From Admission to Discharge:
Patterns of Interpreter Use Among Resident Physicians
Amy Shen1, BA; Jenna Kruger1,2, MPH; Judy Quan1,2, PhD; Alicia Fernandez1,2, MD
1UCSF
School of Medicine,
2 Division
of General Internal Medicine, University of California, San Francisco, CA
BACKGROUND
AIM
 To assess resident physicians’ patterns
of communication with LEP patients
by hospital encounter type.
 To identify predictors of professional
interpreter use.
Female
Level of
training
Residency
program
Race/
Ethnicity
METHODS
Study Design
Cross-sectional survey. Resident
physicians reported on interpreter use
with their last hospitalized LEP patient
with whom they experienced a language
barrier.
Participants
Internal medicine, general surgery, and
family medicine resident physicians from
one academic medical institution who
care for LEP patients across three
hospitals.
Data Analysis
Descriptive statistics were performed to
ascertain residents’ percent use of
professional interpretation, perceived
quality of communication, and patterns of
interpreter use for six routine hospital
encounters. Logistic regression models
were used to determine the independent
contribution of clinical site, patient
characteristics, and physician
characteristics to resident physician use of
professional interpreters.
PGY-1
PGY-2
PGY-3+
Internal Medicine
General Surgery
Family Medicine
White
34 (23)
25 (17)
108 (73)
22 (15)
19 (13)
80 (54)
Asian/Pacific Islander
42 (28)
Hispanic/Latino
Black
Other
16 (11)
5 (3)
4 (3)
Spoke non-English language at home
Proficiency in non-English language+++
(“Speak well enough to provide care”)
Spanish
Mandarin
Hindi
Other
Completed international medical
work
0 hours
Hours of
1-3 hours
interpreter
training
3-5 hours
>5 hours
% Patients with LEP, range (mean)
Language of
LEP patient
Hospital of
LEP patient
Cantonese
Spanish
Russian
Other
Private hospital
Public hospital
Other
52 (35)
80 (54)
52 (65)
7 (9)
6 (8)
17 (21)
80 (54)
33 (22)
57 (38)
37 (25)
15 (10)
10-70
(35)
75 (50)
30 (20)
15 (10)
29 (21)
73 (49)
72 (48)
4 (3)
*The survey response rate was 73%.
++Total percentages may not add up to 100 due to rounding.
+++Total numbers add up to > 80 because subjects could
specify more than one non-English language spoken.
% resident physicians
Age, range (mean)
N (%)*++
25-37
(28.7)
84 (56)
85 (57)
28
30
25
20
15
10
5
0
23
20
19
11
0-20
21-40
41-60
% professional interpreter use
61-80
81-100
In our sample, 71% of residents reported using professional interpreters for less than 60% of hospital clinical
encounters. Professional interpreter use was dichotomized with different percentage cut-offs for different logistic
regression models. There were no consistently significant predictors of professional interpreter use, through physician
specialty, hours of interpreter training and growing up speaking a non-English language were associated with
interpreter use in some models.
% resident physicians
 Underuse of professional interpreters
adversely affects quality of care to
patients with limited English proficiency
(LEP).
Characteristic
 Residents report using different modes
of communication with LEP patients
depending on the clinical encounter.
Figure 1. Resident physicians’ percent use of professional interpretation
during the hospital course of an LEP patient.
Table 1. Characteristics
of Resident Physicians (N= 149)
Figure 2. Resident physicians’ self-rated quality of communication
with an LEP patient compared to an English-speaking patient.
80
60
40
29
20
7
0
Slightly worse
Same
1
1
Slightly better
Much better
Quality of communication
In our sample, most residents (91%) reported that their quality of communication with hospitalized LEP patients was
"slightly worse" (62%) or "much worse" (29%) compared to their communication with clinically similar English-speaking
patients. Only patient language with adjusted odds ratio of 3.57 (95% Cl: 1.01, 12.67) was shown to be a significant, but
borderline, predictor of much worse vs. other quality of communication rating in logistic regression models.
Figure 3. Patterns of interpreter use among resident physicians
for common hospital encounters.
100
Professional only
80
60
61
 To improve provider interpreter
training efforts, future studies with
larger samples sizes are needed to
determine how resident characteristics
such as specialty, hours of training, and
growing up speaking a non-English
language at home predict resident
physicians’ interpreter use when caring
for LEP patients.
60
45
42
21 18
 Our findings confirm prior research
which suggests there is considerable
underuse of professional interpreters
among resident physicians caring for
LEP patients.
73
Got by
40
20
85
Professional+got by
 Variation in professional interpreter
use by type of clinical encounter and
not clinical site or patient language
underscores the importance of resident
decision-making in determining
whether LEP patients receive
professional interpreter services.
 In addition, we found that residents
perceive that their communication with
hospitalized LEP patients to be worse
compared to their communication with
clinically similar English-speaking
patients.
62
Much worse
% use by resident physicians
 Communication with hospitalized LEP
patients relies on individual providers’
decisions to use professional
interpreters.
DISCUSSION
RESULTS
43
ACKNOWLEDGEMENTS
41
26
13
16
Daily rounds
Updates/check-ins
6
9
11
16
14
0
Admission history
Procedure
consents
Family meetings
Discharge
instructions
Patterns of professional interpreter use substantially varied by type of clinical encounter, with more residents reporting
getting by with ad-hoc interpreters, their own language skills or not talking to the patient due to time constraints during
routine daily rounds and check-ins than during “high-stakes” planned encounters such as procedure consents or family
meetings (45% and 41% vs. 9% and 16%, p-value<0.005).
Partial support from R25MD006832 NIH-NIMHD.
Special thanks to UCSF internal medicine, family
medicine, and general surgery residency
programs for their support and participation in
this study.