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Between 2001 and 2004, New Zealand offered re-training programmes to overseas-trained doctors (OTDs). (The Auckland programme, and what participants thought of it, is described in the same issue of the New Zealand Medical Journal.) These courses have now been discontinued, and the question is, what, if anything should take their place?
Having interpreters in your ED can save time in moments of crisis, while at the same time, facilitating more accurate communications among staff, patients, and family members. Make sure interpreters are familiar with basic anatomy, major illnesses, and medications. Human beings can interpret glances or the touch of a hand, which gives them an advantage over telephonic services. Arrange for at least two vehicles for paging interpreters when they are needed.
PURPOSE: This study evaluates the extent to which bilingual children produce the same or overlapping responses on tasks assessing semantic skills in each of their languages and whether classification analysis based on monolingual or conceptual scoring can accurately classify the semantic development of typically developing (TD) bilingual children. METHOD: In Study 1, 55 TD children (ages 4;0 [years;months] to 7;11) from bilingual backgrounds named characteristic properties of familiar items. The extent to which children produced overlapping responses in each of their languages and their errors were examined. In Study 2, 40 TD children (ages 5;0 to 6;1), group matched for age and bilingual language exposure, responded to the Phase 2 version of the Bilingual English Spanish Assessment (BESA; E. D. Peña, V. Gutierrez-Clellen, A. Iglesias, B. A. Goldstein, and L. M. Bedore, in development). Conceptual and monolingual scores were compared to determine the extent to which were comparable for groups of children. RESULTS: The results of Study 1 indicated that TD children from bilingual backgrounds are more likely to produce unique than overlapping responses when they respond to test items. Children were more likely to code switch when tested in Spanish than in English, but they were more likely to produce errors in English. In Study 2, monolingual and bilingual children achieved comparable conceptual scores. For Spanish-speaking bilingual children, the conceptual score was more likely to be in the average range of the monolingual children than was their monolingual score. For testing in English, monolingual and conceptual scores were similar. CLINICAL IMPLICATIONS: Bilingual children will benefit from conceptual scoring, especially when they are tested in Spanish.
The purpose of this investigation was to use Rasch measurement to study the psychometric properties of a 34 item questionnaire designed to measure second language learners' willingness to communicate (WTC) in English inside their language class. 490 Japanese university students' responses to the questionnaire were subjected to a number of different analyses. The first involved a comparison of the category threshold estimates produced by the Rating Scale and Partial Credit models. The questionnaire's items were then evaluated according to how well they defined the willingness to communicate construct. The potential dimensionality of using items that involved different speaking and writing tasks/situations in order to gain a more comprehensive understanding of students' willingness to communicate was also investigated. Next there was an examination of the questionnaire's four-point scale to ensure that it captured meaningful differences in students' WTC. Finally, the questionnaire items were compared using differential item functioning to determine if second year students were more willing than first year students in any of the different speaking and writing tasks/situations. This investigation closes with some suggestions on how the WTC questionnaire can inform second language instruction and curriculum design.
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A critical part of every encounter between a pediatric nurse and a patient is obtaining accurate patient information. Unique obstacles are encountered when patients and their families have little or no understanding of the English language. Federal and state laws require health care systems that receive governmental funds to provide full language access to services. Both legal and ethical issues can arise when caring for non-English-speaking patients. Often, obtaining accurate patient information and a fully informed consent cannot be done without the use of an interpreter. The interpreter informs the family of all the risks and benefits of a specific avenue of care. When inappropriate interpreter services are used, such as when children in the family or other family members act as interpreters, concerns about accuracy, confidentiality, cultural congruency, and other issues may arise. The purpose of this article is to: (a) explore principles related to the use of medical interpreters, (b) examine different models of interpreter services, and (c) identify available resources to assist providers in accessing interpreter services (e.g., books, online resources, articles, and videos). The case study format will be used to illustrate key points.
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OBJECTIVES: We propose an interlingua-based indexing approach to account for the particular challenges that arise in the design and implementation of cross-language document retrieval systems for the medical domain. METHODS: Documents, as well as queries, are mapped to a language-independent conceptual layer on which retrieval operations are performed. We contrast this approach with the direct translation of German queries to English ones which, subsequently, are matched against English documents. RESULTS: We evaluate both approaches, interlingua-based and direct translation, on a large medical document collection, the OHSUMED corpus. A substantial benefit for interlingua-based document retrieval using German queries on English texts is found, which amounts to 93% of the (monolingual) English baseline. CONCLUSIONS: Most state-of-the-art cross-language information retrieval systems translate user queries to the language(s) of the target documents. In contra-distinction to this approach, translating both documents and user queries into a language-independent, concept-like representation format is more beneficial to enhance cross-language retrieval performance.
The University Health System (UHS) leaders organized a comprehensive planning process of its ambulatory care system. As part of this planning process, UHS assessed the cultural and linguistic competence of its outpatient environment. This assessment was conducted within the context of standards outlined in the U.S. Department of Health & Human Services (2001) Standards for Cultural and Linguistically Appropriate Services, using a multimethod approach. This multimethod approach included (1) a review of the organizational profile, (2) a review of organizational documents, (3) a review of policies and procedures, (4) clinic site visits, (5) a staff survey, (6) patient and provider focus groups, and (7) interviews with key stakeholders in the community. Generally, the UHS was found to have several strengths that enable it to continue meeting the medical needs of its target populations. To develop greater capacity in the areas of cultural and linguistic competencies, the UHS should continue to promote respect for diversity by focusing on attitudes; beliefs; behaviors; practices; and communication patterns associated with race, ethnicity, religion, socioeconomic status, historical and social context, physical or mental ability, age, gender, sexual orientation, generational status, and acculturation level. Recommendations for achieving a more culturally competent healthcare organization are provided.
QUESTION: What are the challenges involved in designing, modifying, and improving a major health information portal that serves over sixty million page views a month? SETTING: MedlinePlus, the National Library of Medicine's (NLM's) consumer health Website, is examined. METHOD: Challenges are presented as six "studies," which describe selected design issues and how NLM staff resolved them. MAIN RESULT: Improving MedlinePlus is an iterative process. Changes in the public user interface are ongoing, reflecting Web design trends, usability testing recommendations, user survey results, new technical requirements, and the need to grow the site in an orderly way. CONCLUSION: Testing and analysis should accompany Website design modifications. New technologies may enhance a site but also introduce problems. Further modifications to MedlinePlus will be informed by the experiences described here.
The authors' reflect on the challenges and rewards of partnering as casework supervisors with bilingual and bicultural newcomer paraprofessionals in resettlement work with refugee youth. Such individuals are generally recruited for their linguistic abilities and cultural knowledge, but they can lack formal clinical training or licensing credentials. Drawing on their own experience as supervisors of bilingual and bicultural newcomer paraprofessionals from Cambodia, Laos, and Vietnam, the authors compare their early attempts to establish trust and communication with insights gained in more recent supervisory experiences. Recommendations are offered that promote mutual understanding between newcomer paraprofessionals and their Western-trained supervisors.
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BACKGROUND AND OBJECTIVES: The Future of Family Medicine Final Report calls for greater emphasis on training physicians to provide culturally proficient and effective quality care to an increasingly diverse population. It remains unclear, however, how prepared academic family medicine practices are to address this need. METHODS: We carried out a qualitative sub-study (as part of a larger research study) using depth and focus group interviews at two urban family medicine centers to understand the challenges and opportunities involved in meeting the Department of Health and Human Services Office of Minority Health's National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care. The Lewin Group's Organizational Cultural Competence Assessment Profile was used to analyze the qualitative interview data. RESULTS: The main themes that emerged from interviews with faculty physicians, administrators, staff, and patients were: (1) the need for more linguistically appropriate services, (2) lack of communication among those involved in care delivery, and (3) interest in education about cultural and linguistic competence. CONCLUSIONS: The academic family medicine practices studied are frustrated and challenged to integrate cultural and linguistic competence into patient care. Organizational pressures, multiple competing demands, and resource constraints inhibit preparedness to address the CLAS standards and important new national requirements and guidelines.
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PURPOSE: The current study focuses on describing the English language narrative skills of children who have been exposed to the Filipino language. METHOD: Eight children between the ages of 6;0 (years;months) and 7;7 who spoke primarily English but who were exposed to the Filipino language at home participated. Each child produced three narrative samples based on wordless picture books. Samples were analyzed for narrative complexity as well as measures of productivity and grammaticality. RESULTS: The complexity of children's narratives was comparable to that reported in the literature for monolingual English-speaking children. Grammaticality measures show use of an average of 16.55% Filipino-influenced English forms across three stories. The observed patterns of Filipino-influenced English were predictable based on the comparison of English and Filipino structures. Variability in maze use was related to the amount of exposure to Filipino. CLINICAL IMPLICATIONS: Care should be taken to evaluate grammaticality with respect to nonstandard English forms predicted by the rules of the language in contact with English. Further, maze use may be related to level of exposure to another language and should be further explored when using such information in language evaluation.