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Cited by 17Interpreting and Communication in HealthcareCultural Competency in Health CareInnovations in Medical Education

Culture and language coaching for bilingual residents: the first 10 years of the CHiCoS model

Cowden, John D., Martinez, Francisco J., Dickmeyer, Jodi J., Bratcher, Denise·2023·Teaching and Learning in Medicine
DOI 10.1080/10401334.2022.2092113
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Abstract

ProblemIn the US, there are neither professional standards nor adequate formal training opportunities related to physician use of non-English languages, the most common of which is Spanish. To achieve safe, effective health care for culturally and linguistically diverse patients, the medical profession needs clear standards for physician language use and proven culture and language training models that include validated assessment of linguistic proficiency. InterventionThe authors describe the first decade of an innovative culture and language coaching program for bilingual (Spanish-English) pediatric residents, including the model’s evolution and outcomes, as well as recommendations for implementing similar programs elsewhere. Over 10 years, the model has grown from a central innovation—the professional culture and language coach (CLC). The CLC provides 1:1 in-visit support and post-visit coaching to individual residents during three years of continuity clinic experience in a Spanish-language setting (Clínica Hispana de Cuidados de Salud—CHiCoS). They also provide a range of supplementary learning activities (e.g., simulations, immersion rotations, mock testing) and periodic formal assessment of language proficiency. Foundational program elements include cultural and linguistic humility, variations in language, pragmatic linguistics and trans-languaging, the inseparability of culture and language, health literacy, and a flat teaching hierarchy (“all teach, all learn”). ContextCHiCoS has been implemented continuously since 2009 in the primary care clinic of a stand-alone academic pediatric hospital in the Midwest, where pediatric residents have their continuity clinic experience over three years of residency. ImpactFifty-six residents have participated, reporting improved language skills, cultural knowledge, and ability to care for Spanish-speaking patients. Sixty-eight percent of residents not qualified bilingual upon program entry passed a validated physician language assessment by graduation. 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 (p < .05 for all scores). The program increased bilingual faculty six-fold and changed attitudes and practices related to language supports throughout the residency program. Lessons LearnedCulture and language coaching provides effective preparation and assessment of bilingual physicians, leading to improved care for culturally and linguistically diverse patients. Our model offers an example for developing similar approaches for a variety of clinicians throughout health care. Such approaches should include professional standards for non-English language use, training supports customized to bilingual learners’ proficiency levels, and a focus on integrating practical cultural and linguistic skills to achieve safe, effective clinical communication.

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Authors
Cowden, J. D., Martinez, F. J., Dickmeyer, J. J., & Bratcher, D.
Affiliations
  • University of Missouri–Kansas City (US)
  • Culture and Language Coaching Program, Children’s Mercy Kansas City, Kansas City, Missouri, USA
Corresponding author
Cowden, John D.
ORCID
Cowden, John D.
Venue
Teaching and Learning in Medicine
Publisher
Informa UK Limited
Published
2022-06-30
Volume
35
Issue
5
Pages
589-600
ISSN
  • 1040-1334 (ISSN-L)
  • 1532-8015
DOI
10.1080/10401334.2022.2092113
OpenAlex
W4283750676
Cited by
17
References
28
Citations by year
2026: 4 · 2025: 3 · 2024: 6 · 2023: 4
FWCI
3.73
Type
journal article
Language
en
Open access
closed
Locations
  • Teaching and Learning in Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Interpreting and Communication in Healthcare
  • Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords
Spanish-speaking patients, pediatric residency, continuity clinic, language proficiency assessment, cultural and linguistic diversity, translingual pedagogy, cultural humility, health literacy, patient-provider communication
MeSH terms
Mentoring, Child, Humans, Internship and Residency, Language, Learning, Physicians, Multilingualism

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