论文标题：The power of language-concordant care: a call to action for medical schools

期刊：BMC Medical Education

作者：Rose L. Molina & Jennifer Kasper

发表时间：2019/11/06

DOI：10.1186/s12909-019-1807-4

微信链接：点击此处阅读微信文章

在BMC Medical Education 近期发表的一篇Debate文章中，作者提出医学院校学生需要更多的机会来接触医学语言课程，并着重阐述了将其纳入标准课程的必要性。

有一位患者曾对我说：“Doctora, no soy bruta”，意思是“医生，我不是傻子”。接着她讲述了自己由于不会讲英语而备受歧视的遭遇，生活对她来说如此不易，哪怕是看病，也很难找到像我这样会讲她的语言的医生。

假如你是超级英雄，可以选择一种超能力，你会选择什么？对我们医生来说，成为“语言大师”就是答案。所谓“语言大师”，就是想要听懂所有语言并在多种文化背景下实现无缝交流。和许多许多其他国家一样，美国越来越多样化，来自世界各地移民在这里安家落户。作为医生，我们的患者也日益多样，他们来自不同的行业，拥有各自的语言。聆听是我们工作的核心部分，能够与讲不同语言的患者进行直接的沟通交流对于建立融洽互信的医患关系及医疗体系至关重要。

在近期BMC Medical Education 发表的Debate文章中，我们提出医学院校应增加医学语言课程，并结合循证教学策略、健康平等相关教学内容及标准化语言评估将医学语言课程纳入医学课程体系。对于在美国执业或在全球任何地方从事临床医学工作的医生来说，医患交流中的语言技巧至关重要。考虑到当今医学生对全球医疗卫生事业的空前兴趣，是时候将语言准备纳入专业化的全球健康教育了。

许多医学医学院校已经开始行动了。哈佛大学医学院（HMS）已经在本科医学课程中增加了非英语语言培训课程。我们的医学语言课程包括初级、中级和高级西班牙语、葡萄牙语和中文普通话。我们还为学生提供机会在其他国家进行临床轮转，同时巩固其语言能力和临床技能。二十世纪七十年代，HMS设立了首个医学西班牙语课程，截止目前已有1000多名校友曾参加过HMS的语言选修课。设置这些课程的初衷是强化学生对于语言障碍的认识，通过医患相互尊重的无障碍交流推动健康平等。为了实现这个目标，我们正在积极努力地将文化尊重和健康平等的理念纳入我们的课程。此外，我们也正在建立临床语言能力的标准化评估。

希望我们的这篇文章能让医学院校的领导重视在本科医学教育中加入语言教学的重要性。

摘要：

We live in a world of incredible linguistic diversity; nearly 7000 languages are spoken globally and at least 350 are spoken in the United States. Language-concordant care enhances trust between patients and physicians, optimizes health outcomes, and advances health equity for diverse populations. However, historical and contemporary trauma have impaired trust between communities of color, including immigrants with limited English proficiency, and physicians in the U.S. Threats to informed consent among patients with limited English proficiency persist today. Language concordance has been shown to improve care and serves as a window to broader social determinants of health that disproportionately yield worse health outcomes among patients with limited English proficiency. Language concordance is also relevant for medical students engaged in health care around the world. Global health experiences among medical and dental students have quadrupled in the last 30 years. Yet, language proficiency and skills to address cultural aspects of clinical care, research and education are lacking in pre-departure trainings. We call on medical schools to increase opportunities for medical language courses and integrate them into the curriculum with evidence-based teaching strategies, content about health equity, and standardized language assessments. The languages offered should reflect the needs of the patient population both where the medical school is located and where the school is engaged globally. Key content areas should include how to conduct a history and physical exam; relevant health inequities that commonly affect patients who speak different languages; cultural sensitivity and humility, particularly around beliefs and practices that affect health and wellbeing; and how to work in language-discordant encounters with interpreters and other modalities. Rigorous language assessment is necessary to ensure equity in communication before allowing students or physicians to use their language skills in clinical encounters. Lastly, global health activities in medical schools should assess for language needs and competency prior to departure. By professionalizing language competency in medical schools, we can improve patients’ trust in individual physicians and the profession as a whole; improve patient safety and health outcomes; and advance health equity for those we care for and collaborate with in the U.S. and around the world.

（来源：科学网）