To the Editor:
To meet the needs of increasingly diverse patients in a rapidly globalizing world, we believe that all U.S. medical schools and residencies should assess their trainees' foreign language skills and provide formal training on how to use interpreters. Discordant physician–patient communication has been linked to medication errors, inappropriate treatment, and misdiagnosis,1 yet medical students and residents are not trained with communication strategies necessary to effectively serve non-English-speaking patients. A recent nationally representative survey of U.S. hospitals2 found that 74% of hospitals serve patients whose primary language is not English, and over 87% of these hospitals have bilingual physicians or nurses. Yet, formal assessment of foreign language proficiency was only offered to medical staff at 18% of hospitals, and less than a third of hospitals required medical residents to receive any interpreter services training. There are both domestic and global justifications for greater attention to language barriers in medical education: Increasing numbers of limited English proficiency patients within the United States demand improved interpreter services; expanded global health research and training opportunities similarly create a greater demand for foreign language proficiency.
A mandatory language assessment for all entering medical students would help quantify students' foreign language proficiency and lay the groundwork for expanded interpreter-services training for all students and special language training for that subgroup with demonstrated proficiency. Successful language training programs integrated within the medical curriculum have already been launched at some schools including the University of North Carolina at Chapel Hill School of Medicine3 and the University of California, Irvine, School of Medicine. In addition, formal training on diagnosing language barriers and using interpreters should be a required part of medical education. Students' informed understanding of the limitations of their foreign language skills could help them know when to apply their foreign language skills and when to call for interpreter services.
The importance of foreign language proficiency and interpreter training in medical education should not be ignored but, rather, should be more clearly articulated and reconsidered in U.S. medical education.
Joseph D. Tucker, MD, MA
Instructor, Harvard Medical School, Boston, Massachusetts; [email protected]
Alice H. Chen, MD, MPH
Associate professor, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.
Roger I. Glass, MD, PhD
Director, NIH Fogarty International Center, Bethesda, Maryland.
1. Jacobs EA, Agger-Gupta N, Chen AHM, Piotrowski A, Hardt EJ. Language Barriers in Health Care Settings: An Annotated Bibliography of the Research Literature. Los Angeles, Calif: California Endowment; 2003.
2. Regenstein M. Talking With Patients: How Hospitals Use Bilingual Clinicians and Staff to Care for Patients With Language Needs. Los Angeles, Calif: California Endowment; 2009.
3. Reuland DS, Frasier PY, Slatt LM, Aleman MA. A longitudinal medical Spanish program at one U.S. medical school. J Gen Intern Med. 2008;23:1033–1037.