Assessing impact of Montefiore PCSIM Medical Spanish Curriculum

Assessing impact of Montefiore PCSIM Medical Spanish Curriculum Where do we go from here? Nathaniel Kratz, MD PGY-3 Mentor: Erin Goss, MD

Why Medical Spanish? • Bronx: 1 • • 35% of the population is foreign-born 55% of the population speak a language other than English at home. 46% of the population is Spanish-speaking 350, 000 (23%) of residents have limited English proficiency (LEP) • Overwhelming literature demonstrates correlation between limited English proficiency and poorer health outcomes • Conversely, better outcomes for LEP patients who have access to Culturally and Linguistically Appropriate Services 2 • Most medical providers at Montefiore do not come from the communities we serve 1 American Community Survey, 2014. 2 Culturally and Linguistically Appropriate Services (CLAS). US Health and Human Services Department.

PCSM Medical Spanish Curriculum • Four-week Medical Spanish language course for all incoming PGY-1 residents as a part of the core Social Medicine curriculum. • Tailored to incoming residents according to their self-identified Spanish language fluency level • Taught in partnership with El Taller Latino Americano, a communitybased non-profit arts and education organization

Questions • What is the impact of the curriculum on individual proficiency, selfawareness of that proficiency, and use of interpreters? • What tools are residents given in order to assess their own proficiency, and how close to reality (i. e. objective measure) are those self-assessments? • What are the attitudes of residents toward Medical Spanish and the curriculum? • What are ways this curriculum be improved?

Initial ideas for modifications to curriculum • Added role-playing exercises [implemented] • Adapted clinical scenarios from S. A. B. E. S. Medical Spanish curriculum (University of Denver medical school) [implemented] • Ethics of interpreter use [implemented] • OSCE [not yet implemented] • Interpreter certification [not yet implemented]

Investigation Pre- and Post-curriculum: • Survey • Attitudes and behaviors around interpreter use, value of Medical Spanish • Self-assessment of proficiency • Proficiency scale using linguistic levels established by the Interagency Language Roundtable (ILR) and Common European Framework of Reference (CEFR) • Computerized Oral Proficiency Instrument • • Validated objective assessment Uses same ILR/CEFR language scale as self-assessment Assess concordance with self-assessment Assess impact of curriculum on proficiency

Survey results: Background • 2018/19 class • 10 interns • 1 native Spanish speaker with training in Medical Spanish • 2 others with some level of Spanish spoken in the home (but not Medical) • Average academic/medical Spanish experience, 1. 7 years (range 0 -5 years)

Survey results: Subjective self-assessment Compared to pre-curriculum survey, post-curriculum survey showed: • Trend toward decreasing self-assessed linguistic proficiency level • Increased confidence in ability to identify situations where an interpreter should be used • Increase in self-reported use of interpreters

Objective test results: COPI • IT disaster!

Survey results: Attitudes • 100% would like an ongoing Medical Spanish curriculum throughout residency • 100% feel that Medical Spanish is an important part of the PCSIM curriculum • 100% plan to use Medical Spanish in their future careers • 77% feel that the curriculum needs improvement • 67% would like more clinical scenarios and role-playing

Qualitative: Self-assessment "The medical Spanish curriculum showed me that I was overestimating my own language proficiency before coming to residency. I realized that the gap in my knowledge was greater than I had previously thought. " "I don’t know if anyone is able to fully assess their own proficiency because it’s difficult to see your own blind spots. " "If you are not regularly speaking Spanish it can be difficult to know how proficient you are. " "I think that I definitely overestimated my ability to speak Spanish prior to arriving in residency. "

Qualitative: time "I would like the curriculum to be more frequent and continued throughout the three years in residency. " "I would recommend that it goes beyond PGY-1" "I think more time needed to be allotted for the curriculum. " ". . . we should do medical Spanish like the psychosocial curriculum in which we have sessions once a week with homework. " "I think the primary deficit in the current curriculum is that it is short on time. " "I don't think I progressed Significantly in my medical Spanish given limited time. "

Take-aways • Ability to communicate in Spanish is incredibly important for our patient population • There is a strong desire on part of residents to learn and use Medical Spanish now and in their future careers • Not enough time is dedicated to the curriculum • Curriculum is valuable for residents, but achieving a linguistically and culturally competent workforce will actually depend on recruitment • Spanish proficiency/fluency as a requisite?