Are we training residents to communicate with low health literacy patients?

Abstract

Introduction: A third of Americans have low health literacy (HL). Research indicates a significant knowledge and skills gap among residents pertaining to management of patients with low HL.Objectives: The objective of this study was to assess the teaching and evaluation methods around HL in community-based internal medicine residency programs. In addition, the study compared the teaching and evaluation practices used for doctor–patient communication skills to those used for HL skills.Method: A structured questionnaire was completed by faculty of community-based internal medicine residency programs through the ‘Community Hospital Education and Research Network’ website and the Association of Program Directors in Internal Medicine community hospital assembly meeting in October 2011.Results: Less than 50% of the programs provided any formal teaching on HL. HL was primarily taught via didactics (75%) followed by clinical observation (42%) and role-playing (25%). On the contrary, patient–provider communication skills were taught primarily using clinical observations (90%) and standardized patients (46.7%). The HL dimensions that programs focused on were the use of teach-back technique (100%), prevalence of low HL (83.3%), association between low HL and patient outcomes (83.3%), and use of plain language (83.3%). The areas that were least taught included helping patients navigate the health system (33.3%) and choosing effective written material for low HL patients (50%).Conclusion: Health literacy is not being taught consistently as part of the core curricula of the community-based internal medicine residency programs. There is a need for professional and technical resources to incorporate HL teaching in their curricula. There is a wide variation in terms of how HL skills are being taught and evaluated by community-based internal medicine residency programs.