Public Release: 

Languages of medical residency applicants compared to patients with limited English

The JAMA Network Journals

An analysis of the non-English-language skills of U.S. medical residency applicants finds that although they are linguistically diverse, most of their languages do not match the languages spoken by the U.S. population with limited English proficiency, according to a study in the December 10 issue of JAMA, a theme issue on medical education.

More than 25 million U.S. residents have limited English proficiency, an 80 percent increase from 1990 to 2010. Limited English proficiency (LEP) may impede participation in the English­language-dominant health care system. Little is known about the non-English-language skills of physicians in training, according to background information in the article.

Lisa Diamond, M.D., M.P.H., of Memorial Sloan Kettering Cancer Center, New York, and colleagues conducted a study to characterize the language diversity of all U.S. residency applicants through the Electronic Residency Application Service and contrast applicant language skills with the predominant languages of the U.S. population with LEP. Applicants were asked to self-report proficiency in all languages spoken. The five response options were: native/functionally native; advanced; good; fair; and basic. The applicants' linguistic diversity was contrasted with the U.S. LEP population. The top 25 LEP languages spoken were obtained from the U.S. Census Bureau for individuals 5 years and older between 2007 and 2011.

Most (84.4 percent) of the 52,982 applicants for 2013 reported some proficiency in at least 1 non-English language. The most common languages were Spanish (53.2 percent), Hindi (20.5 percent), French (15.6 percent), Urdu (10.1 percent), and Arabic (9.8 percent). Only 21 percent of applicants reported advanced Spanish proficiency.

Among the 25.1million U.S. LEP speakers, 16.4 million speak Spanish. For every 100,000 U.S. LEP speakers, there were 105 applicants who reported at least advanced proficiency in a non­English language. Relative to this rate, there was an over-representation of Hindi-speaking applicants, and an under-representation of Spanish, Vietnamese, Korean, and Tagalog, which are 4 of the top 5 U.S. LEP languages.

"Further research is needed on whether increasing the number of bilingual residents, educating trainees on language services, or implementing medical Spanish courses as a supplement to (not a substitute for) interpreter use would improve care for LEP patients," the authors write.


(doi:10.1001/jama.2014.15444; Available pre-embargo to the media at

Editor's Note: Dr. Diamond was supported by Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service. The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

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