Language Proficiency Improvements After Longitudinal and Intensive Medical Spanish Courses

Introduction Few U.S. medical schools have a standardized curriculum or assessment for Medical Spanish courses, despite literature showing that language-concordant care is associated with better patient outcomes. The lack of standardized assessments of language proficiency in medical schools limits the comparison of effective instructional models. Methods We led an educational quality improvement study of medical students enrolled in an Intensive Medical Spanish course in Fall 2020 and Fall 2023, as well as an Advanced Medical Spanish course in Spring and Fall 2022 at one medical school. We utilized the ALTA Clinician Cultural and Linguistic Assessment (CCLA), one of the most widely used, validated language proficiency assessments for clinical communication, to evaluate students' Spanish language proficiency before and after taking Medical Spanish courses. We analyzed pre- and post-course ALTA CCLA scores (0-100) of all students who opted in to take the assessment (16/63) using the Wilcoxon signed-rank test. Results Seven students took the ALTA CCLA before and after the Intensive Medical Spanish course, and nine students took the ALTA CCLA before and after the Longitudinal Medical Spanish course. Students in the intensive course had a pre-course median score of 62 (IQR 42-66.5) and a post-course median score of 80 (IQR 61.5-81). The effect size for the median score difference between the pre- and post-scores is 17.7 (95% CI: 12.0-23.0) for the intensive course and is statistically significant using the Wilcoxon signed-rank test; four of the seven students achieved "professional proficiency." Students in the advanced course had a pre-course median score of 66 (IQR 59-74) and a post-course median score of 74 (IQR 74-82). The median score difference between the pre- and post-scores for the advanced course was 8.75 (95% CI: -4, 16), which is not a statistically significant effect size using the Wilcoxon signed rank test; four of the nine students achieved "professional proficiency." Additionally, we found an effect size of 9.9 (95% CI: 0.3-19.4) for the difference between the intensive and advanced courses, even after controlling for the pre-course scores. Conclusions This educational quality improvement study shows improvements in Spanish language proficiency for students who took an Intensive Medical Spanish course.