An Exploratory Investigation of Heritage and Educational Language Exposures as Factors in Medical Student Spanish Language Proficiency.

BACKGROUND

Prior to enrolling in medical Spanish courses, students typically acquire their Spanish skills either through formal second language education only (L2 learners) or by being exposed to Spanish during childhood at home (heritage learners).

OBJECTIVE

To categorize the language exposures of medical students who participated in a medical Spanish course and explore the associations of exposures with their medical language proficiency score on the Physician Oral Language Observation Matrix (POLOM).

SETTING AND PARTICIPANTS

Forty-one fourth-year medical students (2021-2022) self-reported demographics and prior language exposures and participated in videorecorded POLOM-rated Spanish standardized patient encounters.

MAIN MEASURES

To classify heritage Spanish-language exposures, we defined a three-category indicator: no, moderate, and high exposure. To classify formal language educational exposures, we created an indicator distinguishing students with advanced college-level study of Spanish versus all remaining students. Videorecorded encounters were scored by calibrated raters, yielding POLOM scores with a possible range of 6-30, with scores ≥23 indicating readiness for Spanish-concordant patient care.

KEY RESULTS

Nine participants (21.9% of 41) reported heritage Spanish exposure, with six (14.6%) reporting high exposure. Ten students (24.4%) reported advanced college-level study. POLOM scores were correlated with high heritage language exposure (r = 0.476, p = 0.0017) and advanced college-level study (r = 0.374, p = 0.0159). All who achieved the POLOM readiness threshold had high heritage Spanish exposure or advanced study (sensitivity 100%). Among those who scored below the threshold, 76% did not have high heritage exposure or advanced study (specificity 76%).

CONCLUSIONS

High heritage exposure and advanced college-level study are correlated with medical Spanish proficiency, but not all students with high heritage Spanish exposure or college-level coursework are ready for Spanish-concordant care. Future work should further evaluate the proposed three-category heritage language exposure indicator with a larger sample and the effectiveness of educational activities to enhance medical Spanish proficiency for both L2 and heritage learners.