Konexión Paciente: Redefining Medical Spanish Education for Spanish-Speaking Medical Students Through Patient-Based Simulation

Background and/or theoretical framework and importance to the field
The disproportionate lack of Spanish-speaking (SS) physicians in U.S. regions with many SS residents emphasizes the need for increased medical Spanish education. While many schools offer Medical Spanish courses, our co-curricular, simulation-based program (Konexión Paciente/KPAX) aims to optimize learner engagement and outcomes through longitudinal integrated design, provision of feedback using validated assessment instruments, and incorporating issues of equity and inclusion.

Design
KPAX is a student-designed optional program that complements the formal clinical skills curriculum. Learners participate in simulated Spanish-language patient encounters adapted from institutionally-validated, English curricular material. Students are assessed on linguistic adaptability, attention to health disparities, and empathy, in addition to clinical skills proficiency. Feedback is provided based on standardized patient checklists for Spanish-language communication, general communication, and task-specific clinical skills, as well as narrative comments from physician facilitators.

Outcomes
Students reported greater self-efficacy and comfort in SS encounters after participating in KPAX. Participants also scored significantly higher than nonparticipant peers on general communication skills in a subsequent English curricular OSCE encounter assessing clinical content addressed in a pilot KPAX session (p< 0.001), suggesting that program benefits may extend beyond language skills.

Innovation's strengths and limitations
KPAX provides opportunities to engage in higher-order language utilization and emphasizes patient-centeredness and linguistic/ethnocultural diversity in healthcare delivery. Further investigation is needed to address how baseline clinical skills proficiency affects acquisition of language-associated skills, as well as to define the developmental arc of Spanish-language care provision as a competency. The evolution of student performance on the assessment instruments over the course of the program is currently under investigation.

Feasibility and generalizability
KPAX empowers future clinician-leaders to care for the SS community. The program can be adapted for any language community at institutions with simulation capabilities, using existing curricular materials.

References
Dragan, A. The Importance of Addressing Linguistic Ethno‐cultural Diversity in the Delivery of Public Health Services: a Literature Review. 2009 Dec; Region of Peel Public Health. Accessed Oct 28, 2022. https://tinyurl.com/53hc9mhx.
Flores-Rodarte J, Topmiller M, Jabbarpour Y. Distribution of Spanish-Speaking Family Physicians, 2013-2019. Am Fam Physician. 2022 Jun;105(6):654-655. PMID: 35713629.
Marrast LM, Zallman L, Woolhandler S, Bor DH, McCormick D. Minority Physicians’ Role in the Care of Underserved Patients: Diversifying the Physician Workforce May Be Key in Addressing Health Disparities. JAMA Intern Med. 2014;174(2):289–291. doi:10.1001/jamainternmed.2013.12756
Ortega P, Pérez N, Robles B, Turmelle Y, Acosta D. Strategies for Teaching Linguistic Preparedness for Physicians: Medical Spanish and Global Linguistic Competence in Undergraduate Medical Education. Health Equity. 2019 Jul 1;3(1):312-318. doi: 10.1089/heq.2019.0029. PMID: 31294243; PMCID: PMC6615346.
Ortega P, Pérez N, Robles B, Turmelle Y, Acosta D. Teaching Medical Spanish to Improve Population Health: Evidence for Incorporating Language Education and Assessment in U.S. Medical Schools. Health Equity. 2019 Nov 1;3(1):557-566. doi: 10.1089/heq.2019.0028. PMID: 31701080; PMCID: PMC6830530.