How much should a language barrier play into residency choice?

[YellowTurtle]

Hi all. Current MS4 here, plan on applying to general surgery. Currently working on my list of programs to apply to.

I go to a school in the south where one of our main hospitals has a patient population where ~85% of the patients speak Spanish (not even an exaggeration). Being that I am not a native Spanish-speaker, and I can only get by on less than a dozen (non-medical) phrases, it can be frustrating working there. Sometimes the translator has to be called and everything gets slowed down/backed up. *Most* of the time I've seen residents use hacked-up Spanglish to get through a very simple interaction (poop? walk? dolor?), which is must less than what the English-speakers get. As the student, I always feel like there's something missing when I interact with a patient, like they're saying they understand when I get the feeling that they really don't. Or that they're holding back because of the language barrier.

So this comes to my question. I've considered not applying to any programs in the south, unless they have some redeeming quality about them that I can't turn down (extremely high board pass rates? still fleshing this out). Or at least applying to them as a backup, but prioritizing all other interviews over them. Does this seem unwise?

Some of the residents I've talked to have said they "get used to it", but I wonder if they just say that to try to stay positive. I wonder if I would start to regret going to a program because I can't effectively do the simplest things with my patients - talk to them. Has anyone else experienced this? Any anecdotal stories? Or advice? Anything would be appreciated.

TL;DR - Is an overwhelmingly large Spanish-speaking in main teaching hospital a barrier to education in residency? Worth it to overlook programs in south for programs with more patients who speak'a ma' language?

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[SLUser11]

Hi all. Current MS4 here, plan on applying to general surgery. Currently working on my list of programs to apply to.

I go to a school in the south where one of our main hospitals has a patient population where ~85% of the patients speak Spanish (not even an exaggeration). Being that I am not a native Spanish-speaker, and I can only get by on less than a dozen (non-medical) phrases, it can be frustrating working there. Sometimes the translator has to be called and everything gets slowed down/backed up. *Most* of the time I've seen residents use hacked-up Spanglish to get through a very simple interaction (poop? walk? dolor?), which is must less than what the English-speakers get. As the student, I always feel like there's something missing when I interact with a patient, like they're saying they understand when I get the feeling that they really don't. Or that they're holding back because of the language barrier.

So this comes to my question. I've considered not applying to any programs in the south, unless they have some redeeming quality about them that I can't turn down (extremely high board pass rates? still fleshing this out). Or at least applying to them as a backup, but prioritizing all other interviews over them. Does this seem unwise?

Some of the residents I've talked to have said they "get used to it", but I wonder if they just say that to try to stay positive. I wonder if I would start to regret going to a program because I can't effectively do the simplest things with my patients - talk to them. Has anyone else experienced this? Any anecdotal stories? Or advice? Anything would be appreciated.

TL;DR - Is an overwhelmingly large Spanish-speaking in main teaching hospital a barrier to education in residency? Worth it to overlook programs in south for programs with more patients who speak'a ma' language?

I think it's very reasonable to apply to programs that have primarily English-speaking patients, but you will find Spanish-speaking patients in most urban programs, so you'll still have to learn "Spanglish." I don't think simply avoiding a geographic region will be the best approach. I'd do some research into specific city demographics instead.

It's actually interesting because that's essentially what a lot of IMGs have to deal with when they come to America, but they simply learn English, then manage to score adequately on a bunch of English-language exams, etc. Quite an uphill battle. Meanwhile my Spanish-speaking patients have to endure my horrible attempts at Spanish small talk while we both wait impatiently for the interpreter to arrive. Thankfully about 10-20% of my residents are fluent, so it's an absolute joy to have them on service.

For those of us that don't speak Spanish, having a language barrier with 85% of our patients would lead to a worse learning environment for the resident, and certainly worse communication and care for the patient. I hope a choice to avoid such an environment would not be seen as racist.

 

[bannie22]

I dont disagree with your sentiments.
It is extraordinarily difficult to take care of people you cannot communicate with and also a huge detriment to your education and your performance.

I dont think it is racist at all and just identifying the best geographical locality that you would best be able to serve. It is not like you are turning down people who come to seek help.

 

[epsilonprodigy]

OP, if there is a program you love where this is an issue, I would inquire about what support is available for residents to learn Spanish. I understand that the best case scenario is to have a "culturally appropriate trained interpreter, etc etc." I have yet to see a hospital that has anywhere close to adequate staffing for this, and those blue phones work maybe 60% of the time. Programs need to make sure local dynamics are accounted for, and if this means working some language training in to intern education, a wise PD will make it happen.


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