A Novel Simulation to Assess Residents' Utilization of a Medical Interpreter

Abstract

Introduction: Physicians must be facile in working with a medical interpreter (MI) given the large population of patients with limited English proficiency. Methods: To facilitate residents' assessment of their ability to interact with non-English-speaking patients, we developed a simulation case involving one such patient. The case involved a 31-year-old Spanish-speaking postpartum female who presented with eclamptic seizures. The learner needed to request an MI to assist with obtaining the patient's medical history once her concerned family member (also Spanish speaking) arrived. The major critical actions included appropriate use of MI services, recognition of the risk for eclamptic seizures, proper evaluation and treatment, and appropriate disposition to an obstetrician. The case required a high-fidelity mannequin and simulation operator, nurse simulated participant, Spanish-speaking actor (to play the husband or family member), certified Spanish MI, and faculty evaluator. Results: We implemented this case with 60 emergency medicine residents, ranging from PGY 1 to 3. The learner was assessed by both the faculty observer and MI. Checklists for assessment and debriefing materials were provided. Two of 60 residents did not request an MI. When compared to a prior version of this case that did not include the language barrier, median scores dropped from 12 to 10 out of 24, suggesting that the language barrier created a more challenging case. Discussion: The use of MIs is an integral part of health care practice in the United States, and we present a simulation case that can assess learners' use of MIs.

Lost in Translation: An OSCE-Based Workshop for Helping Learners Navigate a Limited English Proficiency Patient Encounter

“…We believe this resource is a significant addition to the body of existing MedEdPORTAL publications that use simulations to teach similar skills. 13 – 15 …”

“…Prior publications focused on Spanish-speaking patients, and simulation cases had adult patients only. 13 – 15 Our module is unique in that it offers OSCE scenarios focusing on communication skills to discuss a plan (rather than making a diagnosis), introduces cultural competency components, and includes a scenario participant who attempts to interpret in place of a certified health interpreter. The two different OSCEs also allow evaluators to compare a baseline score and a postworkshop score to evaluate learners.…”

Analysis of speech rhythm and heart rate as indicators of stress on student interpreters

“…Even if aware of the methodological limitations of using non-real situations, simulations are nowadays an instrumental part of medical and interpreting training (e.g. Zdradzinski et al, 2019).…”

Teaching emergency medicine residents health equity through simulation immersion

“…Prior simulation publications have utilized simulation for medical interpreters and affirmative care for transgender patients, but have not focused on DEI and mass simulation. 5,6 Didactics on themes like microaggression and implicit bias are the foundation for DEI skills, but residents must practice these skills prior to attaining competency. Discussions around culture, racism, discrimination, and medical mistrust are difficult and require practice.…”