewarding international English for Healthcare conference. Excellent plenaries, presentations, workshops and posters along with lots of great discussions and chats over coffee, lunch, and OET-sponsored wine. The conference was well-attended and we met a truly global cross-section of Medical English teachers from across Europe, Japan, Australia and the US among others. Lots of familiar faces and plenty of new ones too.

A particular highlight for me was Professor Elena Semino’s plenary highlighting the impact of communication on healthcare provision through two research projects, one on using visual means to describe pain and one on the use of metaphor in the understanding of treatment and cancer. Both projects inspired me to consider how we can integrate such research into our Medical English courses to add further depth and reach. One of the advantages of digital content is the ability to integrate research results and link to studies as they are published, so providing learners with rich, up-to-date content.

Between myself, Bethan and Virginia, SLC gave three sessions on teaching English to nursing students, the hows and whys of how teachers can use online content in classrooms, and the principles informing the design of SLC’s online Medical Terminology course. All the sessions were well-attended and participants appeared engaged, asking a range of interesting questions.

It was also great to see the interest from a wide range of universities and teachers in our courses at the stand we had in the reception area. We were able to share content on the screen, describe how courses worked for students and teachers, as well as show the teacher books we have just published with answer keys, video and audio transcripts and teaching ideas. We hope that teachers got a clear sense of how the courses can be used to support and engage their students and look forward to continuing a number of conversations we started.

Virginia Allum

The venue – Jaume 1 University in Castellon, Spain – was hugely impressive. Modern, high-tech facilities, great food and lovely weather. The daily temperatures of twenty-five degrees or more certainly made a change from the previous week of autumnal rain in the UK and allowed for a very pleasant weekend in Valencia afterwards!

So, a mighty round of applause to Catherine Richards and her EALTHY team for organising an excellent, thought-provoking event. We’re already looking forward to the next one.

Chris MooreSince taking his first job as an English teacher in Barcelona back in 1989, Chris Moore has designed curricula, trained teachers, run schools, organised worldwide corporate language programmes and created multiple online study courses. He has a particular interest in designing and delivering technical and business language courses which make a real difference to the lives of those taking them.

Katherine Heathcock of Birmingham University Medical School talks about the importance of using simulated patients to train medical students, a tool that gives students a unique insight into their own communication, character and consultation style.

In October 2002, my partner at the time had been riding a bicycle through the streets of Singapore, scouting the route for the Singapore marathon, for which he was the race director, when he was hit by a taxi travelling at 50 miles per hour. He was thrown high into the air and landed on his right side, with his head 2 inches from the kerb. A piece of his scalp was missing and he sustained some nasty bruising, but the main injury was acetabular – the head of his right femur had been forced through its cup-shaped socket in his pelvis. He needed to be on traction and to undergo pelvic reconstruction at Singapore General Hospital before being allowed to return home. The surgery and treatment he received in that hospital was exemplary and after 3 weeks I was able to fly out to bring him back to Britain.

I accompanied him to the first consultation with the orthopaedic specialist registrar at our local hospital. The registrar was astounded by the history and incredulous at how quickly Pete had recovered, moving out of his wheelchair and walking only with the assistance of a stick. I don’t think he fully believed the story, until he saw the x-rays, showing extensive metal work in Pete’s pelvis. He was clearly impressed by the quality of the workmanship. But I shall never forget the words that escaped him that day. He said to Pete “We would expect patients with this kind of injury either to die at the scene of the crash, or to limp to the grave”.

Though his utterance was likely motivated by the esteem he felt for his colleagues in Singapore, from the patient’s perspective, neither of the options on offer was particularly attractive, but Pete had thankfully not died at the scene, which left him with the other choice: that of limping to the grave. Being a very proud Welshman, he downright refused to alter his gait, despite his pain. I was shocked by the registrar’s statement but what must it have felt like to the patient? Perhaps the registrar judged wisely and could see the grim determination that had pulled Pete through this traumatic event and was man-on-man encouraging and rewarding his fortitude? In that moment, he was likely completely oblivious to the imbalance of power that is always present in the doctor/patient dynamic, that exaggerates the influence of any statement a doctor makes, whether newly qualified foundation doctor or senior consultant, the difference in status being obvious to the professionals, but less visible to the trusting patient.

The registrar’s initial disbelief and his subsequently insensitive and dismissive language in fact only served to stiffen Pete’s resolve to walk straight and upright and never to limp. But it could have gone a very different way. The registrar had no insight into how his words might be perceived or their potentially negative effect upon the patient and his recovery. He was likely blissfully unaware that his words were hurtful and potentially damaging to the psychological well-being of the patient in front of him. And I don’t suppose today that he would have the slightest recollection of having said those words; whereas for us, they will never be forgotten. Much has been written on the power of language but to quote Sigmund Freud “Words have a magical power. They can bring either the greatest happiness or the deepest despair”.

People generally enter medicine or related professions in order to help people and yet many patients and relatives, certainly in the UK have a similar story to tell of inadequate or unsympathetic communication. So why do healthcare professionals so often get it wrong? Can we really be content to blame the system with its undeniable pressures of underfunding and under resourcing? Undoubtedly, the economic and temporal pressures form part of the picture but the system is made up of human beings, interacting with other human beings and given the right insight and training, the choices they have about how they communicate with each other and with patients can be clearer.

At Birmingham University’s College of Medical and Dental Sciences, the Interactive Studies Team teaches Clinical Communication to healthcare undergraduates. We currently work across Medicine, Dentistry, Pharmacy and Physician Associate programmes, using role play as our main methodology. Our simulated patient (role player) team is made up of over 100 professionals with backgrounds as diverse as the performing arts and the military. We have dancers and nurses and martial artists and researchers and students and retirees on our books but all have an interest in developing the healthcare workers of the future.

Members of our team are trained to pick up a scenario, with a richly detailed background based on a real case and to simulate (or act out) that scenario with students. The role player will be required to play a patient with a certain condition or set of symptoms, or a relative or colleague. There is no script just background information, which might include past medical history, history of the presenting complaint, social history etc.; there will be learning outcomes for the scenario, which might have to do with handling the anxious relative of a patient, for example. The student is required to engage with the scenario, which will play out according to the behaviours of that individual student. In other words, if the student behaves in a way that reassures the anxious relative, the role player will respond accordingly.

If the student is dismissive or unassertive for example, the simulated patient will respond in role with corresponding behaviours, which may include increased anxiety or perhaps disengagement for example. The interaction is watched by a group of between 3 – 10 other students, depending on the programme and year group, all or some of whom will get the chance to role play subsequently with different scenarios.

Following the scene’s conclusion, the student will be asked to reflect out loud upon how well they think they handled the interaction and if there were moments when they felt uncomfortable or would, in hindsight, like to have done something differently. The observers will be consulted for their impressions of what took place, what they appreciated in their peer’s handling of the situation and what, if anything they would do differently. Then comes perhaps the most valuable part of the learning experience: the role player’s feedback.

Our role players are trained to give feedback ‘out of role’, in other words as themselves, describing the effect of the student’s language, non-verbal communication, questioning, listening, empathy, rapport-building etc. on the patient/relative/colleague they were representing. We ask for it ‘out of role’ because these sessions can be emotional for students and the added objectivity of third-person feedback, helps to decrease any heightened feelings in the room and to protect the simulator from personal criticism. This feedback can be powerfully formative. It enables insight for the student into how they may be perceived in communication. It creates a sense of positive ‘self-consciousness’, which is necessary in the formation and development of self-reflective practitioners. And the role player’s perspective can’t be argued with. When a role player says “when you did this, Mrs Jones felt that”, who can contradict? As a facilitator of these small groups, before the role player feedback I may ask the student observers how they thought the role playing student made the patient (for example) feel. There may be several opinions and these may be debated. However, when a role player makes the statement to the student about the impact on his or her character of the student’s behaviours, it is incontrovertible, potentially generalizable and often the cause of a great deal of reflection. Any anxieties on the part of students about role play generally evaporate in the intense engagement with these discussions. Role players are trained to give balanced feedback in a way that is palatable to the students, so as to minimise defensiveness, which we rarely, if ever see.

This feedback may be a springboard into a more general discussion about empathy and listening. If a role player were to say in feedback “when you told my character that patients with this kind of injury usually ‘die at the scene of the crash, or limp to the grave’, my character felt shocked and defeated”, this would be a powerfully influential experience for the student and may trigger a group discussion about how the choice of words can have an enormous impact on a patient’s recovery and the attitudes that may underpin, and are expressed by, what we say.

In our teaching sessions, the learning is for all participants and observers can learn as much from the interventions as those actively playing in role. (Incidentally, we never ask our students to be anyone other than themselves). A health professional has enormous scope to benefit his or her fellow humans. It is imperative that all learn the power of their own language and attitudes and that their unique and individual way of communicating is flexible; each of us makes choices about what and how we speak and behave towards others and the more self-aware our doctors, dentists, nurses and other healthcare professionals become, the better will be their choices and the consequent impacts on the people in their care.

Katharine HeathcockKatharine Heathcock, is a full time Teaching Fellow for the College of MDS at Birmingham University Medial School, teaching Clinical Communication across the MBChB, Pharmacy and Dentistry courses, with responsibility for MBChB years 1 and 2 and GEC. She also teaches at postgraduate level. Katharine has experience as a coach facilitator on the Referred Student programme. She is a Personal Mentor and has responsibility for academic programming for the Biomedical Science International Summer School. She has a background in theatre, professional role play, training and assessment but her passion is teaching.

Virginia Allum is Head of Medical English at SLC (Specialist Language Courses) and also works as a freelance medical English writer. Author of several online Occupational English Test courses – SLC Reach OET B Medicine 2.0 (doctors) and SLC Reach OET B Nursing 2.0 (nurses) as well as general medical English preparation courses for healthcare professionals: SLC Medical Terminology, SLC English for Nurses: Getting the Essentials Right, SLC English for Doctors: Advanced Communication Skills and SLC English for Care. As a freelance writer she recently co-authored OET Preparation Nursing (CUP India) 2019, author and is a regular contributor of medical English articles for (online magazine for the IFSI -French Nursing Diploma).

You’re a nurse who also works as a materials writer for medical and nursing English. What first led you to medical English?

Like many people, I have meandered through a few different areas of study and associated jobs. Writing medical English materials was a natural progression through previous studies. After school, I started an Arts/Law degree in Sydney. This was a combination Law degree with an Arts degree in languages (Spanish, French and German). I soon realised that my main love was the study of languages. At the same time, I had been working in a care home to earn pocket money for a planned overseas trip. I also realised that I loved Nursing too. After dropping out of university and travelling for a while, I returned to Australia and trained as a nurse at Royal Prince Alfred Hospital in Sydney.

Working for a while in hospitals, I decided to set up a Home Nursing Service in Sydney which developed into a Palliative Care Nursing Service (by accident). I found that Palliative Care was the area of Nursing I loved (you may notice that I always add role plays or units about end-of-life care in my books and courses).

Moving on a few years and I started on a new direction – I became a Nurse Preceptor, teaching students of the ‘College Course’ in Nursing, as it was then called. Nursing was moving into the tertiary sector and this was the first step. I found that Teaching was another area I enjoyed, especially as it was in the workplace and very practical. By chance I read an advertisement for an intake of students for a Grad. Cert. TESOL course. With a love of language learning behind me, I thought this may be an interesting direction to go. After a few years teaching EFL, I was led (again, by chance) into teaching medical English. A Japanese Nurses’ Study Tour was about to walk into the doors of the college where I taught…’You were a nurse, weren’t you? Could you put something together for the tour? Always one to say ‘Yes’ before really considering the ramifications, I agreed. Unfortunately, the existing medical English books were outdated and the college’s materials which were kept in a bottom drawer and were not very useful.

I linked up with the Nursing department of the college to try to find out the needs of international Nursing students and found that much targeted language support was needed, but not available. A comment about this to a friend (Patricia McGarr) led us to the writing of the ‘Cambridge English for Nursing’ books, as (again, by chance) Cambridge University Press were looking for authors for a new series (‘Cambridge English for..’) and need someone to write the Nursing title.

This was the beginning of a new direction for me. I had the advantage of a nursing background to add to EFL training. I found it satisfying to be able to produce materials which were meaningful and near authentic. In fact, many of the dialogues I write come from previous experience. Most are a conglomeration of different interactions I have had with patients, their relatives and other healthcare professionals.

It’s a long way from those first materials found in the bottom drawer which contained useful expressions such as ‘Doctor, my elbow hurts.’

Has awareness of language and communication in nursing changed (in Australia and the UK) since you first qualified? (In what ways? Etc)

Definitely. There have been many changes in communication between healthcare professional colleagues and between healthcare professionals and patients. When I completely my hospital-based training in Sydney in 1982, nurses were ‘on the outer’ regarding communication with other healthcare professionals, particularly doctors. We were still viewed as ‘handmaids’ to doctors, not entitled to view opinions or be part of medical discussions. In my opinion, the change to a Bachelor in Nursing changed this. Nurses became better educated and confident in providing specialist input to patient care. Many bedside nursing tasks are now undertaken by health support workers (Healthcare Assistants in the UK), leaving higher level Nursing tasks to Registered Nurses. From a medical English perspective, this means that communication between colleagues can require an increasingly technical vocabulary.

Communication with patients requires the ability to translate technical language regarding procedures and medication into an everyday health language. An example of this is wound care. When I finished my training in 1982, we had around three types of dressings we could choose from; dry dressings (a piece of gauze), saline dressings (gauze soaked in saline), Eusol dressings (a kind of chlorine solution). Documentation of dressing changes was scant (I remember a ‘Communications book’) and care plans or care pathways were unheard of. There has been a huge change in the level of Health Literacy in patients, so that they have greater expectations of interactions with healthcare professionals. Previous comments such as ‘Don’t worry, it will all work out fine’ don’t wash any more. Patients and their carers expect accurate information which they can understand. Patients may have researched their health status online – accurately or inaccurately. These are new interactions which healthcare professionals now have with patients, either tactfully correcting inaccurate information or being able to build on a basic understanding.

As well, there is a greater understanding of the effect of poor communication. Patients whose anxiety is ignored or minimised often become more anxious which can delay recovery. Tactless interactions when delivering bad news can be traumatic for patients. Lack of understanding of different cultural expectations in hospital or when communicating can also cause distress. I have seen great strides in confronting these sorts of communication issues since my early days as a nurse. I still remember a consultant talking to a patient from New Caledonia who had been transferred to our hospital in Sydney for major brain surgery. The patient only spoke French. The consultant was convinced that his minimal French was sufficient to explain the procedure of a craniotomy and burr holes. The horror of his explanation remains with me (‘I’ll make a hole in your tête and then we’ll…’).

You are also Head of Medical English at Specialist Language Courses, the UKs leading digital provider of medical English training. In your view, is digital training the future for EMP?

Providing medical English training to healthcare professionals has one major difficulty – unpredictable shifts. Healthcare professionals who are already working, but hoping to move to an English-speaking country often have limited opportunities to attend face-to-face classes. I believe that digital learning offers a solution to this. Webinars can supplement the digital content of an online course, allowing for a feeling of personal contact and pronunciation correction. Pages of online courses can be downloaded, if students want to practise writing answers and activities can be done again and again, until the student masters them. As a materials writer, the digital environment is great for a field which changes quite frequently. I often find that I read an article about a new treatment or drug just after producing material on the same topic. In the digital world, I can update immediately. I am lucky to be working with SLC, as the company produces a very good quality product – plenty of pictures to help students understand complex technical jargon and a great team who edits and exercises quality control. It’s very satisfying to see the CPD accreditation on SLC courses which suggests that digital learning works well in the healthcare environment.

You’ve also been closely involved with the occupational English Test and have co-authored a very recent test preparation book, ‘OET Preparation Nursing’ which was published by Cambridge Press India. What makes this book different?

Although there have been quite a few OET preparation books published recently, Cambridge University Press India wanted to produce a book which initially appealed to the Indian market, but was not India-centric. Indian nurses, as well as nurses from other countries in the region (Nepal, Myanmar, the Philippines) have attempted the OET in order to work in Australia and New Zealand. Recent changes in the UK have seen a growth in non-EU nurses applying to work there. Nurses from South-east Asia, predominantly India and the Philippines have turned their attention to the UK as a work destination. Whilst nursing practice is similar in India, for example, the opportunities for interaction with patients is not the same. Time constraints mean that nurses working in India do not have the opportunity to develop a rapport with patients or spend time explaining procedures, so they are understood by patients. There can be hesitance about asking for clarification or admitting that something has not been understood. These differences in cultural interaction between India and Australia or the UK need to be appreciated for a candidate to be successful in the OET, hence the need for a book which is published in India with these issues in mind. As with all OET materials, the idea behind them is not to stop learning about healthcare interaction as soon as the test is passed – an awareness of the importance of effective communication in the workplace is paramount and can go a long way to helping a healthcare professional settle into a new workplace environment.

Medical English has evolved greatly- from lists of vocabulary and short phrases to learning about communication in a medical environment which includes intercultural communication and the ability to switch between technical and everyday health language. For this reason, whilst the OET Preparation book is published in India, it will have a wider appeal for all candidates who should use OET as an opportunity to examine their own methods of interaction with colleagues and patients and perhaps develop alternative modes of communication.

Many of the teachers and trainers who are involved in medical and nursing English are teachers and language specialists but do not have a medical background. Is there any advice that you, with your background in nursing, can give them?

Whilst a background in Medicine or Nursing is not entirely essential to teach medical English, there are obvious advantages in a healthcare background when teaching workplace-based courses. Having said that, a person with a background in Medicine or Nursing will probably not know everything about Medicine or Nursing. Every teacher has to do some research, before teaching a new module. Compare with a History teacher who specialises in the History of the 18th century and is suddenly faced with teaching the History of Ancient Greece.

There are numerous health sites which explain healthcare-related topics. Find one which is easy for you to follow. Have a passing relationship with medical terminology – remember that by learning some of the commonly occurring prefixes and suffixes, you’ll have half a hope of guessing the whole word.

Keep in mind that most, if not all, verbal interactions follow the same structure as any other interaction, e.g. asking for information, providing information, allaying anxiety. Use your students’ experience in their own language to compare interactions. Are they similar or different?

Academic medical English follows the same path as regular academic English. Some texts may be challenging for you to understand, but can be used in teaching to identify medical terms. Abstracts are quite useful for this. Make use of your students as a resource to discuss health-related topics.

They won’t expect you to be experts in Medicine – you are the language expert. Sometimes, it’s handy to have a ‘friend in the business’ who can be asked questions like ‘Which word would you use to explain this?’ Use EALTHY as your ‘go to’ resource. There are plenty of members who can answer specific questions.

With regard to OET texts, remember that they are less likely to contain a large amount of medical terms and any that are used should be explained. So, as a teacher, you are purely training students to understand what a patient says (e.g. during a snippet of a consultation), what a healthcare professional says to a colleague or patient (in a short text of 100-150 words) or an opinion or attitude a healthcare professional expresses during an interview or short presentation.


There are a number of reasons people may not like to talk about language tests. Teachers sometimes find them irrelevant to their teaching and thus unfair to their students and inaccurate measures of what their students know and can do (Shohamy, 2007). For similar reasons, learners often find language tests irrelevant to their needs and thus unfair, stressful, and poor measures of what they know and can do with the language they have been learning (In’nami, 2006; Alderson & Clapham, 1995). Often, too, administrators find language tests somewhat mysterious and wonder what all the fuss is about regarding validity and reliability (Bachman, 2004). In this paper, I want to suggest that there is no reason why language tests, and particularly English for specific purposes tests, have to be painful, irrelevant, or mysterious. If a test is clearly relevant to the test takers’ needs and background and reflects what they have been studying, it will be less stressful for them and more appropriate in the eyes of teachers. If adequate documentation is provided about test objectives, development, and measurement qualities, administrators will have a better understanding and appreciation of what the test is measuring and how to interpret performance on it. We language teaching and assessment professionals have an ethical responsibility to ensure that the tests we make and use are as fair, accurate, relevant, and transparent as possible for the test takers and score users.

The ultimate purpose of the paper is to argue that tests of English for specific purposes should adhere to an overriding criterion of fairness – fairness to the test takers, to teachers, to educational programs, and finally to the societies in which the tests operate. This point is in line with current thinking in language testing generally, that ethical language testing is a much-needed focus in assessment, one that has been neglected for too long. In this paper I will discuss principles of assessment in ESP, going back to such basic questions as the following:

  • Why is ESP testing necessary?
  • What makes ESP tests specific?
  • What is English for Specific Purposes?
  • What problems are associated with ESP testing?

Why is ESP Testing Necessary?

Over the years, language specialists have made the following assertions with respect to the field of ESP testing: 1) Specific purpose language proficiency is really just general purpose language proficiency with technical vocabulary thrown in; 2) specific purpose language tests are not necessary since, if we test general language knowledge, specific uses will take care of themselves; 3) specific purpose language tests are unreliable and invalid since subject knowledge interferes with the measurement of language knowledge; 4) specific purpose language tests cannot be justified theoretically; and 5) specific purpose language testing is impossible anyway, since the logical end of specificity is a test for one person at one point in time (Davies, 1990; Alderson & Urquhart, 1985; O’Neill et al. 2007; Read & Wette, 2009). I will argue in this paper that these assertions are not true, that there is a theoretical justification for ESP, that ESP is different from general purpose language, that language knowledge and specific purpose background knowledge are both part of the ESP construct, and that specific purpose language testing is not only possible but necessary.

We often think of two broad purposes for ESP tests: Academic purposes, to determine whether applicants have enough control over the target language to succeed in academic studies, and occupational or professional purposes, to determine whether job applicants or employees can carry out necessary functions in the target language. There are two reasons why practitioners take the trouble to create ESP tests even though there are plenty of more general purpose tests easily available:

  • Reason One: Language performances vary with context, and
  • Reason Two: Specific purpose language is precise.

Language performances vary with context. Nurses use language differently when they are working directly with patients than when in an operating theatre. In the former situation, they use less technical language, more one-on-one social interaction, more interrogatives and directives. In theatre, nurses use more technical language, more receptive language, fewer well-formed sentences. Thus, we adapt the language we use to the communicative situation we are in. This is in part what specific purpose language is about (Douglas, 2000).

Specific purpose language is precise. Consider the following dialogue (Beare, 2011):

Nurse: Good morning, Ms Adams. How are you doing today?

Patient: Horrible! I can’t eat anything! I just feel sick to my stomach. Take the tray away.

Nurse: That’s too bad. I’ll just put this over here for now. Have you felt queasy for very long?

Patient: I woke up during the middle of the night. I couldn’t get back to sleep, and now I feel terrible.

Nurse: Have you been to the bathroom? Any diarrhea or vomiting?

Patient: I’ve been twice, but no diarrhea or vomiting. Maybe I should drink something. Can I have a cup of tea?

Nurse: No problem, I’ll get you a cup right away. Would you like black tea or peppermint tea?

Patient: Peppermint, please.

Adapted from Beare (2011)

The expressions felt queasy, been to the bathroom, diarrhea, vomiting, and black tea or peppermint tea are examples of precise, though not necessarily technical, specific purpose language. Bathroom is a particularly American expression – Americans find the word “toilet” somehow a bit too earthy, I think. Although these expressions may not strike the reader especially as examples of the type of language we usually associate with specific purpose English, they do represent a desire on the part of the speaker to be precise. In this context, precise means the use of language which, while accurate and exact, is clear and likely to be understood by the listener. Even the offer of two kinds of tea is an attempt on the nurse’s part to make sure the patient will not be surprised by the flavor of the tea when it arrives.

Specific purpose language tests are also necessary from a pedagogical point of view. They are fairer than non-test evaluations since all test takers are given the same instructions, input, and scoring criteria. They are more relevant to the learners than general language tests because ESP tests are based on an analysis of the target language use situation and so reflect the actual communicative needs of people in that context, and they reflect the learning content and style in the ESP course. Finally, ESP tests are more accurate than non-test assessments in giving test takers numerous opportunities to demonstrate what they can do in relevant situations. Thus, ESP test scores can be interpreted as evidence of communicative ability in a target language use situation.

What Makes ESP Tests Specific?

Authenticity and Knowledge make ESP tests what they are. Authenticity of task means that test tasks share features with target language use tasks: in our case, the work of nursing (Douglas, 2000). The interaction between language knowledge and specific purpose content knowledge means that both types of knowledge are necessary components of ESP tests. Authenticity refers to the degree to which a learning activity mirrors real-life language use, but as Widdowson (1979) put it:

It is probably better to consider authenticity not as a quality residing in instances of language but as a quality which is bestowed upon them, created by the response of the receiver. Authenticity in this view is a function of the interaction between the reader/hearer and the text which incorporates the intentions of the writer/ speaker…Authenticity has to do with appropriate response (p. 66).

Widdowson also made a distinction between genuine and authentic:

Genuineness is a property of written and spoken texts and refers to the origin of the text in an actual communicative situation.

Authenticity, on the other hand, is a perception by language users that communication reflects real life language use and is thus not a linguistic property but a cognitive one.

Consider the following dialogue between a nurse and a patient (Shahady, 2008):

Nurse: Good morning! I see you are in for your annual physical. Do you have any concerns about your health?

Charles: No, I’m feeling pretty good.

Nurse: Would you be willing to take a few minutes together to talk about your health and weight?

Charles: I guess so.

Nurse: How do you feel about your weight?

Charles: I know I could stand to lose a few pounds. My wife nags me about it every day!

Nurse: She’s probably just concerned about your health. Right now your body mass index, or BMI, is 30.1. A healthy BMI is below 25. Also, your waist circumference is 41 inches. We consider a healthy waist circumference something less than 40 inches. Your current BMI and waist circumference put you at risk to develop conditions that I see run in your family, like diabetes and heart disease. What do you think about this?

Charles: It sounds like I have some work to do. I’ve watched my brother deal with diabetes and it doesn’t look like much fun. How much weight do I need to lose?

Nurse: Any weight you lose will get you closer to a healthy weight. Have you ever tried anything to get to a healthier weight?

Charles: My wife tries to get me to eat salad and vegetables, but I’m more of a meat and potatoes guy.

This is a genuine dialogue, transcribed from an actual conversation between a nurse and a patient. Given its origin in a real clinic, it is also an authentic dialogue. Several features give the dialogue it authenticity:

  • Setting: Examining room furnishings, antiseptic smells
  • Participants: Patient, Nurse
  • Purpose: Discussing health concerns
  • Content: Health, weight, diet
  • Tone: Polite, professional
  • Language: Standard English, some medical terminology
  • Norms of Interaction: Patient-provider, knowledgeable to less knowledgeable
  • Genre: “Medical consultation”

If we were to use this dialogue in a language lesson, however, we might choose to focus on certain linguistic and pragmatic aspects of it. For example, the patient says his wife “nags” him about his weight. How does the nurse respond to this? Why? What
does body mass index mean? The nurse asks the patient how he feels about his weight and about the risk of diabetes and heart disease. Why? What is the meaning of “run in your family”? In discussing these aspects of the dialogue, we are still working with a genuine text, but I would argue that we lose some authenticity. We lose a number of the aspects of authenticity in the classroom or test:

  • Setting: Classroom furnishings and atmosphere
  • Participants: Learners, teacher
  • Purpose: Language acquisition
  • Content: Vocabulary, syntax, pragmatics, culture
  • Tone: Didactic, communicative
  • Language: Standard English, some Medical English
  • Norms of Interaction: Indirect, teacher-student
  • Genre: “Language lesson”

So although we may use genuine materials in our teaching and testing, authenticity will not necessarily follow unless we try to build it into our lessons and tests. We could do this, for example, by furnishing a corner of the classroom to resemble a medical examining room by bringing in some medical equipment such as a stethoscope, weighing scale, and examining table, we could give the person playing the role of the “nurse” a white coat, and we could perhaps even spray some antiseptic around (Douglas, 2000).

It is usual, too, to distinguish between carrier content and real content in ESP materials (Dudley-Evans & St John 19982). For example, in the writing task illustrated in the next section, based on case notes, the case notes are the carrier content and are probably genuine, or slightly edited, taken from actual medical records. However, in the ESP classroom or test, the real content is language related: vocabulary, comprehension, written rhetorical conventions, and professional communication between nurses. This distinction helps make it clear why authenticity is so important in ESP teaching and assessment: simply using genuine input material does not guarantee that learners/test takers will perceive the tasks we set for them as representative of communication in the target language use situation.

Interaction between Language and Content Knowledge

There are several pieces of information you need to know in order to purchase medicine at a pharmacy. You probably need to know whether the particular medicine requires a prescription or not, what your symptoms are, and perhaps some possible alternatives. Just knowing the language will not get you very far in communicating in specific purpose situations: you also need to have relevant background or content knowledge. An example writing task illustrates the need for content knowledge in ESP testing (OET Writing Subtest, 2009):


Patient History Maria Ortiz is a seven-day-old baby. Her mother has been discharged from the maternity hospital.
Social History Mother Violetta Ortiz (Mrs), DOB 07/08/1980. Husband Jose, 36 years.
Occupation security guard (night shift).
Other children Sam, 5 years (currently not attending school), Teresa, 3 years. Accommodation Two-bedroom flat (rented).

Nursing Notes Normal birth. Breast fed. Mother anxious about coping with 3 children. Baby sleepy; reluctant to feed. Baby’s weight: Birth – 3010g. Discharge – 3020g. Father unable to assist with children (night work). Mother very tired. No car; 20-minute walk to shops. Discharged from hospital, 10 April 2010


Using the information in the case notes, write a letter of referral to the maternal and child health nurse who will provide follow-up care in this case: Ms Josie Hext, Maternal and Child Health Centre, 133 Elm Grove, Oldmeadows.

In your answer: Expand the relevant case notes into complete sentences. Do not use note form.Use correct letter format. The body of the letter should be approximately 180-200 words.

OET Writing Subtest 2009

It seems to me that this task requires field specific background knowledge, first to understand the input text, the test taker must know the meaning of DOB, the significance of the birth and discharge weights of the baby, the meaning of letter of referral and “correct” referral letter format, and secondly, to complete the task, the test taker must be able to judge what is “relevant” in the case notes. Thus, in order to carry out this task, the test taker has to use both language knowledge and content knowledge, which makes this task a defining example of an ESP assessment.

What is English for Specific Purposes?

First, there is the question of whose English we are talking about. The field of World English calls into question not only the notion of whether Standard English exists or not, but also of what it means to be a native speaker of English (World English, 2004). Secondly, we need to know what we mean by Specific. When we talk about English for Nursing, we might mean that used for Licensed Practical Nursing, Nursing Practice, Travel Nursing, Oncology Nursing, Operating Room Nursing, Cardiac Nursing, Radiology Nursing, Nursing Education, Private Duty Nursing, Disabilities Nursing, Gynecology Nursing, Forensic Nursing, Critical Care Nursing, Clinical Nursing, Nursing Home Nursing, Ambulatory Care Nursing, Gastrointestinal Nursing, Pediatric Nursing, or Anesthetic Nursing (Nursing Guide, 2010). How different is the English needed for each of these specializations? Finally, we need to understand what we mean by Purpose. There is no such thing, of course, as English for no purpose. What, then, is General English? I would argue that the traditional distinction between general English and English for specific purposes is no longer tenable since all language teachers these days seek to provide learners with an ability to solve on their own the profusion of communication problems they will encounter when they leave the language learning classroom.

With regard to the notion of specificity, I have argued that rather than talking about specific purpose or general English as if they are dichotomous, it is better to think of a continuum of specificity, with something like “English conversation” at the more
general end, and something like “English for cardiac nursing” at the more specific end, as shown in the figure below:

[figure 1]

English for Specific Purposes has long been categorized into English for Academic Purposes and English for Occupational Purposes. The latter has been categorized into Vocational and Profession Purposes, and each of these consists of both pre- and in-service programs, as shown in the figure below:

[figure 2]

Finally, ESP is not a type of language, teaching material, or method, but rather, since its inception, has been an approach to language teaching/learning based on why learners need to learn English and designed to meet specific learner needs. Its content and methodology are derived from specific disciplines, occupations, and activities, and may be restricted in scope. ESP is usually goal directed, taught for a limited time period, to homogeneous groups of learners (Douglas, 2000; Grove & Brown, 2001; Hutchinson & Waters, 1987; Robinson, 1991; Strevens, 1988). Although these references are fairly old, they are not out of date, and the issue of defining and refining the concept of specific purpose language teaching is an ongoing and current task for practitioners (Douglas, Forthcoming).

ESP tests are based on an analysis of a target language use situation, usually known as needs analysis. Needs analysis techniques include Register Analysis, focusing on technical and sub-technical vocabulary and grammatical features; Discourse Analysis, focusing on specific language forms associated with various language use; and Learning Needs Analysis, focusing on the end product, learning skills for independent learning and language use (see Long 2005, for a discussion and examples of needs analysis).

To conclude this section, my definition of a specific purpose language test is as follows:

A specific purpose language test is one in which content and methods are derived from an analysis of a specific purpose target language use situation so that test tasks and content are authentically representative of tasks in the target situation, allowing for an interaction between the test taker’s language ability and specific purpose content knowledge, on the one hand, and the test tasks on the other, and allowing us to make inferences about a test taker’s capacity to use language in the specific purpose domain.
Douglas 2000, p.19

What are Some Problems Associated with Specific Purpose Language Testing?

The first difficulty with specific purpose language testing is determining where specific purpose language ability resides. Briefly, it resides in our brains: language
ability is a cognitive construct which cannot be observed directly, and can only be predicted or inferred, as if trying to determine what is in a black box that produces a certain outcome and ask the question of what is in the black box.

[figure 3]

We can observe the situational, linguistic, and background knowledge content of the input; we can observe the output; we must infer the nature of the language ability that produced the output (Douglas, 2010). We can make inferences about decontextualized language ability, for example Can write a letter using correct spelling, syntax, and punctuation. Here there is no reference to situation or content knowledge. However, in ESP assessment, we wish to make inferences about language ability and specific purpose background knowledge in the target language use context: Can write a letter of referral, including appropriate medical information. This task implies that the test taker will need knowledge of the situation in which a letter of referral is needed as well as the knowledge of what such a letter should contain. We may need to disentangle language and background knowledge in cases of non-experts, such as trainee nurses, for example. The test tasks should reflect the level of technical expertise the learners have at the time of testing.

With regard to the inferences and decisions we might want to make on the basis of ESP test performance, McNamara (1996) has distinguished between a strong and a weak performance hypothesis. If we adopt the strong hypothesis about what we may infer from test performance, we might say something like This nurse will be able to communicate with physicians, other nurses, and patients while working in a Critical Care facility. Note that this inference refers to what the nurse will be able to do without reference to his or her personality, state of anxiety, or level of knowledge. Adopting the weaker hypothesis, however, we might say something like This nurse can use both technical medical English and colloquial English appropriate to the context of working in a Critical Care facility. This inference focuses on language ability in a context of use, though again without reference to personality or knowledge.

McNamara has stated that he preferred the second of the two since it does not require us to deal either with job performance or specific purpose content knowledge, which he saw as unrelated to language ability.

I would suggest a middle ground, however. We, as language teachers and testers, should indeed make inferences about language ability, not job performance, but specific purpose background knowledge is a part of the ESP construct. Therefore, when we make inferences about the level of ESP language knowledge a test taker possesses, we are also inferring some level of specific purpose content knowledge. This is not easy since it requires us to know something about the field of nursing, not just the field of English language, but I think it is part of what it means to be an ESP teacher or tester.


The procedures and approaches discussed in this paper will make the ESP tests we develop and administer less painful for our learners, more relevant and useful for teachers, and more accessible and interpretable for administrators. Less painful because they will help ensure that the tasks and content of ESP tests are based on the needs and expectations of the test takers; more useful because the inferences and decisions based on test performance will be more applicable to teaching and materials design; and more accessible and interpretable because the results will be more clearly related to eventual job performance in vocational contexts.
The language in ESP tests should be directly related to that used in the target situation, and the tasks in ESP tests should be adapted directly from the target situation (e.g. Grove & Brown 2001). Both the language and the tasks in ESP tests should also reflect the English in the specific purpose syllabus and methodology. Thus ESP tests will be more relevant and more motivating for test takers and also make the inferences and decisions we make about learners, based on test performance, more accurate and fair. English tests for specific purposes, like having a blood sample taken, can never be entirely painless – they are, after all, tasks that require learners to put forth their best efforts – but they need not be agonizing for test takers if they are clearly relevant to their needs and expectations and are based on the learning that has taken place prior to the testing. We have an ethical responsibility to make sure the tests we use and develop are as fair, relevant, and accurate as we can make them.

Reprinted with kind permission of Dan Douglas, Professor Emeritus, TESL/Applied Linguistics Program
English Department, Iowa State University.


Since this paper is based on a keynote talk presented at the 2010 ESP International Symposium, in Kaohsiung, Taiwan, focusing on ESP for Nursing, many of the examples will be from the field of nursing. However, I hope the principles I advocate will be applicable to ESP practitioners in all fields and languages for specific purposes.
Readers will note that many of the citations in this paper are more than 10 years old. This is because there has been relatively little research over the years on the topic of assessment in ESP for nursing or other areas of medical English. I have cited the most recent and relevant work in this paper.
Alderson, J. C. & Clapham, C. (1995). Assessing student performance in the ESL classroom. TESOL Quarterly, 29(1), 184-187.
Alderson, J. C. & Urquhart, A. (1985). The effect of students’ academic discipline on their performance on ESP reading tests. Language Testing, 2, 192-204.
Bachman, L. (2004). Statistical Analyses for Language Assessment. Cambridge: Cambridge University Press.
Beare, K. (2011). English for Medical Purposes: Feeling Queasy. Retrieved on January 6, 2011, from
Davies, A. (1990). Principles of Language Testing. Oxford: Blackwell.
Douglas, D. (2000). Assessing Languages for Specific Purposes. Cambridge: Cambridge University Press.
Douglas, D. Forthcoming. Assessment of Academic Language for Specific Purposes. In C. Chapelle (Ed.), The Encyclopedia of Applied Linguistics, Oxford: Wiley-Blackwell.
Douglas, D.(2010). Understanding Language Testing. London: Hodder Education.
Dudley-Evans, T. & St John, M. J. (1998). Developments in ESP: A Multi-disciplinary Approach. Cambridge: Cambridge University Press.
Grove, E. & Brown, A. (2001). Tasks and Criteria in a Test of Oral Communication Skills for First-Year Health Science Students: Where From? Melbourne Papers in Language Testing, 10(1), 37-47.
Hutchinson, T., & Waters, A. (1987). English for Specific Purposes: A learning-centered approach. Cambridge: Cambridge University Press.
In’nami, Y. (2006). The effects of test anxiety on listening test performance. System, 34(3), 317-340.
Long, M. (2005). Second Language Needs Analysis. Cambridge: Cambridge University Press.
McNamara, T. (1996). Measuring Second Language Performance. London: Longman.
Nursing Guide. (2010). Retrieved on January 6, 2011, from archive-8/Nursing_Specializations.html
OET Writing Subtest. (2009). Retrieved on January 6, 2010, from doc/22275773/General-Information
O’Neill, T.R., Buckendahl, C.W., Plake, B.S., and Taylor, L. (2007). Recommending a Nursing-Specific Passing Standard for the IELTS Examination. Language Assessment Quarterly, 4(4), 295-317.
Read, J. and Wette, R. (2009). Achieving English Proficiency for Professional Registration: The Experience Of Overseas-qualified Health Professionals in the New Zealand Context, in Osborne, J. (ed.), IELTS Research Reports, Volume 10. IELTS Australia, Canberra.
Robinson, P. (1991). ESP Today. New York: Prentice-Hall.
Shahady, E. (2008). Three to five minute discussion – patient with obesity. Retrieved on January 6, 2011, from
Shohamy, E. (2007). The power of English language tests, the power of the English language and the role of ELT. In J. Cummins & C. Davison (Eds.), International Handbook of English Language Teaching (pp. 522-531). New York: Springer.
Strevens, P. (1988). ESP after twenty years: A reappraisal. In M. Tickoo (Ed.), ESP: State of the Art (pp. 1-13). Singapore: SEAMEO Regional Language Centre.
Widdowson, H. (1979). Explorations in Applied Linguistics. Oxford: Oxford University Press.
World English. (2004). Retrieved on January 6, 2011, from
Corresponding author. Address: TESL/Applied Linguistics Program, English Department, Iowa State University, U.S.A.

English in the Medical Laboratory was first published in 1980. An oldy but a goody. It’s out of print but as I write this, two second hand copies are for sale on a well-known large online site…

Anyway, what a great little book this. The aim is to ‘enable students to respond more effectively to written instructions and to write their own reports more clearly and precisely’. My students don’t need to write reports in English but they certainly need to understand instructions in the form of lab protocols and test kit instructions. New apparatus with English instructions also need to be understood. When you’re a biomedical analyst there is no room for approximation and all instructions must be understood with 100% accuracy. Understanding Instructions are far more important than naming apparatus.

I use this book with my 1st year students. Most have no experience of lab work and won’t begin in the labs until their 2nd year. I pick what is relevant, rewrite it if necessary and link to authentic test kit and lab instructions.

The book is a fine example of ESP teaching material which works a treat when adaptations are made for relevancy and currency.

Stephen Nickless considers the value of business cultural training within the context of patient communications in London.

London’s ‘multi-everything’ diversity can be overwhelming. Some incoming health professionals will have trained in ‘monocultural’ regional centres and rural areas where almost everyone looked the same, dressed the same, spoke the same language and worshipped the same god. They may have had very limited interaction with members of other social groups or with non-family members of the opposite sex. They may have little or no experience of communicating across cultural boundaries. What should healthcare employers do to help?

My most recent experience of ‘culture shock’ was during a course on cultural training in a business context. I had not realized how different business culture was from the values, attitudes and behaviours the ‘professional culture’ that I had internalized during my medical training and my years in general practice in London.

The course was not as useful as I had hoped. It did not deliver the new insights into cross-cultural communication that I wanted for my work with refugee doctors. Instead the teaching focused on business executives making short trips to negotiate contracts or manage overseas projects. The assumption was that they would be engaging with their peer-groups in mainly mono-cultural settings.

The big names in cultural training – Hall, Lewis, Hofstede and Mole – have described, measured and compared various dimensions of national cultures. Such ‘generalizations’ may be an improvement on the ‘Völkertafel stereotypes’1 used in the past, but they draw on limited and idiosyncratic data. Some terms they use, like power distance, sound objective but others, masculinity, indulgence, reference challengeable cultural assumptions.

The cultural training approach does provide useful concepts for talking about culture and frameworks for making comparisons. These can help doctors working in multinational teams to notice and adapt to differences in the way their colleagues organize themselves, present information, handle conflict and negotiate solutions.

My issue with this approach, however, is that it concentrates on behaviors. It does not attend to the underlying (unconscious) perceptual, emotional and cognitive processes that give rise to them. In this article I argue that interacting with patients is deeply relational as well as informational and transactional. It demands a different range of communication skills informed by a broader and deeper and awareness of culture. Such thinking needs to be informed by ideas about human evolution2, anthropology and child socialization.

Paleontologists tell us that our human ancestors could ‘do culture’ before they could ‘do language’. Successful human groups evolved cultures of cooperation, mutuality and compassion3. It was the need to make common meaning, to communicate it and to transmit it within groups and across generations that drove the development of language.

Each of us acquires our first language – our ‘mother tongue’ – and our first culture from our primary caregivers. We do this by watching, listening, copying, experimenting and responding to the reactions of others. We gradually adapt and conform until we fit in.

We develop our sense of self through our interactions with others4. Anthropologists have noticed that how closely babies are held, how they are comforted, how independent they are encouraged to be varies from culture to culture. This early unconscious programming of children is very powerful and persistent. It meshes with the kinds of behavior that their society will expect of them as adults5.

There are many ways of making sense of disease, insanity and death. Doctors do need some awareness of medical anthropology6 plus the curiosity and confidence to ask their patients very simple questions. ‘What do you think is wrong with you?’ ‘What effect is it having on your life?’ ‘Why do you think it happened?’ ‘How do you expect it to be managed?’ ‘Would you like to know what I think may help?’

Health professionals in ‘world cities’ like London care for people of all ages, genders, sexual orientations, educational levels and social classes. Hospitals serve large and diverse populations containing many different cultural groups – multi-cultures rather than mono-cultures. In the London district of Newham, for example, 72% of patients are from black or minority ethnic backgrounds and over 200 languages are spoken. Hospital staff cannot know everything about every culture. They simply need the kind of general cultural awareness that I describe above.

Detailed knowledge of a specific cultural group is more useful in primary care. Some districts are home to significant concentrations of one or two minority communities. Here doctors – and teachers, social workers and police – need a deeper understanding of their biggest minority cultures.

Doctors regularly discuss culturally sensitive issues – alcohol, sex and narcotics – with their patients. Culture also shapes attitudes to contraception, abortion and end of life care. Difficult conversations require good interpersonal skills and a sophisticated linguistic resource of appropriate emotional tone and register.

Years ago I encountered a wild horse near an abandoned village in Canada. Over ten minutes I moved slowly closer – maintaining eye contact, watching its reactions carefully, reading its state of fear or aggression, pausing if it seemed alarmed, and making reassuring noises. We finally made contact – nuzzles and apples were exchanged. I recognized that I was in the same state of heightened awareness that I enter during a difficult consultation – perhaps with a psychotic patient or a distressed child. Communication in those situations – and with ‘aliens’ from another culture – is challenging. Doctors need to be able ‘connect’ with patients at a human level. Patients need to feel safe and respected. People seem to recognize in an almost instinctive way whether they can trust someone with their anxiety, shame and need for advice and reassurance. This happens despite our cultural difference and because of our common humanity. In the same way that ELF speakers accommodate to each other in their use of English (tolerating variations in grammar, lexis and pronunciation) people tune-in to each other culturally. They modify their style and tolerate faux-pas which would be offensive if committed by someone who should know their rules. Good enough communication is more important.

Dr Stephen NicklessDr Stephen Nickless practiced as a General Practitioner in a linguistically diverse community in London. He now facilitates weekly educational sessions for refugee doctors preparing to work in the NHS.






2 C. Gamble et al., Thinking Big. How the evolution of social life shaped the human mind. (2014)

3 P. Spikins, How Compassion Made Us Human. (2005)



6 C. Helman, Culture, Health and Illness. (1990)

Getting to grips with life in the UK for refugee doctors often entails going back into the classroom. Louise Lemoine, a retired medical professional, explains how switching to preparing the OET has given her classes an unexpected boost.

Refugee Doctors and the Impact on OETI had sat in this room at the Refugee Council with my students on so many occasions over the past three years, but this Tuesday morning in May was different. More refugee doctors than ever were present, and I had never seen them so engaged in the lesson. I had just read out the OET role play card and, when I looked up, every eye was upon me, arms and elbows on the table, bodies leaning eagerly forward. Three months earlier, the General Medical Council (GMC) had decided to accept the Occupational English Test (OET) as proof of a doctor’s language skills. If I had needed more confirmation of the difference that decision was making, this moment said it all.

I am a medical doctor with experience in clinical medicine, clinical and laboratory-based research and as an assistant editor for a medical journal. I have always been fascinated by language and different cultures. Latin was a favourite subject at school and I speak Spanish, some French, German and Portuguese. In 2015 I made the decision to embark upon a new career as a teacher of English for medical professionals, specifically refugee doctors. Having gained a CELTA qualification, I set about achieving my aim.

After doing some research, I discovered the Refugee Council’s inspirational Building Bridges Programme based in Stratford, East London. This programme supports refugee healthcare professionals to re-qualify to UK standards and find suitable employment. It is an NHS funded partnership between The Refugee Council (the lead partner), Glowing Results (an English language school), RAGU (London Metropolitan University’s Refugee Assessment and Guidance Unit) and several hospitals and GP practices. To work in the UK, the GMC requirement is that doctors must first demonstrate necessary English language skills by passing a test. When I encountered the project, this test was IELTs and refugees received help though the language school, Glowing Results. Then the GMC requires doctors to demonstrate appropriate medical skills and knowledge by passing the Professional and Linguistic Assessments Board test, known as the PLAB. As its name implies this test has an important linguistic component. Volunteer doctors run classes to help refugee doctors to refresh their medical knowledge and skills before taking this test. As part of the programme, the Refugee Council organises clinical attachments through a clinical apprenticeship scheme, helping doctors to access their first NHS post, and RAGU offers careers advice and guidance.

After meeting with Fahira, the project manager for the programme, I began mentoring doctors who were attending preparation classes for IELTs and PLAB. Each week I selected one of the many free interesting places to visit in London. Some examples include the National Gallery, the Victoria and Albert Museum, The Wellcome Collection, the Hunterian Museum. We called this, ‘Learning English and Getting to know London’. It was an excellent opportunity for doctors to practise English outside of the classroom with natural English speakers, to become familiar with different English accents and dialects and to learn and put into practice lexis and functional language relevant to everyday life in the UK.

I also helped at some ‘Preparation for PLAB’ classes. It had taken most of the doctors in these classes many attempts over several years to achieve the required result in IELTS.

It was glaringly apparent that IELTS was the major barrier to their goal of working in the NHS. So much time spent trying to gain IELTS is soul-destroying, especially given the hardship they have already experienced; forced to flee their country because of persecution, war or violence. How could I help? I set about familiarising myself with IELTS. The Refugee Council ran a ‘pre-IELTS’ class which was set up for new refugees and those who were not yet at the required standard to join the Glowing Results IELTS class. I taught alongside Tony Cleary, a retired history teacher. Three years later I am still there, which brings me back to my opening paragraph. Due to the students’ strongly positive response to OET, we now focus on this exam and no longer teach IELTS.

Both IELTS and OET are tests of English language proficiency, but OET places language in a medical context which is familiar to our doctors, allowing them to relax and do well. The sooner refugee doctors get back to using their medical skills, the better it is for their self-esteem and the better it is for our under-staffed NHS. Months, often years, spent attempting IELTS without practising their skills is detrimental. It is early days, but there is already strong evidence that OET is having a positive impact. The Building Bridges partnership supports around 85-100 doctors a year. On average, 7 doctors per annum reached the required IELTS score taking two to three years each. In marked contrast, 16 doctors had achieved the required result in OET within the first six months of its introduction.
The lexis, functional language and communication skills necessary for the OET provide excellent preparation for a medical career in the UK. OET is a bridge between a test of proficiency in English and PLAB. Indeed, because the language and communication skills required for the speaking and writing components of OET are the same as those required for PLAB, volunteer medical professionals at the Refugee Council who prepare refugee doctors for PLAB are now assisting in OET preparation classes.

The doctors attending our class are daring to look towards the future. As one young Sudanese doctor put it, “When I was studying for IELTS, I woke each morning and I felt as if I was walking further away from my career. Now that I am studying for OET, I am walking towards my career. I feel like a doctor again.”
I have never felt so enthusiastic as a teacher. After the rigours of the IELTS test, the medical OET exam is giving refugee doctors well-deserved hope.

Louise LemoineDr Louise Lemoine works with refugee doctors as a mentor and teacher of medical English. She is a retired medical practitioner with a CELTA qualification and experience in clinical medicine, research and medical journalism.

As part of our series into trainer experience of the OET, one of EALTHY’s newest members, Alecia Banfield shares her thoughts and advice. Alecia comes from a fairly unique position. Not only is she a medical professional, she is also one of the few officially accredited OET trainers.

New playing field

The OET was developed from 30 years of research and expert insights, but is still largely from one world region – Australia and the Pacific. Now its introduction into the UK and a more global audience means more eyes on its appropriateness to global settings. Will it, for example, be equally adequate for a rural Caribbean healthcare professional and a top London city NHS Trust doctor?

Keeping it real

As a medical and public health doctor who has worked in hospital and ambulant care, and health initiative implementation, I am familiar with the demands of communication on the job. Learning a couple of foreign languages and being a TEFL/TESOL teacher for the last five years has offered insight into the issues of adult second-language learning in English for Specific Purposes, and OET no less.

OET 2.0 listening, reading and speaking reflect the clinical and non-clinical activities professionals really confront. Beyond strong lexis and grammar, there is also strong reflection of the communicative criteria in the International Patient Safety Goals. This is good. Scenarios are focused on patient’s needs, and inter-professional interactions echo team patient care, handovers, use of technology and continuing medical education. The need for ‘soft skills’ is explicit, such as eliciting and offering information in a sensitive but informed and professional manner, since candidates are looking to work in English-speaking environments where professional-patient relationships open lines of communication that directly impact health outcome.

No shortcut to success

The OET recognizes that candidates don’t just need good test-taking skills, but must promote best practice patient care long after the test is done. And let’s face it, no institution wants lawsuit-liability, not least because staff don’t understand which instrument to ask for, that the patient had a violent reaction to something in the past, or that the notice about needing Advanced CPR Training within the last two years means that you, who did it three years ago, need to go and do the course again!

Implications for the candidate are clear: time spent looking for short cuts to pass the test would be better spent developing real facility in English by engaging with a wide range of medical and non-medical materials and activities. And yes, candidates still need proper test-skills preparation to improve chances of success.

Step by step

For listening, immediate understanding of the audio’s context and which direction it is likely to go helps candidates pre-empt what is coming up and more quickly hone in on key information. It’s a neurological quirk of the forebrain that helps us make connections and react faster. Pertinently, it aids the candidate in honing in on answers while keeping up with an audio. For example, their expectation in an interview about a recent back injury would differ from that for a second surgery for a prolapsed disc, and they would listen for different language. Practicing pre-empting might be of greater benefit than learning specific word associations in a sample test.

In the reading, the shift in contexts and timing do not allow for a second to be wasted when answering questions, far less for figuring out what a word or phrase means. Instant familiarity and comfort with English is needed. Once that is achieved, skimming and scanning become beneficial techniques to find answers quickly.

Speaking targets how the professional relates to patients, and the semantics of things like inference. Some candidates are slow to speak, so starting with a warm-up unrelated to healthcare—a hobby or their favorite wines—seems to shake up non-healthcare nerve connections which then get the healthcare ones going, too. A fun speaking task (emphasis on ‘fun’) the night or morning before the test might help them get into ‘English gear’. Exposure to a range of healthcare situations builds awareness of differing language needed with different patients.

Some candidates are overly confident and run headlong into mistakes they don’t expect, like basic grammar and word choice. I have two words for these candidates: homework assignments. An invaluable tool I found for everyone is having them listen to recordings of themselves reading texts aloud and doing role plays. Even the most bashful student soon starts identifying errors or issues, and wanting to repeat the exercise to do better next time!

Writing remains the ‘stone age’ vestige in OET. Inarguably, it shows level of grammar, vocabulary and idiom, and tests reading and comprehension. But who writes referral letters by hand anymore? Not even me back when I was practicing. More usually, there is a standard format for dropping in information, and the onus is on the recipient to pick out what is relevant to them and/or get the highlights word-of-mouth from the patient. Modern doctors write patient notes and procedural summaries; modern nurses and therapists write care plans and complete computerized records. I look forward to the proposed changes to the writing test.

We must deal with the current incarnation, however, and I spend significant time on time-planning to help candidates avoid overwriting, underwriting or (horror!) writing the same thing twice. They either think that there isn’t enough time to finish the letter, or that they have plenty of time to rewrite if their first attempt looks shoddy. With discerning reading, highlighting and putting important points in order, padding around with relevant language, and then writing, it is possible to produce a polished product with time left to proofread.

So what about the ‘others’?

There is great ado about OET courses targeting the candidates at English B2+/C1 on the Common European Framework of Languages. But what about prospective candidates at A2, B1 or B2- the hopes-and-dreamers? Do they simply go away and come back when they somehow get their language up to scratch? Would they know that a different approach might be needed depending on their language level? Do they on their own even know how to reach B2+/C1?
Language communication is about conditioning the brain to integrate and reproduce four separate skills in real time. It is about refashioning physical neural pathways to fire in new patterns starkly different from the native language. Adult third- or fifth-language learners likely have mature techniques for foreign language learning, but second language learners might not understand this is different from absorbing facts, where to find helpful tools, or how to map their progress as they learn. This last point can itself be quite motivating for learning. At some point, the spotlight must also turn on these ‘Others’.

Alecia BanfieldAlecia Banfield has a Bachelor of Medicine and Surgery, a Master in Public Health, and is a certified TEFL/TESOL teacher. From Barbados, she lives in Germany, and also speaks German and Spanish. Alicia is founder of Banfield’s Professional Medical English.

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)

You are the author of the Academic Word List (AWL) (though it may come as some surprise to our members that the AWL was your MA thesis!) How did the idea for the AWL come about?

There is a bit of a story about this thesis and I wrote about it in the introduction to my new book on vocabulary and English for Specific Purposes (Coxhead, 2018). The idea for the AWL came from sitting in post-graduate classroom on language testing in Wellington, Aotearoa/New Zealand in 1994. Professor John Read (University of Auckland) was lecturing on testing and vocabulary and mentioned the University Word List (UWL) which had been developed by Xue and Nation (1984) needed revising. He said that it would be a good research project. I talked to Professor Paul Nation (Victoria University of Wellington) about the possibility of doing this research project and he gave me articles to read as background for the study. I also talked with Jim Dickie (Victoria University of Wellington), another lecturer in the department, about doing a research project for my MA. He looked me in the eye and said something like, “You know what works, but you don’t know why”. I was also involved in teaching English for Academic Purposes (EAP) at the time, and it seemed to me that research on academic vocabulary would be really useful for language teachers and learners. I now always mention possible research projects in MA classes when I can, because you never know what those suggestions might spark.

The Academic Spoken Word List (ASWL) (Dang, Coxhead, & Webb, 2017) may be new to our members. Can you tell us a little more about this?

The ASWL is a new word list which was developed from a large-scale study of academic spoken texts. Yen Dang developed and evaluated this list as part of her excellent PhD research here at Victoria University of Wellington. There are 1,741 words in this list, and students are likely to come across them in many academic disciplines and in lectures and other academic speaking events. A key feature of the list is that it is designed for learners with different levels of proficiency. This list is important for many reasons, but one of the most important ones from my point of view is that most research up till now has been carried out on written academic texts, for example, the AWL and Gardener & Davies (2014) Academic Vocabulary List.

What do you see as the areas of particular interest in ESP vocabulary research today?

There is plenty going on in terms of research into medical vocabulary and medical communication. There’s a new word list for nursing (Yang, 2015) and there are several medical word lists (e.g. Liu & Lei, 2016). Cailing Lu, one of my current PhD students, is doing some fascinating research on Traditional Chinese Medicine. Amongst other things, she has identified technical vocabulary, for example, based on its language of origin (e.g. qi, yin, yang), everyday words in English with particular meanings in Chinese Medicine (wind, hot), and has identified multi-word units as well. Betsy Quero (Quero & Coxhead, 2018) and I looked into high frequency vocabulary in medical English, because these words are particularly important learners who are reading medical textbooks in English. Medical communication is fascinating too. In my 2018 book I discuss research into testing medical vocabulary, communication between patients and medical staff, and lexical items which are key to medical studies such as proper nouns, for example, Parkinson’s. Medical vocabulary is a great area of research and it is very important.

You’ve made much use of corpora in your research career and have recently written an article with Betsy Quero on using a corpus based approach to select medical vocabulary for an EMP course. Should all ESP teachers, including EMP teachers, be familiar with corpus-based techniques?

When I think about corpora and corpus-based techniques, I feel that the most important thing is that teachers need to know what a corpus is, first of all. I didn’t know about corpora when I first started teaching. I would have liked to have known about ideas such as frequency in vocabulary and how corpora can tell us about that back then. I also think it is important that when teachers are reading research (e.g on word lists), they can figure out how a corpus-based study has been done so that they can see the strengths and weaknesses of the approach and the robustness of the findings.

Recently, I’ve been involved in doing research on technical vocabulary in the trades (see Coxhead, 2018) and in the translation of technical word lists in the trades into Tongan (Coxhead, Parkinson & (2017). Without corpora, and without people to analyse and make sense of the data from the corpora, these projects would not be possible.

You were once an EFL teacher. How has that experience coloured or informed your research career?

Every day in my job, I call on the experience I gained teaching English as a Foreign Language in places like Romania, Hungary and Estonia in my teaching at undergraduate and postgraduate level. I also think about and treasure the friendships and my own language learning journeys from those times. Lucky, lucky me.

Averil Coxhead is an Associate Professor in Applied Linguistics at the University of Wellington in Victoria, New Zealand. She is the author of the Academic Word List, one of the most useful language resources developed for university studies. She teaches courses on second language learning in the BEdTESOL and the MA in Applied Linguistics/TESOL programs. Averil has taught in New Zealand, England, Estonia, Hungary and Romania. Her current research includes specialised vocabulary in the trades, at university and secondary school.



Coxhead, A. (2018). Vocabulary and English for Specific Purposes research: Quantitative and qualitative perspectives. London: Routledge.

Coxhead, A. Dang, Y. & Mukai, S. (2017). University Tutorials and Laboratories: Corpora, textbooks and vocabulary. English for Academic Purposes. 30, 66–78

Coxhead, A., Parkinson, J. & Tu’amoheloa, F. (2017). Using Talanoa to Develop Bilingual Word Lists of Technical Vocabulary in the Trades. First view:

Dang, Y., Coxhead, A. & S. Webb. (2017). The Academic Spoken Word List. Language Learning 67(3), 959–997.

Gardner, D. & Davies, M. (2014) A New Academic Vocabulary List. Applied Linguistics, 35(3), 305–327.

Greene, J. & Coxhead, A. (2015). Academic Vocabulary for Middle School Students: Research-based lists and strategies for key content areas. Baltimore: Brookes.

Lei, L. & Liu, D. (2016). A New Medical Academic Word List: A corpus-based study with enhanced methodology. Journal of English for Academic Purposes, 22, 42–53.

Nation, I. S. P. (2016). Making and Using word Lists for Language Learning and Testing. Amsterdam: John Benjamins.

Quero, B. & Coxhead, A. (2018). Using a Corpus-based Approach to Select Medical Vocabulary for an ESP Course: The case for high-frequency vocabulary. In Yasemin Kirkgöz & Kenan Dikilitaş (Eds.). Key issues in English for Specific Purposes in higher education, pp. 51–75. New York: Springer.

Xue, G. and Nation, I.S.P. (1984). A University Word List. Language Learning and Communication 3(2), 215–229.

Yang, M-N. (2015). A Nursing Academic Word List. English for Specific Purposes, 37, 27–38.

Q: Who are you, what do you do and how long have you done it?

I am Eugenia Dal Fovo, conference and healthcare interpreter (language combination: IT, EN, DE). I have an MA degree in conference interpreting and a Ph.D. in Interpreting and Translation Studies. I live in Trieste (Italy) and have been working here as freelance interpreter for almost 9 years. In 2012 I started working as healthcare interpreter for a local association of cultural mediators (Associazione INTERETHNOS Onlus ( and two years ago I started teaching consecutive and dialogue interpreting as adjunct professor at the Universities of Trieste and Macerata (Italy), both at BA and MA level. When I am not working or lecturing I take care of my research: I am a published author within the field of Interpreting studies, specialising in TV interpreting and healthcare interpreting.

Q: As a medical interpreter, what exactly do you do?

The profession of “medical interpreter” in Italy is not recognised – let alone regulated – at national level. Norms and codes of conduct have been developed at regional level, mostly with the aim of addressing issues that are strictly relevant to the local environment. The job is rarely assigned to individuals with a degree in interpreting: medical interpreters are rather known as “cultural mediators”, a very broad label, usually indicating individuals with a migration history who have elected Italy as their country of residence. In the years I have been working as medical interpreter, I have found myself dealing with very diverse situations: the job is on call, and assignments may be urgent (e.g. a foreign patient at the E.R.) or planned in advance (e.g. a check-up ultrasound scheduled two months before the due date of a pregnancy); medical interpreters working for the Association are available to public healthcare institutions in the province of Trieste exclusively and assist any sort of foreign-speaking person (e.g. tourist, legal or illegal migrant, non-Italian-speaking citizens…).

Q: If you lecture and no-longer interpret, how did that come about?

I did not stop working as a freelance interpreter when I started lecturing, for two main reasons: one is (sadly) money-related, as my salary as University lecturer only covers a small percentage of my expenses; the second reason is based on my firm conviction that no one can teach a profession without working in the field – in other words, I feel it would be hypocritical of me to teach interpreting without being an interpreter in my everyday life.

Q: How did you become interested in medical interpreting?

It all started by chance: a good friend and former University colleague of mine was already working as medical interpreter for the Association I mentioned. One day her German-speaking colleague was not in Trieste and the hospital needed a German-speaking interpreter urgently. So my friend called me, I said yes, and that is how I started.

Q: What is your educational background?

I have a BA degree in Translation and Interpreting, an MA degree in Conference Interpreting and a Ph.D. in Interpreting and Translation Studies.

Q: What languages do you speak?

I am a native Italian speaker, my working languages are English and German.

Q: What qualifications are needed to become a medicalinterpreter?

In Italy? Absolutely none. My colleague and I are the only medical interpreters in the association with an MA degree in interpreting.

Q: What skills are needed to do medical interpreting (over and above language skills)

Let me start by stressing once again the fact that there is currently no official legislation regulating the profession in Italy, and it is therefore difficult to name a set of skills and competencies without being subjective, i.e. referring to one’s own personal experience. As far as I am concerned, possibly the most important pre-requisite for a medical interpreter (and for any interpreter, for that matter) is awareness of one’s responsibility of communication facilitator, namely being the link through which understanding between interlocutors is -ideally- reached. Such awareness should therefore guide medical interpreters’ every action and choice. Secondly, a good medical interpreter is aware of the identities, roles, goals and tasks associated with the institution s/he is working for, i.e. the healthcare institutions (e.g. hospital, clinic, retirement home, family-counselling unit, etc.). Let me give you an example of goal(s) by breaking down the communication process: doctors and patients in interaction share a primary goal, namely that of curing the patient; in order to do so, the doctor will pursue the sub-goal of obtaining enough relevant pieces of information to formulate a diagnosis and the relevant therapy, while the patient will pursue the sub-goal of providing said pieces of information – and, subsequently, understanding the doctor’s indications correctly – in order to be cured. So the translational choices made by the interpreter should, at this level, adhere to this subset of goals. When further circumscribing the field, one of the principles of healthcare ethics is that doctors may only put forward a suitable course of action to cure a patient; the latter, however, has always the right to choose whether to accept such course of action or not. Linguistically speaking, healthcare interpreters should always bear this in mind when choosing the wording of their translational turns.

Q: What language pairs are particularly useful in your region?

As you may imagine, usefulness of languages heavily depends on social, historic, geographical, political and ethnographical factors. The Friuli-Venezia Giulia region lies right on the border with Slovenia, and, more generally, the Balkans. Slavic languages, therefore, have always been a priority. To the North, the region borders with Austria, while its southern shore faces the Adriatic Sea, making the area a very popular destination for German-speaking tourists. Like in many other Italian cities, in Trieste too lives a large community of Chinese migrants. Furthermore, the current geo-political situation has determined a massive flow of migrants coming from Northern Africa and Nigeria, on one hand, and the Middle East, mainly Syria, on the other. Finally, the city of Trieste hosts the International School for Advanced Studies (SISSA), which attracts dozens of international scholars (and their families) from all over the world, and whose internal working language is English.

Q: What are some of the challenges associated with medical interpreting?

Do not even get me started… 😉 I should say that challenges associated with this profession are very diverse in nature, ranging from purely technical and language-related difficulties, to ethical, emotional, and moral issues. Technical difficulties refer to logistics, for instance: healthcare institutions are scattered throughout Trieste, so one might find oneself assisting a patient in the main hospital and then having to rush to the opposite side of town to assist another at the family-counselling unit. Travelling expenses are not covered either by the Association or by the local healthcare agency, so most of us rely on public transport to move around, as it is the cheapest way of reaching one’s destination within the urban area – but also the slowest, more often than not, and this may result in delays in the service, especially in the case of urgent assignments. Language-related challenges have not much to do with medical terminology, but a lot to do with accents, dialects, and idioms (e.g. Nigerian patients speaking pidgin English, illiterate patients, …). Ethical, emotional and moral issues largely concern one’s self-imposed boundaries: when you find yourself assisting a Nigerian woman in need of a simple gynaecological visit, and while waiting for the doctor you find out that she is a single mother, her asylum application has been rejected, and, with nowhere to go, she’s planning to leave Trieste that very night with her baby daughter with nothing but her purse and pram, to board the first train to Naples, where, as some guy at the shelter told her, she can work as a prostitute with no need of documents, where do you draw the line?

Q: What are the hours?

According to the convention regulating the cooperation between the local healthcare service and the Association, interpreters are available Monday to Friday, from 8 a.m. to 8 p.m., and on Saturdays from 8 a.m. to 2 p.m. Healthcare operators, however, may call the Association 24/7 and, in case of emergencies, remote interpreting is provided. Despite such official arrangements, it is not infrequent that interpreters work late at night or during the weekend, especially in the E.R. (e.g. when a patient is admitted at 7 p.m. and is only treated at 10 p.m., or has to wait for test results, etc.).

Q: What about the money?

Interpreters are paid by the hour and are paid very little. To give you an idea, let me tell you that, in order to reach the minimum wage of € 1,000 per month, each interpreter should work at least 50 hours every month, which is hardly the case, given the fact that there are at least two interpreters for every language combination, for a total of 62 individuals working in the city of Trieste exclusively – with a number of foreign citizens that amounts to the 9.34% of the total inhabitants (ca. 200,000).

Q: Where could interested people go for more information?

People interested in knowing more about healthcare interpreting in general may find a lot of information on the official websites of the AUSIT (National association for the translating and interpreting profession). In order to know more about the situation I have been depicting so far, anyone is very welcome to contact me personally via email (please, contact the EALTHY Association to receive my contact information).

In English in Medical Education: An intercultural approach to teaching language and values, the authors take a fresh and very contemporary look at the topic of language education in medicine, examining the importance of cross-cultural competence in both language and medical training and discussing the methodological shift towards ‘task-based’ language learning and “problem based” medical training. This is a highly readable, thought-provoking book which any EMP teacher will find useful.

There are nine chapters in the volume covering a variety of themes including an exploration of intercultural communicative competence training and critical cultural awareness in education; a focus on the language of medical communication and professional-patient exchanges; a practical look at the analysis of language and the use of corpora; the use of literature and visual arts in medical education, and a chapter on task design and course design. Each chapter is both theoretical and practical, offering both the ELT/ESP practitioner and the medical trainer food for thought. Chapters contain ‘Activity’ box-outs which encourage the reader to reflect on their own professional situation.

The book is aimed at a large group that, at one end, includes seasoned language specialists without any medical background and, at the other, medical practitioners with little experience or knowledge of language analysis or presentation. This could be its downfall, but the volume is well-balanced between the theoretical and the practical and is supported by current and well-respected research drawn from a range of fields. Lu and Corbett do not shy away from acknowledging controversy or shortcomings — their warning that much television medical drama may not be as useful as other learning resources I welcome.

There are many books concerned with intercultural communication and education currently in print that, in reality, contain little that might be said to be practical or teacher-friendly. Lu and Corbett don’t forget the classroom, the student or the teacher, and they offer a good range of task ideas and activity box-outs that are appropriate for group work or training sessions. Sometimes, however, the brief overview such a book demands results in a rather sketchy summary: the chapter on task based learning is overly simplified, as Lu and Corbett acknowledge, while chapter 5 attempts to cover a vast number of complex areas under the heading ‘Medical Talk’ and is the least cohesive in the book.

These small issues aside, the book is nonetheless very well-written and certain to be of great interest to English teachers working in the medical and healthcare field.


Q: Who are you, what do you do and how long have you done it?

My name is Susan Bosher and I am a Professor in the English Department at St. Catherine University in St. Paul, Minnesota, USA.  I have been working at St. Catherine since 1997 and in the area of English for Nursing since 1999.

Q: As an ESP researcher, what exactly do you do?

As a Professor of English and Director of ESL, I primarily teach a variety of courses, including writing and immigrant literature courses for non-native speakers of English; language studies courses, including a TESL course; and courses on immigration and the immigrant experience.  My work as an ESP researcher in the area of English for Nursing developed from the needs of immigrant students at my university and was initially funded by a grant from the federal government.  I have also worked in the area of linguistic modification, reducing the linguistic complexity of multiple-choice test items for a major test developer to increase their readability for non-native speakers of English.  In addition, I have consulted with nursing departments on topics related to ESL students in nursing, most notably, reducing linguistic bias on multiple-choice tests and responding effectively to ESL student writing.  Most recently I have been working on materials development for an online nursing education program in East Africa.

Q: How did you become an ESP researcher?

From 1999-2002, I worked on a 3-year grant at my university from the U.S. Department of Health and Human Services (DHHS) to recruit and retain multicultural and other underrepresented groups in nursing.  In connection with that grant, I conducted a needs analysis of immigrant and international students in the baccalaureate-degree nursing program; developed materials and taught courses on English for Cross-Cultural Nursing; and conducted several research studies on the effects of linguistic modification on ESL students’ comprehension of and performance on multiple-choice nursing course exams.

I have also conducted needs analyses, developed materials, and taught courses in English for Library Workers and English for Eco-tourism.

Q: What is your background? Do you have a medical background?

My background is in applied linguistics.  I have an M.A. in TESOL from Teachers College, Columbia University and a PhD in Curriculum and Instruction from the University of Minnesota, with emphasis on second languages and cultures education, linguistics, and composition and communication.  I do not have a medical background per se, but for the three years I worked on the DHHS grant, I attended nursing lectures, labs, and clinicals to learn all I could about nursing and the language-related skills and tasks that nursing students must be able to perform successfully in the nursing program and in the clinical setting.  In addition, I have collaborated with nurse educators on a number of projects, including an anthology of essays on creating a more culturally inclusive environment in nursing education and two textbooks for ESL nursing students, one focusing on academic skills and the other on communication skills in the clinical setting.

Q: What qualifications, if any, are needed to become a language researcher?

In my opinion, it is necessary to have graduate-level education in applied linguistics, including second-language acquisition, best practices in language teaching, discourse analysis, and materials development.

Q: What skills are needed to be a good researcher?

A researcher needs to ask the right questions to discern the key issues related to a topic.  The researcher also needs to know how to access resources and learn as much as possible about the topic; how to design a study or conduct a needs analysis, the results of which can be used to determine the best course of action; how to design a program or curriculum and develop materials and other resources to meet the needs of students and other stakeholders; and how to evaluate the success of the project from multiple perspectives.  The researcher must also be a good communicator, not only to access resources about the topic, but also to disseminate the findings and ensure the sustainability of the project after the researcher’s work is done.

Q: What are some of high points of your career to date?

I love the consulting work I do, as I am interacting with people outside my area of expertise, who can benefit the most from presentations about acquiring academic literacy in a second language and the linguistic and cultural challenges that immigrant students face in higher education.  At the same time, nurse educators are a challenging audience because they have to worry about patient safety and professional standards.  There is often a real give-and-take at these presentations as they bring a healthy scepticism to the table, but at the same time, they recognize the importance of creating a more culturally and linguistically diverse nursing profession and really want to bring out structural changes even if they are not sure how.

Another highlight of my career has been the books that I have worked on.  Each one has been a tremendous amount of work that has taken several years to complete, but the feeling of accomplishment in the end has been worth it.  One of the books, an anthology on creating a more culturally inclusive environment in nursing education, which I co-edited with a nursing colleague, won an award for faculty excellence at my university, which was also very rewarding.

Q: What are some of the challenges associated with your job?

As my work is primarily as a Professor at my university, my challenge has been finding the time to do the project-based ESP work that I so enjoy.  When I have worked on federal grants (from 1999-2002 for the work in English for Nursing and 2004-2009 for English for Library Workers), I have received course releases to do the research and materials/course development.  But, usually these projects have been in addition to my full-time job.

Q: What are the hours?

The hours are in addition to my regular responsibilities of teaching and service to the University except when working on federal grants, as mentioned above.  However, I have been able to count the ESP research that I have done toward the expectations for research and publication at my university.

Q: What about the money?

There is no additional compensation in connection with federal grants; indeed, academics are obligated to take course release(s) when they are working on a federally funded project so as not to exceed their regular work load.  However, because my research benefits the students and faculty at my university, I have also received internal grants in more recent years to conduct research studies, develop materials, and work on book projects.  These grants mostly pay for expenses incurred in connection with the project but they can also include a small stipend for faculty.   In addition, I am able to arrange consulting fees individually with universities and other organizations.

Q: Where could interested people go for more information?

Professional organizations, such as TESOL and IATEFL that have an ESP Special Interest section, are an excellent source of information.   Conferences that focus on ESP or on a particular area of ESP, such as English for Medical Purposes, are another highly effective way to learn more about the field and to meet people who have done work in ESP.  Several excellent books have been published in recent years that explain how to conduct a needs analysis and develop materials in ESP, and the journal English for Specific Purposes provides examples of research studies and curriculum development projects that have made substantial contributions to the field.  Finally, there is a Medical ESP list-serv that disseminates information about conferences and publications of interest; it is also possible to ask for information or advice about a particular topic by posting it on the list-serv.

Q: Any advice for people wanting to get into language research?

What are the areas of need for immigrant and international students in your locale or place of employment?  What are local or national sources of funding for educational initiatives that could help to meet those needs?  If you are enrolled in a graduate program in TESOL or in a related field, choose topics for research projects that will give you practice in assessing and meeting the needs of students in a specific area of ESP.  Such projects will not only give you invaluable experience in the field, but it could also put you in touch with experts in the field.  Since ESP practitioners often have to collaborate with experts in the field, such contacts could prove useful for future projects.

Q: Anything else you think is useful to know?

Accept every project that comes your way, within reason, as it will improve your skill set in some way, increase your contacts with experts in the field, and add to your portfolio that could lead to other projects in the future.

Q: Who are you, what do you do and how long have you done it?

My name is David Tracey. I was born in England, but grew up in Sydney (Australia), where I studied biological sciences and then completed a doctorate in neuroscience near San Francisco. After this I carried out postdoctoral research in Munich and Paris and then returned to Australia, where I worked for many years as a medical academic involved in teaching, research and administration. After retiring as an emeritus professor, I returned to Europe with my wife Silke; I started working as a medical translator and editor of English texts in London in 2008. We now live with our two children in Bern, Switzerland. Silke is a German-trained doctor who worked for some years in London. When not counselling clients in her practice or teaching medicine and medical English to students, she supports my work with her bilingual background and also proofreads many of my translations.

Q: As a medical translator, what exactly do you do?

I translate all kinds of medical texts from German to English and also edit and proofread medical and technical texts in English. The work involves not only translation as such, but also good word processing and formatting skills. I should make it clear that I’m a translator, not an interpreter – in other words I work with written texts, not speech.

Q: How did you become a medical translator?

I became a medical translator by chance. We were living with our young children in London, where I was teaching part-time while Silke undertook a postgraduate degree at London Business School. I saw an advertisement from a small translation agency looking for translators with university qualifications. I started to work freelance with them, but also registered with an online platform for translators and agencies in the hope of getting more work. I didn’t have much success at first, and so I decided to sit for the examination offered by the Chartered Institute of Linguists (CIOL) in the UK for a Diploma in Translation. I took an online course to prepare for the exam and sat in on lectures in the German department at University College London, where I was teaching anatomy and physiology. The diploma proved to be useful, and I gradually got more work from translation agencies. However, I have since acquired some direct clients and have enough work to keep me busy.

Q: What is your professional background?

I worked as an academic in the medical faculties of various universities in Australia, the US, Germany and the UK, and this medical background is obviously useful for medical translation. But language skills are more important, and I owe a debt to my high school teacher in Sydney who contributed to my skills in writing English, as well as to my colleagues while I was a postdoctoral researcher at the University of Munich; they agreed to speak German with me while their English was still much better than my German. I later gained a lot of experience in writing, editing, proofreading and publishing technical texts in English with grant applications, papers for scientific journals, book chapters and so on.

Q: What qualifications, if any, are needed to become a medical translator?

No formal qualification is required to become a medical translator. But you must be able to demonstrate good skills in at least two languages – that goes without saying. A university degree in languages and membership of a respectable association of translators such as the Institute of Translation and Interpreting (ITI) in the UK are also useful.

Q: What skills are needed to be a medical translator (over and above language skills)

Good computer skills are increasingly important. Most translators now use computer-assisted translation tools that incorporate machine translation. You still need excellent language skills, but the tools allow you to work more quickly and consistently. You also need to have an eye for detail (even detail that may appear trivial) and you must be a bit of a perfectionist. And you may have to put up with being somewhat isolated. If you work as a freelance translator, you will often be working by yourself, perhaps at home, without cheerful colleagues to distract you.

Q: What language pairs are particularly useful in your region?

There are four official languages in Switzerland, the most important being German and French. So German/French and vice versa are important for interpreters. But as a translator, your location is less important – you can translate in your language pair anywhere, as long as you have a good Internet connection. However, it sometimes helps to live in the same region as your clients.

Q: What are some of the challenges associated with medical translation?

An obvious challenge is the specialised terminology. A related challenge is the overload of specialised abbreviations – particularly in medical reports, which doctors dictate in a hurry to their secretaries, adding inaccuracy to obscurity. Confidentiality is an issue in the medical field as well as in other areas. I often read comments suggesting that errors in medical translation can have lethal consequences. But I think one needs to strive for accuracy in any area of technical translation, and most of the medical translations I do deal more with administrative matters than with existential issues.

Q: What are the hours?

I am a full-time freelance translator. As such I have the advantage (and disadvantage!) that to a considerable extent I can translate whenever (and wherever) I like. But it sometimes helps to be in a time zone near that of your clients.

Q: What about the money?

The money is a major issue for freelancers, not so much if you are employed. But as a freelancer, you are facing global competition from freelancers all over the world. As a result, rates can range from less than 5 eurocents to more than 40 eurocents per word, depending on your location, your language pair and who you are working for. My advice to would-be translators is not to give up your day job until you’re established.

Q: Where could interested people go for more information?

If you are interested in working as a translator, you could contact one of the universities that teaches translation, e.g. City University, London, or a translators’ association in your country (e.g. the ITI or the CIOL in the UK). Or you can send me an email if you wish.

Q: Any advice for people wanting to break into the field?

Make sure you have the relevant qualifications and skills, and don’t give up your day job until you’re established!

Q: Anything else you think is useful to know?

There are a number of portals on the Internet that connect translators and agencies, the biggest and best of which is You can offer your services on these portals, many of which have useful features such as lists of average rates for translators and the opportunity to ask colleagues for advice on how to translate difficult terms.