Using Developmental "Milestones" to Evaluate Health Literacy Communication Skills in Clinical Practice

The burden falls on today’s clinicians to improve their own written and oral communication skills to ensure that their patients can fully understand and act on the healthcare information they need to safely care for themselves.

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).