Physicians’ Perspectives on Using Direct Observation to Assess Non-English Language Proficiency for Clinical Practice: A Qualitative Study

Abstract

Background

Communication barriers are known to adversely affect patient safety. Yet few health systems assess and track physician non-English language proficiency for use in clinical settings. Barriers to current assessments (usually simulated clinician oral proficiency interviews) include time constraints and lack of interactivity. This study's objective was to investigate physician perspectives on using direct clinical observation as an alternative form of assessment of their non-English language skills.

Methods

The authors conducted semistructured interviews with 11 fully and partially bilingual primary care physicians (general internists) from a large academic health system to understand physician perspectives on using direct observation as an alternative form of assessing non-English proficiency for use in clinical practice. Two researchers independently and iteratively coded transcripts using thematic analysis with constant comparison to identify themes.

Results

Participants, mostly women (n = 9; 81.8%), reported varying levels of proficiency in Cantonese, Mandarin, Russian, or Spanish. Participants expressed three main themes: (1) benefits of direct observation, including familiar setting, relevant content, and convenience; (2) disadvantages, including discomfort, potential embarrassment, and limitations of observing a single encounter; and (3) suggestions to enhance use of direct observation tools, such as observing multiple encounters, and use of remote observation.

Conclusion

To ensure high-quality language-concordant care, health systems must assess physicians’ non-English language proficiency. If validated tools can be developed and disseminated in clinical practice, direct observation may be an acceptable option.