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

IF 2.3 Q2 HEALTH CARE SCIENCES & SERVICES Joint Commission journal on quality and patient safety Pub Date : 2024-11-20 DOI:10.1016/j.jcjq.2024.11.008
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)
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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.
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医师使用直接观察评估临床非英语语言能力的观点:一项质性研究。
背景:众所周知,沟通障碍会对患者安全产生不利影响。然而,很少有卫生系统评估和跟踪医生在临床环境中使用的非英语语言能力。目前评估的障碍(通常是模拟临床医生口语水平访谈)包括时间限制和缺乏互动性。本研究的目的是调查医生对使用直接临床观察作为评估其非英语语言技能的另一种形式的观点。方法:作者对来自大型学术卫生系统的11名完全和部分双语的初级保健医生(普通内科医生)进行了半结构化访谈,以了解医生对在临床实践中使用直接观察作为评估非英语熟练程度的替代形式的看法。两位研究人员独立地、反复地使用主题分析和不断比较来确定主题。结果:参与者主要为女性(n = 9;81.8%),报告说粤语、普通话、俄语或西班牙语的熟练程度各不相同。参与者表达了三个主要主题:(1)直接观察的好处,包括熟悉的环境、相关的内容和便利性;(2)缺点,包括不舒服、潜在的尴尬和观察一次相遇的局限性;(3)建议加强直接观测工具的使用,如多次观测和远程观测。结论:为了确保高质量的语言协调护理,卫生系统必须评估医生的非英语语言能力。如果能够开发出有效的工具并在临床实践中推广,直接观察可能是一种可接受的选择。
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来源期刊
CiteScore
3.80
自引率
4.30%
发文量
116
审稿时长
49 days
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Table of Contents Editorial Board Table of Contents Editorial Board Examining Patient Safety Events Using the Behaviour Change Wheel: A Cross-Sectional Analysis
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