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In order for Doctors to be provided with a licence they first need to ensure the GMC are satisfied with their level of experience and knowledge of English language, which they are required to use whilst working at an English-speaking healthcare workplace.

Not only is this to benefit their confidence and professionalism, but more importantly to ensure that the patient’s safety is never at risk. The doctor should be confident in communicating with their patients and colleagues to ensure their work is always carried out to the high standards expected of them, as well as to prevent errors or any misunderstanding.

Communicating includes writing, listening, reading and speaking.

There are several ways in which the doctor can demonstrate their English language skills as the GMC recognises that doctor’s may take different routes to obtain these skills.

Below we give an overview of the four main ways that the GMC shall accept evidence.

#1 OET (Occupational English Test)

The OET is a test designed purely for healthcare professionals to demonstrate their English language skills.

To enable the doctors to obtain their license, this test will assess the language and communication skills in all four areas, with a direct focus on reflecting the ability to communicate in an English-speaking healthcare workplace.

Where can I take the test?

The OET is available in 46 countries. Candidates can take find a test centre local to them, as well as exam dates by clicking here.

How is the test structured?

The test has four sub-tests within it, including listening, reading, writing and speaking.

Listening

The Listening exam consists of three parts and 42 questions, which equate to 50 minutes with questions based on general healthcare. The total length of the listening audio is around 40 minutes, including recorded speech and pauses to allow time for writing answers. The candidate will hear each recording once and be expected to write their answers whilst listening.

Listening sub-test structure

Part A – consultation extracts (around 5 minutes each) Two recordings will be played to the health professional, which they will then need to complete notes using the information provided.

Part B – short workplace extracts (around 1 minute each) The healthcare professional will be played six recorded extracts and have to answer one multiple-choice question for each extract.

Part C – presentation extracts (around 5 minutes each) The doctor will then listen to two different extracts and have to answer six multiple-choice questions per extract.

How is my Listening exam scored?

The answers for Part A are double-marked by trained OET assessors. These answers are randomly assigned to assessors to avoid any conflict of interest. Then the answers for Part B and Part C are computer scanned and automatically scored.

For Part A, Listening assessors use a detailed marking guide which sets out which answers receive marks. Assessors use this guide to decide whether you have provided enough correct information to be given the mark. Assessors are monitored for accuracy and consistency.

Reading

The Reading exam consists of three parts and 42 questions which equates to 60 minutes to complete. Topic focused on general healthcare interest.

Reading sub-test structure

Part A – expeditious reading task (15 minutes) This sub-test consists of reading four short texts in a quick and efficient manner. The doctor must answer 20 questions in the allocated time provided.

Part B and Part C – careful reading tasks (45 minutes) Part B provides six short texts sourced from the healthcare workplace (around 100-150 words each) which the doctor will need to answer one three-option multiple-choice question on per text.

Part C consists of two texts (800 words each) on topics of interest to healthcare professionals. For each text they must answer eight four-option multiple-choice questions.

How is my Reading ability assessed?

Reading Part A (the expeditious reading task) tests the health professional’s ability to skim and scan quickly across different texts on a given topic in order to locate specific information. For that purpose, Part A is strictly timed and all 20 question items must be answered within the allocated 15 minutes. To complete the task successfully, they will also need to understand the conventions of different medical text types and understand the presentation of numerical and textual information.

Reading Part B tests their ability to understand the detail, gist or main point of complex texts commonly found in the healthcare workplace. To complete the task successfully, they will need to identify specific ideas at sentence level.

Reading Part C tests their ability to understand the explicit or implied meaning as well as the attitude or opinion presented in a longer text. To complete the task successfully, they will need to identify the relationship between ideas at sentence and paragraph level. Part C also tests the doctor’s ability to accurately understand lexical references and complex phrases within the text.

Writing

The Writing exam takes a total of 45 minutes and is profession-specific.

Writing sub-test structure

The doctor is tasked with writing two letters, which is usually a referral letter and a written response to a complaint – however, this will differ. Along with the task instructions, the doctor will also receive some stimulus material such as case notes, which can be used for information to include in letter responses.

How is my Writing ability assessed?

The doctor’s performance on the Writing sub-test is marked independently by a minimum of two trained Assessors.

Neither Assessor knows what scores the other has given, or what scores the doctor has achieved in any of the other sub-tests.

Their performance is scored against six criteria and receives a band score for each criterion: • Purpose (Whether the purpose of the letter is immediately apparent to the reader and sufficiently expanded in the course of the letter) • Content (Whether all the necessary information is included and accurate for the reader) • Conciseness & Clarity (Whether unnecessary information is omitted so that the letter is an effective summary for the reader) • Genre & Style (Whether the register, tone and use of abbreviations are appropriate for the reader) • Organisation & Layout (Whether the letter is organised and well laid out for the reader) • Language (Whether the accuracy of the grammar, vocabulary, spelling and punctuation communicates the necessary information to the reader)

Speaking

The Speaking exam is carried out individually as a role-play and takes around 20 minutes. The role-play will include the doctor (playing as their professional role) and an interlocutor who will act as a patient, client, patient’s relative or carer.

Speaking sub-test structure

In each Speaking test, the doctor’s identity and profession are checked by the interlocutor and there is a short warm-up conversation about their professional background. Then the role-plays are introduced one by one and the doctor will have three minutes to prepare for each.

The role-plays take about five minutes each.

How is my Speaking ability assessed?

The whole Speaking sub-test is recorded and it is this audio recording that is assessed. • The Speaking sub-test is marked independently by a minimum of two trained OET Assessors. • Neither Assessor knows what scores the other has given the doctor, or what scores they have achieved on any of the other sub-tests. • The test day interlocutor plays no role in the assessment of the doctor’s performance. • OET Assessors’ judgements are targeted and specific, not a general evaluation of candidates’ ability in spoken English. • OET Assessors are trained to focus on how a candidate responds to the particular task on the day. They apply specific assessment criteria that reflect the demands of communication in the health professional workplace. Remember that OET is a test of English-language skills, not a test of professional knowledge.

OET test scoring

The four sub-tests that make up the OET are reported on a scale from 0 to 500 in ten-point increments (e.g. 350, 360, 370 etc). The numerical score will be mapped to a separate letter grade for each sub-test ranging from A (highest) to E (lowest).

Most recognising boards and councils require candidates to score at least 350 (grade B) in each of the four sub-tests. But to make sure you’re up-to-date with requirements, always check with the relevant boards and councils that regulate your profession.

Click here for more information on the scoring and results.

#2 IETLS (International English Testing Language System)

There are two types of IELTS – Academic and General. The recommended test to take is Academic, as this is specifically for those applying for higher education or professional registration.

Where can I take the test?

The test is available in over 1,600 locations in more than 40 countries. Click here for more information.

How is the test structured?

The test includes sub-tests for Listening, Reading, Writing and Speaking. The Listening, Reading and Writing sections of all IELTS tests are completed on the same day, with no breaks in between them. The Speaking section, however, can be completed up to a week before or after the other tests. The chosen test centre will advise. The total test time is 2 hours and 45 minutes.

Listening

The Listening sub-test consists of four recordings to be listened to which are referred to as Part 1, 2, 3 and 4. The overall test equates to around 30 minutes.

Sub-test structure

There are four parts with ten questions each. The questions are designed so that the answers appear in the order they are heard in the audio. The first two parts deal with situations set in everyday social contexts.

Part 1: The doctor will listen to a conversation between two speakers (for example, a conversation about travel arrangements). Part 2: This section is a monologue in an everyday social context (for example, a speech about local facilities).

The final two parts deal with situations set in educational and training contexts.

Part 3: This is based on a conversation between two main speakers (for example, two university students in discussion, perhaps guided by a tutor) Part 4: The recording will be a monologue based on an academic subject. The recordings are heard only once. They include a range of accents, including British, Australian, New Zealand, American and Canadian.

How is my Listening exam scored?

The Listening test is marked by certificated markers, who are regularly monitored to ensure their reliability. All answer sheets, after being marked, are further analysed by Cambridge Assessment English.

Band score conversion

A Band Score conversion table is produced for each version of the Listening test which translates scores out of 40 into the IELTS 9-band scale. Scores are reported in whole bands and half bands.

One mark is awarded for each correct answer in the 40-item test. Care should be taken when writing answers on the answer sheet as poor spelling and grammar are penalised.

Reading

The Reading sub-test consists of 40 questions, designed to test a wide range of reading skills. These include reading for gist, reading for main ideas, reading for detail, skimming, understanding logical argument and recognising writers’ opinions, attitudes and purpose.

IELTS Academic test - this includes three long texts which range from the descriptive and factual to the discursive and analytical. These are taken from books, journals, magazines and newspapers. They have been selected for a non-specialist audience but are appropriate for people entering university courses or seeking professional registration.

The test is carried out in 3 parts and the total text length is between 2,150–2,750 words which should take around 60 minutes (including transfer time).

How will my Reading ability be assessed?

The Academic Reading test is marked by certificated markers, who are regularly monitored to ensure reliability. All answer sheets, after being marked, are further analysed by Cambridge Assessment English.

Band score conversion

A Band Score conversion table is produced for each version of the Academic Reading test, which translates scores out of 40 into the IELTS 9-band scale. Scores are reported in whole bands and half bands.

Writing

The Writing sub-test is structured in two tasks. Of which topics are of general interest to, and suitable for, test takers entering undergraduate and postgraduate studies or seeking professional registration. The test should take around 60 minutes.

Task 1: The doctor will be presented with a graph, table, chart or diagram and asked to describe, summarise or explain the information in your own words. They may also be asked to describe and explain data, describe the stages of a process, how something works or describe an object or event.

In Task 1, test takers are asked to describe some visual information (graph/table/chart/diagram) in their own words. They need to write 150 words in about 20 minutes.

Task 2: They will then be asked to write an essay in response to a point of view, argument or problem. Responses to both tasks must be in a formal style. In Task 2, they respond to a point of view or argument or problem. They need to write 250 words in about 40 minutes.

How will the Writing ability be assessed?

Each task is assessed independently. The assessment of Task 2 carries more weight in marking than Task 1. Responses are assessed by certificated IELTS examiners. All IELTS examiners hold relevant teaching qualifications and are recruited as examiners by the test centres and approved by the British Council or IDP: IELTS Australia.

Scores are reported in whole and half bands. Detailed performance descriptors have been developed which describe written performance at the nine IELTS bands. These are available on the How IELTS is scored page. They apply to both IELTS Academic and IELTS General Training versions and are based on the following criteria.

Task 1 responses are assessed on:

• Task achievement

• Coherence and cohesion

• Lexical resource

• Grammatical range and accuracy.

Task 2 responses are assessed on:

• Task response

• Coherence and cohesion

• Lexical resource

• Grammatical range and accuracy.

Performance descriptors

Task 1

Task achievement

This assesses how appropriately, accurately and relevantly the response fulfils the requirements set out in the task, using the minimum of 150 words. Academic Writing Task 1 is a writing task which has a defined input and a largely predictable output. It is basically an information-transfer task that relates narrowly to the factual content of an input diagram and not to speculative explanations that lie outside the given data.

Coherence and cohesion

This concerns overall clarity and fluency: how the response organises and links information, ideas and language. Coherence refers to the linking of ideas through logical sequencing. Cohesion refers to the varied and appropriate use of cohesive devices (for example, logical connectors, pronouns and conjunctions) to assist in making the conceptual and referential relationships between and within sentences clear.

Lexical resource

This refers to the range of vocabulary used and its accuracy and appropriacy in terms of the specific task. Grammatical range and accuracy

This refers to the range and accurate use of grammar as manifested in their sentence writing.

Task 2

Task response

In both IELTS Academic and IELTS General Training versions, Task 2 requires test takers to formulate and develop a position in relation to a given prompt in the form of a question or statement. Ideas should be supported by evidence, and examples may be drawn from the test takers’ own experience. Responses must be at least 250 words in length. Scripts under the required minimum word limit will be penalised.

Coherence and cohesion

This assesses the overall clarity and fluency of the message: how the response organises and links information, ideas and language. Coherence refers to the linking of ideas through logical sequencing. Cohesion refers to the varied and appropriate use of cohesive devices (for example, logical connectors, pronouns and conjunctions) to assist in making the conceptual and referential relationships between and within sentences clear.

Lexical resource

This criterion refers to the range of vocabulary used and its accuracy and appropriacy in terms of the specific task.

Grammatical range and accuracy

This assesses the range and accurate use of grammar, as manifested in their test takers’ writing at sentence level.

Speaking

The Speaking sub-test consists of an oral interview between the test takers’ and an examiner. All Speaking tests are recorded. This should take around 11-14 minutes.

Speaking sub-test structure

Part 1: The examiner will ask the doctor general questions about themselves, as well as a range of familiar topics, such as home, family, work, studies and interests. This part lasts between four and five minutes.

Part 2: They will then be given a card which asks them to talk about a particular topic. They will have one minute to prepare before speaking for up to two minutes. The examiner will then ask one or two questions on the same topic.

Part 3: After this, the doctor will then be asked further questions about the topic in Part 2. These will give them the opportunity to discuss more abstract ideas and issues. This part of the test lasts between four and five minutes.

How will my speaking be assessed?

Speaking performances are assessed by certificated IELTS examiners. All IELTS examiners hold relevant teaching qualifications and are recruited as examiners by the test centres and approved by the British Council or IDP: IELTS Australia.

Scores are reported in whole and half bands. Detailed performance descriptors have been developed which describe spoken performance at the nine IELTS bands. These are available on the How IELTS is scored page.

Fluency and coherence

This refers to the ability to talk with normal levels of continuity, rate and effort and to link ideas and language together to form coherent, connected speech. The key indicators of fluency are speech rate and speech continuity. The key indicators of coherence are logical sequencing of sentences, clear marking of stages in a discussion, narration or argument, and the use of cohesive devices (e.g. connectors, pronouns and conjunctions) within and between sentences. Lexical resource

This criterion refers to the range of vocabulary used and the precision with which meanings and attitudes can be expressed. The key indicators are the variety of words used, the adequacy and appropriacy of the words used and the ability to circumlocute (get round a vocabulary gap by using other words) with or without noticeable hesitation.

Grammatical range and accuracy

This refers to the range and the accurate and appropriate use of the test takers’ grammatical resource. The key indicators of grammatical range are the length and complexity of the spoken sentences, the appropriate use of subordinate clauses, and the range of sentence structures, especially to move elements around for information focus. The key indicators of grammatical accuracy are the number of grammatical errors in a given amount of speech and the communicative effect of error.

Pronunciation

This criterion refers to the ability to produce comprehensible speech to fulfil the Speaking test requirements. The key indicators will be the amount of strain caused to the listener, the amount of the speech which is unintelligible and the noticeability of L1 influence. More information on IELTs and it’s format can be found here.

IELTS test scoring

The doctor must complete the academic version of the IELTS test and achieve:

• At least 7.0 in the listening and reading sections

• At least 7.0 in the writing and speaking sections

• At least 7.5 (out of a possible 9) overall

The GMC will not accept applicants who score lower than this standard and the IELTS scores are valid for two years.

For more information on the IELTs results and scoring please click here.

#3 Primary Medical Qualification taught in English

As well as the two options mentioned above, the GMC also accepts a primary medical qualification as evidence – however, this must have been taught or examined in English.

If the qualification was awarded by a University then please click here and scroll down to see if the University is stated on their list of acceptance. If your awarding body does not appear on the list, it does not mean that they will accept a letter from it as evidence of English. GMC will assess it and may accept it as evidence of the doctor’s knowledge of English if it meets the criteria stated below.

When can you use your primary medical qualification as acceptable evidence?

They may accept the doctor’s primary medical qualification if it:

• is less than two years old when you apply for registration, and

• was taught and examined solely in English.

The doctor will then need to email the GMC a letter or certificate from their university or medical college that confirms:

• all of the course, including clinical activities, was taught and examined solely in English

• at least 75% of any course related clinical interaction, including personal contact with patients, their families and other healthcare professionals, was conducted in English i.e. without any translation support

• the date you passed your final exam

Additionally to this, they may be able to accept an offer of employment if the doctor is applying for registration.

However, if they are applying to take the PLAB test or applying for registration with an offer of sponsorship, they can’t use their offer of employment to demonstrate their knowledge of English.

They can only use their offer of employment as evidence of their English knowledge if it is from a UK healthcare organisation. This organisation must be a designated body.

The UK employer should email them a completed English language reference form from the doctor who appointed the doctor applying to register. The reference should meet all of the criteria as documented in the form guidance.

In our next blog we will provide information on the PLAB tests and how you can acquire them if you haven’t already.