“Oh! She Doesn't Speak English!” Assessing Resident Competence in Managing Linguistic and Cultural Barriers

Authors

  • Sondra Zabar MD,

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • Kathleen Hanley MD,

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • Elizabeth Kachur PhD,

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • David Stevens MD,

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • Mark D. Schwartz MD,

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • Ellen Pearlman MD,

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • Jennifer Adams MD,

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • Karla Felix BS,

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • Mack Lipkin Jr. MD,

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • Adina Kalet MD, MPH

    1. New York University School of Medicine, New York University Primary Care Internal Medicine Residency Program, Section of Primary Care, Division of General Internal Medicine, New York, NY, USA.
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  • The authors do not have any conflicts of interest to declare.

  • Presented in part at the Annual Meeting of the Society of General Internal Medicine, May 10, 2004. Funded by HRSA, Bureau of Health Professionals.

Address correspondence and requests for reprints to Dr. Zabar: First Avenue, Old Bellevue, D401B, New York, NY 10016 (e-mail: szabar@breitezabar.com).

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.

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