US Medical Schools Research Articles

From Didactics to Disasters: Unveiling CBRNe and Counter-Terrorism Medicine Training in US Medical Schools.

The threat of chemical, biological, radiologic, nuclear, and explosive (CBRNe) terrorist attacks has increased over time. The need for rapid and effective responses to such attacks is paramount. Effective medical counter-measures to CBRNe events are critical and training for such may effectively occur early in physician training. While some medical specialties are more involved than others, counter-terrorism medicine (CTM) spans all medical specialties. All United States allopathic medical schools were examined via online curriculums and queries for academic content related to CBRNe and terrorist medical counter-measures. Analysis of 153 United States allopathic medical schools demonstrated that 15 (9.8%) medical schools offered educational content related to CBRNe and terrorist counter-measures. This is in contrast to legislation following the September 11, 2001 attacks that called for high priority for such education. Effective CBRNe medical counter-measures are currently in place; however, there is room for improvement in education that may begin during medical school. While certain medical specialties such as emergency medicine, primary care, and dermatology may have specific niches in such events, physicians of all medical specialties have something to offer, and even a basic education in medical school can help best prepare the nation for future attacks.

PharmaCORE: Optimizing medical pharmacology education with an innovative instructional dashboard

What was the educational challenge? Diminishing emphasis on pharmacology education in medical schools has resulted in a concerning lack of prescribing knowledge among physician graduates. These concerns mirror our graduates’ expressed dissatisfaction with the structure and quality of pharmacology educational experiences over the past 5 years. What was the solution? PharmaCORE, a web-based instructional dashboard, was developed as an interactive faculty development tool to enhance integration and instruction of pharmacology content in pre-clinical curriculum at a US medical school. How was the solution implemented? PharmaCORE was introduced in Spring 2022 for instructors teaching pharmacology in the pre-clinical curriculum. Instructors used the dashboard to assess coverage of specific drug topics throughout the curriculum and to apply tailored, learner-centered teaching strategies to optimize learner engagement and comprehension. What lessons were learned that are relevant to a wider global audience? The initial assessment indicated that the dashboard was user-friendly and positively influenced instructor awareness of pharmacology content and learner-centered teaching. This faculty development approach underscores the importance of skill-based mapping and maintaining learner-centered teaching standards to address other integrated subjects and broader curricular challenges. What are the next steps? This study lays the foundation for the broader applicability of instructional dashboards in tracking and addressing curricular challenges across pharmacology and other science subjects. Future steps include more personalized feedback for instructors, creating a student-accessible version, and ongoing monitoring of maintenance measures like milestone exams.

Racial and Ethnic Disparities in Situational Judgment Testing Among Applicants to an Anesthesiology Residency Program.

Background The Computer-Based Assessment for Sampling Personal Characteristics (CASPer) is a situational judgment test (SJT) that assesses noncognitive skills like professionalism, communication, and empathy. There are no reports of the effects of race/ethnicity and sex on CASPer scores among residency applicants. Objective We examined the effects of race/ethnicity, sex, and United States vs international medical school attendance on CASPer performance. Methods Our anesthesiology residency program required all applicants for the 2021-2022 Match cycle to complete an online video and text-based SJT (CASPer). We compared these results, reported as z-scores, with self-identified race/ethnicity, sex, United States vs international medical school attendance, and United States Medical Licensing Examination (USMLE) Step 1 scores. Results Of the 1245 applicants who completed CASPer, 783 identified as male. The racial/ethnic distribution was 512 White, 412 Asian, 106 Black, 126 Hispanic, and 89 Other/No Answer. CASPer z-scores did not differ by sex. White candidates scored higher than Black (0.18 vs -0.57, P<.001) and Hispanic (0.18 vs -0.52, P<.001) candidates. Applicants attending US medical schools scored higher than those attending international medical schools (z-scores: 0.15 vs -0.68, P<.001). There was no correlation between CASPer z-scores and USMLE Step 1 scores. Conclusions Our results suggest that CASPer scores favor White applicants over Black and Hispanic ones and applicants attending US medical schools over those attending international medical schools.

Education Research: Observational Study of Educational Debt Among US Medical Graduates Entering Neurology, 2010-2021.

To identify trends in educational debt for US medical school graduates entering neurology and compare debt to anticipated compensation. Data of 148 accredited medical schools were obtained from the Association of American Medical Colleges Graduation and Matriculating Student Questionnaires to identify self-reported educational debt for graduates pursuing neurology training. Trends were assessed in a 2-year interval from 2010 to 2021. Descriptive statistics were used to assess characteristics associated with debt. Dollar amounts were adjusted to 2021 US dollars. Total compensation by subspecialty from the 2021 American Academy of Neurology Compensation and Productivity Survey was used to calculate debt-to-income ratios by subspecialty. There were 182,738 responses recorded from medical graduates from 2010 to 2021, of which 4,466 planned on neurology training. The percentage of medical graduates entering neurology with debt decreased from 82% in 2010-2011 to 71% in 2020-2021. Among indebted, the median educational debt increased 9% from $192,613 (interquartile range [IQR] $140,908) in 2010-2011 to $209,396 (IQR $159,128) in 2020-2021 (p < 0.001). Medical graduates with debt more often reported family income in the bottom 3 quintiles of US household income (18% with debt vs 7% without debt; p < 0.001). Graduates from self-identified race and ethnicity groups who are underrepresented in medicine (URiM) were more likely to have debt (15% vs 9%; p < 0.001) and had greater debt when compared with graduates not self-identifying as URiM (median $211,616 [IQR $152,760] vs $202,379 [IQR $153,340]; p < 0.001). In 2021, 46% of indebted neurology-bound graduates indicated plans to use Public Service Loan Forgiveness, which increased from 16% in 2010. In 2021, the median debt for neurology graduates represented between 70% and 93% of total annual compensation with the highest debt-to-income ratios among behavioral neurology (0.93), child neurology (0.91), and movement disorders (0.89). The burden of educational debt for neurology-bound graduates is increasingly concentrated among those from lower-income families and racial and ethnic groups who are URiM. Subspecialties that often manage patients in the outpatient setting, as compared with those that are primarily inpatient/procedural, may have greater debt with respect to their compensation. Nearly half of 2021 graduates pursuing neurology plan to use tax-payer funds for loan forgiveness.

Assessment of Student Perceptions of Aspects of a Career in Radiation Oncology

PurposeTo determine medical students’ views of various aspects of a career in radiation oncology (RO) to identify areas that may benefit from reform and to guide initiatives to stimulate broader and more diverse student interest in the specialty. Methods and materialsAn electronic survey was sent to student oncology interest group members at seven US medical schools. The survey asked students to rate 19 aspects of RO on a 5-point bipolar Likert-type scale. Descriptive statistics are reported, along with subgroup analyses based on participants’ demographics. ResultsThe response rate was 51.1% (n = 275 of 538). The most favorably rated aspects of RO were outpatient working hours (mean ± SD Likert-type rating of 4.51 ± 0.82), routinely working with other physicians (4.45 ± 0.76), and use of advanced technology to treat patients. The most unfavorably rated aspects of RO were less geographic flexibility for residency or employment (1.98 ± 1.04), spending a lot of time on a computer doing treatment planning (2.80 ± 1.21), and having a job that is not well understood by most doctors and the general public (2.89 ± 1.02). Gender was associated with significant differences in 8 of 19 questions in how each aspect of RO was viewed. Few differences were observed based on race or ethnicity, though Asian participants had a significantly more favorable view of RO being a more science-oriented specialty compared with White or underrepresented students, respectively (3.50 versus 3.21 versus 2.84, P = .01). ConclusionsThese findings inform the RO community in the development of more effective initiatives to encourage students to fully explore the specialty.

Exploring Quality and Requirements in Faculty Development Related to Teaching.

Little is known about medical school requirements for faculty development related to teaching (FDT) in medical education. This study examined the national landscape and local faculty perceptions of their own institution's FDT requirement. An electronic survey was disseminated to Faculty Affairs Offices in US medical schools to assess FDT requirements. A second survey was distributed to faculty within one medical school to gauge faculty perceptions related to existing FDT requirements. Responses were received from approximately 33% of US medical schools and 36% of local faculty. Few responding medical schools had formal FDT requirements. There was a wide range variation of hours and activities necessary to satisfy existing requirements and consequences for noncompliance. For respondents from schools that did not have a requirement, many saw value in considering a future requirement. Many local faculty agreed that the FDT requirement improved their teaching skills. When asked to share other thoughts about the FDT requirement, several qualitative themes emerged. This study helps establish a national benchmark for the status of FDT requirements in medical education and revealed information on how to optimize and/or improve such requirements. The authors offer five recommendations for schools to consider regarding FDT.

US Fourth-Year Medical Students: Diabetes Knowledge and Confidence Dissonance.

Self-assessed confidence is not a reliable indicator of knowledge levels, as multiple studies have shown; however, it is often used as a measure of knowledge. The purpose of this study is to identify whether the confidence of graduating students in a US medical school to diagnose and treat diabetes is correlated with their diabetes-related knowledge. We developed a 38-question survey, targeting students' external experiences, knowledge, and confidence related to the diagnosis, treatment, and prevention of diabetes. The survey includes six self-reported confidence questions and 15 multiple choice-style questions, to test diabetes knowledge. The survey was administered electronically using REDCap to the graduating medical school class (n=176) at Upstate Medical University. We calculated mean knowledge scores and confidence scores were calculated. We used Pearson correlation and t tests to assess for correlations and differences in the collected data. We also reviewed diabetes content in the current curriculum. The response rate was 38%. The mean confidence score was 19.97 out of 30 (SD=3.92) and the mean knowledge score was 9.63 out of 15 (SD=2.09). Total knowledge and confidence scores were not correlated. A positive correlation between confidence in prescribing/adjusting medications to treat patients with type 1 diabetes and knowledge levels was found (R=.325, P=.007). Academic electives, external experiences with diabetes, and demographics did not correlate with knowledge and confidence differences. Students overestimated their ability to adequately manage people with diabetes. Better approaches are needed to prepare future physicians to diagnose and treat diabetes.

Celiac Disease in Medical Curriculum

Introduction: Celiac disease is a common autoimmune illness precipitated by the ingestion of gluten, a protein contained in grains (e.g., wheat, barley, and rye). Celiac disease can present with a wide variety of manifestations across nearly any body system, but most individuals with celiac disease present with subclinical symptoms. Despite relatively inexpensive testing and an effective treatment (i.e., a gluten free diet), most individuals with celiac disease remain undiagnosed, leading to significant disease burden. Research suggests that physicians have poor knowledge of celiac disease, likely contributing to the high rates of missed diagnoses. This study sought to assess the information encountered by students in pre-clinical medical education regarding celiac disease.&#x0D; Methods: Information was drawn from recent literature to create a rubric to evaluate the presentation of celiac disease in curricular and educational resources for pre-clinical medical students. Categories evaluated included prevalence, morbidity/mortality, manifestations, comorbidities, and testing recommendations. This rubric was used to assess the curriculum from a large US medical school and First Aid for the USMLE Step 1, a popular commercial resource used by medical students.&#x0D; Results: The medical school curriculum scored higher overall than First Aid (31/48 and 12/48, respectively). The curriculum also scored higher in all categories except morbidity/mortality. The curriculum showed deficits predominantly in morbidity/mortality and testing recommendations. First Aid showed deficits in all categories.&#x0D; Discussion: Results showed that the medical school curriculum provided more complete information about several aspects of celiac disease. First Aid did not thoroughly address any of the categories evaluated with the rubric. While First Aid may be an effective consolidation of Step 1 material, it seems likely that it is focused on “teaching to the test” rather than providing thorough medical education for future physicians. The medical curriculum is a more complete resource for students to learn about celiac disease.

Teaching respect for body donors: A US medical student perspective.

Recent controversies over the mismanagement of body donors in US medical schools have raised public concerns over the ethical treatment of bodies in "anatomical gift" programs. Despite widespread moral outrage at such cases, medical students may still make seemingly inconsequential mistakes or jokes that in fact constitute acts of disrespect. This may partially be attributed to the process of desensitization in working with human remains, and indicates a further need to inculcate into medical students the ethical responsibilities of working with body donors. Donation agreement statements that lack specific information about the respectful treatment of bodies in the anatomy laboratory may serve as an additional point of concern for potential donors seeking reassurance about the future treatment of their bodies. This viewpoint draws from the anecdotal experiences of medical students to portray two scenarios of medical students' disrespectful conduct toward body donors, and constructs an account of moral respect for human remains based on respect for posthumous autonomy and respect in attitude. It then provides suggestions for US medical schools to incorporate this ethical framework into their anatomy curricula to instill respectful dispositions in its students and facilitate a more robust informed consent process for potential donors who entrust their bodies to medical students.

Medical Spanish Graphic Activity: A MeGA Deliberate Practice Approach to Reducing Jargon Use With Spanish-Speaking Acute Care Patients.

Medical Spanish courses in US medical schools aim to teach patient-centered communication, yet many existing resources focus on technical vocabulary and may inadvertently increase jargon use with patients. Graphic medicine presents an opportunity for interactive learning that centers the patient experience, yet it has never been explored in medical Spanish education. We developed a Medical Spanish Graphic Activity (MeGA) for medical student deliberate practice of patient-centered verbal communication focused on three aspects: diagnosis, treatment, and follow-up care. Each 30-minute activity included a comics handout depicting a patient with a common problem. Students used voice-to-text technology to record their explanations in response to prompts. Transcripts were analyzed for jargon use, including total jargon, unexplained jargon, and problem words (non-Spanish words plus unexplained jargon), utilizing a previously published, reliable protocol for Spanish medical jargon classification. Participants voluntarily provided postactivity feedback. Twenty-nine fourth-year students with intermediate or greater Spanish skills participated in a series of 10 MeGA activities between January and April 2022. Unexplained jargon use and problem words progressively decreased for all transcripts (diagnosis, treatment, and follow-up; all ps < .001). Total jargon use also decreased, but this was not significant in follow-up transcripts (p = .38). All students agreed that MeGA helped them enhance communication skills applicable to patient care and self-identify strengths and limitations. MeGA is realistic to implement, engages students' active participation in the speaking domain, and reduces unexplained jargon use. Future studies should explore the broader application of this model and engage patient perspectives.

Institutional leadership after Dobbs: a mixed methods analysis of US medical schools' public statements regarding abortion

IntroductionMedical schools, as significant and influential organisations within their communities, have the potential and the capacity to impact abortion policy. Organisations often engage in advocacy by issuing public statements that...

Variability and Inconsistency of Titles for Part-time Faculty Appointments at US Medical Schools

Variability and Inconsistency of Titles for Part-time Faculty Appointments at US Medical Schools

DEATH AND DYING EDUCATION IN US MEDICAL SCHOOLS: A SCOPING REVIEW

Abstract With an aging population, knowledge about death, dying, loss, grief, and end-of-life (EOL) care is an essential skill for most physicians. However, EOL education has been minimally incorporated into medical school curricula in the United States (U.S.); there is a significant need to better prepare medical students for the unique challenges of improving patient wellbeing at end-of-life. To understand how death and dying topics have been incorporated into U.S. medical school education, we conducted a systematic scoping review, using PRISMA guidelines, of published research on death education for medical students between 2010 through 2022. An initial search in EMBASE and PubMed yielded 3,443 citations; 265 articles met the initial inclusion criteria (e.g., research-based, EOL education specific), with 97 articles selected for full-text review. Overall, we found significant variation in the type and content of EOL training in U.S. medical schools. Using a competency-based medical education framework that reflects tangible knowledge, skills, and attitudes as a guide to ensure proper EOL training, a deductive coding approach yielded several themes including: reliance on brief, skills-based workshop interventions and limited longitudinal integration into curricula; general research on student attitudes and wellbeing; and an emphasis on needs assessments highlighting gaps in evidence-based EOL training interventions. Using these findings, we offer applied considerations for teaching EOL related skills in U.S. medical schools. In turn, this work contributes to the enhancement of health across the lifespan and might ultimately lead to a society where a “good death” is not an exception, but a reality.

Diversity in Mission Statements and Among Students at US Medical Schools Accredited Since 2000

Diversity in the physician workforce improves patient care and decreases health disparities. Recent calls for social justice have highlighted the importance of medical school commitment to diversity and social justice, and newly established medical schools are uniquely positioned to actively fulfill the social mission of medicine. To identify diversity language in the mission statements of all medical schools accredited since 2000 and to determine whether the presence of diversity language was associated with increased diversity in the student body. Cross-sectional study of public websites conducted between January 6, 2023, and March 31, 2023. Qualitative content analysis of mission statements was conducted using a deductive approach. Eligible schools were identified from the 2021-2022 Medical School Admission Requirements and American Medical Colleges and American Association of Colleges of Osteopathic Medicine websites. Each school's publicly available website was also reviewed for its mission and student body demographics. All United States allopathic and osteopathic medical schools that have been accredited and have enrolled students since 2000. Content analysis of medical school mission statements. Prevalence of diversity language in medical school mission statements and its association with student body racial diversity. Data were analyzed in 5-year groupings: 2001 to 2005, 2006 to 2010, 2011 to 2015, and 2016 to 2020). Among the 60 new medical schools (33 [55%] allopathic and 27 [45%] osteopathic; 6927 total students), 33 (55%) incorporated diversity language into their mission statements. In 2022, American Indian or Alaska Native individuals accounted for 0.26% of students (n = 18), Black or African American students constituted 5% (n = 368), and Hispanic or Latinx individuals made up 12% (n = 840). The percentage of schools with diversity language in their mission statements did not change significantly in schools accredited across time frames (60% in 2001: mean [SE], 0.60 [0.24] vs 50% in 2020: mean [SE], 0.50 [0.11]). The percentage of White students decreased significantly over the time period (26% vs 15% students in 2001-2005 and 2016-2020, respectively; P < .001). No significant differences were observed in student body racial or ethnic composition between schools with mission statements that included diversity language and those without. In this cross-sectional study of US medical schools accredited since 2000, diversity language was present in approximately half of the schools' mission statements and was not associated with student body diversity. Future studies are needed to identify the barriers to increasing diversity in all medical schools.

Observed Structured Teaching Experiences (OSTEs) in a Students as Teachers Course.

Teaching is an important competency in graduate medical education (GME). Many residency programs have implemented curricula to develop residents' teaching skills and observed structured teaching experiences (OSTEs) have been used to assess these skills. There is an increasing focus on building teaching skills earlier in the medical education continuum, however, there is limited literature on assessing medical students' teaching skills. The authors developed an OSTE for medical students enrolled in a students-as-teachers course to address this gap and provide formative feedback on teaching skills. OSTEs were conducted for fourth-year medical students (M4s) enrolled in a Students as Teachers Advanced Elective at a US medical school. An M4 observed a first-year medical student (M1) during a simulated encounter with a standardized patient. The M4 gave feedback and a chalk talk. A physician observer assessed the M4's teaching using the modified Stanford Faculty Development Program (SFDP) questionnaire. The M1s and M4s also completed the SFDP. The M4 completed pre- and post-OSTE self-efficacy surveys (score range 6-30) and a post-OSTE acceptability survey. All (30/30) M4s completed the OSTE. The SFDP identified common teaching strengths and areas for growth. ANOVA tests demonstrated significant differences between the mean (SD) scores from physician assessors, M1s, and M4s [4.56 (0.63) vs. 4.87 (0.35) vs. 4.08 (0.74), p<0.001]. There was a statistically significant difference in mean (SD) self-efficacy scores pre- and post-OSTE [18.72 (3.39) vs. 23.83 (3.26), p<0.001]. All M4s (30/30) somewhat or strongly agreed with all three OSTE acceptability questions. The authors successfully conducted an OSTE in an M4 advanced elective. The OSTE was highly acceptable to participants, and M4s demonstrated improved teaching self-efficacy. Further research should explore the validity of the OSTE to measure medical students' teaching skills and the long-term impact of developing teaching skills in medical school. The online version contains supplementary material available at 10.1007/s40670-023-01952-3.

Challenges Facing First-Generation College Graduates in Medical School

First-generation (FG) medical students remain underrepresented in medicine despite ongoing national efforts to increase diversity; understanding the challenges faced by this student population is essential to building holistic policies, practices, and learning environments that promote professional actualization. Although FG students have been extensively studied in the undergraduate literature, there is little research investigating how FG students experience medical education or opportunities for educators to intervene. To explore challenges that FG students experience in undergraduate medical education and identify opportunities to improve foundational FG support. This qualitative study was conducted using an online platform with 37 FG students enrolled in 27 US medical schools. An interprofessional team of medical educators and trainees conducted semistructured interviews from November 2021 through April 2022. Participants were recruited using a medical student listserv. Data were analyzed from April to November 2022. After conducting a preliminary analysis using open coding, a codebook was created and used in a thematic analysis; the codebook used a combination of deductive and inductive coding. Among the 37 students recruited for this study, 21 (56.8%) were female; 23 (62.2%) were in the clinical phase of training; 1 (2.7%) was American Indian or Alaska Native, 7 (18.9%) were Hispanic, Latino, or of Spanish origin, 8 (21.6%) were non-Hispanic Asian or Asian American, 9 (24.3%) were non-Hispanic Black or African American, and 23 (32.4%) were non-Hispanic White; mean (SD) age was 27.3 (2.8) years. Participants described 4 major themes: (1) isolation and exclusion related to being a newcomer to medicine; (2) difficulty with access to basic resources (eg, food, rent, transportation) as well as educational (eg, books); (3) overall lack of faculty or institutional support to address these challenges; and (4) a sense of needing to rely on grit and resilience to survive. Although grit and resilience are desirable traits, results of this study suggest that FG medical students face increased adversity with inadequate institutional support, which forces them to excessively rely on grit and resilience as survival (rather than educational) strategies. By applying the holistic model often used in admissions to the postmatriculation educational process, targeted and flexible initiatives can be created for FG students so that all students, regardless of background, can achieve robust professional actualization.

Re-conceptualizing medical education in the post-COVID era

Purpose The COVID-19 pandemic has forced changes in the delivery of medical education. We aimed to explore these changes and determine whether they will impact the future of medical education in any way. Methods We invited leaders in medical education from all accessible US-based medical schools to participate in an online individual semi-structured interview. Results Representatives of 16 medical schools participated. They commented on the adequacy of online education for knowledge transfer, and the logistical advantages it offered, but decried its negative influence on social learning, interpersonal relationships and professional development of students, and its ineffectiveness for clinical education. Most participants indicated that they would maintain online learning for didactic purposes in the context of flipped classrooms but that a return to in-person education was essential for most other educational goals. Novel content will be introduced, especially in telemedicine and social medicine, and the students’ roles and responsibilities in patient care and in curricular development may evolve in the future. Conclusions This study is the first to document the practical steps that will be adopted by US medical schools in delivering medical education, which were prompted and reinforced by their experience during the COVID-19 pandemic.

Preclerkship Medical Students’ Use of Third-Party Learning Resources

Undergraduate medical education increasingly relies on asynchronous, virtual learning; and medical educators have observed students engaging in self-directed learning outside of their institutional curriculum using widely available third-party resources. If medical educators better understand how students are learning, they may uncover novel opportunities to improve preclerkship education. To explore how and why preclerkship medical students use third-party learning resources. This qualitative study recruited second-year medical students from 7 public and private allopathic US medical schools and conducted 7 virtual focus groups (1 per institution) from September 2022 to January 2023, exploring how and why students use third-party resources. Data were iteratively analyzed in parallel with focus groups using constructivist grounded theory methodology. Data analysis was performed from October 2022 to February 2023. Fifty-eight second-year US medical students who had used a third-party resource at least once participated; 36 (61%) identified as women; 13 (23%) identified as Asian, 6 (11%) as Black, 30 (53%) as White, 6 (11%) as multiracial, and 4 (7%) as other; 6 (10%) identified as Hispanic, Latino, or Spanish origin, and 52 (90%) identified as non-Hispanic, Latino, or Spanish origin; 48 (83%) were aged 23 to 25 years. Participants described engaging in a cyclical process of deciding whether and how to use third-party resources. Four broad themes were identified: (1) hearing about resources, (2) selecting resources, (3) using resources, and (4) tensions and possible solutions. Participants largely heard about third-party resources from peers and turned to resources out of dissatisfaction with some aspect of their medical school curriculum. Students used resources in various ways that were user-dependent and context-dependent. Participants endorsed multiple benefits over their in-house curricula, particularly efficiency, clarity, and concision. Tensions included navigating resource drawbacks and the perception of an antagonistic relationship between medical schools and third-party resources. Participants suggested that medical schools examine the resources, recommend specific ones, integrate them into the curriculum, and subsidize their cost. In this qualitative study of preclerkship medical student use of third-party resources, participants perceived that the resources had numerous benefits for learning and suggested that medical schools should more formally acknowledge and integrate their use.

Current State and Proposal of Best Practices of Standardized Patients for Spanish-Language Objective Structured Clinical Encounters in US Medical Schools.

Medical Spanish programs commonly engage Spanish-speaking standardized patients (SPs) for communication skills assessment, yet no studies address SP recruitment, selection, or training. We sent questionnaires to medical Spanish faculty at 20 US medical schools to gauge their practices in recruiting and selecting Spanish-language SPs. We invited faculty to distribute a separate questionnaire to Spanish-language SPs to gather SP language abilities, training, and experience. We analyzed data using descriptive statistics and qualitative content analysis. When available, we reviewed SP video encounters to formally assess participating SPs' linguistic performance using the SP Oral Language Observation Matrix, a rating tool adapted from the Physician Oral Language Observation Matrix to assess oral medical Spanish proficiency. Eighty percent of faculty (16/20) responded. Standardized patient recruitment sources included institutional English-language SPs, Hispanic student groups and professional organizations, communities, and language professionals. Faculty-reported strategies to determine language readiness included interviewing SP candidates in Spanish and asking them to self-rate language skills using a validated scale. Fifteen SPs (54%, 15/28) from 5 schools responded to the SP questionnaire, and one third (5/15) reported that their Spanish was not assessed before being selected as an SP. In addition, one third (5/15) did not receive any initial training before performing a medical Spanish case. Raters assessed 11 different SPs using the SP Oral Language Observation Matrix, and 6 were rated as linguistically "ready" for the SP role. Current approaches to recruitment, training, and language assessment of SPs vary. We propose strategies to ensure that medical Spanish encounters authentically reflect Spanish-speaking patients.

Undue Burden the Medical School Application Process Places on Low-Income Latinos

Undue Burden the Medical School Application Process Places on Low-Income Latinos