84 Unseen and unheard: Medical student perspectives on interpreter use and the hidden curriculum

Abstract Background A growing number of Canadians are predominantly speaking a language other than English or French. When healthcare and health information is provided in a non-preferred language, adverse outcomes such as reduced understanding of medical information, poorer relationships with health care team members, and higher degrees of medical errors have been noted. A recent survey study across Canadian paediatric residency programs showed that while a variety of interpreter services are available across Canada, these remain underused by paediatric residents—even with awareness that clinical interactions in the absence of an interpreter are suboptimal. Experiences of how learners are taught and modelled to use interpreters have not been well described. Objectives Explore medical students' perceptions of interpreter use in clinical years. Investigate the potential influence of the hidden curriculum on medical students' decision-making regarding interpreter use. Design/Methods An interview guide was developed based on previous literature on medical students' experiences related to cultural humility and interpreter use, and REB approval was obtained. Semi-structured interviews were completed with 11 third- and fourth-year medical students at the University of British Columbia. Data analysis was iterative and thematic analysis was used to identify patterns across the dataset. Results Four key themes were identified from the data. The first was the tension between system efficiency versus patient-centred care, highlighting how time constraints and institutional pressures often led to the underutilization of interpreters, even when their use was acknowledged as vital for effective patient care. The theme of the trainee as resistor was also identified, where students described moments of pushing back against clinical norms that downplayed the need for interpreters. This was closely linked to the importance of role modelling, where the behaviour of attending physicians and senior residents either reinforced or diminished the perceived importance of using interpreters. Another significant theme was the awareness of a hierarchy of tasks, where responsibility for arranging and utilizing interpreters frequently fell to trainees, reinforcing the sense that interpreter services were of lower priority within the clinical hierarchy. Conclusion The hidden curriculum has a core role in shaping students' behaviours regarding interpreter use. To improve systemic use of interpreters, it is imperative to address both the hidden curriculum and structural barriers presented to trainees. Direct teaching and improved role-modelling behaviours can help counteract the implicit messages conveyed within the hidden curriculum, and ultimately improve care for patients with limited English/French proficiency

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