Communicating with patients with limited English proficiency (LEP) can be a challenge. Despite laws and studies reinforcing the need to use appropriate interpretation services, many fail to do so. Impressing upon learners the importance of effective communication with LEP patients poses another barrier. We created an innovated immersive experience to help learners understand the communication challenges faced by LEP people and their effect on poor health outcomes.
Purpose:
Identify challenges that patients with limited English proficiency face in navigating the health care system.
Description:
Our team consisted of 2 hospitalists and a healthcare interpreter. We conducted our innovative immersion experience in 2 separate 1-hour sessions: one with internal medicine interns, and the other with 2nd/3rd-year residents.
Participants each rotated through 3 stations at 10-minute intervals. Each station paralleled a task that patients are often required to perform (filling out forms, learning a step-wise task like wound care, following instructions in sorting medications), all in the presence of a language/literacy barrier.
We then facilitated a group debrief about what challenges they faced, comparing their responses to those faced by patients. Participants identified ways to change their practice to help minimize these barriers.
We then shared evidence-based data about LEP patients and outcomes, and provided resources they could use during LEP encounters.
Twenty-three interns participated in the first session, and 13 upper-level residents participated in a 2nd session; all submitted a post-exercise survey. All the PGY2/3 participants (100%) rated the exercise very to extremely helpful, compared to 57% of PGY1s, with 30% of PGY1s rating it somewhat helpful and 13% a little helpful. Most (92%) of PGY2/3s were very to extremely likely to change their practice, compared to 70% of PGY1s, with 22% somewhat likely and 8% a little likely to change. Themes from participants debriefing included frustration with the language/literacy barrier and appreciation of how patients must feel. They identified ways they could specifically change their practice, including using interpreters, asking patients to repeat back information to check understanding, and screening for literacy before providing written material.
Conclusions:
We developed and implemented an innovative LEP immersion experience to help learners understand the challenges faced by LEP patients, and helped them identify ways in which they could implement behavioral changes to improve outcomes. Participant responses suggested this also supported empathetic understanding of the LEP patient experience. We implemented this exercise initially for internal medicine residents, and plan to repeat it with faculty. Our innovation can be generalized to learners at any level with minimal additional resources required for curricular integration.