Abstract:

BACKGROUND: Language barriers are an important detriment to quality health care. After emergency department discharge, Spanish speaking patients are less likely than English speaking patients to understand their diagnosis, prescribed medications or follow‐up care and this same group is more likely to miss appointments and skip prescriptions. These patients express dissatisfaction with medical staff listening skills, getting questions answered, receiving explanations about medications, procedures or test results, and receiving reassurance and support from their care providers. Most concerning is that these patients may be at greater risk of serious medical errors as opposed to their English‐speaking counterparts. With the Hispanic/Spanish speaking population being the fastest growing in the U.S, a clear language and cultural gap has opened with regard to quality medical care.

OBJECTIVE: Bridge the gap with Spanish language education to reduce the incidence of health care disparities in Hispanic populations and improve patient care.

METHODS: We designed a novel, longitudinal 3-year curriculum for basic medical Spanish language acquisition for EM residents in the setting of a large Hispanic/Spanish speaking patient population in Tucson, Arizona. Primary outcome is resident proficiency in Spanish confirmed by annual language competency testing gauged on Interagency Language Roundtable (ILR) scale. Expected attainment is of One Plus (1+) level by year three. This endpoint is defined by whether speakers can initiate and maintain predictable face-to-face conversations and satisfy limited social demands.

Curriculum is longitudinal over their three years of residency and is integrated into their training. In their first year, residents are introduced to the program through a 1-day Spanish language immersion “boot-camp”. This is followed by didactics which encompass reading, listening, speaking, grammar, writing, and cultural understanding. This is supplemented with specific training in obtaining medical history, medications, describing signs and symptoms, and even complaint based patient role plays. A key aspect of their training is the use of Spanish in the clinical setting.

RESULTS: Ten Residents entered the program in July 2010. Baseline testing placed residents in a range on the ILR scale from 0- to one individual at 3+. After one year of immersion curriculum, 4 of 6 completing the post-testing raised their proficiency by at least one ILR level. 30% of these students had already attained the final benchmark of year 3 of ILR (1+) or above. Residents were also asked to describe how the curriculum related to their daily practice in our environment. Feedback was generally positive, with comments like “what I have learned has helped decrease the barrier between patient and doctor,” and “I learned the names of diseases and how they are treated in the Hispanic world.”

CONCLUSIONS: This is preliminary data concerning the success of a novel longitudinal curriculum for language acquisition in an EM residency. The program has demonstrated improved language fluency of our residents while educating them on the cultural nuances of their patients. Future goals are to assess the extent to which this program is aiding to bridge the language and cultural gap that is inherent in our environment, improving patient care.

Keywords:

Language Acquisition Medical Spanish.