Though medical students have non-English language skills that accurately reflect the diversity of languages spoken in British Columbia, they would not feel comfortable using those languages in a clinical encounter.
As Canada becomes increasingly diverse, the medical community is recognizing the unique challenges of providing health care for patients with different linguistic and cultural backgrounds. A single-page survey was administered to assess the language skills of first- and second-year medical students at the University of British Columbia. More than a quarter of the respondents are fluent in a language other than English as their first language. More than half of the respondents speak one or more languages other than English at a moderate to advanced level. Despite demonstrated ability and interest, a majority of medical students who are fluent in another language do not consider themselves proficient enough to communicate about medical issues with a patient in that language. Bridging this discrepancy will ensure that the health care needs of our multicultural population are better met.
British Columbia is home to a culturally diverse population. In BC, 24.5% of the population belongs to a visible minority. Twenty-nine percent of British Columbians have a non-English first language and 16.5% of us speak a non-English language at home. Furthermore, 3.1% of BC’s population reports that they have no knowledge of English. Therefore, cultural competence is an important and essential capability for physicians to provide care to a substantial portion of our society.
To be culturally competent means that physicians have developed the knowledge, skills, and approaches to patient care that enables them to function effectively and to respond appropriately and sensitively in cross-cultural settings. As the Canadian population becomes increasingly diverse, the medical community is recognizing the unique challenges of providing health care for patients with different linguistic and cultural backgrounds. Medical students must be trained to be aware of cultural nuances in clinical encounters in order to optimize rapport and, thus, to individualize the assessment and management of patients. The Medical Council of Canada has recognized this need and has outlined sociocultural competency as an objective to be met through the Licentiate of the Medical Council of Canada examination. Indeed medical schools are working toward improving cultural sensitivity training, but greater effort is needed.[4,5]
Language is an often overlooked capacity that has the potential to bridge the cultural gap and enhance the doctor-patient relationship. Identifying and encouraging the development of language skills in medical students might be the key to fostering more culturally competent physicians. As an initial step toward that goal, a survey was conducted in order to assess the language skills of UBC medical students and their ability to communicate with patients who speak a non-English language in a clinical setting.
A single-page, original eight-question anonymous survey (see Figure) was administered to assess the language skills of first- and second-year medical students (classes of 2011 and 2010) at UBC. The survey was distributed in paper format during the Doctor, Patient, and Society (DPAS) class on the first day of the academic year. The survey and analysis were carried out as part of a student-directed project in the DPAS course. The data were analyzed in Microsoft Excel by eight second-year medical students.
In total, 237 of 301 students in first year and 177 of 261 students in second year chose to take part in the survey. The total number of students includes 40 dental students in each year because of the combined medical and dental curriculum at UBC. The responses from the medical and dental students were not differentiated. The response rate was 78.7% and 66.8% for first and second year respectively. Twenty-seven percent of the first-year class and 31% of the second-year class have a language other than English as their first language. The four most spoken first languages for both classes were in similar ranges and rank order—respectively for the first- and second-year classes those were Cantonese (8% and 12%), Mandarin (3% and 5%), Farsi (3% and 4%), and Punjabi (3% in both).
In terms of language spoken most often at home, 22% and 29% of the first- and second-year class, respectively, speak a language other than English. With regard to the current language skills of UBC medical students, 54% and 59% of the first- and second-year class speak one or more languages other than English at a moderate to advanced level (defined as conversational to proficient) (see Table). Of the students who speak a language other than English fluently (moderate to advanced level), only 24% feel they are proficient enough to communicate with a patient in that language.
When asked how important it is for them to be able to communicate competently (defined in the survey as “speaking proficiently in the language or using a translation service”) with patients who do not speak English, 89% of all students rated that skill to be either “helpful” or “very important.” The remainder rated it as “nice, but not a priority” or “no use at all.”
Further, when asked if they would like to attend workshops aimed at improving language and cross-cultural skills, many students expressed great interest in the option; 72% of the first-year class and 62% of the second-year class suggested they would attend such workshops. As such, it is clear that if cross-cultural and medical language skills training were included in the curriculum or as extracurricular activities, it would be useful and appreciated by the majority of students from UBC medical school.
There are a number of limitations to our study. The study sample was drawn from undergraduate medical students from a single Canadian province and is not necessarily representative of medical students from other provinces and countries. The study also relied on the self-reported information of individual survey respondents. The questions were few in number and had limited content. The objective of the survey was to gather baseline information. Therefore, the decision was made to limit the number and content of the questions, with the intent to follow this survey with another in-depth survey at a later time.
A similar percentage of UBC medical students and BC’s population speak a non-English first language. Furthermore, a higher percentage of UBC medical students speak a non-English language at home compared with BC’s population. Despite the clearly demonstrated ability and interest, a majority of medical students who were fluent in a non-English language did not consider themselves proficient enough to communicate with a patient in that language. It is likely that students lack the basic medical terminology/vocabulary in their non-English languages and, as such, feel unqualified to communicate effectively with their patients. This suggests that students who are fluent in a language may not feel fluent in a medical setting and may need additional training in order to effectively use their language skills.
As expected, a majority of the medical students felt that effective communication would be an important part of patient care. The survey results indicate that there is a need to teach students medical terminology in different languages in order for them to utilize their multilingual skills for the benefit of patients. This could be accomplished by conducting student-directed language workshops similar to those run by the Students for Cross-Cultural Health Care (SCCHC) group at UBC. In these sessions, resources were provided as well as opportunities to practise medical language skills with a native speaker. Other sessions may be devoted to conducting interviews with a translator or bridging the cultural divide with basic language and cultural understandings. We believe that enhancing cultural and linguistic skills in medical students is a constructive step toward preparing future physicians to meet the sociocultural competency mandated by the Medical Council of Canada and, most importantly, providing culturally sensitive health care for our multicultural population.
We thank our classmates (Fiona Young, Kate Potter, Navraaj Sandhu, Gursteven Sra, Grace Leung, Clare Sun, Siu Him Chan, and Iman Hemmati) for their input and help in conceiving, carrying out, and analyzing this survey. We thank Dr Gurdeep Parhar, Shafik Dharamsi, and Navdip Gill for their guidance as mentors for SCCHC and DPAS student group. We also thank Dr Alexandra Tcheremenska-Greenhill for reviewing our manuscript.
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5. Loudon RF, Anderson PM, Singh Gill S, et al. Educating medical students for work in culturally diverse societies. JAMA. 1999;282:875-880.
6. Students for Cross-Cultural Health Care. Events and getting involved, 2008.http://ubcscchc.googlepages.com (accessed 5 December 2008).
Mr Siu, Ms Mann, Ms Mangat, and Mr Rawstron are students in the University of British Columbia MD undergraduate program. Dr Dharamsi is assistant professor in the Department of Family Practice and associate director of the Centre for International Health at the University of British Columbia.