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

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.

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.

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.

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%).

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.