Peter Gliatto

Readability of Patient Education Materials Available at the Point of Care

BackgroundMany patient education materials (PEMs) available on the internet are written at high school or college reading levels, rendering them inaccessible to the average US resident, who reads at or below an 8th grade level. Currently, electronic health record (EHR) providers partner with companies that produce PEMs, allowing clinicians to access PEMs at the point of care.ObjectiveTo assess the readability of PEMs provided by a popular EHR vendor as well as the National Library of Medicine (NLM).DesignWe included PEMs from Micromedex, EBSCO, and MedlinePlus. Micromedex and EBSCO supply PEMs to Meditech, a popular EHR supplier in the US. MedlinePlus supplies the NLM. These PEM databases have high market penetration and accessibility.MeasurementsGrade reading level of the PEMs was calculated using three validated indices: Simple Measure of Gobbledygook (SMOG), Gunning Fog (GFI), and Flesch–Kincaid (FKI). The percentage of documents above target readability and average readability scores from each database were calculated.ResultsWe randomly sampled 100 disease-matched PEMs from three databases (n = 300 PEMs). Depending on the readability index used, 30-100% of PEMs were written above the 8th grade level. The average reading level for MedlinePlus, EBSCO, and Micromedex PEMs was 10.2 (1.9), 9.7 (1.3), and 8.6 (0.9), respectively (p ≤ 0.000) as estimated by the GFI. Estimates of readability using SMOG and FKI were similar.ConclusionsThe majority of PEMS available through the NLM and a popular EHR were written at reading levels considerably higher than that of the average US adult.

Do Attending Physicians, Nurses, Residents, and Medical Students Agree on What Constitutes Medical Student Abuse?

Background Whether attending physicians, residents, nurses, and medical students agree on what constitutes medical student abuse, its severity, or influencing factors is unknown. Method We surveyed 237 internal medicine attending physicians, residents, medical students, and nurses at 13 medical schools after viewing five vignettes depicting potentially abusive behaviors. Results The majority of each group felt the belittlement, ethnic insensitivity, and sexual harassment scenarios represented abuse but that excluding a student from participating in a procedure did not. Only a majority of attending physicians considered the negative feedback scenario as abuse. Medical students rated abuse severity significantly lower than other groups in the belittlement scenario (p < .05). Respondents who felt abused as students were more likely to rate behaviors as abusive (p < .05). Conclusions The groups generally agree on what constitutes abuse, but attending physicians and those abused as students may perceive more behaviors as abusive.

Medical student documentation in the medical record: is it a liability?

Medical students have routinely documented patient encounters in both inpatient and outpatient care venues. This hands-on experience has provided a way for students to reflect on patient encounters, learn proper documentation skills, and attain a sense of being actively involved in and responsible for the care of patients. Over the last several years, the practice of student note writing has come into question. Institutional disincentives to student documentation include insurance regulations that restrict student documentation from substantiating billing claims, concerns about the legal status of student notes, and implementation of electronic medical records that do not allow or restrict student access. The increased scrutiny of the medical record from pay-for-performance programs and other quality measures will likely add to the pressure to exclude students from writing notes. This trend in limiting medical student documentation may have wide-ranging consequences for student education, from delaying the learning of proper documentation skills to limiting training opportunities. This article reviews the educational value of student note writing, the factors that have made student documentation problematic, and the potential educational impact of limiting student documentation. In addition, it offers some suggestions for future research to guide policy in this area.

Medical students' experiences with authorship in biomedical research: a national survey.

Purpose To explore authorship issues related to medical students’ primary research projects, assess medical students’ knowledge about authorship issues in biomedical research, and determine their interest in learning about authorship guidelines. Method In 2011, the authors developed and conducted an electronic survey of 243 U.S. medical students who attended an educational event at the National Institutes of Health as part of their funded, yearlong research fellowship programs. The authors then analyzed the results using descriptive statistics. Results Of 243 students, 152 (63%) responded. Most (120/151; 79%) had completed or were in the process of writing a manuscript based on their projects. Of these, most (95/119; 80%) wrote the entire manuscript independently or with guidance. Whereas almost two-thirds (99/152; 65%) indicated that expectations and criteria for authorship were clarified for them, 26% (40/152) indicated that they were not. Most students (108/118; 92%) were in the authorship position they expected and had no concerns about who the other authors were (91/119; 77%). Of those with concerns, 52% (11/21) did not raise the issue for fear of challenging their mentor. Two-thirds (95/145; 66%) never received formal training in authorship guidelines, and 41% (42/103) believed such training would be valuable. Conclusions Although a majority of students had conversations about authorship and were clear about the guidelines for ethical authorship, additional work is needed. The authors recommend that academic institutions develop a menu of options for teaching students about this important area in research ethics.

Health Literacy in Transitions of Care: An Innovative Objective Structured Clinical Examination for Fourth-Year Medical Students in an Internship Preparation Course

BackgroundLow health literacy is associated with adverse health outcomes, especially during transitions of care. Competency-based assessments may improve communication during this time.AimTo develop an Objective Structured Clinical Examination (OSCE) for medical students to demonstrate communication skills to be used during the hospital discharge process with patients of low health literacy.SettingThe OSCE was integrated into the curriculum of an internship preparatory clerkship.ParticipantsOne hundred and one fourth-year medical students participated.Program DescriptionStudents received a skills-based health literacy workshop. In the OSCE, learners counseled standardized patients regarding initiation of anticoagulation at discharge and wrote discharge instructions.Program EvaluationFifty-seven students completed the workshop prior to the OSCE, and 44 participated in the workshop after the completing the OSCE. Participants who completed the workshop first outperformed their peers on the checklist (15.1 vs. 13.4, p < 0.0001) and on the reading level of their written instructions (9.9 vs. 10.6, p = 0.01); 82% felt confident communicating with patients of low health literacy after the workshop and OSCE.DiscussionThis OSCE is a tool to train and evaluate future interns’ ability to communicate with patients of limited health literacy levels at hospital discharge. Such innovations may make this period of time safer for patients, improving health outcomes.

Long Case or Case Vignettes: A Comparison of Two Instructional Methods in Inpatient Geriatrics for Medical Students

The varied, atypical manifestations of geriatric syndromes make knowledge transfer the ability to extend knowledge from one context to another a particularly relevant concept. The authors hypothesized that multiple, contrasting short cases, by facilitating knowledge transfer, would improve knowledge more than a single long case in geriatric medicine. The authors’ objective was to assess the impact of two instructional methods (a single long case vs. contrasting short cases) on knowledge and knowledge retention among 3rd-year medical students on their Internal Medicine-Geriatrics Clerkship. They participated in the curriculum which consisted of four weekly mandatory sessions covering five content areas based on a systematic needs assessment. Instructional method alternated by month. Knowledge and knowledge retention were measured using an online multiple-choice question test administered before, immediately after, and one year following the curriculum. Students also completed a demographic survey prior to the curriculum and an evaluation of the curriculum following the curriculum. There was significant improvement in test scores from pre- to postcurriculum in both groups that persisted one year after the experience with no significant differences between the two groups. The two case-based instructional methods resulted in significant and enduring knowledge improvement, but one method was not better than the other.

Wound Care in Home-Based Settings

Wounds in homebound adults are common; clinicians who care for such patients require a working knowledge of prevention, diagnosis, prognosis, and therapeutics in order to minimize morbidity and maximize healing and comfort. The most frequently encountered wounds are decubitus wounds, also known as pressure wounds. Lower extremity ulcers are also common and can be venous, arterial, or neuropathic in origin. Wounds caused by malignant neoplasms are less common but are substantial causes of psychological and physical morbidity. Home-based medical providers who care for patients with wounds require a conceptual framework for dressings tailored to various types of wounds, as well as knowledge of home-based approaches such as negative-pressure wound therapy. Accurate and thorough documentation of wounds and wound care, appropriate billing, and collaboration with multiple disciplines are essential skills for the home-based clinician.