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Factors Associated With Accuracy of Self-Assessment Compared With Tested Non–English Language Proficiency Among Primary Care Providers

Diamond, Lisa, MD, MPH*,†,‡; Toro Bejarano, Marcela, BA*,§; Chung, Sukyung, PhD, MPH; Ferguson, Warren, MD; Gonzalez, Javier, MFA*; Genoff Garzon, Margaux, MA*,#; Mujawar, Imran, MBBS, MS**; Gany, Francesca, MD, MS*,†

doi: 10.1097/MLR.0000000000001105
Original Articles

Background: There are no accepted best practices for clinicians to report their non–English language (NEL) fluencies. Language discordance between patients with limited English proficiency and their clinicians may contribute to suboptimal quality of care.

Objectives: To compare self-assessed clinician NEL proficiency with a validated oral language proficiency test. To identify clinician characteristics associated with self-assessment accuracy.

Subjects: Primary care providers from California and Massachusetts.

Research Design: We surveyed 98 clinicians about demographics and their NEL self-assessment using an adapted version of the Interagency Language Roundtable (ILR) scale followed by an oral proficiency interview: The Clinician Cultural and Linguistic Assessment (CCLA). We compared the ILR to the CCLA and analyzed factors associated with the accuracy of self-assessment.

Results: Ninety-eight primary care providers participated: 75.5% were women, 62.2% were white, and Spanish was the most common NEL reported (81.6%). The average CCLA score was 78/100 with a 70% passing-rate. There was a moderate correlation between the ILR and CCLA (0.512; P<0.0001). Participants whose self-reported levels were “fair” and “poor” had a 0% pass-rate and 100% who self-reported “excellent” passed the CCLA. Middle ILR levels showed a wider variance. Clinicians who reported a NEL other than Spanish and whose first language was not English were more likely to accurately self-assess their abilities.

Conclusions: Self-assessment showed a moderate correlation with the validated CCLA test. Additional testing may be required for clinicians at the middle levels. Clinicians whose native languages were not English and those using languages other than Spanish with patients may be more accurate in their self-assessment.

*Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service

Department of Healthcare Policy and Research, Weill Cornell Medicine

Department of Medicine, Memorial Sloan-Kettering Cancer Center

§Weill Cornell School of Medicine, New York, NY

Palo Alto Medical Foundation Research Institute, Palo Alto, CA

Department of Family Medicine and Community Health, University of Massachusetts Medical School, North Worcester, MA

#Department of Clinical Psychology, The New School for Social Research, New York, NY

**Centers for Disease Control and Prevention, Washington, DC

Supported by the National Cancer Institute R21 (1 R21 CA168489-01), the California Endowment Grant # 20082043. L.D.: salary support from grants 5K07CA184037 and 3P30CA008748 from the National Cancer Institute and AD-1409-23627 from the Patient-Centered Outcomes Research Institute.

The authors declare no conflict of interest.

Reprints: Lisa Diamond, MD, MPH, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10017. E-mail:

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