Using Standardized Patient Assessments to Evaluate a Health Literacy Curriculum

BACKGROUND AND OBJECTIVES: Patients' health literacy is a growing concern as patients are expected to perform more self-care. While many US schools implement health literacy in their curricula, time spent on the topic ranges from 0 to 8 hours and is largely didactic. Evaluation of health literacy skills is not well defined. The effectiveness of a health literacy curriculum for third-year medical students was evaluated by two standardized patients assessments (SPAs). METHODS: All third-year medical students complete a required 4-week clerkship in family medicine. After participating in seminars on patient-centered communication, health literacy, mindfulness, implicit bias, and chronic disease management, students complete SPA-1. Students also work in two team-based teaching clinics with chronic disease patients with limited health literacy and receive faculty feedback. At week 4, students complete SPA-2. Six raters evaluated all video-recorded SPA performances using the Common Ground validated instrument and a tailored health literacy skills checklist. RESULTS: Using SPAs and reliably-trained nonclinical raters is an effective method for training and evaluating students about health literacy. Two classes (2013 and 2015) had significant improvement in Common Ground core skills from SPA-1 to SPA-2. For all classes, a small but significant increase in student use of health literacy checklist was seen from SPA-1 to SPA-2. CONCLUSIONS: Didactic sessions prepare students to demonstrate competence on Common Ground and health literacy skills. Improvements in students' health literacy and communication skills are feasible in a 4-week clerkship utilizing the curriculum and evaluation process described.