Equity in telehealth: Educating physicians on interpreter utilisation

Abstract

The rise of virtual care aims to improve healthcare access, yet disparities persist, especially for patients with non-dominant language preference (NDLP). While most residency programmes have developed trainings on the use of medical interpreters, they do not usually incorporate details pertinent to virtual settings. Without proper training in this context, physicians do not feel comfortable offering virtual visits to NDLP patients, potentially contributing to disparities in Telehealth access.¹

We developed an asynchronous, 30-minute, self-directed, interactive module accessible via mobile device by employing Articulate360, a user-friendly software for online course creation. We utilised text, video, flip-cards and images that highlighted both standard practices for medical interpreter use in all settings, as well as institution-specific logistical steps to engage the interpreter over phone and video visits. The module also reviewed important cultural considerations unique to telehealth. We shared the link to the module with 33 internal medicine interns via email along with information highlighting the importance of this training. Interns were encouraged to complete the module at their convenience within their ambulatory week in place of a 1-hour, in-person lecture during their academic half day; one reminder email was sent. Pre- and post-surveys were integrated at the beginning and end of the module.

At baseline, only 13.8% of residents felt comfortable providing virtual care to NDLP patients. While 65% of residents felt confident in their ability to access interpreter services for in-person encounters, only 20.7% did so for telehealth. Module completion significantly increased intern reported ability to access telehealth interpreters and overall comfort providing virtual care to NDLP patients. This highlights the importance of developing and updating curricular programmes to ensure that physicians are equipped to offer equitable care regardless of patient language preference or encounter modality. Particularly in training environments where clinical responsibilities are demanding, didactic time limited and burnout rates high, this asynchronous module proved to be both effective and engaging, capturing an 88% completion rate. Other features that made this module successful for busy trainees were its short duration, self-directed nature, multimedia components that required interaction and ability to complete ‘on the go’ from any mobile device. It helped that, while the module was asynchronous, it replaced an in-person lecture, so time was protected. Interestingly, most participants completed the module during off hours, rather than during the time technically allotted for it. Approximately 96% of participants considered the time required to complete the module reasonable, and 100% would recommend this learning activity to other residents. One limitation was the inability to ask instructors questions, which will be addressed by incorporating a discussion board that alerts instructors of new posts. We will also include a downloadable quick-reference sheet at the module's end. In conclusion, while Telehealth promises to increase access to care, it may widen health disparities if physicians are not equipped to use the technology with diverse patient populations. A simple, brief, asynchronous training module can increase physician comfort with caring for NDLP patients in Telehealth encounters by improving their ability to access and utilise interpreter services in virtual settings.

Luisa Paredes Acosta: Methodology; visualization; writing—review and editing; data curation; project administration; formal analysis; writing—original draft; investigation. Tiffany Marie Shin: Conceptualization; visualization; software; resources. Nancy Denizard-Thompson: Conceptualization; investigation; writing—review and editing; supervision.