Medical Spanish Standardization in U.S. Medical Schools: Consensus Statement From a Multidisciplinary Expert Panel

Academic Medicine - Tập 95 Số 1 - Trang 22-31 - 2020
Pilar Ortega1, Lisa C. Diamond2, Marco A. Alemán3, Jaime Fatás-Cabeza4, Dalia Magaña5, Valeria Pazo6, Norma Pérez7, Jorge A. Girotti8, Elena Ríos9
1is clinical assistant professor, Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine, Chicago, Illinois; ORCID:.
2is assistant attending, Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Hospital Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York.
3is professor, Department of Medicine, University of North Carolina School of Medicine, and director, Comprehensive Advanced Medical Program of Spanish, Chapel Hill, North Carolina.
4is associate professor, Department of Spanish and Portuguese, and director, Undergraduate Translation and Interpretation Program, University of Arizona, Tucson, Arizona.
5is assistant professor, Department of Literature, Languages and Cultures, University of California, Merced, Merced, California.
6is instructor, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, and course director, Medical Spanish, Harvard University, Boston, Massachusetts.
7is director, School of Medicine Special Programs and Hispanic Center of Excellence, University of Texas Medical Branch, Galveston, Texas.
8is assistant professor, Department of Medical Education, and director, Hispanic Center of Excellence, University of Illinois College of Medicine, Chicago, Illinois.
9is president, National Hispanic Health Foundation, Washington, DC.

Tóm tắt

Medical Spanish (MS) education is in growing demand from U.S. medical students, providers, and health systems, but there are no standard recommendations for how to structure the curricula, evaluate programs, or assess provider performance or linguistic competence. This gap in medical education and assessment jeopardizes health care communication with Hispanic/Latino patients and poses significant quality and safety risks. The National Hispanic Health Foundation and University of Illinois College of Medicine convened a multidisciplinary expert panel in March 2018 to define national standards for the teaching and application of MS skills in patient–physician communication, establish curricular and competency guidelines for MS courses in medical schools, propose best practices for MS skill assessment and certification, and identify next steps needed for the implementation of the proposed national standards. Experts agreed on the following consensus recommendations: (1) create a Medical Spanish Taskforce to, among other things, define educational standards; (2) integrate MS educational initiatives with government-funded research and training efforts as a strategy to improve Hispanic/Latino health; (3) standardize core MS learner competencies; (4) propose a consensus core curricular structure for MS courses in medical schools; (5) assess MS learner skills through standardized patient encounters and develop a national certification exam; and (6) develop standardized evaluation and data collection processes for MS programs. MS education and assessment should be standardized and evaluated with a robust interinstitutional medical education research strategy that includes collaboration with multidisciplinary stakeholders to ensure linguistically appropriate care for the growing Spanish-speaking U.S. population.

Từ khóa


Tài liệu tham khảo

Deville, 2015, Diversity in graduate medical education in the United States by race, ethnicity, and sex, 2012., JAMA Intern Med, 175, 1706, 10.1001/jamainternmed.2015.4324

Morales, 2015, National survey of medical Spanish curriculum in U.S. medical schools., J Gen Intern Med, 30, 1434, 10.1007/s11606-015-3309-3

Reuland, 2008, A longitudinal medical Spanish program at one US medical school., J Gen Intern Med, 23, 1033, 10.1007/s11606-008-0598-9

Hardin, 2013, Medical Spanish programs in the United States: A critical review of published studies and a proposal of best practices., Teach Learn Med, 25, 306, 10.1080/10401334.2013.827974

Vela, 2016, Medical students’ experiences and perspectives on interpreting for LEP patients at two US medical schools., J Racial Ethn Health Disparities, 3, 245, 10.1007/s40615-015-0134-7

Flores, 2002, Dolor aquí? Fiebre?: A little knowledge requires caution., Arch Pediatr Adolesc Med, 156, 638, 10.1001/archpedi.156.7.638

Ortega, 2005, Longitudinal research in second language acquisition: Recent trends and future directions., Annu Rev Appl Linguist, 25, 26, 10.1017/S0267190505000024

Ortega, 2018, Spanish language concordance in U.S. medical care: A multifaceted challenge and call to action., Acad Med, 93, 1276, 10.1097/ACM.0000000000002307

2000, Improving access to services for persons with limited English proficiency. Executive Order 13166., Fed Regist, 65, 50119

Diamond, 2012, The use of Spanish language skills by physicians and nurses: Policy implications for teaching and testing., J Gen Intern Med, 27, 117, 10.1007/s11606-011-1779-5

Azar, 2012, Accuracy of data entry of patient race/ethnicity/ancestry and preferred spoken language in an ambulatory care setting., Health Serv Res, 47, 228, 10.1111/j.1475-6773.2011.01305.x

Ngo-Metzger, 2007, Providing high-quality care for limited English proficient patients: The importance of language concordance and interpreter use., J Gen Intern Med, 22, 324, 10.1007/s11606-007-0340-z

Diamond, 2010, Do hospitals measure up to the national culturally and linguistically appropriate services standards?, Med Care, 48, 1080, 10.1097/MLR.0b013e3181f380bc

2016, Nondiscrimination in health programs and activities. Final rule., Fed Regist, 81, 31376

Jaramillo, 2016, The Hispanic clinic for pediatric surgery: A model to improve parent-provider communication for Hispanic pediatric surgery patients., J Pediatr Surg, 51, 670, 10.1016/j.jpedsurg.2015.08.065

Parker, 2017, Association of patient-physician language concordance and glycemic control for limited-English proficiency Latinos with type 2 diabetes., JAMA Intern Med, 177, 380, 10.1001/jamainternmed.2016.8648

Fernández, 2017, Adherence to newly prescribed diabetes medications among insured Latino and white patients with diabetes., JAMA Intern Med, 177, 371, 10.1001/jamainternmed.2016.8653

Ortega, Physicians interrupting patients [published online ahead of print July 3, 2019]., J Gen Intern Med

Ortega, 2017, Evaluation of a medical Spanish elective for senior medical students: Improving outcomes through OSCE assessments., Med Sci Educ, 27, 329, 10.1007/s40670-017-0405-5

Diamond, 2014, Relationship between self-assessed and tested non-English-language proficiency among primary care providers., Med Care, 52, 435, 10.1097/MLR.0000000000000102

Englander, 2013, Toward a common taxonomy of competency domains for the health professions and competencies for physicians., Acad Med, 88, 1088, 10.1097/ACM.0b013e31829a3b2b

Ortega, 2019, Strategies for teaching linguistic preparedness for physicians: Medical Spanish and global linguistic competence in undergraduate medical education., Health Equity, 3, 312, 10.1089/heq.2019.0029

Pérez, 2018, Student acceptance of clinical conversational Spanish in medical curriculum., Cogent Med, 5, 1475691, 10.1080/2331205X.2018.1475691

Dawson, Spanish Acquisition Begets Enhanced Service (S.A.B.E.S.): A beginning-level medical Spanish curriculum., MedEdPORTAL

O’Rourke, Spanish bilingual medical student certification., MedEdPORTAL

Hardin, 2012, Targeting oral and cultural proficiency for medical personnel: An examination of current medical Spanish textbooks., Hispania, 95, 698, 10.1353/hpn.2012.0139

Chalabian, 1997, Standardized patients: A new method to assess the clinical skills of physicians., Best Pract Benchmarking Healthc, 2, 174

Diamond, 2019, A systematic review of the impact of patient-physician non-English languag e concordance on quality of care and outcomes., J Gen Intern Med, 34, 1591, 10.1007/s11606-019-04847-5