For medical professionals - nurses and doctors in particular - aspiring to work in foreign countries where English is the native language, passing the International English Language Test System (IELTS) is among the requirements before being accepted for employment.

One of the world's most popular English tests for non-native English speakers, it assesses an individual's communication competency based on their reading, writing, listening and speaking skills.

IELTS is recognized in 9,000 organizations globally such as schools, universities, employers, immigration authorities and professional bodies. Aside from the United States, it is also used in Australia, Canada, New Zealand and the United Kingdom.

In 2015, an estimated 2.7 million took the IELTS.

While it appears to be a simple examination, it has been identified as a "stumbling block" for many Filipino nurses seeking to work overseas. IELTS demands a high level of English language proficiency uniformly in different language medium areas. 

To illustrate this, the Express & Star once reported that only 8 out of 220 Filipino nurses passed the IELTS to work in Wolverhampton hospitals in the U.K. 

Rundown of the basics

For all intents and purposes, the test is fair for all takers and actively avoids cultural bias. It is widely available worldwide with 1,100 locations. There could be 48 test dates annually.

IELTS has two formats - Academic and General Training. The academic version is for those who are pursuing higher education in universities and professional pathways. Nurses and doctors take this exam format.

Meanwhile, the general training version is for those who will undergo training, are aiming to gain work experience, and for those eyeing migration.

IELTS itself has four parts, each for Listening, Reading, Writing and Speaking – collectively taken for around 3 hours.

For the Listening module, test takers will listen to a conversation playing in an audio device. The audio clip will only be played once so paying close attention to it is very crucial. This runs for about 20-30 minutes. The Reading Module is accomplished for an hour with 40-item questions spread in three sections. Needless to say, an important factor to consider is the time constraints.

The Writing Module part asks the test takers to answer two questions under an hour, and according to a source, is categorized based on grammar, vocabulary, task-attainment, and cohesion. Likewise, the Speaking Module is based on fluency, grammar, pronunciation, and vocabulary.  

IELTS grading

Each of the four testing areas are given individual scores, ranging from 0 to 9, after which a collective score will be computed and shall become the IELTS band score - the overall score - also ranging from 0 to 9.

Technically, there is really no pass or fail score. Institutions decide on their own overall score requirements, with 9.0 as the highest possible score. However, many institutions set a band score of 7.0 to pass.

IELTS a stumbling block for Filipino nurses

IELTS a stumbling block for Filipino nurses

One 2016 IELTS test taker, who spoke to MIMS on condition of anonymity, has confirmed that the exam is indeed very rigorous. The taker's best effort fell short by point five (0.5) of the required grade to pass the English exam.

Had she passed the test, she would have been headed for the United Kingdom or Northern Ireland, both of which usually require a band score of 7.0, but also require that individual scores in Reading, Listening, Writing and Speaker also be at least 7.0. While she did score 7.0 in all other tests, she only got 6.5 for the Writing part.

A taker who scored ‘0’ may mean s/he did not attempt to take the test at all; ‘1.0’ is described as “essentially no ability to use the language beyond possibly a few isolated words, while ‘9.0’ is described as ‘Expert User’ with the taker supposedly having full operational command of the language, uses it appropriately, accurately, and is fluent with complete understanding.

The most often required mark, ‘7.0’ means the taker is a ‘Good User’ who has “operational command of the language,” though s/he may experience “occasional inaccuracies, inappropriateness and misunderstandings in some situations.”

A score of 7.0 means that the taker can handle complex language and can understand detailed reasoning.

“It’s not what it seems,” she said, “it only looks easy, [like a sumple English comprehension test] but it’s actually not.” She mentioned that time pressure was a big factor in the exams. She even went as far to note that preparing for IELTS requires nearly the same (or equal) amount of preparation as the local board exam NLE  [Nurse Licensure Examination].

Like many others, she opted to sign up for a review programme to get coaching on the rigorous exam. Review programmes usually cost Php 6,000. This is on top of the IELTS fee, which costs a hefty PhP10,000 for the regular Academic IELTS. She paid more, Php 13,000, for the test she took, which is the UK-centred IELTS, or the IELTS-UKVI (United Kingdom Visas and Immigration).

She told MIMS it was very hard not to be disappointed after seeing her test results, saying, " You'd think your efforts were not enough."

Fortunately for her, she can take the IELTS exam again, and hopefully get the required score then. On the downside, she needs to pay the fees again, although she will just opt for the regular Academic IELTS, not the IELTS-UKVI to reduce her expenses.

Relaxed rules

The UK’s Nursing and Midwifery Council (NMC), which uses IELTS and requires a band score of 7.0 and 7.0 on all the other sub-test areas, has relaxed their policy to give way to a more inclusive measure for nurse-applicants to get in without compromising their required score.

Those who failed to get all the required 7.0 scores on all areas during the first take may undergo an IELTS retake within six months provided that they will achieve the required scores on either of the exam takes with no grade lower than 6.5.

Previously, a 6.5 grade in any of the areas (Reading, Writing, Listening, and Speaking) will deem a test-taker unqualified for NMC, according to the source.

But now, the council is allowing test-takers who got 6.5 in their first exam (in any of the language areas) to have an IELTS retake and just earn a 7.0 where they originally incurred a 6.5 score.

And if they happen to get a 6.5 score in any of the language areas in the retake, NMC will still accept their application, provided that they originally got a score of at least 7.0 on that particular area during their first take and that they presented no grade lower than 6.5 in either of the exams taken.

It means test-takers are allowed to submit two IELTS test certificates to NMC, with all areas showing a grade of 7.0 (either in the first or second test) and none lower than 6.5.

For example, a test taker who scored 7.5 in Reading, 7.0 in Listening, 7.0 Speaking, but 6.5 in Writing during the first take but scored 7.0 in Reading, 6.5 in Listening, 8.0 in Speaking, and 7.5 in Writing on the second take will still be accepted, even if she has a grade of 6.5 on her second take.  This is because the test-taker presented a grade of 7.0 in all of the categories in both her tests.

However, and this is a crucial note, the test-taker must not have a grade lower than 6.5 in any of the categories in either of the exam takes.

A test-taker who got 7.0 on Listening, 7.5 in Reading, 6.0 on Writing, and 7.0 on Speaking, but scored 6.0 on Listening, 7.0 on Reading, 7.5 on Writing, and 7.5 on Speaking on the second take will not be accepted, even if the test taker presented a score of 7.0 in all of the categories, because the test taker had two 6.0 scores.

Requirements, process overview and opportunities

Documentary requirements, as per Nurseslabs, includes a completed IELTS form, a valid ID, and passport sized pictures.

According to the British Council, which facilitates the test in the country, IELTS worldwide is administered four times a month. The booking process starts with determining the format of your tests (general or academic), preparation of the needed documentation such as a valid ID or passport, then setting up of the payment method. After which, the test-taker can register online for the test date and location.

The source told MIMS that for Manila-based test takers, the location for the test is usually in a hotel, held in a convention-type of room which can accommodate hundreds of examinees.  

Relatedly, the Philippine Overseas Employment Agency (POEA) has approved about 1,000 job orders for nurses bound for United Kingdom to work in the National Health Services (NHS), according to a news report. This is due to the severe lack of nurses in NHS of which vacancies are close to 20,000.

The areas of focus are cardiology, critical care unit, cardiac surgery unit, coronary care unit, and theater practitioners. MIMS