P0672 - Culture and Language Coaching for Bilingual Residents: The First 10 years of the CHiCoS Model

Program Goals

Professional standards and formal training opportunities related to physician use of non-English languages are lacking. Such standards and training are needed to assure high-quality, safe communication with culturally and linguistically diverse patients. Our objective was to describe the first decade of a culture and language coaching program for bilingual (Spanish-English) pediatric residents, including educational, clinical, and residency program outcomes.

Evaluation

We developed a culture and language coaching model for workplace-based training of bilingual pediatric residents (with intermediate Spanish proficiency or better) in medical Spanish and cultural health beliefs and practices. Throughout residency, a culture and language coach teamed with bilingual faculty to provide each resident 1:1 support during their weekly Spanish-language continuity clinic visits (in the Clínica Hispana de Cuidados de Salud - CHiCoS). The coach served as a communication safety net during visits and gave tailored feedback and supplementary learning activities outside of visits. Educational outcomes included % of residents passing a validated physician language assessment (Clinician Culture and Language Assessment) by graduation, resident self-efficacy related to linguistic and cultural skills, and program rating by residents and faculty; clinical outcomes included effects on bilingual clinic capacity and patient ratings of care. Residency program outcomes included effect on resident recruitment.

Over 10 years, 43 residents participated, reporting improved language skills, cultural knowledge, and ability to care for Spanish-speaking patients; overall program rating was 9.1/10. 70% of residents not qualified bilingual by validated testing upon entry were able to pass the test by graduation. As a direct result of the program, bilingual faculty capacity in CHiCoS increased by 800%. Spanish-speaking patients seen by CHiCoS residents and faculty reported higher satisfaction, trust, and communication scores than those seen in non-bilingual areas of the same clinic. 85% of incoming CHiCoS interns reported ranking the residency program higher than they would have without the opportunity to be in CHiCoS.

Discussion

Culture and language coaching is an effective model for formally training bilingual residents to provide linguistically and culturally appropriate care to Spanish-speaking families in the pediatric setting. Adoption of the culture and language coaching model in diverse sites beyond CHiCoS has begun transforming multiple educational and clinical settings.