New Collection of Articles on Language Equity in Medical Education

On By amroundsIn Guest Perspective, Journal Announcement

To recognize and demonstrate that all persons are valued and respected, academic medicine ideally will reflect the communication needs and language preferences of the population. We have curated a collection of articles with the intent of helping readers understand historical perspectives on the need to address language-related health disparities and informing strategies to enhance language-appropriate health care training and assessment at their institutions.

Each of us, Dr. Pilar Ortega and Dr. Débora Silva, brings a different perspective on language equity informed by our personal and professional experiences. I (P.O.) learned Spanish at home and English in elementary school. As a young immigrant, I quickly became bilingual and, therefore, the linguistic and cultural navigator for my family. In college, I trained as a volunteer medical interpreter and began what would become a core professional focus on language equity education and research. Since then, I have created programs for physician language training and assessment across the continuum of medical education with learners of diverse multilingual backgrounds and proficiency levels. I (D.S.) am a professor of medicine in Puerto Rico, where Spanish is the language spoken by most patients, even though English is also taught at all schools. At medical schools in Puerto Rico, we teach history taking and communication skills in both Spanish and English; thus, our curriculum is multilingual by design, in order to serve our patient population.

Using our collective experience and informed by our prior work as Collection Editors of the MedEdPORTAL Language-Appropriate Health Care and Medical Language Education Collection, we are pleased to share this collection in an effort to advance language equity by increasing awareness of evidence-based resources and supporting trainees and faculty in further engaging in scholarly work related to language and health.

The Why Behind the Collection

Language is the principal tool that clinicians use in providing health care. Furthermore, the language identities and linguistic practices of patients, clinicians, and communities are complex and may intersect with other marginalized characteristics, such as race, ethnicity, culture, nationality, ancestry, and immigration story, among others. One quarter of persons living in the United States report speaking a language besides English.1 Individuals with non-English language preference (NELP)2 have an increased risk of worse clinical outcomes and lower satisfaction with care.3 For clinicians and clinicians-in-training, taking care of patients with NELP presents complex challenges that have not always been addressed through formal medical education. For example, they may not receive training on how and when to work with professional medical interpreters. Additionally, many clinicians have non-English language skills at varying levels of proficiency, yet clinician language data are seldom collected or documented.4 Educational and health systems may not offer training or assessment opportunities for multilingual clinicians, hindering rather than facilitating language-appropriate care.5

A growing body of research and scholarly work regarding language equity in medical education has recently emerged that has begun to address these historical gaps. In curating this collection, we highlight a series of articles published in Academic Medicine that shed light on the following 3 areas:

  • Establishing the need for language equity scholarly work within the medical education literature. The first few articles in this collection comprise perspectives and commentaries that serve as calls to action for the medical education community to address language equity.
  • Providing recommended evidence-based practices and identifying gaps for future scholarly work relevant to medical education about language-appropriate health care. In the next set of articles, we highlight papers that present rigorous research on or synthesize evidence for teaching or assessing language-appropriate skills.
  • Identifying key intersections of language with other aspects of academic medicine and professional identity. Finally, we selected a group of articles that demonstrate the impact of physician linguistic skills on physician identity formation, wellness, and motivation to care for underserved groups and improve health equity.

Suggestions for Using the Collection

We encourage readers to use the language equity collection to promote dialogue and collaboration among clinicians, researchers, and trainees about how language is being addressed at their own institutions and learning environments. It is also important to consider how language factors can be enhanced to improve clinical care and evaluated within current and future research.

Calls to action about the need for more physicians who are language-concordant with the patient population have been published in Academic Medicine for more than 25 years. The lessons learned from published curricular interventions and validated instruments for language proficiency are ready to be more broadly applied and evaluated to support a health care workforce that is equipped to care for the non-English languages most frequently spoken in the United States. Additional work is also needed to explore effective approaches to teaching language skills applicable to highly underserved linguistic groups, such as those in rural populations and those who speak languages that are uncommon nationally but highly concentrated in certain local areas.

By: Pilar Ortega, MD, MGM, and Débora Silva, MD, MEd

References

  1. United States Census Bureau. 2020 American Community Survey 5-Year Estimates Data Profiles. Selected Social Characteristics in the United States. from https://data.census.gov/table?d=ACS+5-Year+Estimates+Data+Profiles&tid=ACSDP5Y2020.DP02. Accessed August 1, 2023.
  2. Ortega P, Shin TM, Martínez GA. Rethinking the term “limited English proficiency” to improve language-appropriate healthcare for all. J Immigr Minor Health. 2022;24:799–805.
  3. Diamond L, Izquierdo K, Canfield D, Matsoukas K, Gany F. A systematic review of the impact of patient-physician non-English language concordance on quality of care and outcomes. J Gen Intern Med. 2019;34:1591–1606.
  4. Ortega P, Vela M, Jacobs EA. Raising the bar for language equity health care research. JAMA Netw Open. 2023;6:e2324485.
  5. Ortega P, Shin TM. Language is not a barrier—It is an opportunity to improve health equity through education. Health Affairs Blog. https://www.healthaffairs.org/content/forefront/language-not-barrier-opportunity-improve-health-equity-through-education. Published July 30, 2021. Accessed August 1, 2023.