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PREREQUISITES AND PLACEMENT IN THE CURRICULUM:

Fourth year medical students with a conversational Spanish level of approximately Level 3 by self-assessment chart below. Students who are unsure of Spanish level or feel they are between Levels 2-3 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

0  -   None

1  -   Knows/understands scattered words

2  -  Able to use some simple words and phrases, but has limited receptive understanding

3  -  Able to have a simple dialogue (e.g., food, the weather) using full sentences

4  -  Able to converse with more sophisticated conjugation skills (past, present, future  tenses) and more robust vocabulary

5  -  Native level fluency. As comfortable conversing in Spanish as in any other language

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

a.  Demonstrate the conversational Spanish skills necessary to introduce him/herself to the  patient and confirm the patient’s identity and chief complaint.
b.  Conduct a history of present illness in Spanish.
c.  Conduct relevant review of systems in Spanish.
d.  Conduct relevant ancillary medical history (medical, surgical, social, sexual, and family histories) in Spanish.
e.  Elicit the patient’s medication list and allergy history in Spanish.
f.  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).
g. Construct appropriate Spanish follow-up questions to the patient’s responses to initial HPI questions.
h.  Construct appropriate Spanish responses to the patient’s questions in the course of the encounter.
i.  Synthesize the historical information provided in Spanish into a working differential diagnosis.
j.  Develop an appropriate diagnostic testing plan and/or treatment plan for the patient.
k.  Describe a plan of care to the patient in Spanish.
l.  Motivate patient compliance by providing culturally- and linguistically-sensitive arrangements for treatment options, informational resources, and follow-up care.
m. Perform increasingly complex Spanish patient interviews and complete case write-up documenting the relevant parts of the history obtained and present case to faculty.
n.  Self-assess his/her own Medical Spanish communication skills.
     1)  Identify and acknowledge his/her limitations in performing a patient interview in Spanish.
     2)  Recognize when help is needed and seek help from a professional interpreter or other appropriate language resources.
     3)  Identify areas for improvement in his/her Medical Spanish skill set.
o.  Demonstrate skill-improvement from mid-course Standardized Patient (SP) experience to end-course SP experience.
p.  Develop Spanish patient-education materials on culturally-relevant health topics.

II. TARGETED GRADUATION COMPETENCIES:

a.   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 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.

b.    Medical KnowledgeThe 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.

c.  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).
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.

d.  Interpersonal and Communication Skills – The crux of the course is to help the student to optimize their 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.

e.  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.
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;

f.  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:
10-week course, 80 hrs. total time commitment
20 h total, 2h/week of class time
20 h total, approx. 2h/week of self-study (reading and language practice for each class) 20 h total, 2 h/week of preparation for SP and Real-patient encounters
2 h = Standardized patient (SP) encounter #1 (mid-course evaluation)
2 h = SP encounter #2 (end-course evaluation)
12 h total, approx 4 h per case = 3 Real-patient interviews and Case write-up/presentations
4 h total, approx 2 h per presentation = Culturally relevant health patient education presentations
   
Description of Learning Activities:

1)  Weekly classes:  Each week 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.

The course-work is spread out over 10 weeks to give time for real and simulated patient experience and home-study in between class sessions. We believe this will encourage long-term retention of the learned information, which is particularly important in this language-based learning which is at high risk for short-term learning that gets lost with disuse after high intensity short duration courses. The 10 week duration will also allow the class to focus more intensely on an organ system per week and to build upon the learned skills on a weekly basis.

2)    Preparation for 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.

3)  Standardized Patient Encounters: A mid-course encounter around week 5 and an end-course encounter around week 10 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.

4)  Culturally-relevant health patient education presentations: Students will break up into pairs and choose amongst a list of culturally relevant health topics and research and create two 5 minute patient education presentations (in Spanish) on that topic (e.g., healthy diet, pediatric safety topics, diabetes, hypertension, asthma care, depression, etc).

5)  Real-patient interviews and case write-up/presentations: Each student will perform three interviews of Spanish-speaking patient; 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. Each student’s oral case presentations will be spread out over the 10 weeks so they can receive feedback verbally from the instructor and have the opportunity to demonstrate improvement over the course.

Course Materials:
Spanish and the Medical Interview: A Textbook for Clinically Relevant Medical Spanish. By Pilar Ortega, MD. Published by Elsevier, Saunders, 2007.  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 around week 5 and an end-course encounter around week 10 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.

ADMINISTRATION:

Course will be offered in Fall, Winter, Spring semesters

Minimum/maximum students accepted: Min-5; Max-20
Faculty Coordinator: 
Jorge Girotti, PhDDirector, Hispanic Center of Excellence
Phone:  
312-996-4493    Fax:   312-996-9922
Email:   
jorgeg@uic.edu
Address:  
990 CME; Hispanic Center for Excellence, MC 591
Faculty Co-Coordinator:
Pilar Ortega, MD   Email: PilarOrtegaMD@gmail.com
Duration of Elective:
2 weeks
Night Call:
N/A
Weekends:
N/A
# of Students Accepted:
Min 5  Max  20
Housestaff Used as Faculty:
N/A
Number of hours per week:
8 hr/wk
Lectures/Conferences/Faculty Contact:
2 hr/wk plus feedback sessions
Laboratory:
Two 2-hr sessions CPC/Simulated Standardized Patient Encounters
Independent Study:
2 hr/wk self-study/vocabulary practice plus 3 self-scheduled patient interviews and 2 health education presentations
Outpatient:
N/A
Inpatient:
N/A
Total Hours /Week:
avg 8 hr/wk spread over 10 weeks, for total 80 hrs (2 wks of elective credit)

 Approved: 7/17/13