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  • Author
    Tucker Avra
  • PI

    Jesus Torres

  • Co-Author

    Breena Taira, Daniel Cordova

  • Title

    Resident Survey to Evaluate Interest in a Bilingual Certification Pathway

  • Program

    Global Short-Term Training Program

  • Other Program (if not listed above)

  • Abstract

    Background: Access to language assistance is a patient’s right under Title VI of the 1964 Civil Rights Act. Section 1557 of the ACA further mandates the provision of a qualified interpreter to patients with Limited English Proficiency (LEP). Although a bilingual certification pathway exists for DHS employees who speak a threshold language at OVMC, residents are excluded from this pathway. This puts residents at potential risk by using their language skills. To achieve high quality care for patients with limited English proficiency, we must address the lack of a testing and certification process for the use of non-English language in the clinical setting for OVMC trainees.

    Objective: To characterize the language skills and interest testing and certification of the Olive View Medical Center (OVMC) trainees to inform possible changes to the bilingual certification process.


    • Study Design: Anonymous online survey questionnaire deployed between May 18, 2021 and July 12, 2021.
    • Subjects: Resident physicians who spend more than fifty percent of their training time at OVMC were eligible and included OV IM, OV Psych, UCLA EM and UCLA OB/GYN.
    • Measures and Outcomes: Measures included year in training, department, native language, and current languages spoken. For those reporting Non-English language (NEL) skills, we collected the frequency of non-English language use in the clinical setting, and their self-reported language ability as measure by the Interagency Language Roundtable (ILR) Scale.  The primary outcome for the study was the percent of residents interested in bilingual certification.  The secondary outcome was the percent of residents who were both interested in bilingual certification and had sufficient self-reported language skills to be likely to pass a testing and certification process, as defined by a level 4 or 5 on the ILR scale.
    • Data Analysis: Study data were managed using REDCap, an electronic data capture tool. Descriptive statistics were performed via Stata
    • IRB exempt approval received by Olive View-UCLA Education & Research Institute - Institutional Review Board

    Results: Of the 289 residents who received the survey, it was completed by 206 (a 71.3% response rate). Incoming interns for the 2021-2022 year comprised 32.0% (66/206), PGY1 24.8% (51/206), PGY2 18.5% (38/206), PGY3 15.5% (32/206), and PGY4 9.2% (19/206) of respondents. UCLA Emergency Medicine residents comprised 29.3% (60/205), UCLA OB/GYN residents 14.1% (29/205), OVMC Internal Medicine residents 46.8% (96/205), and OVMC Psychiatry 9.8% (20/205) of respondents. The native languages of the resident respondents were 88.3% English (181/205), 6.8% Spanish (14/205), 1.5% Chinese (Cantonese or Mandarin), (3/205), 1.5% Korean (3/205), 0.49% Armenian (1/205),  0.49% Vietnamese (1/205),  0.49% Punjabi (1/205), and  0.49% Telugu (1/205). Of 189 resident respondents, 75.7% (143/189) speak a language other than English.

    Of the 143 residents who speak a language other than English, 62.2% (89/143) use their non-English language with patients or clients of the DHS as part of their job. Of those 89, the frequency of use of NEL skills was reported as 11.2% (10/89) rarely use their non-English language skills with patients, 15.7% (14/89) sometimes, 51.7% (46/89) often, and 21.3% (19/89) always. Of the 89 resident respondents who use their non-English language with patients or clients of the DHS as part of their job, 68.5% (61/89) would be interested in being tested in their non-English language to obtain a bilingual certificate from the County of Los Angeles. Resident rated their proficiency in their non-English language based on the Interagency Language Roundtable as 3.3% (2/61) Level 2, 37.7% (23/61) with Level 3, 31.3% (19/61) Level 4 skills, and 27.9% (17/61) Level 5 skills. Of the 56 resident respondents interested in DHS bilingual certification who responded to the exam language preference, 80.4% (45/61) would take the exam in Spanish, 5.4% (3/56) in Chinese (Cantonese or Mandarin), 5.4% (3/56) in Korean, 3.6% (2/56) in Farsi, 1.8% (1/56) in Arabic, 1.8% (1/56) in Armenian, and 1.8% (1/56) in Vietnamese. Thirty-six of the residents interested in DHS bilingual certification report Level 4 and 5 language skills, meaning that they are highly likely to pass an exam and receive the certification.

    Conclusion: There are 61/289 (21%) resident trainees who spend at least 50% of their time at OVMC who answered the survey and are interested in DHS bilingual certification and 36/289 (12.5%) have both interest and self-reported high levels of fluency that portend a passing score on the certification exam.  Providing these 61 residents with a pathway for bilingual certification would be an opportunity to improve care for limited English proficiency patients at OVMC.

    Future directions: Findings will be presented to the CMO and DIO at OVMC and we will work in conjunction with OVMC Administration to launch a pilot project for resident certification. These findings will inform hospital and county policy to provide a bilingual certification pathway for residents.

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