Letters to the Editor
To the Editor:
Lion et al1 have confirmed what we feared for years—our desire to help patients by speaking Spanish could be harming them through our unwitting language errors. Our provision of peer-led medical Spanish classes at Loyola University Chicago Stritch School of Medicine heightened our sense of responsibility for ensuring students who learn medical Spanish use their new skills in a safe manner. Ultimately, we identified the need for a standardized Spanish Bilingual Medical Student Certification (Certification).2 Based on our experience, we offer a number of recommendations for developing a successful language credentialing system and cultivating the capacity to safely provide bilingual health care.
Credentialing programs must recognize that providing bilingual health care requires mastery of many complex skills. Our Certification starts with two phone exams ALTA Language Services, Inc. developed in collaboration with Kaiser Permanente which are recognized as standards for evaluating physicians’ and medical staff persons’ medical Spanish communication skills. However, the challenge of bilingual health care lies in the need to communicate with one’s patients in Spanish and coworkers in English while simultaneously employing the cognitive skills necessary to evaluate clinical information and make clinical decisions. Therefore, the final component of our Certification is a Spanish objective structured clinical exam in which students complete a history and physical in Spanish, document their findings in English, and develop a diagnostic and treatment plan. To acknowledge the mastery of these skills and facilitate recognition of these bilingual providers by both staff and patients, those who earn the Certification receive new identification tags which boldly state, “Hablo Español.”
We knew the Certification was an effective solution to language credentialing the first time a student failed after reporting using Spanish clinically on a daily basis. We knew it was a success the first time a student responded to the feedback after failing, completed remediation, and passed the exams. We saw the true power of the Certification as we witnessed a transformation in the culture of our medical center to one with a heightened commitment to providing language-concordant care to patients with limited English proficiency. Staff now challenge Spanish-speaking providers who do not display Certification identification tags. Likewise, staff who previously relied on ad hoc interpreters have become strong proponents of staff and phone interpreters.
Our Certification is one example of a standardized, comprehensive, and replicable approach to language credentialing. It provides evaluation and instruction, and it is available for all to access and implement. As such, it can serve as a model for universal medical Spanish credentialing. Most important, we hope that the recommendations we have offered based on our own experience will be helpful as others address this problem at their own institutions.
Katherine M. O’Rourke, MD
Resident physician, Department of Obstetrics and Gynecology, University of Wisconsin Hospitals and Clinics, Madison, Wisconsin; firstname.lastname@example.org.
Gregory Gruener, MD, MBA
Senior associate dean for medical education and professor, Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois.
1. Lion KC, Thompson DA, Cowden JD, et al. Clinical Spanish use and language proficiency testing among pediatric residents. Acad Med. 2013;88:1–7
2. O’Rourke K, Gruener G, Quinones D, Stratta E, Howell J. Spanish bilingual medical student certification. MedEdPORTAL. 2013 www.mededportal.org/publication/9400
. Accessed December 17, 2013