“Oh! she doesn’t speak english!” assessing resident competence in managing linguistic and cultural barriers

  • Sondra Zabar
  • Kathleen Hanley
  • Elizabeth Kachur
  • David Stevens
  • Mark D. Schwartz
  • Ellen Pearlman
  • Jennifer Adams
  • Karla Felix
  • Mack LipkinJr.
  • Adina Kalet
Innovations In Education

Abstract

BACKGROUND: Residents must master complex skills to care for culturally and linguistically diverse patients.

METHODS: As part of an annual 10-station, standardized patient (SP) examination, medical residents interacted with a 50-year-old reserved, Bengali-speaking woman (SP) with a positive fecal occult blood accompanied by her bilingual brother (standardized interpreter (SI)). While the resident addressed the need for a colonoscopy, the SI did not translate word for word unless directed to, questioned medical terms, and was reluctant to tell the SP frightening information. The SP/SI, faculty observers, and the resident assessed the performance.

RESULTS: Seventy-six residents participated. Mean faculty ratings (9-point scale) were as follows: overall 6.0, communication 6.0, knowledge 6.3. Mean SP/SI ratings (3.1, range 1.9 to 3.9) correlated with faculty ratings (overall r=.719, communication r=.639, knowledge r=.457, all P<.01). Internal reliability as measured by Cronbach’s α coefficients for the 20 item instrument was 0.91. Poor performance on this station was associated with poor performance on other stations. Eighty-nine percent of residents stated that the educational value was moderate to high.

CONCLUSION: We reliably assessed residents communication skills conducting a common clincal task across a significant language barrier. This medical education innovation provides the first steps to measuring interpreter facilitated skills in residency training.

Key words

medical education residency evaluation cross-language skills 

References

  1. 1.
    Culhane-Pera KA, Like RC, Lebensohn-Chialvo P, Loewe R. Multicultural curricula in family practice residencies. Fam Med. 2000;32:167–73.PubMedGoogle Scholar
  2. 2.
    Betancourt JR. Cross-cultural medical education: conceptual approaches and frameworks for evaluation. Acad Med. 2003;78:560–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Kachur EK, Altshuler L. Cultural competence is everyone’s responsibility!. Med Teacher. 2004;26:101–5.CrossRefGoogle Scholar
  4. 4.
    Flores G, Gee D, Kastner B. The teaching of cultural issues in U.S. and canadian medical schools. Acad Med. 2000;75:451–5.PubMedCrossRefGoogle Scholar
  5. 5.
    United States Census. ‘Language Use and English-Speaking Ability.’ 2000: 1–3. Available at: http://www.census.gov/prod/2003pubs/c2kbr-29.pdf. Accessed: November 29, 2005.Google Scholar
  6. 6.
    Interpretation and Translation Services in Health Care: A Survey of U.S. Public and Private Teaching Hospitals. Washington, DC: National Public Health and Hospital Institute; 1995.Google Scholar
  7. 7.
    Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130:829–34.PubMedGoogle Scholar
  8. 8.
    IOM Report. In: Brian DS, Adrienner YS, Alan RN, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press; 2003. Available at: http://www.nap.edu/books/030908265X/html.Google Scholar
  9. 9.
    Office of Minority Health. U.S. Department of Health and Human Services, National Standards of Cultural and linguistically Appropriate Services in Health Care, 2000.Google Scholar
  10. 10.
    “Executive order 13166: improving access to services for persons with limited english proficiency.” Available at: http://www.usdoj.gov/crt/cor/Pubs/eolep.htm. Accessed: January 4, 2006.Google Scholar
  11. 11.
    Marcos L. Effects of interpreters on the evaluation of psychopathology in non-English speaking patients. Am J Psychiatry. 1979;136:171–4.PubMedGoogle Scholar
  12. 12.
    Putsch RW. Cross-cultural communication: the special case of interpreters in health care. JAMA. 1985;254:3344–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Jacobs EA, Lauderdale DS, Meltzer D, Shorey JM, Levinson W, Thisted RA. Impact of interpreter services on delivery of health care to limited-English-proficient patients. J Gen Intern Med. 2001;16:468–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Altshuler L, Kachur E. A culture OSCE: teaching residents to bridge different worlds. Acad Med. 2001;76:514.PubMedCrossRefGoogle Scholar
  15. 15.
    Zabar S, Hanley K, Stevens D, et al. Measuring the competence of residents as teachers. J Gen Intern Med. 2004;19:530.PubMedCrossRefGoogle Scholar
  16. 16.
    Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J. 1975;1:447–51.PubMedCrossRefGoogle Scholar
  17. 17.
    United States Medical Licensing Examination. Available at: http://www.usmle.org. Accessed January 3, 2006.Google Scholar
  18. 18.
    Gany F, Michael S. Working with interpreters, conference proceedings: immigrant women’s health: current issues and concepts, Center for Immigrant Health, June 4; 1996, 1–102.Google Scholar
  19. 19.
    Yedidia MJ, Gillespie CC, Kachur E, et al. Effect of communications training on medical student performance. JAMA. 2003;290:1157–65.PubMedCrossRefGoogle Scholar
  20. 20.
    Karliner LS, Perez-Stable EJ, Gildengorin G. The language divide. The importance of training in the use of interpreters for outpatient practice. J Gen Intern Med. 2004;19:175–83.PubMedCrossRefGoogle Scholar
  21. 21.
    Baker DW, Hayes R, Fortier J. Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. Med Care. 1998;36:1461–70.PubMedCrossRefGoogle Scholar
  22. 22.
    Goleman MJ. Teaching pediatrics residents to communicate with patients across differences. Acad Med. 2001;76:515–6.PubMedCrossRefGoogle Scholar
  23. 23.
    Van Der Vleuten CPM, Swanson DB. Assessment of clinical skills with standardized patients: state of the art. Teach Learn Med. 1990;2:58–76.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Sondra Zabar
    • 1
  • Kathleen Hanley
    • 1
  • Elizabeth Kachur
    • 1
  • David Stevens
    • 1
  • Mark D. Schwartz
    • 1
  • Ellen Pearlman
    • 1
  • Jennifer Adams
    • 1
  • Karla Felix
    • 1
  • Mack LipkinJr.
    • 1
  • Adina Kalet
    • 1
  1. 1.New York University School of MedicineNew York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal MedicineNew YorkUSA

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