“Culture” can mean different things to different people. For Liza Genao, MD, it describes the part of a person that yearns to be seen.
“Culture is a set of customs, beliefs, language, food, etc., that inform your story,” she said. “Human beings want to be seen. That's what we all crave. Understanding the culture that dictates in part who you are is a key element to feeling seen.”
As a provider who primarily cares for patients living with dementia at the Duke Geriatrics Evaluation and Treatment Clinic, Genao understands how important it is for patients to feel understood and seen. That understanding is what motivates her to teach medical Spanish to future doctors through a course called Advanced Clinically Centered Education in Spanish (ACCES).
A Patient-Centered Course
The elective course, which is open to first-year medical students at Duke University School of Medicine, is designed to help medical students become culturally competent Spanish-speaking health care providers. To enroll, students must have intermediate to advanced-level Spanish skills.
Genao, an associate professor of medicine, said the curriculum centers on the patient, and aligns with the content of other courses the students take during their first year. Through weekly practice activities, including role play, interview of standardized patients, and games, students improve their language and interpersonal skills needed to interview patients in Spanish.
This patient-centered approach to learning will help make the students better providers and lead to better patient outcomes, Genao said. “Language concordant care, that is, the ability to interview a patient in their native language, has been demonstrated to improve quality of care, satisfaction with care and communication, medical understanding, medication adherence, and mental health as well as reduced health care utilization.”
Fulfilling a Need
The ability to interview a patient in Spanish is an invaluable skill that increases the students’ competitiveness as they pursue further training in medicine, especially if they seek to match in major cities where there are large Spanish-speaking populations.
“These students are very passionate about providing care that is high quality, independent of the patient’s preferred language,” Genao said. “It fulfills their need to do something to make a change in this world.”
Genao said even if a provider isn’t fluent in another language, the simple act of trying to speak the language of the patient can go a long way in helping a patient feel welcome and at ease.
“When you have a provider who's trying to try to meet you where you are, and respects your cultural background and your language, you are going to be more comfortable with that provider. It increases patient satisfaction.”
A Student-Driven Initiative
While she is honored to teach the course and is proud of the impact it is making on the medical students and the patients they encounter, Genao said students deserve all the credit for making the class a success.
Medical students created the course. In 2019, students from Duke’s Latino Medical Student Association (LMSA), with the support of Leonor Corsino, MD, MHS, associate dean for student affairs at the School of Medicine, conducted a survey to find out how health professions students felt about the medical Spanish course offered at the school at the time.
Genao said the students surveyed felt the style of teaching used in the previous version of the course, which was not focused on clinical encounters, was insufficient to prepare them to care for patients in a culturally sensitive manner.
The LMSA students compiled the data and presented a new course to the curriculum committee. It was approved in 2020. For the first year, the course was a pilot and didn’t offer credit.
During that pilot year, the pandemic started. Genao said for the students, seeing many Spanish-speaking patients die in the intensive care unit without interpreters present to help them communicate with their families was especially impactful. “That was an experience that changed the lives of the students,” she said. “They said to the medical school, ‘You have to do this.’”
After the first year, the curriculum committee approved the course for credit, and since then, it has continued to evolve. Students continue to play a pivotal role in course re-design each year. For the past three years, student leaders have presented at a national meeting for medical Spanish. In 2023, they won second place in a poster competition.
Genao said because of the course, students are "empowered to be advocates for their patients, and that's part of leadership. This is a core skill that we want to foster in the medical school.”