Roger Garvin

Health Literacy Teaching in U.S. Family Medicine Residency Programs: A National Survey

Health care providers, including medical residents, often lack adequate knowledge and skills to work effectively with patients who have limited health literacy. Little is known about the degree to which medical residents are trained to communicate effectively with people who have limited health literacy. This study aimed to assess the status of health literacy training for physicians in U.S. family medicine residency programs. We conducted an online survey of residency directors at 444 U.S. family medicine residencies. Among 138 respondents (31% response rate), 58 programs (42%) reported teaching residents about health literacy as part of the required curriculum. Most instruction occurred during the 1st year of training. Hours of instruction ranged from 2 to 5 during Years 1 through 3. Skills-based training (e.g., plain language techniques) was taught by most programs. Not having access to a faculty authority on health literacy was strongly associated with lack of a required health literacy curriculum. Respondents overwhelmingly agreed that increasing health literacy training for medical students and residents would help improve residents’ clinical skills. This study provides a baseline snapshot of health literacy curricula in U.S. family medicine residencies and likely overestimates the prevalence of such curricula. Additional studies are needed to determine the quality of health literacy instruction in U.S. family medicine residencies and the most effective methods for teaching residents about health literacy.

Financing Residency Training Redesign

BACKGROUND Redesign in the health care delivery system creates a need to reorganize resident education. How residency programs fund these redesign efforts is not known. METHODS Family medicine residency program directors participating in the Preparing Personal Physicians for Practice (P(4)) project were surveyed between 2006 and 2011 on revenues and expenses associated with training redesign. RESULTS A total of 6 university-based programs in the study collectively received

Entrustable professional activities (EPAS): The next step

5,240,516 over the entire study period, compared with

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4,718,943 received by 8 community-based programs. Most of the funding for both settings came from grants, which accounted for 57.8% and 86.9% of funding for each setting, respectively. Department revenue represented 3.4% of university-based support and 13.1% of community-based support. The total average revenue (all years combined) per program for university-based programs was just under

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875,000, and the average was nearly

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590,000 for community programs. The vast majority of funds were dedicated to salary support (64.8% in university settings versus 79.3% in community-based settings). Based on the estimated ratio of new funding relative to the annual costs of training using national data for a 3-year program with 7 residents per year, training redesign added 3% to budgets for university-based programs and about 2% to budgets for community-based programs. CONCLUSIONS Residencies undergoing training redesign used a variety of approaches to fund these changes. The costs of innovations marginally increased the estimated costs of training. Federal and local funding sources were most common, and costs were primarily salary related. More research is needed on the costs of transforming residency training.

Effect of Curriculum Innovation on Residency Applications and Match Performance

In 2015, Entrustable Professional Activities (EPAs) for the specialty of family medicine were developed and approved by the organizations supporting Family Medicine for America’s Health: the Council of Academic Family Medicine (Association of Departments of Family Medicine, Association of Family