Language proficiency standards in health care—How high is too high?

July 22, 2009


Hamilton, ON July 22, 2009

CSMLS leads the way on research on language proficiency standards for internationally educated medical laboratory technologists

The Canadian Society for Medical Laboratory Science (CSMLS)—the national certifying body for medical laboratory technologists and assistants is leading the way on research to support the development and implementation of language proficiency standards for internationally educated medical laboratory technologists.

Language proficiency testing has become a ‘hot button’ issue for organizations that license and certify internationally educated health care professionals. It is a challenge to set standards for English language proficiency that are appropriate for the Canadian workplace. Set them too low and patient safety will be compromised; too high and integration of internationally educated health care professionals into the workforce will be delayed. Unfortunately, there is little evidence-informed research to guide the development of profession-specific language proficiency standards.

For that reason, CSMLS embarked on research, funded by the Government of Ontario, to validate its English language proficiency standards. Proof of language proficiency is required to determine whether an internationally educated medical laboratory technologist is eligible to have their credentials assessed through the prior learning assessment (PLA) process and finally, to determine eligibility to the national certification examination.

The initial research project, which was completed in 2008, resulted in significant changes to CSMLS’s policies and procedures for language proficiency testing including:

  • the addition of two language proficiency tests (CanTest and IELTS) to the list of accepted tests
  • the introduction of a two-stage language proficiency standard

A second project, completed in March 2009, focused on establishing ‘cut scores’ (minimum scores required to demonstrate proficiency) for the approved language tests and validating a new profession-specific test called MELA (The Michener English Language Assessment). As part of the process, CSMLS hosted a series of standard-setting expert panels comprising employers, internationally educated medical laboratory technologists, educators, language experts and representatives of regulatory bodies.

Guided by the recommendations of the expert panels, on July 1, 2009 CSMLS introduced new cut scores for the approved language proficiency tests (TOEFL, IELTS and CanTest) and accepted MELA. “It’s exciting to see our research translated into policies that provide more options for our PLA clients and ensure that our language proficiency requirements are appropriate for the Canadian workplace,” says Christine Nielsen-Trowhill, CSMLS Director of Certification. “We work closely with Dr. Moira Grant, our Director of Research to ensure that our PLA process is based on sound evidence and best practices. As a result, CSMLS has become recognized as a leader in prior learning assessment in the health care community,” she says.

Another significant outcome of the research is the development of a guidelines tool that can be used by other health care professions to set language proficiency standards. “We’re pleased that our research may be helpful to other health care organizations that are struggling to establish language proficiency standards,” says Ms. Nielsen-Trowhill.

CSMLS completed 508 prior learning assessments in 2008. A total of 637 internationally educated medical laboratory technologists have been certified by CSMLS since 2000. Detailed information about how to become certified as a medical laboratory technologist in Canada is available on the CSMLS website,, click on International Technologists.

Indigenous Land Acknowledgement : We respectfully acknowledge the CSMLS office, located in Hamilton, Ontario, is situated upon the traditional territories of the Haudenosaunee Confederacy, the Mississauga Nation, Anishinaabe Peoples, and the Neutral Peoples. This land is covered by the Dish With One Spoon wampum, which is a treaty between the Haudenosaunee and Anishinaabe to share and care for the resources around the Great Lakes. We further acknowledge that this land is covered by the Between the Lakes Treaty No. 3, 1792, between the Crown and the Mississaugas of the Credit First Nation.


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