{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T06:58:46Z","timestamp":1790319526082,"version":"4.1.0"},"reference-count":19,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Spanish-speaking patients who are lesbian, gay, bisexual, transgender, queer, and other minority sexual orientations and gender identities (LGBTQ+) may encounter overlapping barriers in clinical care related to language discordance, misgendering, heteronormative questioning, and culturally unresponsive communication. These barriers can undermine trust, limit disclosure, and negatively affect care experiences and continuity of care. At the same time, medical Spanish curricula in the United States remain highly variable in content, structure, and assessment, and inclusive, bias-aware communication has not been consistently integrated into language training for health professions learners. Our prior qualitative work with Latinx, Hispanic, and Spanish-origin LGBTQ+ adults identified communication priorities directly relevant to educational design, including respectful forms of address, open-ended relationship language, broader recognition of family structures, and reduced reliance on binary or heteronormative assumptions. Our prior curricular work has also shown that structured medical Spanish instruction using self-study, faculty-led teaching, peer support, standardized patient encounters, and performance-based assessment can be implemented in undergraduate medical education. This tutorial presents a patient-informed framework for developing an inclusive medical Spanish module to address bias in clinical communication. Rather than reporting a new intervention study, it synthesizes prior qualitative findings and prior curricular experience to provide practical guidance for educators. The framework describes how to translate patient-reported communication priorities into curricular design principles, learning objectives, technology-enhanced preparatory activities, standardized patient and live-practice components, feedback and assessment strategies, and implementation planning. It argues that inclusive communication should not be treated as optional cultural content or as a narrow language add-on but as a core component of competent clinical performance in Spanish-language care. This tutorial is intended for medical educators, language educators, course directors, and simulation teams seeking to strengthen language-concordant and bias-aware communication training in medical Spanish. By linking patient-informed findings to concrete educational design choices, the framework offers a practical model for integrating inclusive communication throughout instruction, simulation, and assessment. A patient-informed approach of this kind may help health professions programs move beyond general statements about inclusion and toward more deliberate preparation of learners to communicate respectfully and effectively with Spanish-speaking LGBTQ+ patients.<\/jats:p>","DOI":"10.2196\/98398","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T18:23:10Z","timestamp":1787336590000},"page":"e98398-e98398","source":"Crossref","is-referenced-by-count":3,"title":["Inclusive Medical Spanish Education to Address Bias in Clinical Communication: Tutorial on Patient-Informed Module Development"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7659-3672","authenticated-orcid":false,"given":"Alexandra","family":"Lopez Vera","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/6358624","article-title":"\u201cBrave men\u201d and \u201cemotional women\u201d: a theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain","volume":"2018","author":"Samulowitz","journal-title":"Pain Res Manag"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1353\/hpn.2026.a984947","article-title":"Addressing linguistic gaps in gender-affirming healthcare for Spanish-speaking LGBTQ+ patients: insights from a qualitative study","volume":"109","author":"Lopez Vera","journal-title":"Hispania"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1370\/afm.2321","article-title":"Communicating with patients who have nonbinary gender identities","volume":"16","author":"Goldhammer","journal-title":"Ann Fam Med"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1080\/15532739.2014.890560","article-title":"Trans* Individuals\u2019 experiences of gendered language with health care providers: recommendations for practitioners","volume":"15","author":"Hagen","journal-title":"Int J Transgenderism"},{"issue":"10042","key":"R5","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/S0140-6736(16)00683-8","article-title":"Transgender people: health at the margins of society","volume":"388","author":"Winter","journal-title":"Lancet"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1108\/EIHSC-08-2013-0013","article-title":"Transgender women of color: discrimination and depression symptoms","volume":"6","author":"Jefferson","journal-title":"Ethn Inequal Health Soc Care"},{"issue":"6","key":"R7","doi-asserted-by":"publisher","first-page":"1261","DOI":"10.1007\/s10903-023-01463-8","article-title":"A case study of the impact of language concordance on patient care, satisfaction, and comfort with sharing sensitive information during medical care","volume":"25","author":"Lopez Vera","journal-title":"J Immigr Minor Health"},{"issue":"10","key":"R8","doi-asserted-by":"publisher","first-page":"1434","DOI":"10.1007\/s11606-015-3309-3","article-title":"National survey of medical Spanish curriculum in U.S. medical schools","volume":"30","author":"Morales","journal-title":"J Gen Intern Med"},{"issue":"4","key":"R9","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1080\/10401334.2013.827974","article-title":"Medical Spanish programs in the United States: a critical review of published studies and a proposal of best practices","volume":"25","author":"Hardin","journal-title":"Teach Learn Med"},{"issue":"1","key":"R10","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1089\/heq.2019.0028","article-title":"Teaching medical Spanish to improve population health: evidence for incorporating language education and assessment in U.S. medical schools","volume":"3","author":"Ortega","journal-title":"Health Equity"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-023-04473-0","article-title":"A comprehensive medical Spanish curriculum model: the Vida Medical Spanish Curriculum","volume":"23","author":"Chang","journal-title":"BMC Med Educ"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.15766\/mep_2374-8265.11456","article-title":"Integrating gender-affirming care in a medical Spanish endocrine system curriculum","volume":"20","author":"Lopez Vera","journal-title":"MedEdPORTAL"},{"issue":"1","key":"R13","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-025-06966-6","article-title":"Enhancing clinical Spanish proficiency through standardized patient interactions: a case study on medical students\u2019 performance","volume":"25","author":"Lopez Vera","journal-title":"BMC Med Educ"},{"issue":"4","key":"R14","doi-asserted-by":"publisher","first-page":"296","DOI":"10.2471\/BLT.19.249086","article-title":"Transgender health in medical education","volume":"99","author":"Hana","journal-title":"Bull World Health Organ"},{"issue":"4-6","key":"R15","first-page":"23","volume":"19","author":"Bhatt","journal-title":"Innov Clin Neurosci"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-med-043021-032007","article-title":"Gender-affirming care of transgender and gender-diverse youth: current concepts","volume":"74","author":"Lee","journal-title":"Annu Rev Med"},{"issue":"Suppl 2","key":"R17","doi-asserted-by":"publisher","first-page":"S92","DOI":"10.1370\/afm.2926","article-title":"Transforming medical education to provide gender-affirming care for transgender and gender-diverse patients: a policy brief","volume":"21","author":"Juarez","journal-title":"Ann Fam Med"},{"issue":"3","key":"R18","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.0392","article-title":"Sexual orientation- and gender identity-affirming activities provided in primary care","volume":"8","author":"Akre","journal-title":"JAMA Netw Open"},{"key":"R19","unstructured":"Kirkpatrick DL Kirkpatrick JD . Evaluating Training Programs: The Four Levels. 3rd ed. Berrett-Koehler Publishers; 2006. ISBN: 9781576753484"}],"container-title":["JMIR Medical Education"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T18:53:03Z","timestamp":1790275983000},"score":1,"resource":{"primary":{"URL":"https:\/\/mededu.jmir.org\/2026\/1\/e98398"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":19,"URL":"https:\/\/doi.org\/10.2196\/98398","relation":{},"ISSN":["2369-3762"],"issn-type":[{"value":"2369-3762","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"article-number":"v12i1e98398"}}