The Value of Refugees and Interpreters as Standardized Patients for Interprofessional Education

Approximately 70,000 of these refugees are resettled annually in the United States; with an increase of 20,000 requested of Congress in the next fiscal year for displaced Syrian families.  As a division of the US Department of Health and Human Services, the Office of Refugee Resettlement (ORR) is responsible for overseeing resettlement processes throughout the country.  Refugees from certain ethnic groups have over the years established sizeable communities within different cities.  In 2015, New York State remained the 3^rd largest resettlement destination after Texas and California.  In 2014-2015, New York welcomed 3,904 refugees, most of whom (1,320 or 33.8%) resettled in Buffalo.  Here in Buffalo, individuals and families from Burma, Bhutan, Iraq, Somalia and Sudan are the most recent arrivals.  A 2014 report, Strengthening the Western New York Safety Net, assessed the urban West Side of Buffalo, where the majority of incoming refugees initially settle.² Acknowledging that refugees have become a source of increased population and community revitalization, the report recognizes struggles related to poverty, transportation, employment, health and mental health care, and use of adequate, trained interpreters.  Recommendations from the report specifically targeting refugee populations include: raising awareness of the law mandating use of trained interpreters for individuals of limited English proficiency (LEP), advocacy for a longer benefit window for newly resettled refugees, and improved access to health and mental health services, as well as enhanced provider training in cultural awareness.

Health and mental health issues are priority concerns for incoming refugee individuals, and also for local health care providers.  Two recent Refugee Health Summits held in Buffalo highlight the compelling need for optimal health care, culturally competent providers, and culturally and linguistically appropriate services, including the use of trained interpreters.³  At the same time, the Liaison Committee on Medical Education (LCME) is requesting that medical schools enhance the preparation in cultural competency and communication skills for providers in training.⁴

At the University at Buffalo, there is emphasis on Interprofessional Education (IPE)⁵ among the health science schools.  “Interprofessional education occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes. Once students understand how to work interprofessionally, they are ready to enter the workplace as a member of the collaborative practice team. This is a key step in moving health systems from fragmentation to a position of strength.”⁶

Project Objectives:

1. Recruit and hire nine refugees from local communities to serve as standardized patients (SPs) (persons trained to consistently portray and assess student performance), interpreters or both to fulfill LCME requirements and provide cultural awareness to the Burmese and Iraqi communities. 
2. Pilot SP encounters with students from three health disciplines – nursing, medicine, and social work.  Students will demonstrate:
   1. an understanding of and respect for, the roles of other health care professionals, and of the need to collaborate with others in caring for individual patients and in promoting the health of defined populations.
   2. the ability to obtain an accurate “first visit” history which is thorough and includes issues related to age, gender, cultural background and socioeconomic status.
   3. the ability to communicate effectively with patients/clients.
   4. an understanding of the roles and responsibilities of the interpreter, health care providers (medicine, nursing, social work) and patient in the interpreted appointment.
   5. an understanding about legal issues, particularly those issues affecting refugees and immigrants
3. Video tape the encounters for later debriefing of all three health care providers related to communication through an interpreter with a non-English speaking patient.
4. Evaluate the a) project feasibility b) student response c) SP/interpreter response, and d) faculty response.
5. Work collaboratively with two APEX disciplines; UB School of Law and UB Department of Communications.
6. Develop a training manual for standardized patients and interpreters.