Long-term Effects of a Health Literacy Curriculum for Family Medicine Residents.

INTRODUCTION: Improving education about health literacy for health care professionals has been recommended, and many US family medicine residency programs have developed such curricula. Few studies have evaluated the effectiveness of health literacy curricula for health care professionals. This pilot study aimed to determine whether a longitudinal health literacy curriculum for family medicine residents could achieve long-term sustained improvements in health literacy knowledge and clear communication practices. METHODS: Self-reported pre- and postassessments were conducted for a series of four health literacy didactic and experiential trainings over 11 months with a cohort of 12 first-year family medicine residents (study adequately powered for cohort of 10 or more). RESULTS: Five out of five health literacy knowledge items showed sustained significant improvement immediately after the initial didactic training. Two out of eight clear communication behaviors (eliciting patients' questions through an open-ended approach, and using a teach-back method to check for patients' understanding) showed sustained significant improvements in the 11-month follow-up period. The remaining six behaviors demonstrated a saw-tooth pattern, wherein each training session produced improvements in planned behaviors, which were, however, not maintained at subsequent follow-up assessments. CONCLUSIONS: These data suggest that residents learned the cognitive material related to health literacy and clear communication easily, but had difficulty integrating many trained skills into clinical practice, despite the use of experiential learning techniques. Future studies should use an observational design to assess clear communication behaviors, and should include assessment of potential barriers to implementing clear communication skills in clinical practice.

Long-Term Effects of a Health Literacy Curriculum for Medical Students.

BACKGROUND AND OBJECTIVES: Although there are reports of short-term benefits of health literacy curricula for improving health care professionals' communication with patients, no studies have included long-term follow-up. We sought to determine (1) whether a pre-clerkship health literacy training can improve medical students' perceived knowledge and intended behaviors vis-á-vis communication with patients who have low health literacy, (2) the longevity of any such impact at 12 months, and (3) the impact of a follow-up training 1 year later. METHODS: We conducted pre- and post-training assessments of self-perceived knowledge and perceived and planned behavior following a health literacy training for first-year medical students, with a 12-month follow-up training and repeat pre/post assessment. RESULTS: Among 48 pre-clerkship students, improvement was reported on 10 of 12 items following the Year 1 training. At 12-month follow-up, prior to the Year 2 training, ratings on 8 of 10 items had regressed to baseline levels. Nine of these items again improved significantly after the Year 2 training. Students were asked after both trainings if they felt they had overestimated their understanding of health literacy; significantly more students agreed with this statement following the Year 2 training than the Year 1 training. CONCLUSIONS: Among a cohort of pre-clerkship medical students, improvements in perceived knowledge and planned behavior vis-á-vis health literacy training largely did not persist at 12-month follow-up. Efforts to teach medical students about health literacy principles and practices should include a longitudinal or integrated format, rather than a one-time lecture format.