Introduction: Title VI of the Civil Rights Act requires that language services be available to persons with limited English proficiency in order to ensure safe access to needed health care services. To address the need for more Spanish-speaking health care providers, many medical schools are teaching students medical Spanish. Once students start their clinical rotations, it is important that they have insight into their abilities to safely care for Spanish-speaking patients so they can properly determine whether or not they can do so without a professional interpreter’s assistance. Although medical Spanish interpreter exams are widely available, we were unable to identify an exam that evaluated all the skills bilingual medical students use in both direct patient care and ad hoc interpreting. To address this potential barrier to patient safety and quality patient care, we developed and implemented the Spanish Bilingual Medical Student Certification (SBMSC). Methods: The SBMSC consists of a combination of three standardized, validated exams that collectively evaluate fluency in Spanish speech and listening, medical Spanish vocabulary, medical Spanish-English interpreting skills, clinical skills, and cultural competency. These exams include the Clinician Cultural and Linguistic Assessment (CCLA), a standardized phone exam evaluating the competency of bilingual physicians; the Qualified Bilingual Staff Assessment (QBSA), a standardized phone exam that evaluating the competency of bilingual medical assistants to provide patient care, medical interpreting, and sight translation; and the Spanish Objective Structured Clinical Exam (SOSCE), an OSCE evaluating the clinical skills of medical students as they complete a history and physical exam in Spanish and document their findings and plan in English. To earn the SBMSC, students must earn a passing score on all three component exams. Additionally, since all three component exams provide formative feedback, all students who complete the exams receive instruction on methods to improve their medical Spanish and clinical skills regardless of whether or not they earn the SBMSC. Students who earn the SBMSC receive priority placement at clerkship sites with a high portion of Spanish-speaking patients, a Hablo Español tag that hangs behind their photo identification cards so staff and patients can identify them as bilingual students, and a notation of the SBMSC on their transcripts. Results: To date, 41 students have completed the SBMSC, with a 78% pass rate. The CCLA had an 80% pass rate, the QBSA had a 93% pass rate, and the SOSCE had a 90% pass rate. Of the students who failed to earn the SBMSC, four failed one exam, three failed two exams, one failed three exams, and one failed two exams and did not complete the third. The fact that there was not a perfect concordance between the three exams suggests that they may measure different skills. Thus, it is important to include all exams to appropriately evaluate students’ abilities to care for Spanish-speaking patients. Two students have retaken the SOSCE and passed on the second attempt. As a result, a total of 34 students have now successfully earned the SBMSC. These students received their ID tags and went on to serve Spanish-speaking patients during their clinical clerkships. Discussion: Both medical center staff members and patients appreciate the ability to easily recognize bilingual medical students through their ID tags. Patients appreciate receiving language-appropriate and culturally competent care from SBMSC-certified students. All students who participated in the SBMSC have benefited from the formative feedback they received.
- Accurately describe their level of medical Spanish skills.
- Identify the domains of bilingual clinical skills that require improvement.
- Implement practice-based improvement to further develop medical Spanish skills.
- Utilize their medical Spanish skills to provide direct patient care.
- Utilize their medical Spanish skills to facilitate communication between their English-speaking team members and Spanish-speaking patients.
- Serve as cultural brokers for Spanish-speaking patients.
After participating in the SBMSC, students who do not earn the certificate will be able to appropriately utilize interpreter services.
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The Role of the SP in a Spanish Bilingual Medical Student Certification. Oral presentation at: Clinical Skills Education and Assessment Chicago Style Conference; 2011; Lombard, Illinois.
The language of patient safety: A Spanish bilingual medical student certification. Panel discussion at: AAMC IQ Initiative: Integrating Quality: Linking Clinical and Educational Excellences; 2011; Chicago, Illinois.
Global health at home: Spanish bilingual medical student certification. Poster presented at: American Association of Family Physicians Global Health Workshop; 2010; Coral Gables, Florida.
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