Incorporate Language in Medical Education to Address Structural Barriers to Care During the COVID-19 Pandemic and Beyond.

Abstract

To the Editor: The disproportionate impact of COVID-19 on ethnic minority individuals in the United States, including many Spanish speakers with limited English proficiency (LEP), 1 may be related in part to the lack of language-concordant health care professionals 2 and limited access to onsite or telemedicine language-appropriate services. 3 The current public health crisis presents an opportunity to incorporate language in medical education as a strategy to address longstanding structural barriers to health care. For instance, as medical educators consider how best to redesign and shift standardized patient (SP) encounters from onsite to virtual settings, they should review and potentially revise case content and SP characteristics to better reflect the racial, ethnic, and linguistic diversity of the patient population and include student training in interpreter use. In so doing, they may create a virtual approach that not only addresses pandemic-related gaps in medical school curricula but also enhances long-term fulfillment of required curriculum content standards 4 including cultural competence, health care disparities, and communication skills. A majority of U.S. medical schools report medical Spanish educational efforts, but these range from student-run clubs to formal courses and clinical clerkships involving LEP populations. 5 Cancellation or postponement of these experiences due to the pandemic may result in gaps in the teaching of skills to communicate with minority communities. Transforming existing medical Spanish education to virtual platforms would provide opportunities to reevaluate courses’ alignment with best practices, such as competency-based training and learner skills assessment. 6 Example strategies for virtual medical Spanish education include teleconference class time for practicing authentic communication and role playing, supervised small-group discussions, prerecorded audiovisual content or written material for students to review before online class sessions, and telemedicine encounters with Spanish-speaking SPs. Importantly, virtual medical Spanish education may increase the quality and accessibility of such course content, particularly in medical schools where qualified onsite faculty are not available. Virtual education may further facilitate meaningful collaborations across institutions (e.g., rural and urban medical schools), health professions (e.g., medicine, nursing, pharmacy), disciplines (e.g., language, humanities, medical fields), and languages (e.g., Spanish, Chinese). For instance, virtual collaborators can bypass geographic barriers by auditing each other’s courses, conducting peer review of course materials, sharing of online content and resources, and co-developing standardized learner performance assessments. As medical schools adjust their educational environments in the COVID-19 era, they must make intentional efforts to prepare future physicians to care for the individuals most vulnerable to this and future crises.