A Patient Safety and Transitions of Care Curriculum for Third-Year Medical Students

Abstract

The elderly are the most vulnerable to adverse events during and after hospitalization. This study sought to evaluate the effectiveness of a curriculum on patient safety and transitions of care for medical students during an Internal Medicine-Geriatrics Clerkship on students' knowledge, skills, and attitudes. The curriculum included didactics on patient safety, health literacy, discharge planning and transitions of care, and postdischarge visits to patients. Analysis of pre- and postassessments showed afterwards students were significantly more comfortable assessing a patient's health literacy and confident performing a medication reconciliation, providing education regarding medications, and identifying barriers during transitions. More students were able to identify the most common source of adverse events after discharge (86% vs. 62% before), risk factors for low health literacy (28% vs. 14%), and ways to assess a patient's health literacy (14% vs. 2%). It was feasible to implement a postdischarge visit assignment in an urban tertiary care setting and only required on average of approximately an one and one half hours for students to complete.

Effectiveness of a Comprehensive Health Literacy Consultation Skills Training for Undergraduate Medical Students: A Randomized Controlled Trial

“…By means of an RCT, we demonstrated that this comprehensive Health Literacy MCS-training was effective among an international sample of medical students. Other studies also successfully implemented health literacy training in curricula for undergraduate medical students using an experiential learning format, although these training programs were less comprehensive [32,45]. We, therefore, expect that it is feasible to embed this comprehensive health literacy training in other medical curricula that provide basic training in consultation skills.…”

Low Health Literacy Is Associated with Increased Transitional Care Needs in Hospitalized Patients

“…4,19 Training programs for medical students and nurses advise teaching skills in health literacy as part of fostering effective transitions in care. 20,21 Although low health literacy is generally recognized as a barrier to patient education and self-management, little is known about whether patients with low health literacy are more likely to have other risk factors that could further increase their risk for poor transitions in care. A better understanding of associated risks would inform and improve patient care.…”

Medication safety curriculum: enhancing skills and changing behaviors

“…pre- post- comparisons or a control group) was included, nor did students have opportunities to demonstrate proficiency with these skills with actual patients [ 12 ]. Similar to our PCMH curriculum, a “transitions” curriculum reported by Bradley et al indicated that students’ self-reported confidence in performing MR and communicating medication information to patients improved after patient safety/discharge planning/health literacy topics were added to a 3rd year clerkship; however, in this curriculum there was no indication that students had opportunities to practice these skills with either real or standardized patients – thus questioning if either student behaviors or patient care was impacted by this new clerkship component [ 13 ].…”