Discussion

Language barriers in healthcare are apparent and their negative consequences are widely recognized. This scoping review is the first to provide a qualitative synthesis of the literature on the potential of medical students in bridging the language barrier in academic healthcare centers by engaging as interpreters.
In the context where access to medical interpretation services is often limited, students constitute a favorable alternative to other forms of ad hoc interpretation such as family and friends. Multilingual medical students are often asked to interpret in patient encounters and represent a valuable resource towards providing language-concordant care. 20,24,33,34 Positive attitudes have been expressed surrounding this practice, especially in situations where students previously received interpretation training. Patients and providers have reported being grateful for student involvement, appreciating the additional availability for interpretation and rating their performance highly. 32, 35 Students emphasized a positive educational value in receiving such training, noting improvement in communication skills, empathy, and cultural awareness. They also acknowledged their value as team members and developed their professional identity as patient advocates. 20, 35, 40Such training programs were also recognized to offload the demand for interpretation among health systems. 20, 40
However, most medical students receive no formal education regarding interpretation. Academic healthcare institutions and medical schools can optimize the potential of students as interpreters in the clinical setting by offering additional training. As existing programs have shown, students would benefit from a blend of interpretation theory and scenario-based activities. Post-training evaluation of students should include direct observation of a clinical encounter, ideally completed by a professional interpreter. The program format should be condensed to accommodate the workload and time constraints of medical students. Proposed funding models mainly consist of joined support from a medical school and one of its affiliated health centres.
Challenges raised surrounding this practice relate predominantly to ethical considerations. Students may be unaware of the professional implications of an interpreter, thus limiting the distinction with their role as a clinical learner. 14 In addition, variation among students in fluency and knowledge of medical terminology in the concerned language may result in differences in interpretation quality. Measures have been taken to recognize and address these concerns. Existing training programs are provided by professional interpreters and cover the ethical-legal obligations of students in that role. Language fluency is assessed in the evaluation process and students reported increased confidence when asked to interpret following participation in a program. 20, 35, 40
Additional guidelines should be established to standardize the operationalization of student interpreters. There is currently a lack of clear policies surrounding this practice, which may be a reflection of the dearth of literature available to inform standards. Although some countries have established recommendations around medical interpreters, there is significant inconsistency across regulatory bodies and students are often not mentioned explicitly. In the United States, the Affordable Care Act requires all healthcare providers receiving federal assistance to provide LLP patients with a qualified interpreter, including on-site or video interpretation. 41 To be qualified, an individual must complete a formal training program. In Canada, healthcare interpretation services are seen as ancillary services that are not universally ensured. However, there has been discussion on whether these services should be considered medically necessary. 
It is also important to recognize that formal interpreters remain the gold standard in providing language-concordant care, and efforts should be made to improve access to these services.