Letters to the Editor
To the Editor:
In their October article, Thompson et al1 highlight a common and growing issue faced by residents and practicing physicians around the country. They conclude that pediatric residents do not receive proper training on use of medical interpreters, and suggest updating residency training curricula. The authors do not address their selection bias for programs in areas of high limited English proficiency (LEP), which likely led to overestimating pediatric residents’ proficiency in working with interpreters. With nearly 10% of the U.S. population having LEP, and increased medical access for members of racial and ethnic minority groups resulting from the enactment of the Affordable Care Act,2 these findings present a sobering view of our next generation of physicians’ ability to communicate well with many of their patients. To be fully prepared to treat an increasingly diverse population of patients, we believe that all physicians-in-training should receive formal global health training in undergraduate and postgraduate medical education.
Over the last decade, many medical schools have incorporated global health teaching in their curricula, and people have suggested creating global health competencies.3 At Harvard Medical School, all first-year students take a social medicine and global health course, which includes lectures and group discussions on health inequalities and social determinants of health, among other topics. While these principles are a fundamental part of medical education, they must be reinforced on a more practical level during postgraduate training.
Postgraduate training programs for global health should be structured, standardized, and universal.4 Thompson et al highlight one of many skills that are missing from the Accreditation Council for Graduate Medical Education’s six core competencies. Standardizing global health training through measured competencies would generate better physicians while improving the delivery of medical care. All physicians should possess these skills, and the perils of not teaching them to residents will continue to impede proper medical care for all people.
Paul K. Drain, MD, MPH
Instructor in medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; firstname.lastname@example.org.
Joseph J. Rhatigan, MD
Assistant chief, Division of Global Health Equity, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.
1. Thompson DA, Hernandez RG, Cowden JD, et al. Caring for patients with limited English proficiency: Are residents prepared to use medical interpreters? Acad Med. 2013;88:1485–1492
2. Clemans-Cope L, Kenney GM, Buettgens M, Carroll C, Blavin F. The Affordable Care Act’s coverage expansions will reduce differences in uninsurance rates by race and ethnicity. Health Aff (Millwood). 2012;31:920–930
3. Battat R, Seidman G, Chadi N, et al. Global health competencies and approaches in medical education: A literature review. BMC Med Educ. 2010;10:94
4. Brewer TF, Saba N, Clair V. From boutique to basic: A call for standardised medical education in global health. Med Educ. 2009;43:930–933