Background: Non-English language fluency is increasingly important in patient care. Fluency self-assessment is easily obtained, but its accuracy is unknown. Purposes: The purpose is to determine accuracy of medical students' self-assessed Spanish fluency. Methods: Four matriculating classes assessed their own oral fluency as ("none":"novice";"intermediate";"advanced";"nativespeaker"). Participants who rated themselves greater than "novice" and who expressed interest in medical Spanish coursework took a standardized fluency test (Spoken Language Evaluation, scaled 1-12). Using predetermined test categories (1-5 = novice, 6-8 = intermediate, 9-12 advanced/native), we determined the predictive value of self-assessment for predicting the same or greater fluency on the test. Results: Of 102 participants, 12 (12%) tested belowtheir self-assessed level, 77 (75%) tested at their self-assessed level, and 13 (13%) tested above. The predictive value of self-assessment for having at least that fluency level was 88% (95% CI = 80, 94). Conclusions: In medical students reporting greater than "novice" capability and interest in medical Spanish coursework, fluency self-assessment was a good indicator of scores on a standardized fluency test.