Abstract
INTRODUCTION
Policymakers have recommended recruiting or training (or both) more US physicians who can provide care in Spanish. Few longitudinal medical Spanish programs have been described and evaluated.
OBJECTIVE
This study aims to describe development and evaluation of the preclinical phase of a 4-y program designed to graduate physicians who can provide language-concordant care in Spanish.
SETTING
Study was done in one public medical school in southeastern USA.
PROGRAM DESCRIPTION
The program targeted intermediate/advanced Spanish speakers. Standardized fluency assessments were used to determine eligibility and evaluate participants’ progress. Curriculum included didactic coursework, simulated patients, socio-cultural seminars, clinical skills rotations at sites serving Latinos, service-learning, and international immersion.
PROGRAM EVALUATION
For the first two cohorts (n = 45) qualitative evaluation identified program improvement opportunities and found participants believed the program helped them maintain their Spanish skills. Mean interim (2-y) speaking proficiency scores were unchanged from baseline: 9.0 versus 8.7 at baseline on 12-point scale (p = 0.15). Mean interim listening comprehension scores (second cohort only, n = 25) increased from a baseline of 77 to 86% (p = 0.003). Proportions “passing” the listening comprehension test increased from 72 to 92% (p = 0.06).
DISCUSSION
We describe development of a longitudinal Spanish program within a medical school. Participation was associated with improved Spanish listening comprehension and no change in speaking proficiency.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Shin HB, Bruno R. Language use and English-speaking ability; US Census Bureau. October 2003.
Harlan LC, Bernstein AB, Kessler LG. Cervical cancer screening: who is not screened and why? Am J Public Health. 1991;81(7):885–90. Jul.
Greek AA, Kieckhefer GM, Kim H, Joesch JM, Baydar N. Family perceptions of the usual source of care among children with asthma by race/ethnicity, language, and family income. J Asthma. 2006;43(1):61–9. Jan-Feb.
Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med. 2005;20(9):800–6. Sep.
Morales LS, Cunningham WE, Brown JA, Liu H, Hays RD. Are Latinos less satisfied with communication by health care providers? J Gen Intern Med. 1999;14(7):409–17. Jul.
Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Med Care. 1988;26(12):1119–28. Dec.
Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA. 1996;275(10):783–8. Mar 13.
Lee LJ, Batal HA, Maselli JH, Kutner JS. Effect of Spanish interpretation method on patient satisfaction in an urban walk-in clinic. J Gen Intern Med. 2002;17(8):641–5. Aug.
Perez-Stable EJ, Napoles-Springer A, Miramontes JM. The effects of ethnicity and language on medical outcomes of patients with hypertension or diabetes. Med Care. 1997;35(12):1212–9. Dec.
Silberman P, Bazan-Manson A, Purves H, et al.. North Carolina Latino health, 2003. A report from the Latino Health Task Force. N C Med J. 2003;64(3):113–21. May-Jun.
Flores G, Mendoza FS. Dolor aqui? Fiebre?: a little knowledge requires caution. Arch Pediatr Adolesc Med. 2002;156(7):638–40. Jul.
US Census Bureau. Hispanic Population Passes 40 Million; Available at http://www.census.gov/ Accessed February, 2008.
Maben K, Dobbie A. Current practices in medical Spanish teaching in US medical schools. Family Med. 2005;37(9):613–4. Oct.
Nora LM, Daugherty SR, Mattis-Peterson A, Stevenson L, Goodman LJ. Improving cross-cultural skills of medical students through medical school-community partnerships. West J Med. 1994;161(2):144–7. Aug.
ALTA Language Services Inc. Spoken Language Evaluation (SLE)ä; More at http://www.altalang.com/. Accessed Feb 27, 2008.
Roosevelt C., ALTA Language Services, Inc. (personal communication); Nov 27, 2007.
Roosevelt C., ALTA Language Services (personal communication); level 6 on ALTA Spoken Language Evaluation (SLE) corresponds to level 2 on Interagency Roundtable (ILR) scale. More at: http://www.utm.edu/staff/globeg/ilrhome.shtml. Accessed Feb 27, 2008.
Cotton CE, Tolman EE, Cardona Mack J. A su salud. Cuaderno. New Haven, CT: Yale University Press; 2005:364.
National Library of Medicine. MedlinePlus en español; Available at http://medlineplus.gov/spanish/. Accessed Feb 27, 2008.
Prince D, Nelson M. Teaching Spanish to emergency medicine residents. Acad Emerg Med. 1995;2(1):32–6. discussion 6–7, Jan.
Flores G, Laws MB, Mayo SJ, et al.. Errors in medical interpretation and their potential clinical consequences in pediatric encounters. Pediatrics. 2003;111(1):6–14. Jan.
Burbano O’Leary SC, Federico S, Hampers LC. The truth about language barriers: one residency program’s experience. Pediatrics. 2003;111(5 Pt 1):e569–73. May.
Pilar Ortega Hernâandez MD. Spanish and the medical interview: a textbook for clinically relevant medical Spanish. Philadelphia: Saunders Elsevier; 2007:173. xiii.
Stewart AL, Napoles-Springer A, Perez-Stable EJ. Interpersonal processes of care in diverse populations. Milbank Q. 1999;77(3):305–39. 274.
Acknowledgements
The authors thank Dr. Beat Steiner for his encouragement and early work on this project. We also thank Drs. Marschall Runge and Cheryl McCartney for support during our efforts to obtain external funding. We thank Dr. Mike Pignone for his helpful comments. We thank the NRSA Primary Care Research fellows group for their feedback.
External financial support
Major project funding was provided by The Duke Endowment, Health Care division (all authors). Ms. Slatt and Dr. Alemán were also supported by the Bureau of Health Professions, D-56HP05213. Dr. Reuland was also supported by National Research Service Award Fellowship, T32 HP14001.
Prior presentations
Portions of this program description and interim findings were presented at the Society of General Internal Medicine meeting, Toronto, Ontario, Canada, April 26, 2007.
Conflicts of Interest
None disclosed. Note: ALTA Language Services, Inc. administered the language tests under a contract with our program. They provided technical advice about the administration and interpretation of language tests. They played no role in the design or funding of the program or in the decision to publish the results of the evaluation.
Human subjects statement
The University of North Carolina Biomedical Institutional Review Board approved this study. Written informed consent was obtained from all students who enrolled in the program.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Reuland, D.S., Frasier, P.Y., Slatt, L.M. et al. A Longitudinal Medical Spanish Program at One US Medical School. J GEN INTERN MED 23, 1033–1037 (2008). https://doi.org/10.1007/s11606-008-0598-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-008-0598-9