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.

Medical Student Perceptions of Sociocultural Issues in Healthcare: A Multisite Study of Medical Spanish Education.

THEORY: Cultural competence and humility are core elements of medical education in a diverse society. Language is inseparable from culture, as language informs, indexes, frames, and encodes both culture and worldview. Spanish is the most common non-English language taught in U.S. medical schools, yet medical Spanish courses tend to artificially separate language from culture. It is unknown to what extent medical Spanish courses advance students' sociocultural knowledge or patient care skills. HYPOTHESES: Based on current predominant pedagogy, medical Spanish classes may not adequately integrate sociocultural issues relevant to Hispanic/Latinx health. We hypothesized that students who completed a medical Spanish course would not demonstrate significant gains in sociocultural skills following the educational intervention. METHOD: An interprofessional team developed a sociocultural questionnaire, and 15 medical schools invited their students to complete the questionnaire before and after completing a medical Spanish course. Of participating schools, 12 implemented a standardized medical Spanish course and three served as control sites. Survey data were analyzed regarding: (1) perceived sociocultural competence (recognition of common cultural beliefs, recognition of culturally normative non-verbal cues, gestures, and social behaviors, ability to address sociocultural issues in healthcare context, and knowledge of health disparities); (2) application of sociocultural knowledge; and (3) demographic factors and self-rated language proficiency (Poor, Fair, Good, Very Good, or Excellent) on the Interagency Language Roundtable scale for healthcare (ILR-H). RESULTS: Overall, 610 students participated in sociocultural questionnaire between January 2020 and January 2022. After the course, participants reported an increased understanding of cultural aspects of communication with Spanish-speaking patients and the ability to apply sociocultural knowledge to patient care (all p < 0.001). When analyzed by demographic factors, students who identified as Hispanic/Latinx or as heritage speakers of Spanish tended to report increased sociocultural knowledge/skills following the course. When examined by Spanish proficiency, preliminary trends showed that students at both ILR-H Poor and Excellent levels did not demonstrate gains in sociocultural knowledge or ability to apply sociocultural skills. Students at sites with a standardized course were likely to improve sociocultural skills in mental health conversations (p < 0.001) while students at control sites were not (p = 0.05). CONCLUSIONS: Medical Spanish educators may benefit from additional guidance on teaching sociocultural aspects of communication. Our findings support that students at ILR-H levels of Fair, Good, and Very Good are particularly well-suited for gaining sociocultural skills in current medical Spanish courses. Future studies should explore potential metrics to evaluate cultural humility/competence within actual interactions with patients.

An Overview of Online Resources for Medical Spanish Education for Effective Communication with Spanish-Speaking Patients.

PHENOMENON: Despite the rapid development of virtual medical Spanish educational materials, online resources lack transparency and a peer-review process. The purpose of this interdisciplinary study was to provide a critical inventory of virtual resources for medical Spanish education, thereby providing a panorama of the current state of online medical Spanish. APPROACH: Research team members conducted iterative searches to identify medical Spanish online resources, which were then screened for predetermined inclusion/exclusion criteria. Between June and August 2020, a panel of medical and language experts then adapted and applied a previously published evaluation tool to determine whether resources that met study criteria would help learners achieve medical Spanish core competencies and to what extent each resource incorporated communicative language activities. Consensus meetings were conducted to resolve disagreements and identify gaps in online education. FINDINGS: Out of 465 resources, 127 were further screened, and eight were selected for evaluation. Medical and language specialists independently scored each resource and, following discussions, achieved consensus. Overall, no resource met suitability criteria for all five medical Spanish learner competencies or cultural elements, and only one was suitable for achieving the self-assessment competency. INSIGHTS: Interdisciplinary consensus meetings provide an important avenue for resolving differences of opinion and for integrating both language and medical perspectives into the evaluation process. Existing online resources should be used in conjunction with other materials to ensure that all core competencies for medical Spanish education are addressed. This study revealed important gaps in online resources, including a need to target advanced Spanish learners, apply authentic communicative activities, include assessment opportunities, and integrate culture in the learning program. Based on the current state of online medical Spanish, we offer recommendations for future resources.

Scoping Review of Textbooks for Medical Spanish Education.

Despite medical Spanish program proliferation to teach clinicians the language skills to communicate effectively with Spanish-speaking patients, course material selection remains a challenge. We conducted a scoping review to systematically identify medical Spanish textbooks, evaluate utility, and identify gaps. On average, language reviewers scored books lower than medical reviewers. Medical and language professionals present complementary perspectives to evaluating medical Spanish educational materials. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01333-8.

Missed Opportunities to Build Rapport: A Pragmalinguistic Analysis of Interpreted Medical Conversations with Spanish-Speaking Patients.

Interpreted medical discourse presents significant challenges for communication because portions of the original message are often reduced, omitted, or revised, particularly by untrained interpreters. Linguistic devices that contribute to rapport and politeness may be perceived as unimportant or unnecessary and therefore are omitted. Thus, when messages are conveyed without interpretation of politeness and rapport attempts, pragmatic issues and misunderstandings occur. This investigation examined 43 transcriptions of interpreted medical consultations at a family medicine clinic. We quantified rapport-building attempts that frequently occurred, yet were not interpreted. We then examined specific and general effects of non-interpretation and noted potential consequences for physician-patient communication. Building on both linguistic and communication frameworks, results align with previous research suggesting that rapport-related variables including verbal immediacy are not secondary to "more important" information communicated by doctors; instead, patients' impressions of rapport may be even more important than the health-related information itself. The application of linguistic pragmatics in this analysis offers additional insights into the relationship between verbal communication and rapport.

Medical Spanish programs in the United States: a critical review of published studies and a proposal of best practices.

BACKGROUND: Despite an increasing demand for medical Spanish training, there has never been a comprehensive review of the methodology and outcomes of existing programs. PURPOSE: This article critically reviews studies published about medical Spanish education and proposes best practices for curriculum design and program research and evaluation. METHODS: The authors reviewed articles published on medical Spanish programs in the United States from 1977 to 2012, then appraised them for the presence of five factors commonly used in second-language acquisition (SLA) research. RESULTS: Only 2 of 23 published studies of programs met all 5 criteria. There was high variability in design and infrequent use of valid and reliable outcome measures. No consensus emerged as to best practices. Instead, reported outcomes were often inadequate surrogate markers for desired educational outcomes in interactions with Spanish speakers. CONCLUSIONS: There is a significant need for effective medical Spanish programs based on solid SLA principles and research methods.