ENGLISH ORAL COMMUNICATION NEEDS, LANGUAGE ANXIETY, AND CURRICULUM INADEQUACY IN PAKISTANI UNDERGRADUATE HEALTHCARE EDUCATION: A CONVERGENT MIXED-METHODS NEEDS ANALYSIS

Abstract

It is argued in the present study that Pakistani undergraduate healthcare students enter clinical practice with critically inadequate English oral communication competence, and that the formal curriculum nominally designed to address this deficit systematically fails to do so. A convergent mixed-methods needs analysis was conducted with 200 undergraduate healthcare students and 20 ESL instructors at two PMDC-recognised medical institutions in Lahore, employing five instruments: the Student Needs and Communication Questionnaire (SNCQ), the Instructor Perception Survey (IPS), the Student Semi-Structured Interview Guide (SSIG), the Instructor Semi-Structured Interview Guide (ISIG), and the Document Analysis Protocol (DAP). The findings indicate that speaking for patient communication was rated as the most severely underdeveloped skill (M=2.35/5.0), while patient history-taking (M=4.70/5.0) and clinical case presentation (M=4.68/5.0) were simultaneously rated as the two most critical professional competences. Furthermore, language anxiety was found to be pervasive and clinically significant (M=39.5/50), suggesting that an anxiety-avoidance cycle operates systematically across both institutions. Document analysis likewise confirmed that oral assessment accounts for an average of 2% of total ENG-251 assessment and 0% of ENG-253 assessment across five institutions, indicating a profound misalignment between curriculum provision and professional communicative demands. Similarly, ESL instructors confirmed these deficiencies with analytical precision, identifying class size, written assessment dominance, and cultural irrelevance of materials as the three structural barriers to communicative instruction. In a nut shell, the study establishes that the communicative deficit is not a consequence of individual student inadequacy but a structural consequence of curriculum and assessment design, and provides a multi-instrument empirical foundation for targeted intervention.