Home Prevalence and quality of medical Spanish education in US osteopathic medical schools: a national survey
Article Open Access

Prevalence and quality of medical Spanish education in US osteopathic medical schools: a national survey

  • Kally Dey , Sinibaldo Romero Arocha , Yoon Soo Park and Pilar Ortega ORCID logo EMAIL logo
Published/Copyright: February 29, 2024
Download Article (PDF)
Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 124 Issue 6

Abstract

Context

Spanish is the language in the United States with the greatest language-concordant physician deficit. Allopathic medical Spanish programs have proliferated, but the national prevalence of medical Spanish education at osteopathic medical schools has never been evaluated.

Objectives

The objectives of this study are to describe the medical Spanish educational landscape at US osteopathic schools and evaluate program adherence to previously established basic standards.

Methods

Between March and October 2022, surveys were sent to all 44 member schools of the American Association of Colleges of Osteopathic Medicine (AACOM). For nonrespondents, data were obtained from publicly available websites. Primary surveys were sent to deans or diversity, equity, and inclusion officers at each osteopathic school to determine whether medical Spanish was offered and to identify a medical Spanish leader. Medical Spanish leaders received the secondary survey. The main measures of this study were the prevalence of medical Spanish programs at osteopathic schools and the extent to which existing programs met each of the four basic standards: having a faculty educator, providing a curricular structure, assessing learner skills, and awarding institutional course credit.

Results

We gathered medical Spanish information from 90.9 % (40/44) of osteopathic schools. Overall, 88.6 % (39/44) offered medical Spanish, of which 66.7 % (26/39) had formal curricula, 43.6 % (17/39) had faculty educators, 17.9 % (7/39) assessed learner skills, and 28.2 % (11/39) provided course credit. Only 12.8 % (5/39) of osteopathic schools with medical Spanish programs met all basic standards. Urban/suburban schools were likelier to offer medical Spanish than rural schools (p=0.020). Osteopathic schools in states with the highest Spanish-speaking populations were more likely to offer student-run initiatives (p=0.027).

Conclusions

Most osteopathic schools provide medical Spanish education, but work is needed to improve consistency, quality, and sustainability. Future research should focus on osteopathic student language proficiency assessment, improve medical Spanish accessibility for students at rural programs, and explore the unique content areas of osteopathic medical Spanish education.

Keywords: communication skills; Hispanic health; limited English proficiency; medical Spanish; multilingualism; non-English language preference

One in five individuals living in the United States speaks a language other than English at home, with most speaking Spanish [1]. Individuals with non-English language preference (NELP) are more likely to experience subpar clinician-patient interactions and healthcare outcomes [2, 3]. Professional medical interpreting, a strategy to address language-related health disparities, is often inaccessible [4] and inappropriately utilized [2, 4], [5], [6], [7], [8], [9], [10]. Language-concordant healthcare, which occurs when clinicians and patients are able to communicate directly in the same language, improves patient satisfaction and outcomes [11], [12], [13], [14]. The current multilingual physician workforce is insufficient to meet the needs of the growing NELP population, and Spanish is the language with the greatest US physician deficit [15].

Medical Spanish education aims to increase the number of physicians who can provide Spanish language-concordant patient care [16]. In medical schools, such courses target students with intermediate or higher language skills [16]. The person-centered approach to patient-physician communication that underpins medical Spanish education also compliments the philosophy of osteopathic medicine, treating the person as a fully integrated being composed of body, mind, and spirit [17]. However, only two published single-site studies report on medical student language skills at osteopathic medical schools. Researchers at one osteopathic medical school found that more than half of medical student respondents reported having non-English language skills, most commonly Spanish [18]. Another study described the outcomes of a medical Spanish course at a single osteopathic medical school [19].

Hispanic/Latinx medical students, who are underrepresented in medicine [20, 21], have historically driven medical Spanish educational advancement through organizations such as the Latino Medical Student Association (LMSA) [22, 23]. Student-led organizations allow medical students to connect with peers and faculty with shared interests and identities and play a crucial role in medical school diversity, equity, and inclusion efforts, such as medical Spanish education [24, 25]. Despite medical Spanish student leadership and course proliferation, a national allopathic medical school survey published in 2021 shows that most allopathic medical Spanish efforts (79 % of reported programs) did not meet one or more basic standards: 31 % of schools did not have a faculty educator, 43 % did not conduct postcourse learner assessment, 46 % were not in the school’s curriculum, and 69 % did not provide course credit [22]. The prevalence of medical Spanish education in osteopathic medical schools has never been evaluated, nor has the extent to which medical Spanish efforts at osteopathic schools met basic educational standards. Understanding the landscape of osteopathic medical Spanish education is necessary to guide future medical Spanish curricular development.

The primary aim of this study was to assess the presence of medical Spanish programming at US osteopathic medical schools and to evaluate to what extent existing medical Spanish programs meet the four basic educational standards previously identified as necessary for effective and sustainable courses (having a faculty educator, providing a curricular structure, assessing learner skills, and awarding institutional course credit) [16, 22]. Finally, we explored the association of schools’ regional, state, and local geographic context with the likelihood of meeting basic standards.

Methods

Design

We surveyed US osteopathic medical schools about their medical Spanish educational opportunities. To ensure a representative sample, we utilized the American Association of Colleges of Osteopathic Medicine (AACOM) website to identify all member osteopathic medical schools [26]. Multi-campus institutions in which each separate campus reported an independent curriculum were treated separately, resulting in a total of 44 osteopathic medical schools. We sent an initial electronic survey invitation in March 2022 to all 44 schools, and nonrespondents received up to three reminders over 8 months, following the protocol previously described for the national allopathic survey in 2019 [22]. We collected primary and secondary survey data between March and October 2022. For nonrespondent schools, additional data were obtained by reviewing publicly available institutional websites and course catalogs for medical Spanish information; key terms included “medical Spanish” and “Spanish.” The University of Illinois Institutional Review Board determined that this study met exemption criteria on October 28, 2017 (Protocol# 2017-1157).

Participants

We searched each school’s website for contact information of institutional deans and education leaders (e.g., Assistant/Associate Dean of Curriculum or Diversity, Equity, and Inclusion) and LMSA or medical Spanish faculty advisors. If contact information was unavailable, we contacted LMSA student leadership to identify medical Spanish faculty. Institutional leaders not known to be directly involved in medical Spanish initiatives received a brief six-item primary survey to determine whether medical Spanish was offered at the school and, if so, identify a leader involved in medical Spanish. If applicable, medical Spanish leaders received a 14-item secondary survey requesting more detailed information.

Main measures

Primary and secondary surveys had been previously developed for the allopathic medical school national survey [22] based on evidence-based guidelines [16, 27, 28] and commonly cited barriers to high-quality medical Spanish education [29]. The research team, including a physician faculty member, an osteopathic medical student, an allopathic medical student, and a psychometrician, reviewed the prior surveys for applicability to osteopathic medical schools. Because the questions focused on structural elements of medical Spanish programs rather than on detailed content, only minor changes were needed. The research team modified the surveys to (a) update the introduction describing the rationale and purpose of the study, (b) add the word “osteopathic” within the survey questions, as appropriate, and (c) add a response option to the question about the types of medical Spanish education provided to include Spanish-language training for student volunteers at student-run free clinics. The surveys are available in Supplementary Material.

The main measures included, first, the presence of any medical Spanish program. Secondly, for schools that offered medical Spanish, we asked to what extent their programs met each of the previously published basic standards: having a faculty educator, providing a curricular structure, assessing learner skills, and awarding institutional course credit [16, 22]. For nonrespondent schools, information about meeting basic standards was extracted from their website by following a series of steps. If a Spanish-related program (course, club, activity, etc.) was identified, we then reviewed the relevant portions of the website for specific information corresponding to each standard: whether a course educator was listed, whether it was listed in the course catalog, whether an assessment/examination was offered, and whether course credit was provided.

Analysis

Statistical analyses were conducted utilizing descriptive statistics (frequencies and percentages) to study overall trends in survey responses. Proportions were compared using chi-squared tests. Data were compiled and analyzed utilizing Stata 17 (College Station, TX).

We evaluated the association of schools’ geographic features that may impact the likelihood of having medical Spanish programs or meeting basic standards. We categorized schools by local setting (urban, suburban, or rural) utilizing the AACOM’s Choose DO Explorer database [26] and by geographic region utilizing the Association of American Medical Colleges (AAMC) regional framework (Midwest, Northeast, South, West) because the AACOM does not formally organize schools by region. We also identified osteopathic schools located in the six states with greater than 500,000 Spanish speakers who reported speaking English less than very well and are classified by the US Census as having limited English proficiency (LEP) – California, Texas, New York, Florida, Illinois, and New Jersey [30].

Results

We gathered medical Spanish education information from 90.9 % (40/44) of US osteopathic medical schools utilizing survey data and website review. The majority of these institutions (25/44, 56.8 %) participated in the national survey; participation was defined as responding to either or both the primary and/or secondary surveys. Half of the institutions (22/44) completed at least one of the surveys fully. Three survey responses were incomplete such that we were unable to determine the presence of medical Spanish at their institutions; we counted these three institutions as respondents but supplemented the insufficient data by reviewing their websites as we did for nonrespondents. Four schools (9.1 %) neither responded to surveys nor had available online information regarding medical Spanish.

In the primary survey, 56.8 % of osteopathic schools (25/44) participated. Of these 25 schools, 22 (88.0 %) responded to all survey questions, and 19 (76.0 %) identified a medical Spanish leader to receive the secondary survey. Five medical Spanish leaders (26.3 %) completed the secondary questionnaire. Of the 22 schools that had insufficient survey data to determine whether they offered medical Spanish programming (which included 19 nonrespondents and three incomplete responses), 19 schools (86.4 %) had medical Spanish information publicly available on their websites to incorporate for analysis.

Across primary survey respondents, 88.0 % (22/25) indicated that medical Spanish is wanted or needed at their schools, and 56.0 % (14/25) indicated that faculty development for medical Spanish teaching and assessment would be helpful to their institution.

Prevalence of medical Spanish and association with school characteristics

Of all 44 osteopathic medical schools, 39 (88.6 %) offered opportunities in medical Spanish education. Of the 22 schools for which we obtained sufficient information from the surveys, all but one (95.5 %) reported teaching medical Spanish; similarly, of the 22 schools for which website review was utilized to gather data, all but 4 (81.8 %) had medical Spanish offerings.

Table 1 shows the distribution of current osteopathic medical Spanish programs by US region, local setting (urban, suburban, rural), and the state’s Spanish-speaking population with LEP. When we grouped urban and suburban settings, we found that urban and suburban schools were significantly more likely to offer medical Spanish programs than those in rural locations (p=0.020). There were no significant differences by US region nor by state Spanish-speaking population. Notably, all osteopathic schools in the six states with the highest Spanish-speaking LEP population reported a medical Spanish program, as opposed to 86.1 % of schools in other states; however, the differences were not statistically significant.

Table 1:

Prevalence of medical Spanish by school characteristics (row %).

Characteristic No medical Spanish (n=5; 11.4 %) Medical Spanish (n=39; 88.6 %) p-Value
Region Midwest 12.5 87.5 0.752
Northeast 0.0 100.0
South 15.8 84.2
West 9.1 90.9
Local settinga Rural 33.3 66.7 0.059
Urban 10.0 90.0
Suburban 4.0 96.0
State Spanish-speaking population States with <500,000 Spanish speakers with LEP 13.9 86.1 0.263
States with >500,000 Spanish speakers with LEP 0.0 100.0

  1. p values based on chi-squared test. LEP, limited English proficiency. States with >500,000 Spanish speakers with LEP are Florida, Illinois, New Jersey, Texas, California, and New York [30]. aWhen urban and suburban schools were grouped together for analysis, 94.3 % had medical Spanish; p=0.020 (94.3 % urban/suburban vs. 66.7 % rural).

Basic standards for medical Spanish programs

Table 2 summarizes the number and percentage of osteopathic medical schools reporting medical Spanish education who met each of the basic standards.

Table 2:

Adherence to basic educational standards for osteopathic medical schools that offer medical Spanish education (n=39).

Basic standard Number (%) of schools meeting the standard Number (%) of schools not meeting the standard
Formal curriculum 26 (66.7 %) 13 (33.3 %)
Faculty educator 17 (43.6 %) 22 (56.4 %)
Learner assessment 7 (17.9 %) 32 (82.1 %)
Course credit 11 (28.2 %) 28 (71.8 %)
All basic standards 5 (12.8 %) 34 (87.2 %)

  1. Bold is used to signify the number and percentage of schools meeting or not meeting all four basic standards for medical Spanish education, including formal curriculum, faculty educator, learner assessment, and course credit.

Formal curriculum

Twenty-six osteopathic schools reported offering formal medical Spanish curricula, representing 59.1 % (26/44) of all US osteopathic medical schools, with two-thirds of those reporting some form of medical Spanish (26/39). Most formal curricula were elective courses (92.3 %, 24/26), whereas two schools (7.7 %) had a medical Spanish requirement.

One-third of schools offering medical Spanish (13/39) did so only as an extracurricular activity, whereas 10 sites (25.6 % of 39) indicated a combination of formal curricular and extracurricular options. Over half of all osteopathic schools (52.3 %, 23/44) offered student-run Spanish clubs or workshops; there were no significant differences in likelihood of having student-run programs by US region (p=0.91) or local setting (p=0.68). Osteopathic schools in states with the highest Spanish-speaking populations were more likely to offer student-run initiatives than states with smaller Spanish-speaking populations (30.4 vs. 4.8 %, p=0.027).

Other noncurricular medical Spanish offerings reported by schools included asynchronous, non-faculty-led online courses reported by five (12.8 % of 39) schools. Three schools incorporated medical Spanish into clinical experiences and simulations, such as standardized patient interactions to teach students how to work with professional medical interpreters and study abroad opportunities in Spanish-speaking countries. Of the two schools that indicated Spanish-related study abroad trips, one included a formal medical Spanish educational component, and the other did not. One school reported canceling medical Spanish due to COVID-19 and indicated efforts toward restarting the program. One school that did not currently offer medical Spanish reported active program development.

Faculty educator

Among osteopathic schools that offered medical Spanish programming, 43.6 % (17/39) reported having faculty educators. These faculty members most frequently included physicians (MD/DO), whereas two schools reported non-physician faculty, including one PhD (field of expertise unspecified) and one language professor.

Learner assessment

Seven schools with medical Spanish offerings (17.9 % of 39) reported having a postcourse assessment of learner skills. Evaluation methods were variable, including observed patient interviews, standardized patient encounters, written examinations, and learner confidence self-assessments.

Course credit

Across osteopathic schools with medical Spanish, 28.2 % (11/39) reported granting institutional course completion credit ranging from 1 to 2.5 credit hours per course. Some institutions issued certificates of completion or listed the course as a 0-credit elective in official transcripts as course credit alternatives.

Meeting all basic standards

Overall, 12.8 % (5/39) of osteopathic medical schools that offered medical Spanish programming met all four basic curricular standards: formal curriculum, faculty educator, learner assessment, and course credit. There was no significant difference in meeting the four basic standards by US region (p=0.49), local setting (when analyzed separately by urban, suburban, or rural sites, p=0.43; when analyzed by grouping suburban/urban vs. rural sites, p=0.11), nor by state Spanish-speaking LEP population (p=0.91).

Discussion

This study evaluated the prevalence of medical Spanish education across a national sample of osteopathic medical schools. Nearly 90 % of US osteopathic medical schools offer medical Spanish educational opportunities. Additionally, most institutional leaders who responded to the survey perceived that medical Spanish is a needed and desired element of their medical school.

The structure of medical Spanish programs at osteopathic schools was variable, and many courses did not comply with basic educational standards. Among osteopathic schools with medical Spanish offerings, only five (12.8 %) met all four basic standards, similar to the small percentage of allopathic schools (21 %) that met all standards in 2019 [22]. The standard most frequently met by osteopathic schools was having a formal curriculum, achieved by 66.7 % of schools with medical Spanish offerings. Nearly half (43.6 %) had faculty educators, and just under one-third (28.2 %) provided course credit. The standard least often achieved by osteopathic medical schools was learner skills assessment, which was reported by only 17.9 % of schools that offered medical Spanish.

Understanding the prevalence and gaps in meeting basic standards can help inform key focus areas for future osteopathic medical Spanish educational development. Although it is inspiring to note the national proliferation of medical Spanish courses across osteopathic schools, it is concerning that assessment practices to confirm medical student proficiency in Spanish prior to patient care have fallen behind. Learner assessment is considered a basic standard of medical Spanish courses to protect patient safety; when student or physician skills in a non-English language are left unassessed, the individual may use the language with patients out of perceived necessity even when they feel unprepared to do so [31], or mistakenly consider themselves ready for language-concordant care when they are not, a concept known as “false fluency” [32]. Furthermore, providing formative feedback is a standard educational practice for progressive skills improvement. To advance the field and promote patient safety, osteopathic schools with medical Spanish programs should develop or adopt a validated process for learner proficiency assessment, such as the Physician Oral Language Observation Matrix [33] or the Clinician Cultural and Linguistic Assessment [34].

Our study highlighted a few notable findings regarding osteopathic school characteristics. First, institutions in urban and suburban areas were more likely than those in rural areas to have some form of medical Spanish programming (94.3 vs. 66.7 %), which may be related to decreased racial/ethnic diversity in rural populations [35]. The osteopathic profession emphasizes its dedication to providing primary care to rural underserved areas [17]. Rural areas are also home to migrant workers and undocumented individuals who may be undercounted in official population counts and experience numerous access-to-healthcare barriers besides language discordance [36, 37]. Furthermore, professional interpreter availability may be more limited in rural hospitals [38]. Thus, while language-discordant encounters may be less frequent in rural areas, when they do occur, the patient’s situation may be particularly complex and would greatly benefit from a language-concordant clinician [39]. Additionally, rural schools might have more challenges in teaching medical Spanish due to difficulty identifying local qualified faculty educators or clinical sites where students can regularly use their Spanish skills with supervision once they have achieved the desired proficiency. Faculty-taught, live virtual medical Spanish courses are one strategy to address this challenge because faculty do not need to be in the same geographic area as students [40].

We identified trends across osteopathic schools in the six states with the highest Spanish-speaking populations. Student-run medical Spanish efforts were more prevalent in these states than those with fewer Spanish speakers, highlighting the importance of student initiatives to drive medical Spanish education in conjunction with state/local population health needs [41]. All medical Spanish programs in the six highest Spanish-speaking LEP states included a formal curriculum, which is also a testament to the power of student advocacy. Efforts in these states, however, had adherence to all basic standards as low as states with smaller Spanish-speaking populations. Although student-run initiatives are essential for advocacy and may address an acute need for medical Spanish instruction, institutional support in the form of faculty educators, course credit, and formal assessment are critical to ensure program effectiveness and sustainability. Osteopathic schools in areas with high numbers of Spanish-speaking patients could explore opportunities to recruit and train ethnically, racially, and linguistically diverse faculty as a strategy to better prepare students to address the needs of the population.

As a descriptive study, our scope focused on evaluating osteopathic medical Spanish course prevalence and adherence to basic standards. In the future, educators and researchers should explore the unique aspects of osteopathic medicine for inclusion in osteopathic medical Spanish courses. For example, compared to allopathic counterparts, osteopathic schools teach more musculoskeletal content due to their roots in osteopathic manipulative medicine [42]. Secondly, osteopathic curricula are most commonly organ-system –based, followed by team-based, whereas allopathic curricula are most often organ-system – based, followed by discipline-based [43]. These differences may impact the content and structure of medical Spanish courses to most effectively align with osteopathic institutional curricula.

This survey study has limitations, such as respondent bias; schools that valued medical Spanish education may have been more motivated to participate. Our survey response rate was 56.8 %, which is average for survey studies but may still affect generalizability. To address this, we supplemented our data through a detailed review of nonrespondent and incomplete respondents’ publicly available websites and found that most school websites provided detailed medical Spanish information. Nonetheless, websites may be outdated or inaccurate, potentially resulting in underestimating or overestimating how many schools offered medical Spanish or met basic standards. Finally, although we evaluated basic standards in medical Spanish education, we acknowledge that, even among schools meeting each standard, there is a high degree of course variation. As a relatively nascent field of academic inquiry, gold-standard approaches to medical Spanish curricula, pedagogy, and assessment have yet to be established.

Conclusions

Our study provides an empirical landscape of osteopathic medical Spanish education. Osteopathic medical Spanish programs are both common and desired, but additional work is needed to achieve basic standards for quality and sustainability. Future work should focus on student proficiency assessment to ensure patient safety, consider collaborations that facilitate the participation of rural osteopathic students in medical Spanish courses, and explore unique aspects of osteopathic medicine that should be highlighted in medical Spanish courses contextualized in osteopathic medical schools.

Corresponding author: Pilar Ortega, MD, MGM, Departments of Medical Education and Emergency Medicine, University of Illinois College of Medicine, 808 S. Wood Street, MC 591, Chicago, IL 60612, USA; and Department of Diversity, Equity, and Inclusion, Accreditation Council for Graduate Medical Education, Chicago, IL, USA, E-mail:

  1. Research ethics: The University of Illinois Institutional Review Board determined that this study met exemption criteria (Protocol# 2017-1157).

  2. Informed consent: Not applicable.

  3. Author contributions: All authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; all authors drafted the article or revised it critically for important intellectual content; all authors gave final approval of the version of the article to be published; and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  4. Competing interests: Dr. Ortega receives textbook author royalties from Elsevier. The authors declare no other competing interests.

  5. Research funding: None declared.

  6. Data availability: The raw data can be obtained on request from the corresponding author.

References

1. The state of languages in the U.S.: a statistical portrait. American Academy of Arts & Sciences; 2016. https://www.amacad.org/publication/state-languages-us-statistical-portrait [Accessed 27 Oct 2023].Search in Google Scholar

2. Fernandez, A, Schillinger, D, Warton, EM, Adler, N, Moffet, HH, Schenker, Y, et al.. Language barriers, physician-patient language concordance, and glycemic control among insured Latinos with diabetes: the Diabetes Study of Northern California (DISTANCE). J Gen Intern Med 2011;26:170–6. https://doi.org/10.1007/s11606-010-1507-6.Search in Google Scholar PubMed PubMed Central

3. Schenker, Y, Karter, AJ, Schillinger, D, Warton, EM, Adler, NE, Moffet, HH, et al.. The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: the DISTANCE study. Patient Educ Couns 2010;81:222–8. https://doi.org/10.1016/j.pec.2010.02.005.Search in Google Scholar PubMed PubMed Central

4. Schenker, Y, Pérez-Stable, EJ, Nickleach, D, Karliner, LS. Patterns of interpreter use for hospitalized patients with limited English proficiency. J Gen Intern Med 2011;26:712–7. https://doi.org/10.1007/s11606-010-1619-z.Search in Google Scholar PubMed PubMed Central

5. Brophy-Williams, S, Boylen, S, Gill, FJ, Wilson, S, Cherian, S. Use of professional interpreters for children and families with limited English proficiency: the intersection with quality and safety. J Paediatr Child Health 2020;56:1201–9. https://doi.org/10.1111/jpc.14880.Search in Google Scholar PubMed

6. Cohen, AL, Rivara, F, Marcuse, EK, McPhillips, H, Davis, R. Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics 2005;116:575–9. https://doi.org/10.1542/peds.2005-0521.Search in Google Scholar PubMed

7. Divi, C, Koss, RG, Schmaltz, SP, Loeb, JM. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care 2007;19:60–7. https://doi.org/10.1093/intqhc/mzl069.Search in Google Scholar PubMed

8. DuBard, CA, Gizlice, Z. Language spoken and differences in health status, access to care, and receipt of preventive services among US Hispanics. Am J Public Health 2008;98:2021–8. https://doi.org/10.2105/ajph.2007.119008.Search in Google Scholar PubMed PubMed Central

9. Fernández, A, Quan, J, Moffet, H, Parker, MM, Schillinger, D, Karter, AJ. Adherence to newly prescribed diabetes medications among insured Latino and White patients with diabetes. JAMA Intern Med 2017;177:371–9. https://doi.org/10.1001/jamainternmed.2016.8653.Search in Google Scholar PubMed PubMed Central

10. Patel, DN, Wakeam, E, Genoff, M, Mujawar, I, Ashley, SW, Diamond, LC. Preoperative consent for patients with limited English proficiency. J Surg Res 2016;200:514–22. https://doi.org/10.1016/j.jss.2015.09.033.Search in Google Scholar PubMed PubMed Central

11. Diamond, L, Izquierdo, K, Canfield, D, Matsoukas, K, Gany, F. A systematic review of the impact of patient-physician non-English language concordance on quality of care and outcomes. J Gen Intern Med 2019;34:1591–606. https://doi.org/10.1007/s11606-019-04847-5.Search in Google Scholar PubMed PubMed Central

12. González, HM, Vega, WA, Tarraf, W. Health care quality perceptions among foreign-born Latinos and the importance of speaking the same language. J Am Board Fam Med 2010;23:745–52. https://doi.org/10.3122/jabfm.2010.06.090264.Search in Google Scholar PubMed PubMed Central

13. Parker, MM, Fernández, A, Moffet, HH, Grant, RW, Torreblanca, A, Karter, AJ. Association of patient-physician language concordance and glycemic control for limited-English proficiency Latinos with type 2 diabetes. JAMA Intern Med 2017;177:380–7. https://doi.org/10.1001/jamainternmed.2016.8648.Search in Google Scholar PubMed PubMed Central

14. Stoneking, LR, Waterbrook, AL, Garst Orozco, J, Johnston, D, Bellafiore, A, Davies, C, et al.. Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations? Adv Med Educ Pract 2016;7:467–73. https://doi.org/10.2147/amep.s110177.Search in Google Scholar PubMed PubMed Central

15. Garcia, ME, Bindman, AB, Coffman, J. Language-concordant primary care physicians for a diverse population: the view from California. Health Equity 2019;3:343–9. https://doi.org/10.1089/heq.2019.0035.Search in Google Scholar PubMed PubMed Central

16. Ortega, P, Diamond, L, Alemán, MA, Fatás-Cabeza, J, Magaña, D, Pazo, V, et al.. Medical Spanish standardization in U.S. Medical schools: consensus statement from a multidisciplinary expert panel. Acad Med 2020;95:22–31. https://doi.org/10.1097/acm.0000000000002917.Search in Google Scholar PubMed

17. About osteopathic medicine. American Association of Colleges of Osteopathic Medicine; 2023. https://www.aacom.org/become-a-doctor/about-osteopathic-medicine [Accessed 25 Jan 2024].Search in Google Scholar

18. Tripathi, V, Wisniewski, SJ, Rowan, J, Ruger, K. Establishing a baseline for multilingual capabilities of medical students at the Michigan State University College of Osteopathic Medicine. J Osteopath Med 2023;123:243–8. https://doi.org/10.1515/jom-2021-0102.Search in Google Scholar PubMed

19. López-Hernández, GY. Enhancing culturally sensitive curriculum in an osteopathic medical school. Mo Med 2019;116:376–9.Search in Google Scholar

20. Association of American Medical Colleges. Total U.S. MD-granting medical school enrollment by race/ethnicity (alone) and gender, 2018-2019 through 2022-2023. AAMC; 2023. https://www.aamc.org/media/6121/download [Accessed 4 Feb 2024].Search in Google Scholar

21. Ali, A. 2021-22 osteopathic medical college total enrollment by gender and race/ethnicity. American Association of Colleges of Osteopathic Medicine; 2022. https://www.aacom.org/searches/reports/report/2021-22_tenroll_gender_re_com [Accessed 4 Feb 2024].Search in Google Scholar

22. Ortega, P, Francone, NO, Santos, MP, Girotti, JA, Shin, TM, Varjavand, N, et al.. Medical Spanish in US medical schools: a national survey to examine existing programs. J Gen Intern Med 2021;36:2724–30. https://doi.org/10.1007/s11606-021-06735-3.Search in Google Scholar PubMed PubMed Central

23. Ortega, P, Shin, TM, Francone, NO, Santos, MP, Girotti, JA, Varjavand, N, et al.. Student and faculty diversity is insufficient to ensure high-quality medical Spanish education in US medical schools. J Immigr Minor Health 2021;23:1105–9. https://doi.org/10.1007/s10903-021-01198-4.Search in Google Scholar PubMed

24. Dady, N, Mungroo, KA, Young, T, Akinsanya, J, Forstein, D. Diversity in osteopathic medical school admissions and the COMPASS program. J Osteopath Med 2021;121:157–61. https://doi.org/10.1515/jom-2019-0260.Search in Google Scholar PubMed

25. Abdulrazzak, A, Chandler, A, Lu, R, Mobarakai, O, Lebron, B, Ingram, N, et al.. Mini-medical school programs decrease perceived barriers of pursuing medical careers among underrepresented minority high school students. J Osteopath Med 2021;121:883–90. https://doi.org/10.1515/jom-2021-0125.Search in Google Scholar PubMed

26. Explorer, – ChooseDO. https://choose.do/explorer/ [Accessed 30 Nov 2023].Search in Google Scholar

27. Hardin, KJ, Hardin, DM. Medical Spanish programs in the United States: a critical review of published studies and a proposal of best practices. Teach Learn Med 2013;25:306–11. https://doi.org/10.1080/10401334.2013.827974.Search in Google Scholar PubMed

28. Reuland, DS, Frasier, PY, Slatt, LM, Alemán, MA. A longitudinal medical Spanish program at one US medical school. J Gen Intern Med 2008;23:1033–7. https://doi.org/10.1007/s11606-008-0598-9.Search in Google Scholar PubMed PubMed Central

29. Morales, R, Rodriguez, L, Singh, A, Stratta, E, Mendoza, L, Valerio, MA, et al.. National survey of medical Spanish curriculum in U.S. medical schools. J Gen Intern Med 2015;30:1434–9. https://doi.org/10.1007/s11606-015-3309-3.Search in Google Scholar PubMed PubMed Central

30. U.S. Department of Justice Civil Rights Division. Total Persons 5 Years and Over Who Speak English “Less than Very Well” and Who Speak Spanish at Home. 2015. https://www.lep.gov/sites/lep/files/resources/US_state_ES_count.ACS_5yr.2015.pdf [Accessed 11 Dec 2023]Search in Google Scholar

31. Vela, MB, Fritz, C, Press, VG, Girotti, J. Medical students’ experiences and perspectives on interpreting for LEP patients at two US medical schools. J Racial Ethn Health Disparities 2016;3:245–9. https://doi.org/10.1007/s40615-015-0134-7.Search in Google Scholar PubMed

32. Diamond, LC, Schenker, Y, Curry, L, Bradley, EH, Fernandez, A. Getting by: underuse of interpreters by resident physicians. J Gen Intern Med 2009;24:256–62. https://doi.org/10.1007/s11606-008-0875-7.Search in Google Scholar PubMed PubMed Central

33. Diamond, LC, Gregorich, SE, Karliner, L, González, J, Pérez-Cordón, C, Iniguez, R, et al.. Development of a tool to assess medical oral language proficiency. Acad Med 2023;98:480–90. https://doi.org/10.1097/acm.0000000000004942.Search in Google Scholar

34. Tang, G, Lanza, O, Rodriguez, FM, Chang, A. The Kaiser permanente clinician cultural and linguistic assessment initiative: research and development in patient-provider language concordance. Am J Public Health 2011;101:205–8. https://doi.org/10.2105/ajph.2009.177055.Search in Google Scholar

35. Racial and ethnic minorities made up about 22 percent of the rural population in 2018, compared to 43 percent in urban areas. Economic Research Service, U.S. Department of Agriculture; 2007. https://www.ers.usda.gov/data-products/chart-gallery/gallery/chart-detail/?chartId=99538 [Accessed 4 Feb 2024].Search in Google Scholar

36. Derose, KP, Escarce, JJ, Lurie, N. Immigrants and health care: sources of vulnerability. Health Aff 2007;26:1258–68. https://doi.org/10.1377/hlthaff.26.5.1258.Search in Google Scholar PubMed

37. Golding, SA, Winkler, RL. Tracking urbanization and exurbs: migration across the rural–urban continuum, 1990–2016. Popul Res Policy Rev 2020;39:835–59. https://doi.org/10.1007/s11113-020-09611-w.Search in Google Scholar PubMed PubMed Central

38. Tran, AV, Roberts, KP. Language accommodations for limited English proficient patients in rural health care. J Immigr Minor Health 2023;25:674–9. https://doi.org/10.1007/s10903-022-01416-7.Search in Google Scholar PubMed

39. Regenstein, M, Andres, E, Wynia, MK. Appropriate use of non-English-language skills in clinical care. JAMA 2013;309:145–6. https://doi.org/10.1001/jama.2012.116984.Search in Google Scholar PubMed

40. Ortega, P, Shin, TM, Pérez-Cordón, C, Martínez, GA. Virtual medical Spanish education at the corazón of Hispanic/Latinx health during COVID-19. Med Sci Educ 2020;30:1661–6. https://doi.org/10.1007/s40670-020-01058-0.Search in Google Scholar PubMed PubMed Central

41. Ortega, P, Pérez, N, Robles, B, Turmelle, Y, Acosta, D. Teaching medical Spanish to improve population health: evidence for incorporating language education and assessment in U.S. medical schools. Health Equity 2019;3:557–66. https://doi.org/10.1089/heq.2019.0028.Search in Google Scholar PubMed PubMed Central

42. Sabesan, VJ, Schrotenboer, A, Habeck, J, Lombardo, D, Stine, S, Jildeh, TR, et al.. Musculoskeletal education in medical schools: a survey of allopathic and osteopathic medical students. J Am Acad Orthop Surg Glob Res Rev 2018;2:e019. https://doi.org/10.5435/jaaosglobal-d-18-00019.Search in Google Scholar PubMed PubMed Central

43. Lin, IC, Sen-Crowe, B, Pasarin, A, McKenney, M, Elkbuli, A. Variability in tuition and curriculum among allopathic and osteopathic medical schools in the United States. Ann Med Surg. 2021;69:102737. https://doi.org/10.1016/j.amsu.2021.102737.Search in Google Scholar PubMed PubMed Central

Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/jom-2023-0110).

Received: 2023-05-05
Accepted: 2024-01-03
Published Online: 2024-02-29

© 2024 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Frontmatter
  2. General
  3. Original Article
  4. Implementation and mixed-methods evaluation of “Walk with a Doc” program at Stony Brook
  5. Medical Education
  6. Original Articles
  7. Prevalence and quality of medical Spanish education in US osteopathic medical schools: a national survey
  8. A validity study of COMLEX-USA Level 3 with the new test design
  9. Neuromusculoskeletal Medicine (OMT)
  10. Original Article
  11. Effectiveness of osteopathic manipulative applications on hypothalamic–pituitary–adrenal (HPA) axis in youth with major depressive disorder: a randomized double-blind, placebo-controlled trial
  12. Public Health and Primary Care
  13. Original Article
  14. Comorbidities associated with symptoms of subjective cognitive decline in individuals aged 45–64
  15. Clinical Image
  16. Tumid lupus masquerading as rosacea
https://doi.org/10.1515/jom-2023-0110
Keywords for this article
communication skills; Hispanic health; limited English proficiency; medical Spanish; multilingualism; non-English language preference
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. General
  3. Original Article
  4. Implementation and mixed-methods evaluation of “Walk with a Doc” program at Stony Brook
  5. Medical Education
  6. Original Articles
  7. Prevalence and quality of medical Spanish education in US osteopathic medical schools: a national survey
  8. A validity study of COMLEX-USA Level 3 with the new test design
  9. Neuromusculoskeletal Medicine (OMT)
  10. Original Article
  11. Effectiveness of osteopathic manipulative applications on hypothalamic–pituitary–adrenal (HPA) axis in youth with major depressive disorder: a randomized double-blind, placebo-controlled trial
  12. Public Health and Primary Care
  13. Original Article
  14. Comorbidities associated with symptoms of subjective cognitive decline in individuals aged 45–64
  15. Clinical Image
  16. Tumid lupus masquerading as rosacea
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 13.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jom-2023-0110/html
Scroll to top button