A Pediatric Resident Curriculum for the Use of Health Literacy Communication Tools

Abstract

Background: Despite evidence that use of evidence-based communication tools (EBCT) with a universal precautions approach improves health outcomes, medical trainees report inadequate skills training. Objective: We developed, implemented, and evaluated a novel, interactive curriculum featuring a 30-minute, single-session didactic with video content, facilitated case-based discussions and preceptor modeling to improve use of EBCT among pediatric residents. A direct observation (DO) skills checklist was developed for preceptors to evaluate resident use of EBCT. Methods: Shortly after implementation of the curriculum, residents completed a survey assessing self-reported frequency of EBCT use both pre- and post-intervention. DOs were conducted 2 to 3 weeks after the didactic was completed and scores were compared among residents who participated in the curriculum and those who did not. A longitudinal 6-month follow-up survey was also distributed to assess changes over time. Key Results: Forty-seven of 78 (60%) of residents completed the survey and 45 of 60 (75%) of the eligible residents participated in the DO. There was significant change in self-reported use of all but one EBCT after participation in the curriculum. Residents reported sustained increased frequency of use of all communication tools except for Teach Back, Show Back, and explanation of return precautions in the 6 months following the curriculum. Notably, there was no significant difference in resident scores in the DO among residents who participated in the didactic session and those who did not. Conclusions: This novel interactive curriculum addresses ACGME (Accreditation Council for Graduate Medical Education) core competencies and fulfills a needed gap in resident curricula for health literacy-related skills training. Findings suggest a small, positive affect on frequency of self-reported use of health literacy EBCT. However, our findings demonstrate a lack of parallel improvement in resident performance during DO. Future curricula may require certain modifications, as well as reinforcement at regular intervals. [ HLRP: Health Literacy Research and Practice . 2022;6(2):e121–e127. ] Plain Language Summary: Use of evidence-based communication tools, such as presenting information in small chunks and avoiding complex medical terms among pediatric trainees, is limited. This study describes a new and interactive health literacy curriculum, with emphasis on preceptor modeling and DO to improve use of evidence-based communication tools among residents. After participation in the curriculum, residents report greater use of evidence-based communication tools. However, results from DO of residents did not demonstrate similar improvements.

A Refined Teach-back Observation Tool: Validity Evidence in a Pediatric Setting

“…The Ten Attributes of a Health Literate Health Care Organization, ( Brach et al, 2012 ) and many recommendations for using HL-based communication strategies ( Agency for Healthcare Research and Quality [AHRQ], 2015 ; American Dental Association, n.d. ; Brach et al, 2012 ; Centers for Disease Control and Prevention, n.d. ; Coleman et al, 2017 ; Glick et al, 2019 ; Hersh et al, 2015 ; Institute for Healthcare Improvement, n.d. ; Institute of Medicine, 2004 ; Morrison et al, 2019 ; National Quality Forum, 2010 ; Schwartzberg, 2016 ; The Joint Commission, 2007 ; U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, 2010 ) underscore the need for system-based training on HL-informed practices for medical students, graduate medical trainees, faculty, and other health care team members ( Brach et al, 2012 ; Coleman, 2011 ; Institute of Medicine 2004 ). Many such efforts have been described ( Anderson et al, 2020 ; Coleman, 2011 ; Coleman & Fromer, 2015 ; Costich et al, 2022 ; Mnatzaganian et al, 2017 ; Ruggeri, et al, 2021 ; Saunders et al, 2019 ; Toronto & Weatherford, 2015 ). Evaluation of the varied approaches to teaching these skills includes changes in pre-/post-knowledge, confidence, attitudes, and intention to use, objective structured clinical examinations (OSCEs), and direct observation.…”