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.
Keywords
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References
- Office of the Legislative Counsel. Compilation of Patient Protection and Affordable Care Act.US Government Printing Office, Washington, DC2010 (Available at:) (Accessed January 5, 2014)
- The next GME accreditation system—rationale and benefits.N Engl J Med. 2012; 366: 1051-1056
Migration Policy Institute. MPI data hub: migration facts, stats, and maps. Available at: http://www.migrationinformation.org/datahub/state2.cfm?ID=US. Accessed September 13, 2012.
Migration Policy Institute. Place of birth for foreign-born population. Census 2000 and ACS 2006–11. Available at: http://www.migrationinformation.org/globaldata/charts/MPIDataHub-Region-birth-1960.xlsx. Accessed August 26th, 2013.
- A prescription for cultural competence in medical education.J Gen Intern Med. 2006; 21: 1116-1120
- Cultural Competence Education for Students in Medicine and Public Health: Report of an Expert Panel.Association of American Medical Colleges and Association of Schools of Public Health, Washington, DC2012 (Available at:) (Accessed January 5, 2014)
Accreditation Council for Graduate Medical Education. Pediatrics milestones to be reported on semi-annualy. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources/Pediatrics_Milestones_to_be_reported_on_semi-annually.pdf. Accessed March 11, 2013.
- Primary care resident perceived preparedness to deliver cross-cultural care: an examination of training and specialty differences.J Gen Intern Med. 2007; 22: 1107-1113
- Resident physicians’ preparedness to provide cross-cultural care.JAMA. 2005; 294: 1058-1067
- Resident cross-cultural training, satisfaction, and preparedness.Acad Pediatr. 2013; 13: 65-71
- Mixed messages: residents’ experiences learning cross-cultural care.Acad Med. 2005; 80: 874-880
- Impact of interpreter services on delivery of health care to limited-English-proficient patients.J Gen Intern Med. 2001; 16: 468-474
- Pediatricians’ use of language services for families with limited English proficiency.Pediatrics. 2007; 119: e920-e927
- Resident physicians’ use of professional and nonprofessional interpreters: a national survey.JAMA. 2006; 296: 1050-1053
- The truth about language barriers: one residency program’s experience.Pediatrics. 2003; 111: e569-e573
- The role of self-efficacy in achieving health behavior change.Health Educ Q. 1986; 13: 73-92
- Self-efficacy: an essential motive to learn.Contemp Educ Psychol. 2000; 25: 82-91
- Self-efficacy: toward a unifying theory of behavioral change.Psychol Rev. 1977; 84: 191-215
- The effect of training in communication skills on medical doctors’ and nurses’ self-efficacy. A randomized controlled trial.Patient Educ Couns. 2007; 66: 270-277
- Efficacy of a communication and stress management training on medical residents’ self-efficacy, stress to communicate and burnout: a randomized controlled study.J Health Psychol. 2010; 15: 1075-1081
- Why don’t physicians follow clinical practice guidelines? A framework for improvement.JAMA. 1999; 282: 1458-1465
- Is the professional satisfaction of general internists associated with patient satisfaction?.J Gen Intern Med. 2000; 15: 122-128
- Rates of medication errors among depressed and burnt out residents: prospective cohort study.BMJ. 2008; 336: 488-491
- Career choice selection and satisfaction among US adult nephrology fellows.Clin J Am Soc Nephrol. 2012; 7: 1513-1520
- Applications of self-efficacy theory to understanding career choice behavior.J Soc Clin Psychol. 1986; 4: 279-289
Center for Workforce Studies; Association of American Medical Colleges. Recent studies and reports on physician shortages in the US. October 2012. Available at: https://www.aamc.org/download/100598/data/. Accessed January 5, 2014.
- Qualitative Research and Evaluation Methods.3rd ed. Sage Publications, Thousand Oaks, Calif2002
- The use of Spanish language skills by physicians and nurses: policy implications for teaching and testing.J Gen Intern Med. 2012; 27: 117-123
- “Does this doctor speak my language?” Improving the characterization of physician non-English language skills.Health Serv Res. 2012; 47: 556-569
- Getting by: underuse of interpreters by resident physicians.J Gen Intern Med. 2009; 24: 256-262
- Getting past getting by: training culturally and linguistically competent bilingual physicians.J Pediatr. 2012; 160: 891-892.e1
- Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters.Ann Emerg Med. 2012; 60: 545-553
National Council on Interpreting in Health Care. Available at: http://www.ncihc.org. Accessed October 22, 2012.
- Working effectively with interpreters: a model curriculum for physician assistant students.Med Teach. 2008; 30: 612-617
- Teaching medical students how to use interpreters: a three year experience.Med Educ Online. 2009; 14: 12
Article info
Publication history
Accepted:
December 17,
2013
Received:
March 19,
2013
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
