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.