The consequences of English language testing for international health professionals and students: An Australian case study

A critical race analysis of structural and institutional racism: Rethinking overseas registered nurses' recruitment to and working conditions in the United Kingdom

Language tests for overseas registered nurses (ORN) working outside their home country are essential for patient safety, as communication competency needs to be established in any workforce. We argue that the current employment of existing language tests is structurally and institutionally racist and disadvantages ORNs from non-European Union (EU) and non-White countries seeking to work in the United Kingdom. Using Critical Race Theory (CRT), we argue that existing English language tests for ORNs seeking registration in the United Kingdom are discriminatory due to the UK's racist migration policies and a regulatory body for nursing and midwifery that fails to acknowledge and understand its own institutionally racist practices.

Nurse Migration in Australia, Germany, and the UK: A Rapid Evidence Assessment of Empirical Research Involving Migrant Nurses

Forecasts predict a growing shortage of skilled nursing staff in countries worldwide. Nurse migration is already a common strategy used to address nursing workforce needs. Germany, the UK, and Australia are reviewed here as examples of destination countries for nurse migrants. Agreements exist between countries to facilitate nurse migration; however, it is not evident how nurse migrants have contributed to data on which these arrangements are based. We examined existing primary research on nurse migration, including educational needs and initiatives to support policymakers’, stakeholders’, and health professions educators’ decisions on measures for ethical and sustainable nurse migration. We conducted a rapid evidence assessment to review available empirical research data which involved, was developed with, or considered migrant nurses to address the research question: what are the findings of research that directly involves migrant nurses in producing primary research data? A total of 56 papers were included. Four main themes were identified in this research data: Research does not clearly define what is meant by the term migrant nurses; discrimination is often reported by migrant nurses; language and communication competencies are important; and structured integration programs are highly valued by migrant nurses and destination healthcare employers.

Migrant nurses continue to experience discrimination and reduced career opportunities and therefore should be included in research about them to better inform policy. Structured integration programs can improve the experience of migrant nurses by providing language support (if necessary), a country-specific bridging program and help with organisational hurdles. Not only researching migrant nurses but making them active partners in research is of great importance for successful, ethical, and sustainable migration policies. A broader evidence base, especially with regard to the views and experiences of migrant nurses and their educational support needs, should be promoted to make future immigration policy more needs-based, sustainable and ethically acceptable.

Language Assessment for Immigration: A Review of Validation Research Over the Last Two Decades

It is not uncommon for immigration-seekers to be actively involved in taking various language tests for immigration purposes. Given the large-scale and high-stakes nature those language tests possess, the validity issues (e.g., appropriate score-based interpretations and decisions) associated with them are of great importance as test scores may play a gate-keeping role in immigration. Though interest in investigating the validity of language tests for immigration purposes is becoming prevalent, there has to be a systematic review of the research foci and results of this body of research. To address this need, the current paper critically reviewed 11 validation studies on language assessment for immigration over the last two decades to identify what has been focused on and what has been overlooked in the empirical research and to discuss current research interests and future research trends. Assessment Use Argument (AUA) framework of Bachman and Palmer (2010), comprising four inferences (i.e., assessment records, interpretations, decisions, and consequences), was adopted to collect and examine evidence of test validity. Results showed the consequences inference received the most investigations focusing on immigration-seekers' and policymakers' perceptions on test consequences, while the decisions inference was the least probed stressing immigration-seekers' attitude towards the impartiality of decision-making. It is recommended that further studies could explore more kinds of stakeholders (e.g., test developers) in terms of their perceptions on the test and investigate more about the fairness of decision-making based on test scores. Additionally, the current AUA framework includes only positive and negative consequences that an assessment may engender but does not take compounded consequences into account. It is suggested that further research could enrich the framework. The paper sheds some light on the field of language assessment for immigration and brings about theoretical, practical, and political implications for different kinds of stakeholders (e.g., researchers, test developers, and policymakers).

Filipino nurses' perspectives of the clinical and language competency requirements for nursing registration in England: A qualitative exploration

AIM

To understand Filipino nurses' experiences of the 'Test of Competence' process, alongside the additional competency requirements of their sponsor Trust.

BACKGROUND

The Philippines has been a significant and sustained source of foreign trained nurses to the UK over the past twenty years. Since October 2014, the Nursing and Midwifery Council has required that all non-UK nurses pass a 'Test of Competence' prior to acquiring registration. However, there is limited evidence exploring how overseas nurses experience this process and the tests which comprise it.

DESIGN

A qualitative study informed by pragmatism, using focus group discussions.

METHODS

Focus groups were held with pre-departure nurses in Manila, the Philippines and with post-arrival Filipino nurses in the Southeast of England. A total of 21 male and female Filipino nurses participated. Qualitative data were analysed using Reflexive Thematic Analysis.

RESULTS

Three themes were generated in relation to the competency process. Firstly, inappropriate preparation, Second, a competency/practice disparity and finally intergenerational and intra-professional support.

CONCLUSION

Some aspects of the 'Test of Competence' process were seen as unnecessarily difficult, contradictory, repetitious and/or of little relevance to practice. Lack of support and insufficient information relating to how best prepare for the tests were mitigated to some extent by individual learning and informal support mechanisms. An evaluation of the impact that repeated changes to the Test of Competence process may have on the quality of support offered by NHS Trusts to overseas nurses is recommended.

Evaluating the lexico-grammatical differences in the writing of native and non-native speakers of English in peer-reviewed medical journals in the field of pediatric oncology: Creation of the genuine index scoring system

INTRODUCTION

The predominance of English in scientific research has created hurdles for "non-native speakers" of English. Here we present a novel application of native language identification (NLI) for the assessment of medical-scientific writing. For this purpose, we created a novel classification system whereby scoring would be based solely on text features found to be distinctive among native English speakers (NS) within a given context. We dubbed this the "Genuine Index" (GI).

METHODOLOGY

This methodology was validated using a small set of journals in the field of pediatric oncology. Our dataset consisted of 5,907 abstracts, representing work from 77 countries. A support vector machine (SVM) was used to generate our model and for scoring.

RESULTS

Accuracy, precision, and recall of the classification model were 93.3%, 93.7%, and 99.4%, respectively. Class specific F-scores were 96.5% for NS and 39.8% for our benchmark class, Japan. Overall kappa was calculated to be 37.2%. We found significant differences between countries with respect to the GI score. Significant correlation was found between GI scores and two validated objective measures of writing proficiency and readability. Two sets of key terms and phrases differentiating NS and non-native writing were identified.

CONCLUSIONS

Our GI model was able to detect, with a high degree of reliability, subtle differences between the terms and phrasing used by native and non-native speakers in peer reviewed journals, in the field of pediatric oncology. In addition, L1 language transfer was found to be very likely to survive revision, especially in non-Western countries such as Japan. These findings show that even when the language used is technically correct, there may still be some phrasing or usage that impact quality.