Assessing Medical Student Readiness to Navigate Language Barriers in Telehealth: A Cross-Sectional Survey Study (Preprint)

BACKGROUND The COVID-19 pandemic has massively increased telehealth usage in the U.S. Patients with limited English proficiency (LEP) face barriers to healthcare, which may be mitigated when providers work with professional interpreters. However, telemedicine may exacerbate disparities if clinicians are not trained to work with interpreters in that setting. Although medical students are now involved in telehealth on an unprecedented scale, no educational innovations have been published that focus on digital care across language barriers. OBJECTIVE To investigate advanced medical students’ confidence in caring for patients with LEP during telehealth encounters. METHODS We administered a written survey to medical students on clinical clerkships in one U.S.-based institution between August to September 2020. We assessed students’ overall confidence in working with interpreters; confidence in performing eight clinical tasks in in-person versus telehealth encounters; and frequency of performing five different clinical tasks with patients with LEP compared to English-speaking patients during in-person versus telehealth encounters. Wilcoxon signed rank tests and chi-squared tests were used to compare confidence and task performance frequency respectively for patients with LEP vs. English-speaking patients during telehealth encounters. Students were also asked to identify barriers to care for patients with LEP. The free response was qualitatively analyzed using open coding to categorize barriers (key themes). RESULTS Of 300 medical students surveyed, 121 responded. 72 students answered >50% of questions and were included in the analyses. Compared to caring for patients with LEP during in-person encounters, respondents were less confident in working with interpreters (p<0.001), developing trust (p<0.001), identifying agenda (p=0.005), eliciting preferences for diabetes management (p=0.012), and empowering patient in lifestyle modifications (p=0.044) during telehealth encounters. During both in-person and telehealth encounters, nearly half of students (40-78%) reported engaging less frequently in every clinical task with patients with LEP and this was as low as 22% (13/59) for some tasks. Students identified these key barriers to care for patients with LEP: time pressure, interpretation quality and access, technical difficulties, cultural differences, and difficulty with rapport building. CONCLUSIONS Advanced medical students were significantly less confident caring for patients with LEP via telehealth than in person. Broader implementation of training around navigating language barriers is necessary for telehealth care, which has rapidly expanded in the U.S. Our study identified potential key areas for curricular focus, including creating patient-centered agendas and management plans within the constraints of virtual settings. These developments must take place simultaneously with systems-level improvements in interpreter infrastructure in order to ensure high quality care for linguistically diverse patients. CLINICALTRIAL N/A