Empowering Trainees to Care for Patients and Families with
Limited English Proficiency (LEP) Authors: Jessica Jones, MD, Kerrilynn Rice MD, MPH, Coralee Del Valle Mojica MD, MPH, Victor Cueto, MD, Meghan Stawitcke, BA, Sara Salem, EdM, Elizabeth Talley, MD, Rebecca Blankenburg MD, MPH
Association of Pediatric Program Directors; Annual Spring Meeting Atlanta, GA March 23rd, 2018
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Disclosures
The authors have no financial relationships or conflicts of interest to disclose.
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Objectives
1. Discuss the importance of training initiatives focused on the use of professional medical interpretation in everyday clinical scenarios.
2. Practice in-situ teaching of trainees in scenarios that require professional medical interpretation.
3. Compare different strategies for teaching residents, fellows, and faculty on the appropriate use of professional medical interpretation.
4. Propose one goal to improve training on the use of professional medical interpretation in your home institution.
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Agenda
• Language Immersion Activity
• Why it Matters: Case Scenario
• Interactive Practice Stations
• Large Group Discussion/Wrap up
• Individual Commitment
• Evaluation
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Language Immersion Activity
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Case Scenario
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Small Groups Practice Stations
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Video Interpretation
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Individual Commitment
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Acknowledgements
Special Thanks To:
• Stanford Pediatrics LEAD Program Leadership • Stanford Pediatrics Residency Leadership and Office Staff • All of our patients and families!
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Resources
Physician's Practical Guide to Culturally Competent Care https://www.thinkculturalhealth.hhs.gov/Content/ContinuingEd.asp (free continuing medical education course)
Agency for Healthcare Research and Quality – Overview of Medical Interpreter Standards of Practice http://www.ahrq.gov.laneproxy.stanford.edu/professionals/systems/hospital/lepguide/lepguidefig5.html
How to Communicate Effectively Through Interpreters: A Guide for Leaders http://www.au.af.mil/au/awc/awcgate/army/using_interpreters.htm
National Council on Interpreting in Health Care https://www.facebook.com/ncihc
National Standards for Culturally and Linguistically Appropriate Services in Health Care http://http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53
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References 1. “The Limited English Proficient Population in the United States.” Migrationpolicy.org, July 7, 2015. 2. Eneriz-Wiemer, Monica, Lee M. Sanders, Donald A. Barr, and Fernando S. Mendoza. “Parental Limited English Proficiency and Health Outcomes for Children with Special Health Care Needs: A Systematic Review.” Academic Pediatrics 14, no. 2 (April 2014): 128–36. 3. Flores, Glenn. “The Impact of Medical Interpreter Services on the Quality of Health Care: A Systematic Review.” Medical Care Research and Review: MCRR 62, no. 3 (June 2005): 255–99. doi:10.1177/1077558705275416. 4. DeCamp, Lisa Ross, Edith Kieffer, Joseph S. Zickafoose, Sonya DeMonner, Felix Valbuena, Matthew M. Davis, and Michele Heisler. “The Voices of Limited English Proficiency Latina Mothers on Pediatric Primary Care: Lessons for the Medical Home.” Maternal and Child Health Journal 17, no. 1 (January 2013): 95–109. doi:10.1007/s10995-012-0951-9. 5. Crossman, Kristen L., Ethan Wiener, Genie Roosevelt, Lalit Bajaj, and Louis C. Hampers. “Interpreters: Telephonic, in-Person Interpretation and Bilingual Providers.” Pediatrics 125, no. 3 (March 2010): e631-638. doi:10.1542/peds.2009-0769. 6. Diamond, Lisa C., Yael Schenker, Leslie Curry, Elizabeth H. Bradley, and Alicia Fernandez. “Getting by: Underuse of Interpreters by Resident Physicians.” Journal of General Internal Medicine 24, no. 2 (February 2009): 256–62. doi:10.1007/s11606-008-0875-7. 7. Burbano O’Leary, Sonja C., Steven Federico, and Louis C. Hampers. “The Truth about Language Barriers: One Residency Program’s Experience.” Pediatrics 111, no. 5 Pt 1 (May 2003): e569-573. 8. DeCamp, Lisa Ross, Dennis Z. Kuo, Glenn Flores, Karen O’Connor, and Cynthia S. Minkovitz. “Changes in Language Services Use by US Pediatricians.” Pediatrics 132, no. 2 (August 2013): e396-406. doi:10.1542/peds.2012-2909. 9. Kuo, Dennis Z., Karen G. O’Connor, Glenn Flores, and Cynthia S. Minkovitz. “Pediatricians’ Use of Language Services for Families with Limited English Proficiency.” Pediatrics 119, no. 4 (April 2007): e920-927. doi:10.1542/peds.2006-1508. 10. Mendoza, Fernando S., Leslie R. Walker, Barbara J. Stoll, Elena Fuentes-Afflick, Joseph W. St Geme, Tina L. Cheng, Javier A. Gonzalez del Rey, et al. “Diversity and Inclusion Training in Pediatric Departments.” Pediatrics 135, no. 4 (April 2015): 707–13.
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The Challenge
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The Challenge
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Limited English Proficiency (LEP)
Law/Guidelines Quality/Disparities
- Extension of National Origin
- Civil Rights Act Title VI - Executive Order 13166 - ACA Section 1557 - HHS Rule 45 CFR Part
92 - Joint Commission
- Medical Errors - Medication Errors - Impaired Access - Poorer Understanding - Impaired Decision Making - Admission/Re-admission - Length of Stay - Return to ER - Quality of Life - Health Status
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Pre- Encounter Clinical Encounter
Post-Encounter
- Identify Communication Needs
- Record Preferred Language
- Provide Language Interpretation
- Train Front-desk/Intake Staff
- Signage - Translated Intake Forms/
Documents
- Use Qualified Interpreters - No ‘Getting By’ - Never Use Children - Staff should not be used
unless qualified and ‘part of duties’
- Use of Family/Friends prohibited (unless requested)
- Provide Written Translated Instructions
- Translation of Medication Labels
Providing High Quality Care
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Medical Interpretation Modalities
In Person Telephone Video
- High Satisfaction - Personal Connection - Eye Contact/Body
Language - Cultural
Ambassador - High Cost - Languages Likely
Limited
- Poor Satisfaction - No Eye Contact/
Body Language - Impersonal - Low Cost - Many Language
Offered (100s) - Potentially
Cumbersome - Equipment
Considerations - Connectivity
Concerns
- Moderate/High Satisfaction
- Captures Some Body Language
- Privacy Concerns - Additional Cost - Growing Number of
Languages - Equipment
Considerations - Connectivity
Concerns
