These tests are covered in more detail below.

Pearson Test of English Academic (PTEA) is an English language test designed to assess a student’s readiness to participate in tertiary academic study in English. PTEA reports an overall score, four communicative skills scores, and six enabling skills scores. The overall score gives test-takers an indication of their general competence in academic English. The four communicative skills scores correspond to the four major language skills: listening, reading, speaking, and writing. The six enabling skills scores provide more detailed information about test-takers’ abilities in sub-language skills related to speaking and writing. PTEA is completely machine-scored, meaning no human rater is used, even for speaking and writing tasks. PTE test-takers do not interact with a human interlocutor as IELTS and OET test-takers do in speaking. All tasks in PTEA are delivered on the computer.

 There are eight types of tasks for PTEA speaking and writing. The tasks require test-takers to read aloud texts on the computer screen, repeat sentences after the recordings of the sentences are played, give verbal summaries of images on the screen, re-tell the content of short lectures after the lectures are played, answer questions verbally after the questions are played, write one-sentence summaries after reading texts, and compose an extended essay on a given topic. Tasks such as summarising a written text assess more than one language skill as it involves both reading and writing. 

The tasks in PTEA reading include multiple-choice questions, paragraph ordering tasks, and filling-the-blank tasks. PTEA listening asks the test-takers to select answers to multiple-choice questions, fill in blanks as recordings play, select the most suitable summaries after listening to recordings, choose missing words to complete recording transcripts, identify words in transcripts that differ from the recordings, and type the sentences verbatim as they appear in the recordings. Some of the listening tasks also assess more than one skill. For example, the verbatim typing task assesses not only test-takers’ listening skill but also their writing skill.

The Test of English as a Foreign Language (TOEFL) Internet-based Test (iBT) measures test-takers’ ability to understand and use English in tertiary academic settings. TOEFL assesses the traditional four language skills: listening, reading, speaking, and writing, but it has a stronger focus on more authentic language tasks frequently encountered in university-level study. 

TOEFL listening includes lectures and conversations in the academic context and measures skills such as listening for main ideas, understanding speakers’ intentions, synthesising information, and drawing conclusions. The lectures are longer (500-800 words each) than those in other English language tests so as to better represent the listening tasks in university classes. It should be noted that listening recordings are only played once and test-takers cannot see the questions until the recordings finish, though note-taking is allowed when the recordings play. 

As with TOEFL listening, TOEFL reading has fewer but longer (600-700 words each) texts to imitate academic reading tasks. The reading section assesses test-takers’ ability to comprehend, infer, and read to learn. 

A novel feature of TOEFL is integrated tasks in the speaking and writing sections. TOEFL speaking has two independent tasks and four integrated tasks. The independent speaking tasks require test-takers to express opinions on given topics. The integrated tasks ask test-takers to either listen to short recordings or read short texts first before requiring them to speak. The integrated tasks therefore assess the ability to synthesise information from different sources. TOEFL speaking is not as interactive as tests such as OET and IELTS since TOEFL test-takers speak to a computer instead of an interlocutor. 

Similar to TOEFL speaking, TOEFL writing has an independent task that asks test-takers to write an opinion essay, and an integrated task that requires test-takers to first read a text, then listen to a recording on the same topic, and finally write a summary based on the text and the recording. The integrated tasks in TOEFL speaking and writing better represent the academic language tasks in real life as tertiary students are often expected to listen, read, speak, and write at the same time in class. 

The Occupational English Test (OET), as the name suggests, is a language test designed to assess test-takers’ language skills in healthcare workplace communication. The test thus assumes a certain degree of health knowledge with its materials and scenarios based on health-related content. OET has 12 specific versions tailored to 12 healthcare professions: dentistry, dietetics, medicine, nursing, occupational therapy, optometry, pharmacy, physiotherapy, podiatry, radiography, speech pathology and veterinary science. OET assesses the traditional four language skills separately: reading, listening, speaking, and writing. 

The reading and listening sections are the same for all 12 professions as the content is of a generic nature that should be accessible to all test-takers with a health background. These two sections assess test-takers’ ability to comprehend the gist, details, explicit meaning, and implicit meaning of spoken and written discourse. 

OET speaking and writing are specific to the 12 professions, which means, for example, a test-taker taking the nursing version will only encounter topics and tasks/scenarios related to the nursing profession in the speaking and writing sections. OET speaking requires the test-taker to role-play the health professional in their chosen profession with an interlocutor role-playing a patient or carer. Test-takers are assessed not only on their linguistic skills such as fluency and grammar but also on their clinical interactional skills such as rapport building and information gathering. 

In OET writing, test-takers need to write a discipline-specific letter such as a referral letter. Similar to OET speaking, OET writing assesses not only linguistic skills in writing but also skills specific to writing in the clinical context, such as genre awareness and professional register.

The International English Language Testing System (IELTS) Academic test is a language test designed to assess students’ readiness to study in English-speaking higher education settings. The test has four sections for the traditional four language skills: reading, listening, writing, and speaking. The first three sections can be taken either on paper or computer but the speaking section is always administered face-to-face with a certified IELTS examiner. 

 IELTS reading consists of three long texts that assess test-takers’ ability to identify the main idea and details of the texts, to understand the logic of the arguments, and to recognise the writers’ attitudes and opinions. 

IELTS listening contains four recordings, two of which are monologues and the other two of which are conversations. Similar to the skills assessed in reading, the listening section looks at test-takers’ ability to understand the main ideas and details of the recordings, grasp the speakers’ opinions and attitudes, and follow the arguments in the recordings. 

IELTS writing has two tasks. In Task 1 test-takers need to write a description or summary based on information presented in a graph or chart. Task 2 requires test-takers to write a reflective essay in response to a question or a statement. In both tasks, test-takers are assessed on their ability to achieve the requirements of the task, the coherence and cohesion of their writing, the range of vocabulary and grammatical structures they use, and the accuracy of their language.  

Similar to OET and different from TOEFL and PTEA, IELTS speaking is conducted in person with a human interlocutor. There are three parts to IELTS speaking. In Part 1 the test-taker is expected to answer general questions about themselves such as their work, studies, and family. In Part 2 the test-taker will receive a prompt card that gives them a specific topic to talk about. The test-takers have one minute to prepare and up to two minutes to deliver a monologue. The examiner will also ask questions on the same topic. Part 3 involves further in-depth discussion on the topic in part 2, where the examiner can ask questions on more complex and abstract issues. Test-takers are assessed on their ability to speak fluently, coherently, intelligibly, and accurately. It is also desirable to demonstrate a wide range of vocabulary and knowledge of complex grammatical structures. 

Language proficiency tests are sometimes expected to predict students' clinical communication skills. Health educators and clinicians sometimes are surprised that a student can score high on a language test but does not possess the communication skills they expect to see in clinical environments. This perceived mismatch is due to the difference between the constructs of the language tests (what skills language tests are assessing as explained above) and the constructs of effective clinical communication (how experienced and competent clinicians communicate).  

Effective clinical communication requires the mobilization of a range of linguistic and non-linguistic resources to 1) build rapport with patients, 2) display clinical reasoning, and 3) demonstrate professionalism. If we take speaking as an example. clinicians need to 

• manage interactions with their patients, patient families and other health providers on a turn-by-turn basis drawing on verbal and body language 

• constantly adjust their communication styles depending on who they are talking to

• and engage with their interlocutors at the emotional (rapport building), logical (clinical reasoning), and moral (displaying professionalism) levels. 

The ability to manage these complex interactional, sociocultural, and interpersonal aspects of communication is termed speakers' Interactional Competence (Dai & Davey, 2023; Galaczi, 2014; Hall & Pekarek Doehler, 2011). 

Below is a video recording of an experienced physiotherapist interacting with a patient. A transcript of the first 42 seconds of the recording is provided using a lite version of the Conversation Analysis transcription conventions (Jefferson, 2014). You are encouraged to watch the video, look at the transcript and think about whether the language tests your institutions use can cover or predict a health student's Interactional Competence in the clinical context. We thank Prof Prue Morgan from the Department of Physiotherapy at Monash University who gave us permission to use this video recording.

References

Dai, D. W., & Davey, M. (2023). On the promise of using membership categorization analysis to investigate interactional competence. Applied Linguistics.1-26. 

Galaczi, E. D. (2014). Interactional competence across proficiency levels: How do learners manage interaction in paired speaking tests?. Applied linguistics, 35(5), 553-574. 

Hall, J.K. & Pekarek Doehler, S. (2011). ‘L2 interactional competence and development’ in J. K. Hall, J. Hellerman, & S. Pekarek Doehler (eds.): L2 Interactional Competence and Development. Multilingual Matters 1–15. 

Jefferson, G. (2004) Glossary of transcript symbols with an introduction. In G. Lerner (Ed.), Conversation Analysis: Studies from the First Generation (pp. 13-31). John Benjamins.