Recognizing and Dismantling Raciolinguistic Hierarchies in Latinx Health.

Latinx individuals represent a linguistically and racially diverse, growing US patient population. Raciolinguistics considers intersections of language and race, prioritizes lived experiences of non-English speakers, and can help clinicians more deftly conceptualize heterogeneity and complexity in Latinx health experiences. This article discusses how raciolinguistic hierarchies (ie, practices of attaching social value to some languages but not others) can undermine the quality of Latinx patients' health experiences. This article also offers language-appropriate clinical and educational strategies for promoting health equity.

Las personas latinx representan una creciente población estadounidense diversa de pacientes desde el punto de vista lingüístico y racial. La raciolingüística considera las interrelaciones del idioma y la raza, prioriza las experiencias vividas de personas que no hablan inglés y puede ayudar a los médicos a conceptualizar de manera más hábil la heterogeneidad y la complejidad en las experiencias de salud de latinx. Este artículo analiza cómo las jerarquías raciolingüísticas (es decir, las prácticas de otorgar valor social a algunos idiomas, pero no a otros) pueden socavar la calidad de la experiencia sanitaria de los pacientes latinx. Este artículo también ofrece estrategias clínicas y educativas adecuadas al lenguaje para promover la equidad sanitaria.

Novel academic center model for Spanish-speaking patients in the southeastern United States.

Latinos form the largest U.S. minority and will account for one quarter of the population by 2050. Immigration trends from 1995-2010 challenged health systems in "new destination" regions such as the southeastern U.S., with Latino population increases of 200-400%, and a minimal bilingual health workforce. Academic medical centers and safety net hospitals are challenged to respond beyond the interpreter paradigm of care delivery to provide efficient, cost-effective and compassionate care that complies with the U.S. Title VI mandates. We describe the design and successful implementation of an academic model in the care of Spanish-speaking patients in the pediatric and adult primary care and subspecialty settings in the University of North Carolina Health Care System. This model leverages a limited bilingual workforce to maximize the extent and quality of language-concordant care for this population The innovative features of the UNC Center for Latino Health (CELAH) is based upon five principles: patient navigation, a medical home, a block-scheduling system, a "virtual clinic" model using existing space, and leveraged cost-neutral resources. Patients are scheduled to specific half-day sessions in specialty clinics and matched with bilingual faculty and staff. This facilitates door-to-door care in Spanish for patients, the majority of whom are immigrants from rural Mexico and Central America with limited English and health literacy. CELAH is considered an academic transition model in anticipation of an adequate bilingual health workforce in 1-2 decades. As a hub, this clinical platform supports unique programs in medical education, translational and health equity research, community outreach, and faculty engagement.

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

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.

Effect of Spanish language immersion rotations on medical student Spanish fluency.

BACKGROUND AND OBJECTIVES: The study's objective was to determine whether participation in an international health rotation in a Spanish-speaking country (immersion) is associated with improved Spanish fluency compared to participation in domestic medical Spanish coursework alone. METHODS: Participants matriculated at one US medical school in the years 2004--2008. At matriculation (baseline), all had intermediate to advanced Spanish fluency based on a standardized, oral fluency test. All took didactic coursework in years 1 and 2 of medical school. Some elected to participate in a post-year 1 immersion rotation in a Spanish-speaking Latin American country. Oral fluency was reassessed using the same method in years 2 and 4 by independent evaluators who were blind to individuals' immersion participation status and prior fluency scores. The authors compared participants' likelihood of demonstrating greater Spanish fluency over baseline among those who did post-year 1 immersion versus those who did US-based coursework alone (controls). RESULTS: The likelihood of having greater Spanish fluency at the second-year assessment was 80% (45/56) among immersion participants, compared with 46% (21/46) for controls. The likelihood of having increased fluency at the fourth-year assessment was 65% (13/20) among those who did immersion versus 28% (7/25) for controls. Odds of having improved fluency for immersion participants remained statistically significantly higher after adjusting for baseline fluency (AOR [95%CI]=4.3 [1.7, 10.6], at year 2 and 5.1 [1.2, 21.6], at year 4). CONCLUSIONS: Among medical students with intermediate to advanced baseline Spanish fluency, participants in a post-year 1 Spanish language international health immersion rotation were more likely to improve their Spanish fluency than participants in US-based coursework alone.

Accuracy of self-assessed Spanish fluency in medical students.

BACKGROUND: Non-English language fluency is increasingly important in patient care. Fluency self-assessment is easily obtained, but its accuracy is unknown. PURPOSES: The purpose is to determine accuracy of medical students' self-assessed Spanish fluency. METHODS: Four matriculating classes assessed their own oral fluency as ("none":"novice";"intermediate";"advanced";"native-speaker"). Participants who rated themselves greater than "novice" and who expressed interest in medical Spanish coursework took a standardized fluency test (Spoken Language Evaluation, scaled 1-12). Using predetermined test categories (1-5 = novice, 6-8 = intermediate, 9-12 = advanced/native), we determined the predictive value of self-assessment for predicting the same or greater fluency on the test. RESULTS: Of 102 participants, 12 (12%) tested below their self-assessed level, 77 (75%) tested at their self-assessed level, and 13 (13%) tested above. The predictive value of self-assessment for having at least that fluency level was 88% (95% CI = 80, 94). CONCLUSIONS: In medical students reporting greater than "novice" capability and interest in medical Spanish coursework, fluency self-assessment was a good indicator of scores on a standardized fluency test.

A longitudinal medical Spanish program at one US medical school.

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.