June 6, 2022
Salma Iftikhar, M.D., and others have developed a curriculum for students at Mayo Clinic Alix School of Medicine that is focused on working with medical interpreters. It's a skill that is critical in communicating with and caring for patients whose first language isn't English, Dr. Iftikhar says.
Salma Iftikhar, M.D., wants to make sure that future generations of health care professionals are equipped to communicate effectively with and treat patients whose first language isn't English.
Dr. Iftikhar, a consultant in Internal Medicine, has seen the limitations of language barriers in her own practice, and the importance of communication in learning about a patient's health. While Mayo Clinic provides interpreters, it takes skills to have effective and thorough conversations about a patient's health through an interpreter. These skills typically are not part of medical training in the U.S., and Dr. Iftikhar wants to change that.
Over the past several years, Dr. Iftikhar and others have developed a curriculum for students at that is focused on working with medical interpreters. Students also observe clinicians working with interpreters in the outpatient setting.
Majken Wingo, M.D., director of the Preclinical Clerkship Skills Program, says it's important that students have the opportunity to practice the skills they learn. The training to work with medical interpreters includes opportunities for each student to rehearse with a simulated patient — a trained medical actor — and a professional medical interpreter in the Multidisciplinary Simulation Center.
"Students sometimes find it awkward or uncomfortable working with an interpreter," Dr. Wingo says. "Many clinicians have had to learn on the fly as they enter the clinical setting. We provide students the opportunity to go through the encounter, and they receive valuable feedback from three people: the clinician who's observing, the simulated patient and the interpreter."
An important part of culturally sensitive care
It's an important skill at Mayo Clinic, where the number of international patients continues to grow. Mayo provides care for patients from nearly 140 countries each year. Patients can request a medical interpreter, and Mayo provides the service free of charge.
In 2021, Mayo Clinic provided interpreters for nearly 290,000 patient appointments in more than 77 languages. And even though many patients may be accompanied by spouses and relatives, Mayo encourages relying on professionals to translate. Professional interpreters are not only versed in medical terminology, but they ensure all information is conveyed without being unintentionally abridged or filtered.
Interpreters typically attend patient appointments in person, but they also can provide translation by phone or video. They also can help clinicians address each patient's cultural preferences and concerns, so the exam and discussion take the patient's expectations into account.
Mayo recognizes the significance of providing this training in medical school, not just to make students comfortable, but as part of teaching culturally sensitive care.
Essential for clinicians at every stage
Working with a professional translator is not as straightforward as it sounds, says Caroline Doherty, a second-year medical student.
During the simulated patient sessions, Doherty says she learned useful pointers about speaking in short sentences, and posing each question individually for the interpreter to translate and for the patient to respond.
And there are more subtle lessons. Body position is critical during the interaction. The patient, clinician, and interpreter should be oriented toward each other in a triangle. But after introducing the interpreter to the patient, the clinician should avoid looking at the interpreter.
"Your eye contact, questions and focus remain on the patient, even though you're taking in information in both ears," Dr. Iftikhar says.
Medical students say they're grateful for the training, which has helped them participate in volunteer clinics that serve recent immigrants and to feel more comfortable in the outpatient clinic with patients who don't speak English.
"Even when you know theoretically what you're supposed to do when an interpreter is present, it's another step to learn how to direct the flow of conversation," says Sherry Zhou, a second-year medical student.
Zhou speaks several languages but says a professional interpreter is best for relaying health information and for helping to establish a connection.
Broadening the reach
Being able to navigate communication through an interpreter is so central to patient care that Dr. Iftikhar provides lectures on the topic for residents in Internal Medicine and has presented the topic at Grand Rounds for other medical staff.
"It's essential for clinicians at every stage," she says. "When this training is incorporated early on, students find they become comfortable with it, and soon, it comes naturally."
Plans are underway to bring the curriculum to students at Mayo Clinic Alix School of Medicine in Arizona and Florida.