Article Review: Using medical interpreters

The United States is becoming culturally and linguistically diverse. Consequently, cultural competency should play a crucial part in the medical school curriculum. Specifically, all medical practitioners should know how to properly work with medical interpreters in patient encounters. I never was trained in this skill and unfortunately learned more by just doing.

A 2007 article in the Journal of General Internal Medicine focused on building two instruments which assessed how effectively medical students use medical interpreters. To me, the most helpful part of this whole article is the list of assessment criteria for these instruments.

• Interpreter Impact Rating Scale (IIRS) - Standardized patient uses this score sheet.
• Faculty Observer Rating Scale (FORS) - Faculty, who is observing, uses this score sheet.

Pearls on using medical interpreters:

1. Look more at the patient than the interpreter during the clinical encounter. Direct eye contact with the patient builds rapport and trust.
2. Talk to the patient in the first person ("How strong is YOUR chest pain?" instead of "Can you ask the patient how strong her chest pain is?")
3. Introduce the interpreter and his/her purpose at the beginning of the interview.
4. Ask the patient one question at a time to make it easier for the interpreter to translate accurately and to allow the patient time to listen and answer.
5. Don't interrupt the patient and interpreter when listening to the answers.
6. Present information to the patient (through the interpreter) in "digestible chunks".

The study involved medical students taking a history from standardized patients with faculty observers. The standardized patients and the faculty observers completed the IIRS and FORS scoresheets, respectively. Both scores were compared to scores from a general communication skill assessment instrument - the Physician Patient Interaction (PPI) scale.

Result/ Conclusion

The itemized scores for the IIRS and FORS tools are listed in the figure below. The IIRS scores correlated well with the general PPI scores (r=0.88, p less than 0.0005). Oddly, the FORS scores did not correlate with the PPI scores (r=-0.22, p=0.32). Regardless, the authors have created two useful instruments to assess students' ability to appropriately use medical interpreters. More research should be done to determine their validity with actual (not standardized) patients.

IIRS and FORS scores (click to enlarge image)

Reference:
Lie D, Boker J, Bereknyei S, Ahearn S, Fesko C, Lenahan P. Validating measures of third year medical students' use of interpreters by standardized patients and faculty observers. J Gen Intern Med. 2007 Nov;22 Suppl 2:336-40. View entire article.