Learning Spanish to Proficiency in Residency – Si Tu Puedes! (Yes It Can Be Done!)
Barr WB, Valdini A, Gravel J, Kimball P, Augart C, Olivieri M
AAFP Program Directors’ Workshop- Kansas City, MO - March 30, 2015
Innovation Showcase -Presenter: Wendy Barr MD MPH MSCE
What did you do?
The Lawrence Family Medicine Residency mission is to train family medicine physicians to care for
underserved populations. Our own patient population is predominantly Spanish speaking so as part of
our mission our goal is for each graduate to complete residency proficient to provide medical care in
Spanish. We do not require Spanish Language skills to apply or match to our program. Integrated into
our required curriculum, all residents receive intensive Spanish language training focused in the first
year of residency.
The basic components of the curriculum are a ten day off site intensive language course (the Rassias
Program at Dartmouth College) during orientation, one on one Spanish language instruction throughout
the first year (and beyond if needed), one on one Spanish language feedback and instruction during
clinical sessions with a Spanish teacher, a two week international Spanish language elective in the first
year, and immersion in the language during clinical training.
When did you implement your idea?
The Spanish language curriculum has been part of the residency since it started in 1994. Over the last 20
years, the curriculum has been revised and improved upon based on resident and faculty feedback and
changing resources and needs. The current makeup of the curriculum has been relatively stable since
2004.
How did you do it?
The Spanish Curriculum takes about one month of elective time used during a prolonged orientation
period in early July and for the Spanish Language elective during the R1 year. In addition, one to two
sessions per a rotation are used for one on one Spanish language instruction mostly during the first year.
The program currently costs about $6000 per resident (or $60,000 per year for a 10-10-10 program)
which is seen as an investment by the health center in developing a clinician who will not require use of
increased resources for interpretation.
What worked?
We have evaluated our curriculum over the last 10 years using first the ACTFL exam and now the ALTA
Language Testing Clinician Cultural and Linguistic Assessment. Our evaluation shows that nearly all our
residents are proficient in oral Spanish skills on graduation and that most make significant progress in
reaching this by the end of the first year. Also of interest, that their proficiency continues to improve
over the three years of residency despite minimal formal teaching after the first year. Based on this, key
elements in training residents to linguistic proficiency are: intensive instruction and exposure at the
beginning of training during dedicated sessions (not done as an extra activity during nights and
weekends), one on one instruction to maximize improvement at the level of the learner, and daily real
world use of the language with adequate support (interpretation and instruction in real world settings).
What didn’t work?
During the 20 years that the LFMR has had a Spanish curriculum, we found that weekly group classes for
all residents (or an entire class of residents) does not advance skills to proficiency for most residents and
therefore is a less efficient use of resident time. We also found that for residents who have no or basic
Spanish language skills on entry to residency that a single immersive language instruction experience or
course is generally not sufficient for the resident to achieve proficiency. These residents generally
require two such experiences within the first year in addition to regular one or one instruction and daily
“real world” immersion.
What would you do differently?
We would like to better tailor the curriculum to meet individual resident learning needs based on their
Spanish language skills at the beginning of residency and their progression after key learning
experiences and residency milestones. This requires having an easy, standardized way to assess oral
Spanish language skills that can be administered multiple times during their residency. We are starting
to use the ALTA Testing to see if these results can help us tailor our use of language instruction.
What advice would give to others trying to accomplish this?
If you are going to include language instruction in your residency curriculum it should be with the goal of
gaining proficiency so that the resident can safely see patient without an interpreter. Spanish proficiency
can be obtained during residency if time and resources are allocated so that instruction happens during
the day and during dedicated times so residents can focus on this skill. While daily immersion working
with Spanish speaking patients is important, it is equally important for residents to obtain formal
language instruction and evaluation as part of the curriculum.
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