Melanie Stone|Oralia V. Bazaldua|Jason D. Morrow
Developing Health Literacy Communication Practices for Medical Students
Cal Humanities|The University of Texas Health Science Center at San Antonio|The University of Texas Health Science Center at San Antonio|Cal Humanities|The University of Texas Health Science Center at San Antonio
open accessjanuary 28 2021developing health literacy communication practices medical students melanie stone mph med oralia bazaldua pharmd jason morrow md phd melanie stone mph med assistant director community service learning center medical humanities ethics university texas health science center san antonio email address email protected google scholar articles author oralia bazaldua pharmd professorclinical department family community medicine university texas health science center san antonio department pharmacotherapy pharmacy services university health google scholar articles author jason morrow md phd associate professor medicine howard betty halff professor medical humanities ethics university texas health science center san antonio google scholar articles author httpsdoiorg1015766mep2374826511091 sectionsaboutabstractpdf toolsdownload citations sharefacebooktwitteremail abstract introduction health literacy associated communication practices critical patientcentered care endorsed various associations important health professional training unfortunately little published literature teach health literacy medical students health professionals methods developed twopart curriculum required module medical students including introductory session first year skillbuilding workshop second year workshop students studied observed practiced three health literacy communication techniques teachback avoiding jargon effective questioning results workshop implemented approximately 100 secondyear medical students part course required curriculum results wilcoxon rank sum test prepost survey responses showed statistically significant move towards conviction importance confidence ability use three health literacy techniques discussion skillsbased workshop health literacy skills improve medical students conviction confidence using health literacy communication practices educational objectives end activity learners able 1discuss benefits using three health literacy communication practices teachback avoiding jargon effective questioning2observe demonstration three health literacy communication practices teachback avoiding jargon effective questioning role models peers3demonstrate three health literacy communication practices teachback avoiding jargon effective questioning introduction health literacy degree individuals capacity obtain process understand basic health information services needed make appropriate health decisions1 however 12 adults health literacy proficiency required navigate health system1 low health literacy linked poor health outcomes higher health care costs1 health literacy practices key element effective communication patients health professionals leading higherquality patientcentered care2 therefore health literacy training imperative health professional education accrediting organizations american association colleges nursing accreditation council graduate medical education endorse training health professionals recognize address health literacy national guidelines called health professionals trained effectively communicate patients low health literacy35 unfortunately little concrete guidance given achieve call published literature topic teaching health literacy skills health science education sparse pubmed searched relevant articles using terms health literacy combined professional education curriculum articles identified examining reference lists included articles handsearching journals health literacy research practice health communication time period searched 20042019 22 articles returned articles discussed teaching health literacy variety health professions medical nursing dental hygiene pharmacy variety approaches described methodologies typically followed format didactic lecture prevalence consequences low health literacy including active learning aimed improving skills health literacy communication techniques evaluation measures focused improvement knowledge health literacy skills confidence ability care patients low health literacy 22 articles seven specified teaching health literacy medical education specific interventions targeted third fourthyear medical students residents authors suggested health literacy adequately taught us health professions schools2 aimed fill gap early medical education embedded 2hour session firstyear medical students required curriculum beginning 2015 part medicine behavior society mbs preclinical module course focusing ethics health policy social determinants health among topics introducing concept health literacy first year medical school underscored importance foundational concept throughout professional training first hour session interactive lecture introduced concept health literacy scope problem second hour skillbuilding workshop introduced technique teachback smallgroup casebased roleplaying activity focused teachback core skill evidence base confirmatory communication techniques eg show take insulin strong top consensus recommendation among health literacy experts6 principles adult education encourage concept reinforcement repeat messages helpful making learning stick changing habits based health literacy curricular research recommended teach health literacy practices longitudinal integrated format rather onetime session7 therefore added additional 2hour workshop secondyear medical students mbs course built upon firstyear session briefly reviewing health literacy teachback introducing two additional skills ranked top three teach students avoiding jargon effective questioning6 three communication skills practiced smallgroup roleplaying cases publication discusses latest iteration health literacy communication skillbuilding workshop implemented secondyear medical students methods developed workshop based previous experience teaching health literacy workshop taught two presenters professor department family community medicine assistant director community service learning additionally six promotores county hospitals health system helped roleplaying demonstration shared health literacy experiences preparation session review basic health literacy concepts previous year students asked complete preassignment appendix included reading two articles89 watching brief video10 format 2hour workshop detailed appendix c 1 didactic component reviewed taught three health literacy communication techniques 30minute powerpoint presentation appendix b 2 modeling 30minute wholegroup live demonstration health literacy scenario 3 15 minutes casebased roleplay practicing health literacy communication skills appendix including observation feedback appendix e 4 25minute debriefreflection period time included beginning end workshop students complete prepost survey appendix f didactic portion workshop delivered facilitator brief powerpoint presentation presented research backing prioritization top 32 health literacy best practices6 powerpoint reviewed teachback introduced practiced students previous year introduced jargon questioning showing examples brief video clips order reinforce learning variety modalities rest workshop consisted modeling discussing roleplaying cases cases adapted scenarios publication scenarios success patient communication training guide healthcare providers11 first wholegroup case demonstration interaction health care provider patient ignored health literacy principles followed case demonstrated health literacyappropriate interaction facilitator managed discussion students health care provider patient roles played trained faculty residents community member volunteers standardized patients rehearsed scenario session invited group community health workers promotores one performed patient role wholegroup case demonstration portraying reallife community members helped work every day also pharmacy residents shadowing pharmacy faculty instructor join session another bad case modeled whole group time included interaction audience presenting one run case two actors repeated students encouraged interject raised hands step point scenario felt could perform scene better health literacysensitive way facilitator saw students hand go froze scene student replaced one actors typically student replaced health care provider actor engaged patient actor using healthy literacy communication techniques taught brief wholegroup discussion experience students asked partner person sitting next practice two scenarios using three health literacy communication skills one student role health care provider one patient students switched roles second case student played patient used observation tool appendix e note share feedback use health literacy communication techniques student playing provider facilitators faculty invited guests walked around room approaching student pairs help facilitate interactions last activity session whole group reflect sessions activities specifically importance comfort using health literacy communication practices patients reflection period allowed health care providers community health workers others joined session share stories patient encounters stressed importance health literacy developed prepost survey based standard conviction confidence scales sixquestion survey administered students beginning session questions designed gauge students conviction confidence using three health literacy communication practices teachback avoiding medical jargon using effective questioning techniques questions used 7point likert scale 1 strongly agree 2 agree 3 somewhat agree 4 neither agree disagree 5 somewhat disagree 6 disagree 7 strongly disagree exact survey administered postsession survey analysis performed using spss software ibm spss statistics v25 wilcoxon signed rank test used test significance completion mbs course students asked complete course evaluation included 11 questions health literacy workshop questions used 4point likert scale 1 strongly disagree 4 strongly agree students marked na receive value students could also write comments workshop implemented among medical students interprofessionally students health care professions also implemented residents faculty preferred instructors experience working patients low health literacy optimal timing workshop 2 hours adaptations made needed shorten time removing wholegroup case demonstration discussing powerpoint depending space activity could also done small groups three one student playing provider one playing patient one observer results although attendance recorded presenters assumed approximately 100 students student body 210 attended workshop evidenced number responses received 100 prepost survey administered paper start end session comparing responses pre postworkshop using wilcoxon rank sum test found statistically significant shift towards stronger agreement change statistically significant questions minimum p 05 survey data presented table table health literacy prepost survey questionstable health literacy prepost survey questions course evaluation revealed mean 3334 40 11 likertscale questions indicating majority students responded positively agree strongly agree questions majority comments 21 28 alluded fact students felt already learned information well introductory 2hour health literacy session conducted first year overly receptive addressing topic example student stated seemed repetition first health literacy session think would better sessions done together 2hour session educators feel repetition key adopting practices moving forward consider modifying session secondyear students content review takes place presession online thus allowing inperson session entirely practice skills overall however student comments indicated lectures health literacy well received information retained course comments positive example learned lot think helpful representation different techniques discussion review literature health literacy indicates training health professionals topic understudied212 includes impact training specific health professions students ideal timing duration targeted curricular interventions workforce education planning12 workshop represents novel contribution study areas prepost survey results workshop indicate majority workshop participants either sustained showed improvement conviction confidence using top three health literacy practices data statistically significant challenge medical health science schools find time curriculum conduct workshop fortunate include module required mbs course spanning years 1 2 medical school institution regarding implementation found beneficial actors demonstrating two wholegroup case scenarios rehearse beforehand since least three facilitators involved two actors moderator advisable one advance planning meetings discuss roles topics person handle recommend moderator take lead transitioning activities giving instructions students session avoid confusion roles limitation assessment half student body attended workshop completed surveys despite status mandatory session another limitation assessment used selfreport data took place right workshop assess longterm effects intervention plan develop implement support recently awarded grant interprofessional health literacy objective structured clinical exam fourthyear medical students data contribute sparse literature regarding health literacy curricular evaluation anecdotally since bringing health literacy medical curriculum institution witnessed shift culture health literacy awareness practice causative link cannot made noticed students increasingly speaking focusing health literacy especially teachback technique venues community service learning projects observations representative student habits clinical interactions perhaps introduction health literacy awareness skill building early course medical education norm references1 us department health human services health literacy fact sheet health literacy basics healthgov accessed july 11 2019 httpshealthgovcommunicationliteracyquickguidefactsbasichtmgoogle scholar2 coleman c teaching health care professionals health literacy review literature nurs outlook 20115927078 httpsdoiorg101016joutlook201012004medline google scholar3 institute medicine health literacy prescription end confusion national academies press 2004google scholar4 us department health human services office disease prevention health promotion national action plan improve health literacy us department health human services 2010 accessed july 19 2019 httpshealthgovsitesdefaultfiles201909healthliteracyactionplanpdfgoogle scholar5 coleman c kurtzrossi mckinney j pleasant rootman shohet l calgary charter health literacy rationale core principles development health literacy curricula centre literacy 2011 accessed july 19 2019 httpswwwghdonlineorguploadsthecalgarycharteronhealthliteracypdfgoogle scholar6 coleman c hudson pederson b prioritized health literacy clear communication practices health care professionals health lit res pract 201713e91e99 httpsdoiorg103928247483072017050301medline google scholar7 coleman ca petersonperry bumsted longterm effects health literacy curriculum medical students fam med 20164814953medline google scholar8 graham brookey j patients understandperm j 20081236769 httpsdxdoiorg1078122ftpp2f07144medline google scholar9 mauksch lb questioning taboo physicians interruptions interactions patients jama 20173171010211022 httpsdoiorg101001jama201616068medline google scholar10 tedx talks confused health information youre alone lisa fitzpatrick tedxmidatlantic youtube june 29 2016 accessed august 15 2019 httpswwwyoutubecomwatchvx6dlqtak2ggoogle scholar11 castillo lm correa scenarios success patient communication training guide healthcare providers university health system 2013 accessed july 19 2019 httpswwwuniversityhealthsystemcommediafilespdfhealthscenariospdfgoogle scholar12 saunders c palesy lewis j systematic review conceptual framework health literacy training health professions education health prof educ 2019511329 httpsdoiorg101016jhpe201803003google scholar sign latest publications mededportal add email appendicesreferencesrelateddetailsappendices preassignmentdocx presentationpptx agendadocx casesdocx observation tooldocx prepost surveydocx appendices peer reviewed integral parts original publication download copyright permissions 2021 stone et al openaccess publication distributed terms creative commons attributionnoncommercial licensekeywordscommunication skillshealth literacycommunicationacknowledgmentswe wish thank christine gaspard msls assistance literature review jason rosenfeld drph mph jonathan gelfond md phd assistance data analysis also wish acknowledge ruth berggren md macp director center medical humanities ethics supporting work finally appreciate promotores community health workers volunteered time contribute educational session disclosures none report fundingsupport none report ethical approval reported applicable loading