Improving linguistic and cultural competence in the health sector: a medical Spanish curriculum for resident physicians

Abstract

Existing medical Spanish curricula have improved language skills, but are incompatible with resident-physician schedules, and do not always integrate cultural education. A 2009 survey at our institution revealed that residents saw Spanish-speaking patients regularly and wanted a medical Spanish curriculum designed for them. Our objective was to improve medical Spanish and cultural competency among resident physicians at our institution. Kramsch's (1998) principle of combining language and cultural instruction, Gardner's (1983) theory of multiple intelligences, and the American Council for the Teaching of Foreign Languages 5Cs provided a framework for the self-directed curriculum, which consisted of nine-month long modules with online and in-person grammar, vocabulary, listening comprehension and conversation practice. We conducted pre-intervention, midterm and final assessments of language and cultural competency. We found moderate correlations between the number of modules completed and self-reported fluency, understanding of health-related cultural beliefs, and change in receptive language. While revisions are necessary, we found a self-directed resident medical Spanish curriculum, combining language and cultural instruction, to be feasible.

Los planes actuales de estudio de español para médicos que existen han contribuido a mejorar las habilidades lingüísticas del personal sanitario. Sin embargo, son en su mayor parte incompatibles con los horarios de los médicos residentes y frecuentemente no incluyen formación cultural. En 2009, una encuesta realizada en nuestra institución mostró que los médicos veían a pacientes hispanohablantes regularmente y deseaban un plan de estudio de español diseñado para ellos. Nuestro objetivo era mejorar el español médico y el entendimiento cultural de este grupo. El principio de Kramsch (1998) de combinar instrucción lingüística y formación cultural, la teoría de Gardner (1983) de las inteligencias múltiples, y las 5C del American Council for the Teaching of Foreign Languages nos guiaron para formar el plan de estudio, que consistía en nueve módulos de gramática, vocabulario y práctica de conversación en línea y en persona. Se llevaron a cabo evaluaciones de competencia lingüística y cultural preliminares, a mitad de programa y finales. Encontramos correlaciones moderadas entre el número de módulos completados y el nivel de fluidez reportado, la comprensión de las creencias culturales relacionadas con la salud, y la capacidad de entendimiento del lenguaje. Aunque el curso amerita revisiones, constatamos que el desarrollo de un currículum autogestionado de español para médicos residentes es factible.

Keywords:

• curriculum development
• non-traditional language learning environments
• medical Spanish
• cultural competence
• resident physicians
• health sector

Palabras clave:

• desarrollo curricular
• entornos no tradicionales de aprendizaje de idiomas
• español médico
• competencia cultural
• médicos residentes
• sector sanitario

Acknowledgements

The authors wish to thank Rosemarie Fisher, MD, Associate Dean of Graduate Medical Education at Yale School of Medicine; Alan Friedman, MD, President, Yale-New Haven Hospital Medical Staff; Celia Carvalho, Junta for Progressive Action, New Haven; Angela Frentress, Director, and Isabel Pachiarotti, Yale-New Haven Hospital Office of Interpreter Services; Constanza Bustamente; Ricardo Pérez-Truglia, PhD; and Sarah Gottfried, MD, MPH, Director, Yale Resident Spanish Initiative for their assistance with the design and implementation of the YRSI curriculum.

Disclosure statement

No potential conflict of interest was reported by the authors.