Lea Dacy
Rochester, Minnesota, United States

The anesthesiologist was thrilled when she asked a Spanish-speaking post-surgery patient to wiggle his toes, and he understood and complied. A medical secretary appropriately triaged a caller from Caracas. Other colleagues on their lunchbreaks were able to direct Spanish-speaking visitors to the nearest restroom or coffee shop. These Mayo Clinic employees, representing a wide range of professional roles and educational levels, were graduates of a custom-designed course in Medical Spanish. The course was based upon the Rassias Method^® of teaching a foreign language, which typically prepares government workers and business executives for international postings. At Mayo Clinic, we found that the method “translated” well into a medical setting. Benefits included enhanced service to patients and greater employee satisfaction.

In the early 1990s, Mayo Clinic saw increasing numbers of patients from Spanish-speaking countries as well as seasonal agricultural workers from Mexico and southern Texas. Physicians and other health professionals were frustrated by wait times for the overworked Spanish interpreters, which delayed scheduled appointments and procedures. The Sections of Employee Education and Professional Education proposed offering a course in basic medical Spanish that might help staff to explain a procedure in basic terms, give simple instructions, or at the very least, explain to the patient that a Spanish interpreter was on the way.

Before joining Mayo Clinic in Rochester, Minnesota, as a medical secretary, I had been teaching Beginning Spanish at a community college. After two years at Mayo, I learned about the proposal for the medical Spanish class, and I persuaded them to let me teach it. While teaching in the community-college system and with no previous teaching experience, I had avidly attended workshops to learn how to teach. At an in-service for language instructors, the guest speaker, Professor Micheline Lyons of Dartmouth College, introduced the Rassias Method. Enthralled, I immediately signed up for a weekend-long teacher-training workshop on the Dartmouth campus, co-taught by Professor Lyons and Professor John Rassias himself. I was inspired to become a “born-again“ language instructor who threw away textbooks and taught principally in the target language.

John A. Rassias (1925–2015) was born in Manchester, New Hampshire, of Greek immigrant parents. He was a Marine during World War II and piloted an amphibious tank in the battle of Okinawa. With an undergraduate degree from the University of Bridgeport in Connecticut, he studied in France as a Fulbright scholar and earned a doctorate. He directed a pilot language-teaching program for the Peace Corps in the 1960s, which eventually became the Rassias Method. Key features included rapid-fire drills, cultural immersion, and a touch of theater. In 1965, he joined the Romance Languages Department of Dartmouth College, and his unconventional, fast-track instruction led to consultant work for global business ventures and occasional late-night appearances on Johnny Carson.

The Rassias Method forces the instructor and students to begin using the target language almost immediately. Most learners are understandably anxious when they discover that they must try to avoid speaking English from Day One, and the Mayo consultants and allied health staff who registered for Spanish were no exception. To lay the groundwork, I sent out orientation materials a couple of weeks before class started. The cover letter explained the class structure: per the Rassias model, we would use only Spanish until the last ten minutes of class time, when they could ask questions in English. If students felt the question was too important to postpone, they could speak English if they first raised their hand and asked permission in Spanish. (As we progressed, they learned increasingly sophisticated ways to phrase the request.) Borrowing an often-repeated Rassias theme, I reiterated that they had all already successfully completed a language-immersion course as toddlers with their parents as instructors—most of us with English, but some of the physicians were native speakers of Farsi, German, or Italian.

Unlike Dartmouth undergraduates, who meet in class and small-group drill session several times a week,¹ we at Mayo met for an hour twice a week for twelve weeks, which made rapid immersion all the more necessary. Some introductory materials replaced the activities that normally occurred on the first day of class; I introduced myself in a one-paragraph biography, and a questionnaire, which students returned via intra-clinic mail, allowed me to get know them before class started. In addition, I asked them to provide phrases that they often used in patient contact in their work and would like to be able to say in Spanish. These phrases, inserted where they best illustrated a grammatical point, became supplements to the workbook I had created. Some of the phrases were specialty-specific and inevitably provoked guffaws (e.g., the colorectal nurse who needed to say in Spanish “please remove all your clothes below the waist”), but many were universal (wayfinding, asking for a name or a birthdate). Training classes and surveys were not unusual in the formal workplace environment that characterized Mayo Clinic in the 1980s and 1990s. I needed a way to convey in advance that this class would differ from other Mayo-based training. Thus, the final question on the pre-class survey was deliberately silly: “Do you think that Elvis is still alive, and have you seen him?” Many students told me afterward that the question was their first clue that the class would be different. (Nearly everyone answered it.)

Instructors build rapport by acquainting themselves with the pop-culture interests of the students. As a community-college instructor, I familiarized myself with then-current songs, soap operas, celebrities, and fashion trends of people in their late teens and early twenties. At Mayo, however, we already shared a unique vocabulary and culture. Of course, some needed specific vocabulary and phrases to instruct patients before and during medical procedures, but we also found it amusing to find idiomatic Spanish ways to express typical Minnesota pleasantries: “Is it cold (hot) enough for you?” or “Do you think we’ll get all the snow they’re predicting?”

Some Rassias techniques translated directly to Mayo without modification. For example, in the number drill, a student and partner throw a pair of dice and take turns naming the numbers that turn up. (After a few minutes, the students were instructed to add the numbers and then to multiply them.) The Simple Substitution drill and its cousin, Progressive Substitutions, were not unique to Rassias, but Rassias added an elegant choreography that involved a step, finger snap, and pointing to the student invited to respond. To indicate a group response, the instructor makes an upward sweep of the hands like an orchestra leader. Demonstrated by the elegant Professor Lyons, it was a joy to behold. Despite practicing it in front of a full-length mirror, mine was significantly less graceful but still effective in commanding attention and focus (and quicker than some recent YouTube demonstrations I’ve watched).

Other techniques received medical center-inspired modifications. Practicing in pairs, students instructed each other in how to put on and tie an examining robe. Vocabulary for articles of clothing—which staff often had to ask patients to remove—were made more memorable when I bulkily appeared fully dressed in a man’s suit and removed each article from tie to shirt to slacks to socks as students took turns correctly identifying the items in Spanish. Inevitably, as I emerged fully dressed in feminine “business-professional” attire, some smart-aleck would call “quítese el vestido” (take off your dress). I would mime unzipping, but from then on, I held up articles of underwear and lingerie without further modeling; all these vocabulary words were necessary for nurses and clinical assistants who roomed patients.

One Rassias exercise, designed to reinforce wayfinding vocabulary, was so memorable that even the New York Times obituary writer recounted it.² Rassias would blindfold a student and have others guide him or her through an imaginary minefield. He warned that if they failed, the student would blow up. Adapting it to Mayo, I borrowed from the movie Airplane. The blindfolded student was now actually a plane carrying Mayo physicians returning to the Rochester airport from a conference. The backstory, introduced in Spanish with extensive hand gestures, was that the crew and most passengers became violently ill after eating contaminated peanuts, leaving just one Mayo physician with, of course, no aviation experience to pilot the plane. This exercise proved so popular that we repeated it so that multiple learners could be the physician-piloted plane or the control tower.

As Mayo hired more interpreters (and more Spanish-speaking medical staff) and utilized telephone and (now) online interpreting services, the class became less necessary. Still, the relationships and camaraderie that resulted were invaluable. The class was unique at the time in combining physicians and allied health staff. (I wish I could take credit for it, but that idea actually came from my obstetrician, who didn’t want me to teach both a noon and evening class because of the prolonged standing involved. The combined class was so well received that it continued even after my daughter was born.) Even years later, I still hear “Hola, Señora Dacy,” when strolling the Mayo subways and skyways in Rochester.

References

1. Stansfield C, Hornor J. The Dartmouth-Rassias Model of Teaching Foreign Languages. ADFL Bulletin 1981;12(4):23-27.
2. Grimes W. John Rassias, who pioneered foreign language teaching, dies at 90. The New York Times 2015 Dec 5; Section A, page 21, New York Edition.