LAB Experience Utilized to Improve Physical Therapist Students’ Ability to Care for N0N-English Speaking Patients
Purpose:
Following their first clinical experiences, anecdotal feedback from Rutgers University DPT students was noted to include students’ reports of feeling highly challenged by their encounters working with patients who did not speak English. The purpose of this poster is to describe a novel standardized patient encounter used to improve DPT students’ self-efficacy and ability to communicate and provide care to patients with low English proficiency (LEP.) Survey data regarding the availability and types of translation services utilized in the clinic, students’ insights into the use of alternative communication methods and technology, and feedback from the course faculty about student performances during the encounter, will be presented.
Methods/Description:
During the 2015 – 2018 academic years, 198 first year, Rutgers University doctor of physical therapy students (SPT), 43 standardized patients (SP), and 4 course faculty participated in SP encounters in which bilingual SPs portrayed patients with LEP. The SPTs completed an informal, self-efficacy survey asking the SPTs to reflect on their confidence levels, both before and after the SP encounter, with regards to their ability to provide physical therapy to patients with LEP, and their ability to utilize technology to assist with communication. The course instructor also collected feedback from the SPTs, faculty and SPs, regarding their observations throughout the encounter. These surveys and feedback were originally collected as part of normal class activities in order to debrief SPTs and inform the educational process. To gain knowledge about the availability and types of language access & translation services found in the physical therapy practices with which the Rutgers DPT Program has clinical education agreements, an online survey was distributed to 340 clinical sites, 110 (32.4%) of which submitted responses.
Results/Outcomes:
Following the SP encounter, SPTs indicated a slight increase in self-efficacy when responding to the survey statement, “You can successfully present yourself in a culturally competent and respectful manner when treating a person who speaks a language other than your own”, which changed from a rating of “not very confident” prior to the SP encounter to a rating of “somewhat confident” afterwards. Although the majority of SPTs noted that use of language translation technology (e.g. Google Translate© ) was useful, there was a perceived difference noted in the efficacy of using technology based on which languages and dialects were spoken by the SPs. In addition, SPTs described the use of demonstration, pictures, gesturing, and other body language to be beneficial in developing rapport and communicating with the SPs. Observation by faculty and SPs during the encounters revealed that SPTs deferred to use of technology translation despite it often being inefficient and ineffective, and that SPTs avoided using gestures, demonstrations, and other non-verbal communication methods until cued by the faculty. In addition, faculty and SPs noted that the challenges associated with communicating with patients with LEP caused students to frequently disregard precautions, safety, professional behavior, and time management during the SP encounter. Finally, results of the clinical site survey revealed that 83.2% of all respondents reported that the clinical site provided some type of language access services ranging from certified interpreters to the use of colleagues who were bilingual. However, availability of language access services varies considerably between types of clinical settings, ranging from 100% in large medical system settings (including acute care and outpatient services) to only 27% in small private practice outpatient settings.
Conclusions/Relevance to the conference theme:
It is widely accepted that effective communication between health care providers and recipients leads to improved compliance with treatment protocols and healthcare outcomes, and results in reduced healthcare disparities for patients with LEP. Although communication through the use of certified medical translators is recommended as an ideal, many of the clinics in which DPT students complete their clinical experiences do not have translation access services available. SPTs who encounter patients who speak languages other than their own may become overwhelmed, thereby compromising clinical decision making, safety, and effective interactions with their patients, and amplifying health care disparities in the LEP population. Opportunities to practice a variety of communication skills when working with patients with LEP in the absence of certified translators and language access services may improve SPT self-efficacy and performance during clinical experiences, and improve cultural competence.