This elective will be offered

September 09 – September 21, 2024

February 17 – March 01, 2025

PREREQUISITES AND PLACEMENT IN THE CURRICULUM:
Third- or Fourth-year medical students with a conversational Spanish level of approximately Fair or above by self-assessment chart below. This is equivalent to a low-intermediate general Spanish-speaking ability. Students who are unsure of Spanish level or feel they are borderline to pre-qualify should contact faculty instructor directly to determine appropriateness.

PURPOSE:
The purpose of the course is to increase medical student comfort level with Spanish-language interviews, examination, and patient education. It will provide ample experience in live and simulated Spanish patient interviews, supervision of interview styles and Spanish-language skills, discussion of common diagnosis, procedural consent, treatment plans, and patient education in Spanish to empower medical students to practice medicine with the nationally growing monolingual Spanish-speaking patient population.

Please select which of the following best describes your current level of general Spanish fluency.

Level, from Adapted International Language Roundtable (ILR) Scale for Physicians

• Excellent –  Speaks proficiently, equivalent to that of an educated speaker, and is skilled at incorporating appropriate medical terminology and concepts into communication. Has complete fluency in the language such that speech in all levels is fully accepted by educated native speakers in all its features, including breadth of vocabulary and idioms, colloquialisms, and pertinent cultural references.
• Very Good – Able to use the language fluently and accurately on all levels related to work needs in a healthcare setting. Can understand and participate in any conversation withing the range of his/her experience with a high degree of fluency and precision of vocabulary. Unaffected by rate of speech. Language ability only rarely hinders him/her in performing at task requiring language; yet, the individual would seldom be perceived as a native.
• Good – Able to speak the language with sufficient accuracy and vocabulary to have effective formal and informal conversations on most familiar topics. Although cultural references, proverbs and the implications of nuances and idiom may not be fully understood, the individual can easily repair the conversation. May have some difficulty communicating necessary health concepts.
• Fair – Meets basic conversational needs. Able to understand and respond to simple questions. Can handle casual conversation about work, school, and family. Has difficulty with vocabulary and grammar. The individual can get the gist of most everyday conversations but has difficulty communicating about healthcare concepts.
• Poor – Satisfies elementary needs and minimum courtesy requirements. Able to understand and respond to 2-3 word entry level questions. May require slow speech and repetition to understand. Unable to understand or communicate most healthcare concepts.
• None – Has minimal to no Spanish conversational abilities.

LEARNING OUTCOMES:
At the conclusion of the course, students will be able to:

• Demonstrate the conversational Spanish skills necessary to introduce him/herself to the  patient and confirm the patient’s identity and chief complaint.
• Conduct a history of present illness in Spanish.
• Conduct relevant review of systems in Spanish.
• Conduct relevant ancillary medical history (medical, surgical, social, sexual, and family histories) in Spanish.
• Elicit the patient’s medication list and allergy history in Spanish.
• Comprehend the historical information provided by the patient in Spanish. This will be a building skill and the ultimate level of comprehension achieved at the conclusion of the course will vary slightly by student based on their starting-point conversational Spanish level. The goal for each student will be increased exposure to and practice with Spanish-language patient interviews such that their comprehension level goes up by one level (see self-assessment language skills chart above).
• Construct appropriate Spanish follow-up questions to the patient’s responses to initial HPI questions.
• Construct appropriate Spanish responses to the patient’s questions in the course of the encounter.
• Synthesize the historical information provided in Spanish into a working differential diagnosis.
• Develop an appropriate diagnostic testing plan and/or treatment plan for the patient.
• Describe a plan of care to the patient in Spanish.
• Motivate patient compliance by providing culturally- and linguistically-sensitive arrangements for treatment options, informational resources, and follow-up care.
• Perform increasingly complex Spanish patient interviews and complete case write-up documenting the relevant parts of the history obtained and present case to faculty.
• Self-assess his/her own Medical Spanish communication skills.
• Identify and acknowledge his/her limitations in performing a patient interview in Spanish.
• Recognize when help is needed and seek help from a professional interpreter or other appropriate language resources.
• Identify areas for improvement in his/her Medical Spanish skill set.
• Demonstrate skill-improvement from mid-course Standardized Patient (SP) experience to end-course SP experience.
• Develop Spanish patient-education materials on culturally-relevant health topics.

TARGETED GRADUATION COMPETENCIES:
Patient Care – All patient care graduation competencies are addressed in this course as regards the care of monolingual or primarily Spanish-speaking patients. The course builds on the third or fourth year medical student’s pre-existing medical knowledge base in English and adds the relevant Spanish vocabulary and Hispanic/Latino cultural information to provide appropriate patient care.

1.  Obtain a medical history in Spanish appropriate to the patient’s medical concerns.
2. Perform a skillful physical examination giving appropriate Spanish instructions for parts of exam requiring patient cooperation, warning prior to exposing or palpating parts of the body, and feedback regarding examination results.
3. Formulate a differential diagnosis and problem list. This requires Spanish-listening comprehension of the provided patient history and an understanding of the patient’s complaints in a cultural context.
4. Perform, order, and interpret diagnostic investigations that result in accurate diagnosis and treatment. This course does not involve direct patient care; however the patient interviews performed and case presentations that follow will be reviewed with respect to suggested diagnostic evaluation and a discussion of the ordered tests with the patient.
5. Utilize data to reason and solve problems. In particular, this will be discussed within cultural context.
6. Develop management and therapeutic plans. We will focus on discussing management plans with patient and obtaining informed consent.
7. Consider cultural and socioeconomic factors in management options, in particular with respect to Hispanic cultural, immigration, and health issues.
8. Form an effective therapeutic relationship with Hispanic/Latino patients, in particular those who are predominantly Spanish-speaking.
9. Counsel and educate patients and their families in Spanish.
10. Apply the principles of epidemiology and evidence-based medicine and be able to discuss these concepts as appropriate with patients to guide their management.d problem list. This requires Spanish-listening comprehension of the provided patient history and an understanding of the patient’s complaints in a cultural context.

Medical Knowledge
The course will focus on the application of medical knowledge to clinical cases as discussed in Spanish. Special attention will be paid to medical conditions that are more prevalent in Hispanic/Latino populations.

1. Scientific principles of basic and clinical sciences that will enable him/her to competently practice evidence-based medicine. In particular, medical vocabulary will be learned in Spanish to allow the student to competently understand and discuss medical topics with Spanish-speaking patients.
2. Determinants of poor health, disease-based risk factors, factors for disease prevention and healthy lifestyles (principles of preventive medicine) will be reviewed in Spanish.
3. Elements of health education; Students will each put together 2 patient health education presentations and listen to those of their peers. This will give them an arsenal of patient health education topics and vocabulary to use in clinical practice.
4. Principles of epidemiology and population-based medicine will be learned and discussed as apply primarily to Hispanic/Latino patient populations.
5. Principles, risks, and possible benefits of complementary and alternative medicine, as applies to Hispanic/Latino patient populations.
6. Cultural factors important to health care in Hispanic/Latino patient populations.
7. Relevant legal and ethical concepts in the care of Hispanic/Latino patients.

Practice-based Learning and Improvement
This is a critical skill in a language course to enable the student to accurately self-assess and accept constructive feedback regarding his/her abilities to enable safe, competent patient care in the student’s non-native language (i.e., Spanish).

Heritage speakers who grew up fully or partially speaking Spanish also benefit from learning to apply Spanish skills to medical contexts.

1. Sets clear learning goals, pursues them, and continuously integrates knowledge gained and applies it to improve medical care. Each student will complete a pre-course assessment evaluation to help them to understand their pre-course general and medical Spanish competency and their personal objectives for improvement.
2. Assesses his/her strengths and weaknesses in order to improve performance and identify effective ways to address limitations and enhance expertise. This will be done at various intervals throughout the course in an informal way, and a formal self-re-evaluation will be done at the time of mid-course Standardized Patient encounter as well as at the end of the course.
3. Accesses information effectively, efficiently, critically appraises the information and relates it to their patients’ health problems.
4. Admits his/her limits of knowledge, knows what to do when those limits are reached, can deal with uncertainty, and respects the opinions of others. Knowledge limitation with regard to language competency will be particularly reviewed, such as when the student may require an interpreter for appropriate completion of an interview or patient education.

Interpersonal and Communication Skills
The crux of the course is to help the student to optimize his/her interpersonal Spanish clinical skills and patient communication.

1. Listens attentively and comprehends Spanish-speaking patient history and questions.
2. Communicates clearly with patients and patients’ families both orally and in writing in Spanish, and is able to interpret the information interchanged adequately to then communicate a complete case presentation or consultation question with other clinicians and supervising physicians.

Professionalism
Students will learn and practice professionalism as regards to culturally acceptable physician-patient relationship with patients and family of Hispanic/Latino backgrounds. In addition, learning to practice medicine in Spanish will preserve the integrity of the physician-patient relationship in its most confidential form, with less need for a third-party interpreter. Professionalism in self-recognition of language limitations and understanding how to work with medical interpreters will also be incorporated into the course as a critical skill.

1. Provides leadership in patient care, while respecting the views and interests of all members of the health care team, the patient and patient’s family;
2. Maintains and respects patient confidentiality, and is aware of the unique doctor/ patient relationship;
3. Knows and admits to his/her limits of knowledge;

System-based Practice
Students will learn to provide patient care in the larger context of the Hispanic/Latino community health, to consider and learn to access community resources, to access language-assistance resources such as interpreting services when necessary, and to identify the important legal and professional requirements relevant to non-English speaking patient care.

1. Defines health in terms of the Hispanic/Latino community in which the patient lives.
2. Evaluates and integrates community resources into the health maintenance of individual patients and their families such as alternative medicine or spiritual resources used commonly in the Hispanic/Latino community.
3. Assesses the effect of the physical environment on community health, such as limited access to nutritious food and health-care providers.
4. Understands key legal concepts and is aware of professional requirements governing medical practice as relevant to non-English speaking patients.
   
   

INSTRUCTIONAL METHOD:
Course Time-commitment and hours per week:
2-week intensive course, approximately 80 hrs. total time commitment

Lectures/Conferences/Faculty hours per wk: 15 weekly hours total (10 hours lecture, 5 hours language practice and role-play)
Independent Study hours per wk: 25 hours total (12 hours textbook study/exercises, 4 hours practice/live-patient interviews. 5 hours case write-up, 4 hours cultural study)
Evaluation 2 weekly hours (Mid-elective evaluation: SP encounter; Final evaluation: SP encounter)

Description of Learning Activities:

1)  Lectures: Each lecture will focus on a specific organ system, divided as follows – Musculoskeletal, Cardiovascular, Pulmonary, Gastrointestinal, Endocrine, Genitourinary/Obstetrics, Ear/Nose/Throat, Neurologic, Psychiatric, and Pediatrics. Each session will begin with a review of pertaining anatomy, history-taking of common related chief complaints, and relevant physical examination. We will then learn common medications, diagnostic studies, and care instructions in Spanish to facilitate patient education and informed consent. Learning methods during class-time will include brief lectures, large-group discussions of related cultural topics, small-group practice exercises, role-play activities, and simulated patient encounters.

2) Language practice: Each language practice session will be an “immersion” opportunity for students to focus on a particular health topic related to the lecture and have a discussion in Spanish together. They will also practice role-playing patient cases with each other under faculty supervision. In addition, during this time, while the students are practicing their language skills with each other, the instructor will be reviewing their case write-ups and will provide immediate corrections and feedback on an individual basis to each learner.

3) Preparation SP and Real-patient encounters will consist of pairs of students arranging designated practice time to role play patient encounters with each other. Students will be come up with relevant cases to each week’s topic, develop the case and act as the patient for the other student to interview, and vice versa. This is expected to take at least 2 hours per week which the students can arrange on their own time, with the exception of two of their meetings over the duration of the course, which will be directly supervised by the faculty instructor. During the supervised meetings, the student pairs will role play one of their cases with the faculty instructor in order to receive direct feedback prior to the mid-course SP encounter, and a second case for a supervised session prior to the end-course evaluation. This will help the students prepare and succeed in their SP and Real-patient interviews.

4) Standardized Patient Encounters: A mid-course encounter an end-course encounter around will be completed by each student at the Clinical Performance Center with a Spanish-speaking Standardized Patient (SP). These will be directly supervised by the faculty instructor and one-on-one feedback will be provided. The goals of this portion of the course will be to directly assess the learner’s expressive communication skills with a Spanish-speaking SP (How well does he/she communicate interview questions with the patient?), to assess the learner’s receptive communication skills with a Spanish-speaking SP (How well does he/she understand the information that the patient provides in response?), to assess the learner’s Spanish language skills (How is the learner’s breadth of vocabulary, accuracy of vocabulary, grammar and conjugation skills?), and to provide the learner with exposure to a Spanish-speaking SP in a low-risk environment to allow for practice, testing his/her own language limits, and improvement opportunities.

5) Independent Study hours: 25 weekly hours total (12 hours textbook study/exercises, 4 hours practice interviews, 5 hours case write-up, 4 hours cultural study)

• Text study: Students will be assigned 2 chapters of independent reading from the required textbook each day. They will need to complete the post-chapter exercises as practice.
• Practice/Real-patient interviews: Each student will be expected to perform a minimum of four Spanish-speaking patient interviews on a weekly basis; they can choose a patient in the inpatient wards or outpatient clinics and will complete the interview in Spanish, then complete a case write-up and will give a brief oral case presentation during class.  Opportunities for patient interviewing will be coordinated by faculty with UI Health clinical departments to facilitate completion of this requirement.
• Case write-up: Students are expected to turn in a case write-up in Spanish on a daily basis corresponding to the lecture topic presented each day in class. The case write-ups allow for practice of the related health vocabulary for each organ system as well as practicing how to discuss an assessment and plan with a patient. Emphasis is placed on language appropriate for patient-level discussions (as opposed to overly-technical or scientific language). The case write-up will be turned in at the beginning of the next day’s lecture and will be reviewed with immediate feedback from the instructor during the language practice time, as described above. This will give the student the opportunity to fix recurrent problems (e.g., gender agreement, vocabulary errors, syntax errors, etc.) for his/her next case.
• Cultural study: Students will break up into pairs and choose amongst a list of culturally relevant health topics in order to research and create brief patient education presentations (in Spanish) on that topic (e.g., healthy diet, pediatric safety topics, diabetes, hypertension, asthma care, depression, etc) and also educate their peers on the culturally relevant health issues related to the chosen topic.

Course Materials: 
Spanish and the Medical Interview: A Textbook for Clinically Relevant Medical Spanish, 2nd Edition. By Pilar Ortega, MD. Published by Elsevier, Saunders, 2015.  Additional resources for optional workbook and grammar review books will be provided. Handouts will be provided as supplemental material as needed throughout the course.

ASSESSMENT: 
The Standardized Patient (SP) encounters, as described above will be the most formalized portion of the student evaluations. Specifically, these encounters which will be directly observed by the faculty instructor, will aim to identify areas for improvement in Spanish skills (expressive communication, receptive communication, and language skills) and to improve the student’s self-assessment skills. A mid-course encounter and an end-course encounter will be completed by each student at the Clinical Performance Center with a Spanish-speaking SP. Students will receive written and verbal feedback at the points of the mid-course and end-course evaluation.