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Assessing Medical Students' Skills in Working With Interpreters During Patient Encounters: A Validation Study of the Interpreter Scale

Lie, Désirée MD, MSEd; Bereknyei, Sylvia MS; Braddock, Clarence H. III MD, MPH; Encinas, Jennifer; Ahearn, Susan; Boker, John R. PhD

Academic Medicine:
doi: 10.1097/ACM.0b013e31819faec8
Physician-Patient Relationship

Purpose: Interpreted patient encounters require distinct communication skills. The absence of available reliable, valid, and practical measures hinders the assessment of these skills; therefore, the authors aimed to construct and validate the Interpreter Scale (IS).

Method: The authors constructed the IS based on expert consensus and prior studies. They administered the IS to two classes (n = 182) in an interpreted standardized patient (SP) case setting. Standardized interpreters in the examination room assessed, using the IS, students' communication skills. Concurrently, SPs, using the validated Patient-Physician Interaction scale (PPI) and the Interpreter Impact Rating Scale (IIRS), also assessed students' skills. Trained observers watched DVDs and used the Faculty Observer Rating Scale (FORS) to assess student performance. A prior study documented the qualities of the IIRS and FORS. The authors determined the internal consistency reliability and examined construct validity of IS scores through factor analysis and concordance with other measures' scores.

Results: IS reliability analysis yielded Cronbach α = 0.77. Factor analysis demonstrated two IS dimensions. Nine items, “managing the encounter,” and four items, “setting the stage,” explained 76% and 15% of score variance, respectively. IS and FORS scores significantly correlated (r = 0.385; P < .0001). IS factor 1 scores significantly correlated (all P < .0001) with FORS (r = 0.402), IIRS (r = 0.277), and PPI (r = 0.332) scores.

Conclusions: The IS has reasonable internal consistency reliability and construct validity to warrant use for formatively measuring student communication skills in interpreted SP encounters, and it needs testing in actual patient encounters.

Author Information

Dr. Lie is director, Research/Faculty Development, Department of Family Medicine, University of California, Irvine, School of Medicine, Irvine, California.

Ms. Bereknyei is research assistant, Stanford University School of Medicine and program manager, National Institutes of Health/National Heart, Blood, and Lung Institute-supported National Consortium for Multicultural Education for Health Professionals, Stanford, California.

Dr. Braddock is associate dean, Medical Education, Stanford University School of Medicine, Stanford, California.

Ms. Encinas is research coordinator, Department of Family Medicine, University of California, Irvine, School of Medicine, Irvine, California.

Ms. Ahearn is director, Clinical Skills Training Center, University of California, Irvine, School of Medicine, Irvine, California.

Dr. Boker is vice president, Academic Affairs, Geisinger Health System, Danville, Pennsylvania.

Correspondence should be addressed to Dr. Lie, Department of Family Medicine, 101 The City Drive South, Bldg 200, Rm 512, Orange, CA 92868; telephone: (714) 456-5171; fax: (714) 456-7984; e-mail: (

© 2009 Association of American Medical Colleges