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SPEAKING SUB-TEST

TIPS AND SKILLS

 

Overall Communicative Competence

One of the categories the assessors use to judge the English level of candidates is “Overall Communicative Competence”. For this criterion, you need to demonstrate your ability to handle a typical conversation between you as a health professional and the interviewer as a patient. This means you must lead the conversation based on the role-play scenario on your card. You must ask questions clearly to find out the patient’s condition and /or main concern. You must also respond appropriately to questions from the patient (interviewer).


Do I need to follow the card completely?
No you do not, although it is obviously very useful as a guide regarding the direction the consultation will take. What you need to do is spend 2 or 3 minutes reading the card, as allowed in the exam format. Use this time carefully to plan your role-play, and underlining the important parts of the role-play. This includes

• Identifying the setting
• Making notes of any important points regarding the patient’s medical history
• Identifying the main concerns of the patient
• Identifying what the task requires you to do

Be patient rather than card focussed
Once you are ready, begin the role-play in the appropriate manner. The key points is, try to not be too focussed at this stage on the content of your card. Focus your attention on the patient and respond to their condition and concerns. There is a danger that if you pay too much attention on what your card says then you may not respond to what the patient says. If you focus on your card and not the patient you will find it difficult to have a meaningful conversation with the patient. Remember, the card is used as a guide only, and once in the role-play respond as naturally as possible to the patient and let your instincts take over. If you do this, the task will take its natural course. Also remember, the interviewer has a role to play as a patient so you need to respond to their questions.

Another important point is not to talk over the patient. If they interrupt you, you have to allow this and respond to their question. Although it is expected that you do 75% of the talking, (as it is your English that is being assessed not the interviewers!) it is not good for you to talk continuously. So when explaining important points, ask questions to the patient and seek clarification to ensure they are following what you say. See functions of language for examples of how to do this.

Talk to the patient rather than at the patient
You need to demonstrate your ability to talk to a real person and show compassion for their situation.

Remember, although you may have the medical knowledge to advise the patient, always do this in the context of their unique situation, which is far better than just talking in general or “from the textbook” The way to do this is to ask questions then respond to the patients comments based on your medical knowledge. For example if you are dealing with a child who has eczema, and you may know that there are various factors which can cause this condition such as animal hair, woollen clothes etc, do not say: Ensure that your child does not come in contact with pets and avoid using woolen clothes and soaps. This may be correct advice, but is far better to asks questions to determine the environment of the patient. So you could have a dialogue as follows:

First, as I said, the rash might be related to allergy and irritation, so please avoid things that may irritate the skin, like soaps.
Have you noticed any itchiness after bathing your son?

Animals hair is another irritant. Do you have a pet? / Does your son come in regular contact with animals?


In this way, rather than delivering your speech in a monologue, you will be having a meaningful conversation with the patient, and offering advice based on the specific context of their situation, rather than just speaking in general terms, which may not be relevant to their situation.

Whose job is it to keep the conversation moving?
It is also important that as a medical professional, you lead in the role play. That means you need to begin and end the role-play and if the patient is silent, then you need to fill gaps and not wait for patient as they may not say anything. It is also important to note that silence in the role-play is not a favourable thing from the candidates point of view as it can indicate that you are not in control of the interview. So always be prepared to keep the conversation moving.

Intelligibility

This refers to how clearly you speak and can be broken down into the following categories:

• Pronunciation
• Intonation
• Syllable and word stress
• Rhythm

While you are not expected to speak like a native speaker, it is expected that what you say can be clearly understood. Therefore you need to ensure that you pronounce words clearly, particularly words specific to a medical consultation.
For all people from non-English speaking backgrounds there are some sounds, stress patterns or rhythm which are difficult. It is important that you identify which aspects of English are difficult for you and work hard to improve in those areas. Recording your own speech is a useful starting point.

There are a range of strategies to improve clarity of speech, but it requires dedication and determination to improve in this area, especially if your speech patterns have become “ingrained” after many years of English speaking. It is also hard if you are not living in Australia or another English speaking country. Listed below are some strategies which can help you improve in this area.

Listen and Repeat
Find podcasts which have transcripts and read aloud in time with the audio. This will help you develop rhythm, syllable and word stress as well as fluency. You should do this regularly and it will also help you improve your listening skills at the same time. Suitable websites include

• Health Minutes: http://www.abc.net.au/health/minutes/
• The Better Health Channel: http://www.betterhealth.vic.gov.au

Record your own Speech
This is a very useful technique as you once you listen to your own speech you will be able to analyse your own strengths and weaknesses and develop your skills accordingly. So practice the role-play tasks for your profession with a friend or colleague and record your role-play. Then analyse your performance. Remember, practice makes perfect!

Medical Terminology
Many medical words such as the names of various conditions are long and difficult to pronounce. A good website which features English and US pronunciation of most common medical words is:
• http://www.thefreedictionary.com/

 

Fluency

This is a challenging category especially if you are not using English on a daily basis. If your speech contains too many hesitations or pauses you will be marked down. To get a B grade or above in the exam your aim is to speak at an even and controlled speed. If fluency is a weak area for you, then practicing the scenarios often can help you become more familiar with the various stages of the role-play and what expressions are suitable for each stage. You need to practice role-play scenarios regularly so that you have the confidence to respond to the scenario and patient with a reasonable degree of fluency.


How to Increase Fluency
All role plays will be similar in that you are required to do three things:

1. Find out about the patient by taking a brief, specific history (note, there is not usually enough time to ask general questions so always focus on the situation at hand)
2. Provide information about the condition
3. Teach the patient how to manage the condition

Depending on the situation, it may be necessary to provide comfort and reassurance to the patient or even persuade the patient to do something against their wishes in order to improve their health.

Therefore you can improve fluency be becoming familiar with suitable expressions that allow you to deal with these situations. In addition, the wider range of vocabulary you have, then the more fluent you will be able to speak. See functions of language for examples of how to do this.

Another sources of good spoken language is the website:

• Health Minutes: http://www.abc.net.au/health/minutes/

Look carefully at the vocabulary and expressions used by Norman Swan and try to incorporate this into your speech. You will be surprised at what it difference it can make in a relatively short time if you work hard.

How to Decrease Fluency
For some students, lack of fluency is not the problem, but rather rushed speech. If your speech is rushed or words are joined together in a non-standard manner, then the patient may not understand you. This is especially important when you are explaining complex conditions or giving important advice. In such situations, it is necessary to develop some self awareness so that you can consciously control the speed at which you deliver information. Technical words, including names of illnesses, medications and treatment methods, should not be rushed or “lost” within a sentence. A good strategy is to always ensure that the patient can follow what you say by regularly checking with them i.e Is that clear?

Appropriateness of Language

Technical Language
In this category, you are basically being tested on your ability to explain medical and technical jargon commonly used in your profession, into simple, clear language. You can be guaranteed that if you use technical language, the patient (interviewer) will ask you to explain what you mean. That does not mean you cannot use some medical terminology, it just means that you need to be ready to explain it in simple terms to the patient.

If you need improvement in this category, practice explaining a variety of conditions common to your profession in simple terms. You may find it useful to record your own speech and do this on a regular basis. Again, you will find the old adage: “Practice makes Perfect” is the key to success.

Don’t be too Formal
Although a consultation is a formal situation, it is very common to use casual and natural expressions when talking to a patient. This will help the patient to feel comfortable and at ease. This will also make it easier to provide reassurance or comfort if required or gentle persuasion. Always aim to speak in a friendly, clear and positive voice.

Don’t be too Casual
The role-play is a formal situation in that you are not friends with the patient. You may also be dealing with an elderly patient so it may good to speak in a respectful manner.
Some inappropriate expressions if overused include:

• yeah Vs yes
• wanna Vs would like to
• gonna Vs going to

Gender
A common error is incorrect use of pronouns. Him /his when the patient is a female or her/hers when the patient is a male. If you have difficulties with pronouns, write them down in large letters on your role-play card as a reminder!

Resources of Grammar and Expression

This relates to how accurately you speak. To achieve a B score you will need to demonstrate good grammatical control in your speech. You can improve your grammar and sentence structure by writing out dialogues for for various scenarios common to your profession and have them checked by your teacher or a native speaker friend. See functions of language for examples of how to form suitable sentences.
Below are a list of common errors which you should study carefully so that you can avoid them in your own speech.

 

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