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

Abstract

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.

Changes in Language Services Use by US Pediatricians

“…[39][40][41] Teaching about appropriate use of language services has been incorporated into both undergraduate and postgraduate medical and other health care professional education, generally as part of cultural competency training. [41][42][43][44] These curricula have been shown to increase knowledge of when and how to use a professional interpreter and the hazards of ad hoc interpreters. [42][43][44] The longterm impact of these curricula on appropriate language services use has not been evaluated, and demonstrating a positive impact on patient outcomes is difficult.…”

“…[41][42][43][44] These curricula have been shown to increase knowledge of when and how to use a professional interpreter and the hazards of ad hoc interpreters. [42][43][44] The longterm impact of these curricula on appropriate language services use has not been evaluated, and demonstrating a positive impact on patient outcomes is difficult. 42,43,45 Another important component of improving communication with LEP patients is assessment of health care providers' foreignlanguage skills to ensure adequate proficiency for health care communication.…”

“…[42][43][44] The longterm impact of these curricula on appropriate language services use has not been evaluated, and demonstrating a positive impact on patient outcomes is difficult. 42,43,45 Another important component of improving communication with LEP patients is assessment of health care providers' foreignlanguage skills to ensure adequate proficiency for health care communication. Opportunities for self-assessment or formal assessment of providers' 19 Finally, we cannot assess the quality of interpreters used.…”

Conceptualizing the Pathways and Processes Between Language Barriers and Health Disparities: Review, Synthesis, and Extension

“…Despite such well documented correlations between language barriers and health disparities, it is rarely examined how exactly language barriers contribute to health disparities [2]. To create better interventions or countermeasures to mitigate the health disparities that individuals with language barriers experience, it is necessary to know the ways that language barriers contribute to health disparities [9].…”

Beyond the Language Barrier 'Speak', 'See', 'Help Me'

“…Studies have highlighted that health care provider-patient communication barrier leads to a decrease in patient satisfaction, potentially poor clinical decision making, increased chances of medical errors, longer hospital stays and poor patient outcomes [1]. However, this risk can be reduced by introducing an interpreter and communicating with patients in their preferred language [5]. Nurses are considered as the primary health care provider for the patient.…”