When English Isn’t the Patient’s First Language: Preparing Students for the Communication Gap

By Martija IHPE

Picture a student in the middle of a patient encounter. The assessment is going well until they realize the person in front of them speaks little English. The student glances around. There is no interpreter scheduled. The patient’s adult daughter is in the room and offers to help. A translation app sits one tap away on the student’s phone. The clock is running, the waiting room is full, and the student has to decide, in that moment, how to proceed.

Most clinical students will face some version of this situation, and many will face it before anyone has taught them what to do. They have been trained in assessment, technique, and documentation, but the communication gap that opens when a patient does not share their language is rarely something a curriculum addresses directly. The result is that students improvise, and improvisation in this particular situation carries real risk.

So how do we prepare students for the patient whose first language is not English? And why does it matter so much that we get this right?

The Stakes Are Higher Than Students Realize

It is easy for a student to view a language barrier as an inconvenience to be worked around rather than a genuine patient safety issue. The evidence says otherwise. A multi-hospital pilot study of adverse events found that patients with limited English proficiency were more likely to experience physical harm when something went wrong. Of the adverse events that occurred, 49.1% of those involving patients with limited English proficiency resulted in physical harm, compared with 29.5% of those involving English-speaking patients (Divi et al., 2007).

The same study found that adverse events affecting patients with limited English proficiency were more likely to stem from communication problems in the first place. Communication failures were a factor in 52.4% of adverse events for these patients, compared with 35.9% for English-speaking patients (Divi et al., 2007). In other words, the language gap is not a peripheral issue. It sits at the center of how and why care goes wrong for these patients.

When students understand that a language barrier is a safety concern on the same level as a medication allergy or a fall risk, they begin to treat it with the seriousness it deserves.

Why Leaning on Family and Quick Fixes Is Risky

When no interpreter is immediately available, the path of least resistance is to ask a bilingual family member to step in, or to reach for a translation app. Both feel helpful in the moment. Both can introduce serious problems.

Research analyzing errors in medical interpretation found that interpretation mistakes are common, averaging 31 per clinical encounter, and that 63% of these errors had potential clinical consequences. Critically, errors made by ad hoc interpreters, the term for untrained stand-ins such as family members or bilingual staff, were significantly more likely to carry potential clinical consequences than errors made by trained hospital interpreters (Flores et al., 2003). The most common error was omission, where information simply gets left out, often without anyone in the room realizing it happened.

This is the part students need to understand. A well-meaning family member is not neutral. They may soften bad news, skip details they find embarrassing, insert their own opinions, or simply lack the vocabulary to convey clinical information accurately. A child interpreting for a parent carries an additional emotional burden that no patient or family should be asked to bear. And while translation apps have a place for simple logistics, they are not built for the nuance, consent, and accuracy that clinical communication demands.

What Professional Interpreters Actually Change

The alternative is not complicated, but it does require intention. A systematic review of the evidence found that the use of professional interpreters is associated with improved clinical care, and that professional interpreters raise the quality of care for patients with limited English proficiency to approach or equal the quality of care received by patients without a language barrier (Karliner et al., 2007). The same review found that professional interpreters tend to outperform ad hoc interpreters across measures including communication, utilization, clinical outcomes, and patient satisfaction.

This is a powerful teaching point. Working with a professional interpreter is not a courtesy or a delay. It is the intervention that narrows the safety gap the research describes. Students who learn to see professional interpretation as a core part of safe care, rather than an optional extra when time allows, are better equipped to advocate for their patients.

Teaching Students to Work With Interpreters, Not Around Them

Knowing that professional interpreters matter is not the same as knowing how to work with one. This is a learnable skill, and the evidence suggests it should be taught deliberately rather than left to chance.

A 2024 study that integrated interpreter and limited English proficiency patient training into medical and physician assistant student education found that students reported greater confidence working with interpreters and came to value the feedback interpreters provided. The authors concluded that involving experienced interpreters directly in training supported students’ confidence and perceived preparedness for real-world encounters in ways that didactic instruction alone may not (Nguyen et al., 2024).

Simulation has emerged as a particularly promising approach. A curriculum developed for oral health professions used simulation and interprofessional education to address exactly this training gap, teaching students to work with interpreters as part of a coordinated care team. The developers positioned these team skills as central to safe, effective communication with patients who have limited English proficiency (Woll et al., 2020). The skill set is concrete and teachable: positioning the room so the clinician speaks directly to the patient rather than the interpreter, using first-person statements, pausing to allow complete interpretation, and checking for understanding rather than assuming it.

What Clinical Instructors Can Do

Preparing students for the communication gap does not require a complete curriculum overhaul. A few deliberate practices make a meaningful difference.

Name it as a safety issue. Frame language access alongside other patient safety concerns so students internalize that working without proper interpretation is a risk, not a shortcut.

Teach the mechanics before the moment arrives. Walk students through how to call for and work with a professional interpreter, including the practical details of positioning, pacing, and speaking directly to the patient. Students should not be learning this for the first time with a patient in front of them.

Address the family member question directly. Help students develop the language to decline a family member’s offer to interpret graciously while still securing professional interpretation. This is socially awkward for a novice, and rehearsing it removes the hesitation.

Use simulation when you can. Practicing an interpreted encounter in a low-stakes setting, ideally with a real interpreter involved, builds competence and confidence that carry into clinical practice.

Model it yourself. When you work with an interpreter in front of students, narrate your choices. Show them what good looks like.

The Takeaway

The patient whose first language is not English is not an edge case. As communities grow more linguistically diverse, this is an ordinary and recurring part of clinical practice, and students who are unprepared for it can unintentionally put patients at risk. The good news is that this is one of the more solvable challenges in clinical education. The tools exist, the skills are teachable, and the evidence for what works is clear.

What students need from us is the preparation to use those tools with confidence, before the moment arrives when a patient is waiting and the decision cannot wait. The question for us as educators is whether we are teaching students to close the communication gap deliberately, or leaving them to improvise when it matters most.

How does your program prepare students to care for patients across language barriers? We would love to hear from you.

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References

Divi, C., Koss, R. G., Schmaltz, S. P., & Loeb, J. M. (2007). Language proficiency and adverse events in US hospitals: A pilot study. International Journal for Quality in Health Care, 19(2), 60-67. https://doi.org/10.1093/intqhc/mzl069

Flores, G., Laws, M. B., Mayo, S. J., Zuckerman, B., Abreu, M., Medina, L., & Hardt, E. J. (2003). Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics, 111(1), 6-14. https://doi.org/10.1542/peds.111.1.6

Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727-754. https://doi.org/10.1111/j.1475-6773.2006.00629.x

Nguyen, Q., Flora, J., Basaviah, P., Bryant, M., Hosamani, P., Westphal, J., Kugler, J., Hom, J., Chi, J., Parker, J., & DiGiammarino, A. (2024). Interpreter and limited-English proficiency patient training helps develop medical and physician assistant students’ cross-cultural communication skills. BMC Medical Education, 24, 185. https://doi.org/10.1186/s12909-024-05173-z

Woll, A., Quick, K. K., Mazzei, C., Selameab, T., & Miller, J. L. (2020). Working with interpreters as a team in health care (WITH Care) curriculum tool kit for oral health professions. MedEdPORTAL, 16, 10894. https://doi.org/10.15766/mep_2374-8265.10894