Supply and Demand: Association Between Non-English Language-Speaking First Year Resident Physicians and Areas of Need in the USA.

BACKGROUND: Over 25 million US inhabitants are limited English proficient (LEP). It is unknown whether physicians fluent in non-English languages are training in geographic areas with the highest proportion of LEP people. Diversity of language ability in the physician workforce is an important complement to language assistance services for providing quality care to LEP patients. OBJECTIVE: To determine whether non-English language-speaking resident physicians matched in the geographic areas where language skills are needed. DESIGN: Cross-sectional study. PARTICIPANTS: Postgraduate medical training applicants to the Association of American Medical College's Electronic Residency Application Service in 2013-2014 (n = 50,766). We included data from the Graduate Medical Education Track database, mapped against American Community Survey data. INTERVENTIONS: N/A. MAIN MEASURES: We assessed the geographic alignment of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. KEY RESULTS: While 37% of resident physicians spoke at least one non-English language, in most cases the languages they spoke were not those in greatest need by the US LEP population. LEP speakers' potential exposure to non-English language-speaking residents varied. For Spanish, the language with the lowest national resident physician to Spanish LEP patient ratio, the ratio was most favorable in New York at 23.7/100,000 LEP population versus 5.1 in Los Angeles. For Tagalog, the group with the highest geographic mismatch, the ratio was 70.4 in New York but 0 in San Diego, San Jose, and Seattle. Among the top five LEP languages in the USA, Chinese-speaking resident physicians were the most geographically matched. CONCLUSIONS: We found considerable misalignment of the geographic distribution of non-English language-speaking resident physicians relative to the distribution of the LEP-speaking population. Residency programs in areas of high need could consider better matching the non-English language needs of their community with the language abilities of the resident physicians they are recruiting.

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

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.

Preoperative consent for patients with limited English proficiency.

BACKGROUND: Informed consent is important for limited English proficient (LEP) patients undergoing surgery, as many surgical procedures are complicated, making patient comprehension difficult even without language barriers. The study objectives were to (1) understand surgeons' preoperative consenting process with LEP patients, (2) examine how surgeons self assess their non-English language proficiency levels using a standardized scale, and (3) identify the relationship between self assessed non-English language proficiency and surgeons' self-reported use of interpreters during preoperative informed consent. MATERIALS AND METHODS: A thirty-two item survey assessing surgeons' reported preoperative informed consent process, with questions related to demographics, level of medical training, non-English language skills and their clinical use, language learning experiences, and hypothetical scenarios with LEP patients. RESULTS: Surgeons who were not fluent in non-English languages reported they often used those limited skills to obtain informed consent from their LEP patients. Many surgeons reported relying on bilingual hospital staff members, family members, and/or minors to serve as ad-hoc interpreters when obtaining informed consent. If a professional interpreter was not available in a timely manner, surgeons more frequently reported using ad-hoc interpreters or their own nonfluent language skills. Surgeons reported deferring to patient and family preferences when deciding whether to use professional interpreters and applied different thresholds for different clinical scenarios when deciding whether to use professional interpreters. CONCLUSIONS: Surgeons reported relying on their own non-English language skills, bilingual staff, and family and friends of patients to obtain informed consent from LEP patients, suggesting that further understanding of barriers to professional interpreter use is needed.

Cross-sectional Ct distributions from qPCR tests can provide an early warning signal for the spread of COVID-19 in communities.

Background: SARS-CoV-2 PCR testing data has been widely used for COVID-19 surveillance. Existing COVID-19 forecasting models mainly rely on case counts obtained from qPCR results, even though the binary PCR results provide a limited picture of the pandemic trajectory. Most forecasting models have failed to accurately predict the COVID-19 waves before they occur. Recently a model utilizing cross-sectional population cycle threshold (Ct-the number of cycles required for the fluorescent signal to cross the background threshold) values obtained from PCR tests (Ct-based model) was developed to overcome the limitations of using only binary PCR results. In this study, we aimed to improve on COVID-19 forecasting models using features derived from the Ct-based model, to detect epidemic waves earlier than case-based trajectories. Methods: PCR data was collected weekly at Northeastern University (NU) between August 2020 and January 2022. Campus and county epidemic trajectories were generated from case counts. A novel forecasting approach was developed by enhancing a recent deep learning model with Ct-based features and applied in Suffolk County and NU campus. For this, cross-sectional Ct values from PCR data were used to generate Ct-based epidemic trajectories, including effective reproductive rate (Rt) and incidence. The improvement in forecasting performance was compared using absolute errors and residual squared errors with respect to actual observed cases at the 7-day and 14-day forecasting horizons. The model was also tested prospectively over the period January 2022 to April 2022. Results: Rt curves estimated from the Ct-based model indicated epidemic waves 12 to 14 days earlier than Rt curves from NU campus and Suffolk County cases, with a correlation of 0.57. Enhancing the forecasting models with Ct-based information significantly decreased absolute error (decrease of 49.4 and 221.5 for the 7 and 14-day forecasting horizons) and residual squared error (40.6 and 217.1 for the 7 and 14-day forecasting horizons) compared to the original model without Ct features. Conclusion: Ct-based epidemic trajectories can herald an earlier signal for impending epidemic waves in the community and forecast transmission peaks. Moreover, COVID-19 forecasting models can be enhanced using these Ct features to improve their forecasting accuracy. In this study, we make the case that public health agencies should publish Ct values along with the binary positive/negative PCR results. Early and accurate forecasting of epidemic waves can inform public health policies and countermeasures which can mitigate spread.

Impact of an LGBTQ Cultural Competence Training Program for Providers on Knowledge, Attitudes, Self-Efficacy, and Intensions.

This paper describes the development and implementation of a robust lesbian, gay, bisexual, transgender, and queer (LGBTQ) cultural competence curriculum for training health and human service providers across New York State. Between 2013-2018, The National LGBT Cancer Network developed and published Best Practices in Creating and Delivering LGBTQ Cultural Competency Trainings for Health and Social Service Agencies and designed a training curriculum. They also conducted Train the Trainer sessions, and evaluated pre- and post- curriculum knowledge, attitudes, self-efficacy and intentions of individuals who attended educational sessions conducted by the certified trainers. Most respondents improved from pretest to posttest, with significant improvements in knowledge, attitudes, self-efficacy and intentions. An increase in self-efficacy was significantly associated with pre- to posttest improvement in respondent intention. Future research should focus on what components specifically bolster self-efficacy and intention. Increasing the number of health and human service providers who are trained to address the needs of this population is an important step toward providing culturally competent care.

Sleep behavior of New York City taxi drivers compared to the general US population.

Introduction: Taxi drivers are a low income population with long work hours, a high-stress sedentary occupation, and varied work shifts, augmenting their risk for sleep disorders. We evaluated sleep quality among New York City (NYC) taxi drivers, a predominantly immigrant/minority population, for associations with sleep outcomes and examined intervention development and policy implications. Methods: A cross-sectional survey was conducted at driver-frequented locations with 211 consenting NYC taxi drivers and included the 12-item Medical Outcomes Study Sleep Scale and the Perceived Stress Scale-10. For five domains (sleep disturbance, snoring, shortness of breath, sleep adequacy, and somnolence) and Sleep Problems Index-II, self-reported scores were calculated and normed against a nationally representative 2009 US sample to obtain standardized t-test scores. Scores <47 were lower than US averages, indicating worse sleep quality. Results were explored in multivariable linear and logistic regression models. Results: Almost one-half (47%) of drivers had scores indicating sleep quality below US averages for snoring, 36% for shortness of breath/obstruction, and 19% for somnolence. There were significant associations of perceived stress with Sleep Problems Index II (p<0.001), sleep disturbance (p<0.001), somnolence (p<0.001), and sleep adequacy (p<0.05). Stress was predictive of sleep adequacy (p<0.05, bivariate; p<0.05, multivariate) and shortness of breath/obstruction (p<0.01, bivariate; p<0.001, multivariate). Nightshift drivers had significantly worse sleep disturbance scores than dayshift drivers (p<0.05). Taxi drivers were more likely to get an inadequate amount of daily sleep (<7 hours) than the average US male (48.5% vs. 38.3%). Conclusions: Sleep hygiene and stress management interventions could benefit the health of this population and improve driver and public safety. The associations of taxi driver sleep quality and stress indicate an opportunity for targeted intervention. Further research into sleep as an important determinant of taxi driver health is needed, especially in the burgeoning for-hire vehicle (Uber, Lyft, etc) sector.

Smoking Among Chinese Livery Drivers.

We aimed to assess a key risk factor for lung cancer, smoking, in a vulnerable group, Chinese livery drivers in New York City (NYC). This is a nested cohort study conducted in the summer/fall of 2014 within a larger NIMHD-funded R24 program, the Taxi Network. The Taxi Network Needs Assessment (TNNA) survey was administered to a broad demographic of drivers. This study reports on the TNNA survey smoking-related results among NYC Chinese livery drivers. 97 drivers participated. Mean age was 44.7 years, 2.1% were English proficient, and 23.4% were living below the poverty line. Most were insured (82.5%), had a PCP (82.5%), and had had a routine check-up within the past year (79%). 73% were current or former smokers. Culturally and linguistically tailored smoking cessation interventions, strategies to mitigate exposure to air pollution, and programs to facilitate lung cancer screening should be developed and implemented for high-risk Chinese livery drivers.

"Their Stories Have Changed My Life": Clinicians' Reflections on Their Experience with and Their Motivation to Conduct Asylum Evaluations.

Many clinicians perform asylum evaluations yet no studies describe the motivation to perform them or their perceived rewards. The number of asylum seekers in the US is increasing and more clinicians are needed as evaluators. A survey to an asylum evaluators' network asked participants to qualitatively reflect on their experience and motivation. Answers were analyzed for themes and sentiment. Respondents cited commitment to humanistic and moral values, noted personal and family experiences, having skills, expertise, and career interests as drivers. They found the experience very rewarding personally and professionally, and in their perceived benefit to asylees. Negative sentiment was less frequent and centered on emotions related to client narratives. Process-oriented frustrations were also noted. This is the first published study describing clinicians' motivation and experience with asylum evaluations. It may illuminate clinicians' drive to volunteer, and serve as a resource for organizations for recruitment and education.

Increasing influenza vaccination in New York City taxi drivers: A community driven approach.

The Healthy People 2020 influenza immunization goal is 80% for non-institutionalized adults 18-64. However, vaccination rates remain stubbornly low. Culturally tailored approaches to communities with poor vaccine uptake are necessary. Taxi drivers are at risk for influenza and its complications, could serve as vectors for influenza infection, and could be an effective vaccination target to enhance herd immunity of the urban population. To the best of our knowledge, this is the first study related to influenza vaccination among taxi drivers. The NYC Taxi Network surveyed a convenience sample of 53 taxi drivers to understand vaccination barriers. Only 17% had been vaccinated. Results informed a pilot tailored workplace intervention, which resulted in vaccinations for 44% of unvaccinated drivers. The study revealed that older drivers were more likely to be vaccinated than younger drivers, while the most common barrier to immunization was that drivers thought vaccination was 'not necessary'.

Self-reported vicarious trauma in asylum evaluators: a preliminary survey.

Hundreds of clinicians in the US conduct asylum evaluations, to document evidence of torture and persecution of people fleeing their home countries. Participating in these encounters puts clinicians at risk for vicarious trauma (VT). Little research addressed VT in physicians. Even less is known about VT among asylum evaluators. A survey was distributed to members of the asylum network of Physicians for Human Rights in Spring 2012. The majority (65%) of survey participants denied having experienced VT. However, being female, being a mental health professional and having performed a greater number of evaluations was associated with a higher likelihood of reporting VT. We present preliminary data about VT in asylum evaluators. Recruiters and trainers should make every effort to address the issue and educate their volunteers about means of identifying and managing symptoms. Formal and informal support services and resources should be developed and shared with volunteers.

A 12-year comparison of students' perspectives on diversity at a Jesuit Medical School.

BACKGROUND: Many studies have assessed perspectives of medical students toward institutional diversity, but few of them have attempted to map changes in diversity climate over time. OBJECTIVE: This study aims to investigate changes in diversity climate at a Jesuit medical institution over a 12-year period. METHODS: In 1999, 334 medical students completed an anonymous self-administered online survey, and 12 years later, 406 students completed a comparable survey in 2011. Chi-square tests assessed the differences in percent responses to questions of the two surveys, related to three identities: gender, race, and sexual orientation. RESULTS: The 1999 versus 2011 samples were 46% versus 49% female, 61% versus 61% Caucasian, and 41% vs. 39% aged 25 years or older. Findings suggested improvements in medical students' perceptions surrounding equality 'in general' across the three identities (p<0.001); 'in the practice of medicine' based on gender (p<0.001), race/ethnicity (p=0.60), and sexual orientation (p=0.43); as well as in the medical school curriculum, including course text content, professor's delivery and student-faculty interaction (p<0.001) across the three identities. There was a statistically significant decrease in experienced or witnessed events related to gender bias (p<0.001) from 1999 to 2011; however, reported events of bias based on race/ethnicity (p=0.69) and sexual orientation (p=0.58) only showed small decreases. CONCLUSIONS: It may be postulated that the improvement in students' self-perceptions of equality and diversity over the past 12 years may have been influenced by a generational acceptance of cultural diversity and, the inclusion of diversity training courses within the medical curriculum. Diversity training related to race and sexual orientation should be expanded, including a follow-up survey to assess the effectiveness of any intervention.