Longitudinal Development of Medical Students' Communication Skills in Interpreted Encounters

Objective: Describe longitudinal skill development of medical students for the interpreted encounter. Method: Two successive classes of students (n=92 and 100) participated in standardized clinical stations testing general communication skills and skills for working with interpreters at the end of their second year and after completing clinical clerkships during their third year. Performance was rated by standardized patients, interpreters and students using validated scales. Analysis: Analysis of individual matched paired data was performed for each scale item using the Wilcoxon signed-rank test. Pairwise correlation was used to compare global scores of the standardized patient and standardized interpreter with student self-ratings. Results: Over one year students' (n=124-168) performance worsened in behaviors for 'managing the encounter' (per interpreters' ratings) or remained unchanged (per patients' ratings). By patients' ratings, performance scores in general communication remained high. Students rated themselves as significantly improved in five of eight skills for working with interpreters despite a lack of external evidence of improvement from patient or interpreter. Students showed a trend toward underestimating their own global skills at baseline and overestimating them in comparison with the interpreters' global ratings. Discussion: Students' general communication skills remained excellent over one year of training but some skills for working with interpreters worsened. Over time students showed a pattern of overrating their own skills compared with trained observers. Faculty who teach students should focus on specific behaviors that are most likely to decay without reinforcement and practice.