Language background, pro®ciency in English, and selection for language development A Chur-Hansen Department of Psychiatry, University of Adelaide, South Australia SUMMARY With a diverse language background pro®le in an Australian medical student population, teaching inter- ventions are necessary for students whose English lan- guage pro®ciency is not adequate for the study of medicine. This paper describes the screening of written and aural English language pro®ciency in 143 ®rst year undergraduate students using a standardized instru- ment. Students identi®ed as experiencing language dif®culties were subsequently assessed by interview and allocated to faculty-based Language Development Programme. Students with the greatest need for lan- guage support participated in a full 2 year programme. Those requiring less assistance were offered more lim- ited support in the form of speci®c modules within the programme. Students allocated to the full programme were signi®cantly weaker in language pro®ciency com- pared to those offered speci®c modules and those not offered a placement. The information gathered during the structured interview is valuable in establishing for medical educators speci®c areas in which language- related teaching for students who require it can be directed. Future research is required to evaluate the effectiveness of faculty-based language interventions in terms of improvement in language pro®ciency over time and the effect of any improvements in language pro®- ciency on academic and clinical performance. Keywords *Education, medical, undergraduate; *language; *South Australia; teaching, *methods INTRODUCTION Australia is a multicultural country and as such has representatives from almost every corner of the globe and from numerous language backgrounds. Our cul- tural and linguistic diversity, which has implications at many levels for medical educators (Maher 1993), is re¯ected in both student and patient populations. This paper reports on the need to quantify the English lan- guage pro®ciency of undergraduate medical students where a standard level of pro®ciency cannot be auto- matically assumed and describes one approach to id- entifying students who require support to develop their English language skills. Since 1990 at the University of Adelaide Faculty of Medicine up to 50% of the current undergraduate medical student intake could identify their language background to be other than English. Potential stu- dents are informed that a high pro®ciency in written and verbal English is an important prerequisite for en- try into the course, but up to the time of writing there has been no compulsory testing for English language pro®ciency prior to entry. In 1994 the faculty decided to implement a Language Development Programme, in response to feedback from teaching and clinical staff that some of the students were poorly equipped with the language skills necessary for tertiary study and for interaction with patients. In Australia the major contributors to our knowledge of undergraduate medical students' English language pro®ciency are Farnill & Hayes, from the University of Sydney, who commenced testing the language skills of their incoming ®rst year medical student groups in 1990 (Farnill & Hayes 1994). They assessed English language pro®ciency using the Screening Test of Adolescent Language (STAL) (Prather et al. 1981). Satisfactory reliability and validity of the STAL has been established in several studies (Hayes & Farnill 1992, 1993a; Farnill et al. 1995). However, as with any psychometric test, there is always the possibility that errors of classi®cation will occur if decisions are based on a sole score. Prather et al. (1981), Stephens & Montgomery (1985), Lieber- man et al. (1987) and Hayes & Farnill (1992) have all advocated further evaluation of language skills after preliminary testing with a screening test, to allow re- classi®cation of false positive and false negative cases. Hayes & Farnill (1994) reported that students were initially reluctant to participate in voluntary language support programmes at the University of Sydney. 312 MEDICAL EDUCATION 1997, 31, 312±319 Ó 1997 Blackwell Science Ltd Correspondence: Dr Anna Chur-Hansen, Department of Psychiatry, University of Adelaide, South Australia 5005, Australia