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We must educate and provide resources for medical students and institutions.
“I’ve been feeling bad since I had COVID. My chest pain is unbearable. It hurts so much. I wish I could have come earlier but I do not have health insurance. Please, tell me I’ll be okay. Please.”* I spoke these words in a sad tone, in pain, and with a hint of desperation. That is the job of an interpreter: to relay everything that is said by a patient. I embodied the patient’s feelings so that the team would understand her pain.
Interpreting is its own work of art—a theater where the interpreter is receiving the lines in live action and expected to act these lines immediately. Before you are able to process this, you begin to receive more lines and continue the play. Except the lines you are receiving are real words spoken by real patients who experience profound disease processes. Sometimes you interpret illness, pain, and grief, while other times you interpret happiness.
As you channel the grief and worry, you also unknowingly shoulder vicarious or secondary trauma. Secondary trauma is heightened by the interpretation practice of speaking in first-person.1 Vicarious trauma—interchangeably known as secondary trauma—happens to clinicians, interpreters, and medical students who absorb their patient’s traumatic experiences, words, and feelings.2 Vicarious trauma can be painful and transformative. The symptoms of secondary trauma include reimagining the traumatic event, intrusive thoughts, irritability, and generalized anxiety, among other posttraumatic stress disorder (PTSD)-like symptoms.1 The lack of experience and the increased exposure to patients’ stories make medical students more vulnerable to secondary traumatic stress.1
As a medical student without professional interpreter training, I act as an ad-hoc interpreter. Many times, in the health care setting, this can be for a family member, a medical assistant, nursing staff, and medical students. I started interpreting for my mother when I was about 9 years old. This was when she injured her shoulder and had several doctor appointments and a surgery. Being an ad-hoc interpreter and a language broker is a very common phenomenon for Latino immigrant children.3 For most of us, interpreting for our loved ones was what exposed us to the medical field. Some of us had great experiences, and others were fueled by injustice. We hoped our culture, language, and narratives would lead to better health care outcomes for our Latinx community.
However, many of us found ourselves regressing to ad-hoc interpreters during our clinical rotations. Several studies have shown that medical students also experience vicarious trauma on the wards.1 We may experience grief, anger, shock, or sadness during rotations, especially when we lose a patient. What happens to the medical students who serve in both roles? And why is this so important? From what I have seen, the majority of my colleagues who are bilingual medical students and serve as ad-hoc interpreters come from communities that are underrepresented in medicine (URiM). We already know that URiM students experience structural barriers and racism. Many are the first in their family to go to medical school. What if URiM medical students also bear emotional vicarious trauma as interpreters?
Personally, it is through my own therapy that I have gained insight and have been able to process the emotional vicarious trauma I experienced in the wards. It is through my own therapy that I was able to recognize that my role as an ad-hoc interpreter was also triggering my previous trauma as a child ad-hoc interpreter for my mother during her doctor appointments.
It is imperative that physicians, health care workers, and other professionals acknowledge the vicarious trauma that medical students may experience while ad-hoc interpreting and therefore opt to use professional interpreters instead.4 Health care teams may allow medical students to talk to their patients in their native language. However, medical schools and institutions should have clear guidelines, language assessments, and support for students who choose to interpret for LEP patients.5 It is also important that medical students who act as ad-hoc interpreters receive therapy services and workshops on vicarious trauma, and become informed on how to set boundaries with their teams. The work, most importantly, should be on institutions to provide these resources and emphasize their importance for the well-being of doctors in training.
*Patient quote has been altered to protect patient privacy.
Ms Mendoza is a medical student in the Program in Medical Education for the Latino Community (PRIME-LC) at the University of California, Irvine (UCI) School of Medicine. She is the co-founder and co-chair of the Child and Adolescent Psychiatry Interest Group at UCI and an. advocate for diversity in mental health. She is currently working on a qualitative research project with Violeta Osegueda PGY-1 at UCLA/VA Psychiatry on this very important topic.
1. Crumpei I, Dafinoiu I. Secondary traumatic stress in medical students. Procedia Soc Behav Sci. 2012;46:1465-1469.
2. McCann IL, Pearlman LA. Vicarious traumatization: a framework for understanding the psychological effects of working with victims. J Trauma Stress. 1990;3:131-149.
3. Kam JA, Lazarevic V. The stressful (and not so stressful) nature of language brokering: identifying when brokering functions as a cultural stressor for Latino immigrant children in early adolescence. J Youth Adolesc. 2014;43(12):1994-2011.
4. Paradise RK, Hatch M, Quessa A, et al. Reducing the use of ad hoc interpreters at a safety-net health care system. Jt Comm J Qual Patient Saf. 2019;45(6):397-405
5. Vela MB, Fritz C, Press VG, Girotti J. Medical students' experiences and perspectives on interpreting for LEP patients at two US medical schools. J Racial Ethn Health Disparities. 2016;3(2):245-249.