BACKGROUND: When patients do not speak the same language as their doctors, they face poorer medical outcomes, decreased doctor-patient trust, and a diminished desire to seek medical care. It has been well established that interpretation is an essential part of an accessible healthcare system, but effective use of such language services relies on both the interpreters themselves and the healthcare teams working with them. This study presents an interdisciplinary examination of the motivations of undergraduate student medical interpreters, a group which serves as a bridge between these roles. While not full-time interpreters, they receive official training and spend time serving patients in local clinics. Further, for those who aspire to careers in medicine, interpreting provides invaluable exposure to the medical field and early professional know-how.
METHODS: Semi-structured individual interviews with undergraduate student interpreters were conducted to describe this multifaceted educational experience. A thematic analysis framework was employed to understand how and why they volunteer their time to interpret.
RESULTS: Motivations of student interpreters were found to fall under three general categories: (1) personal identity, or connection to family, language, and their career aspirations; (2) community engagement, or the opportunity to make a direct impact on patients at an early stage; and (3) pre-professional experience, both in general and specifically in healthcare. Each of these contributes to the view of a student medical interpreter as a unique contributor to language equity in medicine, as they provide language services in the short-term as well as set themselves up to be linguistically and culturally competent providers in the long-term.
CONCLUSIONS: A greater understanding of student motivations adds to knowledge about language mediation and validates the utility of students in this role, encouraging the development of more student interpreter programs. Particularly in communities with high proportions of non-English speakers, these students can contribute to making medical care as inclusive and accessible as possible.

ABSTRACTEffective communication between patients and providers is critically important, particularly in the setting of acute illness. In time-sensitive medical emergencies, language barriers may be seen as burdensome, but should be addressed attentively to gather accurate information and to form a trusting relationship with patients and their families. Such is the case with a 79-year-old man who was brought to the emergency department (ED) with symptoms concerning for acute stroke. His Russian-speaking wife was the only source of the patient\'s history, and information was initially gathered without the aid of a medical interpreter. Based on this information, which was provided in broken English, the patient was determined to be out of the time window to receive intravenous tissue plasminogen activator (IV tPA). Subsequent history taken by the admitting medicine team with the help of a medical interpreter revealed that the patient\'s symptoms began much more recently than previously understood. Based on the time he was last seen normal, the patient could have been a candidate for IV tPA when he first presented, but the information was clarified after he was outside this time window. Subsequent head imaging confirmed the presence of acute infarct in the left middle cerebral artery territory.This communication failure serves to highlight the importance of thorough and detailed communication between healthcare providers and their patients. As evidenced by the case presented, the outcomes of this underutilization can lead to catastrophic decision-making and, in turn, hinder the ability of providers to provide quality care for their patients.

As the United States population is ever changing and is growing in diverse population patterns, the health care system is called to initiate responsive health care practices that are based on the public\'s changing and diverse cultural patterns. This study sought to explore the perceptions of certified medical interpreter dual-role nurses and their experiences with Spanish-speaking patients from admission to discharge in hospital stays.
A qualitative descriptive case study was applied in this study.
Data was collected from nurses working at a United States Southwest Borderland hospital using purposive sampling and semi-structured in-depth interviews. A total of four dual-role nurses participated, and thematic narrative analysis was applied.
Four major themes emerged. The main themes were \"being a dual-role nurse interpreter,\" \"patient experience,\" \"culture and competence, \"and \"nursing and caring,\" With each major theme multiple sub themes emerged. Two sub themes emerged with \"being a dual-role nurse interpreter,\" and two sub themes emerged with \"patient experiences.\" The major themes that emerged from the interviews indicated that the language barrier greatly affects Spanish-speaking patients in their hospital stay. Participants reported having at least one encounter with a Spanish-speaking patient that was not afforded interpretation services or had interpretation from someone other than a qualified interpreter. Patients experienced confusion, apprehension and anger associated with not being able to communicate their needs to the healthcare system.
According to the experiences of the certified dual-role nurse interpreters, having a language barrier makes a tremendous impact on the care of Spanish-speaking patients. Nurse participants describe how patients and their family members experience dissatisfaction, anger and confusion when there is a language barrier and most importantly how language barriers have detrimental effects on patients with wrong medication prescriptions and wrong diagnosis.
When hospital administration recognize and support nurses as certified medical interpreters as a key component for patient care when assisting persons with limited English proficiency, patients are empowered to become active members of their healthcare regimen. The role of dual-role nurses enables brokering between the healthcare system and serves as a tool to bridge health disparities based on linguistic inequities existing in healthcare. Recruitment and retention of certified medical interpreter trained Spanish-speaking nurses deter errors in healthcare and makes a positive impact on the healthcare regimen of Spanish-speaking patients enabling patient empowerment through education and advocacy.

Latinx (includes Hispanics and is the non-gendered term for Latino/Latina which is a person of Latin American origin or descent) constitutes the largest racial and ethnic minority group in the United States (US). Many members of this group report limited English proficiency, experience discrimination, feel distrust in the healthcare setting, and face poorer health outcomes than non-Latinx Whites. As healthcare systems assess internal structures of care, understanding the experiences of Latinx patients may inform strategies to improve care. This narrative review describes studies that assessed the experiences of Latinx patients with limited English proficiency (LEP) in the inpatient and outpatient settings in the US. We searched PubMed for studies published between January 1, 1990, and March 2021. We reviewed all citations and available abstracts (n = 429). We classified study titles (n = 156) as warranting detailed consideration of the original article. Limited English proficiency is a well-documented challenge reported by Latinx patients seeking care in the outpatient setting, resulting in mistrust of healthcare organizations and clinicians. The effects of LEP overlap substantially with challenges related to patients\' immigration status, cultural traditions, and socioeconomic needs. Use of professional interpretation rather than ad hoc interpretation improves trust and satisfaction. There is no consensus about the most effective mode of delivering professional interpretation (in person, telephonic, video conferencing), although rapid simultaneous telephone translation is a promising modality. Increasing awareness of the barriers to effective communication, improving skills in communicating through translators, and increasing the amount of time spent with patients may improve communication and trust more than structural changes like mode of translation or bedside rounding. Cultural fluency training, standardized language training for providers, and incentive pay for fluency are also deserving of further consideration.

UNASSIGNED: In Canada, healthcare professionals often rely on ad hoc interpreters, who are untrained volunteers recruited via intercom hospital announcements to interpret for patients with language barriers. This study analyzed the frequency of ad hoc interpreter requests via intercom announcements to estimate hospital interpretation needs.
UNASSIGNED: A retrospective cohort analysis from intercom requests for medical interpretation collected from five hospitals of the McGill University Health Center. Requests included date, time, language requested, hospital location, and extension for who placed the request.
UNASSIGNED: A total of 1265 intercom requests were placed for 48 languages, with the top five languages being Mandarin (17.8%), Punjabi (10.1%), Inuktitut (9.8%), Arabic (7.3%), and Cantonese (6.4%). Almost 69.8% of requests were made during working hours, 13.2% on workday evenings, and 14.8% on weekends. Requests came from urgent care (42.3%), outpatient (29.5%), and inpatient (23.3%) settings.
UNASSIGNED: This is the first published study that measures interpretation needs via intercom requests. We propose that our method can be replicated to inform implementation of professional medical interpretation services. We conclude that linguistic interpretation needs are significant in the Montreal area, and likely in Canada in general and pose a barrier to effective medical care.

Osteogenesis imperfecta (OI) is an inherited connective tissue disorder with variable clinical manifestations involving many structures and organ systems, leading to characteristic presentations such as low bone mineral density (BMD), vertebral compression fractures, hearing loss, and blue sclerae. Even within the same family, individuals with the same inherited genotype may have differential presentations due to variable expressivity. Early diagnosis of OI in the pediatric population may allow for earlier treatment and interprofessional interventions. This case describes a minority female infant who initially presented with bilateral complexion-associated melanosis (CAM) inclusions in her eyes. The appearance of her inclusions was reminiscent of the blue sclera seen in OI; however, there was no clinical suspicion for OI on birth, developmental, and family histories. Her growth and development were unremarkable at all well-child checks until her three-year well-child check. It was then discovered that she suffered multiple long bone fractures due to low trauma, vertebral compression fractures, and kyphoscoliosis. Due to the occurrence of these fragility fractures, she was given a clinical diagnosis of osteoporosis with pending genetic testing for osteogenesis imperfecta. It was later discovered that there was, in fact, an extensive history of recurrent childhood fractures in the patient\'s brother, mother, and numerous maternal relatives. Our case demonstrates the greater need for certified medical interpretation services to obtain clear past medical and family history, especially in the face of language barriers and low health literacy, in conjunction with clinical findings, i.e., CAM, to guide the differential diagnosis and subsequent management appropriately.

Persons who are deaf are more likely to avoid health care providers than those who can hear, partially because of the lack of means of communication with these providers and the dearth of available interpreters. The use of video remote interpretation, namely the video camera on an electronic device, to connect deaf patients and health providers has rapidly expanded owing to its flexibility and advantageous cost compared with in-person sign language interpretation. Thus, we need to learn more about how this technology could effectively engage with and respond to the priorities of its users.
We aimed to identify existing evidence regarding the use of video remote interpretation (VRI) in health care settings and to assess whether VRI technology can enable deaf users to overcome barriers to interpretation and improve communication outcomes between them and health care personnel.
We conducted a search in 7 medical research databases (including MEDLINE, Web of Science, Embase, and Google Scholar) from 2006 including bibliographies and citations of relevant papers. The searches included articles in English, Spanish, and French. The eligibility criteria for study selection included original articles on the use of VRI for deaf or hard of hearing (DHH) sign language users for, or within, health care.
From the original 176 articles identified, 120 were eliminated after reading the article title and abstract, and 41 articles were excluded after they were fully read. In total, 15 articles were included in this study: 4 studies were literature reviews, 4 were surveys, 3 were qualitative studies, and 1 was a mixed methods study that combined qualitative and quantitative data, 1 brief communication, 1 quality improvement report, and 1 secondary analysis. In this scoping review, we identified a knowledge gap regarding the quality of interpretation and training in sign language interpretation for health care. It also shows that this area is underresearched, and evidence is scant. All evidence came from high-income countries, which is particularly problematic given that most DHH persons live in low- and middle-income countries.
Furthering our understanding of the use of VRI technology is pertinent and relevant. The available literature shows that VRI may enable deaf users to overcome interpretation barriers and can potentially improve communication outcomes between them and health personnel within health care services. For VRI to be acceptable, sign language users require a VRI system supported by devices with large screens and a reliable internet connection, as well as qualified interpreters trained on medical interpretation.

Clínica Esperanza/Hope Clinic (CEHC) employs Navegantes, who are specially-trained bilingual Community Health Workers (CHW), as key team members who improve the ability of the clinic to provide care for and improve the health status of a large population of uninsured Spanish-speaking patients in Providence, Rhode Island. Given the growing demand for CHWs at the clinic and in the broader healthcare sector in the state, CEHC developed the Advanced Navegante Training Program (ANTP). The ANTP prepares community members to become certified CHWs who are equipped to provide patient navigation and lifestyle coaching as well as professional medical interpretation services. The ANTP is developed and taught by CEHC Navegantes who themselves are bilingual and bicultural peers of trainees as well as the population that CEHC serves. Upon graduation, ANTP trainees have been able to attain higher-paying and fulfilling careers in a range of healthcare and other community settings. The ANTP offers a low-cost, community-based model for training CHWs who are uniquely prepared to promote health and well-being among medically underserved patients.

Language barriers limit healthcare access. However, professional interpretation usage is infrequent due to high cost and poor interpreter availability. Healthcare-oriented mobile applications are becoming more accepted and may help alleviate this burden. This literature review aims to better understand the utility of mobile technology in healthcare interpretation. Specifically, the objective of this review is to synthesize the feasibility, outcome, and challenges of implementing technological medical interpretation services.
No patients were involved for this review.
In December 2019, MEDLINE (Ovid) was systematically searched according to PRISMA guidelines. All articles discussing the utility of technology in healthcare interpretation encounters were included.
Two major themes emerged: 1) comparing video and phone interpretation with in-person interpretation and 2) assessing direct translation software in healthcare settings. Phone and video interpretation help reduce overall patient wait-times. Both patients and clinicians preferred in-person or video interpretation over interpretation by phone. Chief benefits of using direct translation software include immediate access, low costs, and sustainability. Several studies discussed potential translation inaccuracies and the importance of having professional interpreters in medico-legal discussions.
Mobile applications may be used to facilitate access to medical interpreters with high clinician and patient satisfaction. Direct in-app translations facilitate access but risk inaccuracies with important medico-legal considerations.
Mobile applications are available at low costs and can improve access to interpreters though video and phone calls. Mobile software can also provide direct translation and facilitate clinical care. Clinicians should prioritize face-to-face encounters with professional medical interpreters, whenever possible. In a time of social distancing amidst the current COVID-19 pandemic, there is crucial value in elucidating the best telehealth interpretation practices.

UNASSIGNED: With nearly 400 000 migrant workers in Singapore, many from Bangladesh, India and Myanmar, language and cultural barriers posed a great many challenges during the COVID-19 pandemic. This was especially so as majority of the COVID-19 clusters in Singapore emerged from their communal dormitories. With concerns arising as to how this minority group could be best cared for in the intensive care units, the need for medical interpreters became clear.
UNASSIGNED: In response, the Communication and Supportive Care (CSC) workgroup at the Singapore General Hospital developed the \'Medical Interpreters Training for ICU Conversations\' program. Led by a medical social worker-cum-ethicist and 2 palliative care physicians, twenty volunteers underwent training. The program comprised of 4 parts. Firstly, volunteers were provided with an overview of challenges within the COVID-19 isolation ICU environment. Discussed in detail were common issues between patients and families, forms of distress faced by healthcare workers, family communication modality protocols, and the sociocultural demographics of Singapore\'s migrant worker population. Secondly, key practice principles and \'Do\'s/Don\'ts\' in line with the ethical principles of medical interpretation identified by the California Healthcare Interpreters Association were shared. Thirdly, practical steps to consider before, during and at the end of each interpretation session were foregrounded. Lastly, a focus group discussion on the complexities of ICU cases and their attending issues was conducted. Targeted support was further provided in response to participant feedback and specific issues raised.
UNASSIGNED: As a testament to its efficacy, the program has since been extended to the general wards and the Ministry of Health in Singapore has further commissioned similar programs in various hospitals. In-depth training on the fundamentals of medical terminology, language and cultural competency should be provided to all pertinent healthcare workers and hospitals should consider hiring medical interpreters in permanent positions.