Question 1. What is the Current Landscape of Medical Student Interpretation?
1.1 Medical students are frequently asked to interpret in the clinical setting. During the clerkship phase of training, medical students become active members of the healthcare treating team and interact closely with patients. The literature shows that bilingual medical trainees frequently act as interpreters for patients with limited language proficiency and with whom they share a common language. This was found to be especially true in the United States, where most bilingual (English- and Spanish-speaking) students in a single graduating class (84%) reported being asked to interpret at some point during their clinical rotations (Table 1 ).32A similar trend has been found for other languages by Vargas Palaez et al, who surveyed fully bilingual first to third year medical students (speaking 21 languages) in Pennsylvania and reported that 55% of them had interpreted in community/healthcare organizations, and 79% had interpreted for family/friends.21 Similar data was reported in New Zealand and in Australia, where 50% and 34% of bilingual students respectively reported having acted as ad-hoc interpreters during their clinical training.25, 33 In most instances, students were involved for brief information relaying or interpretation of patients’ conditions and treatments. However, several studies have also reported student involvement during complex procedures, critical care situations, and emotionally sensitive clinical encounters.25, 33, 34 It is also worth mentioning that the majority of medical students (>95%) surveyed in the above studies had no formal interpreting training or qualifications.
1.2 Training programs in medical interpretation have been developed for medical students. This review identified five medical interpretation training programs developed for medical trainees.15, 21, 34-36 The existing training programs vary in structure, duration, content, and assessment/evaluation. Information on these five training programs has been summarized inTable 2. All programs include theoretical foundation on the ethics of interpretation, as well as practical sessions where students participate in role-play activities or sample clinical scenarios. In terms of evaluation and assessment for official certification, these programs include either formal assessment via an examination, or direct observation during an interpretation session. These methods can be compared to current competency-based evaluations in medical curricula. Assessments and observations are performed by professional interpreters or bilingual physicians 15, 35, 36Moreover, additional certification in medical interpretation upon completion of the standard training is offered as an option to pursue by two of the programs.15, 21 None of the studies measured transfer of learning, which is defined as one’s capacity to apply learned skills in a new setting.37 Finally, all training programs are optional for medical students.
The effectiveness of the above training programs has been demonstrated through student self-assessments and/or feedback from healthcare teams and patients. Upon completion of training, most students reported an improvement in interpreting comfort, understanding of the interpreter’s role, interpretation skills, and empathy towards LLP patients.21, 34, 36 In two of the studies, student trainees were rated highly by hospital staff, professional interpreters, and patients. 34, 35
1.3 Limitations of medical interpretation training programs. Several limitations have been identified for the training programs. Vargas et al has pointed that medical students often find it difficult to participate in prolonged training programs due to their busy schedules. It was suggested that programs should be modified to reduce time commitment. 21 The lack of objective comparison with control group of untrained students has also been identified as a major challenge when assessing training effectiveness.21, 34 Moreover, though most programs collected self-assessments from participants, many lacked objective third-party assessment. 21, 34, 36