title: Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?
abstract: BACKGROUND
  After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.
  
  
  OBJECTIVE
  To determine if integrating a longitudinal medical Spanish and cultural competency curriculum into emergency medicine residency didactics improves patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.
  
  
  METHODS
  Our ED has two Emergency Medicine Residency Programs, University Campus (UC) and South Campus (SC). SC program incorporates a medical Spanish and cultural competency curriculum into their didactics. Real-time Spanish surveys were collected at SC ED on patients who self-identified as primarily Spanish-speaking during registration and who were treated by resident physicians from both residency programs. Surveys assessed whether the treating resident physician communicated in the patient's native Spanish language. Follow-up phone calls assessed patient satisfaction and adherence to discharge instructions.
  
  
  RESULTS
  Sixty-three patients self-identified as primarily Spanish-speaking from August 2014 to July 2015 and were initially included in this pilot study. Complete outcome data were available for 55 patients. Overall, resident physicians spoke Spanish 58% of the time. SC resident physicians spoke Spanish with 66% of the patients versus 45% for UC resident physicians. Patients rated resident physician Spanish ability as very good in 13% of encounters - 17% for SC versus 5% for UC. Patient satisfaction with their ED visit was rated as very good in 35% of encounters - 40% for SC resident physicians versus 25% for UC resident physicians. Of the 13 patients for whom Spanish was the language used during the medical encounter who followed medical recommendations, ten (77%) of these encounters were with SC resident physicians and three (23%) encounters were with UC resident physicians.
  
  
  CONCLUSIONS
  Preliminary data suggest that incorporating Spanish language and cultural competency into residency training has an overall beneficial effect on patient satisfaction and adherence to medical recommendations in Spanish-speaking patients with limited English proficiency.
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, AZ.
authors.forename: L R
authors.initials: LR
authors.lastname: Stoneking
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, AZ.
authors.forename: A L
authors.initials: AL
authors.lastname: Waterbrook
authors.affiliation: Department of Emergency Medicine, Sinai Health System, Chicago, IL.
authors.forename: J
authors.initials: J
authors.lastname: Garst Orozco
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, AZ.
authors.forename: D
authors.initials: D
authors.lastname: Johnston
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, AZ.
authors.forename: A
authors.initials: A
authors.lastname: Bellafiore
authors.affiliation: Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ.
authors.forename: C
authors.initials: C
authors.lastname: Davies
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, AZ.
authors.forename: T
authors.initials: T
authors.lastname: Nuño
authors.affiliation: Department of Spanish and Portuguese, University of Arizona, Tucson, AZ.
authors.forename: J
authors.initials: J
authors.lastname: Fatás-Cabeza
authors.affiliation: Department of Family and Community Medicine, University of Arizona, Tucson, AZ.
authors.forename: O
authors.initials: O
authors.lastname: Beita
authors.affiliation: Department of Emergency Medicine, University of Arizona, Tucson, AZ.
authors.forename: V
authors.initials: V
authors.lastname: Ng
authors.affiliation: Department of Emergency Medicine, Regions Hospital, St Paul, MN.
authors.forename: K H
authors.initials: KH
authors.lastname: Grall
authors.affiliation: Department of Surgery, University of Arizona, Tucson, AZ, USA.
authors.forename: W
authors.initials: W
authors.lastname: Adamas-Rappaport
keywords: adherence; emergency department; limited English proficiency (LEP); medical Spanish; medical education; patient satisfaction