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Medical schools, programs and educators are increasingly expected to address medical student stress and wellbeing, yet also ensure student competence and fitness to practice. Educators play a central role in supporting students when evaluating a student's concerns and in deciding whether support and/or sanction should be offered. It is not known how educators approach or resolve such potentially contradictory responses. We conducted an interview study of 21 medical educators from a range of professional backgrounds across 11 on-campus and clinical teaching sites. Using Positioning Theory to inform our thematic analysis, we found that participants adopted an overarching position of Diagnostician, and at times, two alternative positions, the Judge and the Confidant when supporting students. In their narratives of support encounters, individual students were positioned as Good Students or Troubling Students. For most, educator positions were fluid and responsive to the storylines enacted in encounters. Rigidly adopting Judge or Confidant positions could lead to "failure to fail" and violations of professional boundaries. Positioning Theory locates student support in a moral space and helps explain the consternation experienced by educators when support is not effective. Positioning analysis offers a language, and metaphors which are meaningful to educators, for framing discussion and reviews of support practices and progression decisions. Such insights could encourage reflective practice and guide further research to inform practice when students with troubling concerns and persistently borderline performances require support.

In many Western countries such as Australia, international medical graduates (IMGs) play a crucial role in meeting health workforce needs. For doctors for whom English is an additional language and who have received their medical education in non-Western settings, a challenge is the patient-centred approach to communication, which is well established in Western medical education as the optimal approach for safe and effective healthcare. It acknowledges the patient as an active participant in the healthcare interaction, and the importance of the psychosocial dimension of patient well-being. While there is a vast literature on doctor-patient discourse in the qualitative health literature, there is little in the medical education domain that systematically examines the linguistic patterns of doctors who are learning or are less familiar with patient-centred paradigms of communication. This article examines how IMG doctors manage patient-centred interviewing. The data are 15 video-taped 8-minute roleplay consultations of IMGs and simulated patients. Systemic functional linguistics and genre theory provided the theoretical framework and tools to analyse how the doctors realised the tasks of patient-centred communication as informed by the medical education literature, with a particular focus on the tasks of gathering information, providing information and decision-making. The findings suggest that the discourse patterns of doctor-patient communication demonstrated by the IMG doctors were towards a model of patient-centred communication; that is, aspects of the communication resonated with the features of patient-centred communication. However, valued aspects such as seeking patient perspectives and eliciting and validating patient emotions were either not given discursive prominence or were largely absent. Medicalised language featured in the doctor talk to explore sensitive behaviours or topics. The findings provide insights for medical educators into how IMG doctors from non-Western educational contexts might interpret the communication demands of patient-centred care.

The aim of this paper is to investigate from a discourse analytic perspective task authenticity in the speaking component of the Occupational English Test (OET), an English language screening test for clinicians designed to reflect the language demands of health professional-patient communication. The study compares the OET speaking sub-test roleplay performances of 12 doctors who were successful OET candidates with practice Objective Structured Clinical Examination (OSCE) roleplay performances of 12 international medical graduates (IMGs) preparing for the Australian Medical Council clinical examination. The premise for the comparison is that the OSCE roleplays can represent communication practices that are valued within the medical profession; therefore a finding of similarity in the discourse structure across the OET and the OSCE roleplays could be taken as supporting the validity of the OET as a tool for eliciting relevant communication skills in the medical profession. The study draws on genre theory as developed in Systemic Functional Linguistics (SFL) in order to compare the roleplay discourse structure and the linguistic realizations of the two tasks. In particular, it examines the role relationships of the participants (i.e. the tenor of the discourse), and the ways in which content is represented (i.e. the field of the discourse) by roleplay participants. The findings reveal some key similarities but also important differences. Although both tests inevitably fall short in terms of authentic representation of real world interactions, the findings suggest that the OET task, for a range of reasons including time allowances, training of test interlocutors, and the limits of contextual information provided to candidates, constrains candidate topic exploration and treatment negotiation, compared to the OSCE format. The paper concludes with proposals for mitigating these limitations in the interests of enhancing the OET's capacity to elicit more professionally relevant language and communication skills.

The gap between linguistic and professional criteria is a widely acknowledged but unresolved issue in the teaching and assessment of languages for specific purposes (LSP). In the teaching of professional writing, language experts and workplace professionals have been characterized as living worlds apart with respect to their views of communication. Likewise, in testing contexts, a number of studies have shown significant divergence in judgements between the language experts who traditionally assess performance on LSP tests and those with experience of the relevant professional context. It has been argued that if LSP tests are to act as proxies for the demands of communication faced by candidates entering the workforce, then the judgements of such professionals should not be ignored. The preliminary study reported in this article is part of a larger research project relating to a specific-purpose English language test for overseas-trained health professionals (HPs): the Occupational English Test (OET). The larger project is designed to validate both the criteria against which candidates are assessed on this test and the performance standards required for registration. The OET, a four-skill test, is recognized by 12 health professions as a mechanism for ensuring adequate language skills for nonnative-English-speaking applicants for entry to the profession. Test performances on the OET are currently rated against a common set of essentially linguistic criteria: (1) intelligibility; (2) fluency; (3) appropriateness of language; (4) resources of grammar and expression; and (5) overall communicative effectiveness. These criteria, although applied by highly trained language specialists, may nevertheless differ from those which HPs see as essential for effective healthcare communication. Moreover, the appropriateness of the passing standards on the OET required in terms of these criteria are the subject of ongoing debate, with concerns that HPs with a non-English-speaking background may pass the test but nevertheless struggle with interactions in the clinical setting. Tests like the OET thus bear a heavy burden of responsibility for making decisions affecting the careers of candidates and the people for whom they are subsequently responsible. Further investigation of the test's claim to form a valid basis for determining professional entry could therefore be seen as an ethical imperative. This report focuses on findings from the first phase of the project designed to probe views of spoken communication by three groups of HPs: (1) doctors; (2) nurses; and (3) physiotherapists. It elicits these views by analyzing clinical experts' (clinicians with an HP education role) feedback on instances of trainee-patient communication proffered "independently" of the test setting. (Contains 2 tables.)

The recently published article "English Proficiency Tests and Communication Skills Training for Overseas-Qualified Health Professionals in Australia and New Zealand" (Wette, 2011) aims to address perceived problems and misconceptions associated with the testing of English language skills and professional communicative competence of overseas-trained health professionals (HPs). In this response, the authors point to the questionable nature of a number of claims put forward by Wette. The main point that Wette seeks to make in her commentary is that the assessment of and support provided for overseas-qualified HPs is currently inadequate. Although the authors agree that support is often lacking, they suggest that her arguments regarding the assessment of overseas-qualified HPs warrant closer scrutiny. Wette asserts that registration bodies use language proficiency tests "as their sole measure of communicative ability and mastery of relevant professional discourses in healthcare contexts." The authors contend that this is not in fact the case. It would be more accurate to say that the registration bodies assess English language proficiency using recognised tests but that "mastery of relevant professional discourses in healthcare contexts" is not assessed by those tests. It is certainly a matter of concern if registration bodies presume that English proficiency tests are assessing the professional communication skills of their registrants, but the situation is complex. Language tests alone may well not provide sufficient evidence of HPs' work-readiness; however, this is not the remit of the tests, as they were neither designed for this purpose nor sanctioned for it by the registration bodies. The authors concur with Wette's conclusion that there may be a need for diagnostic assessment by both language and health specialists and for more ongoing training to help overseas-qualified HPs assimilate to the requirements of their new working environment, not only in the bridging program but also in the workplace. However, there is equally a need to retain English language proficiency tests to help to establish whether HPs entering such training have sufficient language skills to be able to derive benefits from it. It is essential in this cross-disciplinary field that there is recognition of the purpose and value of all the various elements of assessment and training required to promote the successful integration of overseas-qualified HPs into the Australian workplace.

Awareness of how different cultural beliefs may influence one's own and others' linguistic choices is fundamental to successful spoken communication, particularly in intercultural professional settings such as contemporary healthcare. The aim of this paper is to outline how this sensitivity can be enhanced through teaching that develops reflectiveness as practice for analyzing and understanding the interrelationship of language, communication and culture. The setting is an intercultural ESP learning context supporting international students in undergraduate medical and health sciences education. A multimedia tool was developed as a trigger for the teacher to assist learners to explore, understand, and take into account the interrelationship between language, culture and communication in healthcare settings. The multimedia tool includes a series of "voxpop" style interviews with students to give voice to the students' perceptions and experiences of their clinical experience in Australia. Simulated interactions of these ESP learners in clinical settings provide triggers for classroom discussion, build reflective practice skills, and develop the requisite language competence and clinical communication skills. The discussion includes strategies for implementation and evaluation of the multimedia supported methodology.

One broad goal for English for Academic Purposes students is to learn to write effectively so they can succeed in their chosen academic studies. The teaching of academic writing sensitive to context and texts has benefited from disciplinary based writing studies, allowing EAP teachers and their students to become better informed about the valued writing practices of various disciplines. A further development in this area can be gained by investigating from a linguistic perspective the role of writing for learning in those disciplines. This paper reports on a longitudinal study which mapped from a lexicogrammatical perspective how L[subscript 1] education students' writing developed as their disciplinary knowledge increased. Systemic functional linguistics provided the theoretical framework for the study and the analytical tools. Reasoning and explaining, reporting and engaging with knowledge claims, and engaging with the discipline as a future practitioner were intrinsic to the learner discourse of education in this study. The contextualised descriptions of the lexicogrammatical choices the students made in their writing provide authentic disciplinary examples for EAP writing teachers. These resources will allow EAP teachers and their students to examine writing not only from the perspective of learning to write, but from the perspective of writing to learn in the discipline. (Contains 1 figure and 6 tables.)

Teachers of English for Academic Purposes (EAP) and academic language and learning advisors have long recognised the importance of developing students' academic vocabulary for successful writing and learning at university. There is little, however, in the EAP literature on the place of teaching and learning discipline specific vocabulary, despite the growing attention paid to differences in disciplinary discourses in the EAP field. This paper aims to raise awareness of the role of the specialist language of academic disciplines in learning disciplinary knowledge. It identifies the nature of specialist language in a learner discourse of one academic discipline as well as examines how students incorporate this specialist language in their writing as their disciplinary knowledge increases. The data are drawn from a longitudinal study of undergraduate Education students' writing. The students' incorporation of specialist language in their writing is explored through the concepts of technicality and abstraction as they have been developed within systemic functional linguistics. The findings from this study show that learning specialist knowledge in pre-service teacher education involves adopting technical terms as well as coming to terms with the abstract dimension of the discourse. This paper also provides an analytical tool which can be adapted for examining the ways in which language represents experience in academic discourses. This analytical tool can assist academic language researchers and teachers to investigate variation in disciplinary discourses beyond the level of text organization and purpose so as to inform the teaching of specialist language. (Contains 3 figures and 3 tables.)

Language and learning advisers and non-English speaking background (NESB) postgraduate students negotiate complex territory when working together to improve students' texts. However, the individual writing consultation is sometimes conceptualised one-dimensionally by faculty as a form of editing. The writing consultation with NESB postgraduate students has also received only sporadic attention in the higher education literature. This paper provides a contextual, discourse analytical account of one writing consultation between a faculty-based language adviser and a Master of Public Health NESB student. The findings show that the consultation was a dynamic exchange during which a range of meanings were negotiated. The findings also show that the adviser scaffolded the student's academic writing and learning in a number of ways. More research is needed in different teaching contexts and at various stages of students' writing in order to provide a greater understanding of the writing support consultation to inform guidelines for providing individual language support to NESB postgraduate students. (Contains 1 note.)

Classroom discourse analysis has contributed to understandings of the nature of student-teacher interactions, and how learning takes place in the classroom; however, much of this work has been undertaken in teacher-directed learning contexts. Student-centred classrooms such as problem-based learning (PBL) approaches are increasingly common in professional disciplines such as the health sciences and medicine. With the globalisation of education, health science and medical education, PBL classrooms are often sites of considerable linguistic and cultural diversity, yet little is known from a classroom discourse perspective about the language demands of PBL. This paper examines the ways in which the students and tutor negotiate and construct meanings through language in one first year physiotherapy PBL tutorial at an Australian university, with a particular focus on the ways in which the discourse is regulated in a student-centred learning environment. The analysis of the classroom discourse is underpinned by Halliday's systemic functional linguistics. The findings provide a description of the linguistic resources students draw on to co-construct and negotiate knowledge, as well as show how the tutor, with minimal strategic interventions, scaffolds the students' learning. The findings also suggest that the PBL environment can be a challenging one for students whose cultural and language backgrounds are different from that of the classroom. (Contains 11 tables and 1 endnote.)

This paper examines the concepts of discourse community and writing apprenticeship in the context of undergraduate education students' writing. Drawing on an integrated research methodology using marker feedback on student assignments and interview data, the paper addresses to what extent the concepts of discourse community and apprenticeship can be applied to the disciplinary context of teacher education. The findings suggest that tertiary literacy practitioners need to be critical in adopting these concepts to specific disciplinary contexts, but also that the concepts of discourse community and apprenticeship provide rich contextual frameworks for investigating the social practices that shape students' writing. Furthermore, this paper provides a detailed methodological framework for exploring the extent to which marker feedback attempts to socialise students' writing to the discursive practices of the discipline. (Contains 1 table and 2 figures.)