title: Predictors of resident satisfaction in caring for limited English proficient families: a multisite study.
abstract: OBJECTIVE
  To assess residents' self-efficacy, satisfaction and frustration in the care of limited English proficient (LEP) families and to identify individual and programmatic factors associated with the above outcomes.
  
  
  METHODS
  A multisite cross-sectional survey of pediatric residents currently in training and caring for LEP families was conducted. Resident self-efficacy scores in specific skill domains were assessed. Clustered multivariate logistic regression analyses were used to identify individual and programmatic factors associated with increased satisfaction and frustration. Qualitative analyses were also utilized to identify themes related to frustrating aspects of care.
  
  
  RESULTS
  A total of 271 of 449 eligible residents representing 7 US pediatric residency programs participated in our study (60% response rate). A majority of residents (51%) rated their self-efficacy in the overall care of LEP families as low. Satisfaction was associated with a high self-efficacy score (odds ratio [OR] 4.7, 95% confidence interval [CI] 1.8-12.6), increasing year in training (OR 3.2, 95% CI 1.01-10.2), frequent non-English language use (OR 3.1, 95% CI 1.1-8.8), and instruction on the use of interpreters (OR 1.9, 95% CI 1.02-3.64). Satisfaction was inversely associated with increased LEP patient volumes (OR 0.40, 95% CI 0.18-0.91). Clinical inefficiency related to interpreter use and distrust of interpreter skills were frequently cited as aspects that contribute to overall frustration.
  
  
  CONCLUSIONS
  A majority of residents reported lacking self-efficacy in their ability to deliver care to LEP patients, which may influence overall satisfaction with such encounters. Strategies that promote resident self-efficacy and assess non-English language proficiency should be included in future training curricula. Exposing trainees to best practices in interpreter-based encounters may further promote resident satisfaction.
authors.affiliation: Children's Hospital, Johns Hopkins Medicine, St Petersburg, Fla; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md. Electronic address: Raquel.hernandez@allkids.org.
authors.forename: Raquel G
authors.initials: RG
authors.lastname: Hernandez
authors.affiliation: Children's Mercy Hospitals and Clinics, Kansas City, Mo.
authors.forename: John D
authors.initials: JD
authors.lastname: Cowden
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Margaret
authors.initials: M
authors.lastname: Moon
authors.affiliation: Children's Hospital, Johns Hopkins Medicine, St Petersburg, Fla; Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Chad K
authors.initials: CK
authors.lastname: Brands
authors.affiliation: Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Sisson
authors.affiliation: Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
authors.forename: Darcy A
authors.initials: DA
authors.lastname: Thompson
mesh_terms: D003144:Communication Barriers; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005190:Family; D006801:Humans; D007396:Internship and Residency; D007802:Language; D016017:Odds Ratio; D010372:Pediatrics; D010549:Personal Satisfaction; D012044:Regression Analysis; D020377:Self Efficacy
keywords: competency; graduate medical education; health care reform; health disparities; limited English proficiency; resident training; satisfaction; self-efficacy