Maria Esteli Garcia MD, MPH, MAS (is Assistant Professor, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, and Senior Scholar, Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF)), Lisa C. Diamond MD, MPH (is Hospitalist and Research Faculty Member, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York), Mia Williams MD, MS (Associate Professor, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, UCSF), Sunita Mutha MD (is Professor, Department of Medicine, and Director, Healthforce Center, UCSF), Jane Jih MD, MPH, MAS (is Associate Professor, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, UCSF, and Co-Director, Asian American Research Center on Health, San Francisco), Sarita Pathak MPH (is Research Coordinator and PhD Student, Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University), Leah S. Karliner MD, MAS (is Professor and Director, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, UCSF. Please address correspondence to Maria Esteli Garcia)
{"title":"Physicians’ Perspectives on Using Direct Observation to Assess Non-English Language Proficiency for Clinical Practice: A Qualitative Study","authors":"Maria Esteli Garcia MD, MPH, MAS (is Assistant Professor, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, and Senior Scholar, Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF)), Lisa C. Diamond MD, MPH (is Hospitalist and Research Faculty Member, Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York), Mia Williams MD, MS (Associate Professor, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, UCSF), Sunita Mutha MD (is Professor, Department of Medicine, and Director, Healthforce Center, UCSF), Jane Jih MD, MPH, MAS (is Associate Professor, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, UCSF, and Co-Director, Asian American Research Center on Health, San Francisco), Sarita Pathak MPH (is Research Coordinator and PhD Student, Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University), Leah S. Karliner MD, MAS (is Professor and Director, Multiethnic Health Equity Research Center, Division of General Internal Medicine, Department of Medicine, UCSF. Please address correspondence to Maria Esteli Garcia)","doi":"10.1016/j.jcjq.2024.11.008","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Participants, mostly women (<em>n</em> = 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<em>,</em> 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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":14835,"journal":{"name":"Joint Commission journal on quality and patient safety","volume":"51 3","pages":"Pages 211-215"},"PeriodicalIF":2.3000,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Joint Commission journal on quality and patient safety","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1553725024003659","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
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.