Impact of Language Proficiency Testing on Provider Use of Spanish for Clinical Care

Abstract

To measure the impact of an objective evaluation of provider Spanish-language skills on self-reported language proficiency and comfort using Spanish in a range of clinical scenarios. We enrolled pediatric residents with any self-reported Spanish language ability from 3 residency programs. Participants completed a baseline survey, objective language testing, and a posttest survey. We gathered demographics, self-reported Spanish ability, and comfort using Spanish in various clinical scenarios, which were grouped and analyzed by degree of complexity. Between surveys, a language testing service administered a 20-minute, telephone-based assessment of general Spanish proficiency. Scores were reported on a scale from 1 to 12, with scores ≥ 9 designated "proficient." Participants received a numeric score and brief qualitative feedback on their language ability. Following testing, residents (n = 76) were significantly less likely to report comfort using Spanish in straightforward clinical scenarios, from 64% to 51% (P = .007). That difference was accounted for entirely by residents who tested at a non-proficient level (56% to 39%, P = .006). Testing had no impact on comfort using Spanish in complex or medical-legal scenarios, at any proficiency level. We found no change in self-reported Spanish proficiency in any resident group. Objective Spanish-language testing decreased nonproficient resident comfort using Spanish in straightforward clinical encounters, but it did not change comfort in complex or legal scenarios. In combination with education and enforceable policies, language testing may play an important role in decreasing nonproficient Spanish use and improving care for patients with limited English proficiency.