Emily Spengler|Miriam Schechter|Paulo Pina|Hai Jung H. Rhim
You Can Teach Every Patient: A Health Literacy and Clear Communication Curriculum for Pediatric Clerkship Students
St. Christopher's Hospital for Children|Drexel University|Children's Hospital at Montefiore|Albert Einstein College of Medicine|New York University|Children's Hospital at Montefiore|Albert Einstein College of Medicine
open accessjanuary 22 2021you teach every patient health literacy clear communication curriculum pediatric clerkship students emily spengler md miriam schechter md paulo pina md mph hai jung helen rhim md mph emily spengler md httpsorcidorg0000000296420258 assistant professor department pediatrics drexel university college medicine st christophers hospital children email address email protected google scholar articles author miriam schechter md associate professor department pediatrics albert einstein college medicine childrens hospital montefiore google scholar articles author paulo pina md mph clinical assistant professor department pediatrics new york university grossman school medicine google scholar articles author hai jung helen rhim md mph assistant professor department pediatrics albert einstein college medicine childrens hospital montefiore google scholar articles author httpsdoiorg1015766mep2374826511086 sectionsaboutabstractpdf toolsdownload citations sharefacebooktwitteremail abstract introduction poor health literacy negative impact various health care outcomes medical schools consistently providing health literacy training overly rely didactics methods curriculum thirdyear pediatric clerkship students taught principles health literacy evidencesupported clear communication strategies communication skills structured novel mnemonic ctep clear language teachback effectively encouraging questions pictures curriculum included 30minute didactic followed 12 weeks later 90minute interactive workshop 188 clerkship students attended didactic lecture approximately half 90 attended followup workshop students completed formative objective structured clinical encounter standardized patients evaluated students use four clear communication skills students completed survey assess confidence knowledge use skills results compared didacticonly group students didactic workshop group frequently used teachback 53 vs 27 p 01 pictures 46 vs 10 p 01 addition didactic workshop group improved recall selfreported use comfort skills didactic workshop group solicited questions standardized patient less often difference use clear language two groups discussion interactive curriculum health literacy clear communication pediatric clerkship students superior didactic alone optimizing instructional methods health literacy skills help future physicians properly communicate patients improve health outcomes educational objectives end activity learners able 1discuss best health literacyinformed communication skills use patients2demonstrate clear language teachback openended questions use pictures simulated pediatric patient encounter3incorporate four specific clear communication skills patient care introduction health literacy defined health medicine division hmd national academy sciences degree individuals capacity obtain process understand basic information services needed make appropriate health decisions1 fact approximately onethird us adults limited health literacy2 farreaching consequences health outcomes health care costs medication errors hmd recommended health literacy skills training professional skills 20041 2010 survey us allopathic schools 47 response rate 72 health literacy curricula3 health literacy curricula yet universally implemented recent increase published curricula area413 robust effective health literacy curricula medical students4810 residents671112 attendings512 multidisciplinary fields5 published resources mostly utilize interactive workshops teach health literacy skills practice overreliance didactics example 2010 survey medical school health literacy curricula common curricular method didactics 84 fewer used workshops 46 standardized patients sps 573 studies compared efficacy didactics versus types educational methods area past health literacy curricula published mededportal focused adult care451213 limited published curricula teaching health literacy clear communication skills caring pediatric patients teaching parents caregivers fill gap designed curriculum pediatric clerkship students learn health literacy clear communication skills didactics taped simulated patient encounters feedback smallgroup roleplays primary instructional methods students also learned novel mnemonic encourage repeated practice four core communication skills workshop future clinical work curriculum informed theory deliberate practice learners repeatedly engage practice skills order gain mastery them14 intended learner curriculum clerkship student chose learner students early process establishing clinical routines practice important lay groundwork early incorporating strong evidencebased communication skills future practice facilitators preferably experience clinical medicine familiar key concepts health literacy clear communication skills evaluated curriculum giving different curricular elements two separate groups students comparing performance formative lowstakes objective structured clinical encounter osce one group students attended didactic group attended didactic participated additional workshop curriculum adds following growing body knowledge health literacy curricula 1 easytoimplement curriculum tailored pediatric clerkship students easily adapted pediatric practitioners 2 unique betweengroups design evaluate optimal curricular method teaching skills methods minicurriculum focused health literacy clear communication skills added thirdyear pediatrics clerkship review medical school curriculum assistant dean medical education found students mandatory prior medical school experience topics prerequisite learning required curriculum curriculum focused evidencebased consensussupported clear communication techniques21516 directed agency healthcare research quality2 curriculum used universal precautions approach students taught one never knows poor health literacy clear communication skills always used clerkship orientation students attended 30minute didactic lecture health literacy four clear communication skills appendix didactic included background health literacy featuring definition health literacys prevalence united states impact clinical care second half didactic dedicated concrete evidencebased consensussupported clear communication skills four skills introduced along mnemonic developed teach every patient ctep c standing clear language teachback e effectively encourage patient questions using openended technique p pictures 12 weeks didactic approximately half students participated required 90minute smallgroup skills workshop topics half students participated workshop allow betweengroups comparison workshop group group didactic instruction workshop group size approximately five eight students facilitator group workshop included roleplays feedback video critiques smallgroup discussions along powerpoint appendix b guide facilitator beginning workshop students given ctep cards four clear communication skills appendix c students asked refer card workshop could keep future use specific instructions given use card future students watched video simulated patient encounter appendix critiqued communication skills using ctep framework reviewed key concepts health literacy didactic time discuss importance reflect personal experiences health literacy remaining time workshop dedicated skills practice practiced reviewed four skills following order 1clear language facilitator gave student one medical case scenario appendix e students took turns explaining case clear language group group gave student feedback performance facilitator used clear language cases instructors guide appendix f exercise2teachback technique roleplay exercise students paired practiced teachback technique first one pair demonstrated group followed group feedback pairs practiced five sample cases appendix g instructor chose one case group demonstration gave pair two different cases pair roleplayed cases one student taking provider role patientcaregiver role provider explained case patientcaregiver elicited teachback patientcaregiver students reversed roles second case facilitator used teachback cases instructors guide appendix h exercise3effectively encouraging questions facilitator taught use openended technique encouraging patient questions saying questions instead questions subsequent roleplay facilitator reminded students use openended approach eliciting patient questions4pictures group students discussed ways use pictures clinical care three simple clinical instructions appendix students volunteered draw board others guessed clinical instruction facilitator used picture cases instructors guide appendix j exercise5ctep final roleplay exercise students split pairs exercise structured teachback exercise first one pair demonstrated group followed group feedback pairs practiced five sample cases appendix k instructor chose one case group demonstration gave pair two different cases pair roleplayed cases one student taking provider role patientcaregiver role provider explained case patientcaregiver using four techniques ctep students reversed roles second case encouraged take pen paper incorporate pictures teaching facilitator used ctep cases instructors guide appendix l exercise end facilitator summarized key points students shared one thing would take away workshop andor change future clinical practice estimated time section workshop follows videointroduction 15 minutesclear language group practice 20 minutesteachback group observing pair group feedback pairing practicing 20 minutespictures group practice 5 minutesctep practice group observing pair group feedback pairing practicing 30 minuteswrapup 5 minutes materials used workshop included following large display screen computer project powerpoint onto screenwhiteboardhandouts case scenarios instructors students appendices el curriculum evaluation objectives included improved knowledge skills attitudes evaluate effectiveness curriculum conducted betweengroups design implementation year program students divided two groups based clinical sites sites chosen based convenience workshop administration create cohort students comprising approximately half class test effects didactic versus didactic workshop students attended didactic lecture 90minute skills workshop given half students studentsdidacticonly didactic workshopparticipated educational day midway clerkship 23 weeks didactic workshop day tested knowledge attitudes learning survey use skills behavior selfreported use performance osce assess behavioral changes brief 5minute counseling task sp simulation center added existing pediatric clerkship osce case separate educational goals addition case challenged students explain fever antipyretic dosing sp acting parent sick infant emergency department setting sp evaluated students based checklist many four clear communication skills used appendix checklist adapted tool developed green gonzaga cohen spagnoletti evaluate health literacy clear communication curriculum internal medicine residents6 sps professional agency trained faculty member osce case use evaluation tool important note checklist used counseling osce evaluate health literacy clear communication therefore specific addition osce focusing fever antipyretic dosing included publication evaluate changes knowledge attitudes students completed survey knowledge use skills retrospective prepost question comfort skills appendix n edits made survey start study students final twothirds year completed final version survey data final version survey analyzed results curriculum successfully implemented thirdyear pediatric clerkship students total 188 students participated students attended didactic 90 attended workshop data include survey responses 80 students sp osce performance ratings 188 students survey results summarized table 1 students workshop group could recall greater number four primary clear communication skills compared didacticonly group 24 vs 04 p 01 retrospective prepost survey improved ratings comfort using skills curriculum 14 vs 07 p 01 workshop group 96 reported using skills clerkship compared 64 didacticonly group p 01 table 1 postcurriculum survey results n 80table 1 postcurriculum survey results n 80 osce performance results summarized table 2 students workshop group used teachback 53 vs 27 p 01 pictures 46 vs 10 p 01 greater rate significant group difference use clear language 88 vs 84 p 38 didacticonly group likely ask sp questions 92 vs 78 p 01 among asked questions nonsignificant trend towards greater use preferred openended method workshop group 25 vs 15 p 13 table 2 objective structured clinical encounter datatable 2 objective structured clinical encounter data summary didactic workshop curriculum led greater use two four clear communication skillsteachback method picturesin osce students didactic workshop group could name key communication skills greater comfort using skills higher rates selfreported use skills clerkship discussion improving communication skills involves conscious change standard clinical practice one seems cannot met simple didactic session curriculum presented showed statistically significant improvements knowledge use skills students received instruction two discrete encounters presented interactive manner compared single didactic session furthermore health literacy curriculum easy administer one published care pediatric patients curriculum based theory deliberate practice ericsson defined conditions associated improved performance skill learners 1 given task welldefined goal 2 motivated improve 3 provided feedback 4 offered opportunity repetition refinement performance14 workshop included context meaning skills learners opportunity repeated purposeful practice skills along time reflection feedback allowed learners start road toward mastery skills incorporate clinical practice curriculum studied pediatric clerkship students however easily adaptable use across educational continuum pediatric residents attendings across disciplines nurses medical assistants advanced practitioners easily adapted clerkships residency types adapting cases recommend early introduction skillsat time learners developing clinical scripts habitsto best incorporate longterm clinical practice greatest challenge implementation curriculum faculty engagement didactic easy implement workshop studied small groups five eight students required significant amount faculty time year curriculum studied workshop also implemented large group 30 students breakouts smaller groups roleplays always well received good engagement required two three faculty successful study shows statistically significant differences didactic workshop group compared didacticonly group areas similar results two groups worth noting groups similar sp ratings use clear language see table 2 despite prompts explaining jargon well training retraining necessary sps tool imperfect measure clear language use better assessment language use transcripts andor multiple evaluators would preferable yield richer results another surprising finding students workshop group asked sps questions less often didactic group may workshop group frequently used skills teachback pictures context timelimited encounter like osce simply ran time asking sp questions alternatively possible students didactic group overly reliant asking whether sp questions assess patient understanding instead using teachback however students workshop group asked sp questions workshop group statistically insignificant trend toward using openended approach questions often didactic group limitation curriculum evaluation two groups assigned randomly rather based clinical sites convenience administration workshop half class however reason believe clinical site assignment way correlated clear communication health literacy skills another limitation survey validated however survey included retrospective prepost question shown useful assessment learning17 much work needs done field health literacy clear communication education hard effect longterm sustainable changes clinical practice address needs patients low health literacy based experience future curricular efforts must include repeated encounters material interactive teaching methods future curricular evaluation methods include evaluations patients better assess reallife application skills taught curriculum important start cannot stand alone demanded deliberate practice theory skills repeatedly reinforced across educational curriculum sustained impact work done construct longitudinal curricula address needs patients low health literacy references1 institute medicine health literacy prescription end confusion national academies press 2004google scholar2 brega ag barnard j mabachi nm et al ahrq health literacy universal precautions toolkit 2nd ed agency healthcare research quality 2015 ahrq publication 150023efgoogle scholar3 coleman ca appy health literacy teaching us medical 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appendicesreferencesrelateddetailsappendices hlcc didactic powerpointpptx workshop powerpointpptx ctep carddocx video critiquem4v clear language cases studentsdocx clear language cases instructors guidedocx teachback cases studentsdocx teachback cases instructors guidedocx picture cases studentsdocx picture cases instructors guidedocx ctep cases studentsdocx ctep cases instructors guidedocx communication checklistdocx student surveydocx appendices peer reviewed integral parts original publication download copyright permissions 2021 spengler et al openaccess publication distributed terms creative commons attribution licensekeywordscommunication skillspediatricshealth literacycurriculum developmentdisclosures none report fundingsupport work supported albert einstein college medicine grants excellence medical education ethical approval reported applicable loading