Clinical Spanish use and language proficiency testing among pediatric residents.

PURPOSE: To describe patterns of clinical Spanish use by pediatric residents, and to compare self-assessment of language proficiency against an objective language test. METHOD: In 2010, the authors e-mailed a survey to all 247 pediatric residents at three institutions, inviting those with any level of Spanish language ability to participate. Participants completed a survey reporting Spanish proficiency, interpreter use, and comfort using Spanish in a range of clinical scenarios. Clinical scenarios were grouped and analyzed by degree of complexity. Self-reported Spanish proficiency was compared with tested proficiency, as measured by a 20-minute telephone assessment of general language ability. Scores were categorized as "not proficient," "proficient," and "highly proficient." RESULTS: Of the 247 residents, 78 (32%) participated, self-reporting a range of Spanish skills; 23% of those reported spoken proficiency ("proficient" or "fluent"). Participants at all levels of proficiency reported using Spanish without interpretation, including 63% of those who were not proficient. The majority (56%) of nonproficient residents reported comfort using Spanish in straightforward clinical scenarios, and 10% reported comfort in clinical scenarios with legal implications. Self-reported proficiency had a positive predictive value of 67% for testing at a proficient level and 22% for testing at a highly proficient level. CONCLUSIONS: Regardless of level of Spanish proficiency, pediatric residents provide clinical care to patients in Spanish. Self-reported Spanish proficiency does not reliably predict tested ability, especially when using stringent criteria to define proficiency. Provider language "credentialing" is an important step in implementing a policy to improve care for limited English proficiency patients.

Impact of language proficiency testing on provider use of Spanish for clinical care.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.