Progression in understanding and implementing the cultural and linguistic appropriate services standards: five-year follow-up at an academic center.

In 2001, 14 national standards on Culturally and Linguistically Appropriate Services (CLAS) in health care were issued by the US Department of Health and Human Services Office of Minority Health to guide outcomes specific to disparities affecting patients with limited English proficiency. Additionally, demographic changes are rapidly occurring throughout the United States leading to more culturally and racially diverse communities, which have increased language barriers in the health care environment. This nonrandomized, cross-sectional study assessed changes and attitudes and applications of CLAS in an academic health care setting over a 5-year period (2006 to 2011). Results indicated that, in 2006, 72.6% participants reported they were "not at all familiar with CLAS" in comparison with 28.8% in 2011. In 2006, 16.5% participants strongly agreed to the question, "I know how to work with medical interpreters" compared with 24.9% in 2011. The same trend is seen with the question, "I use medical interpreters when I have a Spanish-speaking patient," in 2006, 25.5% strongly agreed in comparison with 35.4% in 2011. This study suggests that significant improvements occurred in the use of medical interpreters and understanding of CLAS as a result of educational activities implemented from 2006 to 2011.

A strategy for incorporating palliative care and end-of-life instruction into physician assistant education.

PURPOSE: Physician assistant (PA) education has not historically taught end-of-life and palliative care in its curricula. While medical education has been reformed in the past 15 years to include palliative care, PA education lags behind. The Medical College of Georgia PA Program obtained a HRSA grant in 2009 to teach PA students about end-of-life issues and improve palliative education in the didactic and clinical years. EDUCATIONAL STRATEGIES: Sparse published data exist for end-of-life/palliative education in PA programs. We built a Wiki Internet tool to help teach these concepts. We revised objectives in clinical medicine, emergency medicine, and surgery to improve instruction in end-of-life issues, including common symptom management. We extended the adult medicine clinical course from 4 weeks to 8 weeks to provide long-term care and hospice exposure. Students journaled their adult medicine experiences on the Palliative Care Wiki Discussion Forum. STUDENT EXPERIENCES: Students who participated in the Wiki Discussion Forum reported better understanding of end-of-life issues for patients who were near death or actively dying. Students expressed that bedside instruction, small groups, and hospice home visits were valuable venues for learning about end-of-life care. Students recommended more frequent and specific instruction in pain management and requested more time in hospice and critical care. Students appreciated learning from other students' experiences through the Wiki Discussion Forum. CONCLUSIONS: PA programs should incorporate palliative care and end-of-life instruction into existing curricula. Pain management and treatment of common end-of-life symptoms should be emphasized. Structured clinical experiences in critical care, hospice, and long-term-care settings should be offered.

Awareness of the National Standards for Culturally and Linguistically Appropriate Services at an academic health center.

The study's objectives were to (a) determine the level of familiarity of faculty and students at an academic health center with the National Standards for Culturally and Linguistically Appropriate Services (CLAS), (b) identify faculty's and students' interest and preferred method of learning Medical Spanish, and (c) determine their aptitude for working with medical interpreters. A survey was developed, piloted, and sent via e-mail to all faculty members (n = 1,025) and students (n = 1,956) currently affiliated with or enrolled at the Medical College of Georgia. Reminder e-mails were sent after 2 weeks, and responses were accepted for 1 month. The total response rate for faculty members was 29% (300/1,025), and that for students was 44% (871/1,956). Nearly 22% of the responding faculty and 23% of the responding students reported that they were less than familiar with the National Standards for CLAS. Both faculty (46%) and students (70%) were willing to spend time learning Medical Spanish. Web-based instruction was the preferred educational delivery mode for those who completed the survey; however, 18% of faculty and 5% of students strongly disagreed with this point. When questioned about how often interpreters services are used, the rates for faculty and students ranged from 34% to 39%. These results suggest that a void exists in understanding the National Standards for CLAS and that there are varying levels of willingness to learn medical Spanish.