Structure and Written Expression Section on Paper-Based TOEFL : Perceived Difficulties by Nursing Students of Poltekes Solok, West Sumatera

English language ability is one of the skills that must be possessed by college students, including nursing students. Having good English skills will open broad opportunities for increasing the competency and expertise of nursing students. One form of recognition of good English skills is to have a high TOEFL score. However, getting a high TOEFL score is still a challenge for nursing students. Facts in the field show that many nursing students find it difficult to achieve high scores on the TOEFL test. The most common form of difficulty is the problem in answering questions related to the structure and written expression section in the Paper-Based TOEFL test. The purpose of this research is to investigate nursing students’ difficulties in the structure and written expressions section tested in the Paper-Based TOEFL. The population of this study was 80 nursing students of POLTEKES Solok, and the sample was selected by using cluster random sampling. Data of the research was collected through tests and interviews. The result of the research found that that there were 8 items considered as the most difficult elements met by nursing students in the TOEFL test. These items were word order, parallel structure, singular and plural nouns, missing and extra words, articles, comparative and superlative, word choice, and word form. In addition, the findings also show that several factors influence nursing students' difficulties in the structure and written expression section. The factors were unfamiliarity with the TOEFL test, lack of practice, and lack of grammatical competence.


Introduction
TOEFL (Test of English as a Foreign Language) is one kind of standardized test which is addressed for speakers in which English is not as their native language. As one of the English standardizes tests, TOEFL becomes one of the important tools in measuring English proficiency for non-native speakers. It is used to test the non -native ability to understand spoken English, to determine selected structural and grammatical sentences in standard written English, and to understand short English passages 1 .
TOEFL, as a language proficiency test, takes several forms namely Paper Based Test (PBT), Computer Based Test (CBT), Internet-Based Test (IBT), and Institutional Testing Program (ITP). Among those tests, a Paper-Based Test is one of the familiar TOEFL tests taken by the test takers. The working system in this type of test is to use sheets of question paper and answer sheets that must be filled with 2B pencil 2 . This test is divided into three main sections; listening comprehension, structure and written expression, reading comprehension. The first section, listening comprehension, is used to assess the examinees' understanding in spoken English. It includes the ability to understand different types of English recording in the form of a short conversation, long conversation, and long talks. All of the items are presented in multiple-choice questions. examinees can continue to the structure and written expression section. This section aims to examine the examinees' ability to identify English grammar sentences correctly. It involves an ability to choose the correct answer that completes the sentence and an ability to recognize underlined word or phrase that is not appropriate in the sentence. Finally, reading comprehension is used to assess the examinees' ability to understand English reading passages. It involves finding a topic, answering the main idea in the passage, recognizing the organization of ideas, answering stated and unstated details, guessing meanings of difficult words from structural clues and context clues, looking for general and specific information 3 . For nursing students, TOEFL is helpful to support their academic skills in teaching and learning medical health. By having a higher TOEFL score indicate that the students might have good English skill. They can use that skill to communicate fluently with their colleagues from other countries, attend an international seminar, find a lot of English sources, and even fulfill a requirement to continue their studies abroad. It cannot be rejected that TOEFL is used by many (overseas) universities for their admission processes that must be fulfilled by prospective new foreign 3 Iskandar Abdul Samad, Miftahul Jannah, and Siti Sarah Fitriani, 'Efl  However, there are still many nursing students who fail to get good results in the paper-based TOEFL. From the informal interview result done with some students, it was found that most of the students agreed that one of their biggest hurdles was section two of the test, which examines the structure and written expression. Thus, they always feel the burden of doing this section. They also stated that problems with grammar were thought to prevent them from getting a high score in TOEFL. has four underlined words/phrases in the sentence.
These four underlined words/phrases are marked (A), (B), (C), and (D). The examinees have to identify errors/mistakes from the underlined word/phrases to correct the sentence 6 .
Generally, there are two main points that are tested in this section; structure and written expression. Each point has some specific aspects to be answered by the test takers. The further variables for each point can be described below:

Structure
In this part of the test, the examinees are asked to choose the right answer from the four-word/phrase options provided beneath the sentence.

Example:
Geysers have often been compared to Volcanoes -----------they both emit hot liquids from below the Earth's Surface. (A) due to (B) because (C) in spite of (D) regardless of -The correct choice is (B) 7 There are five aspects of structure to be tested in PBTTOEFL; (1) WIAS (What is a sentence), It is based on the presume that a clause consists of only one subject and one verb, (2) Word choice (It tests students to choose the correct word or phrase appropriate to the sentence), (3) Word order (It requires students to choose the appropriate word order in a sentence), (4 Tenses), (5) Parallelism (It means choosing the parallel structure in the sentence) 8 .
In addition, structure questions usually examine the following items:

Sentence structure
The sentence structure questions asses the examinees' ability to complete a sentence correctly.

Word order
Word order questions consist of more detail-oriented sentence structure questions.

Word form
Word form questions assess the examinees' ability to identify the correct use of word form in a given situation.

Word choice
The word choice questions examine the examinees' ability in understanding idiomatic expressions, such as how to use prepositions with certain words.

Missing or extra words
The missing or extra word questions frequently examine the examinees' ability to recognize that a word is missing or that an extra word appears in a sentence. 9

2) Written Expressions:
In this section, the examinee will see that each sentence has four underlined words/ phrases. He/she needs to figure out one underlined choice that is not correct. The example from this part can be explained in the following . Guppies are sometime called rainbow fish A B because of the males' bright colors.
-The correct choice is(A) 10 Generally, there are some aspects to be tested in written expression. In addition, there are ten aspects tested on this section. (a). Part of speech. It is defined as the class of word which consists of noun, verb, adverb, adjective, pronoun, conjunction, preposition and interjection; (b). Plural. It means more than one in terms of nouns; (c). Parallelism. It appears much more in part B than in part A. (d). Pronoun Errors. Pronoun is used to substitute a noun either singular or plural. (e). Prepositional Errors. It is considered one of the most difficult aspect in written expression part. (f). Verb form. Like in part A, in part B, problems with verbs also concern with choosing correct verb forms in terms of its tenses. (g). Deleted Words. It is a missing word that is needed to complete a sentence. (h). Word order. This aspect appears more in part A than in part B. (i). Article. Even though it appears in small percentage, article is considered the most difficult aspect in English grammar tests. (j). Conjunction. It is a connector to join a part of speech with another part of speech, a clause with another clause, and a sentence with another sentence. 12 Based on the explanations above, the researcher is inspired to research the problems experienced by nursing students in the structure and written Expression of paperbased TOEFL. The objectives of this study 10  were to find out what kind of difficulties were faced by nursing students in the structure and the written section of the paper-based TOEFL test and to figure out factors that affect the students' difficulties in the test.

Methodology
This research design was descriptive research. It aimed to investigate and identify nursing students' difficulties in the structure and written expression section of the Paper-Based TOEFL test. This research used mixedmethod research in which including both quantitative and qualitative data in the research. Both of these data provided a better understanding in answering the research questions. The quantitative data gave details information to explain the first research question about nursing students' difficulties in the structure and written section of TOEFL test in a numerical way. In other way, the qualitative data was applied to answer the second research question about the factors that influenced nursing students' difficulty in answering the structure and written expression section.
This research was done in the Nursing Department of Poltekes Solok, West Sumatera. It was conducted at the first-grade nursing students of Poltekes Solok. There were 80 students registered as the population of the research. They were divided into 2 classes; class A and class B. The population of this research can be seen as follow: To get the sample, the researcher employed a cluster random sampling. It is one of the sampling technique in which the sample selection of group have similar characteristics.
In choosing the sample, the researcher chose one among two classes randomly by using two rolls of small paper, in which each contains one class. Finally, class A was chosen as a sample of this research.
The researcher employed test and interview as the instrument of the research. The test was applied to discover the most difficult element in the structure and written expression section which was administered to 40 students. The sources of the test was adopted from TOEFL books such as 13 . The test format was similar to the standard TOEFL test in the multiple-choice form. For this research, the researcher only employed the structure and written expression section. It is divided into two parts; part A and part B. Part A, structure (word completion), contained 15 questions. Meanwhile, Part B, written expression (error analysis), contained 25 questions. The total questions of the test were 40 questions, and the students had 25 minutes to accomplish the test.
Also, the items for each section in the test were based on several indicators that had been arranged appropriately. Further explanation can be seen in the following table. Furthermore, interview aimed to get detail information about the factors influence the nursing students' difficulty in the structure and written expression section of TOEFL test. The researcher employed a semi-structured interview in case there were maybe other optional questions and information during the interview session. The students had been inquired about their profound reasons behind their difficulties in the structured and written expression section.
The data of this research was collected through the structure and written expression section of TOEFL test and interview. In the test, the students were asked to choose the correct answer which consists of all indicators of structure and written expression section of TOEFL test. The test consisted of 40 items and it was held on August 6, 2019. The students were given 25 minutes to answer the questions in the test. After that, the researcher collected the students' answer sheet and scoring the students' answers. Furthermore, the researcher also employed interviews with 5 students who got the lowest score in the test. It might be a representative from the sample in providing detail information about factors influence nursing students' difficulty in structure and written expression section test.
To calculate the students' score in the structure and written expression section of TOEFL test, the researcher started by checking the answers given by the students. Furthermore, she divided the correct and incorrect answers. Then, she calculated the percentage of error for each indicator by using a formula by 14 : P = f_ x 100% N In which: P = Percentage of error in each indicator f = The number of incorrect answer in each indicator N= Total number of students Then, interview was used to know factors influence nursing students' difficulty in structure and written expression section test. The researcher analyzed the result from transcription and identified the factors influence students' difficulty in the test.

Findings and Discussion The Students' Test Result
The researcher used a test to collect the data about nursing students' difficulty in structure and written expression section on the TOEFL test. After analyzing the test, the researcher found the students' errors which were divided into two categories; structure and written expression. The followings are the result of data analysis of nursing students' difficulties in the TOEFL structure sub-test.  Table 3 displays the results of students' tests in part A. The highest percentage of incorrect answers was in item numbers 4 and 15 (90%). Then, it continued to the item number 10 (75 %), item number 6 (72%), item number 7 and 11 (70%), and item number 8, 12, 13, 14 (62%). The moderate percentage of the incorrect answer can be found in item number 9 (52%). Finally, the lowest percentage of the incorrect answer was in item number 3 (25%).  Table 4 demonstrates the results of students' test in part B. From the data results, the highest percentage of students' incorrect answers was in item number 22, 23, 27 with 90%, follow up with item number 26, 32, 33, 36, 37 which was 85%. The moderate percentage of students' incorrect answers was seen in item number 21, 25 with 50%. Lastly, the lowest percentage of students' incorrect answers was in item number 39 with 20%.  Table 5 demonstrates the total percentage of correct and incorrect answers for both part A and part B. For part A, the total percentage of students' incorrect answers was 62%. On the other side, part B got a lower percentage of incorrect answers with 56%. The averages of students' incorrect answers from these two parts were 59%. In different circumstances, the total percentage of students' correct answers was 18% lower than the incorrect score with 41%.  Table 6 describes the results of the highest frequency of students' errors in the structure and written expression section. From the table, it can be seen that there were 8 items considered as the most difficult items in the test. The explanation for the items can be explained in the following: Word Order Word order is the most difficult items experienced by nursing students in the TOEFL test. It got the highest percentage for incorrect answer with 90%. Word order questions can be found in the item 4 and 6.
Item number 4 The professor has not written a book __________ to the masses to generate interest from a publisher.
(A) enough appealing (B) appealing enough (C) appeal enough (D) enough appeal For this item, only 4 students chose (B) as the correct answer, and the rest of Fitri Handayani 143 Structure and Written… students' answers were varied, choosing (A), (C) or (D). It indicated that understanding the use of appropriate word order in a sentence still become the biggest problems by the students. They could not able to find the correct answer while facing it in the test.
Item number 6 Never before __________ in an earnest attempt to resolve their differences.
(A) have the leaders of these two countries met (B) the leaders of these two countries have met (C) have the leaders the two countries meet (D) met the leaders of the two countries In addition, the other difficulty in word order also can be found from item number 6. In this item, 29 students chose incorrect answer varied from (A), (B), or (C). As a result, the total percentage of incorrect answer was 72%.
It still indicated the students' understanding about word order was low.

Parallel Structure
Nursing students also faced difficulty in figuring out parallel structure in the TOEFL test. The question of parallel structure was included in part B of the test. It had been put into item number 22 and 23. From the test result, it showed that most of the students could not be able to answer the questions correctly. The total percentage of incorrect answer was 90%. The detail questions can be seen in the following:

Item number 22
Ceramics can be harder, light, and more A resistant to heat than metals. B C D

Item number 23
Chemical engineering is based on the A principles of physics, chemists, and B C mathematics. D For those items, only 4 students could choose correctly and 36 students failed to answer correctly. The total percentage of incorrect answer was 90% which indicated as one of the highest difficult item for nursing students in the structure and written expression section.

Singular and Plural Noun
Singular and plural noun had been used as one of criteria to be tested in the TOEFL test. It had been put in the item number 26 and 27. The followings are the explanation for each item.

Item number 26
Sharks can detect minute electrical A B discharges coming from its prey. C D In this item, the total percentage of incorrect answers was 85%. There were only 6 students could find the correct answer. Most of the students preferred (B) as the correct answer, while the rest of the students chose (A) and (C).

Item number 27
The fossil remains of much extinct A mammals have been found in the tar pits B C at Rancho La Brea in Los Angeles. D Related to question number 26, this question was still asking about singular and plural noun. 36 students were unsuccessful to identify the correct answer. Only 2 students took (A) as the correct answer. And the rest of the students chose (B) and (D).

Missing and Extra words
The question for these criteria was provided in part A of the test. It was the the item number 13, 14, and 15. The result score for each item varied and the highest percentage of incorrect answer was in the item number 15 (90%). the explanation for each item can be seen in the following:

Item number 13
This course is one of __________ few English courses offered by the college each month.
(A) the (B) only (C) mostly (D) Almost The total percentage error for this question was 62%. It was gotten from 25 students failed to choose correct answer. Only 15 students answered correctly by choosing (A).

Item number 14
One of the two students is studying to be a doctor, but __________ wants to be a musician. (

A other (B) others (C) another (D) the other
Similarly, it also happened with the item number 14. 25 students also failed to choose the correct answer in the test. As a result, 62% students could not answer the question in the item yet.

Item number 15
Whether there should be more control over handguns __________ long been a topic of debate in the United States.
(A) Having Also, this item is assumed as one of the most difficult questions. It was because most students got failed with 90% in percentage. It means that 36 students could not determine the right answer in the question. There were only 4 students could guess the correct answer.

Article
Articles became one criterion to be tested in part B. It was included in the item no 32 and 33. The analysis of students' test result can be explained in the following:

Item no 32
The most butterfly eggs are coated with a A B sticky substance that holds them to C plants. D In this item, more than half of the students failed to choose the correct answer with 85% as the total percentage of incorrect answers. There were only 4 students chose (A) as the correct answer.

Item no 33
Wilmington is an only large city in the C Similarly to the question number 32, only 4 (15%) students chose the correct answer. 36 (85%) students could not be able to identify the right answer. It indicated that understanding articles was also the biggest problem for the students in the TOEFL test.

Comparative and Superlative
Comparative and superlative also became one of the difficulties experienced by nursing students in the TOEFL test. The students could not be to identify the use of correct comparative and superlative in a sentence. It was proved from the students test result which failed to get high score in the test.

Item number 36
The most small vessels in the circulatory A B system are capillaries.
C D For this item, most of the students fail to get a good score. 85% students failed to choose the correct answer. Only 15% students could choose the correct answer. It showed that the students have difficulty in identifying the use of comparative and superlative in a sentence.

Item number 37
The period is probably the most easiest A B C punctuation mark to use D Similar to the item number 36, this item got the same percentage of students' error in comparative and superlative.
Most of the students could not be able to identify the use of correct comparative and superlative in the test. 85 % students could not be able to identify the correct answer, meanwhile only 15 % students could recognize correct answer.

Word Choice
Understanding the word choice in a sentence was also one of difficulty faced by nursing students in the TOEFL test. It could be found from the students' test result which failed to choose the correct answer in the test. Word choice had been put in the item no 10, 11 and 12, and the explanation of students' result can be seen below:

Item number 10
The children became ill after taking medicine that was __________ date.
(A) off the (B) outside (C) out of (D) over For item number 10, 30 students (75%) failed to determine the correct answer. There were only 10 students (25%) obtained the correct answer.

Item number 11
__________ , these students are among the best prepared who have been through this university.
(A) At the whole (B) On the whole (C) In the general (D) In generally Similarly to the question number 10, only 12 (30%) students chose the correct answer. 28 (70%) students could not able to choose the correct answer. It indicated that understanding word choice Fitri Handayani 146 Structure and Written… becomes the biggest obstacle for the students in the TOEFL test.

Item number 12
Bill took not only a French class __________ a Japanese class. (A) but also (B) and (C) too (D) but too Finally, in this last item about word choice, it also showed students' difficulty by showing students' low score in choosing the correct answer. Only 15 (38%) students could chose the correct answer, while 25 (62%) students failed to give the correct answer.

Word Form
The last difficult item experienced by nursing students in the TOEFL test was word form. The questions for this item had been put in the question number 7 and 8. the followings are the analysis for each question:

Item number 7
A cupful of stagnant water may ______ millions of microorganisms.
(A) contains (B) to contain (C) contain (D) containing For this question, the highest percentage of student's error was 70%. Only 12 students chose the correct answer. 28 students failed to choose the correct answer. The researcher assumed that not many of them were aware of the use of correct word form in the question.

Item number 8
Sarah Knight ______ a fascinating account of a journey she made from Boston to New York in 1704.
(A) written (B) write (C) wrote (D) writing For item number 8, 62% students chose incorrect answer by selecting option (B). Only 15 students could identify the correct answer and the rest of them chose (A).

The Students' Interview Result
After analyzing the students' test results and identify the students' difficulties in the structure and written expression section, the researcher began to interview with some students to find detail information about their difficulties in the TOEFL test. The researcher interviewed with 5 students. They were selected because they got the lowest score compared with the other students. The aim of the interview was significantly to figure out what factors influence nursing students' difficulty in structure and written expression section test. Some of the factors were as follows:

Unfamiliarity with the TOEFL Test
The first factor encountered by nursing students was unfamiliarity with the TOEFL test. Some students stated their reasons as follows: From the students' responds above, the students' difficulties in answering the TOEFL test were due to their lack of familiarity with TOEFL test. Most of the students never took the TOEFL test before, as a result, they did not have knowledge and experience in answering the questions in the test. Furthermore, they also did not know the strategy and techniques in answering the question in the test. Also, they said that TOEFL test was something unusual for them. They never faced it in their academic life before.

Lack of practice
The second factor indicated the students' difficulty in the TOEFL test arrived from their lack of practice before attending the test. Some of them responded: (a From the students' respond above, it showed that they did not get enough time to get practice in the TOEFL test, moreover some of them never had practice before attending the test. Many of them did not familiar with the items/questions to be tested in the test. They only took the test with very little knowledge about the test. Consequently, less practice makes them fail to get a good score in the test.

Lack of grammatical competence
Grammatical competence became one of the important aspects which make students difficult in answering the questions in the TOEFL test. From the interview, it seems that the students had a lack of grammatical competence and thus make them struggle in the test. Some of them said: (a)."I know a little bit about tenses and some aspect of grammar that I have learned in senior high school. But, when the sentence is long and complicated, it is difficult to recognize the errors."; (b). "I feel the burden when it comes to determining the error in part B. It is like every word in the sentence was correct"; (c). "Tenses are difficult for me, and I do not know how to identify the correct use of it."; (d). "I do not understand English grammar. The item for each part was difficult and all about grammar."; (e). "For me, it is very hard to discover the Subject and Predicate and the other aspects of grammar in the TOEFL test. I did not know the name of each aspect in detail and did not know how to use it appropriately in a sentence. Moreover, every word in part B seems correct to me." From the students' answered above, it stated that the students' grammatical competence was poor. It makes them struggle in answering the test. They have no idea about subject-verb agreement, preposition, article, and other aspects of grammar which is tested in the test.
From the findings above, it was found that there were 8 items considered as the most difficult items in the structure and written expression section of the TOEFL test. The items were word order, parallel structure, singular and plural noun, missing and extra words, article, comparative and superlative, word choice, word form. Furthermore, from the interview result, it is reported that the students got difficulty in the test because of some factors; unfamiliarity with the TOEFL test, lack of practice, and lack of grammatical competence.
For nursing students, taking the TOEFL test was a new experience. Only a few students ever took the test when they were in senior high school, and the rest of the students never took the TOEFL test. Unfamiliarity with the test makes them hard to acquire the items or topics assessed in the structure and written expression section of TOEFL test. This is in line with 15 which states that many participants failed in the test because they never studied TOEFL before.
Also, the lack of practice becomes an important aspect influence students' difficulty in the TOEFL test. In this case, the nursing students were rare to have practice and training about TOEFL. They were not trained intensively to gain their knowledge of TOEFL. They only got a little explanation on TOEFL from their previous senior high school, and it did not improve their basic skills on TOEFL yet. Students need to have an intensive practice such as TOEFL classroom 15  preparation in preparing them for the real test. As a result, they will have a familiarity with the test and a clear direction on how to prepare the test 16 .
Finally, the students also had low grammatical competence that makes them hard to answer the questions in the test. This result also supported by 17 which say that the students' difficulty in structure and written expression section indicated that students do not have a good comprehension in grammar. They do not have a good understanding of the sentence structure and word form.

Conclusion
From the findings of the research, it can be stated that nursing students had difficulties in the structure and written expressions section on the TOEFL test. These difficulties became the major causes of students' failure in achieving this test successfully. The research findings revealed that there were 8 items considered as the most difficult elements in grammar use found in the TOEFL test. The items were word order, parallel structure, singular and plural noun, missing and extra words, article, comparative and superlative, word choice, and word form.
Besides, the findings also reported that there were some factors dominated the nursing students' difficulty in the structure and written expression section of the TOEFL test. The factors were unfamiliarity with the TOEFL Test, lack of practice, and lack of grammatical competence