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My current role is as Director of a newly formed Graduate Medical Education program in a small community hospital. Our region (central California) is woefully under-served and there is an extreme shortage of primary and specialty care physicians thus the idea for a robust residency program was born. I have lived in this area for most of my life and I personally can see the need. In our local school districts, there are over 60 different languages spoken. We have large populations of Latinos, Hmong and Indians (mostly from the Punjab region of India due to the agricultural wealth of our area). It is truly multicultural, so English is the common language factor and is required for our residency programs. During the fall each year, our program interview and recruit from hundreds of qualified applicants from all over the globe. Their ability to communicate during the interview process is scrutinized and weighed against their recommendations, medical school grade and various test scores. After interviews, we rank candidates and are matched with residents each March who will join our ranks that coming July. Each student comes to use to learn and their ability to communicate in English influences their academic journey as well as their future career. The inability to communicate with patients and other specialists could compromise patient safety and medical outcomes and ultimately cripple an otherwise budding career. The idea of teaching English came to me from one of our faculty members who was extremely frustrated translating for a student (from India) with one of our critically ill patients. He stormed into my office and demanded that we provide ESL courses so that our patient satisfaction numbers don’t “drop like a stone!”. After getting marked down in a review for the unilateral drop in patient satisfaction, I started looking at ways to assist and better prepare our medical residents. From here the idea was born. On a personal level with parents in their late 80s, I have sat with my parents when a hospitalist arrives and barks out orders that we can barely understand. This inability to connect with patients and their caregivers impacts the health and well-being of the patients, leads to massive frustration and even medical errors. Institutionally, our medical center has instituted “interdisciplinary rounds” where teams of caregivers talk to patients and family members but if the communication breaks down, the rounds are of no use. We all realize that we have patients who do not speak English and for this we have translators, but the translators translate into English so if the medical team member isn’t fully proficient, problems occur. I had an exchange last week where one of my nursing staff was suggesting we use the Hindi translator for the physician. This is not acceptable. As I watch my third class, which is referred to as the “international house of pancakes”, round on patients in our medical center, I am hopeful that they will get the support they need. Their ability to effectively communicate in English impacts not only their career but the health, safety and lives of our patients.
