Medical Spanish Endocrinology Educational Module.

Introduction: Hispanic/Latinx patients experience health disparities in endocrine disease, such as higher rates of mortality due to diabetes mellitus, worse outcomes in the surgical treatment of thyroid cancer, and lack of knowledge about bone health and osteoporotic fracture prevention. Educational strategies to teach cultural and linguistic medical Spanish knowledge to medical students have the potential to improve Hispanic/Latinx endocrine health. Methods: We created an 8-hour medical Spanish endocrine module targeting language and cultural skills acquisition. Specifically, students practiced obtaining a past medical history, obtaining a medications history, providing and explaining a diagnosis, explaining discharge instructions, and discussing sociocultural aspects of endocrine health. We divided the module into four 2-hour sessions: (1) preclass self-study, (2) class period, (3) role-play/interviewing practice session, and (4) case/cultural activity assignment. Participants completed a pre- and postassessment to measure student confidence level and knowledge. Results: We implemented the module four times at one medical school, with 47 fourth-year medical students with intermediate or higher general Spanish skills. Confidence increased for all learners in the endocrine-focused interview and exam in Spanish. Heritage Spanish learners, who were exposed to Spanish at home as children, reported higher postmodule confidence in eliciting the past medical history of endocrine problems. Discussion: The medical Spanish endocrine module improved the communication skills of medical students with intermediate through advanced Spanish proficiency. Future study should evaluate learner clinical performance metrics and applications to other groups of learners, such as resident physicians or health professions involved in the care of patients with endocrine disease.

Bilingual diabetes workshop to improve Latinx care.

BACKGROUND: Linguistic and cultural discordance between clinicians and patients contributes to suboptimal care of Latinx patients with diabetes. Bilingual pedagogies may help learners with pre-existing Spanish skills to improve health communication with linguistic minorities. APPROACH: We designed a diabetes workshop for health professions students that applied the educational principles of bilingual pedagogies, focus on learners with prior Spanish skills, and intersectionality of language and culture. The session introduced diabetes concepts in Spanish and English, applied Latinx cultural beliefs to clinical conversations about diabetes and explored the impact of clinician language and cultural skills on diabetes-related communication. EVALUATION: Voluntary surveys evaluated learner knowledge, confidence and attitudes before and after the intervention. Of 60 attendees, 57 participants (95%) completed surveys. Comparison of pre and post responses yielded statistically significant increases in respondents' cultural knowledge and confidence in explaining diabetes concepts in Spanish (all p < 0.001). When controlling for Spanish level, most items still showed a significant improvement. Latinx and heritage learners were more likely to express lower confidence in explaining diabetes post-workshop (p < 0.05), suggesting an increased awareness of limitations. IMPLICATIONS: Bilingual educational interventions that emphasise culturally appropriate clinical skills may be an effective way to prepare health professions students who are heritage Spanish or second-language learners to better communicate with Latinx patients about diabetes. We provide actionable recommendations for clinical educators interested in incorporating communication skills training for linguistically diverse patient care.

Student and Faculty Diversity is Insufficient to Ensure High-Quality Medical Spanish Education in US Medical Schools.

Medical Spanish education aims to reduce linguistic barriers in healthcare and has historically been led by Hispanic/Latinx students and faculty, often without formal training or institutional support. We surveyed 158 US medical schools about their medical Spanish programs. We then examined national trends in Underrepresented in Medicine and Hispanic/Latinx faculty and students as factors associated with meeting medical Spanish basic standards for curricula, educators, assessment, and course credit. We received responses from 125 schools (79%), of which 98 (78%) reported offering some form of medical Spanish. Schools with greater racial/ethnic diversity were more likely to have medical Spanish required courses (P-values < 0.01) but not curricular electives. Overall, likelihood of meeting all basic standards did not differ by diversity characteristics. High-quality medical Spanish requires more than recruitment of diverse students and faculty. Institutions should prioritize meaningful inclusion by supporting evidence-based curricula and faculty educators.

Medical Spanish in US Medical Schools: a National Survey to Examine Existing Programs.

BACKGROUND: Most medical schools offer medical Spanish education to teach patient-physician communication skills with the growing Spanish-speaking population. Medical Spanish courses that lack basic standards of curricular structure, faculty educators, learner assessment, and institutional credit may increase student confidence without sufficiently improving skills, inadvertently exacerbating communication problems with linguistic minority patients. OBJECTIVE: To conduct a national environmental scan of US medical schools' medical Spanish educational efforts, examine to what extent existing efforts meet basic standards, and identify next steps in improving the quality of medical Spanish education. DESIGN: Data were collected from March to November 2019 using an IRB-exempt online 6-item primary and 14-item secondary survey. PARTICIPANTS: All deans of the Association of American Medical Colleges member US medical schools were invited to complete the primary survey. If a medical Spanish educator or leader was identified, that person was sent the secondary survey. MAIN MEASURES: The presence of medical Spanish educational programs and, when present, whether the programs met four basic standards: formal curricular structure, faculty educator, learner assessment, and course credit. KEY RESULTS: Seventy-nine percent of medical schools (125 out of 158) responded to either or both the primary and/or secondary surveys. Among participating schools, 78% (98/125) of medical schools offered medical Spanish programming; of those, 21% (21/98) met all basic standards. Likelihood of meeting all basic standards did not significantly differ by location, school size, or funding type. Fifty-four percent (53/98) report formal medical Spanish curricula, 69% (68/98) have faculty instructors, 57% (56/98) include post-course assessment, and 31% (30/98) provide course credit. CONCLUSIONS: Recommended next steps for medical schools include formalizing medical Spanish courses as electives or required curricula; hiring and/or training faculty educators; incorporating learner assessment; and granting credit for student course completion. Future studies should evaluate implementation strategies to establish best practice recommendations beyond basic standards.

Medical Spanish Musculoskeletal and Dermatologic Educational Module.

Introduction: While many medical schools provide opportunities in medical Spanish for medical students, schools often struggle with identifying a structured curriculum. The purpose of this module was to provide a flexible, organ system-based approach to teaching and learning musculoskeletal and dermatologic Spanish terminology, patient-centered communication skills, and sociocultural health contexts. Methods: An 8-hour educational module for medical students was created to teach musculoskeletal and dermatologic medical communication skills in Spanish within the Hispanic/Latinx cultural context. Participants included 47 fourth-year medical students at an urban medical school with a starting minimum Spanish proficiency at the intermediate level. Faculty provided individualized feedback on speaking, listening, and writing performance of medical Spanish skills, and learners completed a written pre- and postassessment testing skills pertaining to communication domains of vocabulary, grammar, and comprehension as well as self-reported confidence levels. Results: Students demonstrated improvement in vocabulary, grammar, comprehension, and self-confidence of musculoskeletal and dermatologic medical Spanish topics. While students with overall lower starting proficiency levels (intermediate) scored lower on the premodule assessment compared to higher proficiency students (advanced/native), the postmodule assessment did not show significant differences in skills performance among these groups. Discussion: An intermediate Spanish level prerequisite for this musculoskeletal and dermatologic module can result in skills improvement for all learners despite starting proficiency variability. Future study should evaluate learner clinical performance and integration of this module into other educational settings such as graduate medical education (e.g., orthopedic, rehabilitation, and dermatology residency programs) and other health professions (e.g., physical therapy and nursing).

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.

Investigating Group Differences in Examinees' Preparation for and Performance on the New MCAT Exam.

In 2015, the Medical College Admission Test (MCAT) was redesigned to better assess the concepts and reasoning skills students need to be ready for the medical school curriculum. During the new exam's design and rollout, careful attention was paid to the opportunities examinees had to learn the new content and their access to free and low-cost preparation resources. The design committee aimed to mitigate possible unintended effects of the redesign, specifically increasing historical mean group differences in MCAT scores for examinees from lower socioeconomic status (SES) backgrounds and races/ethnicities underrepresented in medicine compared with those from higher SES backgrounds and races/ethnicities not underrepresented in medicine.In this article, the authors describe the characteristics and scores of examinees who took the new MCAT exam in 2017 and compare those trends with historical ones from 2013, presenting evidence that the diversity and performance of examinees has remained stable even with the exam's redesign. They also describe the use of free and low-cost MCAT preparation resources and MCAT preparation courses for examinees from higher and lower SES backgrounds and who are enrolled in undergraduate institutions with more and fewer resources, showing that examinees from lower SES backgrounds and who attend institutions with fewer resources use many free and low-cost test preparation resources at lower rates than their peers. The authors conclude with a description of the next phase of this research: to gather qualitative and quantitative data about the preparation strategies, barriers, and needs of all examinees, but especially those from lower SES and underrepresented racial/ethnic backgrounds.

Evaluation of a Spanish Health Topics Course for Undergraduate Pre-health Latino Students.

INTRODUCTION:  Language concordance between doctors and patients and increased matriculation of underrepresented minorities in medical school are commonly cited goals of medical centers and medical schools in addressing health disparities for individuals with limited English proficiency. Pre-medical education may represent a high-yield untapped opportunity to address both through a Spanish Health Topics, or Temas de Salud, course for Latino pre-health students.  Methods: The authors implemented a longitudinal course for pre-health, Latino, undergraduate students to prepare them for success in bilingual health careers. The course included educational components of health knowledge, Spanish terminology, Hispanic/Latino sociocultural context, and exposure to medical learning formats presented during monthly sessions spread out over two years. A post-course survey with comfort and knowledge assessments was administered after each one-year cycle of the program.  Results: One hundred and sixteen students (57%) out of 203 course-participants responded to the Spanish Health Topics course survey. The student comfort level and self-perceived knowledge about specific health issues increased for both students of native-level Spanish and less advanced fluency, though a larger improvement was noted in several health topics for native speakers. Eighty-five percent of students reported perceiving the class to be useful for their future careers, and 92% of respondents indicated having applied learned concepts in social and/or academic settings outside of class. DISCUSSION:  Most students reported benefits of the course. Future studies should focus on a more detailed evaluation of enrolled students' knowledge, attitudes, confidence, and long-term retention compared to students in a standard premedical path. Temas de Salud may enhance the bilingual, bicultural skillset of Latino underrepresented minorities in medicine, and can be replicated at other institutions.

Evaluation of a Medical Spanish Elective for Senior Medical Students: Improving Outcomes through OSCE Assessments.

BACKGROUND: There is no standardized curriculum or assessment method that addresses Spanish skills in U.S. medical schools. The authors implemented a 10-week Clinical Medical Spanish elective for fourth-year medical students. METHODS: Data were collected for 58 students from 2013 to 2015 pertaining to pre- and post-course self-evaluation of Medical Spanish comfort level and Objective Structured Clinical Examinations. RESULTS: Student comfort level with Spanish-speaking patients improved for performing history and examination skills (P < 0.05). Standardized Patient (SP) and faculty-rated fluency were each higher than the student self-rated pre-course fluency (P < 0.001). Fluency levels were higher than the faculty rating of student ability to perform the medical interview (P < .001). DISCUSSION: Differences in student self-rating, SP scores, and faculty assessment illustrate the complexities of assessing medical skills in a second language, and highlight the importance of training and evaluating medical students and hospital staff in the appropriate use of Medical Spanish.

The Urban Medicine Program: Developing Physician-Leaders to Serve Underserved Urban Communities.

PURPOSE: Medical school graduates are poorly prepared to address health care inequities found in urban, underserved communities. The University of Illinois College of Medicine developed the Urban Medicine Program (UMed) to prepare students for the roles of advocate, researcher, policy maker, and culturally competent practitioner through a four-year curriculum integrating principles of public health with direct interventions in local, underserved communities. This study assessed the program's effectiveness and evaluated early outcomes. METHOD: The authors analyzed data for UMed students (graduating classes 2009-2013) from pre- and postseminar assessments and longitudinal community project progress reports. They also compared UMed and non-UMed outcomes from the same classes, using graduation data and data from two surveys: Medical Students' Attitudes Toward the Underserved (MSATU) and the Intercultural/Professional Assessment. RESULTS: UMed students were more likely than non-UMed students to endorse MSATU constructs ("Universal medical care is a right" [P = .01], "Access to basic medical care is a right" [P = .03], "Access is influenced by social determinants" [P = .03]); to be selected for the Gold Humanism Honor Society (P < .0001); to complete joint degrees (P < .0001); and to enter primary care residencies (P = .002). CONCLUSIONS: Early outcomes reveal that a longitudinal, experiential curriculum can provide students with competencies that may prepare them for leadership roles in advocacy, research, and policy making. Contact with diverse communities inculcates-in medical students with predispositions toward helping underserved populations-the self-efficacy and skills to positively influence underserved, urban communities.

Ensuring a fair and equitable selection of students to serve society's health care needs.

OBJECTIVES: This study aimed to evaluate a selection and programmatic intervention designated 'Conditional Admissions' (CA), which is intended to expand access to medical education for individuals from under-represented ethnic, racial and rural groups. Further aims were to establish principles of practice designed to increase access for under-represented groups based on an empirical comparison of programmatic changes made to CA in 2005, and to quantify the costs associated with its implementation. METHODS: Data for all students admitted between 1999 and 2009 (n = 3227) were compiled; these included demographic data, undergraduate college performance grades, medical school performance indicators, and information on honours, residency placement and md degree completion. To examine the outcomes of the CA intervention, students were divided into two cohorts of those admitted through the CA initiative during 1999-2004 and 2005-2009, respectively, and analysed for differences. Costs associated with CA were also calculated. RESULTS: There were 274 students admitted through CA (8.5% of all admittances) during 1999-2009; of these, 81.4% were from under-represented ethnic or racial backgrounds and 18.6% were from rural backgrounds. These students had more hours of science coursework, lower science and cumulative grade point averages (GPAs), and lower mean Medical College Admission Test (MCAT) scores than non-CA students. However, first-time pass rates and mean scores on the US Medical Licensing Examination (USMLE) Step 1 and USMLE Step 2 Clinical Knowledge increased significantly in the CA cohort during 2005-2009. Additional costs incurred per student ranged between US$849 and US$3801. CONCLUSIONS: Interventions such as CA can significantly increase diversity in the physician workforce. Interventions must be based on careful assessment of academic preparedness, as well as on non-academic factors that contribute to ability to successfully manage the rigors of medical education. Furthermore, the selection and subsequent professional development of students must nurture commitment to addressing the health care needs of diverse communities. Equity must be viewed as a means of increasing fairness for both prospective medical students and the residents of communities that may benefit from the eventual service.

The scope and variety of combined baccalaureate-MD programs in the United States.

The landscape of combined baccalaureate-MD programs has changed substantially in the last two decades but has not been documented in detail. The authors review the current state of these programs and discuss opportunities for future study of their evolving role and potential impact.In 2011, using a definition of baccalaureate-MD program built on prior research, the authors reviewed Association of American Medical Colleges sources and medical school Web sites to identify and characterize 81 active programs. In addition, they surveyed the 57 medical schools offering those programs; 31 schools with 39 programs responded. The resulting database inventories the number and distribution of programs; institutional affiliations; missions or goals; length; size; admissions criteria; curricula; and retention requirements.Since the inception of combined programs in 1961, their number and curricular length have increased. Pressures that spurred earlier programs remain evident in the goals of today's programs: attract talented high school or early college students, especially from diverse backgrounds; prepare physicians to meet societal needs; and offer an enriched premedical environment. Baccalaureate educational activities achieve program goals through special courses, medical experiences, community service, and learning communities tailored to students' needs. Admission and retention criteria are comparable to those of traditional medical schools.Combined baccalaureate-MD programs have evolved along several paths during the last half century and have enriched the baccalaureate experiences of medical students. Shifting expectations for the selection and education of future physicians warrant focused research on these programs to document their effectiveness in addressing those expectations.