David Schleich, PhD

One would expect that our students would bring with them into their first year more than adequate writing, reading, speaking and listening skills to get through medical school. Such skills are, after all, fundamental for professional success. However, the experience of our deans, chairs and academic coordinators suggests that more students than we would like exhibit language proficiency problems. Research indicates that postsecondary underachievement, failure and attrition are highly correlated with academic underpreparedness, especially with respect to deficits in language proficiency. One would have thought, though, that our admission processes would funnel out those in trouble before they get into more trouble. Our students, as it turns out, do not represent a homogeneous population with easily diagnosed English language use difficulties; rather, they exhibit a wide range of abilities and needs related to language proficiency. Our faculty have complained more than once that we will have to do a better job of identifying students who are at risk of not successfully completing their programs because of deficits in language proficiency. We need to consider timely provision of appropriate remediation where necessary.

Researchers with the U.S. National Commission on Writing (NCOC) warned professional education schools almost a decade ago that there was ferment in the pipeline in terms of the emergent skill levels of students moving out of the secondary school panel into undergraduate preparation for further study. The Commission, in speaking of “the need for a writing revolution” (1), also called for “a new commitment to measuring writing quality, insisting that assessment composed only of multiple choice tests was not adequate to this demanding task” (29). “An authentic assessment of writing,” they explained, “depends on requiring the student to produce a piece of prose that someone reads and evaluates” (NCOC 29). Similarly, the NCOC recommended that postsecondary institutions should place writing squarely in the center of the school agenda and that policy makers should provide the resources required to improve writing. Our admissions colleagues and the chairs and deans of our programs, not to mention the professors on the frontline, acknowledge the NCOC’s contention that the reward of disciplined writing is the most valuable job attribute of all, namely, a mind equipped to think. Writing today, they insisted, is not a frill for the few but an essential skill for the many. Writing can help students seize opportunities, imagine endless possibilities and surmount life’s difficulties (NCOC 11, 26).

Assessment

There does not appear to be a persistently high dropout rate in our ND programs, although neither the individual programs nor the Association of Accredited Naturopathic Medical Colleges has had the opportunity (or sufficient numbers of students in difficulty because of writing skills) to warrant a full survey that might disclose trends. There are clues, though, that there could be trouble ahead or that it may already be here. Such clues grow out of the well-documented correlation between the persistently high college dropout rate among the general population of postsecondary students and the level of academic underpreparedness characteristic of a significant proportion of beginning students, including language challenges faced by students arriving from nontraditional pathways. The literature is replete with studies supporting the need for early identification and upgrading of students who are “at risk” of not completing their postsecondary programs because of deficits in academic preparedness, especially with respect to language deficits (Andres and Carpenter, Beck and Davidson, Boylan, Fisher and Engemann, Griswold, Kozeracki, McCarthy et al.). Writing not only about undergraduate-level but also about graduate-level programs, Roueche and Roueche similarly noted that “colleges must require entry-level assessment of all entering students to determine if skill levels are adequate for college-level courses. Has the time come, then, in our naturopathic admissions and matriculation processes, to turn to test data to keep students from enrolling in classes where they have no chance of success and to place them in classes where their skills could be developed to appropriate levels?” (1994a, 3-4). Have more and more of these students with recurrent writing, speaking, listening and reading skills slipped into our programs undetected?

Significantly, Kingsbury and Tremblay (2008, 2009) concluded their analysis of language competency assessment practices with the observation that the single element most often mentioned by the college teachers surveyed in their study was “the ability to transpose one’s thoughts into writing” (1). This focus on the centrality of writing as the critical skill in academic settings and professional preparation for the world of work is also well supported by the literature (Airasian et al., Barakett and Cleghorn, Bartlett, Fisher and Engemann). “Writing,” noted Eric Schneider, “is the edifice on which the rest of education rests” (Bartlett 7).

Overall, the extent and diversity of current assessment practices at our naturopathic colleges suggest that not much activity is occurring in this field, and while many of these current practices are supported by the literature (multiple measures, focus of writing modality, use of rubrics, training and calibration of graders, etc.), there is not a general understanding of what we must be on the lookout for and what we should even shoulder with respect to formal assessment of language proficiency. Certainly, questions arise regarding the logistics, timing and costs of universal language assessment of all incoming naturopathic medical college students, but the necessity of such a commitment is a recurrent theme in the literature, suggesting that even at the graduate school level there will be an effect (Carini et al., Colton et al., Kozeracki, Moore and Carpenter, Perin 2002, Perin 2004, Phipps, Weissman et al.). Roueche and Roueche, for example, noted that “skills assessment and placement should be mandatory, with test data used to place students in appropriate classes” (1994b, 221).

What, then, can we do to assuage the nagging concern out there that such a problem is alive and spreading in our naturopathic programs? There are three general methods of formal language assessment we could turn to. We could require (1) specific language proficiency testing using writing samples, (2) computerized assessment of reading comprehension and/or (3) sentence skills or multiple measures that include a combination of writing sample, computerized reading assessment comprehension and sentence skills.

Two Dimensions of Language Proficiency (From Beck and Davidson)

Writing Sample

Although indirectly assessed and not specifically graded, there is consideration of writing skills and aptitude in naturopathic college admissions. The most common manifestation of this method requires students to write a persuasive essay in response to a single prompt or, in some cases, to a selection of prompts in the application process. Time allotments for students are not prescribed or monitored in our current processes. Most often, writing samples show up as text, rather than as handwritten material. Software programs such as WritePlacer (ACCUPLACER, College Board [www.collegeboard.com/accuplacer) are available for this purpose, requiring computer-entered writing samples.

Computer-Based Assessment

None of our colleges have a formal computer-based assessment of language proficiency in place so far. There are, though, several platforms available that could speed this facility. A widely known computer-based instrument is the ACCUPLACER, including Reading Comprehension and/or Sentence Skills tests. These commercially available products have the benefit of relative cost-effectiveness and virtually immediate turnaround time, but their perceived effectiveness is premised on the assumption that competencies in reading comprehension and/or sentence skills are legitimate proxies for language proficiency in general and in writing.

However, there are those who doubt the diagnostic value of such tools and materials. For example, Driver and Krech, in their comparative analysis of computerized placement versus traditional writing samples, noted that “what is easiest to measure—often by means of a multiple choice test—may correspond least to good writing, and…choosing a correct response from a set of possible answers is not composing” (17). Similarly, Brown noted that multiple-choice tests “require a passive, reactive mental state when actual writing requires and fosters a sense of human agency, an active state” (3). There are also those who point to the daunting expensive logistical problems associated with both traditional noncomputerized grading methods and their digital successors. The norming and calibration process for professors involved in grading writing samples is not a skill set our medical curriculum faculty are equipped to handle.

In any case, the multiple measures in language assessment show up in the literature as a preferred way to go about dealing with this challenge (Breland, Driver and Krech, Greenberg, White). For example, White noted that the “results of a careful multiple-choice test, when combined with the results of a single essay test, will yield a fairer and more accurate measure of writing ability than will either test when used by itself” (240-1). Driver and Krech similarly concluded their comparative analysis of language assessment methods by recommending “a combination of tests as the most accurate measure of students’ placement needs” (19). However, they also noted that, because of the expense and logistical demands of using multiple measures, this practice might not be practical for many institutions (Driver and Krech 3).

There is also the challenge of dealing with the remediation needs of those students whom we may find among us already, not to mention those on their way to us. The literature overwhelmingly indicates that at-risk students who participate in some form of academic intervention, variously termed remediation, upgrading, developmental, foundational, and/or supplemental language instruction, achieve higher grades and retention rates than students who required but had not participated in such interventions (Fisher and Engemann, Marshall, Martin and Arendale, McCarthy et al., Wallace, Weissman et al.). Stated bluntly, remediation for at-risk students “increases academic performance and retention” (Martin and Arendale 3). Our curriculum delivery budgets have little room for this kind of intervention in their current manifestations.

Whether based on preadmission screening, postadmission informal classroom assessment or postadmission formal assessment for placement purposes, any system we consider in the naturopathic college world will be complex and difficult to introduce and administer, especially considering that many faculty would prefer to exclude such at-risk candidates at the admission and screen stage. However, at the same time, if this problem presents more consistently, we will have to undertake, for purposes of retention and our commitment to student success, various models of classroom delivery that may well require us to institute smaller class sizes, more hours of instruction, pedagogical accommodations, and/or specialized teachers.

Such student-centered approaches to language remediation are well supported in the literature, which documented the benefits of smaller classes in terms of more flexibility and individualized assistance, greater student engagement, more active learning, and increased formative feedback (Beatty-Guenter, Shults). Specifically in terms of class size, some suggested that writing-intensive classes should set limits at “ideally 20 students and no more than 25” (United Nations Correspondents Association 2), while others promoted classes of fewer than 20 students, especially in the context of language remediation (Haswell, Horning, Maggio et al., McCusker).

No matter what we find, there are communication skills that our faculty consistently report to be essential not only for success in the naturopathic medical program itself but also for success in the working landscapes of primary care. The essential skill set the faculty at National College of Natural Medicine (Portland, Oregon) emphasize is two-fold: (1) communicate clearly, concisely and correctly in the written, spoken and visual form that fulfills the purpose and meets the needs of the audience and (2) respond to written, spoken or visual messages in a manner that ensures effective communication. What these generalized expectations translate to at a more specific level are the following:

Understand, speak and write effectively
Listen to understand and learn
Read, comprehend and use written materials
State a discernible purpose and use a logical pattern or organization
Cohesively argue a controlling idea
Construct paragraphs that develop a main idea with details and examples clearly related to the primary point
Demonstrate control of the essential mechanics of writing (e.g., complete sentences, subject-verb agreement and consistent use of tense)

At the very least, our incoming and outgoing students need to have mastered these basic writing skills, which in turn assume sophistication in reading, listening and speaking. Our profession will sputter if we do not have these fundamentals in every graduate’s backpack.

David Schleich, PhD is president and CEO of NCNM, former president of Truestar Health, and former CEO and president of CCNM, where he served from 1996 to 2003. Other previous posts have included appointments as vice president academic of Niagara College, and administrative and teaching positions at St. Lawrence College, Swinburne University (Australia) and the University of Alberta. His academic credentials have been earned from the University of Western Ontario (BA), the University of Alberta (MA), Queen’s University (BEd) and the University of Toronto (PhD).

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