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NHLBI: Teaching Multi-cultural Practice

Resources for Education

Language Access

Physicians and health care providers have multiple strategies available to them to ensure linguistically and culturally appropriate care through language through language services and cultural competence training. Language services can be provided through a variety of forms such as in-person, telephone or videoconference interpretation. There are many benefits of providing linguistically and culturally competent care, including: increased patient satisfaction, potential for decreased costs (through fewer readmissions and decreases in length of time for treatment in emergency rooms), and protects against miscommunication by protecting patients from medical errors and hospitals from lawsuits.

Consortium Curricula | Online Curricula |Key Laws, Guidelines and Standards

Consortium Curricula

Evaluating Effective Use of Interpreters in OSCE Setting: Checklists

Development and validation of three checklist items focusing on effective interpreter use: Faculty Observation Rating Scale (FORS), the Interpreter Impact Rating Scale (IIRS), and the Interpreter Scale (IS). The checklists have been cross-validated on the Patient-Physician Interaction scale (PPI). SP cases include modifications for the following four languages: Spanish, Mandarin, Vietnamese, and Russian.

We are currently validating a modified Interpreter Scale (IS) to be used by interpreters in real-time clinical settings.

Lie D, Bereknyei S, Braddock CH, Encinas J, Ahearn S, Boker J. Who Should Assess Medical Students for Interpreter use Skills? A Validation Study. In press, Academic Medicine 2009 May.

Lie D, Boker J, Bereknyei S, Ahearn S, Fesko C, Lenahan P. Validating Measures of Third Year Medical Students' Use of Interpreters by Standardized Patients and Faculty Observers. Journal of General Internal Medicine 2007 Nov:22 (s)2. Available at: Journal of General Internal Medicine

For more information, please contact:

Desiree Lie, MD, MSED

Standardized Patient-Interpreter Cases

  • Training Guide for Standardized Patient Instructors to Teach Medical Students Culturally Competent Tobacco Cessation Counseling. MedEdPORTAL link This module was supported by a grant from the National Cancer Institute to develop, implement, and evaluate a culturally-competent Web-based curriculum on tobacco cessation for undergraduate medical students (R25CA096562, PI: J. Spangler, MD MPH). The module was designed to serve as a toolkit for health care educators interested in training lay persons to serve as tobacco-using standardized patient instructors (SPIs).

Crandall S, Foley K, Marion G, Walker K, Kronner D, Vaden K, Spangler J. Training Guide for Standardized Patient Instructors to Teach Medical Students Culturally Competent Tobacco Cessation Counseling. MedEdPORTAL; 2008. Available from MedEdPORTAL

For more information, please contact:

Sonia Crandall, PhD, MS

  • The Standardized Patient is a non-English speaking patient presenting with an URI, while the Standardized Interpreter is present during the encounter. Objective: student is to perform a focused history and physical examination while appropriately utilizing an interpreter. Evaluation of student performance based on FORS, IIRS and Interpreter checklists. The case has been tested on MS1 students using the following languages: Mandarin, Russian, Spanish and Vietnamese.

    For more information, please contact:

    Sylvia Bereknyei, MS


Medical Spanish Working Group: Preliminary Objectives

  • Document the extent of medical Spanish training in US medical schools
  • Establish Consortium resource site for methods of medical Spanish training and how credit is given
  • Investigate links between medical Spanish training, student satisfaction with health care delivery skills, and documented patient care
  • Establish guidelines for best practices for medical Spanish training in US medical schools

For more information, please contact:

Sonia Crandall, PhD, MS

Lynn Bickley, MD

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Online Curricula

Hablamos Juntos, RWJ Release More Than Words Series

Toolkit Provides Practical Solutions for Effective
Translated Health Information: Clear communication is a cornerstone of patient safety and quality health care. In the United States, there are nearly 24 million people who are unable to speak or understand English, which poses significant communication challenges to health care providers and medical organizations. Quality translated health materials can serve as valuable communication tools for both patients and providers, and can help ensure the delivery of safe, effective and high-quality care. Unfortunately, poor quality translations are pervasive in health care, with many organizations wasting precious resources producing materials patients are unable to understand or use.

To help address this challenge, Hablamos Juntos and the Robert Wood Johnson Foundation (RWJF) are releasing the More Than Words Toolkit Series, a first-of-its-kind resource that clarifies the translation process, and provides a roadmap to help health care organizations improve the quality of their translated materials in order to get better results.

Practicing Spanish

Medical Spanish for healthcare providers. In addition to a "daily dialogue" consisting of a few statements from the patient, the patient's family, and healthcare providers, the website has links to cultural topics, geography, anatomy and FAQs.

AMA Strategies to Improve Communication in Latino/Hispanic Patients

This CME Program covers skills needed to work effectively with a low-literate Spanish-speaking population. These skills are readily transferable to all patient interactions; focus on clarity, cultural humility and message confirmation are important to patient care.

HRSA Health Literacy On-Line Training

Unified Health Communication 101: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency is a free on-line learning experience that will help you

  • improve your patient communication skills
  • increase your awareness and knowledge of the three main factors that affect your communication with patients: health literacy, cultural competency and low English proficiency
  • implement patient-centered communication practices that demonstrate cultural competency and appropriately address patients with limited health literacy and low English proficiency

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Key Laws, Guidelines and Standards

Title VI of the Civil Rights Act of 1964

Title VI of the Civil Rights Act of 1964 “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”

Limited-English Proficiency Guidance The number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee. The frequency with which LEP individuals come in contact with the program, activity or service. The nature and importance of the recipient’s program, activity, or service. The resources available to the grantee/recipient and costs.

Standards for Culturally and Linguistically Appropriate Services (CLAS)

The CLAS standards are issued by the U.S. Department of Health and Human Services’ Office of Minority Health. The 14 CLAS standards can be organized into three main themes: culturally competent care, language access services and organizational support for cultural competence. Four of the 14 standards are based on Title VI.

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Standards

The new standard (as of 2006) requires JCAHO-accredited hospitals to document patients’ language and communication needs. The report, funded by the California Endowment, Hospitals, Language, and Culture: A Snapshot of the Nation describes a three-year study analyzing 60 hospitals across the country in their efforts to offer culturally competent care. The report makes recommendations to hospitals and policymakers and shares best practices for health care for diverse populations.

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  • NCME @ Health Literach Annual Research Conference
    • Two workshops on cultural competency and MedEdPORTAL
    • October 17-18, 2011, Chicago, IL
  • RWJ National Health Plan Collaborative Toolkit
    • This toolkit has resources, lessons, best practices and case studies to assist health plans reduce disparities.
  • AHRQ Health Literacy Toolkit
    • The toolkit can help your practice and communicate with patients.
  • Stopping Discrimination Before it Starts: The Impact of Civil Rights Laws on Healthcare Disparities
  • Curricular Products from the National Consortium for Multicultural Education for Health Professionals
  • Conferences:
    • AAMC annual meeting 2010
      • November 5-10, Washington, DC
    • APHA annual meeting 2010
      • November 6-10, Denver, CO