non-English Language Proficiency Research Articles

Physicians’ Perspectives on Using Direct Observation to Assess Non-English Language Proficiency for Clinical Practice: A Qualitative Study

BackgroundCommunication barriers are known to adversely affect patient safety. Yet few health systems assess and track physician non-English language proficiency for use in clinical settings. Barriers to current assessments (usually simulated clinician oral proficiency interviews) include time constraints and lack of interactivity. This study's objective was to investigate physician perspectives on using direct clinical observation as an alternative form of assessment of their non-English language skills. MethodsThe authors conducted semistructured interviews with 11 fully and partially bilingual primary care physicians (general internists) from a large academic health system to understand physician perspectives on using direct observation as an alternative form of assessing non-English proficiency for use in clinical practice. Two researchers independently and iteratively coded transcripts using thematic analysis with constant comparison to identify themes. ResultsParticipants, mostly women (n = 9; 81.8%), reported varying levels of proficiency in Cantonese, Mandarin, Russian, or Spanish. Participants expressed three main themes: (1) benefits of direct observation, including familiar setting, relevant content, and convenience; (2) disadvantages, including discomfort, potential embarrassment, and limitations of observing a single encounter; and (3) suggestions to enhance use of direct observation tools, such as observing multiple encounters, and use of remote observation. ConclusionTo ensure high-quality language-concordant care, health systems must assess physicians’ non-English language proficiency. If validated tools can be developed and disseminated in clinical practice, direct observation may be an acceptable option.

Improving Communication with Patients with Limited English Proficiency: Non-English Language Proficiency Assessment for Clinicians

Improving Communication with Patients with Limited English Proficiency: Non-English Language Proficiency Assessment for Clinicians

Language-Concordant Care: a Qualitative Study Examining Implementation of Physician Non-English Language Proficiency Assessment

BackgroundLanguage concordance can increase access to care for patients with language barriers and improve patient health outcomes. However, systematically assessing and tracking physician non-English language skills remains uncommon in most health systems. This is a missed opportunity for health systems to maximize language-concordant care.ObjectiveTo determine barriers and facilitators to participation in non-English language proficiency assessment among primary care physicians.DesignQualitative, semi-structured interviews.ParticipantsEleven fully and partially bilingual primary care physicians from a large academic health system with a language certification program (using a clinician oral proficiency interview).ApproachInterviews aimed to identify barriers and facilitators to participation in non-English language assessment. Two researchers independently and iteratively coded transcripts using a thematic analysis approach with constant comparison to identify themes.Key ResultsMost participants were women (N= 9; 82%). Participants reported proficiency in Cantonese, Mandarin, Russian, and Spanish. All fully bilingual participants (n=5) had passed the language assessment; of the partially bilingual participants (n=6), four did not test, one passed with marginal proficiency, and one did not pass. Three themes emerged as barriers to assessment participation: (1) beliefs about the negative consequences (emotional and material) of not passing the test, (2) time constraints and competing demands, and (3) challenging test format and structure. Four themes emerged as facilitators to increase assessment adoption: (1) messaging consistent with professional ethos, (2) organizational culture that incentivizes certification, (3) personal empowerment about language proficiency, and (4) individuals championing certification.ConclusionsTo increase language assessment participation and thus ensure quality language-concordant care, health systems must address the identified barriers physicians experience and leverage potential facilitators. Findings can inform health system interventions to standardize the requirements and process, increase transparency, provide resources for preparation and remediation, utilize messaging focused on patient care quality and safety, and incentivize participation.

P44 - Development of a Tool to Assess Medical Oral Non-English Language Proficiency: Presenter(s): Lisa Diamond, Memorial Sloan Kettering Cancer Center, United States

P44 - Development of a Tool to Assess Medical Oral Non-English Language Proficiency: Presenter(s): Lisa Diamond, Memorial Sloan Kettering Cancer Center, United States

Surgical Residents as Certified Bilingual Speakers: A Quality Improvement Initiative

The objective of this quality improvement initiative was to identify general surgery residents proficient in a non-English language and have each attempt the Clinician Cultural and Linguistic Assessment (CCLA) to become qualified bilingual staff speakers. General surgery house staff were asked to self-identify as proficient in a language other than English. Fees for the certification examination were waived, and each resident was excused from clinical duties to complete the exam. McNemar's test was used for statistical analysis. All residents responded to the initial survey, with 18/65 reporting a non-English language proficiency. Of the 12 residents who sat for the CCLA exam, 9 (75.0%) passed, with 5 certifying in the most commonly spoken non-English languages at this institution. The number of certified residents increased from 1 to 10 (1.5 % to 15.4%, p = 0.004). Language barriers result in health care disparities for patients with limited English proficiency. This reproducible quality improvement initiative significantly increased the number of qualified bilingual speakers, while 25.0% of self-described proficient speakers did not demonstrate adequate language proficiency. These newly certified providers allow for increased language concordant care, which may be associated with improved outcomes.

Effects of Language, Insurance, and Race/Ethnicity on Measurement Properties of the PROMIS Physical Function Short Form 10a in Rheumatoid Arthritis

Most studies that have evaluated patient-reported outcomes, such as those utilizing the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Short Form 10a (PF10a) in rheumatoid arthritis (RA), have been performed in white and English-speaking populations. The aim of our study was to assess the measurement properties of the PF10a in a racially/ethnically diverse population with RA and to determine the effect of non-English language proficiency, insurance status, and race/ethnicity on the validity and responsiveness of the PF10a. Data were abstracted from electronic health records for all RA patients seen in a university-based rheumatology clinic between 2013 and 2017. We evaluated the use of the PF10a, floor and ceiling effects, and construct validity across categories of language preference, insurance, and race/ethnicity. We used standardized response means and linear mixed-effects models to evaluate the responsiveness of the PF10a to longitudinal changes in the Clinical Disease Activity Index (CDAI) across population subgroups. We included 595 patients in a cross-sectional analysis of validity and 341 patients in longitudinal responsiveness analyses of the PF10a. The PF10a had acceptable floor and ceiling effects and was successfully implemented. We observed good construct validity and responsiveness to changes in CDAI among white subjects, English speakers, and privately insured patients. However, constructs evaluated by the PF10a were less correlated with clinical measures among Chinese speakers and Hispanic subjects, and less sensitive to clinical improvements among Medicaid patients and Spanish speakers. While the PF10a has good measurement properties and is both practical and acceptable for implementation in routine clinical practice, we also found important differences across racial/ethnic groups and those with limited English proficiency that warrant further investigation.

Mapping the global health employment market: an analysis of global health jobs

BackgroundThe number of university global health training programs has grown in recent years. However, there is little research on the needs of the global health profession. We therefore set out to characterize the global health employment market by analyzing global health job vacancies.MethodsWe collected data from advertised, paid positions posted to web-based job boards, email listservs, and global health organization websites from November 2015 to May 2016. Data on requirements for education, language proficiency, technical expertise, physical location, and experience level were analyzed for all vacancies. Descriptive statistics were calculated for the aforementioned job characteristics. Associations between technical specialty area and requirements for non-English language proficiency and overseas experience were calculated using Chi-square statistics. A qualitative thematic analysis was performed on a subset of vacancies.ResultsWe analyzed the data from 1007 global health job vacancies from 127 employers. Among private and non-profit sector vacancies, 40% (n = 354) were for technical or subject matter experts, 20% (n = 177) for program directors, and 16% (n = 139) for managers, compared to 9.8% (n = 87) for entry-level and 13.6% (n = 120) for mid-level positions. The most common technical focus area was program or project management, followed by HIV/AIDS and quantitative analysis. Thematic analysis demonstrated a common emphasis on program operations, relations, design and planning, communication, and management.ConclusionsOur analysis shows a demand for candidates with several years of experience with global health programs, particularly program managers/directors and technical experts, with very few entry-level positions accessible to recent graduates of global health training programs. It is unlikely that global health training programs equip graduates to be competitive for the majority of positions that are currently available in this field.

The language and social background questionnaire: Assessing degree of bilingualism in a diverse population.

Research examining the cognitive consequences of bilingualism has expanded rapidly in recent years and has revealed effects on aspects of cognition across the lifespan. However, these effects are difficult to find in studies investigating young adults. One problem is that there is no standard definition of bilingualism or means of evaluating degree of bilingualism in individual participants, making it difficult to directly compare the results of different studies. Here, we describe an instrument developed to assess degree of bilingualism for young adults who live in diverse communities in which English is the official language. We demonstrate the reliability and validity of the instrument in analyses based on 408 participants. The relevant factors for describing degree of bilingualism are: (1) the extent of non-English language proficiency and use at home, and (2) non-English language use socially. We then use the bilingualism scores obtained from the instrument to demonstrate their association with: (1) performance on executive function tasks, and (2) previous classifications of participants into categories of monolinguals and bilinguals.

Preoperative consent for patients with limited English proficiency

BackgroundInformed consent is important for limited English proficient (LEP) patients undergoing surgery, as many surgical procedures are complicated, making patient comprehension difficult even without language barriers. The study objectives were to (1) understand surgeons' preoperative consenting process with LEP patients, (2) examine how surgeons self assess their non-English language proficiency levels using a standardized scale, and (3) identify the relationship between self assessed non-English language proficiency and surgeons' self-reported use of interpreters during preoperative informed consent. Materials and methodsA thirty-two item survey assessing surgeons' reported preoperative informed consent process, with questions related to demographics, level of medical training, non-English language skills and their clinical use, language learning experiences, and hypothetical scenarios with LEP patients. ResultsSurgeons who were not fluent in non-English languages reported they often used those limited skills to obtain informed consent from their LEP patients. Many surgeons reported relying on bilingual hospital staff members, family members, and/or minors to serve as ad-hoc interpreters when obtaining informed consent. If a professional interpreter was not available in a timely manner, surgeons more frequently reported using ad-hoc interpreters or their own nonfluent language skills. Surgeons reported deferring to patient and family preferences when deciding whether to use professional interpreters and applied different thresholds for different clinical scenarios when deciding whether to use professional interpreters. ConclusionsSurgeons reported relying on their own non-English language skills, bilingual staff, and family and friends of patients to obtain informed consent from LEP patients, suggesting that further understanding of barriers to professional interpreter use is needed.

Predictors of Resident Satisfaction in Caring for Limited English Proficient Families: A Multisite Study

ObjectiveTo assess residents' self-efficacy, satisfaction and frustration in the care of limited English proficient (LEP) families and to identify individual and programmatic factors associated with the above outcomes. MethodsA multisite cross-sectional survey of pediatric residents currently in training and caring for LEP families was conducted. Resident self-efficacy scores in specific skill domains were assessed. Clustered multivariate logistic regression analyses were used to identify individual and programmatic factors associated with increased satisfaction and frustration. Qualitative analyses were also utilized to identify themes related to frustrating aspects of care. ResultsA total of 271 of 449 eligible residents representing 7 US pediatric residency programs participated in our study (60% response rate). A majority of residents (51%) rated their self-efficacy in the overall care of LEP families as low. Satisfaction was associated with a high self-efficacy score (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.8–12.6), increasing year in training (OR 3.2, 95% CI 1.01–10.2), frequent non-English language use (OR 3.1, 95% CI 1.1–8.8), and instruction on the use of interpreters (OR 1.9, 95% CI 1.02–3.64). Satisfaction was inversely associated with increased LEP patient volumes (OR 0.40, 95% CI 0.18–0.91). Clinical inefficiency related to interpreter use and distrust of interpreter skills were frequently cited as aspects that contribute to overall frustration. ConclusionsA majority of residents reported lacking self-efficacy in their ability to deliver care to LEP patients, which may influence overall satisfaction with such encounters. Strategies that promote resident self-efficacy and assess non-English language proficiency should be included in future training curricula. Exposing trainees to best practices in interpreter-based encounters may further promote resident satisfaction.

“Does This Doctor Speak My Language?” Improving the Characterization of Physician Non‐English Language Skills

To describe the initial impact of an organizational policy change on measurement of physician non-English language proficiency. Multispecialty health care organization in the San Francisco Bay Area. In response to preliminary findings suggesting that the organization's nonvalidated and undefined three-category tool for physician self-report of non-English language proficiency levels was likely inadequate, the organization asked physicians to rate their non-English language proficiency levels using an adapted Interagency Language Roundtable (ILR) scale, a validated measure with five rating levels and descriptors. We then compared the self-reported language proficiency on the original scale and the ILR for those physicians who completed both and used regression analysis to investigate physician characteristics potentially associated with a change in score on the old versus ILR scales. Six months after the ILR scale was implemented throughout the organization, 75 percent (258/342) of physicians had updated their language proficiency ratings. Among clinicians who had previously rated themselves in the "Medical/Conversational" category, there were substantial variations in scores using the ILR scale. Physicians who spoke two or more non-English languages were significantly more likely to lower their self-reported proficiency when updating from the old scale to the ILR scale. The organization was willing to adopt a relatively straightforward change in how data were collected and presented to patients based on the face validity of initial findings. This organizational policy change appeared to improve how self-reported physician language proficiency was characterized.

The Use of Spanish Language Skills by Physicians and Nurses: Policy Implications for Teaching and Testing

Language barriers present a substantial communication challenge in the hospital setting. To describe how clinicians with various levels of Spanish language proficiency work with interpreters or their own Spanish skills in common clinical scenarios. Survey of physicians and nurses who report ever speaking Spanish with patients on a general medicine hospital floor. Spanish proficiency rated on a 5-point scale, self-reported use of specific strategies (own Spanish skills, professional or ad-hoc interpreters) to overcome the language barrier. Sixty-eight physicians and 65 nurses participated. Physicians with low-level Spanish proficiency reported frequent use of ad-hoc interpreters for all information-based scenarios, except pre-rounding in the morning when most reported using their own Spanish skills. For difficult conversations and procedural consent, most used professional interpreters. Comparatively, physicians with medium proficiency reported higher rates of using their own Spanish skills for information-based scenarios, lower rates of professional interpreter use, and little use of ad-hoc interpreters. They rarely used their own Spanish skills or ad-hoc interpreters for difficult conversations. Physicians with high-level Spanish proficiency almost uniformly reported using their own Spanish skills. The majority (82%) of nurses had low-level Spanish proficiency, and frequently worked with professional interpreters for educating patients, but more often used ad hoc interpreters and their own Spanish skills for information-based scenarios, including medication administration. Physicians and nurses with limited Spanish proficiency use these skills, even in important clinical circumstances in the hospital. Health-care organizations should evaluate clinicians' non-English language proficiency and set policies about use of language skills in clinical care.

Learning Disability in Children as an Outcome in Anesthesia and Analgesia Research

Learning Disability in Children as an Outcome in Anesthesia and Analgesia Research

Accuracy of Physician Self-Report of Spanish Language Proficiency

As health systems strive to meet the needs of linguistically diverse patient populations, determining a physician’s non-English language proficiency is becoming increasingly important. However, brief, validated measures are lacking. To determine if any of four self-reported measures of physician Spanish language proficiency are useful measures of fluency in Spanish. Physician self-report of Spanish proficiency was compared to Spanish-speaking patients’ report of their physicians’ language proficiency. 110 Spanish-speaking patients and their 46 physicians in two public hospital clinics with professional interpreters available. Physicians rated their Spanish fluency with four items: one general fluency question, two clinically specific questions, and one question on interpreter use. Patients were asked if their doctor speaks Spanish (“yes/no”). Concordance, sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for each of the items, and receiver operating (ROC) curves were used to compare performance characteristics. Concordance between physician and patient reports of physician Spanish proficiency ranged from 84 to 91%. The PPV for each of the four items ranged from 91 to 99%, the NPV from 60 to 90%, and the area under their ROC curves from 90 to 95%. The general fluency question gave the best combination of PPV and NPV, and the item on holding sensitive discussions had the highest PPV, 99%. Physicians who reported fluency as “fair” were as likely to have patients report they did not speak Spanish as that they did. Physician self-report of Spanish language proficiency is highly correlated with patient report, except when physicians report “fair” general fluency. In settings where no financial or other incentives are linked to language skills, simple questions may be a useful way to assess physician language proficiency.

Social profile of first-year dentistry students at the University of Sydney.

There has been constant interest in the background of dentistry students over the years. This paper, based on the data amassed by surveying the first-year dentistry students of 1994 and 1995, builds on previous questionnaires and publications, and shows that certain trends in student make-up, predicted earlier, have been checked. The article examines such features as the gender breakdown of first-year students, age at the end of their first year, their own and their parents' countries of origin, English and non-English language proficiency, type of school attended, parents' occupations, parents' highest level of education, motivations for choosing dentistry as a career, aptitude for a career in dentistry, and previous studies and employment. The data are analysed with the view to determining changes over time in the social composition of dentistry students.