Language training for health professionals: an opportunity
During my first few years in medical school, I helped to launch the Harvard Medical Language Initiative (HMLI). The group was created to meet the demand among my classmates for language training during the academic year (it had previously been offered only in the summer for fourth year students). We inherited a Spanish course from the class ahead of us and during my time at the HMLI a committed group of students worked to strengthen that foundation. We found faculty mentors to teach the courses, we worked with the Dean for Medical Education so that faculty could cite their teaching in their promotions portfolios and we worked with the Office of Diversity and Community Partnership to secure grant funding. We expanded to offer courses in Portuguese and Mandarin (covering the top three languages in Massachusetts, after English) and we won recognition for the courses as official Harvard Medical School electives. These all felt like huge accomplishments.
As more of our classmates took the courses, we started to wonder about our impact. We became concerned that graduates might misinterpret finishing the course as a measure of fluency. We read an article in JAMA that highlighted concern about “physicians and medical trainees [who] underuse professional interpreters… substituting their own limited spoken Spanish during clinical encounters.” Could we be contributing to the problem?
We started to design our curriculum to address these concerns. We incorporated more simulated patient encounters, we introduced cultural sensitivity training into the courses, we had Interpreter Services from one of our hospitals train the students on the importance and proper use of interpreters. We tested students more and talked frequently about knowing one’s limits. I dreamed that we could have our students undergo something like Interagency Language Roundtable testing, to rate their proficiency in a language. Funding proved to be an obstacle for the last idea, but I believe that we succeeded in making our students more self-conscious about their language skills.
The busyness of third-year has separated me a bit from the HMLI. A new generation of students is in charge and, I understand, doing a fantastic job. Though I remain concerned about the outcomes from language training for health professionals, I’m still a supporter. Healthcare is a field driven by skills and competencies; it is natural for providers who want to take good care of a diverse patient population to seek to learn another language. The key is that this be taken as an opportunity to train students in cultural sensitivity, interpreter use and critical self-assessment of their language skills. Very few people will come away from a language course with anything close to fluency in Spanish, Portuguese or Mandarin. Everyone, though, can learn to take better care of their patients with limited English proficiency.
