"Oh! She doesn't speak English!" Assessing resident competence in managing linguistic and cultural barriers.
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.
Zabar
Sondra
S
Primary Care Internal Medicine Residency Program, Division of General Internal Medicine, New York University School of Medicine, New York, NY, USA. szabar@breitezabar.com
Hanley
Kathleen
K
Kachur
Elizabeth
E
Stevens
David
D
Schwartz
Mark D
MD
Pearlman
Ellen
E
Adams
Jennifer
J
Felix
Karla
K
Lipkin
Mack
M
Kalet
Adina
A
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