2024-25854. Standardized Tests and Minimum Passing Scores for Foreign Health Care Workers To Demonstrate English Language Proficiency

Summary of Recommendations on English Language Proficiency Tests and Scores

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Test name	Test section	Current score	Recommended score	Justification and impact	Evidence	Timeframe
[Insert Name of Test]	[Insert what section of the test the modification refers to, i.e., overall, listening, reading, writing, or speaking.]	[Insert current score for each test by health profession or occupation by level of degree.]	[Insert recommended score for each test by health profession or occupation by level of degree.]	[Provide a brief description of why the modification is necessary.] [Provide a brief description of potential impact of the modification if accepted.]	[Describe evidence to support this modification ( i.e., concordance analysis and findings, evaluation studies, and other supporting material to substantiate this recommendation).]	[Insert if this modification is time sensitive. If yes, describe why.]
Summary of Administrative Comments on English Language Proficiency Tests and Scores

Test name	Test section	Current language	Suggested language	Justification and impact	Evidence	Timeframe
[Insert Name of Test]	[Insert what section of the test the modification refers to, i.e., overall, listening, reading, writing, or speaking, if applicable.]	[Insert recommended modification by health profession or occupation by level of degree.]	[Insert recommended modification by health profession or occupation by level of degree.]	[Provide description of why the modification is necessary.] [Provide description of potential impact of the modification if accepted.]	[Describe evidence to support this modification ( i.e., concordance analysis and findings, evaluation studies, and other supporting material to substantiate this recommendation).]	[Insert if this modification is time sensitive. If yes, describe why.]
General
[Insert any other comments.]

Proposed Modifications to the June 2022 List of Approved Standardized Tests and Minimum Passing Scores:

(1) Cambridge English provides in-depth exams to prove knowledge of the English language.^[1] HRSA proposes the following modification to the listing:

a. Change the title of the tests from “Cambridge Assessment English: B2 First, C1 Advanced, or C2 qualifications exams” to “Cambridge English B2 First, C1 Advanced, or C2 Proficiency,” because Cambridge English changed the name of the exams.

b. The minimum passing scores for each of the occupations will remain unchanged.

(2) Test of English as a Foreign Language internet-Based Test (TOEFL iBT) prepares test-takers for immigration to the United States by examining their English ability.^[2] HRSA proposes the following modifications to the listing:

a. Change the title from “Test of English as a Foreign Language (TOEFL) internet-Based Test” to “Test of English as a Foreign Language internet-Based Test (TOEFL iBT),” to reflect the organization's current name for the exam.

b. Increase the overall passing score from an 81 to an 83 for registered nurses and Bachelor of Science level health care workers to enhance parity among minimum passing test scores across approved tests.

c. Increase the minimum passing score for the “Speaking” section from 24 to 26 for registered nurses and Bachelor of Science level health care workers to enhance parity among minimum passing test scores across approved tests.

d. There are no proposed changes to the minimum passing scores for health care workers holding less than a Bachelor of Science degree and occupational therapists/physical therapists.

(3) HRSA understands that the TOEFL Paper-Based Test has been discontinued.^[3] HRSA therefore proposes the following modification to the listing:

a. Remove the TOEFL Paper-Based Test from the list of standardized tests and minimum passing scores to demonstrate English language proficiency, since it is no longer available for test-takers.

(4) Test of English in International Communication (TOEIC) (Listening and Reading) and TOEIC (Speaking and Writing) measure English comprehension skills and determines a test-taker's ability to communicate in English effectively and proficiently.^[4] HRSA proposes the following modifications to the listing:

a. Increase the minimum passing score from 700 to 725 for “Listening and Reading” for health care workers holding less than a Bachelor of Science degree to enhance parity among minimum passing test scores across approved tests.

b. There are no proposed changes to the minimum passing score of 160 for “Speaking” and 150 for “Writing” for registered nurses, Bachelor of Science level health care workers, and health care workers holding less than a Bachelor of Science degree.

(5) The Occupational English Test (OET) is a language test designed to evaluate language skills of healthcare professionals in an English-speaking environment.^[5] HRSA proposes the following modifications to the listing:

a. Change test scores from a letter-based scoring system to numerical values, as suggested by OET, to increase precision in scoring and overall parity across English language proficiency tests. For registered nurses and Bachelor of Science level health care workers, the current minimum passing score for “Reading,” “Writing,” and “Listening” is a letter grade of C+ and a letter grade of B for “Speaking.” HRSA proposes to replace these letter scores with the equivalent numeric scores of 300 for ( print page 88296) “Reading,” “Writing,” and “Listening,” and 350 for “Speaking” which, per consultation with OET, does not represent an increase or decrease in minimum passing test scores.

b. For health care workers holding less than a Bachelor of Science degree, the current minimum passing score for “Reading,” “Writing,” and “Listening” is a letter grade of C and a letter grade of B for “Speaking.” HRSA proposes to replace these letter scores with the equivalent numeric scores of 250 for “Reading,” “Writing,” “Listening,” and 350 for “Speaking” which, per consultation with OET, does not represent an increase or decrease in minimum passing test scores.

c. For occupational and physical therapists, there are currently no minimum passing tests scores listed for OET. HRSA proposes the minimum passing scores of 300 for “Reading,” “Writing,” and “Listening” and the score of 350 for “Speaking” to include versions of OET designed specifically for occupational and physical therapists.

(6) Pearson PTE Academic is a computer-based exam that measures academic-level speaking, writing, reading, and listening skills.^[6] HRSA proposes the following modification to the listing:

a. Add a new passing minimum score of 63 for “Speaking” for registered nurses and Bachelor of Science level health care workers. Previously, no passing minimum score for “Speaking” was listed. HRSA proposes this change to enhance parity among minimum passing test scores.

To reflect the aforementioned modifications*, HRSA proposes to update its website to replace the June 2022 listing of approved standardized tests and minimum passing scores with the following table, which reflects the information described above:

*  Proposed modifications are bolded and italicized for this document but will not appear in bold and italics when published on the website.

English competency tests	Scores: occupational therapists/physical therapists	Scores: registered nurses and B.S. level health care workers	Scores: <B.S. level health care workers
Cambridge English B2 First, C1 Advanced, or C2 Proficiency	Cambridge English Scale 185 overall and 185 Speaking	Cambridge English Scale 176 overall and 185 Speaking	Cambridge English Scale 169 overall and 185 Speaking.
Educational Testing Service: TOEFL Internet-Based Test	Overall 89 with minimum of 63 on Reading, Listening and Writing and 26 on Speaking	Overall 83 with minimum of 57 on Reading, Listening and Writing and 26 on Speaking	Overall 77 with minimum of 53 on Reading, Listening, and Writing and 24 on Speaking.
Educational Testing Service: TOEIC (Listening and Reading)	Not applicable	725	725.
Educational Testing Service: TOEIC (Speaking/Writing)	Not applicable	160 Speaking/150 Writing	160 Speaking/150 Writing.
International English Language Testing System (IELTS)	Not applicable	6.5 academic with minimum of 7 on Speaking	6 academic or general with minimum of 7 on Speaking.
Michigan English Test (MET)	Not applicable	Overall 55; minimum Speaking section score of 55	Overall 55; minimum Speaking section score of 55.
Occupational English Test (OET)	Reading, Writing, Listening/300; Speaking 350	Reading, Writing, Listening/300; Speaking 350	Reading, Writing, Listening/250; Speaking 350.
Pearson PTE Academic	Not applicable	Overall 55; Reading, Writing, Listening, no section below 50 63 minimum for Speaking	Overall 55; Reading, Writing, Listening, no section below 50.