Language barriers in health care contribute to poorer health outcomes among patients who do not speak the same language as their health care provider. Several studies have found that when health care providers use professional interpreters, clinical care for patients with limited English language proficiency is significantly improved (e.g. Karliner et al. 2007). Despite clear clinical benefits, health care providers often do not use professional interpreters (Diamond et al. 2008), for example because they find it easier to 'get by' without (professional) interpreters, or because they tend to overestimate their own competencies in this regard (Hudelson et al. 2012).

Studies have shown that care providers who have received any training about the impact of language barriers and/or the use of interpreters are more likely to call on appropriate interpreters when needed (e.g. Lee et al. 2006; Kalet et al. 2010).

In order to train our medical students , an e-learning-module was developed, which aimed to increase students' knowledge and self-perceived self-efficacy in working with professional interpreters.

121 fourth-year medical students took this e-learning just before the start of their clinical rotations. In this e-learning, they answered questions relating to three patient-physician-interpreter video vignettes, and compared their answers with best practices. In the video vignettes main pitfalls were introduced, for example, when using a family member or a bilingual staff member as an interpreter.

Before and after the e-learning students completed a questionnaire. This pretest and posttest consisted of 10 multiple choice questions and 2 self-efficacy questions.

Our results indicate that the median score of knowledge increased after the e-learning (median 9.00, IQR 2.00 vs. before the e-learning: median 6.00, IQR 4.00; p<0.001).  A similar pattern was observed for self-efficacy. Before the e-learning the median score was 4.00 (IQR 2.00) whereas after the median score was 7.00 (IQR 2.00), with a statistically significant difference (p<0.001).

Our e-learning resulted in improved knowledge and self-efficacy in arranging and using professional interpretation services among fourth-year medical students.  Such interactive educational formats may lower the barriers for current and future healthcare providers to use professional interpreters in clinical practice, improving quality of services for a multi-ethnic patient population.

•  An e-learning module is an efficient educational intervention to improve students' knowledge and self-efficacy with regard to the use of interpreters;
• The e-learning, however, does not replace face to face teaching sessions;
• Role-playing sessions in which students have the opportunity to practice working with an interpreter are equally important.

    Diamond LC, Schenker Y, Curry L, Bradley EH, Fernandez A. Getting By: Underuse of interpreters by resident physicians. J Gen Intern Med. 2008;24(2):256-262.

Hudelson  P, Pernegere T, Kolly V, Perron NJ. Self-assessed competency at working with a medical interpreter is not associated with knowledge of good practice. PLos One 2012;7(6)e38973.

Kalet AL, Mukherjee D, Felix K, Steinberg SE, Nachbar M, Lee A, Changrani J, Gany F. Can a web-based curriculum improve students' knowledge of, and attitudes about, the interpreted medical interview? J Gen Intern Med. 2005; Oct 20(10):929-34.

Hudelson P, Perneger T, Kolly V, Perron NJ. Self-assessed competency at working with a medical interpreter is not associated with knowledge of good practice. PLoS One. 2012;7(6):e38973.

Karliner LS, Jacobs EA, Chen AH, Mutha S. Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Serv Res. 2007;42(2):727-754.

Lee KC, Winickoff JP, Kim MK, Campbell EG, Betancourt JR, Park ER, Maina AW, Weissman JS. Resident physicians' use of professional and nonprofessional interpreters: a national study. JAMA 2006: 296: 1050-3.