The Development of a Formalized Medical Spanish Program

1
The Development of a Formalized Medical Spanish
Program for Mount Sinai Medical
Students Jonathan Hausmann, Stefan Kénel-Pierre,
Alon Seifan, Gabriela Soriano, and Ryan
Ungaro Mount Sinai School of Medicine, New York,
NY 10029
INTRODUCTION
SUMMER PILOT PROJECT
SECOND-YEAR STUDENTS

• First Semester Medical Spanish Elective
• 56, out of 120 students in second-year class,
  enrolled in the elective.
• The 30-hour elective includes a combination of
  classes and clinical experiences with
  Spanish-speaking patients.
• Beginner, Intermediate, and Advanced classes
  offered with 20 students per class
• Beginners/Intermediates
• 24 hours of class
• 6 hours of clinical experiences
• Advanced
• 18 hours of class
• 12 hours of clinical experiences

• The Mount Sinai Medical Center and its
  affiliated hospitals serve a large Latino
  population.
• As part of their clinical training, medical
  students rotate through these hospitals and often
  encounter Spanish-speaking patients. However, a
  majority of medical students are not proficient
  in Spanish.
• It is not clear to what extent these language
  barriers affect the delivery of medical care and
  the clinical education of medical students.
• Medicina en Español, a student-run group, was
  created to address these issues by improving
  student proficiency in Spanish and creating
  cultural awareness. In the past year, these
  efforts have intensified to integrate solutions
  into the medical school curriculum.

• An eight-week Medical Spanish pilot course,
  funded by the Center for Multicultural and
  Community Affairs, was designed and offered to
  medical students during summer 2005.
• Classes were taught by Primera Languages, a
  company that specializes in teaching Spanish to
  professionals.
• The curriculum was systems-based with a focus on
  conversational Spanish, grammar, medical
  vocabulary, and the medical history.
• Topics included those covered in the first-year
  clinical skills class, The Art and Science of
  Medicine I (ASM).

OBJECTIVES

• Assess the frequency of medical student clinical
  encounters with Spanish-speaking patients.
• Determine the perceived need for and student
  interest in medical Spanish training.
• Create and evaluate a summer pilot course
  designed to meet this need, and use it as a model
  for future programs.
• Develop a 4-year medical Spanish program that
  parallels the medical school curriculum.

• Written examinations were administered at the
  beginning and end of the course in order to track
  Spanish level progress. Students were rated on a
  scale from 1-10, 1no Spanish, 10fluent, based
  on exams and class performance (Figure 3).
• Student feedback, including critique of class and
  self-evaluation, was collected at the end of the
  course (Figure 4).
• 91 of students rated the class as Very
  Good/Excellent.

NEEDS ASSESSMENT

• Second Semester Immersion Weekends
• Intensive Spanish immersion weekends will be
  offered to prepare students for their clerkships.
  Classes will include a thorough review of the
  history and physical exam in Spanish, with a
  strong emphasis in communication skills.

FIRST-YEAR SURVEY

• 102 students of the class of 2008 answered a
  survey via email (85 response rate).
• 88 of respondents believed that Spanish
  language should be a component of Mount Sinais
  medical school curriculum.
• 82 of students believe that Spanish language is
  currently underrepresented in the Mount Sinai
  curriculum.
• 78 of those surveyed expressed interest in
  taking a medical Spanish elective during the
  semester.

CONCLUSIONS AND FUTURE DIRECTIONS

• Mount Sinai students regularly serve
  Spanish-speaking patients during their clinical
  encounters, even though most students are not
  proficient in the language. This may have
  negative impacts on patient care and student
  learning. Students have shown an overwhelming
  interest in learning Spanish, and our classes
  have proven to be effective in improving
  competency in communicating in Spanish. In light
  of this information, we plan to integrate medical
  Spanish into the curriculum as follows
• Establishment of a formal medical Spanish program
• Development of a four-year program that
  parallels and supplements the medical school
  curriculum.
• Medical school support
• Successful long-term implementation will require
  further support from the medical school including
  significant logistical, administrative, and
  financial backing.
• Certificate program
• Students who successfully complete the necessary
  requirements (Figure 6) will receive a
  certificate of completion and formal recognition
  in their Deans Letter.
• Distinction track in Culture and Communication
• Intended to recognize students who, in addition
  to earning the certificate, complete a project
  that addresses cultural or communication barriers
  in healthcare delivery.
• Distinguishing Mount Sinai School of Medicine and
  its graduates
• It is the intention of this program to aid the
  school in its mission to create graduates who are
  not only highly skilled but also culturally
  competent and compassionate caregivers

FOURTH-YEAR SURVEY

• Thirty-five students of the class of 2005
  responded to an email survey.
• 60 of respondents classified their Spanish
  proficiency level as None/Understand a Little
  (low proficiency, LP), while 37 considered
  themselves as Proficient/Fluent (high
  proficiency, HP).
• 77 of students reported they Often/Always
  encountered Spanish-speaking patients during
  their required clinical rotations, regardless of
  the students level of Spanish proficiency.
• Students with LP were significantly more likely
  to avoid encounters with Spanish-speaking
  patients than HP students because of the language
  barrier (86 vs. 46, plt0.05).
• LP students were significantly less likely to be
  involved in administering consent forms (19 vs
  92, plt0.05) and discussing bad news with Spanish
  speaking patients than HP students (5 vs. 77,
  plt0.05).
• 86 of respondents agreed that it would have been
  beneficial to have taken a Mount Sinai medical
  Spanish elective during medical school.

FIGURE 4 - Students self-reported competency in
communicating in Spanish, before and after taking
the summer course.
FIGURE 3 - Individual students Spanish level
assessment before and after taking the summer
program
CURRENT MEDICAL SPANISH PROGRAM

• Based on the success of the summer program and
  on student interest in learning medical Spanish,
  a full-year curriculum was developed for first
  and second-year students.
• The current program parallels the topics covered
  in ASM I and II that relate to the medical
  history and physical exam, and will also include
  cultural topics relevant to the clinical
  encounter.
• First-semester classes were funded by the Mount
  Sinai Alumni Association and the East Harlem
  Health Outreach Partnership (EHHOP). Funding for
  the second semester elective will be provided by
  the Arnold P. Gold Foundation.

FIRST-YEAR STUDENTS

• First Semester Spanish Enrichment Class
• Beginner and Intermediate classes focused on
  basic Spanish grammar and vocabulary.
• 15 hours of class taught by Primera Languages.
• 80 students applied to take the class, but lack
  of space permitted only 40 students to enroll.
  Students with little knowledge of Spanish were
  chosen to take the class.
• Second Semester Medical Spanish Elective
• Three levels will be offered.
• Class will parallel topics covered in ASM I.
  Clinical experiences with Spanish-speaking
  patients will be a required part of the elective.

FIGURE 1 - Level of agreement with statement I
was able to understand/convey medical information
to Spanish-speaking patients of 4th year
students with different levels of proficiency.
Small improvements in language proficiency showed
statistically significant improvements in the
ability to convey medical information to
patients.
Special Thanks to Monique Hardin-Cordero, The
Center for Community and Multicultural Affairs,
The Mount Sinai Alumni Association, East Harlem
Health Outreach Partnership, The Arnold P. Gold
Foundation, The Mount Sinai Student Council, Dr.
Rainier Soriano, Dr. Valerie Parkas, Dr. Edward
Poliandro, and Judith Quintana.