Language Discordance Between Students and Patients: Impact on Clinical Learning

Abstract

Background: The clinical education of medical students relies on having direct patient experiences, which can be challenging when the patient population speaks multiple languages. In Singapore, students regularly encounter patients with whom they do not speak the same language. Objective: The purpose of this study was to examine the role of student–patient language discordance (SPLD) on students’ clinical education experience. Methods: In this sequential mixed-methods study, medical students who have completed at least 1 year of clinical education at the Duke-NUS Medical School in Singapore were asked to complete an online survey to obtain their self-reported language proficiency in local languages, experiences interacting with patients who do not speak English, and perceptions of the impact on clinical learning. A follow-up interview with selected participants was conducted. Results: Overall, 35.9% of eligible students responded to the survey. Demographic analysis of respondents adequately represented the school’s overall student population. Non-Mandarin-speaking respondents reported that learning medicine in a multilingual environment negatively impacts clinical learning due to significantly more frequent challenges to clerking patients and feeling hindered from learning from doctors due to language barriers. However, no difference was observed in the performance on clinical exams of the three groups. Qualitative interviews uncovered possible reasons for the confounding results and two interrelated themes that highlight clinical learning experiences and challenges in a multilingual environment. Conclusion: Students perceive SPLD as a hindrance toward their clinical education experience. Follow-up interviews uncovered the quandary of using translators and how language discordance impacts student’s professional identity formation.