Addressing Mental Health Care Disparities through Resident Training: Evaluation of a Hispanic Psychiatry Clinic Within a Major Academic Medical Center

Abstract: Background/Significance: Spanish is the predominant non-English language spoken in US homes, representing 62% of non-English speakers. However, the physician workforce lacks proportional representation, with 6.3% identifying as Hispanic (Mora, 2022), and an unknown number being Spanish-speaking. Research has demonstrated that language-concordant care improves outcomes, underscoring the need for more Spanish services (Diamond, 2019). In response to this critical gap, a Hispanic Psychiatry Clinic (HPC) was established within a major academic medical center with a dual goal of enhancing access to psychiatric care for Spanish speakers and offering advanced clinical training for Spanish-speaking psychiatry residents. The aims of this study are: 1) to evaluate the impact of the clinic in fostering trainees’ comfort and confidence in delivering culturally appropriate care to Spanish-speaking patients; and 2) to better understand the needs of the Hispanic population seeking care at our institution.



Methods: Employing mixed research methods, this study will assess residents’ readiness to deliver care to an underserved patient population. Residents completed pre- and post-pilot surveys measuring their confidence and comfort providing culturally sensitive care. Semi-structured interviews with residents will delve deeper into their experiences, with qualitative analyses informing modifications to the clinic's structure and curriculum. Patient referral data will be analyzed to identify trends and needs within the Hispanic demographic at our institution, helping us identify potential resident-led initiatives aimed at expanding services, while nurturing leadership skills among residents.



Results: Residents in the HPC completed the MGH/Harvard Survey: Residency Training in Cross-Cultural Care at the beginning and at the end of the clinic’s pilot. Preliminary findings indicate positive shifts in their perceptions of preparedness and confidence. Ongoing data collection aims to track the evolving perspectives of residents and the impact of training over time. Analysis of patient referral data has unveiled notable trends, such as significant burden of medical comorbidities and high demand for culturally tailored trauma-informed care. As a result, efforts are underway to develop a resident-led trauma-informed care curriculum for trainees.



Discussion: The results from the surveys and individual feedback will help us identify potential gaps in the curriculum, guiding improvements to the training experience within the HPC. Additionally, patient referral data holds promise in elucidating precise needs, barriers to care, and medical complexity of patients referred to the clinic. This understanding will allow for development of resident-led projects targeting these gaps, and for further collaboration with referring primary and specialty care providers.

Conclusion/Implications: We hope the results from this study will lead to enhancements in the clinic and foster leadership in Hispanic psychiatry. The prospect of disseminating this model to other academic medical centers offers a pathway for addressing health disparities and optimizing psychiatric services for Hispanic communities on a national scale.