Use of certified interpreters
Background: Professional interpreters have been shown to improve the care for patients with limited English proficiency (LEP) in the areas of communication (errors and comprehension), utilization (shorter length of stay and lower readmission rates), clinical outcomes, and satisfaction. (37,38) Professional interpretation services are required by law at any institution receiving federal funding (Title VI of the Civil Right Act and the Executive order 13166). (39)
Students who speak a second language may be asked to interpret for patients with LEP even when not fluent or certified. (40) Use of ad-hoc interpreters has been demonstrated to compromise patient safety and patient care. (41) While interpreting can be an opportunity for students to contribute to patient care, it can detract from their role as a learner. Maintaining a distinction between their clinical and interpreter roles can be challenging and can introduce inequities. (42)
- Recommend teams work with certified interpreters. Discourage using students as ad-hoc interpreters.
- Add this information to team orientation emails for wide dissemination to students and supervising physicians.
- Allow certified student interpreters to volunteer to interpret for team patients (opt-in approach). Supervisors should not ask students to interpret for multiple patients as this may detract from their role as a learner.
- Encourage all students to work with patients with LEP and to utilize interpretive services.
- Resource: Example handout on use of certified interpreters (Appendix 2)
Faculty educational opportunities: Mitigating the effect of “minority tax” and “affinity bias”
Background: Faculty from UIM groups are often asked to take on extra responsibilities in medical education, e.g., mentoring UIM learners or teaching DEI-related concepts. While many UIM faculty may take pride in contributing to DEI efforts, they are often not compensated or given time to support their efforts. This has been described as a “minority tax”. (43)
Educational leaders may be prone to “affinity bias,” the unconscious favoring of faculty with shared connections or backgrounds. (44 )This bias may cause leaders to preferentially offer educational opportunities and possible career advancement to certain faculty members.
- Create a “request for application” (RFA) process for all clerkship teaching and mentoring opportunities. This request should include a description of the opportunity and selection criteria and should be disseminated widely within relevant settings.
- Be deliberate in recruitment and hiring efforts and intentionally include UIM faculty as educators for all clerkship topics, not exclusively DEI topics.
Educational Continuous Quality Improvement
Background: Adopting a culture of quality improvement (QI) means shifting focus from individual blame to system responsibility. (45 )The educational continuous QI (ECQI) process includes monitoring programmatic variables related to identity to evaluate for differences between groups, and a review of mistreatment reports submitted by students to assess for bias-related events and opportunity for action. (46-48) It is critical to adopt an approach of system responsibility to support psychological safety and encourage growth mindset in supervisors.
- Build anonymous reporting mechanisms to gather student reports about the CCLE and mistreatment. This can include an automated process that reviews anonymous course evaluation comments for reports of bias. (48,49)
- Review school-collected quantitative and qualitative data on variables that relate to the CCLE and equity and inclusion, as part of the annual clerkship review process (e.g., metrics that could be related to an inequitable learning environment). Utilize QI techniques to address data systematically.
- Metrics could include differences in numerical performance and grades by certain demographics.
- Other data can include the number and type of mistreatment experiences reported by students, and a review of student satisfaction with the clerkship to identify areas of concern.
- Seek out additional verbal feedback from students through non-evaluating staff or faculty, as formal course evaluations may not capture inequitable learning experiences.