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.
aDepartment of Pediatrics, University of Washington, Seattle, ashington 98104-2499, USA.
K Casey
KC
Lion
Darcy A
DA
Thompson
John D
JD
Cowden
Eriberto
E
Michel
Sarah A
SA
Rafton
Rana F
RF
Hamdy
Emily Fitch
EF
Killough
Juan
J
Fernandez
Beth E
BE
Ebel
D000328:Adult; D001291:Attitude of Health Personnel; D003144:Communication Barriers; D054521:Cultural Competency; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007807:Language Tests; D008297:Male; D019303:Multilingualism; D010372:Pediatrics / Q000193:education; D011446:Prospective Studies; D011787:Quality of Health Care; D057566:Self Report; D014175:Translating; D014481:United States