Teaching plain language to medical students: improving communication with disadvantaged patients

Abstract

Background Low health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce. ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students ‘translate’ the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students’ written communication skills using a tool designed for purpose. Methods Students, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-discharge home visit. Structured feedback from course instructors was given for each letter. An assessment tool was developed to evaluate students’ ability to tell the hospitalization narrative using plain and clear language. First and last letters were blindly evaluated for the entire cohort (74 letters; 87 students). Results Students scored higher in all assessment categories in the third letters, with significant improvement in overall score 3.5 ± 0.8 vs 4.1 ± 0.6 Z = -3.43, p = 0.001. The assessment tool’s reliability was high α = 0.797, it successfully differentiated between plain language categories, and its score was not affected by letter length or patient’s medical condition. Conclusions Plain language discharge letters written for real patients in the context of experience-based learning improved in quality, providing students with skills to work effectively in an environment where poor health literacy is prevalent. ETGAR may serve as a model for learning written communication skills during clinical years, using the assessment tool for formative or summative evaluation.

Effectiveness of innovative instructional module for professional competence in health literacy in medical students

“…First, the proposed curriculum adopted multidimensional indicators, such as conception and evaluation, empathy and acceptance, communication and interaction, as well as medical information and shared decision-making. Other previous studies did not include such comprehensive indicators and most lacked shared decision-making aspects [ 26 – 29 , 35 , 36 ]. Second, we applied various student-centric teaching methods and created interesting materials for innovative teaching, including inquiry-based learning, observational learning, group discussion, game-based learning, and role-play.…”

“…However, the lack of a comparative group was noted in previous intervention studies, which revealed insufficient evidence to support the effectiveness of the training curriculum. In the recent years, some research on training in health literacy focused on medical students and revealed a positive effect, but lacked comprehensive intervention approaches or evaluation methods [ 26 – 29 ].…”

Better safe than sorry: Evaluating the implementation process of a home-visitation intervention aimed at preventing unintentional childhood injuries in the hospital setting

“…The use of this bypass to overcome the disconnect between the hospital and community was implemented in the ETGAR program (36) aimed at reducing recurrent admissions following discharge from hospital. ETGAR, also developed by the medical school, uses medical students to visit patients and provide guidance following discharge (36). As demonstrated by ETGAR, there is a need for improved coordination and collaboration between hospital and community.…”

The Portuguese Model of Home Respiratory Care: Healthcare Professionals’ Perspective

“…The responsibility for patients' and carers' education needs to be shared with other HCPs beyond the hospital and home healthcare setting. Crucial written information should be provided in plain language [21,26,27], easily irrespective of the literacy level and should be standardized among hospital, primary care and homecare understandable teams. This shared responsibility and reinforcement of education at distinct moments has potential to improve patients' acceptance of the HRT and long-term adherence [28].…”