Medical Student Perceptions of Sociocultural Issues in Healthcare: A Multisite Study of Medical Spanish Education

Abstract

Theory Cultural competence and humility are core elements of medical education in a diverse society. Language is inseparable from culture, as language informs, indexes, frames, and encodes both culture and worldview. Spanish is the most common non-English language taught in U.S. medical schools, yet medical Spanish courses tend to artificially separate language from culture. It is unknown to what extent medical Spanish courses advance students’ sociocultural knowledge or patient care skills. Hypotheses Based on current predominant pedagogy, medical Spanish classes may not adequately integrate sociocultural issues relevant to Hispanic/Latinx health. We hypothesized that students who completed a medical Spanish course would not demonstrate significant gains in sociocultural skills following the educational intervention. Method An interprofessional team developed a sociocultural questionnaire, and 15 medical schools invited their students to complete the questionnaire before and after completing a medical Spanish course. Of participating schools, 12 implemented a standardized medical Spanish course and three served as control sites. Survey data were analyzed regarding: (1) perceived sociocultural competence (recognition of common cultural beliefs, recognition of culturally normative non-verbal cues, gestures, and social behaviors, ability to address sociocultural issues in healthcare context, and knowledge of health disparities); (2) application of sociocultural knowledge; and (3) demographic factors and self-rated language proficiency (Poor, Fair, Good, Very Good, or Excellent) on the Interagency Language Roundtable scale for healthcare (ILR-H). Results Overall, 610 students participated in sociocultural questionnaire between January 2020 and January 2022. After the course, participants reported an increased understanding of cultural aspects of communication with Spanish-speaking patients and the ability to apply sociocultural knowledge to patient care (all p < 0.001). When analyzed by demographic factors, students who identified as Hispanic/Latinx or as heritage speakers of Spanish tended to report increased sociocultural knowledge/skills following the course. When examined by Spanish proficiency, preliminary trends showed that students at both ILR-H Poor and Excellent levels did not demonstrate gains in sociocultural knowledge or ability to apply sociocultural skills. Students at sites with a standardized course were likely to improve sociocultural skills in mental health conversations (p < 0.001) while students at control sites were not (p = 0.05). Conclusions Medical Spanish educators may benefit from additional guidance on teaching sociocultural aspects of communication. Our findings support that students at ILR-H levels of Fair, Good, and Very Good are particularly well-suited for gaining sociocultural skills in current medical Spanish courses. Future studies should explore potential metrics to evaluate cultural humility/competence within actual interactions with patients.