The study, published in the Journal of General Internal Medicine, was led by Aubrey Samost-Williams of McGovern Medical School at the University of Texas Health Science Center at Houston, together with a multidisciplinary team spanning team science, anthropology, patient safety, and resilience engineering. The stakes are high: patients with a non-English language preference suffer harmful medical errors at higher rates than English-speaking patients, and those who experience diagnostic errors report more difficulty understanding follow-up instructions and more trouble finding interpreters when they need them. Language barriers are associated with disparities in clinical testing, delayed or missed diagnoses, and unplanned hospital readmissions.

To understand what interpreters actually contribute to safety, the team conducted three virtual focus groups with 17 current or former certified medical interpreters recruited from a large company providing interpretation services at more than 30,000 sites across the United States, Canada, and the United Kingdom. The focus group participants were a seasoned group, with between 5 and 24 years of experience, all fluent in English and Spanish, and all experienced with in-person, video remote, and phone interpretation. Five additional former interpreters reviewed the findings and checked that the researchers’ interpretations matched their lived experience. The analysis followed COREQ qualitative research guidelines and was approved by an institutional review board.

The analytical framework came from an unexpected corner of safety science: resilience engineering. Erik Hollnagel’s definition of a resilient healthcare system describes one that can adjust its functioning before, during, or after disturbances so that it sustains required performance under both expected and unexpected conditions. Hollnagel identifies four resilience potentials—the potential to respond, to monitor, to learn, and to anticipate. Rather than asking interpreters simply what their job involves, the researchers asked them to describe their experiences during ambulatory diagnostic visits for new or worsening symptoms, then mapped what they heard onto these four potentials.

The results revealed eleven behaviors clustered within the four potentials. Under the potential to respond, interpreters described managing the flow of communication during appointments, using verbal and nonverbal cues to keep patients and clinicians speaking in short phrases that allow more accurate interpretation. They described strengthening the patient’s voice, ensuring that tone and emotion survived the crossing between languages, and even mirroring a patient’s hesitancy in their own delivery when they sensed the patient was holding something back. They saw their role as extending from the moment a patient arrives until the moment they leave, helping patients schedule follow-up appointments and understand next steps. Some even described stepping in when they overheard inaccurate machine-generated Spanish drifting out of a clinic room they were merely walking past.

That last detail is a striking one, because it shows interpreters already acting as human quality-control agents for the very technologies meant to replace them. The study also found that interpreters monitor three things continuously during an encounter: the patient’s emotions and understanding, the dynamics of the clinical team, and the impact of technology on communication quality. Interpreters noted that patients often tell the clinician they have no questions, only to turn to the interpreter afterward to ask about a clinical detail—a disconnect that a word-for-word translation tool would never flag. Interpreters also reported miscommunications stemming directly from newer AI translation tools, and vulnerabilities in video-based interpretation such as poor connections and badly placed screens.

The potential to learn emerged from two sources. Interpreters frequently share a cultural background with the patient even when the clinician does not, positioning them to notice when a cultural misunderstanding could derail the diagnostic process. They described extracting sensitive information a patient would not otherwise disclose and navigating culturally mismatched diagnostic tests that could have profoundly affected the outcome. Over time, they also grew more confident speaking up and advocating for patients within the boundaries of company policies and national interpreter standards of practice.

The potential to anticipate proved perhaps the most sophisticated. Interpreters used cultural knowledge to predict which patients might not return for follow-up testing. In some cultures, they explained, medicine is viewed as infallible—so if symptoms persist after a first appointment, the patient assumes the fault must be their own. By surfacing that belief to the clinical team, an interpreter could prompt the clinician to address the concern preemptively, before it caused a patient to disappear from follow-up. Interpreters also proposed system-level improvements, such as formal guidelines for when virtual versus in-person interpretation is appropriate, and gender-matched interpreters for sensitive appointments in urology, gynecology, or mental health.

Crucially, the researchers found that these potentials do not operate in isolation. Monitoring behaviors feed responding behaviors: noticing a patient’s confusion allows the interpreter to intervene before a miscommunication hardens into a diagnostic error. Learning feeds anticipating: cultural knowledge gained over years lets an interpreter predict which patients need closer safety monitoring. This interlocking web of perception, judgment, and action is precisely what current AI interpretation tools lack. Those tools focus on rendering the words being exchanged, in written or spoken form, and do not account for the cultural brokering, emotional surveillance, team monitoring, and threat anticipation that human interpreters perform as a matter of course.

The implications for the healthcare industry are uncomfortable but clear. Interpreters are a finite and expensive resource, and institutions are understandably eager to swap them for cheap, always-available AI systems. But the study warns that measuring an AI tool purely by language accuracy threshold would miss the safety functions that human interpreters quietly provide. The authors suggest two paths forward. One is to design AI tools that integrate additional data sources, such as video or electronic health record data, to flag when a patient is at risk of misunderstanding or when cultural differences may be relevant. The other is a model of AI as teammate, in which AI handles raw language conversion while a human interpreter supervises and takes on the broader advocate and navigator role. The researchers also identified barriers on the human side: medical hierarchies can make it hard for an interpreter to challenge a clinician, and interpreters often noticed safety threats—poor team dynamics, patients unlikely to return—without feeling empowered to act. Short pre-appointment briefings, in which clinicians explicitly invite interpreters to voice safety concerns, emerged as a simple, powerful remedy. The study’s limitations are real: it captures only interpreters’ self-reported experiences, not the perspectives of patients or clinicians, and future work will need to test AI tools against human interpreters in real-world settings. But the core message is already actionable. As hospitals race to deploy voice-to-voice machine translation and even real-time in-ear interpretation devices, the quiet safety work of human interpreters—responding, monitoring, learning, and anticipating—must be designed into the workflow, or the resilience that protects millions of patients will simply vanish with the interpreter.

Subject of Research: The safety roles of medical interpreters beyond language translation and their implications for AI interpretation tools

Article Title: The Role of Interpreters in Supporting Resilience and Implications for Artificial Intelligence

Article References: Samost-Williams, A., Wermuth, P., Fernández Castillo, G., Zipkin, R., Hanley, K., Xie, Y., Newton, M. E., Salas, E., Tannenbaum, S., Wiig, S., Thomas, E. J., & Bell, S. K. (2026). The Role of Interpreters in Supporting Resilience and Implications for Artificial Intelligence. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10850-4

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10850-4

Keywords: medical interpreters, patient safety, resilience engineering, diagnostic error, artificial intelligence, language barriers, ambulatory care, qualitative research, healthcare disparities, machine translation, cultural brokering, Hollnagel resilience potentials

The course is a partnership between the Eastern Association for the Surgery of Trauma and a team of communication experts. Now in its sixth year, the program is delivered entirely online across five weekly modules using Zoom technology. Each session concentrates on a single, distinct communication skill, and every class includes one hour of deliberate skills practice with professional actors, facilitated by a physician. That structure reflects a growing consensus in medical education that communication is not a personality trait students either possess or lack, but a clinical skill that can be explicitly taught, rehearsed, observed, and refined, much like suturing or operative technique.

The scale of the collaboration is notable. Twenty-four students and ten faculty members drawn from seventeen medical schools in Saudi Arabia and the United States participated in the course, supported by nineteen simulated patient actors. The actors, many of them former patients, portray individuals in clinically realistic scenarios, allowing students to conduct medical interviews that feel authentic without any risk to real patients. Physician facilitators then guide debriefing sessions in which learners dissect what worked, what faltered, and how the encounter might have felt from the patient’s perspective. This combination of simulation, immediate feedback, and physician mentorship mirrors the deliberate-practice model that has transformed training in surgery and procedural medicine.

To evaluate the course’s impact, the research team conducted, recorded, and transcribed three focus groups designed to elicit students’ reflections on the class and its influence on their patient-centered communication. Twelve students, including both Saudi and US-based participants, took part in the focus groups. The researchers then applied thematic analysis, a qualitative method in which coded segments of transcript data are iteratively grouped into broader patterns, to identify recurring themes across the discussions. The analysis surfaced three broad domains: communication skills, cultural competency, and professionalism.

Across the focus groups, participants consistently reported increased self-confidence in executing important patient-centered medical interviews. Patient-centered communication, a framework in which the clinician elicits the patient’s own concerns, values, and expectations rather than simply extracting a symptom checklist, has been repeatedly associated in the literature with better adherence, improved health outcomes, and reduced disparities in care. Yet studies of medical training have long documented a curricular disconnect: students learn communication frameworks in the classroom but struggle to apply them during clinical clerkships, where observation and structured feedback are often scarce. The international course appears to narrow that gap, with students specifically appreciating the clinical relevance of what they learned in the virtual classroom and describing opportunities to apply those concepts in practice.

The cross-cultural dimension of the course proved to be one of its most powerful elements. Students reflected on the influence of cultural context in areas such as gender roles and family authority, recognizing that a question or behavior that seems neutral in one cultural setting may carry very different weight in another. In some families, for example, medical decisions may be shaped by senior family members rather than the patient alone, and students learned to navigate these dynamics respectfully rather than dismissing them as obstacles. By pairing learners from two distinct healthcare cultures, the course exposed students to varied cultural expectations and practices firsthand, turning the virtual classroom itself into a living exercise in intercultural exchange.

The program also functioned as an early proving ground for medical professionalism. Participants demonstrated positive attributes of professionalism during class participation, an outcome the authors consider significant because professionalism, like communication, is increasingly treated as a competency to be cultivated and assessed throughout medical education rather than absorbed by osmosis. Prior research has explored peer evaluation and self-evaluation as tools for assessing professionalism in early training, and the course’s emphasis on respectful, sensitive responses to patients from diverse cultures gave students a concrete stage on which to practice those attributes under observation.

The study’s findings arrive against a well-documented backdrop. Reviews of cultural competency in medical education have concluded that such training is essential for minimizing disparities in healthcare access and quality, and a Cochrane systematic review of interventions to improve medical students’ interpersonal communication in consultations underscores both the importance and the difficulty of doing this well. Questions have also been raised about whether patient-centered cultural competency training can be effective in non-Western countries, making a course that genuinely bridges US and Saudi institutions particularly relevant. By operating virtually, the program sidesteps the cost and logistics of international travel, suggesting a scalable model that other specialties and regions could adapt.

The researchers are careful about the limits of their evidence. The evaluation rests on qualitative focus group data from twelve students, which can illuminate how learners experienced the course and what they believe changed, but cannot by itself quantify improvements in clinical performance or patient outcomes. Data from the study are available by request, and the authors note that all contributors, including the many actors who portrayed patients, were essential to the program’s success. Still, the consistency of the themes across both Saudi and US participants lends weight to the conclusion that the course prepared students to respond respectfully and sensitively to patients from diverse cultures.

For a specialty like surgery, where time-pressured encounters and high-stakes decisions amplify the consequences of miscommunication, the implications are striking. If a five-week virtual course built on simulation, physician facilitation, and international peer exchange can measurably boost students’ confidence and cultural awareness, medical schools may have a low-cost, exportable blueprint for embedding multicultural competence into undergraduate training. As the course enters future iterations, the challenge will be to track whether these self-reported gains translate into durable changes in behavior at the bedside, and ultimately into more equitable care for the increasingly diverse populations that modern medicine serves.

Subject of Research: A virtual international communication skills course for US and Saudi medical students and its effects on cultural competency and patient-centered care

Article Title: Multicultural competence education improves care: an international communication course for medical students

Article References: Newcomb, A. B., Mashbari, H., Abbaker, R., Stidham, M., Elhadi, K., Muzaiiadi, S., March, E., Appelbaum, R. D., Wells, K. M., & Mohess, D. (2026). Multicultural competence education improves care: an international communication course for medical students. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 133. https://doi.org/10.1007/s44186-026-00538-y

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00538-y

Keywords: medical education, cultural competency, communication skills, patient-centered care, virtual learning, simulation, Saudi Arabia, United States, surgical education, professionalism, healthcare disparities, qualitative research

The study, led by researchers at the University of Cincinnati College of Medicine together with a Gender-Affirming Care Clinical Specialist from Equitas Health, a community health center dedicated to serving the LGBTQIA+ community, set out to test whether a brief didactic intervention could move the needle on knowledge and attitudes among imaging professionals. The training team included medical students, several of whom identified as LGBTQIA+ community members themselves, and the content was adapted from cultural responsiveness trainings that the Equitas Health specialist, a nurse with more than a decade of experience training hundreds of medical professionals, had previously designed and led. What distinguished this effort was its audience: rather than targeting physicians alone, the session was built for the entire patient-facing team involved in breast cancer screening, including clinical support specialists who handle scheduling, mammography and ultrasound technologists, and radiologists.

The clinical stakes are substantial. Nearly one in eight women in the United States will develop breast cancer, which remains the second-leading cause of cancer death among cisgender women, and early detection through screening with clinical breast examination, mammography, molecular breast imaging, ultrasound, or magnetic resonance imaging is the cornerstone of reducing mortality. Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority individuals carry distinct medication-related, behavioral, and reproductive risk factors for cancers that originate in breast tissue, which the researchers refer to with the gender-inclusive term breast/chest cancer. Yet the true prevalence of these cancers in LGBTQIA+ populations remains unclear because sexual orientation and gender identity data are collected inconsistently and inaccurately in clinical records and cancer registries. The data that do exist are sobering: available studies show delays in diagnosis and a threefold higher chance of recurrence among LGBTQIA+ patients.

Why are transgender and gender diverse patients underscreened? The study’s authors point to two converging problems. The first is a knowledge gap among the clinicians who would ordinarily recommend screening, including primary care clinicians and gynecologists, many of whom are unfamiliar with current screening guidelines for transgender and gender diverse patients. The second, and arguably more powerful, barrier is anticipated discrimination. Patients who expect to be misgendered at check-in, questioned about their identity, or made to feel unwelcome in the imaging suite often simply do not schedule the appointment. This is precisely the point in the care pathway where the Cincinnati training intervened, because the people patients meet first, the schedulers and technologists, are rarely included in educational efforts about LGBTQIA+ care.

The training itself was deliberately compact. Delivered virtually over the lunch hour to breast center team members at a large urban academic health center, including staff working on community-based mobile mammography units, the session covered terminology pertinent to the LGBTQIA+ community, the importance of inclusive communication, an overview of current breast/chest cancer screening guidelines for transgender and gender diverse patients, principles of trauma-informed care, and concrete strategies for making clinical spaces more welcoming. Leadership confirmed that participation occurred during paid time free of patient care duties, and continuing education credit was offered, though completing the evaluation surveys was not required for credit. A distinctive feature of the session was storytelling: trainers shared relevant lived experiences, and participant feedback later identified these narratives as the single most valued component of the training.

To measure the effect, participants completed electronic surveys via the REDCap platform immediately before and after the session on their own devices. The evaluation captured demographics, job titles, the frequency of interactions with lesbian, gay, bisexual, transgender, and nonbinary patients, and prior exposure to LGBTQIA+ training. Knowledge was assessed in two complementary ways. First, participants self-rated their knowledge of five key learning objectives on a four-point scale: the definition of LGBTQIA+, the use of inclusive terminology in medical settings, current screening guidelines, ways to create a welcoming environment, and the distinctions between sex, gender, gender expression, and sexual orientation. Second, they answered eight multiple-choice questions, including scenario-based items pilot-tested for readability and difficulty, that asked them to choose the best response to realistic situations such as calling a transgender patient from the waiting room, correcting a verbal pronoun mistake, and confirming a patient’s identity when the appointment name does not match the legal name. Attitudes toward gender diversity were measured with an adaptation of a transphobia scale developed by Stroumsa and colleagues in 2019, using eight statements rated on a seven-point scale.

The pre-survey results alone made a compelling case for the training’s relevance. Among the 17 participants who completed the pre-survey out of 28 attendees, 77 percent reported sometimes, often, or very often working with transgender and gender diverse patients, and 94 percent reported comparable frequency of interaction with lesbian, gay, and bisexual patients. Despite this routine exposure, only three participants, both radiologists and one mammography technologist, had ever received LGBTQIA+-specific training, and only about a third felt they had adequate access to resources on LGBTQIA+ patient care. In open-ended responses, participants described barriers that will resonate with many clinicians: discomfort discussing the topic in front of colleagues, uncertainty about where to start, and worry about how to support LGBTQIA+ patients without unintentionally singling them out.

The outcomes told a nuanced story. Self-reported knowledge of LGBTQIA+ terminology and related content rose from a mean of 2.4 before the training to 3.13 afterward on the four-point scale, a change the researchers found statistically significant with a large effect size, Hedges’ g of 1.1, and every one of the five individual knowledge items improved significantly. Directly assessed knowledge, measured by the multiple-choice questions, increased from an average of 8.08 correct answers to 9.16, a small effect that did not reach statistical significance, likely reflecting the small sample size. Scores on the gender attitudes scale shifted from 42.36 to 44.36, a medium effect size indicating a trend toward greater acceptance of gender diversity, but again without statistical significance. The authors attribute these null findings at least in part to the pilot’s small sample and to a retention challenge: only 14 participants completed the post-survey, a rate the team attributed to insufficient time for surveys within the one-hour lunch slot as staff prepared to resume patient care.

Nevertheless, the researchers argue that this is the first published training aimed at the entire team of imaging professionals involved in breast cancer screening, and its significance lies in where it intervenes. Previous work has offered clinical vignettes to address physician knowledge gaps in transgender breast imaging, and the Cincinnati team had earlier received positive qualitative feedback from radiology residents on a transgender curriculum, but no prior study had measured the impact of education delivered to all critical patient-facing staff, including technologists and clinical service specialists. The findings align with a systematic review of brief LGBTQIA+ cultural competency trainings for health professionals and with a study of interprofessional emergency department teams, both of which found that short sessions can move self-reported knowledge.

The authors are candid that measuring changes in staff knowledge is only a first step. The next frontier is evaluating the training’s impact on patients themselves, including whether affirming screening encounters reduce the anticipated discrimination that keeps transgender and gender diverse patients away from mammography in the first place. They also plan to incorporate additional narratives into the curriculum, given how strongly participants valued the storytelling element. If those efforts succeed, the payoff could be substantial: a screening experience that feels safe and respectful for every patient, higher screening rates among underserved populations, and, ultimately, fewer deaths from a cancer that is highly treatable when caught early. In a field where the difference between early detection and late diagnosis is often measured in lives, a 45-minute conversation about names, pronouns, and welcome may prove to be one of the most cost-effective interventions in cancer prevention.

Subject of Research: A pilot educational intervention training breast imaging professionals in transgender-inclusive breast cancer screening practices

Article Title: Training imaging professionals on transgender-inclusive breast cancer screening practices

Article References: Martinez, A., Whitton, S., Yokoyama, J., Madzia, J., Hartlage, C. S., Kelly, E., Schumacher, M., Sosa, D., Makkad, H., Xu, C., Patel, R., Pickle, S., & Stryker, S. (2026). Training imaging professionals on transgender-inclusive breast cancer screening practices. Cancer Causes & Control, 37(10), Article 163. https://doi.org/10.1007/s10552-026-02241-1

Image Credits: AI Generated

DOI: 10.1007/s10552-026-02241-1

Keywords: transgender health, breast cancer screening, mammography, LGBTQIA+ inclusive care, health disparities, radiology training, cultural competency, gender diversity, cancer prevention, trauma-informed care, health professions education, Cancer Causes & Control