Should medical students act as interpreters?

Tapping their diverse skills can benefit not only students, but also patients and health care teams

Casting my mind back to medical school, I recall the anxiety of changing clinical team with each new rotation and the strong desire to be seen to be doing the right thing. Twenty‐five years on, medical students regularly share accounts of the same struggles when I meet with them. I am also struck during these meetings by the diverse experiences that students bring to medical school. It is against a similar backdrop that Ryan and colleagues examined the frequency and experiences of medical students acting as interpreters in health care settings, as reported in this issue of the Journal.1 Their study brings into the open a question rarely discussed in Australia: that of medical students acting as interpreters during clinical placement.

The researchers from the University of Melbourne surveyed final year medical students in 2014 and found that 34% of respondents — or at least 11% of the entire cohort — reported that they had acted as interpreters during their clinical rotations. Although the authors surveyed students in only one medical school, their findings build on reports of bilingual medical students acting as interpreters for clinicians in New Zealand and the United States. While the exact proportion of students acting as interpreters in clinical situations may vary, it is unlikely that the practice in Australia is confined to Victoria.

Using bilingual medical students as ad hoc interpreters raises a number of ethical questions. Several studies have found that ad hoc interpreters are more likely to make communication errors than regular interpreters.2 Using professional interpreters is associated with better patient understanding and overall better care for patients with limited English, for which reason state government guidelines recommend the use of accredited interpreters.3 The guidelines stipulate that unaccredited bilingual speakers are appropriate under a limited number of circumstances, such as when no on‐site or telephone interpreter is available.

The codes of ethics of the Australian professional association for interpreters highlight the importance of maintaining professional detachment and impartiality.4 This may be a challenge for a medical student, who is both untrained as an interpreter and learning to be a member of a health care team. Accredited interpreters engage in continuous professional development and must be able to decline work beyond their competence. The power imbalance experienced by bilingual medical students was starkly described by one student in the study by Ryan and her colleagues: “it's hard to say no to senior doctors to interpret.”1

But might there be more appropriate circumstances in which medical students could act as interpreters? Some medical schools in the United States have developed schemes for training their bilingual medical students as interpreters.5,6,7 Medical students volunteer for training and often serve as interpreters alongside other students and staff in the medical schools’ supervised student‐run clinics. Their roles as interpreters and as members of the treating clinical team are clearly separated. The scheme at the Loyola Chicago Stritch School of Medicine leads to certification as an interpreter after training, formal language assessment in a national examination, and supervised practice.7 Similar schemes could be offered as part of a student elective unit or as an extracurricular opportunity in Australian medical schools.

The findings of the study by Ryan and colleagues should trigger further discussions between state and territory governments, health care organisations, and universities about the role of students acting as interpreters. In particular, the limited circumstances under which unaccredited students might be called upon to interpret should be explicitly delineated. The results of the study should also stimulate further consideration of how we might offer training to our talented bilingual students so that they can become accredited interpreters in Australia.