儿科住院医师的西班牙语临床应用和语言熟练程度测试。

Clinical Spanish use and language proficiency testing among pediatric residents.

机构信息

Dr. Lion is acting assistant professor, Department of Pediatrics, University of Washington, Seattle, Washington. Dr. Thompson is assistant professor, Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado. Dr. Cowden is assistant professor, Children's Mercy Hospitals and Clinics, Kansas City, Missouri. Mr. Michel is a medical student, University of Washington School of Medicine, Seattle, Washington. Ms. Rafton is administrative director, Odessa Brown Children's Clinic, Seattle Children's Hospital, Seattle, Washington. Dr. Hamdy is attending physician, Department of Pediatrics, Medstar Franklin Square Medical Center, Baltimore, Maryland. Dr. Killough is chief pediatric resident, Children's Mercy Hospitals and Clinics, Kansas City, Missouri. Mr. Fernandez is supervisor, Department of Interpreter Services, Seattle Children's Hospital, Seattle, Washington. Dr. Ebel is associate professor, Department of Pediatrics, University of Washington, Seattle, Washington, and director, Harborview Injury Research and Prevention Center, University of Washington, Seattle, Washington.

出版信息

Acad Med. 2013 Oct;88(10):1478-84. doi: 10.1097/ACM.0b013e3182a2e30d.

DOI:10.1097/ACM.0b013e3182a2e30d

PMID:23969350

Abstract

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.

摘要

目的

描述儿科住院医师使用西班牙语的临床模式，并将自我评估的语言熟练程度与客观语言测试进行比较。

方法

2010 年，作者通过电子邮件向三家机构的 247 名儿科住院医师发送了一份调查，邀请所有具有西班牙语语言能力的人参加。参与者完成了一份调查，报告西班牙语熟练程度、口译员使用情况以及在一系列临床情况下使用西班牙语的舒适度。临床情景按复杂程度分组并进行分析。自我报告的西班牙语熟练程度与通过 20 分钟电话评估一般语言能力的测试熟练程度进行比较。分数分为“不熟练”、“熟练”和“精通”。

结果

在 247 名住院医师中，有 78 名（32%）参与了调查，报告了西班牙语水平的范围；其中 23%的人报告了口语熟练程度（“熟练”或“流利”）。所有熟练程度的参与者都报告说在没有口译的情况下使用西班牙语，包括 63%的不熟练者。大多数（56%）非熟练居民报告在直接的临床情况下使用西班牙语感到舒适，10%的人报告在具有法律影响的临床情况下感到舒适。自我报告的熟练程度对测试达到熟练水平的阳性预测值为 67%，对测试达到精通水平的阳性预测值为 22%。