¿Hablas Español? Language Assessment in Medical Students

Background: For patients with limited English proficiency, reports show improved health care outcomes when physicians are proficient in the language spoken by the patient. Formal language assessment has been explored as an effort to ensure language concordance, and it may be a valuable tool for helping medical students become bilingual health care providers. Objective: We assess current student interest in improving second language skills, self-reported language proficiency, and the effects of formal language assessment on the level of comfort with using this second language in a variety of clinical scenarios. Design: Mixed design including 1) cross-sectional baseline survey and 2) a randomized subgroup selected for intervention with formal language assessment and follow-up, using within-subjects analysis. 132 medical student volunteers completed an initial survey, 50 of which were randomly selected to complete a formal language assessment and a follow-up survey.  Interventions: Spanish formal language assessment was utilized by telephone survey provided and assessed by Versant™. Main Outcomes and Measures: Self-reported interest in becoming a bilingual health care provider, self-reported language proficiency, formally-assessed language proficiency, preferred modalities for learning a second language, and comfort level with using a second language in a variety of clinical scenarios. Results: Self-reported proficiency rating was correlated with overall scores on formal assessment. Formal assessment did not alter reported comfort level with using a second language except in proficient/fluent students. These students reported a decrease in comfort with providing care in scenarios that are complex (3.72 to 3.41, p=0.005) and those that have medical-legal implications (3.72 to 3.44, p=0.05). Students reported being most interested in learning a second language via an immersion experience (72%), international rotation (70%), or online course (54%).  Conclusions: Self-reported Spanish proficiency is correlated with formally assessed language ability. However, the decrease in comfort level among proficient/fluent medical students following formal assessment may reflect an initial overestimation of language ability or “false fluency.” This could potentially contribute to suboptimal healthcare outcomes in patients with limited English proficiency. Institutions wishing to focus on second language capabilities of their students should consider language assessment. They may also consider providing opportunities for interested students with language learning modalities that do not displace the mainstream medical curriculum.