Development, Implementation and Evaluation of a Limited English Proficiency Curriculum

Background: Sixty percent of U.S. internal medicine (IM) residency directors report their program includes a curriculum focused on the needs of patients with limited English proficiency (LEP). Objective: This quality improvement project sought to improve knowledge of best practices for caring for LEP patients by IM residents by implementing an educational curriculum. Methods: Residents from three IM residency programs in a large academic health system were surveyed on their perceived LEP education and barriers at the beginning of the 2018–2019 academic year. A LEP curriculum was developed and delivered to interns of one of the programs. These residents were re-surveyed early in the following academic year. Results: 118/392 (30%) residents completed the pre-curriculum survey. 35% of respondents reported frustration or stress while caring for LEP patients. 59% of residents reported deferring an interpreter for LEP patients less than half of the time. After implementation of the curriculum, a significantly higher percentage of residents responded they informed patients of LEP services at the beginning of the patient encounter (42% vs. 58%, p = 0.03), used “teach-back” (38% vs. 63%, p = 0.002), and felt confident in their ability to know if the patient understood the interpreter (25% vs. 42%, p = 0.01). There were no significant changes after implementation of the curriculum on the effect of time pressures, deferring of formal interpretation, and use of ad-hoc interpreters. Conclusions: A LEP curriculum delivered as a brief workshop for IM residents increased perceived education in caring for LEP patients and heightened awareness of LEP patient rights to formal interpretation.