Learning by doing: Medical students practice working with interpreters

First- and second-year medical students getting ready to put their book knowledge into real-world practice got a chance to work with medical interpreters during a pre-clerkship program organized by the College of Medicine and MUSC Health Interpretation & Translation Services.

Terrell Washington, who’s entering her second year in the College of Medicine, said she embraced the chance to think about putting herself in the shoes of someone who doesn’t speak the language but needs medical care.

“I feel like you should get the same care no matter what language you speak. If it were me going to another country, I would want people to have patience with me,” she said.

The college has held mandatory training on working with interpreters for about six years, said Alyssa Rheingold, Ph.D., who serves as one of the theme directors for the Fundamentals of Patient Care curriculum for pre-clerkship students.

This year was different, however, in that it was the first time the college partnered with Interpretation & Translation. The partnership meant that students got to work with Spanish language interpreters, as they have in the past, but also with American Sign Language interpreters. Community members volunteered as mock patients.

Antwan Walters, manager of Interpretation & Translation Services at MUSC Health, said members of the deaf and hard-of-hearing community were delighted to participate and are already looking forward to next year.

Many times, deaf patients feel that doctors don’t know how to work with them, said Walters, who began his MUSC Health career as an ASL interpreter. “They felt like they actually had an opportunity to train the next generation of providers on ‘how to work with me to meet my needs.’ They loved that opportunity,” he said.

"They felt like they actually had an opportunity to train the next generation of providers on ‘how to work with me to meet my needs.’ They loved that opportunity."
Antwan Walters, manager,
Interpretation & Translation Services

Rheingold said the students appreciated getting feedback from the interpreters on things they could be doing differently, whether it was speaking more slowly, remembering to maintain eye contact with patients or avoiding idioms or jokes that won’t translate.

“For a lot of students, they reported it was more challenging than they anticipated,” she said. “They have to make a much more conscious effort of watching their phraseology and how to engage and establish rapport and empathy with a patient when you’ve got that additional language barrier, so I think it helps highlight to them some of those concepts.”

Washington said the program forced students used to the go-go-go rhythm of medical school to slow down and practice patience.

The James Island native has some experience with this, as she often accompanies her father, who is blind, to medical appointments and has seen how people who aren’t paying attention can inadvertently walk him into walls. So far in her experiences as a medical student in the hospital she hasn’t encountered anyone who needed interpretation help, but she’s glad to know the service is there. It’s an opportunity to demonstrate inclusion, she said.

Walters said there’s an art to medical interpreting. Interpreters are there to support the patient-doctor relationship, not to get in the middle. Therefore, a spoken language interpreter should sit behind the patient so the patient and doctor look at each other rather than the interpreter.

“If the interpreter is out of sight, it requires the provider to make eye contact and look at the patient, and vice versa,” Walters said. “Compared to if the interpreter was in a triangle, everyone would focus on the interpreter so now the patient and the provider no longer have that connection and the interpreter becomes the center of attention, which is not the goal. We are supposed to be as unobtrusive as possible.”

That doesn’t work for patients who use sign language, since they need to be able to see the interpreter. But even then, proper placement can help with the doctor-patient relationship. If the signing interpreter sits in line with the doctor, it’s easier for the patient to quickly look from the interpreter to the doctor and back again.

"I thought it was definitely a necessary class. It’s one of those things in health care I don’t think we put enough emphasis on." 

Terrell Washington
College of Medicine student

Walters also noted that a medical interpreter’s job is to interpret exactly what the patient and doctor say, not to loosely translate meaning. That means if a doctor starts using highly technical language, interpreters don’t presume to give a plain-language explanation.

For example, the interpreter knows from experience and training that “myocardial infraction” means “heart attack.” But if the doctor says “myocardial infraction,” then that’s what the interpreter says. If the patient looks confused, however, the interpreter might tell the doctor the patient doesn’t seem to understand.

“We don’t take it upon ourselves to lower the level of language,” Walters said. “Our goal is to allow the provider to do that, because that’s their patient.”

It’s all part of fostering a strong doctor-patient relationship, he said.

Rheingold said the chance for real-life practice is important for students, who will encounter people of all backgrounds during their careers. “That is essential for them to have that opportunity,” she said.

Washington appreciated that MUSC makes these resources available and noted that the program emphasized it’s the doctor’s responsibility to use these resources. A language barrier isn’t an excuse for providing inadequate care, she said.

“I thought it was definitely a necessary class. It’s one of those things in health care I don’t think we put enough emphasis on,” she said. “And you really don’t think about it. You don’t think about it until you get into the hospital and you’re like, ‘Oh! This patient only speaks Spanish and I have absolutely no way to communicate with them,” so it’s great they’re introducing this while we’re in the pre-clerkship years.”

Walters said they hope to add speakers of other languages for next year’s program. He’s had some interest from people who speak Vietnamese, Mandarin and Tagalog.

Interpretation & Translation Services and the College of Medicine are also collaborating to create a new elective for fourth-year students on language access in health care.