According to the 2010 U.S. census, 24.5 million Americans—a startling 8 percent of the population—require language assistance to access social and medical services. Harvard’s teaching hospitals, which serve large, often-marginalized immigrant communities from Asia and Latin America, reflect this national trend.
Language barriers can significantly affect care. Studies indicate that patients with limited English proficiency receive less preventive care, are less likely to adhere to medication regimens, and are more likely to leave the hospital against medical advice. In contrast, patients with physicians who speak their language are more likely to discuss lifestyle modifications and reveal past traumatic experiences. They also report receiving better medical education. These advantages lead to better care, higher rates of referral and improved patient compliance. Even basic language skills in the hospital setting could reduce simple miscommunications that delay appropriate diagnosis and treatment.
Though services exist to support non-English-speaking patients, these resources are severely underutilized. Recent research indicates that, even when patients are offered the complimentary assistance of medical interpreters, fewer than half of emergency department visits by patients with limited English proficiency took advantage of an interpreter service. Only 23 percent of U.S. teaching hospitals train physicians to work with interpreters, and this training is usually optional.
Given these realities, it seems clear that language training is an important tool for providing high-quality, responsible medical care to certain patient populations. Many prominent medical schools, including Johns Hopkins; the University of California, San Francisco; the University of California, San Diego; Stanford; Yale; and New York University offer medical language electives to first- and second-year medical students.
In response to the need for language training at HMS, students organized a program known as the Harvard Medical Language Initiative, or HMLI. The program provides instruction in Mandarin, Portuguese and Spanish, reflecting the largest local populations of non-English speakers. I was among the student organizers, and I took the medical language course in Spanish.
The HMLI program began in the fall of 2009 and attracted considerable interest. Nearly a fifth of the entering Class of 2013 elected to participate in one of the language tracks. An intermediate-level class taught how to collect a history through weekly sessions focusing on an aspect of the history, relevant vocabulary and cultural concerns. An advanced class, taught entirely in Spanish by Vilma Ortiz, HMS assistant professor of anesthesia at Massachusetts General Hospital, was geared toward students already proficient in conversational Spanish. These classes were exceptional. Students learned medicine as well as the vocabulary and grammar required to communicate medical information to patients; questions during and after the class were asked and answered only in Spanish.
In addition to the weekly didactic sessions, monthly simulation sessions directed by Kim Khoury, HMS clinical instructor in population medicine at Harvard Vanguard Medical Associates, provided the opportunity to practice classroom lessons. In a memorable and engaging forum, students honed practical clinical skills and improved their use of Spanish in a clinically relevant setting.
Building on the success of the fall pilot program, last spring the advanced curriculum was expanded to include more disease-specific discussions and bimonthly simulation sessions. Guest lecturers from affiliated hospitals spoke in Spanish about specific medical topics. In collaboration with Interpreter Services at Mass General, students trained to work with interpreters. Beyond classroom presentations and discussions, students had opportunities to practice conversing through an interpreter with patients who spoke still other languages. Students also shadowed an interpreter, which was a particularly enlightening experience: One afternoon might include visits throughout the hospital, with each stop a strong teaching point.
HMLI continues to grow. In addition to expanding the opportunities afforded last year to nearly a quarter of the Class of 2014, other initiatives include rigorous and objective evaluation of the program’s effectiveness.
Foreign language training is an important means of providing better medical services to a large, underserved population. HMLI aims to provide strong language training to HMS students through didactic and simulation sessions as well as collaborations with the Harvard-affiliated teaching hospitals. Core support for the program is provided by the Department of Anesthesia, Critical Care and Pain Medicine at MGH, and from the Gilbert Program in Medical Simulation at HMS.
—Erika Williams is a second-year MD–PhD student