Residents' perceptions of their health literacy skills and training needs across specialties

T Nelson, L Altshuler, C Gillespie, M Naidu, A Squires, S Yin, S Zabar

Research output: Contribution to journalMeeting Abstract

Abstract

BACKGROUND: Low health literacy (HL) is common, particularly in underserved communities. HL deficits have been associated with patient safety issues and poor health outcomes. Provider use of HL-informed communication strategies, including plain language verbal and written communication, and use of “teach back” to confirm patient understanding, has been linked to improved patient outcomes, therefore; a “universal precautions” approach is recommended. A recent survey of medical schools found that 72 % of the 133 U.S. allopathic medical schools included HL in their curriculum, with a only a median time spent of 3 h in total (Coleman & Appy, 2012). As part of a needs assessment of residents at our institution, we surveyed residents across 7 programs to determine their previous training in HL, current practices, comfort level with HL skills and desire for further training. This allowed us to assess overall need and to identify differences by specialty. METHODS: Data was collected from residents via an online survey (Qualtrics) during the 2013-2014 academic year. Residency programs surveyed included Emergency Medicine (EM), Internal Medicine (IM), Obstetrics/Gynecology (OB), Orthopedics (OR), Pediatrics (PED), Primary Care (PC), and Surgery (SUR). Completed responses were received from 269 residents (of 394 total), for a response rate of 68% overall. This ranged from a 100% response rate from OR down to 57% from EM. HL questions for the survey were adapted from Schwartzberg et al. (2007) and Turner et.al. (2009). The following domains were assessed: 1) prior HL training (1Q), 2) use of HL techniques (8Q), 3) perceived skill in key HL techniques (3Q), 4) desire for HL training (1Q). Prior HL training was assessed with a question about whether they had HL training, and if so, where they received it. Use of HL techniques was rated on a 5-point Likert scale from1 (never) to 5 (always); techniques included teach-back, providing easy to read written materials, underlining key points on written materials. A Overall HL Use score was calculated by averaging responses (Cronbach's alpha=.88). Perceived skill in key HL techniques was, rated on a 4-point scale from 1 (not at all skilled) to 4 (very skilled); skills assessed included teach-back, choosing appropriate written materials, and converting medical terms into plain language. A HL Skills score was calculated by averaging responses (Cronbach's alpha=.70). Finally, participants were asked to respond to open-ended questions re: what HL training they would like. RESULTS: Sixty-five percent of residents reported prior training related to HL, with the majority of this being in medical school; educational formats used included didactics and OSCEs. Across specialties, 84 % of OR residents reported having had previous training, while IM was the lowest at 47 %. Statistically significant differences in reported Overall HL Use across programs was determined by one way ANOVA (F (6, 268)=8.77, p=.0.0001). Post hoc Tukey test revealed that SUR Overall HL Use score was significantly higher than the other specialties, (p=0.05). No other significant differences were found. For the HL Skill score, one way ANOVA was significant (F(6265)=3.48, p= 0.002). Tukey post-hoc analysis revealed that SUR was again the highest scorer, with scores significantly higher than both IM and OB (p=0.05). When asked what future training residents wanted, there were consistent themes across the specialties. Many residents wanted to know where to find easily accessible printed material suitable for low-literacy patients, ways to match health education literature to patients' HL levels, and pragmatic strategies for integrating HL approaches in a busy clinical setting with diverse patient populations. CONCLUSIONS: Most residents across multiple specialties report at least some training in HL during medical school, although the extent of such training is not known. There are differences between specialties with respect to self-reported use of and comfort with HL approaches, with surgeons feeling the most prepared and internal medicine and obstetrics trainees less so. In spite of their reported skill level, all groups identified need for further HL training. Additionally, this study assessed self-report of HL skill and use. To better understand differences by specialty assessing actual HL skill and use from an observational study is planned.
Original languageEnglish (US)
Pages (from-to)S71
JournalJournal of General Internal Medicine
Volume30
StatePublished - 2015

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Health Literacy
Internal Medicine
Medical Schools
Obstetrics
Orthopedics
Emergency Medicine
Teach-Back Communication
Gynecology

Keywords

  • Cronbach alpha coefficient
  • Likert scale
  • United States
  • analysis of variance
  • comfort
  • community
  • curriculum
  • emergency medicine
  • health
  • health education
  • health literacy
  • human
  • infection control
  • internal medicine
  • interpersonal communication
  • language
  • medical school
  • needs assessment
  • observational study
  • obstetrics
  • orthopedics
  • patient
  • patient safety
  • pediatrics
  • population
  • post hoc analysis
  • primary medical care
  • reading
  • self report
  • skill
  • society
  • student
  • surgeon
  • surgery
  • written communication

Cite this

Nelson, T., Altshuler, L., Gillespie, C., Naidu, M., Squires, A., Yin, S., & Zabar, S. (2015). Residents' perceptions of their health literacy skills and training needs across specialties. Journal of General Internal Medicine, 30, S71.

Residents' perceptions of their health literacy skills and training needs across specialties. / Nelson, T; Altshuler, L; Gillespie, C; Naidu, M; Squires, A; Yin, S; Zabar, S.

In: Journal of General Internal Medicine, Vol. 30, 2015, p. S71.

Research output: Contribution to journalMeeting Abstract

Nelson, T, Altshuler, L, Gillespie, C, Naidu, M, Squires, A, Yin, S & Zabar, S 2015, 'Residents' perceptions of their health literacy skills and training needs across specialties', Journal of General Internal Medicine, vol. 30, pp. S71.
Nelson, T ; Altshuler, L ; Gillespie, C ; Naidu, M ; Squires, A ; Yin, S ; Zabar, S. / Residents' perceptions of their health literacy skills and training needs across specialties. In: Journal of General Internal Medicine. 2015 ; Vol. 30. pp. S71.
@article{be9a349c14314c888c702b6280251f17,
title = "Residents' perceptions of their health literacy skills and training needs across specialties",
abstract = "BACKGROUND: Low health literacy (HL) is common, particularly in underserved communities. HL deficits have been associated with patient safety issues and poor health outcomes. Provider use of HL-informed communication strategies, including plain language verbal and written communication, and use of “teach back” to confirm patient understanding, has been linked to improved patient outcomes, therefore; a “universal precautions” approach is recommended. A recent survey of medical schools found that 72 {\%} of the 133 U.S. allopathic medical schools included HL in their curriculum, with a only a median time spent of 3 h in total (Coleman & Appy, 2012). As part of a needs assessment of residents at our institution, we surveyed residents across 7 programs to determine their previous training in HL, current practices, comfort level with HL skills and desire for further training. This allowed us to assess overall need and to identify differences by specialty. METHODS: Data was collected from residents via an online survey (Qualtrics) during the 2013-2014 academic year. Residency programs surveyed included Emergency Medicine (EM), Internal Medicine (IM), Obstetrics/Gynecology (OB), Orthopedics (OR), Pediatrics (PED), Primary Care (PC), and Surgery (SUR). Completed responses were received from 269 residents (of 394 total), for a response rate of 68{\%} overall. This ranged from a 100{\%} response rate from OR down to 57{\%} from EM. HL questions for the survey were adapted from Schwartzberg et al. (2007) and Turner et.al. (2009). The following domains were assessed: 1) prior HL training (1Q), 2) use of HL techniques (8Q), 3) perceived skill in key HL techniques (3Q), 4) desire for HL training (1Q). Prior HL training was assessed with a question about whether they had HL training, and if so, where they received it. Use of HL techniques was rated on a 5-point Likert scale from1 (never) to 5 (always); techniques included teach-back, providing easy to read written materials, underlining key points on written materials. A Overall HL Use score was calculated by averaging responses (Cronbach's alpha=.88). Perceived skill in key HL techniques was, rated on a 4-point scale from 1 (not at all skilled) to 4 (very skilled); skills assessed included teach-back, choosing appropriate written materials, and converting medical terms into plain language. A HL Skills score was calculated by averaging responses (Cronbach's alpha=.70). Finally, participants were asked to respond to open-ended questions re: what HL training they would like. RESULTS: Sixty-five percent of residents reported prior training related to HL, with the majority of this being in medical school; educational formats used included didactics and OSCEs. Across specialties, 84 {\%} of OR residents reported having had previous training, while IM was the lowest at 47 {\%}. Statistically significant differences in reported Overall HL Use across programs was determined by one way ANOVA (F (6, 268)=8.77, p=.0.0001). Post hoc Tukey test revealed that SUR Overall HL Use score was significantly higher than the other specialties, (p=0.05). No other significant differences were found. For the HL Skill score, one way ANOVA was significant (F(6265)=3.48, p= 0.002). Tukey post-hoc analysis revealed that SUR was again the highest scorer, with scores significantly higher than both IM and OB (p=0.05). When asked what future training residents wanted, there were consistent themes across the specialties. Many residents wanted to know where to find easily accessible printed material suitable for low-literacy patients, ways to match health education literature to patients' HL levels, and pragmatic strategies for integrating HL approaches in a busy clinical setting with diverse patient populations. CONCLUSIONS: Most residents across multiple specialties report at least some training in HL during medical school, although the extent of such training is not known. There are differences between specialties with respect to self-reported use of and comfort with HL approaches, with surgeons feeling the most prepared and internal medicine and obstetrics trainees less so. In spite of their reported skill level, all groups identified need for further HL training. Additionally, this study assessed self-report of HL skill and use. To better understand differences by specialty assessing actual HL skill and use from an observational study is planned.",
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author = "T Nelson and L Altshuler and C Gillespie and M Naidu and A Squires and S Yin and S Zabar",
year = "2015",
language = "English (US)",
volume = "30",
pages = "S71",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
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TY - JOUR

T1 - Residents' perceptions of their health literacy skills and training needs across specialties

AU - Nelson, T

AU - Altshuler, L

AU - Gillespie, C

AU - Naidu, M

AU - Squires, A

AU - Yin, S

AU - Zabar, S

PY - 2015

Y1 - 2015

N2 - BACKGROUND: Low health literacy (HL) is common, particularly in underserved communities. HL deficits have been associated with patient safety issues and poor health outcomes. Provider use of HL-informed communication strategies, including plain language verbal and written communication, and use of “teach back” to confirm patient understanding, has been linked to improved patient outcomes, therefore; a “universal precautions” approach is recommended. A recent survey of medical schools found that 72 % of the 133 U.S. allopathic medical schools included HL in their curriculum, with a only a median time spent of 3 h in total (Coleman & Appy, 2012). As part of a needs assessment of residents at our institution, we surveyed residents across 7 programs to determine their previous training in HL, current practices, comfort level with HL skills and desire for further training. This allowed us to assess overall need and to identify differences by specialty. METHODS: Data was collected from residents via an online survey (Qualtrics) during the 2013-2014 academic year. Residency programs surveyed included Emergency Medicine (EM), Internal Medicine (IM), Obstetrics/Gynecology (OB), Orthopedics (OR), Pediatrics (PED), Primary Care (PC), and Surgery (SUR). Completed responses were received from 269 residents (of 394 total), for a response rate of 68% overall. This ranged from a 100% response rate from OR down to 57% from EM. HL questions for the survey were adapted from Schwartzberg et al. (2007) and Turner et.al. (2009). The following domains were assessed: 1) prior HL training (1Q), 2) use of HL techniques (8Q), 3) perceived skill in key HL techniques (3Q), 4) desire for HL training (1Q). Prior HL training was assessed with a question about whether they had HL training, and if so, where they received it. Use of HL techniques was rated on a 5-point Likert scale from1 (never) to 5 (always); techniques included teach-back, providing easy to read written materials, underlining key points on written materials. A Overall HL Use score was calculated by averaging responses (Cronbach's alpha=.88). Perceived skill in key HL techniques was, rated on a 4-point scale from 1 (not at all skilled) to 4 (very skilled); skills assessed included teach-back, choosing appropriate written materials, and converting medical terms into plain language. A HL Skills score was calculated by averaging responses (Cronbach's alpha=.70). Finally, participants were asked to respond to open-ended questions re: what HL training they would like. RESULTS: Sixty-five percent of residents reported prior training related to HL, with the majority of this being in medical school; educational formats used included didactics and OSCEs. Across specialties, 84 % of OR residents reported having had previous training, while IM was the lowest at 47 %. Statistically significant differences in reported Overall HL Use across programs was determined by one way ANOVA (F (6, 268)=8.77, p=.0.0001). Post hoc Tukey test revealed that SUR Overall HL Use score was significantly higher than the other specialties, (p=0.05). No other significant differences were found. For the HL Skill score, one way ANOVA was significant (F(6265)=3.48, p= 0.002). Tukey post-hoc analysis revealed that SUR was again the highest scorer, with scores significantly higher than both IM and OB (p=0.05). When asked what future training residents wanted, there were consistent themes across the specialties. Many residents wanted to know where to find easily accessible printed material suitable for low-literacy patients, ways to match health education literature to patients' HL levels, and pragmatic strategies for integrating HL approaches in a busy clinical setting with diverse patient populations. CONCLUSIONS: Most residents across multiple specialties report at least some training in HL during medical school, although the extent of such training is not known. There are differences between specialties with respect to self-reported use of and comfort with HL approaches, with surgeons feeling the most prepared and internal medicine and obstetrics trainees less so. In spite of their reported skill level, all groups identified need for further HL training. Additionally, this study assessed self-report of HL skill and use. To better understand differences by specialty assessing actual HL skill and use from an observational study is planned.

AB - BACKGROUND: Low health literacy (HL) is common, particularly in underserved communities. HL deficits have been associated with patient safety issues and poor health outcomes. Provider use of HL-informed communication strategies, including plain language verbal and written communication, and use of “teach back” to confirm patient understanding, has been linked to improved patient outcomes, therefore; a “universal precautions” approach is recommended. A recent survey of medical schools found that 72 % of the 133 U.S. allopathic medical schools included HL in their curriculum, with a only a median time spent of 3 h in total (Coleman & Appy, 2012). As part of a needs assessment of residents at our institution, we surveyed residents across 7 programs to determine their previous training in HL, current practices, comfort level with HL skills and desire for further training. This allowed us to assess overall need and to identify differences by specialty. METHODS: Data was collected from residents via an online survey (Qualtrics) during the 2013-2014 academic year. Residency programs surveyed included Emergency Medicine (EM), Internal Medicine (IM), Obstetrics/Gynecology (OB), Orthopedics (OR), Pediatrics (PED), Primary Care (PC), and Surgery (SUR). Completed responses were received from 269 residents (of 394 total), for a response rate of 68% overall. This ranged from a 100% response rate from OR down to 57% from EM. HL questions for the survey were adapted from Schwartzberg et al. (2007) and Turner et.al. (2009). The following domains were assessed: 1) prior HL training (1Q), 2) use of HL techniques (8Q), 3) perceived skill in key HL techniques (3Q), 4) desire for HL training (1Q). Prior HL training was assessed with a question about whether they had HL training, and if so, where they received it. Use of HL techniques was rated on a 5-point Likert scale from1 (never) to 5 (always); techniques included teach-back, providing easy to read written materials, underlining key points on written materials. A Overall HL Use score was calculated by averaging responses (Cronbach's alpha=.88). Perceived skill in key HL techniques was, rated on a 4-point scale from 1 (not at all skilled) to 4 (very skilled); skills assessed included teach-back, choosing appropriate written materials, and converting medical terms into plain language. A HL Skills score was calculated by averaging responses (Cronbach's alpha=.70). Finally, participants were asked to respond to open-ended questions re: what HL training they would like. RESULTS: Sixty-five percent of residents reported prior training related to HL, with the majority of this being in medical school; educational formats used included didactics and OSCEs. Across specialties, 84 % of OR residents reported having had previous training, while IM was the lowest at 47 %. Statistically significant differences in reported Overall HL Use across programs was determined by one way ANOVA (F (6, 268)=8.77, p=.0.0001). Post hoc Tukey test revealed that SUR Overall HL Use score was significantly higher than the other specialties, (p=0.05). No other significant differences were found. For the HL Skill score, one way ANOVA was significant (F(6265)=3.48, p= 0.002). Tukey post-hoc analysis revealed that SUR was again the highest scorer, with scores significantly higher than both IM and OB (p=0.05). When asked what future training residents wanted, there were consistent themes across the specialties. Many residents wanted to know where to find easily accessible printed material suitable for low-literacy patients, ways to match health education literature to patients' HL levels, and pragmatic strategies for integrating HL approaches in a busy clinical setting with diverse patient populations. CONCLUSIONS: Most residents across multiple specialties report at least some training in HL during medical school, although the extent of such training is not known. There are differences between specialties with respect to self-reported use of and comfort with HL approaches, with surgeons feeling the most prepared and internal medicine and obstetrics trainees less so. In spite of their reported skill level, all groups identified need for further HL training. Additionally, this study assessed self-report of HL skill and use. To better understand differences by specialty assessing actual HL skill and use from an observational study is planned.

KW - Cronbach alpha coefficient

KW - Likert scale

KW - United States

KW - analysis of variance

KW - comfort

KW - community

KW - curriculum

KW - emergency medicine

KW - health

KW - health education

KW - health literacy

KW - human

KW - infection control

KW - internal medicine

KW - interpersonal communication

KW - language

KW - medical school

KW - needs assessment

KW - observational study

KW - obstetrics

KW - orthopedics

KW - patient

KW - patient safety

KW - pediatrics

KW - population

KW - post hoc analysis

KW - primary medical care

KW - reading

KW - self report

KW - skill

KW - society

KW - student

KW - surgeon

KW - surgery

KW - written communication

M3 - Meeting Abstract

VL - 30

SP - S71

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

ER -