Microaggressions, Advocacy, and Interpreter Services: A Video-Based Curriculum for Trainees

Abstract

Introduction

Patients with limited English proficiency (LEP) who receive language-discordant communication are at risk for disparate perinatal outcomes, heightened distrust of healthcare teams, and underutilization of perinatal services. As junior members of the healthcare team, trainees are often unsure regarding advocacy for patients with LEP. Medical students at one institution received bystander training to assist with the recognition and mitigation of microaggressions. Unconscious bias and discrimination against patients with LEP are an unfortunate reality in OB/GYN. Formal opportunities during the clerkship year for students to identify peers who can reinforce and normalize the advocacy training previously introduced are limited.

To address this issue, we developed a student-led OB/GYN clerkship workshop to bolster student capacity to recognize/mitigate bias, explore communication barriers, and advocate for trained medical interpreters in the care of patients with LEP.

Methods

We created a video of a simulated clinical encounter between a patient with LEP and the healthcare team. A 60-minute workshop curriculum was developed using the video as a trigger for small- and large-group discussions. Pre- and post-workshop surveys assessed change in perception of bias, advocacy, and correct utilization of interpreter services. Using Kirkpatrick’s model of evaluation, we also sought to determine if near-peer education resulted in positive downstream impact on advocacy for workshop student leaders and their junior clerkship trainees. IRB approval was obtained.

Results

Six student workshop leaders were identified from 2023-2025. The workshop was offered to approximately 108 medical students; 69% (n=75) completed the pre-workshop survey and 59% (n=64) completed the post-workshop survey. Qualitative feedback at course conclusion demonstrated improved confidence in bystander bias mitigation for patients with LEP. Forty-one percent more students agreed that they were familiar with hospital policy regarding the use of interpreter services (58.7% pre-workshop vs. 100% post-workshop, p<0.001). Twenty-three percent more students agreed or strongly agreed that the use of family members as ad hoc interpreters is inappropriate for clinical care (60.8% pre-workshop vs. 84.4% post-workshop, p<0.05). Longitudinal results support broad applicability of knowledge, attitudes, and skills gained during the course. After completing the course, two students utilized the interpreter services workshop education to develop and pilot verbal and visual communication tools designed to assist patients with communication in labor. Forty-six nurses and faculty were involved in this quality improvement initiative. Two student leaders from the 2023-2024 workshop utilized the training provided to evaluate current practice and develop an interpreter services worksheet for non- obstetric patients within a student-run general medicine clinic. Forty-one students received best practice training in the use of interpreter services through this pilot quality improvement initiative.

Conclusion

The student-led advocacy workshop encouraged students to identify communication barriers, apply strategies to reduce bias, and advocate for the use of interpreters for patients with LEP. Next steps include (1) a qualitative, longitudinal follow-up evaluation of students to characterize the bias and system barriers to interpreter services use during the clerkship rotation and (2) a simulated patient encounter activity during which students must practice bias mitigation and advocate for the use an interpreter.