Schmuter importantly highlights the value of medical Spanish courses in diversifying medical school curricula as part of the comprehensive “institutional commitment to diversity” proposed by Sklar.1 Enrolling medical students from diverse backgrounds must be complemented by curricula in which all students—and the residents and faculty they will become—can feel that their lived experience, identity, and skills are appreciated, nurtured, and promoted.
For many Hispanics/Latinos, speaking Spanish represents an important cultural inheritance that translates into a critical health communication skill. Review of medical student self-reported language proficiency data from 2013 shows that 95% of Latino students reported at least some Spanish skills and 84.5% reported native-level proficiency.2 Patient–physician language concordance improves patient outcomes,3 and strategies to attain this should include attaching institutional value to medical Spanish competencies and education.
Despite having these skills, underrepresented minorities have lower rates of career promotion and retention.4 Compounding the problem, medical Spanish courses often rely on minority students to initiate, promote, and teach, raising sustainability and quality concerns and potentially overburdening minorities. Further, students with preexisting Spanish skills may not have uniform proficiency and should reasonably expect their medical school to be equipped to help them improve and assess the medical communication skills that many intend to use with a large and growing subset of the U.S. population.
Language in health care—including medical education—should not be viewed as a “barrier” to be overcome5 but as an opportunity to enrich institutions and communication with diverse populations. The demand for curricular diversification often starts with medical students, such as Schmuter, but it should not end there. Institutionally driven medical Spanish curricular efforts support the valuable contributions of linguistic minority professionals that already (sometimes invisibly) walk the hallways of medicine.
Pilar Ortega, MD
Clinical assistant professor, Departments of Emergency Medicine and Medical Education, University of Illinois College of Medicine, Chicago, Illinois; POrtega1@uic.edu; Twitter: @pilarortegamd; ORCID: http://orcid.org/0000-0002-5136-1805.
1. Sklar DP. Diversity, fairness, and excellence: Three pillars of holistic admissions. Acad Med. 2019;94:453–455.
2. Diamond L, Grbic D, Genoff M, et al. Non-English-language proficiency of applicants to US residency programs. JAMA. 2014;312:2405–2407.
3. Diamond L, Izquierdo K, Canfield D, Matsoukas K, Gany F. A systematic review of the impact of patient-physician non-English language concordance on quality of care and outcomes. J Gen Intern Med. 2019;34:1591–1606.
4. Kaplan SE, Raj A, Carr PL, Terrin N, Breeze JL, Freund KM. Race/ethnicity and success in academic medicine: Findings from a longitudinal multi-institutional study. Acad Med. 2018;93:616–622.
5. Showstack R. Patients don’t have language barriers; the healthcare system does. Emerg Med J. 2019;36:580–581.