Spanish for Medical Professionals Immersion Course

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Though it has been awhile since my last post, I would like to start off a new year of blog writing by promoting a Spanish for medical professionals immersion course that is being offered this summer in Oviedo, Spain. What makes this course unique is its focus not only on the language but also on cultural aspects that arise when working with Latino patients in the healthcare setting. As often discussed here in this blog, culture and beliefs can impact communication and health outcomes and are, thus, an important topic to include in medical Spanish classes.

Classes: Each day, students attend four hours of classes (Grammar and Vocabulary, Medical Terminology, Strategies for Good Communication in the Medical Interview, and Hispanic Culture: Beliefs and Myths in the Healthcare Setting), for a total of 80 classroom hours.

Practicum: Students will have the opportunity to work along side Spanish medical professionals, in order to practice and further internalize the knowledge and the skills they are learning. The practicum will be tailored to the academic level and experience of the professional.

Seminars: University of Oviedo is known for having one of the most prestigious medical schools in Spain. Students in the immersion course are invited to attend seminars offered by the medical school professors.

Cultural Activities: Extracurricular cultural activities are included to allow students to enjoy part of Spanish and Asturian culture while they are abroad. For example, students will visit the parts of Asturias such as the towns of Cangas de Onís and Covadonga as well as take a walk in the mountains to see the lakes of Covadonga. Another excursion will also be to León and Astorga so that students can experience more of Spain and Spanish culture.

Course Dates: The course runs from May 27th to June 23rd

Minimum Requirements: The course is open to all those who work in the healthcare field –or are studying to do so– and have at least an intermediate (B1) level of Spanish. Class sizes are limited in order to promote quality learning and group interaction. Registration closes February 15th.

For more information, you can access the course website here or check out the flier below.

Spanish for medical Professionals folleto final REV

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Literature Analysis on Dialect Variants at the CSIC

Today I am writing from Madrid where I am in the midst of my second research stay of the year, this time with the Centro Superior de Investigaciones Científicas (CSIC). The CSIC is the largest research center in Spain and the third largest in Europe. It is multidisciplinary and seeks to “develop and promote research that will help bring about scientific and technological progress”. Specifically, I am working from the Centro de Ciencias Humanas y Sociales in the department of language and discourse analysis.

What does this have to do with teaching medical Spanish?

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Language Laws and Limited English Proficiency

Last week, I discussed the existence of language laws and standards geared towards providing access to quality care for speakers with limited English proficiency (LEP). Though these statutes are not necessarily an aspect that should be taught to medical professionals other than interpreters, they are an important piece of knowledge for course instructors who may need to offer their students guidance. In this post, I will briefly describe the following law and standards as they apply to the context of LEP patients in the medical setting: Title VI of the Civil Rights Act of 1964, HHS Regulation on Implementing Title VI and Executive Order 13166. Of all the sources I have read or seen on the topic, the one I find best explains it is a 25 minute training video in which Paul Cushing, the regional manager of Region III for the Office of Civil Rights, explains the implications of Title VI for LEP individuals. The information in this post in summarized from that training and the video has also been embedded at the end of this post.

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Is knowing the laws related to language in healthcare important?

As I have mentioned, I was recently traveling around the southeast United States conducting and promoting my research in the area of medical Spanish. Though I had previously worked in the US health system with Latino patients, the opportunity to have contact with such a diverse variety of clinics across almost thirty cities allowed me to reflect more on some of the issues that I had previously dismissed. One of those aspects was the varying degrees of compliance among organizations regarding discrimination and language laws.

During the trip, I spent a good deal of time calling and visiting clinics. Those singled out to be contacted in our study were those that receive a high number of Latino patients (typically > 5% of their patient population being Latino). Due to LEP (Limited English Proficiency) related laws, one would thus expect to find a certain amount of language assistance being provided to that population. However, what I actually encountered was a wide range of familiarity and compliance with those laws. For example, some clinics took every effort to ensure equal care by posting all signs in English and Spanish, offering educational brochures in both languages, implementing a bilingual phone system, contracting bilingual staff, interpreters or language phone line services, and some even went so far as providing assistance programs such as the Navigators, which I wrote about a couple of weeks ago. Amongst the clinics offering at least some amount of language support, the quality of the what was provided ranged from those that pull bilingual staff from other duties to interpret to others that only allow certified interpreters to interact with the patients and do not even let Spanish-speaking doctors use their Spanish with the patients. 

In contrast, on the other end of the support spectrum, I came in contact with some clinics and even large hospital systems who, after stating they receive a significant hispanic population, admitted that they do not have interpreters nor bilingual staff but request that the patient bring a friend or family member. Some affirmed that they only contact a professional interpreter in more extreme cases. [For confidentiality reason, the states, counties and clinic names associated with each response are maintained anonymous.]  Some of the reasons cited for not providing language support include a recent increase in hispanic population in their area, the unavailability / inaccessibility of adequate language resources, the cost of implementing those services and the uncertainty around what percent of the patient population would need to be Spanish-speaking to require compliance with those laws.

Since the importance of doctor-patient communication and the noxious nature of a language barrier have been proven again and again, it is surprising to still see so much variety between clinics. On speaking with a few medical professionals about the issue, I found that, though most interpreters are very aware of the laws, many medical professionals and even clinic coordinators are not. Some are also confused as to the implications of the law, for example, what is considered adequate language support? Others believed that they were saving money by not complying, when in reality the opposite is often true. For those who run the clinic, the government makes the rules quite clear and even offers videos to explain some of these laws in more detail. Nonetheless, the question remains as to if it would be beneficial to teach medical professionals about these laws in Spanish for healthcare professionals courses. Though part of interpreter training includes learning these laws, it is something it is not something currently taught to medical professionals. This is probably due to the fact that it is the CEOs and clinic managers who make the decisions of what services they offer and also due to the fact that there is scarcely enough time to cover the language and cultural aspects during the course, much less touch on the complexity of the law. Additionally, even if there were time, it would be difficult for many of the professionals to see the point when they would rather their limited time and energy for outside of work education focused on learning to communicate well with the patient. For those reasons, I agree that it is probably not necessary to include this topic in the course, nevertheless, it is important that the instructor have a good idea of the laws in order to better respond to questions and promote abidance. For this reason, in the next post I will briefly discuss the following laws and standards as well as provide links to more information on each.

  • Title VI of the Civil Rights Act of 1964 along with the HHS Policy Guidance on how it affects persons with Limited English Proficiency
  • HHS Office of Minority Health´s National Standards on Culturally and Linguistically Appropriate Services in Healthcare
  • Executive Order 13166
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I have not forgotten you…

I apologize sincerely for the long absence. This spring has been very intensive between publication deadlines, research stays and conferences. However, that time has allowed me to learn more that will aid me in (hopefully) continually enriching the content of this blog. Though this post will serve mostly as an update regarding the two projects mentioned in previous posts for those who are interested, next week´s will be back to the regular content.

First, the research stay in the United States went well. This project sought to encourage medical professionals to participate in a survey on the use of Spanish dialect variants by Latino patients in the medical setting. The goal of the survey is to create a catalog of the variants that occur in this setting that includes indicators of frequency, importance and country of origin. This catalog could then be used both in reference material design and Spanish for medical professionals course development. Though the survey does not close until May 31st, as of yesterday170 individuals have signed up to take the survey. 

The second study that was being conducted in parallel looked at the use and effectiveness of medical Spanish reference materials. In the end, twenty-one medical professionals across the US participated in the survey for that study. The results of the survey and a proposal for a more effective reference system was presented in the AESLA (Asociación española de lingüística aplicada – Spanish association of applied linguistics) Conference in Sevilla two weeks ago. Though many of the responses reflected known weaknesses in current resources, one surprising need came up over and over again: the desire to be able to tailor the resource in such a way as to receive the most relevant responses to the provider´s setting first. For example, a provider working in OB-GYN could mark that specialty in their preferences and receive search results listed in order of relevance to that field. The proposed design takes into account this need along with the others mentioned in order to create a reference resource that can be more quickly and easily used in the medical setting. The paper version of the presentation will be published in May.

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Cultural and language support

I have now reached the halfway point of my research trip and have been so fortunate to not only have been met with a high level of interest in my project, but also to have had the honor of meeting so many different people and learning about a variety of programs and services offered for the Latino population. In previous posts, I have spoken about the difficulties, linguistically and culturally, in regards to accessing a healthcare system in another country. I have also described the challenges that different systems can present to newcomers. During this trip, I have enjoyed taking the opportunity to speak with some of the clinics and hospitals about how they are confronting these challenges. The responses have varied from relying solely on interpreter phone lines to implementing new programs and initiatives directed towards caring for this population. In this post, I will highlight one program that I found of particular interest and promise which also happens to be similar to one in which I worked in the past.

While working in a large medical center in North Carolina, I participated in a program directed at helping Latino immigrants understand and better access the services available to them . We also were attempting to prove that having this program not only resulted in better health outcomes but also cost savings for our medical center. Though we were able to prove this, due to various reasons, the study was never published.  However, another program in South Carolina connected with the University of South Carolina has created a similar program, though better structured, and is implementing it with great success. This is the “navigator program” taking place in Columbia and the surrounding area.

The purpose of the navigator program is to help connect Latinos with community resources and health services. Though they also can serve as interpreters when needed, that is not their main role.  As an example of their work, suppose a medical professional needs to help a new mother who cannot afford a breast pump to find one.  The medical professional can direct that mother to the navigator, who already has a resource list, and can help set the mother up with what she needs. The navigator can also help new immigrants to understand the health system: when to set up appointments for vaccines, when to go to urgent care, when to see their primary care physician, etc.

Having that kind of service available to clinics is key to better meeting the needs of Latino patients.  Interpreters are essential for overcoming the language barrier when medical professionals do not speak Spanish or do not know enough Spanish. They also often provide a cultural bridge between the doctor and the patient. Nevertheless, they are often limited in the involvement they are allowed to have by restrictions placed on the field.  The availability of someone whose primary role is not that of a language specialist but rather that of a resource specialist complements the interpreter or bilingual medical professional role by filling other gaps.  This person serves as a guide, an educator, a resource directory, and a cultural bridge. At the North Carolina medical center, we had one per clinic.  However, it seems to work well in the navigator program having one person for various clinics. Though the navigator study is still in progress and not yet published, I am looking forward to seeing the results. I feel that this program can help serve as a model design for other regions with large Hispanic populations. If and when the study is published, I plan to read through it and share the results on this blog.

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Certifications and Continuing Education

I have now been traveling around the United States promoting our survey (that I mentioned in last week´s post) for about a week now. It has been a wonderful experience to meet interpreters and bilingual medical professionals and share stories about our experiences. It seems that no matter where I go, we can all agree that the Latino community is culturally rich and diverse, leaving room for the constant need for continued learning. Unfortunately, the amount of continuing education materials and courses available is scarce.  To offset this insufficiency, some clinics have put into place their own continuing education systems. For example, the interpreters at one hospital write down all the words that they come across which are not as common (such as interpreting “jumping jacks” in physical therapy) and the list is sent out to the whole interpreting group on a weekly basis, after being vetted by the interpretive services coordinator. I would be interested in hearing if any readers have recommendations for continued learning. Please let me know in the comments!

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