Overcoming the language barrier: a novel curriculum for training medical students as volunteer medical interpreters

Background Over 41 million people in the United States speak Spanish as their primary language, of which 16 million have limited English proficiency (LEP). It is well-established that language barriers contribute to health disparities and that the use of ad-hoc interpretation by untrained family members results in substandard care. We developed a novel interpreter training program for medical students to serve as in-person interpreters at a charitable, resident continuity clinic so as to overcome the language barrier in the delivery of healthcare to LEP patients. Methods The Medical Student Interpreter Training Program (MSITP) consists of three steps. First, fluent Spanish-speaking students shadowed a licensed interpreter. Second, students took a standardized phone exam to demonstrate language proficiency. Finally, students completed a three-hour training on the methodology and ethics of interpreting conducted by the Department of Interpreter Services. Results Pre- and post-tests were administered to assess students’ familiarity with the Interpreter Code of Ethics and interpreter skills. Familiarity with the Interpreter Code of Ethics increased significantly with all students reporting feeling comfortable (47%) or very comfortable (53%) after training. The pre- and post-tests included free response questions, which were administered to assess competence in the methodology and ethics of interpreting. The cohort’s aggregate score increased by 35% after the training (Wilcoxon signed rank z-score = 2.53; p = .01). Conclusions Implementing the MSITP resulted in an increased number of trained, Spanish-speaking interpreters available to provide their services to LEP patients at an affiliated charitable clinic and throughout the university hospital. Unlike other program models which are time and resource-intensive, this program is replicable and easily managed by volunteers. The MSITP is an effective model for training students as medical interpreters to ensure the delivery of quality healthcare for LEP patients.

Educating Clinicians to Improve Telemedicine Access for Patients with Limited English Proficiency

The COVID-19 pandemic prompted the rapid incorporation of telemedicine into healthcare systems, resulting in increased access challenges for patients in the United States with limited English proficiency (LEP). Non-English-language speakers face challenges with telemedicine that magnify pre-existing barriers to language-appropriate care, such as difficulty accessing professional medical interpreters and navigating both electronic health information and online patient portals. Improved medical education on telehealth would increase equitable care for linguistic minorities. Medical education targeting telehealth care delivery should include clinician instruction on working with interpreters in telehealth contexts, increasing patient access to telehealth resources, and addressing patients’ language needs for telemedicine.

Visibility of Chinese ad hoc medical interpreters through text ownership: A case study

Professional interpreters’ visibility in the European context has been widely discussed in the field of community interpreting, but the visibility of untrained ad hoc interpreters in non-European contexts such as China has received little academic attention. By adopting the concept of “text ownership” proposed by Angelelli (2004a), this study examines Chinese ad hoc interpreters’ manifestations of visibility in an authentic medical setting. Based on field observations, audio recordings and interviews, the study reports on four types of visibility demonstrated by ad hoc interpreters: (a) replacing the interlocutor; (b) expressing affect towards a patient; (c) exploring answers; and (d) brokering comprehension. Other forms of visibility are also identified, such as omissions of doctors’ or patients’ remarks and small talk between doctor and interpreter. Interpreters’ deeply held views on social factors as well as the institutional and social norms they have been exposed to are believed to influence their manipulation of medical discourses. This study concludes that in a context where professional medical interpreting services are unavailable, ad hoc interpreters may act as linguistic facilitators by taking on various roles that go beyond mere interpreting. However, their excessive visibility may give rise to potential clinical risks, especially when direct doctor–patient communication is compromised. Attention is drawn to the importance of proper training as well as to the need for the professionalization of medical interpreting in China.

Do Hispanic Patients Who Require a Medical Interpreter Understand the Severity of Their Glaucoma Diagnosis?

Background and Hypothesis: Glaucoma is a group of progressive optic neuropathies characterized by a degeneration of retinal ganglion cells with characteristic changes in the visual field. The Los Angeles Latino Eye Study (LALES) is the largest and most recent study to determine the prevalence of open-angle glaucoma in Hispanics; reported at nearly 5%. Between 2010 – 2019, Hispanic patients accounted for more than half of the United States population growth, reaching a record of 60.6 million Hispanics living in the United States. With an influx of Hispanic’s migrating to the United States, there is an increased need for medical interpreters to assist medical professionals in encounters with Hispanic patients. The success of a medical encounter relies on a multitude of factors, but when a medical interpreter is involved, the stakes are even higher. We hypothesize that Hispanic speaking patients will have lower rates of understanding their glaucoma diagnosis and severity, in comparison to English speaking patients due to gaps in translation provided by medical interpreters. Project Methods: Native Spanish and native English-speaking patients from the Eskenazi Health Eye Clinic were recruited via phone, reminding them of their upcoming eye appointment and their eligibility to participate in the study. Interested patients were provided with information regarding the study and consent materials at the start of the medical encounter. Participants who consented were administered the survey at the end of their medical encounter, in their preferred language, in person, at the clinic. Results: This is an ongoing prospective study. Potential Impact: This study will determine if medical interpreters successfully relay all the necessary information regarding a Hispanic patient’s glaucoma diagnosis. This study could also provide a partial explanation as to why there is a high no show rate and high medication noncompliance rate within the Eskenazi Health Eye Clinic Hispanic population.

Medical terminology circulation and interactional organisation in interpreter-mediated medical encounters

Two medical encounters taking place in a Northern Italian hospital are analysed in this paper from a qualitative point of view, based on the author’s previous research. The aim is to reveal the strategies adopted by medical interpreters, in these two specific cases, to translate medical terminology and promote/exclude interlocutors’ active participation. This latter aspect is influenced by the way the interaction is socially and linguistically organised and, in particular, by how interlocutors’ utterances are translated. The prevalence of dyadic or triadic sequences and especially the shifts between such communication exchanges are pivotal in fostering or hindering interlocutors’ participation. Furthermore, medical interactions, as a form of institutional talk, enshrine specific expectations, which are mainly of a cognitive nature but may also be affective, as in the two encounters observed. By conveying such expectations and expressions of personal interest, interpreters have proved to contribute to the fair distribution of active participation among primary interlocutors. Hospital ethical approval and subjects’ written informed consent have been obtained.

Technical Meets Traditional: Language, Culture, and the Challenges Faced by Hmong Medical Interpreters

Introduction Ineffective intercultural communication can occur due to inaccurate medical interpreting for limited English proficiency (LEP) patients. Research shows that Hmong patients experience poorer quality interpreter services than other LEP populations. This study’s purpose is to understand Hmong medical interpreters’ perceptions of the factors that affect their ability to make accurate medical interpretations during clinical encounters. Method A qualitative study was conducted with Hmong-speaking medical interpreters. The interviews were semistructured, audio recorded, and analyzed using conventional content analysis. Results 13 interpreters aged 29 to 49 years participated in the study. Three factors affected the interpreters’ ability to make accurate medical interpretations for Hmong-speaking patients: (a) matched gender between the interpreter and patient, (b) culturally taboo topics in communicating about reproductive body parts and sexual health/activity, and (c) culture and generational language differences between interpreters and Hmong patients. Discussion Clinical encounters that match patient–interpreter ages, gender, and/or local culture may reduce communication barriers.

Evaluating Local Multilingual Health Care Information Environments on the Internet: A Pilot Study

For foreign-born populations, difficulty in finding health care information in their primary language is a structural barrier to accessing timely health care. While such information may be available at a national level, it may not always be relevant or appropriate to the living situations of these people. Our objective was to explore the quality of online multilingual health information environments by pilot-testing a framework for assessing such information at the prefectural level in Japan. The framework consisted of five health care domains (health system, hospitals, emergency services, medical interpreters, and health insurance). Framework scores varied considerably among prefectures; many resources were machine-translated. These scores were significantly associated with foreign population proportion and the number of hospitals in each prefecture. Our multilingual health care information environment (MHCIE) framework provides a measure of health access inclusivity, which has not been quantified before. It is adaptable to other international contexts, but further validation is required.

Healthcare Provider Perspectives Regarding Use of Medical Interpreters During End-of-Life Conversations With Limited English Proficient Patients

Background: Healthcare providers increasingly care for patients with Limited English Proficiency (LEP). There is limited research evaluating healthcare provider utilization practices, attitudes, perceived benefits and barriers regarding the use of medical interpreters in end of life (EOL) and goals of care (GOC) conversations. Objectives: To elicit healthcare providers’ opinions of the role, factors that impact decisions to use medical interpreters and perceived utility of using medical interpreters when conducting EOL and GOC conversations with LEP patients and their families. Design: Cross-sectional survey of internal medicine trainees and attending physicians from a U.S. medical center. Results: A total of 117 surveys were collected with a response rate of 51%. In-person medical interpreters received higher ratings with regard to their helpfulness compared to telephone medical interpreters during EOL and GOC conversations. Being an attending physician and having received training in the use of a medical interpreter predicted higher composite scores reflecting greater awareness of the roles of medical interpreters and endorsement of best communication practices. In-person interpreters were viewed by a subset of participants as “standard of care” during EOL and GOC conversations. Conclusion: Having more years in practice and receiving training in the use of medical interpreters correlated with more favorable attitudes toward the role of medical interpreters and positive communication practices. Incorporating early training in the use of medical interpreters could help enhance communication practices and outcomes during EOL and GOC conversations with LEP patients.

Access to Translator (AT&T) project: Interpreter on Wheels during the COVID-19 pandemic

We report our experience in using virtual technology in our emergency department (ED) to meet communication needs of our patients who have limited English proficiency (LEP) during the COVID-19 pandemic. Our project aim was to improve communication between our ED staff and patients who have LEP. Specifically, our primary aim was to eliminate the use of healthcare staff as ad hoc interpreters by 50% in our ED by using virtual medical interpreters within 2 months. To achieve our goal, several strategies were employed. First, we assessed the need for interpreters in our ED by tracking the number of times our nursing staff is pulled away from their nursing role to help other staff as an ad hoc interpreter. Second, a patient survey was conducted to understand their thoughts and needs for interpretation in the ED. Third, we developed strategies in improving access to interpreters in our ED. During the COVID-19 pandemic, we conducted a trial of using ‘Interpreter on Wheels’ (IOW) in our ED. In a 2-month period, we had 477 virtual interpretation encounters totaling 4123 interpretation minutes of IOW usage. We found that it satisfied not only our communication needs but also reduced some of our potential infection control risks during the pandemic.