Abstract
Purpose: As the U.S. Hispanic population grows, patients with limited English proficiency encounter health disparities that compromise their care. As a result, clinical Spanish instruction in health professions education has become increasingly necessary to address these disparities. This study compared the effects of two instructional schedules: condensed (8-week) versus distributed (2-year), for a required clinical Spanish course in a physical therapist education program. A secondary aim was to implement a Spanish-language OSCE to assess functional communication proficiency.
Methods: Forty-eight students (mean age 25.0 ± 3.3 years; 54% female) from two consecutive cohorts received 16 hours of flipped classroom Spanish instruction. Instruction was delivered as either 8 weekly 2-hour sessions (condensed) or 16 one-hour sessions across 4 semesters (distributed). Primary outcomes (Spanish language confidence, perceived difficulty, and self-assessed proficiency) were assessed at pre-instruction, post-instruction, and post-clinical education (post-CE) via Likert-type surveys; a Spanish language Objective Structured Clinical Examination (OSCE) was also administered at pre- and post-instruction. Confidence and perceived difficulty were assessed using investigator-developed single-item questions, and self-assessed proficiency was measured using the Common European Framework of Reference for Languages (CEFRL). Secondary outcomes included perceived preparedness, instructional value, perceived usefulness, and use of Spanish during clinical rotations, each assessed only at post-CE. All Likert-type primary and secondary outcome measures were developed by the investigators. Linear mixed-effects models were used to test group-by-time interactions, and linear and negative binomial regression models were employed for secondary outcomes. Normality of model residuals was evaluated using the Shapiro-Wilk statistic, and homoscedasticity was assessed using the Breusch-Pagan and Brown-Forsythe tests.
Results: Both groups showed significant pre-to-post gains in clinical confidence (distributed d = 1.53, condensed d = 1.18; p < .001) and OSCE performance (distributed d = 1.35, condensed d = 1.48; p < .001). Significant group-by-time interactions emerged for perceived difficulty (p = .009) and self-assessed clinical (p < .001) and non-clinical (p = .005) proficiency. The distributed group experienced a post-instruction decline in confidence (d = −0.46, p = .012) and proficiency, while the condensed group maintained gains. Post-CE, the distributed group rated instruction as more valuable (d = 0.67, p = .043) and useful (d = 0.73, p = .031) despite similar Spanish use during rotations.
Conclusion: Both schedules improved Spanish proficiency and confidence (primary outcomes); the distributed model showed greater perceived clinical value (secondary outcome), though the non-randomized design limits causal inference. Findings support integrating language instruction with clinical application. A Spanish-language OSCE proved feasible for assessing functional communication skills.
Recommended Citation
Vallejo, Rose M. and Kruger, Eric
(2026)
"Clinical Spanish Instruction in Physical Therapist Education: A Quasi-Experimental Comparison of Instructional Schedules,"
Health Professions Education: Vol. 12:
Iss.
6, Article 3.
DOI: 10.55890/2452-3011.1432
Available at:
https://hpe.researchcommons.org/journal/vol12/iss6/3
