Improving Assessment and Learning Environments for Graduate Medical Trainees to Advance Healthcare Language Equity.

Language-appropriate care is critical for equitable, high-quality health care, but educational standards to assure graduate medical trainees are prepared to give such care are lacking. Detailed guidance for graduate medical education is provided by the Accreditation Council for Graduate Medical Education through the following: (1) an assessment framework for competencies, subcompetencies, and milestones for trainees and (2) the Clinical Learning Environment Review (CLER) Pathways for assessment of trainees' learning environments. These tools do not include a robust framework to evaluate trainees' abilities to offer language-appropriate care. They also do not address the learning environment's potential to support such care. A multidisciplinary group of linguistic, medical, and educational experts drafted a new subcompetency with milestones and an expanded CLER Pathway to highlight the importance of equitable care for patients who prefer languages other than English. These resources offer residency and fellowship programs tools to guide assessment, curriculum development, and learning-environment improvements related to language-appropriate care. Recognizing that programs have unique needs and resources, we propose a range of initial actions to address language equity. A focus on language diversity in the learning environment can have a broad and lasting impact on care quality, patient safety, and health equity.

Culture and language coaching for bilingual residents: the first 10 years of the CHiCoS model.

ProblemIn the US, there are neither professional standards nor adequate formal training opportunities related to physician use of non-English languages, the most common of which is Spanish. To achieve safe, effective health care for culturally and linguistically diverse patients, the medical profession needs clear standards for physician language use and proven culture and language training models that include validated assessment of linguistic proficiency. InterventionThe authors describe the first decade of an innovative culture and language coaching program for bilingual (Spanish-English) pediatric residents, including the model's evolution and outcomes, as well as recommendations for implementing similar programs elsewhere. Over 10 years, the model has grown from a central innovation-the professional culture and language coach (CLC). The CLC provides 1:1 in-visit support and post-visit coaching to individual residents during three years of continuity clinic experience in a Spanish-language setting (Clínica Hispana de Cuidados de Salud-CHiCoS). They also provide a range of supplementary learning activities (e.g., simulations, immersion rotations, mock testing) and periodic formal assessment of language proficiency. Foundational program elements include cultural and linguistic humility, variations in language, pragmatic linguistics and trans-languaging, the inseparability of culture and language, health literacy, and a flat teaching hierarchy ("all teach, all learn"). ContextCHiCoS has been implemented continuously since 2009 in the primary care clinic of a stand-alone academic pediatric hospital in the Midwest, where pediatric residents have their continuity clinic experience over three years of residency. ImpactFifty-six residents have participated, reporting improved language skills, cultural knowledge, and ability to care for Spanish-speaking patients. Sixty-eight percent of residents not qualified bilingual upon program entry passed a validated physician language assessment by graduation. Spanish-speaking patients seen by CHiCoS residents and faculty reported higher satisfaction, trust, and communication scores than those seen in non-bilingual areas of the same clinic (p < .05 for all scores). The program increased bilingual faculty six-fold and changed attitudes and practices related to language supports throughout the residency program. Lessons LearnedCulture and language coaching provides effective preparation and assessment of bilingual physicians, leading to improved care for culturally and linguistically diverse patients. Our model offers an example for developing similar approaches for a variety of clinicians throughout health care. Such approaches should include professional standards for non-English language use, training supports customized to bilingual learners' proficiency levels, and a focus on integrating practical cultural and linguistic skills to achieve safe, effective clinical communication.

Breastfeeding Advocacy: A Look into the Gap Between Breastfeeding Support Guidelines and Personal Breastfeeding Experiences of Faculty Physicians.

Objectives: Despite increased lactation support for mothers over the past few decades, physician mothers still face considerable challenges to achieving their breastfeeding goals. Disparities in breastfeeding exist between physician and nonphysician mothers in the United States. To formulate an effective advocacy agenda for this population, we surveyed faculty physician mothers about their breastfeeding experiences. We hypothesized that identifying frequent, modifiable barriers to breastfeeding could generate ideas for improved lactation support for female physicians. Study Design: A deidentified breastfeeding survey was sent to female faculty physicians at an academic children's hospital in 2020. Inclusion criteria included female faculty physicians who had given birth within the past 5 years. The responses of those who selected "yes" when asked if they had breastfed were analyzed. Results: Fifteen percent of respondents stated that they did not meet their breastfeeding goals. The most prevalent theme for both positive and negative factors in the qualitative analysis was pumping breast milk. Physician mothers provided key insight into (1) the impact of their role as physicians on their breastfeeding experience, (2) impact of their return to work on breastfeeding, and (3) ideas for improved lactation support. Conclusion: This study highlights the need to improve maternal and infant health by advocating for faculty physicians who are providing breast milk for their children. Advocacy efforts should focus on improving conditions for breast milk pumping and for effective policies around return to work after delivery. Further development and study of individualized breastfeeding support plans for physician mothers is needed.