Let’s Not Contribute to Disparities: The Best Methods for Teaching Clinicians How to Overcome Language Barriers to Health Care

Journal of General Internal Medicine (Impact Factor: 3.45). 05/2010; 25:189-193. DOI: 10.1007/s11606-009-1201-8


Clinicians should be educated about how language barriers contribute to disparities for patients with limited English proficiency
(LEP). However, educators must avoid developing educational interventions that increase health disparities for LEP patients.
For example, studies suggest that teaching “Medical Spanish” or related courses may actually contribute to health care disparities
if clinicians begin using these non-English language skills inappropriately with patients. We discuss the risks and benefits
of teaching specific cultural competence skills and make evidence-based recommendations for the teaching content and methods
for educational interventions focused on overcoming language barriers in health care. At minimum, we suggest such interventions
include: (1) the role of language barriers in health disparities, (2) means of overcoming language barriers, (3) how to work
with interpreters, (4) identifying and fixing problems in interpreted encounters, and (5) appropriate and safe use of one’s
own limited non-English language skills.

KEY WORDScommunication barriers-doctor-patient relationships-medical education-health disparities

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    • "A lack of shared mean - ing , or conceptual understanding , because of cultural , socio - economic , and gender differences may lead to misunderstandings of health - related perceptions . The negative consequences of miscommunication in health care settings are well investigated by academic scholars ( Diamond and Jacobs , 2010 ; Kale and Syed , 2010 ) although to date little research was found examining communication barriers of immigrant women during their maternity care in Canada . "
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    ABSTRACT: Background: many immigrant and ethno-cultural groups in Canada face substantial barriers to accessing health care including language barriers. The negative consequences of miscommunication in health care settings are well documented although there has been little research on communication barriers facing immigrant women seeking maternity care in Canada. This study identified the nature of communication difficulties in maternity services from the perspectives of immigrant women, health care providers and social service providers in a small city in southern Alberta, Canada. Methods: a focused ethnography was undertaken incorporating interviews with 31 participants recruited using purposive and snowball sampling. A community liaison and several gatekeepers within the community assisted with recruitment and interpretation where needed (n=1). All interviews were recorded and audio files were transcribed verbatim by a professional transcriptionist. The data was analysed drawing upon principles expounded by Roper and Shapira (2000) for the analysis of ethnographic data, because of (1) the relevance to ethnographic data, (2) the clarity and transparency of the approach, (3) the systematic approach to analysis, and (4) the compatibility of the approach with computer-assisted qualitative analysis software programs such as Atlas.ti (ATLAS.ti Scientific Software Development GmbH, Germany). This process included (1) coding for descriptive labels, (2) sorting for patterns, (3) identification of outliers, (4) generation of themes, (5) generalising to generate constructs and theories, and (6) memoing including researcher reflections. Findings: four main themes were identified including verbal communication, unshared meaning, non-verbal communication to build relationships, and trauma, culture and open communication. Communication difficulties extended beyond matters of language competency to those encompassing non-verbal communication and its relation to shared meaning as well as the interplay of underlying pre-migration history and cultural factors which affect open communication, accessible health care and perhaps also maternal outcomes. Conclusion: this study provided insights regarding maternity health care communication. Communication challenges may be experienced by all parties, yet the onus remains for health care providers and for those within health care management and professional bodies to ensure that providers are equipped with the skills necessary to facilitate culturally appropriate care.
    Midwifery 10/2014; 31(2). DOI:10.1016/j.midw.2014.09.009 · 1.57 Impact Factor
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    • "Over the last several years, accrediting bodies such as the Liaison Committee on Medical Education (LCME) and the Accreditation Council for Graduate Medical Education (ACGME) have developed cultural competency training standards and requirements [16-18]. Integral to this teaching is an emphasis on language barriers as a source of health disparities and how to overcome these barriers through skillful utilization of interpreter services [4,19]. However, little is known about how well medical schools prepare their students to care for LEP patients. "
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    ABSTRACT: Patients with limited English proficiency (LEP) represent a growing proportion of the US population and are at risk of receiving suboptimal care due to difficulty communicating with healthcare providers who do not speak their language. Medical school curricula are required to prepare students to care for all patients, including those with LEP, but little is known about how well they achieve this goal. We used data from a survey of medical students' cross-cultural preparedness, skills, and training to specifically explore their self-rated preparedness to care for LEP patients. We electronically surveyed students at one northeastern US medical school. We used bivariate analyses to identify factors associated with student self-rated preparedness to care for LEP patients including gender, training year, first language, race/ethnicity, percent LEP and minority patients seen, and skill with interpreters. We used multivariate logistic regression to examine the independent effect of each factor on LEP preparedness. In a secondary analysis, we explored the association between year in medical school and self-perceived skill level in working with an interpreter. Of 651 students, 416 completed questionnaires (63.9% response rate). Twenty percent of medical students reported being very well or well-prepared to care for LEP patients. Of these, 40% were in their fourth year of training. Skill level working with interpreters, prevalence of LEP patients seen, and training year were correlated (p < 0.001) with LEP preparedness. Using multivariate logistic regression, only student race/ethnicity and self-rated skill with interpreters remained statistically significant. Students in third and fourth years were more likely to feel skilled with interpreters (p < 0.001). Increasingly, medical students will need to be prepared to care for LEP patients. Our study supports two strategies to improve student preparedness: training students to work effectively with interpreters and increasing student diversity to better reflect the changing US demographics.
    BMC Medical Education 06/2011; 11(1):26. DOI:10.1186/1472-6920-11-26 · 1.22 Impact Factor
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    ABSTRACT: Language barriers present a substantial communication challenge in the hospital setting. To describe how clinicians with various levels of Spanish language proficiency work with interpreters or their own Spanish skills in common clinical scenarios. Survey of physicians and nurses who report ever speaking Spanish with patients on a general medicine hospital floor. Spanish proficiency rated on a 5-point scale, self-reported use of specific strategies (own Spanish skills, professional or ad-hoc interpreters) to overcome the language barrier. Sixty-eight physicians and 65 nurses participated. Physicians with low-level Spanish proficiency reported frequent use of ad-hoc interpreters for all information-based scenarios, except pre-rounding in the morning when most reported using their own Spanish skills. For difficult conversations and procedural consent, most used professional interpreters. Comparatively, physicians with medium proficiency reported higher rates of using their own Spanish skills for information-based scenarios, lower rates of professional interpreter use, and little use of ad-hoc interpreters. They rarely used their own Spanish skills or ad-hoc interpreters for difficult conversations. Physicians with high-level Spanish proficiency almost uniformly reported using their own Spanish skills. The majority (82%) of nurses had low-level Spanish proficiency, and frequently worked with professional interpreters for educating patients, but more often used ad hoc interpreters and their own Spanish skills for information-based scenarios, including medication administration. Physicians and nurses with limited Spanish proficiency use these skills, even in important clinical circumstances in the hospital. Health-care organizations should evaluate clinicians' non-English language proficiency and set policies about use of language skills in clinical care.
    Journal of General Internal Medicine 07/2011; 27(1):117-23. DOI:10.1007/s11606-011-1779-5 · 3.42 Impact Factor
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