title: Through the Veil of Language: Exploring the Hidden Curriculum for the Care of Patients With Limited English Proficiency.
abstract: Patients with limited English proficiency (LEP) experience lower-quality health care and are at higher risk of experiencing adverse events than fluent English speakers. Despite some formal training for health professions students on caring for patients with LEP, the hidden curriculum may have a greater influence on learning. The authors designed this study to characterize the hidden curriculum that medical and nursing students experience regarding the care of patients with LEP.
  
  
  
  In 2014, the authors invited students from one medical school and one nursing school, who had completed an interprofessional pilot curriculum on caring for patients with LEP 6 to 10 months earlier, to participate in semistructured interviews about their clinical training experiences with LEP patients. The authors independently coded the interview transcripts, compared them for agreement, and performed content analysis to identify major themes.
  
  
  
  Thirteen students (7 medical and 6 nursing students) participated. Four major themes emerged: role modeling, systems factors, learning environment, and organizational culture. All 13 students described negative role modeling experiences, and most described role modeling that the authors coded as "indifferent." Students felt that the current system and learning environment did not support or emphasize high-quality care for patients with LEP.
  
  
  
  The hidden curriculum that health professional students experience regarding the care of patients with LEP is influenced by systems limitations and a learning environment and organizational culture that value efficiency over effective communication. Role modeling seems strongly linked to these factors as supervisors struggle with these same challenges.
authors.affiliation: T.C. Kenison is a resident, Department of Medicine, Mount Sinai Hospital, New York, New York. A. Madu is research assistant, Disparities Solutions Center, Massachusetts General Hospital, Boston, Massachusetts. E. Krupat is director, Center for Evaluation, Harvard Medical School, Boston, Massachusetts. L. Ticona is a health policy and management fellow, Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts. I.M. Vargas is an independent science writer and lead instructor, MOSTEC (MIT Online Science, Technology, and Engineering Community) program, Massachusetts Institute of Technology, Cambridge, Massachusetts. A.R. Green is associate director, Disparities Solutions Center, Massachusetts General Hospital, and Arnold P. Gold Associate Professor of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Tiffany C
authors.initials: TC
authors.lastname: Kenison
authors.forename: Andrea
authors.initials: A
authors.lastname: Madu
authors.forename: Edward
authors.initials: E
authors.lastname: Krupat
authors.forename: Luis
authors.initials: L
authors.lastname: Ticona
authors.forename: Iris M
authors.initials: IM
authors.lastname: Vargas
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Green
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003144:Communication Barriers; D003479:Curriculum; D004501:Education, Medical / Q000458:organization & administration*; D004506:Education, Nursing / Q000458:organization & administration*; D054242:Emigrants and Immigrants; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D010817:Physician-Patient Relations; D013337:Students, Medical; D014175:Translating; D014481:United States