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Developing Competencies to Advance Health Care Access and Quality for Latino, Hispanic, and Spanish Origin
Débora H Silva1, John A Davis Rodríguez2, Hector Rasgado-Flores3
1School of Medicine, University of Puerto Rico, San Juan.
Importance:
The Latina, Latino, Latinx, Latine, Hispanic, or of Spanish Origin (LHS+) population is 20% of the US population and experiences disparities in health care access and quality. The common mission of medical schools is to prepare future health care practitioners to deliver high-quality care to all patients. To do this, schools have adopted competency-based medical education (CBME) as a model of developing curricula.
Objective:
To develop specific competencies and milestones that address the unique needs of the LHS+ population.
Evidence Review:
A 13-member national expert working group (ie, Workgroup) was created in April 2023 to lead the project's development. The Workgroup selected a modified Delphi process. For the first Delphi round (May to September 2023), based on the Workgroup's experience and expertise, the Workgroup used targeted literature searches to draft an initial set of competency domains, competencies, and milestones. These were distributed through electronic surveys to 76 reactor panelists in 2 Delphi rounds in September 2023 and March 2024. Consensus was defined as 80% or greater panelist agreement.
Findings:
In round 1 of the modified Delphi process, the Workgroup identified 21 competencies and 38 milestones. After 2 reactor panelist rounds, 19 competencies and 34 milestones across 7 domains reached the 80% consensus threshold. The 7 competency domains included: (1) diversity of LHS+ individuals and families (4 competencies); (2) communicating with individuals, families, and communities who identify as part of the LHS+ community (3 competencies); (3) LHS+ diaspora, immigration, and migration (3 competencies); (4) research (3 competencies); (5) ethics (2 competencies); (6) patient-centered care (3 competencies); and (7) medical and surgical LHS+ workforce disparities (2 competencies).
Conclusions And Relevance:
The LHS+ health equity competencies build on the call for CBME and expand the literature focused on marginalized populations. A critical next step is identifying and supporting educators to develop, implement, evaluate, and publish teaching and learning assessment materials aligned with these new competencies.
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