For those of you who are unfamiliar with Lulu - it is a self-publishing site which works in the same way as Amazon. Click on the book you want and you are directed to a payment page.
I attended an interesting International Medical English seminar in Norwich last Saturday which was hosted by Paul East of The Pyramid Group. Lots of different perspectives on teaching medical English in various arenas - workplace, online, universities and test prep. It was in the area of test prep that I spoke ( 'Medical English tests: How much medical? How much English?) as well as Lesley Hay of Cambridge English Language Assessment ('Promoting effective clinician-patient spoken communication through English language teaching and assessment: the case of Occupational English Test').
An interesting point came out of Lesley's talk which was the challenge of getting non-verbal communication skills across in an audio-only test. The OET role plays are performed face-to-face with an interlocutor playing the part of a patient or caregiver. Audio recordings are made of the role plays. The recordings are then sent to a central marking place where they are assessed. So, the interlocutor is not the assessor. But, the interlocutor is the witness of any non-verbal language used by the candidate. This is an important factor as your interlocutor will still respond to your body language even if it is not recorded visually.
Does this really matter? Well, yes it does. We know that we rely on non-verbal communication for most of the message of what the speaker delivers. We have all watched good and bad examples of the delivery of the same dialogue. That is, the words are the same but the surrounding non-verbal communication is different. The words 'I'm not angry with you' can have a range of meanings from 'Yes, I am really angry with you' to 'No, I'm not angry with you (because I understand the circumstances)'.
The optimum OET test would have a video made of candidates' performance so that all forms of communication could be assessed (as in the 'real world'). Unfortunately, this is not possible because of the resulting increase in cost and the need for more technology and operators of the technology. At present, the audio recording is what candidates have to deal with.
How then to convey non-verbal communication in an 'audio test'? Is it possible?
I believe it is. Think for a minute about people who are visually impaired. They also use non-verbal communication and, more importantly, are able to pick up on non-verbal communication. They listen to the tone and pitch of a person's voice - as in the previous example of 'I'm not angry with you.' They are aware of the direction of a voice. Imagine that I am talking to you but suddenly look around to check the clock on the wall behind me. If I am talking as I am talking, my voice will sound different as I turn around.
Non-verbal communication such as nodding your head or shaking your head will not be recorded on the audio so you'll need to use some verbal communication as well. Nod your head and say things like 'Mm', 'I see' or 'No,I don't think so'. Don't ignore the non-verbal communication, just add to it. You'll use this a lot when you are using empathetic responses. What you are trying to convey is 'I understand that this is difficult'.
Finally, smiling is a powerful tool to use when you are building a rapport with your interlocutor. Everyone responds to a smile and can 'hear' it in your voice. Try saying 'I don't think so' without smiling and then while smiling. What happens? When you smile, the tone of your voice changes and sounds more positive.
I have recently been asked to produce materials for OET for dentists and as I couldn't see any videos already produced for dentists (English for Dentists), I thought I would produce some. This is the first video. It can be found on the OET prep Youtube channel.
I have finally worked out the complicated world of making epub files and have published my first ebooks. Having bought a Kindle for myself last year, I can certainly see the value of being able to download books and take them with me in a small device. I am hoping that my ebooks will be as useful to my readers. I have started with ebooks for the Occupational English Test as this seems to be the priority for many of my youtube subscribers.
Recently, I have been talking with nurses who have come to the UK from Spain to work in hospitals around the UK. Coming from the EU, they were not required to pass an English test like IELTS or OET before working here. All were promised language support on arrival in the UK but this does not seem to have eventuated. It is very hard to manage the specialist English you need when you start in an English-speaking hospital e.g. tasks like giving a handover, telephoning admission information, doing an admission, completing the multitude of assessment tools and many more. I plan to develop some support materials in this area soon and will make an ebook of the Spelling and Vocabulary book as soon as possible. Watch this space!
Abbreviations are used frequently in hospitals, however, in recent years there has been an insistence on avoiding abbreviations or symbols which may be confusing. This is most important in drug administration. An excellent website for national standards regarding acceptable abbreviations in Australia is the Australian Commission on Safety and Quality in Health Care. Find it at http://www.safetyandquality.gov.au/
Read the pdf called ‘Recommendations for Terminology, Abbreviations and Symbols
used in the Prescribing and Administration of Medicines’
You will find a set of tables at the end which explain changes in some abbreviations which were changed because they were considered to be unclear. Some of you who have worked in other English-speaking countries will notice that there are a few differences between Australian abbreviations and those you may be familiar with. I’ll look at these later.
The abbreviations in the table which you will probably be dealing with in the stimulus material of the OET writing subtest are those relating to the administration of medications, specifically:
* TIMES OF ADMINISTRATION - daily ( not OD or d), bd (not BID), tds ( not TID)
- mane ( in the morning) , nocte (at night) , stat (give immediately), prn (give whenever necessary), OTC (over-the-counter medicines), TCM (Traditional Chinese Medicine)
* FREQUENCY OF ADMINISTRATION – every 4 hours -add times e.g. 06:00,10:00 etc- not 4/24
* DAYS, MONTHS,WEEKS - I day (not 1/7), 1 mth (not 1/12) and 1 wk (not 1/52)
The abbreviations 4/24 or 6/24 etc are still quite common in IV fluid administration, however, the recommendation is to write 4 hr or 6 hr.
* DOSAGE – g, mg , mcg (or microgram), ml, units, mg per ml
Other abbreviations have been removed from the list of accepted abbreviations because they are felt to be dangerous or ambiguous. The most common are:
Form to be written now:
Units (write in full) e.g. 5 units Humalog insulin
Sliding Scale (write in full) e.g. sliding scale insulin
R eye / L eye/ both eyes (specify which eye/eyes)
As well as abbreviations, some symbols are also avoided. For example, when charting a urinalysis result, we used to write + ( and say ‘One plus of protein’) , ++, +++ etc .This is an easy one as you can use the correct amount which is also included on the label of the urinalysis sticks. It is less clear if you describe the discharge of a wound as being ‘++ drainage from wound drain’. This supposedly meant ‘ a moderate amount of drainage’ but it was never clear ‘whose’ moderate we were referring to. One nurse’s idea of ‘moderate’ may not be another nurse’s idea of moderate. It is now required that you say exactly how much drainage there is e.g. 120 ml drainage. It is quite acceptable to write ‘minimal drainage of <20 mls’ if it is not possible to accurately measure a very small amount.
Differences from country to country
1. Nurses who have worked in the UK may be confused by the abbreviation 1/24 as the abbreviation '1to the power zero' (see below) is used for ‘hourly’ or ‘over an hour’. In Australia. this abbreviation would be read as ‘primary’ e.g. a primary carcinoma and is on the list of confusing abbreviations.
2. In Australia, the abbreviations bd, tds and qid are used. In the UK, bd, tds and qds are used.
See below: symbol used to mean 'primary' in Australia.
I have decided to add the blog below that I wrote for my dedicated OET prep website. I know that it is difficult for candidates preparing for an exam to focus on developing their communication skills when all they want is to know how to pass the exam! The fact remains that the OET is a language exam which tests the ability to communicate well and safely in a healthcare environment. The words 'communicate well' are the key.
For this reason, I am slowly self publishing materials in book form for candidates to develop skills in the four areas which are tested (reading,writing,listening and speaking).
Blog entry on OET Prep website:
I continue to be asked for more YouTube videos showing sample dialogues for the role plays in the OET speaking subtest. Thank you all for your interest. Some of you also ask for the transcripts but actually, without an explanation about the language used in the dialogue, transcripts are of limited value. For this reason I decided to self publish some books with hints for the OET for nurses. I have just finished a book for the speaking subtest ( see picture to the left). It is available on the self publishing site LULU which is a site similar to AMazon ion the way you order books.
The reason I decided to write the book was to highlight important information about communication and the language functions you will use to communicate effectively. Some people are a little confused when I say 'language function' so I'll just quickly explain here:
Grammar - these are the correct verb tenses, noun forms and adjective order rules which are the building blocks of the language. For example, the Present Perfect, uncountable nouns etc.
Language functions (also called Functional Language) - this is what you do with the grammar you have learned. So, 'asking about the duration of an event' uses the Present Perfect tense (How long have you had the pain in your side?).
To communicate well, it's important to understand which functions to use in a given situation. This is more important than correct grammar. For example, if you say 'Can you explain me about the accident?', I will understand what you mean, even though 'explain me' is incorrect grammar. It should be Can you explain TO me....
The role play samples which I write and put on YouTube show you examples of some of the language functions you might use in similar situations. Remember that you should develop your own style, not just copy mine! I give you one or two examples under each function heading - you need to go away and think about the sorts of role plays you might have to do and think of the language you will use in them.
This is why I advise my students to write down some mini-dialogues covering particular functions. Think of how you will advise a patient about caring for a simple dressing at home. Try to have no more than 3 points you might tell the patient.
For example, 1. keep clean and dry 2. change every 2 days 3. tell your GP if you notice any discharge.
You might think of 3 different points ( cover dressing with a plastic before you have a shower, have a shower not a bath, have the stitches taken out after a week to ten days). It really doesn't matter what your points are. It's more important to think about the language you will use to advise - It's a good idea to.... You should....It's best to....Make sure that you..... Try not to.....
When you look at the videos on YouTube, try to identify the language I have used in them and think about the reasons I used those particular functions. Feel free to use them as a guide for your own dialogues but make sure your dialogues reflect your communication style, not mine!
If I had a dollar for every email I open asking this question, I would be a wealthy woman! Without wishing to sound frivolous, it is not a question I can answer. Like any test, candidates may benefit from a certain degree of luck on the day. The topics covered in the subtest might be familiar, to an extent anyway. Many candidates worry that they won't be familiar at all with the topic and this is always a possibility. Even when familiar with the topic, it may be presented 'with a twist' so it is almost like a new topic.
This is really the point of the OET. You are not expected to rote learn dialogues or learn chunks of text by heart. You are being tested on your ability to understand the language in both forms (spoken and written) and respond appropriately. Despite this, you need to start somewhere so, here are some ideas for you to use as you prepare for the test.
Before I list the ideas, I would like to stress an important aspect of your preparation. That is, it takes time! The length of time it will take depends on several points:
1. What is your starting level of English? - don't try to deal with complex language if you are still at Pre-Intermediate Level (B1-B2). Sometimes, students look at material at B1-B2 level and think that it is too easy for the test. This may be true,however, if you are still struggling at B1 level, you are not ready for the test. Spend time making sure that you know the basics - general language functions. Remember that more complex communication strategies like hedging or dealing with difficult conversations build on basic communication strategies.
2. How well can you skim over a paragraph and pick out the key terms? You need to be able to do this quickly and accurately for the reading test.
3. Can you identify key terms when someone is talking? You need to be able to predict or guess the words you are likely to hear. Remember that words you can read easily may sound quite different when they are spoken.
Speaking: write your own script for the sort of things you think you'll need to say. This will make you feel a bit more confident even if you have to adapt your dialogue for each role play.Some suggestions:
* explaining how to look after a dressing at home.
* explaining about pain relief after an operation
* explaining about eating and drinking after a tooth extraction
* advising about suture removal
* suggesting ways to change diet /exercise habits
Dealing with difficult conversations
Lately, I have had a lot of requests for help in dealing with difficult conversations. Firstly, understand that these are not easy for most of us but we can all learn to manage them better. Some of the scenarios may be:
1. anxious mother/father whose daughter/son is in the middle of an operation. The parent keeps insisting that you let them into the operation.
2. patient who is terminally ill but insists on going home, refuses help and claims that s/he can manage alone. Refuses admission to the hospice or nursing home.
3. young mother whose baby may have jaundice/tries to discharge herself before blood test result back.
4. Patient refuses to take medication because friend says that a herbal remedy is much better. Test results indicate a serious infection which must be treated with antibiotics.
As in real life, you need to 'put yourself in the patient's shoes'. Imagine how they must be feeling (frightened,worried,determined) and start by respecting their feelings.
Empathise: I can see this must be difficult for you. / I understand this is very hard for you.
Remember that you should never say ' I know how you feel' because you don't! You can only imagine how the person feels.
Explain why it is important for them to do something.Acknowledge their concerns first.
I know that you really want to see your daughter now but it's not possible. She's in the middle of an operation so we are not allowed in until she arrives in Recovery.
Negotiate when they insist on an action or when they refuse to accept what you say.
Would you be willing to wait here until the surgeon can come out and speak to you?
Do you think you could wait a little longer for the test results before you decide to go home?
What if the patient insists?
This is difficult for most people to manage. The only way to manage such a situation is to repeat the reasons why you think it is important for them to listen to you. Then, whilst ensuring the patient understands that you respect their right to make their own choice, suggest giving them some information with a phone number to discuss the situation at a later stage. This is as close to an authentic situation as you can get.
Nurse: I appreciate that you have made a decision not to go to the hospice or a nursing home but perhaps you may change your mind later. Can I give you this information leaflet about the services available at the hospice? There is a phone number as well if you ever want to find out more.'
It's important not to keep insisting and very important not to sound judgemental at all.
I was very pleased to hear the results of one of my students who got Bs in everything except writing - one student even scored an A in writing!. What a fantastic result. It is lovely to hear of one student who was able to join her husband in New Zealand now that she can work there as an RN.
I recently had a chat with Sujata Stead and Barbara Zhang of Cambridge Boxhill Language Assessment. I wanted to find out more about the Occupational English Test as I had read about some changes coming in. A very informative chat. I had started with the feeling (shared by some of my students) that the writing test was not relevant for nurses. After all, we said, nurses don't write referral letters any more. However, I have been won over after hearing about the amount of research which has been undertaken to assess the usefulness of this type of writing test.
It comes down to the fact that the writing test assesses the ability to scan patient information which is presented in an authentic format i.e effectively a discharge summary. Whilst the writing of a referral letter may not be usual practice for ward nurses, it is still the practice of certain nurses e.g. in specialised clinics. For ward nurses, the ability to structure patient notes or an incident report in a way that is clear and understandable is always needed. So, my conclusion is that the format of a referral letter is transferrable to other written texts.
Another question was about the lack of feedback for students on their marks. I have students who have attempted the OET several times, receiving a 'C' in writing but seeming to be improving in their writing during their practice sessions. Their wish was to know where they were losing marks i.e.in what criteria. The answer was that it is felt that by pointing out errors, students tend to concentrate only on correcting those mistakes the next time and neglect the 'whole picture'. I can appreciate this but welcome the thought that there may be more information available soon on marking criteria.
I feel the OET is a very useful test to assess the long-term language abilities of future healthcare workers. In other words, the use of appropriate spoken language in a healthcare oriented role play can be recycled in authentic practice. Communication skills such as empathising with a patient, reassuring a patient before a procedure, gently advising a patient to change lifestyle habits, convincing a patient to remain in hospital for treatment, dealing with a patient who is agitated and many more. In the same way, the writing task should help to predict the healthcare worker's ability to produce appropriate written texts such as variance reports on a care pathway, adverse incident reports, messages to colleagues, requests for treatment or assessment of patients and many more.
Testing English for Medical Purposes carries an added responsibility. The OET is not only testing basic English communication, it is testing safe practice from a linguistic point of view. It is not only desirable but vital that communication verbally and in written forms should be clear so that patient safety is not compromised.
I am looking forward to developing my skills in teaching OET preparation in the future.
I have included a video I made giving some hints on the OET Writing for Nurses sub-test. I am finding that You Tube capture is an excellent way to keep in contact with students and potential students from all over the world.
The OET or Occupational English Test is a healthcare profession-specific test which needs to be passed before working in Australia or New Zealand.
co-author of 'Cambridge English for Nursing' Pre-Intermediate and Intermediate+
- Medical English: Spelling