Using Developmental "Milestones" to Evaluate Health Literacy Communication Skills in Clinical Practice
While academic programs in all health professions have recognized the need and implemented curricula in health literacy, the big question remaining is how to evaluate whether their learners have incorporated those skills into everyday clinical practice.
Recently, the ACGME has put into place an outcomes-based evaluation system where future doctors will be measured for their competency in performing the essential tasks necessary for clinical practice in the 21st century. Medical residents and fellows must demonstrate competency in six core areas - patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills and communication.
Each specialty group developed outcomes-based milestones as a framework for determining resident and fellow performance within the six ACGME Core Competencies. A milestone is a significant point in development. For accreditation purposes, the Milestones are competency-based developmental outcomes (e.g., knowledge, skills, attitudes, and performance) that can be demonstrated progressively by residents and fellows from the beginning of their education through graduation to the unsupervised practice of their specialties. As a general framework, there are five developmental levels, from the beginner (1st day of residency) to the graduate physician (level 4), to the experienced practitioner and leader (level 5).
Each specialty committee developed it’s own wording for the milestones for the competency “Interprofessional Skills and Communication” and it’s sub-domain “Communicates effectively with patients, families, and the public”. 20% of the specialties included specific wording on the health literacy competencies. These specialty milestones differ greatly, from assuming that this is a skill that should be learned in medical school and fully demonstrated at Level 1 of the residency (general surgery), to placing it along the continuum and demonstrated at Level 2 (family medicine) or Level 3 (physical medicine and rehabilitation), to listing concrete steps in gaining proficiency at each level (urology).
Learning Areas:Clinical medicine applied in public health
Communication and informatics
Describe how health professional education systems play a role in improving health literacy. Discuss the responsibility of clinician educators to not only teach health literacy communication skills, but to evaluate whether their students incorporate these skills and strategies in their everyday interactions with patients. Discuss at least one way clinician educators can evaluate the health literacy communication skills of their student trainees.
Keyword(s): Health Care Delivery
Qualified on the content I am responsible for because: I have worked in the field of health literacy and clinician/patient clear
communication since 1997. This has included organizing the American Medical Association's ad hoc committee of experts that developed the Council on Scientific Affairs Report on Health Literacy, coordination of physician awareness campaigns based on the Health Literacy Introductory Kit, and development of the Health Literacy: Help Your Patients Understand self-study educational program. I also co-edited one of the first textbooks on health literacy.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.