title: Clinical Spanish use and language proficiency testing among pediatric residents.
abstract: OBJECTIVE
  To describe patterns of clinical Spanish use by pediatric residents, and to compare self-assessment of language proficiency against an objective language test.
  
  
  METHODS
  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.
authors: 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.
authors: K Casey
authors: KC
authors: Lion
authors: Darcy A
authors: DA
authors: Thompson
authors: John D
authors: JD
authors: Cowden
authors: Eriberto
authors: E
authors: Michel
authors: Sarah A
authors: SA
authors: Rafton
authors: Rana F
authors: RF
authors: Hamdy
authors: Emily Fitch
authors: EF
authors: Killough
authors: Juan
authors: J
authors: Fernandez
authors: Beth E
authors: BE
authors: Ebel
mesh_terms: D000328:Adult; D003144:Communication Barriers; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007396:Internship and Residency; D007807:Language Tests; D008297:Male; D019303:Multilingualism; D010372:Pediatrics; D012647:Self-Assessment; D011795:Surveys and Questionnaires