Constraints on Structure and Written Expressions of The TOEFL for Midwifery Students

The purpose of this study was to identify the factors limiting Midwifery students' performance on TOEFL, particularly in Structure and Written Expression sections. This qualitative research conducted as a case two classes midwifery program. Document analysis 89 student response sheets interviews with four students constituted data. Brown (2004)'s difficulty index (IF) formula used analyze quantitative data, while Miles Huberman's interactive model (2004) findings revealed that difficulties stemmed from three factors: inadequate vocabulary knowledge, insufficient TOEFL practice, interference their native language. In addition, extrinsic motivation negatively affected both learning test performance.