October 4, 2008
Subject: Dangerous shortage of pharmacists and suggested solution
Summary
The United States healthcare system is suffering from a dangerous shortage of pharmacists. Consequently, patients are at risk and vulnerable to serious injury due to the lack of pharmacists where needed.
Many pharmacists from foreign countries are technically qualified to enter the profession in the United States but are excluded due to faulty testing procedures as offered by Educational Testing Service (ETS), through its Internet - based Test of English as a Foreign Language (TOEFL iBT). It is the present sole provider of such testing. ETS is not accurate in judging the English language ability of those being tested. ETS has consistently failed to provide secure and adequate testing environments. The result is that many foreign applicants receive incorrect scores. Please see the “horror stories” attached.
A solution to the dangerous shortage of pharmacists would be to allow pharmacists from abroad to use the International English Language Testing System (IELTS) tests which include a personal (one on one) interview to ensure the quality of test results. The IELTS tests are accepted by the nursing profession as well as by many other professions and could be used to solve the present dangerous shortage of pharmacists in the United States.
Detailed Explanation
Assessment professionals agree that English as a foreign language for overseas candidates should meet five basic criteria: Validity, Reliability, Accessibility, Testing Security, and Financial Viability of test takers in developing economies (Templer, JCEPS, Vol. 2, No.1, March 2004, ISSN 1740-2743).
Valid critisms of present English as a Second Language (ESL) - TOEFL iBT testing:
1. Validity of tests:
1.1 Speak with human being/ not computer
A face to face interview is considered the best format for the speaking test since it simulates a real act. In IELTS, the tester is trained to gauge the student’s ability, and to increase or decrease the difficulty of the conversation to elicit more speech (Andrea Scott, director of graduate admissions and recruiting for the University of Minnesota-Twin Cities). The quality of a real interview is far better than the “canned” system of six prerecorded questions, presently used by TOEFL iBT. A real interview eliminates problems with tools, Internet connection, or technical factors. That interview is the main advantage of IELTS over TOEFL. TOEFL is not interactive. Candidates converse with a computer.
1.2 Non verbal communication is missing
Real world communication is both verbal and non-verbal. In person-to-person communications our messages are sent on two levels simultaneously. Sometimes non-verbal messages contradict the verbal. Often, they express true feelings more accurately than the spoken or written language (Herta A. Murphy and Herbert W. Hildebrandt, Effective Business Communication, Enotes). In fact, studies have shown that between 60 and 90 percent of a message's effect may come from nonverbal clues. Therefore, it is important for pharmacists to be aware of the nonverbal messages they send and to develop the skill of reading the nonverbal messages contained in the behavior of others.
There are three main elements of nonverbal communication: appearance, body language, and sounds. In evaluation through the recording system in TOEFL iBT, non-verbal communication is missing while judging communication ability. In addition, people from different cultures may interpret body language and appearance differently. For example, the "O.K." gesture in the American culture is a symbol for money in Japan. This same gesture is obscene in some Latin American countries. Today, some researchers put the amount of information being transmitted non-verbally even higher. Fromkin and Rodman (1983) claims that up to 90% of the meaning of a message is transmitted non-verbally (Stephan Dahl, Middlesex University Business School).
2. Test Reliability
2.1 Tests were often canceled
The TOEFL Internet based test is not reliable in terms of Internet connection, transmission errors, server, recording system, and microphone. On several occasions, candidates travel far away and stay overnight in hotels close. They go to the test centers, only to wait for six hours and hear later that the tests have been canceled due to server problems. (Please see “horror stories” attached.) ETS will ask candidates to reschedule in the next one to three months.
2.2 Tests are unscorable Often, after a long wait, candidates do not receive a score report. They contact ETS and are informed that their tests are unscorable because of a recording problem. If candidates are lucky, ETS will admit that it is ETS’s fault and give candidates a chance to take another test. However, some candidates are less fortunate and are stuck with very low scores in the reading and listening sections after receiving very high scores in these two sections in their previous tests. It must be assumed that data transmission errors occurred while taking the tests, resulting in such low scores. ETS refuses to concede that its scoring process and data transmission are flawed.
2.3 Reliability of test results
Many TOEFL iBT test takers have their tests rescored, hoping that their scores can be increased since several previous test takers received changed results after rescoring. For example, scores have been increased from 22 to 26 or 27. This phenomenon causes many test takers to rescore their tests. ETS charges $60 fee for their rescoring process. Sometimes, it takes forever to receive the score after rescoring. Some test takers received a copy of the same test score report for 42 consecutive days while others never received their scores at all. ETS mentions that a score specialist evaluates in the rescoring process.
This practice has raised questions among test takers as to whether graders of TOEFL iBT-speaking were trained properly or not. Is a TOEFL speaking score reliable? If it is, the discrepancy of scores on the same test of the same test taker is not likely to be as much as four points. All the while, the future of that candidate is at stake.
3. Accessibility on an international scale
3.1 Quality/Quantity
These two terms are always related to each other. ETS claims that the number of TOEFL iBT test centers worldwide is more than that of IELTS. How about the quality? How many test centers are secure or qualified in terms of proper testing facilities? No more than half or only a few testing facilities are in secure, quiet, and acceptable in the test taker's point of view. ETS does not supervise all of its test facilities. Again, professionals are a minority of test takers so their voices are not considered significant enough to make ETS invest in testing facilities.
3.2 The more options, the better
In general, the more English proficiency test options that are available for candidates, the better it is for the candidates. In this critical time, when American citizens are prone to medication errors because pharmacists are busier than ever, would more options for English tests allow more pharmacists to receive FPGEE certificates and help to relieve the shortage?
3.3 Difficulty with registration because of high demand
In April 2007, The Korea Times reported that Korean students were stressed by the Test of English as a Foreign Language (TOEFL) as its agency is doing a poor job of administering the tests to applicants because of a lack of preparation. Test experts as well as students are accusing ETS of failing to have anticipated the rapidly surging number of applicants.
4 Test security (Please see “horror stories” attached)
4.1 ETS has no incentive to improve testing facilities
That ETS is unable to provide a secure and standardized testing facility (which is visible) is one of the obvious examples that prove that the TOEFL iBT is not given fairly. ETS does not go to check or supervise all testing facilities around the world. Even an Internet Café can be certified by ETS to be a testing center. This leads candidates to be skeptical about standard of the grading procedure or how ETS grades the speaking section which is subjective. How can candidates be sure that the process is done properly when it is invisible to anyone other than ETS?
4.2 ETS failed to provide secure testing facilities
Some candidates claim that they passed the speaking section because they overheard other candidates who sat in the same room delivering the answers. In general, tables are set differently in testing facilities. In some test centers, candidates can see other candidates’ computer screens and answers since tables are set too close to each other.
Why?
ETS preferred to use its profit to acquire Thomson Prometric so that it can increase its monopolistic power and profits by expanding worldwide. ETS uses the fact that it provides more test sites to promote itself as the best testing service. However, quantity cannot compensate for the lack of quality, especially in the speaking section. Last year, ETS bought Thomson Prometric and became a billion dollar business.
It has been pointed out that this acquisition demonstrates once again that standardized testing has become a gigantic industry that increasingly serves as the gatekeeper to education and employment. It has been further discussed that it is the problem because there is minimal public oversight or control over these mega-corporations, whose products too often turn out to be defective, unfair or irrelevant” (Robert Schaeffer, public education director of the National Center for Fair and Open Testing, cited by Scott Jaschik, Expansion for ETS, Inside Higher Ed).
5. Financial viability for test takers in developing economies
Exorbitant fee
The average number of times, candidates took TOEFL iBT before receiving a score of 26 was 9. This number derives from 100 divided by the number of those who could pass the speaking section, 11(Score Data summary, ETS, Jan 2007 – Dec 2007). The total spending by average is $150 x 9 =$1,350. This is such a big financial burden and hardship to test takers and their families. This figure does not include the cost of travel and accommodations, and baby sitters, which is higher than test fees when candidates cannot register in test centers close to their homes.
ETS and its monopoly
Candidates filed complaints in forms of telephone calls, letters, fax, and email but ETS chose to ignore or refuse to take corrective action to change the format, improve testing administration, and scoring process, especially the speaking section which is flawed, questionable, and problematic. One obvious reason is that ETS holds monopolistic power so it has no incentive to improve or make changes. Each year, millions of students take TOEFL iBT. Only a small percentage of professionals (< 4%), who are required to receive such a high score in speaking section, take the TOEFL iBT. When this small percentage of candidates complain, ETS does not take it seriously. Therefore, suggesting that pharmacists report problems to ETS directly does not solve this dilemma.
A majority of students are required to pass on the total score by their universities. Even though they cannot acquire such a high score on the speaking section, which only 11 out of 100 candidates passed (Score Data summary, ETS, Jan 2007 – Dec 2007), they are not affected when they receive a low score in the speaking section. For pharmacists, such a faulty testing procedure has degraded their performance, resulting in lower score or score errors. In other words, TOEFL iBT was designed for students to measure their English in general by using a total score, rather than score by section.
Test fees and corporate salaries and compensation
Quote:
“In 2004, Mr. Landgraf, earned $1.07 million and three vice presidents each earned over half a million. Sixteen ETS Vice Presidents and other corporate officers had total compensation of more than $200,000 with several topping the $300,000/year level” (Michael Winerip, Fair Test, Watchdog of Test Industry Faces Economic Extinction, February 22, 2006).
“The ETS offers generous salaries and benefits. Mr. Landgraf's salary in fiscal 2002 was $416,000, and he received another $126,000 in retirement and housing benefits. Most of the vice presidents make $200,000 or more a year, according to the nonprofit's IRS tax document” (David J. Hoff, May 28, 2003, Education Week, School of Education, Stanford University).
Between the lines:
“On November 23, the New York Times printed a front page story on salaries and bonuses paid at Educational Testing Service after Kurt Landgraf became CEO. Indeed, at least two newspapers, The Wilmington News Journal and U.S.1 Newspaper -- had published information on salaries and bonuses paid to top executives (U.S.1, November 13, 2002). In the fiscal year ending June 30, 2001, Landgraf received $431,000 for 11 months (he started in July) plus a bonus of $366,000, and seven employees earned more than $150,000 in one-time payments. Landgraf had defended his compensation policies to U.S. 1, saying that "I need highly motivated, well compensated, highly productive employees. Exactly the same that Bristol-Myers Squibb needs. Not-for-profit is a section of the IRS code, not an operating style.” (http://161.58.97.168/200211/21127c02.html)
Are such corporate salaries justifiable?
“Under its CEO, Kurt Landgraf, who gained a reputation for ‘maximizing income through global sales’, ETS has embarked on an aggressive expansion into overseas markets. Not surprisingly, he has already told reporters that his main agenda for ETS is to ‘increase revenues’....... Moreover, ETS corporate salaries, with an intake of nearly half a billion US$ annually, reflects their capital-corporate mould: in 1997, ‘President Nancy Cole received $378,232 in salary plus $45,716 in deferred compensation. All told, more than 800 employees were paid more than $50,000 annually.’ Are such corporate salaries justifiable? Do they help to account for the high pricing of their ‘test product’? Can we demand more transparency from the private firm that has literally built its dominion within our professional house?”(Templer, JCEPS, Vol.2, No.1, March 2004)
ETS Acquired Thomson Prometric
In 2007, ETS acquired Thomson Prometric at $435 million and increased its annual revenues at over $1 billion (Jaschik, Expansion for ETS, July 3, 2007). Landgraf mentioned that when he took the top job at ETS eight years ago, one of his goals was to see revenue top $1 billion. In 2006, ETS revenue was $836 million while Prometric was $317 million, so that goal would be achieved. After consolidation, Thomson Prometric will be operated as a for-profit subsidiary, paying taxes, but controlled by ETS (Scott Jaschik, July 3, 2007).
Recommended new test: IELTS
IELTS would be a much more preferable test to appraise the English language ability of foreign pharmacists. It is given in enough countries to allow access to foreign pharmacists. It includes a real one-to-one interview which gives much better results than the much flawed ETS examination. As stated above, the IELTS examination is accepted by the nursing profession for their visa screening, and by other professions.
Conclusion Professional Boards have authority to require a test for their professions. However, English language testing should provide candidates with as many options as possible. Passing the English test is an indicator of one’s ability to communicate while performing one’s profession duty. Indeed, if uniformity is considered, nurses, doctors, health care workers and pharmacists are all in the health care system.
After they pass the knowledge based test for their professions, they should use the same standard in communication skill tests. The medical board chooses to design its own communication skills. Other professionals use other English tests to certify communication skills. The secretary of the United States Department of Health and Human Services (HHS, 8 CFR 212.15) has approved 3 testing services: ETS, IELTS, and the Test of English in International Communication (TOEIC).
Nowadays, institutions are open to the use of as many English tests as possible to test their students. The nursing board uses three tests to certify nurses. It is not necessary to use only one test. When only a single testing company is approved by the governing body, the concern is about accessibility to tests and the monopolistic power the test company holds, having a negative impact on test takers.
The American economy is affected by the pharmacist shortage when stores shut down or when medication errors increase hospitalization. Media bombards us with news about medication errors creating a negative impact on our profession, which if not resolved in a timely manner, can cause damage to our profession.
In terms of testing format, ETS does not provide a face to face interview which simulates a real act or real communication in pharmacy practice. ETS has no incentive to set a real interview or invest in a real interview since that would require more money. Because demand for the test is greater than the supply, ETS can remain complacent without fear of financial loss. Test takers are in queue to take the test for three months or more.
Ultimately, it entirely depends on NABP to reconsider to listen to test takers who experience difficulties with ETS, and thereby try to alleviate the health risks that Americans are facing. It is in NABP’s hands to take action so that the loss millions of dollars due to medication errors can be avoided, and tears from those relatives who are affected can be turned to smiles and happiness. These foreign pharmacists can use their skills to relieve the crisis.
Foreign pharmacists are a rich source of test-ethnographic information and perception. It is their lives that have been manipulated by testing regimes in English proficiency over many years—and their voices that should be heard.
Sincerely yours,
References
1. Bill Templer, High- Stakes Testing at High Fees: Notes and Queries on the International English Proficiency Assessment Market, Journal of Critical Education Policy Studies, Volume 2, Number 1 (March 2004), ISSN 1740-2743, http://www.jceps.com/index.php?pageID=article&articleID=21, Accessed on 9/28/2008
2. Scott Jaschik, Taking on TOEFL, August 7, 2006, Inside Higher Ed, http://www.insidehighered.com/layout/set/print/news/2006/08/07/ielts, Accessed on 9/28/2008
3. Non verbal communication, Encyclopedia of Small Business, http://www.enotes.com/small-business-encyclopedia/nonverbal-communication, Accessed on 9/28/2008
4. Stephan Dahl, A short introduction to nonverbal communication, Middlesex University Business School, http://stephan.dahl.at/nonverbal/non-verbal_communication.html, Accessed 9/28/2008
5. Scott Jaschik, Expansion for ETS, Inside Higher Ed, July 3, 2007, http://insidehighered.com/index.php/news/2007/07/03/ets, Accessed on 28/9/2008
6. Test and Score Data Summary for TOEFL Internet-based and Paper-based Tests January 2007 – December 2007 Test Data, Educational Testing Service, http://www.ets.org/Media/Research/pdf/71943_web.pdf,
7. Fair Test, College Admissions Testing: The Real Beneficiaries, October 2001, http://www.fairtest.org/college-admissions-testing-real-beneficiaries
8. Michael Winerip, Fair Test, Watchdog of Test Industry Faces Economic Extinction, February 22, 2006, http://osdir.com/ml/culture.autism/2006-02/msg00134.html
9. Between the lines, PrincetonInfo.com , Article prepared for November 27, 2002 edition of U.S. 1 Newspaper http://161.58.97.168/200211/21127c02.html, Accessed on October 1, 2008
10. David J. Hoff, May 28, 2003, Education Week, School of Education, Stanford University
http://ed.stanford.edu/suse/faculty/displayFacultyNews.php?id=328&tablename=notify1
11. Park Yoon-bae, The Korea Times, Excessive zeal of TOEFL, 04-18-2007
http://www.koreatimes.co.kr/www/news/opinon/2008/09/164_1236.html, Accessed on October 1, 2008
12. Title 8, Chapter 1, part 212, Department of Homeland Security, 8CFR 212.5 - Certificates for foreign healthcare workers, http://vlex.com/vid/19609021