Early in 2003, the Commission on Graduates of Foreign Nursing Schools (CGFNS) announced that the International English Testing System (IELTS) and the Test of English in International Communication (TOEIC) would be accepted as alternatives to the Test of English as a Foreign Language (TOEFL) for health care workers. What follows is an in-depth look at the format and content of each exam to help allied health care professionals decide which exam to take to satisfy the English language requirements for obtaining an employment-based visa.

TOEFL & TOEFL iBT

The Test of English as a Foreign Language (TOEFL) measures the ability of nonnative speakers of English to use and understand North American English. The TOEFL test is offered in different formats, including on paper, depending on the test-taker's location, but is now offered via computer throughout most regions of the world. The TOEFL Internet-based Test (TOEFL iBT) tests all four language skills that are important for effective communication: speaking, listening, reading, and writing. The TOEFL iBT was first introduced in the United States, Canada, France, Germany, Italy, and Puerto Rico in 2005. In March 2006, it opened its test centers in several other countries in limited locations. There are some countries, however, which do not have scheduled TOEFL iBT introduction dates. Further information about the TOEFL / TOEFL iBT is available on their WebSite.

IELTS

The IELTS (International English Language Testing System) is a European & Australian English language skills test jointly administered by the University of Cambridge ESOL Examinations, the British Council, and IDP Education Australia. IELTS provides a complete assessment of reading, writing and speaking proficiency, and scores from the IELTS alone satisfy both the CGFNS Certificate and VisaScreen requirements.

IELTS is available in two formats – Academic and General Training. Nurses are required to take the Academic format. Candidates are tested in listening, reading, writing and speaking. The listening, reading, and writing modules are administered by paper-and-pencil. During the 30-minute listening module, examinees listen to a recorded mixture of monologues and conversations. The recording is heard once and the examinees are given time to read questions and mark their answers. The reading module takes 60 minutes and requires the examinee to read passages and respond to questions. Examinees have 60 minutes to complete the two-part writing module. First, the candidates write a report of approximately 150 words based on material presented in a table or diagram. Next, examinees write a short essay in response to an opinion or problem. The speaking module takes between 11 and 14 minutes and consists of an oral interview between the candidate and an examiner. The ability to communicate with a live examiner may make the IELTS the favorite choice for nurse examinees.

TOEIC

The TOEIC test was originally developed in 1979 by the Educational Testing Service (ETS). The TOEIC test is a two-hour, paper-and-pencil, multiple-choice test that consists of 200 questions divided into two, separately-timed sections; one for listening and one for reading. A more detailed analysis of each section can be found on the TOEIC WebSite.

Open public sessions of the exam are offered approximately once every six weeks at centers worldwide. The TOEIC has a more limited offering of testing centers than the IELTS. For a list of countries with a TOEIC representative, visit the TOEIC WebSite.

Although accepted by CGFNS, the TOEIC Exam presently poses a severe limitation for nursing candidates. The TOEIC exam does not test spoken English proficiency. As a result, a score from the TOIEC exam alone satisfies the language requirement for the CGFNS Certificate, but does not satisfy the language requirement for the VisaScreen. As a result, there is currently no benefit for foreign educated nurses in taking the TOEIC, but as changes are made to the TOEIC testing paradigm, this option may become more attractive at a future date.