title: "Oh! She doesn't speak English!" Assessing resident competence in managing linguistic and cultural barriers.
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 alpha 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.
  
  
  CONCLUSIONS
  We reliably assessed residents communication skills conducting a common clinical task across a significant language barrier. This medical education innovation provides the first steps to measuring interpreter facilitated skills in residency training.
authors.affiliation: Primary Care Internal Medicine Residency Program, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA. szabar@breitezabar.com
authors.forename: Sondra
authors.initials: S
authors.lastname: Zabar
authors.forename: Kathleen
authors.initials: K
authors.lastname: Hanley
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kachur
authors.forename: David
authors.initials: D
authors.lastname: Stevens
authors.forename: Mark D
authors.initials: MD
authors.lastname: Schwartz
authors.forename: Ellen
authors.initials: E
authors.lastname: Pearlman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Adams
authors.forename: Karla
authors.initials: K
authors.lastname: Felix
authors.forename: Mack
authors.initials: M
authors.lastname: Lipkin
authors.forename: Adina
authors.initials: A
authors.lastname: Kalet
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D003144:Communication Barriers; D018864:Cultural Diversity; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency; D016544:Patient Simulation; D010817:Physician-Patient Relations; D015203:Reproducibility of Results