Alda Maria Gonzaga

Addressing health literacy through clear health communication: A training program for internal medicine residents

OBJECTIVE To develop, pilot, and test the effectiveness of a clear health communication curriculum to improve resident knowledge, attitudes, and skills regarding health literacy. METHODS Thirty-one internal medicine residents participated in a small group curriculum that included didactic teaching, practice with a standardized patient, and individualized feedback on videotaped encounters with real patients. Outcomes were assessed using a pre-post survey and a communication skills checklist. RESULTS Mean knowledge scores increased significantly from 60.3% to 77.6% (p<0.001). Residents also reported increased familiarity with the concept of health literacy (mean response 3.2 vs. 4.5 on a 5 point scale), importance placed on health literacy (4.2 vs. 4.9), frequency of considering health literacy in patient care (3.3 vs. 4.0), and confidence in communicating with low literacy patients (3.3 vs. 4.1) (all p<0.001). Use of plain language increased significantly from 33% to 86% (p=0.023). There were nonsignificant increases in the use of teach-back (0-36%, p=0.116) and encouraging questions (0-14%, p=0.502). CONCLUSION Training in clear health communication improves resident knowledge, attitudes, and skills regarding health literacy. PRACTICE IMPLICATIONS The increased use of clear health communication techniques can significantly improve the care and outcomes of vulnerable patients with limited health literacy.

Teaching error disclosure: Advanced communication skills training for residents

Abstract Disclosing errors to patients is an advanced communication skill necessary in clinical practice but traditionally not taught during residency training. We developed an educational seminar for senior residents utilizing didactic, small group discussion, and role play that incorporates principles of error disclosure. Our objectives were to improve residents knowledge of the key components of disclosing medical errors to patients and to provide opportunity to practice communicating medical error in a safe environment. We assessed whether residents are participating in error disclosure and compared self-rated preparedness to disclose an error before and after the teaching session. Nearly all residents (94%) reported that learning about disclosure of medical errors is a very important part of residency training and 58% of residents had already participated in a disclosure discussion. Residents reported they were significantly more prepared to disclose medical errors to patients after participating in the curriculum compared with before, both in terms of the components of medical error disclosure and the emotional aspects of disclosure. This curriculum was associated with improvement in comfort level with error disclosure. Error disclosure represents an ideal educational opportunity for residencies to address multiple core competencies including patient care, communication skills, and professionalism.

The practice patterns of recently graduated internal medicine-pediatric hospitalists.

OBJECTIVES To identify the current practice patterns and professional activities of internal medicine-pediatrics (med-peds) hospitalists who have graduated in the past 5 years (June 2009-June 2013). METHODS The national Medicine-Pediatrics Program Directors Association (MPPDA) conducted a cross-sectional survey study of the 79 residency program directors who are members of the MPPDA regarding the practice patterns of recent graduates (from 2009-2013) currently practicing as hospitalists. The survey was distributed in the spring of 2014 on the MPPDA listserv. The survey inquired about time spent caring for hospitalized adults and children, medical school appointments, practice in freestanding childrens hospitals, and completion of hospital medicine (HM) fellowships. RESULTS Forty-nine program directors (62%) completed the survey and provided data on 1042 graduates from 46 programs. Of those graduates, 26.4% (n=275) practice as hospitalists, and none had completed an HM fellowship. Approximately two-thirds (65%) of med-peds hospitalists provide care to hospitalized children and adults, with one-third providing care solely to hospitalized adults. Approximately one-half (53.5%) have an appointment with a medical school and roughly one-quarter (28%) practice in a freestanding childrens hospital. CONCLUSIONS An increasing percentage of recent med-peds graduates are pursuing careers in HM, and two-thirds are providing care to hospitalized children. As consideration for an accredited pediatric HM fellowship continues, certifying and accrediting bodies should consider how this will impact the med-peds workforce and allow med-peds graduates flexibility in their training requirements that will permit them to acquire the necessary skills to care for hospitalized children and adults.

Adolescent medicine training for medical students.

Medical schools need to integrate training in treating adolescents into their curricula. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

An Inpatient Patient Safety Curriculum for Pediatric Residents

Introduction Patient safety is recognized as an important part of pediatric resident education. There is a lack of published safety curricula targeting pediatric residents. A local needs assessment showed that while residents felt safety was an important part of their current and future jobs, they did not feel prepared to apply safety principles to their future careers or participate in a root cause analysis (RCA). Methods This curriculum was delivered to senior-level pediatric and multiple-board residents during five monthly, hour-long, multidisciplinary sessions. Sessions covered systems-based thinking, terminology, the second victim phenomenon, RCA, and medication errors, while providing feedback on recent event reports filed by residents. Resident knowledge, attitudes, and reporting behavior were evaluated prior to and following the curriculum. Results Attendees showed statistically significant improved safety attitudes and preparedness to apply safety to their future endeavors; conversely, there were no significant changes in nonattendees. There were no significant changes in knowledge scores or event reporting. Answers to qualitative questions identified learning about the reporting process, RCAs, and follow-up on filed event reports as valuable parts of the curriculum. Residents desired more time to debrief about safety events. Discussion The curriculum succeeded in engaging residents in patient safety and making them feel prepared for future practice. Residents showed a dissonance between their intentions to report and their actual reporting behaviors, the reasons for which require further exploration. Residents desired a forum to deal with the emotions involved in errors. This curriculum is easily transferable to other institutions with minor modifications.

Pediatric residents’ attitudes and practice patterns regarding transition to adult-oriented care

ABSTRACT Background: Most youth with chronic illness will survive into adulthood. The complexity of the medical history and care in these patients necessitates a well-planned and coordinated transition over several years as they move from pediatric to adult-oriented health care. Methods: We assessed pediatric residents’ practice patterns and attitudes regarding transition communication by administering a survey about transition to pediatric, combined internal medicine-pediatrics, pediatric neurology, and combined psychiatry-child psychiatry-pediatric residents. Results: Among 110 residents who were contacted, 66 completed the survey, for a response rate of 61%. Surveyed residents report discussing transition with their patients when their patients are age 18 or older, when guidelines suggest a discussion should begin around age 12. Most residents felt that transition should be initially addressed one year prior to transfer. Residents also reported barriers such as lack of experience with transition and lack of role modeling by supervisors as barriers to providing transitional care. Conclusions: The practice patterns and attitudes of pediatric residents in this study do not reflect the recommendations that have been published regarding transitional care services to prepare patients and families for transfer from pediatric to adult-oriented care. In particular, most residents report that they start transition discussions when a patient is near the age of 18, rather than the age of 12 as guidelines suggest and as families would prefer. Pediatric residents need further education regarding transition, with particular emphasis on the need for early and frequent discussions with patients and families regarding transition.

Update in women's health 2006-2007.

In this paper, we summarize recent women’s health articles and guidelines that could potentially change practice, presented at the 30th annual meeting of the Society of General Internal Medicine.