According to the 2020 census, more than 18 percent of the U.S. population identifies as Hispanic or Latino. Amid this large and rapidly growing Spanish-speaking population—the second largest in the world—there are multiple barriers to receiving healthcare, the most significant is finding a healthcare provider who speaks their language and understands their culture.
Despite this need for bilingual clinical care, fewer than six percent of American physicians speak Spanish, and even fewer have graduated from an accredited medical school fluent in medical Spanish.
An enterprising Geisel School of Medicine student, Macri Gil Diaz ’25, saw this lack of bilingual healthcare providers as an opportunity to be explored—she envisioned expanding the Geisel’s established medical Spanish enrichment elective for non-Spanish speakers to a companion advanced elective for native speakers.
Gil Diaz got together with Daniela Orozco ’24 and Kevin Puerta ’24, who were leading the medical Spanish elective, to talk about creating a curriculum for an advanced elective. A native speaker herself, Gil Diaz then taught a semester-long course (alongside the established beginner course) emulating a clinical setting with patient cases in Spanish, giving students an opportunity to practice communication skills and gain a deeper understanding of cultural aspects pertinent to the healthcare of this community.
The student-driven course caught the attention of Sonia N. Chimienti, MD, senior associate dean for medical education. “In these students, I saw a desire to extend their vision of helping fellow students gain an appreciation and a deeper understanding of the importance of interacting deeply and intentionally with individuals from different cultures, and to engage them throughout their time in medical school—and I was excited about it.”
She encouraged Gil Diaz and Puerta to develop their thinking beyond a one-semester enrichment elective.
“We took an inventory of everything available to us and integrated it into what we thought would be the best, but also possible, exposure to medical Spanish,” Gil Diaz says. “Our goal was to give interested Spanish-speaking medical students the knowledge and skills to be fluent in medical Spanish and be comfortable with putting it into practice during residency.”
From those conversations, the pilot Medical Spanish Pathway of Distinction, a longitudinal, integrated experience within the medical school’s curriculum was born.
The four-year Pathway prepares medical students to provide clinical care in Spanish as well as English and integrates the “co-curricular activities we are already involved with here in the Upper Valley, such as Project Salud where we speak Spanish,” Gil Diaz says.
Both the curricular and co-curricular elements of the Pathway were developed by Gil Diaz and Puerta in collaboration with the Latino Medical Student Association Geisel Chapter and Geisel faculty, including Chimienti, the Pathway’s faculty lead.
Once the Pathway was approved as a pilot program by the medical school’s Medical Education Committee, Lisa McBride, PhD, associate dean for diversity, equity, inclusion, and belonging (DICE), and Mayra Guardiola, DICE senior program coordinator and the Medical Spanish Pathway director, joined the leadership team with a keen eye toward implementation. McBride connected Chimienti and Gil Diaz to institutional leaders involved in developing Medical Spanish curricula at other programs, while Guardiola facilitated connections with Geisel pre-clinical curriculum leaders to integrate elements of the pathway with Geisel’s clinical curriculum. Deeply committed to service learning, Guardiola says, “We want the Pathway to serve as an inspiration and model for other medical schools to do something similar.”
Chimienti credits the leadership of Guardiola and McBride with helping Gil Diaz turn her vision into a reality, “they took the students’ vision, led this project to a higher level, and drove the implementation.”
Designed for students with at least an intermediate level of proficiency (or higher) in Spanish who are interested in working with Spanish-speaking populations, first- and second-year medical students need to successfully complete the required Medical Spanish Enrichment Opportunity prior to applying to the Pathway. This spring, the first cohort of 22 students embarked on the Pathway.
“Students in the Pathway are guided to select their clinical experiences in areas where they are working with patients from populations with a large percentage of people for whom Spanish is their primary language,” Chimienti says. “Required pre-clinical experiences include simulation clinic sessions in Spanish with Spanish-speaking standardized patients, and clinical sessions with a preceptor who provides healthcare to Spanish-speaking patients. Second-year students with advanced proficiency may also apply to serve as student facilitators in the Medical Spanish Enrichment Opportunity.
“In their third year, students build on their enrichment opportunities and co-curricular experiences—such as volunteer sessions at Project Salud—by completing at least one, preferably two, clinical rotations at a site serving Spanish-speaking patients. Fourth-year students may select from a group of four-week long learning experiences, domestic or international,” Chimienti explains.
“So many students here at Geisel grew up speaking Spanish and have accompanied their parents to doctor’s appointments—then once at medical school they do not have an opportunity to polish their skills to further health equity or increase access to care for Spanish-speaking patients,” Gil Diaz says.
“At the end of the day, if we graduate medical students from our class who have completed the Pathway, we are tackling this healthcare problem on a national level because these students will enter a residency program and be able to provide care to Spanish-speaking patients.
“For many of us, our culture and heritage are close to our hearts, and I think that when applying for residency we will seek an environment where we feel empowered to help our patients. But being able to practice this while in medical school is key to becoming proficient in medical Spanish without worrying about polishing it during residency—and we will be helping a population that is in dire need of care from providers like us.”
The Class of 2025 cohort will be the first to graduate from the Medical Spanish Pathway of Distinction.