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The 16.2 million and growing Spanish-speaking limited English-proficient (LEP) population of the United States, which makes up 64% of the country’s LEP population,1 presents a significant challenge for health systems lacking in language concordance resources and quality assurance strategies. All dimensions of health care system performance, including quality, cost, access, equity, patient experience, and patient safety,3 are challenged by language discordance. Data that directly link health system performance metrics—such as patient outcomes; patient satisfaction; costs; hospital length-of-stay; readmission rates; and quality measures for standard-of-care treatment of stroke, sepsis, or other time-sensitive conditions—to language concordance or discordance are rarely published. Schools of medicine tasked with the education of competent medical providers are challenged to address the communication issues that their students will face both in medical school and later in residency and independent practice.


Additionally, although some literature mentions the importance of language concordance from the perspective of the patient, there is little focus on the effects that systematic improvements to LEP patient communication may have on the provider’s job satisfaction, wellness, and productivity. Patient-physician language concordance can be addressed in a systematic way for the large U.S. Compounding the paucity of resources is the fact that no standardized process exists to assess and certify bilingual qualifications of medical students or physicians prior to the provider initiating medical care in Spanish. Elements that may need to be tested or verified include general Spanish language proficiency, specific competency with medical Spanish, cultural health knowledge, and ability to use the language in patient interactions and at varied patient health literacy levels.


Further, although prior work has demonstrated that underrepresented minority physicians are more likely to want to practice in areas with underrepresented minority patients,30 this work has not evaluated the effect of language concordance on physician practice location preference. It is plausible that some physicians may choose to work with populations with which they share linguistic and cultural knowledge. Conversely, physicians who are not fluent in a second language may be understandably reticent to practice in an area with a large volume of LEP patients. Though the literature to date demonstrates that patient-physician language discordance presents obstacles to health system metrics2,4-6 and medical education,10-12 and a few isolated solutions have been proposed,18,21-27,31 future efforts should use a multifaceted approach to address this complex health challenge.


The multitude of available medical Spanish educational resources and the varied teaching techniques, educator qualifications, and student proficiency levels make the creation of new medical Spanish educational programs a daunting task for any institution without an existing one. Existing processes for language certification in other industries or ancillary fields, such as professional medical interpretation, can be used as example processes for certifying medical providers in the use of medical Spanish. Government guidelines, such as CLAS standards, that support nondiscrimination with regard to patient language preference should also be more prescriptive about the expected requirements for physicians who practice medicine in languages other than English. Guideline compliance and enforcement would be easier and more standardized if the expectations were clearly defined.


For example, language proficiency documentation should be required for all physicians intending to use a language other than English in patient care. Furthermore, medical centers and research studies receiving federal funding should be expected to comply with the collection of basic information regarding language concordance. Finally, incentives (e.g., special grant funding eligibility) for medical schools and medical centers meeting specific criteria as Hispanic-serving health centers ought to be considered. These criteria should require medical schools and centers to not only provide services to a minimum percentage of Hispanic patients but also to have a minimum percentage of documented Spanish-language-proficient providers to meet language concordance standards.


A similar long-established system that has been used to designate Hispanic-serving institutions in higher education could be used as a framework for this35 and could offer long-term recruitment and retention benefits to medical schools’ and centers’ diversity and inclusion efforts. Language-related challenges to the practice of medicine are a reality in an increasingly global environment. Without a cohesive approach to this complex issue, current efforts will remain disparate and potentially redundant but will not produce the needed national impact. As such, the development and sustainment of the four elements of providing quality language-concordant care to the Spanish-speaking U.S. —resource validation, competency requirements, an incentivized certification process, and health system updates that include routine collection of language concordance data and designation of Hispanic-serving health centers—may benefit from the establishment of an overseeing academy of Spanish language medicine.


Don't know. Do you need to learn the language to be able to achieve certain specific tasks or do you want to learn enough to be accepted as a member of the foreign community? Enough to be able to speak to Spanish people without them wanting to switch to English. Would like to be as close to fluent as possible, without hesitations. 2. A ims What do you want to be able to do in the language? Do you want to communicate in the written or the spoken language? Both. W i l l it be enough i f you just understand the language (at least in the first instance)? At first, yes. For you, is it sufficient to learn just enough language for communication to occur?


No, it has to be with almost no accent and errors for oral communication, very good written communication. Full comprehension. 3 : Functions What use wi l l you be making of the language? Academic, work, social. What kind of situations wi l l you have to perform in? All. 4. Information What kind of linguistic information do you need to meet your needs? How people communicate orally on a general level. E.g. Colloquialisms. Which are the most important: technical vocabulary? The precise meaning of the intonation? A set of ready-made sentences to get by with? Ease and confidence in communication, excellent pronunciation. 5. Activities What need you do to learn what you want?


Need lots of oral and written input, so that I can then imitate. Need a couple strong peer relationships to facilitate practice. How much time can you devote to it? 5-10 hours per week. What are your learning habits? Generally need to be in country of target language in order to be highly motivated. Become bored easily. Do you like working on your own? Somewhat. Is the language lab suitable? Detest language labs. Do you need help? Do you know native speakers who would agree to talk with you in their own language? Do you make full use of other possibilities, e.g., the radio? Sub-titled film? Etc. Entirely internet based. READ I Follow arpiment of complex discourse, group connections.


Can raad a series of articles, papers and forms and see argument clearly. Can read a file of correspondence and understand whole. Can follow argument of newspaper, magazine articles. Can follow straightforward chain ol raasoning In sequential paragraphs. Can understand each point ol argu-ment but often falls to tee connections. Can understand a process or procedure from a description. Can see simple relationships showing cause, effect and simple conditions. • c » — • Reeds and digests at simple sentence level - one sentence at a time. Recognises Individual words, street names, public signs, shop names. READ 1 Extract detailed information and relate to situation. P 3 Socialise, react, repair, vary register, convey attitude. Can deal effectively with total strangers even on the tele-phone, control and Initiate. S f fill 3i! Can function in group ol strangers, discuss topics outside work. Could act as guide/ official, host to visitors, colleagues. Can present himself, make introductions.


There are many options when wanting to get "Spanish Guitar Lessons". One option you could look into, is available online. Several website services offer you the option, so you can take Spanish guitar lessons from your own home. Depending on where you are in the country, you will have multiple options, which vary from state to state, so it would be hard to determine, a specific place to go, other than online. This is only one option, another is actually watching youtube videos, as there are many people showing you exactly how to reach your goal, in completing a wide set knowledge of playing this type of music.


Where could one learn how to solo with a bass guitar? One can learn how to solo with a bass guitar from many different resources that provide lessons. Some online examples include Youtube and About - Guitar. Where could someone go to learn how to play an electric guitar online? One could learn how to play a electric guitar online on YouTube. There are many people that give free guitar lessons. The tutorials are free and very helpful. Where in Toronto Ontario can one find free guitar lessons? One can find free guitar lessons in Toronto, Ontario by checking the local newspaper classifieds to see who is offering them.


Kijiji also has a music section with offers for free guitar lessons in Toronto, Ontario. Where in New York city can you get good but inexpensive guitar lessons? One of the best ways to learn guitar inexpensively, quickly and efficiently is with the use of online guitar lessons. Online guitar lessons allow you to learn either acoustic of electric guitar and learn the techniques and theory behind many music styles. 40 an hour for private guitar lessons. Where can one learn to play bass guitar? One can learn to play bass guitar by taking lessons from a local musician. Most music shops have teachers working for them.


One could also watch tutorials on Youtube. Where in Ottawa can one get lessons on how to play an electric guitar? To get lessons on how to play an electric guitar in Ottawa you have some choices. There are music stores that give instructions, or you can locate a self employed music teacher. Where can you get guitar lessons for free? Ask a friend or someone at church. Most people who can play are willing to share their knowledge. Where can one go to learn how to play electric guitar? Electric guitar can be properly learned by watching YouTube videos of professional guitar musicians and instructors.


There are also beginner guitar lessons on About (dot) com. Where can one find leads to get easy guitar lessons in Winnipeg? One is able to find leads to get easy guitar lessons in Winnipeg at several different online locations including the following websites: River Height Musical School, The Music Cellar, and Quest Musique. What is the size of the Solo Guitar Lessons app by Guitar Jamz in Google Play store? The size of the Solo Guitar Lessons app by Guitar Jamz a the Google Play store is 1.9 M. In order to use it, one must download it on to an Android 2.1 or higher device.