English Language Proficiency Exam Options for Nurses
Posted Apr 26, 2003

As regular MurthyDotCom and MurthyBulletin readers will recall, health care professionals seeking U.S. permanent residence now have alternative English language exam testing options available. This was covered in our February 21, 2003 MurthyBulletin article, New English Tests for Health Care Workers. At that time, the Commission on Graduates of Foreign Nursing Schools (CGFNS) announced that the International English Language 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. The English language requirements have long been a difficult hurdle for many health care workers seeking to immigrate to the U.S. This article takes a closer look at the format and content of each exam to help nurses decide which exam they should take to satisfy the English language requirements for obtaining an employment-based visa.

TOEFL / TWE & TSE

The TOEFL measures the ability of nonnative speakers of the English language to use and understand North American English. The test is offered via computers throughout most regions of the world. In areas where access to computer-based testing is limited, a supplemental paper-and-pencil version of the test is utilized. The TOEFL and the Test of Written English (TWE) are currently administered together. The computer-based TOEFL/TWE consists of four sections: listening, structure, reading, and writing. Examinees are given 60 minutes to complete the listening section, 20 minutes to complete the structure section, and 90 minutes to complete the reading section. The writing section contains one topic, with 30 minutes allowed for essay composition.

The Test of Spoken English (TSE) is administered separately. The TSE is approximately 20 minutes long and requires the candidate to demonstrate his/her ability to communicate in English by responding orally, on tape, under timed conditions, to a variety of printed and recorded data. Further information about the TOEFL/TWE and TSE is available online.

International English Language Testing System (IELTS)

The IELTS 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 via 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 writing module, which consists of two parts. 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 rather than the taped TSE format likely may make the IELTS the favorite choice for nurse examinees. For more detailed information, a Candidate Information Bulletin is available online.

The test is offered at over 210 centers in more than 100 countries. A list of participating countries can be found on the IELTS WebSite. Most centers conduct testing at least once per month. Beginning in September 2003, IELTS will have a fixed test date format and will offer 48 test dates each year. Results are generally available within two weeks of the test.

TOEIC (Test of English for International Communication)

The Educational Testing Service (ETS) originally developed the TOEIC examination in 1979. The TOEIC is a two-hour, paper-and-pencil, multiple-choice test, consisting 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. A list of countries with a TOEIC representative is available on 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. The TWE and TSE must be taken in addition to the TOEIC to obtain a VisaScreen Certificate. Because the TWE and TOEFL are administered at the same time, a candidate effectively would have to take the TOEIC, TOEFL/TWE, and TSE to satisfy the VisaScreen requirements. Therefore, there currently is no benefit for foreign educated nurses to take the TOEIC, but, as TOEIC continues to make changes to its testing paradigm, candidates are advised to keep this third testing option in mind.

Conclusion

At present, the TOEFL / TWE / TSE or the IELTS are the best options in order to avoid additional testing for completing the VisaScreen process. Tutoring for these various programs is available through test preparation companies and individuals who have taken the exams previously. If a nurse has any concerns about the English test requirements, s/he may wish to find a tutor to improve her/his chances of eventually obtaining the CGFNS Certificate and/or VisaScreen.