Introduction: Linguistic communication barriers create challenges in delivering effective healthcare, particularly in emergent or disaster conditions, where miscommunication has dire consequences. Design thinking, a human-centered problem-solving technique, was utilized to identify innovative solutions to improve provider understanding of the effects of those barriers on patient care. Empathy interviews were conducted with patients, and providers evaluated contrasts in patient care between language-concordant and discordant encounters, directing the development and implementation of a preferred-language role-reversal simulation exercise. Methods: Emergency Medicine (EM) resident physicians completed a survey evaluating experience and attitudes in caring for non-English speaking patients. In a structured simulation encounter, English-speaking EM residents placed in a patient role were treated by embedded participant physicians speaking non-English languages. Following the simulation, participants completed a post-survey and structured debrief. Responses were analyzed for differences and themes. Results: In 20 matched responses, residents were overall confident in their ability to diagnose and treat patients and reported lower confidence in their ability to treat non-English speaking patients. Following the simulation, overall confidence decreased, and disparity increased. Participants universally rated communication as challenging, and confidence was lower in understanding concerns and the overall quality of care. Structured debrief sessions were useful in identifying common themes, including perspectives on patient encounters and technology available. Conclusion: This novel exercise was an effective tool to provide education and experience on the care of language discordant patients. Results and reflections exposed a lack of confidence in the current means available and the need for better technology and resources to help alleviate barriers when traditional avenues for communication fail. Simulation is an easily modifiable modality that may be useful to explore the impact of language and other barriers on healthcare and patient experience. This study highlights the need for further research and development to address the quality of patient care when language barriers are present.
Langenfeld et al. (Sun,) studied this question.