education. -...
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Transcript of education. -...
Define health literacy and appreciate its value in PA
education.
Recognize the impact of low health literacy on patient
outcomes.
Describe how health literacy can be incorporated into a
PA program curriculum.
Discuss specific methods used to teach and evaluate
health literacy instruction.
Explore resources to support PA faculty in teaching
health literacy.
The degree to which individuals have the
capacity to obtain, process and understand
basic health information and services needed
to make appropriate health decisions.
DHHS, Health People 2010
Low Health
Literacy
Higher mortality
Less healthy behaviors
Lack of self care
Poorer health status
Hospitalizations
Emergency care
Preventive care Use of services
Medication/treatment errors Knowledge regarding health issues
Health care costs
Enhance student knowledge, skills and attitudes
Enhance patient – provider communication
Promote patient centered care
Improve patient outcomes
Reduce strain on health care system
Provide opportunities for leadership, policy change & research
Health People 2020
Patient Protection & Affordable Care Act 2010
Plain Writing Act 2010
US DHHS National Standards for Culturally and
Linguistically Appropriate Services (CLAS) in Health and
Health Care
US DHHS National Action Plan to Improve Health
Literacy
Agency for Healthcare Research and Quality (AHRQ)
Health Literacy Universal Precautions Toolkit
Centers for Disease Control and Prevention (CDC)
And many more…
56% utilize health literacy in their curriculum
63% have objectives related to health literacy
Taught during didactic and clinical years
Primary teaching strategies included lecture, role playing, small group and web based tutorials
67% of programs felt health literacy education is important
Self rated effectiveness of health literacy curriculum is 53%
Source: Assessing the Current Status of Health Literacy Curricula in US PA Programs Survey (project supported by Stony Brook University Seed Grant Program)
Didactic Year
Lecture
Small group exercises
Video review
Cooperative learning brochure
project
Health literacy standardized
patient encounters during
clinical skills week
Service learning experiences
Clinical Year
Health literacy standardized
patient encounters
Patient case presentations
Masters projects
Define health literacy.
Discuss the impact of low literacy on patient health outcomes.
Describe tools and techniques that can be used to identify low
health literacy.
Assess the readability level of common health information
materials found in print and on public websites using formulas
discussed in class.
Prepare a patient education brochure for low health literacy
populations.
Provide strategies and tools to improve communication between
healthcare providers and patients.
Problem Oriented Medical Record Course
Community Health and Service Learning Course
Clinical Medicine I-IV
Pharmacology
Suggestions from other PA Programs
Clinical Prevention
Cultural Competency
Medical Communications
Health Care Issues
Health Promotion and Patient Counseling
Assessment instruments Newest vital sign
Simple measure of gobbledygook (SMOG)
Microsoft Word readability tool tutorial:
http://www.youtube.com/watch?v=wYQ9CbHBnq0
Sample Online Resources
Joe’s web tools
http://www.joeswebtools.com/text/readability-tests/
Online utility http://www.online-
utility.org/english/readability_test_and_improve.jsp
Includes lists of sentences to review
Readability Formulas
http://www.readabilityformulas.com/free-readability-
formula-assessment.php
Each group (4-5 students) develops an original 2 sided color tri-
fold brochure on a pre-approved topic using 8 x 11½ size paper
Must incorporate guidelines discussed in lecture regarding
content, text construction, font and layout
Each group presents their final project to the class and faculty
and includes
a. reason for choosing the topic
b. target audience
c. description of the layout and content
Presentation and brochure assessed using evaluation form
Determine the level of health literacy in a
standardized patient.
Identify patient barriers in obtaining, processing
and understanding health information.
Establish a treatment plan to promote patient
adherence.
Demonstrate the “teach back method”.
Demonstrate effective patient-provider
communication skills.
20 minute video recorded OSCE with SP
Standardized patients are trained in 2 scenarios
OSCEs focus on patient health literacy
communication skills Mary Pearson (newly diagnosed with Diabetes)
Mildred Roberts (medication non-compliance)
Assessments Standardized patient evaluations of students
Independent reviewer of student videos
Student surveys
Student self assessment/reflection through video review
Evaluation of Physician Assistant Student Health Literacy Communication Skills using Standardized Patients (project supported by NCCPA Foundation Grant Program)
74 patients with DM and low HL and 38 physicians
Audio-taped visits
Teach back method was used in 1 of 5 visits
Teach back method used with fewer than 1 in 8 new
concepts
No reassessment of patient’s understanding
9X increase number of glucose controlled patients exposed
to teach back
Duration of visits using teach back were not longer
Schilinger D, et al. Closing the loop: physicians communication with diabetic
patients who have low health literacy. Arch Intern Med 2003;163:83-90
86% better educational experience compared to other clinical skills experiences
86% found comments from standardized patients a valuable educational exercise
79% considered the OSCE a significant aid in preparing me for clinical practice
93% felt prepared to address patient’s health literacy needs
88% thought that OSCEs should be used for future PA students as an educational tool Source: Health Literacy SP Encounter Student Survey Class of 2013 (project supported by NCCPA
Foundation Grant Program)
Students are required to perform a minimum of 15 hours of service learning activities
School based health literacy program
Community based education projects
Community health fairs
International medical missions
Preceptor modeling
Clinical observation
Case studies
Role Playing
Seminars (student, faculty or preceptor)
Conferences
Web based tutorials
Health literacy is covered with considerable
variability in PA education programs
Close the gap between what is being taught
and what is being done in clinical practice
Need more educational and clinical research
Accreditation standards for PA education 4th edition. Accreditation Review Commission on
Education for PAs, Inc. March 2010.
Agency for Healthcare Research and Quality. Evidence Report/Technology Assessment
Number 199 (AHRQ Pub No. 11-E006-1). Health literacy interventions and outcomes: an
updated systematic review. March 2011
Berkman ND, Sheridan SL, Donohue KE, Halpern DJ, Crotty K. Low Health Literacy and
health outcomes: an updated systematic review. Annals of Internal Medicine.
2011;155(2):95-107 and w34-41.
Coleman C. Teaching health care professionals about Health Literacy: a review of the
literature. Nursing Outlook. 2011;59:70-78.
Coleman C. “Health Literacy” & clear communications: assessing students’ clinical skills
using standardized patients. Power Point Presentation from Health and Literacy:
Constructing Curriculum for Health Care Providers, A Learning Institute, Calgary, AB.
2008. http://www.centreforliteracy.qc.ca/sites/default/files/Coleman_HL_CPX.pdf.
Accessed June 1, 2013.
Coleman C, Appy S. Health Literacy Teaching in US Medical Schools, 2010. Family
Medicine. 2012;44(7):504-507.
.
Competencies for the physician assistant profession. Revised 2012. Accessed at:
http://www.nccpa.net/App/PDFs/Definition%20of%20PA%20Competencies%203.5%20fo
r%20Publication.pdf Accessed on August 30, 2013.
Engel KG, Heisler M, Smith DM, Robinson CH, Forman JH, Ubel PA. Patient comprehension
of emergency department care and instructions: are patients aware of when they do not
understand? Annals of Emergency Medicine. 2009;53(4):454-461.
Kripalani SK, Jacobson KL, Brown S, Manning K, Rask KJ, Jacobson TA. Development and
implementation of a health literacy training program for medical residents. Medical
Education Online. 2006;11(13):1-7.
Kripalani S, Weiss BD. Teaching about health literacy and clear communication. Journal of
General Internal Medicine. 2006;21:888-890
Kutner M, Greenberg E, Jin Y, Paulson C. The Health Literacy of America’s adults: results
from the 2003 national assessment of adult literacy (NCES 2006-483). U.S. Department of
Education. Washington, DC: National Center for Education Statistics. 2006.
Schilinger D, et al. Closing the loop: physicians communication with diabetic patients who
have low health literacy. Arch Intern Med 2003;163:83-90
