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Exclusive: 'Phenomenal increase' in overseas nurses taking new NMC-approved English test

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A company offering healthcare-specific English language tests for nurses has seen a “phenomenal” increase in candidates since the exam was recognised by the Nursing and Midwifery Council.

The NMC began accepting the Occupational English Test (OET) in November last year as an alternative way to prove language skills.

“What we have seen in the last few months is a phenomenal increase in the uptake”

Sujata Stead

The move followed concerns that its only previously approved exam – the International English Language Testing System (IELTS) – was hindering recruitment from overseas.

Since then, Cambridge Boxhill Language Assessment, which runs OET, said it had seen a huge surge in people – mainly nurses – taking the exam, which is specifically designed to test language skills in a healthcare context.

“What we have seen in the last few months is a phenomenal increase in the uptake of OET,” the organisation’s chief executive Sujata Stead told Nursing Times.

“The majority of candidates are doing it for nursing and large numbers are going to the UK,” she said in an interview.

From October last year – before the test was recognised by the NMC – to the latest registration for the July test, she said there had been an increase of 250% to 300% in candidates taking the test.

The biggest growth in uptake was coming from South East Asia and countries like the Philippines, South Asia and the Middle East – but numbers had also shot up in the UK.

Around 70% of those taking the test, which covers 12 different healthcare professions in all, were nurses, said Ms Stead.

She said it was too early to say whether or not the test was helping boost international recruitment by NHS trusts desperate to fill nursing vacancies.

However, she said the plan was to carry out some market research in around October next year to assess the impact on staffing.

OET was developed by language specialists at the University of Melbourne in the 1980s, who were commissioned by the government to devise a test in the light of increased demand for foreign healthcare professionals to come and work in Australia.

“These are simple things like whether you are able to share information effectively with patients and carers”

Sujata Stead

Ms Stead told Nursing Times that the overall feedback from nurses taking the test had been positive.

“The feedback generally is that they like the test because it is more fit for purpose and more appropriate for their profession, because it is all about communicating in a healthcare context with patients and carers,” she said.

“Typically what nurses are telling us is that they feel more confident taking the test because the content is content they can relate to,” she said.

Creators and supporters said the fact that OET was directly related to healthcare made it more attractive to nurses who were then more likely to practise, prepare and ultimately succeed.

There is also research evidence that preparing for the test helps nurses develop language skills they find useful in practice.

“It has two advantages in that you get through that hoop of NMC registration but also in taking the test you are developing language skills that help you in your profession,” said Ms Stead.

“That is the kind of feedback we often get from candidates – that it is not just a box ticking exercise, but actually the washback effect is quite a positive one,” she said.

She said the test, which was also recognised by the General Medical Council in March this year, continued to evolve and was regularly updated based on feedback from nursing practitioners and educators “because in healthcare things change all the time”.

Changes to be introduced from September this year include new assessment of “clinical communication” skills in the speaking part of the four-element test, which also includes writing, listening and reading.

In particular, these new assessment criteria are designed to assess how well nurses relate to and communicate with patients and carers.

“These are basically the communication skills healthcare practitioners need to have in order to communicate with patients and carers,” said Ms Stead.

“These are simple things like whether you are able to share information effectively with patients and carers, and able to summarise clinical notes and technical language into lay language patients and carers can understand,” she said.

“It is not just a box ticking exercise, but actually the washback effect is quite a positive one”

Sujata Stead

Other changes include the introduction of a wider range of accents to the listening test. Meanwhile, the reading and writing tests will feature more tasks related to “professional-to-professional” communication, such as consulting a colleague.

In addition, candidates will get a more detailed score out of 500 for each sub-test to go alongside their A to E results. Nurses applying to the NMC register are expected to achieve a minimum of grade B.

Ms Stead said her company had a deliberate policy of not publishing “pass” rates, because it was could be “damaging for our candidates” by potentially discouraging thorough preparation.

“How likely you are to achieve a grade B depends on a number of criteria,” she said. “If my level of English is very low then am I going to achieve grade B? Probably not.

“But let’s say that my level of English is around grade C, grade C+, then am I going to achieve grade B with preparation – yes,” she said.

“If my basic level of English is good and I have done some preparation, then my likelihood of getting a grade B is actually quite strong,” she added.

“This is still a work in progress but our objective is to talk to as many trusts and recruitment agencies as possible”

Sujata Stead

A recent snapshot trial saw the Specialist Language Courses (SLC) test centre in the UK work with eight nurses to prepare them for OET, including four working as healthcare assistants at Addenbrooke’s Hospital in Cambridge and four based in India and the Philippines recruited to work at King’s College Hospital Foundation Trust.

Six out of the eight got four Bs first time round, while the remaining two were close to passing with three Bs and one C.

She said one of the key messages the organisation was keen to get across was the fact nurses did need to prepare for the test.

“No matter what kind of exam you do, at the end of the day it is taking a test in a timed environment – you should know what you’ll be expected to do in the test and practise your English as well,” she said. “Don’t come in and take the test cold, prepare for your exam.

“We have launched a lot of free resources so you can go straight to our website and download lots of online practice tests and samples and practice as much as possible,” she said.

The test is currently on offer at about 110 test centres across 40 different countries, but Ms Stead said her company was keen to ensure it was accessible to as many people as possible.

“We are regularly monitoring where demand for the test is and making sure that we actually open new centres as soon as possible, so candidates don’t have to travel long distances,” she said.

The company was keen to work closely with NHS trusts and others to raise awareness of the test and was planning to expand its team in the UK, she added.

“One of the things we have been trying to do since November last year is reach out to NHS trusts and NHS England to work with them to improve their understanding of the test so they can make an informed decision as to whether they should go to OET or another English language test,” she said.

Ms Stead said: “This is still a work in progress but our objective is to talk to as many trusts and recruitment agencies as possible.”

She said the forthcoming OET Forum event on 29 August in London was part of the official launch of OET in the UK.

Speakers will include Professor Tim McNamara from the University of Melbourne, the original developer of OET.

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