Language Matters: Development of an Objective Structured Language Test for Foreign Physicians - Results of a Pilot Study in Germany

Objective: To develop a scientifically sound and standardized medical language examination for the State of Bavaria according to the requirements set forth by the 87th Conference of State Health Ministers. This Sprachtest für Ausländische Mediziner (SAM, Language Test for Foreign Physicians) ought to become part of the licensing procedure for foreign physicians in Germany. Using testing stations that are situation-based, it will assess medical language competence and communication skills at the proficiency level of C1. Methods: Case scenarios for four mini-interviews of 10 minutes each were developed. For the written part of the exam, consisting of two separate testing stations with a combined duration of 40 minutes, one video of a physician taking a patient's history and one annotated set of laboratory results were developed. Based on the analysis of existing scientific literature as well as real-life examples, features and characteristics of professional medical language were identified. This served as the basis for the development of itemized rating scales for each of the testing stations. The exam was validated in three simulated trial runs. Each run was video-recorded and subsequently graded by a team of test-raters. Results: 19 participants took part in the three trial runs. A benchmark (gold standard) could be set for 18 of these. A ROC-analysis yielded an AUC-value of .83. This confirmed the predictive quality of the SAM-test. The reliability of the SAM-test could be calculated for only ten participants. The internal consistency, calculated with the use of Cronbach's Alpha, was .85. The pass/fail mark was calculated based on the Youden-Index and yielded a result of >60%. Conclusion: The SAM-test presents a statistically valid medical language examination with a high level of objectivity. As required, it tests language proficiency at the level of C1 and uses authentic communication scenarios within a standardized test setting. Additional studies with larger test samples will help to further validate this test and thus guarantee a higher degree of reliability.