Evaluation of the Health Literacy Curriculum at a Southeastern Medical School

Evaluation of the Health Literacy Curriculum at a Southeastern Medical School | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the Health Literacy Curriculum at a Southeastern Medical School Faith Albertson, Ann Blair Kennedy, Shannon Taylor, Nabil Natafgi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4659697/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Jan, 2025 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Background Health literacy (HL) is crucial for making informed health decisions. Over one-third of US adults have limited HL, leading to adverse health outcomes. Despite its importance, HL education lacks standardization in medical training. This study evaluates the University of South Carolina School of Medicine Greenville’s (USC SOMG) HL curriculum to propose recommendations for HL instruction. Methods A convergent parallel mixed methods design was used to assess the HL curriculum through a curriculum review, student survey, and faculty interviews. The study utilized thematic analysis for qualitative data and statistical analysis for quantitative data, focusing on prior and current HL training, confidence in HL application, and perceptions of HL education. Results The curriculum at USC SOMG incorporates active learning strategies, emphasizing HL, and patient communication. Most participants reported high confidence in their HL knowledge and skills. The preferred teaching methods were hands-on clinical interactions, observing clinical interactions, and interactive lessons. Barriers to using HL interventions included time constraints and lack of real-world experience. Faculty recommended time prioritization and collaborative strategies to overcome these barriers. Conclusions USC SOMG’s HL curriculum combines didactic and active strategies longitudinally, preparing students to feel confident in their ability to engage with patients experiencing LHL. This demonstrates the curriculum’s strength and potential as a model for other schools. However, for broader implementation, standardized requirements and competency-based assessments are recommended to ensure consistent HL education across medical programs, focusing on practical application and overcoming identified barriers. This could markedly enhance patient outcomes by equipping future providers with essential HL skills. health literacy medical education patient communication Figures Figure 1 Introduction Health literacy (HL) is the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others 1 – 2 . More than one-third of adults in the US have limited HL (LHL), which has been associated with higher mortality rates, health disparities, and increased medical costs 3 – 5 . Its links with social determinants of health and poorer health outcomes make HL a concern for healthcare professionals involved in health promotion, disease prevention, and the management of chronic diseases 4 , 6 – 7 . As such, there is a growing recognition of the importance of HL, but progress in this area is still lacking 2 . Two decades ago, the National Academies of Science, Engineering, and Medicine issued its "Prescription to End Confusion," a call to action to address HL rates within the US 8 . One of its key recommendations was training health professional learners to effectively communicate with patients with LHL 6 , 8 . The Agency for Healthcare Research and Quality (AHRQ) supports universal HL precautions 9 , and HL is included in the US Medical Licensing Examination (USMLE) content guidelines for Step 1 and Step 2K exams 10 . However, there are no standardized requirements for teaching providers explicitly about HL within the current Liaison Committee on Medical Education (LCME) guidelines 11 . While the 2025-26 LMCE curriculum guidelines include HL-related concepts such as communication skills, experts have argued that standardized interventions to address LHL should be included explicitly 12 . Although a 2010 study found 72% of allopathic medical schools include HL in their curricula 13 , the average time spent on HL is three hours 9 , 12 – 13 . Without adequate training, future providers have fewer skills and lower confidence in addressing patients with LHL 12 . Short-term HL training has been found to effectively increase students’ HL knowledge and confidence in patient communication 12 . However, more longitudinal formats have successfully promoted a deeper understanding of HL, suggesting HL training should consist of multiple sessions over time 14 – 15 . Medical institutions can empower future providers to address individuals with LHL and improve health outcomes 13 . However, without appropriate guidance on content, structure, and teaching approaches for HL training, medical schools may not address HL education properly 14 . The purpose of this paper is to evaluate the health literacy curriculum at the University of South Carolina Greenville (USCSOMG) to make informed recommendations to medical educators. Methods Methods Design, sampling, and setting A convergent parallel mixed methods design was used to evaluate the HL curriculum at the University of School of Medicine Greenville (USCSOMG), including their Family Medicine Graduate Medical Education (GME) program through the Family Medicine Residency Program Greenville (FMRGVL). The survey participants were USCSOMG students and FMRGVL residents. The sampling frame included a total of 432 individuals, 113 first-year (M1) medical students, 110 second-year (M2) medical students, 98 third-year (M3) medical students, 93 fourth-year (M4) medical students, and 18 family medicine residents. Learners were recruited to participate through class presentations, email/list-serv, short text messages, and GroupMe messaging. To be included in the study, individuals had to be current learners in either program. Five current faculty members within the programs conducted interviews. Faculty members were identified using purposive sampling method and chosen due to the presence of some form of HL or HL-related concepts in their curriculum, as identified by a fellow USCSOMG faculty member. Measures The survey (Appendix 1) assessed medical learners' prior and current HL training, comfort with and knowledge of HL concepts, and opinions of HL education in medical schools. The survey was adapted from a measure developed by Mackert and colleagues 16 used to assess the long-term effects of HL education for medical students 15 , and the components of the AHRQ Health Literacy Universal Precautions Toolkit 9 . General demographics were not included to maintain the anonymity of survey respondents. Question types included multiple-choice, ranking, and open-ended responses. The faculty interview guide (Appendix 1) contained open-ended questions to gather information on the faculty member’s role at the USCSOMG, as well as information and opinions on their explicit and latent HL curriculum. Procedures and statistical analysis. Anonymous online surveys created in Qualtrics were sent out using the same recruitment methods. Survey collection took place from January 17, 2024, to March 1, 2024, and multiple text and email reminders were sent out to students to encourage participation over the course of the collection period. A $ 5 Starbucks gift card was offered for participation. A snowball sampling method was used to reach eligible participants. The survey QR code was shared with learners by some USCSOMG faculty members during class and through email. For a survey to be considered "complete," participants had to answer all the initial categorical questions and at least one of the Likert scale questions. 84 individuals responded to the survey, and 71 individuals completed the survey. Five interviews were conducted with faculty members who include HL in their curriculum to assess their curriculum and opinions on barriers to addressing HL. Interviews were completed over Microsoft Teams and were 20–45 minutes long, with a mean time of 31 minutes and a standard deviation of 8.7 minutes. The interviews were recorded and transcribed, and oral consent was obtained before each interview. Interview data was numerically labeled and deleted upon study completion. Thematic analysis was the primary qualitative method for analyzing USCSOMG curriculum materials, faculty interviews, and open-ended survey responses from medical learners. Interview transcripts and open-ended responses were imported into Microsoft Word and codes were generated by color-coding segments of data that were relevant to evaluating the HL curriculum. Codes were then consolidated into themes and pertinent quotes within each theme were extracted. RStudio, version 4.3.2, with alpha set at 0.05 was used to analyze quantitative survey results. Survey respondents were grouped into pre-clinical (M1-M2 students), clinical (M3-M4 students), and residents. Likert scale questions were grouped into Strongly Agree/Agree, Neutral, and Disagree/Strongly Disagree. Some categorical questions were also grouped, e.g., 0–3 hours, 4–10 hours, and 11–15 + hours spent on HL education and none/little to none, sometimes, a decent amount/almost always use HL interventions in real-world patient interactions. Ranking questions were dichotomized, e.g., a ranking of 1/2 or any other ranking. All percentages were computed using the number of responses to each specific question in the denominator to address missing responses. Descriptive statistics were run for categorical and continuous variables. Kruskal-Wallis tests were conducted to determine response differences for Likert scale and ranking questions between pre-clinical, clinical, and residency groups, and Shapiro-Wilk tests were used to test for normality. The data violated the assumptions needed for parametric testing; therefore, non-parametric tests were used. The University of South Carolina Institutional Review Board determined this project as exempt from review (#Pro00132250). Results Curriculum Review Both programs utilize interprofessional education with faculty members coming from a variety of disciplines beyond clinical medicine and provide education on HL and patient communication. The University of South Carolina School of Medicine Greenville (USCSOMG) includes HL training within its first-year Integrated Practice of Medicine (IPM) curriculum. IPM courses are taught across all four years of medical school and in small groups, with year-long courses for the first two years and one to four-week-long sessions in years three and four 17 . USCSOMG is updating its curriculum to improve patient-centered care, adding semesters on doctoring, the healthcare system, and societal aspects of medicine (Figure 1). First-year students are given a lecture on HL and tasked with creating brochures on HL using plain language. Brochures must include the definition of HL, the impacts of HL on health outcomes, how to assess HL, how to help patients with LHL, information on the teach-back method, statistics about HL, and strategies that healthcare systems can put in place to help patients with LHL. IPM and clinical faculty also work to incorporate training on motivation interviewing, patient teach-backs, medicine reconciliation, and other HL interventions throughout their lessons in the form of role-playing, simulated patient interactions, and discussions. First-year students also have EMT rotations, allowing them to have hands-on experience with patients of varying HL levels before they enter the clinical environment. In the FMRGVL, videos of residents' interactions with patients are reviewed using the Patient-Centered Observation form from the University of Washington 18 . This form allows the instructor to assess how well the resident addresses biopsychosocial aspects of patient care and utilizes good communication techniques, including patient teach-backs. The program also holds Equity M&Ms, which aim to educate residents on concepts related to health equity and encourage discussion of HL, patient teach-backs, and other contributors to healthcare affected by the social determinants of health 19 . Student Survey and Faculty Interviews Quantitative Participants After removing incomplete survey responses, survey respondents included 55 pre-clinical students, 6 clinical students, and 10 residents. Of the residents, most had attended a school other than USCSOMG for their undergraduate medical education (80%). HL Training and Interventions A majority of the respondents (87.3%) had some or a high level of HL training prior to starting medical school or residency. This prior training included previous coursework in public health/health sciences during undergrad, clinical experiences, working as a medical scribe, and summer internships. Variations in training, use of interventions, and opinions on barriers to intervention usage are summarized in Table 1. Opinions on and Confidence with HL Training Education Most respondents felt they had a strong understanding of what HL is and how to assess patient understanding. Satisfaction with the curriculum and confidence in communicating with patients are further explored in Table 2. Rankings of the importance of HL topics and the effective ways to learn HL skills are reported in Table 3. Results of Kruskal Wallis Test No statistically significant difference was found between pre-clinical, clinical, and residency groups for responses to the Likert scale or ranking questions at the alpha = 0.05 confidence level (Table 2-3). Qualitative Of the respondents who chose to answer the open-ended question about how to navigate a mock patient scenario, 93% of respondents explained they would address the possibility of the patient having LHL in various ways including, using layman terms, patient teach-backs, and shared decision making. Five themes were identified from interviews with faculty members, and these include 1) The importance of active learning in HL education, 2) Strengths of the curriculum, 3) Lacking aspects of the curriculum, 4) Barriers to using HL interventions, and 5) Advice from faculty to address barriers. Key quotes from faculty and medical learners for each theme are summarized in Table 4. When asked about a standardized hours requirement, all faculty members indicated this might be difficult to implement because HL is often threaded throughout multiple lessons, especially those on the social determinants of health and population health, and is not explicitly tested. One faculty member summarized this, stating, "My concern is that if you make things stricter and add more guidelines, people will push back against that and only do what they have to do.” Multiple faculty members recommended competency-based HL testing throughout medical school. For example, one faculty member recommended “a mandated simulation experience of some sort specifically around HL and assessing it…so you can see how they do in the first year around working with patients with low HL, and then the second year, third year and fourth year to how they're progressing in their skills and how they are engaging with patients”. Similarly, another faculty member recommended implementing “some sort of high-level objective or competency around awareness of public health or time spent in communities.” Mixed The integration of quantitative and qualitative findings in this study is further augmented by the use of color-coding, a visual tool that allows for a clear and direct connection between the two sets of data (Tables 1-4). The colors serve as a bridge, highlighting where the qualitative comments and quantitative data intersect and diverge, thereby facilitating a deeper understanding of the patterns emerging from the research. During analysis, color-coding was applied to align the qualitative narratives with corresponding quantitative findings, making it visually evident how individual experiences reflect broader statistical trends. For instance, the color-highlighted qualitative comments regarding the substantial value of spoken communication in patient care complement the quantitative data that indicate a majority of the curriculum focused on this aspect (82.2%). Similarly, the qualitative feedback on the challenges of implementing HL interventions due to time constraints and advice on how to address this barrier were color-matched to the quantitative barrier of "Limited time during patient visits" reported by 68.3%. Qualitative data about concerns over limited clinical experiences were color-matched to the quantitative barriers of “lack of relevant clinical experiences” reported by 38.1%. The top three average rankings for the most effective ways to teach HL were also color-matched to qualitative data from faculty members who included these active learning strategies in their discussion of curriculum content. The strategic use of color also aids in drawing attention to areas of discrepancy. While a large percentage of participants reported receiving HL training, qualitative remarks colored correspondingly show an expressed uncertainty about its practical application, particularly in clinical settings. This visual method underscores the need for enhanced educational strategies that not only address HL concepts but also ensure their practical utility and relevance in clinical practice. The color-coding technique used here is not merely an aesthetic choice but a deliberate analytical tool. Discussion Summary of Main Findings This study critically evaluates the integration of health literacy (HL) training within medical education curricula at USCSOMG and the FMRGVL. A comprehensive curriculum review reveals a dedicated approach to HL, incorporating interprofessional education and a variety of teaching strategies, including motivational interviewing and shared decision-making. Our quantitative findings indicate a substantial majority of medical learners (87.3%) have had some level of HL training before or during their current programs. However, satisfaction with HL education varied, with pre-clinical students reporting higher levels of satisfaction and confidence in their ability to communicate health information to patients, as opposed to clinical students and residents. No significant differences were noted across the groups regarding their opinions on HL education. Despite this training, our qualitative data suggests students and residents perceive notable gaps in translating theoretical knowledge into clinical practice, specifically in written communication and applying HL in patient scenarios. Notably, the curriculum's strong focus on spoken communication and patient support systems is echoed in the respondents' qualitative assessments of the program's strengths. The identified barriers, such as time constraints and lack of real-world experience, reflect a disconnect between curriculum design and clinical application, underscoring the need for curricular adjustments that prioritize hands-on HL training. Faculty advice further emphasizes this point, suggesting collaborative strategies to overcome these barriers in clinical practice. The innovative use of color-coding in our mixed-methods approach effectively highlights the congruences and discrepancies between the qualitative and quantitative data, allowing for a nuanced understanding of HL training's impact. Importance of teaching style The respondent ranking of teaching style is reflected in current literature, with multiple studies citing the importance of interprofessional education 12 and hands-on applications of HL knowledge in the form of clinical experiences or simulated patient interactions, small group discussions, and active learning 14 – 15 , 20 . These teaching strategies are largely reflected in the curriculum at USCSOMG and the FMRGVL during first-year EMT rotations, IPM courses, simulated patient scenarios, and small group discussions, likely leading to high levels of HL knowledge and use among medical learners in both programs. Faculty members also come from a variety of disciplines, increasing the breadth of perspectives medical learners in these programs are taught. A similar study found that less than 10% of participants, internal medicine residents, felt confident in HL knowledge or use of skills for identifying and communicating with LHL patients 21 . The marked difference in medical learners’ confidence and variation in the literature suggests a need for a more detailed study to contrast curricula and associated confidence with HL to determine what methods work best. However, medical programs may benefit from adopting a curriculum structure that includes HL as a longitudinal topic and interprofessional education, as evidenced by the high levels of confidence with HL and HL interventions seen in medical learners from USCSOMG and FMRGVL. Recommendations for medical educators and accreditation organizations This study demonstrates the importance of HL training across all years of medical education. Based on the results of the study, medical educators should ensure common barriers to using HL interventions are addressed, such as lack of time during patient visits, concerns over language barriers with patients, and lack of comfort in using interventions. As per USCSOMG faculty recommendations, concerns over lack of time can be addressed by teaching medical learners to prioritize the use of patient teach-backs for high-yield aspects of the appointment, to utilize their time in the learning environment to practice effective communication with patients, and to explore the use of telehealth follow-ups to address limited time during in-person visits. These strategies to address LHL and student barriers have been reiterated in a study that polled 25 HL experts in 2017 22 and studies aiming at improving HL interventions among medical providers 23 . While a mandatory hour requirement may not be feasible due to the progressive nature of HL education and the current curriculum load in medical schools, it would be beneficial to implement a competency-based HL exam each year of medical school to ensure students are taking in all of the information and are comfortable interacting with patients of all literacy levels. Based on student desires and past literature 12 , 14 , this competency exam would be best implemented in the form of a simulated patient scenario each year to further help students apply theoretical knowledge to the real world. Learners also should receive feedback from both their fellow students and faculty each year, potentially in the form of a standardized observation form like the one used in the FMRGVL 6 . To emphasize the importance of HL to medical learners and address both student and faculty concerns identified in this study and past research 12 , the LCME should also explicitly include HL in their required curriculum content. This will ensure that students are more focused on HL training and practice. Furthermore, the measure used in this study may be repurposed to assess students' opinions on their HL education to address the need for instruments that measure the HL knowledge, skills, and attitudes of students after educational intervention 6 . The measure can be used to help medical schools reform and adapt their curriculum to reflect student needs and equip future providers to navigate HL. Through ongoing evaluation of student needs and delivering comprehensive HL education annually, medical schools and residency programs can better equip their students to enhance patient health outcomes. Limitations and future directions Sample sizes for each group were relatively small, which limits the power of the study and the ability to generalize survey results to medical schools outside of USCSOMG. Instrument bias and recall bias may have affected survey results because the number of HL-focused questions may have primed students to consider HL more than they may have during a typical patient interaction. M1/M2 response rates were higher because a snowball sampling method was used to gather survey responses using initial M1/M2 student contacts, and the survey QR code was shared during the health literacy lesson given to M1/M2 students. Although the survey was anonymous, some degree of social desirability bias may have also skewed survey responses. Students who are more interested in HL may have been more likely to participate, resulting in selection bias. Evaluating learners' confidence in their abilities may not accurately reflect their actual skills due to the potential for self-assessment bias. Future research should use Objective Structured Clinical Examinations (OSCEs) or video observations for a more objective measure of learners' competencies. However, despite the limited power of the survey, study findings still correlate with past literature, which supports a higher emphasis on HL education and the importance of active and longitudinal learning. Conclusion While research has long highlighted health literacy's crucial role in healthcare outcomes, there remains a need for more explicit guidelines from accrediting bodies and medical educational institutions. The revised curriculum at USCSOMG, employing a combination of didactic and active strategies in a longitudinal format, equips students to feel confident in their ability to engage with patients experiencing LHL. This demonstrates the curriculum's strength and potential to serve as a model for other schools looking to bolster their curriculum on this meaningful topic, given its implications for patient care. However, explicit guidance is essential within current LCME standards for comprehensive integration of health literacy education, offering students greater focus on and practice in HL interventions. Implementing an annual competency exam to evaluate medical learners' health literacy skills and monitoring curriculum effectiveness is vital. The survey tool developed for this project could support medical schools in tailoring their curriculum to meet student needs and enhance health literacy outcomes. Abbreviations HL health literacy LHL limited health literacy USCSOMG University of South Carolina School of Medicine Greenville FMRGVL Family Medicine Residency Program Greenville AHRQ The Agency for Healthcare Research and Quality USMLE US Medical Licensing Examination LCME Liaison Committee on Medical Education Declarations Ethics approval and consent to participate The University of South Carolina Institutional Review Board approved this project #Pro00132250. Informed consent was gathered by both survey participants and interview participants. Survey participants were prompted to click “next” if they consented to participation and oral consent was given by interview participants. Consent for publication Not applicable Competing interests The authors declare that they have no competing interests. Funding This project was supported in part by an Honors College Thesis Grant from the University of South Carolina Honors College. Authors’ contributions All authors played an equal role in project conceptualization, investigation, and methodology. FA conducted data curation, analysis, project administration, and visualization and wrote the first draft of the manuscript. NN, SST, and ABK oversaw the project and edited manuscript drafts. All authors read and approved the final manuscript and made significant contributions to the project. Acknowledgments Not applicable Authors’ information Faith Albertson: Faith Albertson is a recent graduate from the University of South Carolina Honors College and an incoming Master of Public Health candidate at the University of North Carolina Gillings School of Global Public Health with a concentration in Health Policy. Her primary research interests are health literacy, health equity, and medical education reform. Dr. Ann Blair Kennedy: Dr. Ann Blair Kennedy is an associate professor in the Biomedical Sciences Department at the University of South Carolina School of Medicine Greenville and in the Family Medicine Department at Prisma Health and Director of the University of South Carolina Patient Engagement Studio, Greenville, SC. Dr. Shannon Taylor: Dr. Shannon Stark Taylor is a licensed clinical health psychologist and serves as the Director of Behavioral Science for the Prisma Health Family Medicine Residency Greenville. She holds appointments as a Clinical Associate Professor at the University of South Carolina School of Medicine Greenville and the Clemson University School of Health Research. She has expertise in quantitative research methods and statistics and behavioral randomized controlled trials. Her background is in psychological processes and interventions for chronic pain. Currently, her primary research interests are provider well-being, physician-patient communication, and Diversity, Equity, and Inclusion, and medical education on these topics. Dr. Nabil Natafgi: Dr. Nabil Natafgi is an Assistant Professor of Health Services Policy & Management at the Arnold School of Public Health, and Associate Director of the Patient Engagement Studio, University of South Carolina. Dr. Natafgi's current work is focused on evaluating the effectiveness and impact of telehealth applications on care delivery and outcomes. He also has experience in qualitative data collection and analysis and community-based participatory research, working closely with academic, patient, community, and other stakeholder partners. He co-led two PCORI-funded projects to develop Virtual Patient (VIP) Engagement Studio that aims to use technology to engage patients and caregivers in the development, implementation, and dissemination of research projects. He also collaborates with clinical and academic partners at Prisma Health, Clemson University, and Furman University on projects aimed at improving the virtual care delivery process using telemedicine and the programmatic evaluation of various behavioral health initiatives across the care continuum. His research encompasses a variety of methodological approaches including both quantitative and qualitative analyses, with emphasis on mixed methods and a special interest in the engagement of patients, community members, healthcare providers, and other stakeholders. Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Clinical Trial Number: Not Appliable References Hersh L, Salzman B, Snyderman D. Health Literacy in Primary Care Practice. afp. 2015;92(2):118–24. Santana S, Brach C, Harris L, Ochiai E, Blakey C, Bevington F, et al. 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Additional Declarations No competing interests reported. Supplementary Files InterviewGuide.pdf Tables.docx Cite Share Download PDF Status: Published Journal Publication published 06 Jan, 2025 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 15 Sep, 2024 Reviews received at journal 13 Sep, 2024 Reviewers agreed at journal 09 Sep, 2024 Reviews received at journal 31 Aug, 2024 Reviewers agreed at journal 03 Aug, 2024 Reviewers agreed at journal 31 Jul, 2024 Reviewers invited by journal 23 Jul, 2024 Editor invited by journal 08 Jul, 2024 Editor assigned by journal 08 Jul, 2024 Submission checks completed at journal 08 Jul, 2024 First submitted to journal 29 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4659697","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":333203800,"identity":"301e0bf3-4346-4ade-878b-653a88721aff","order_by":0,"name":"Faith Albertson","email":"","orcid":"","institution":"University of South Carolina","correspondingAuthor":false,"prefix":"","firstName":"Faith","middleName":"","lastName":"Albertson","suffix":""},{"id":333203804,"identity":"62b5667c-1f1c-4a06-a2e2-37c36bcefc8b","order_by":1,"name":"Ann Blair Kennedy","email":"","orcid":"","institution":"University of South Carolina","correspondingAuthor":false,"prefix":"","firstName":"Ann","middleName":"Blair","lastName":"Kennedy","suffix":""},{"id":333203807,"identity":"2ca97b28-4257-4aa0-b2ca-2c38661daf5b","order_by":2,"name":"Shannon Taylor","email":"","orcid":"","institution":"Prisma Health","correspondingAuthor":false,"prefix":"","firstName":"Shannon","middleName":"","lastName":"Taylor","suffix":""},{"id":333203809,"identity":"097024a4-884b-4261-bd4e-6a304175d93b","order_by":3,"name":"Nabil Natafgi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYNACGwYefiB14GEDTIQNr3rGBoY0Bh5JoOoDiaRoYTA4AGQSpcVcuvn5gx8JtTLG1w4/PJC4wyaxgf/wA4YPZYdxarGcc8ywsSfhOI/Z7TSDA4ln0owZJNIMGGecw63F4EaCYQPvj2NALQlALW2H5RgkeBiYedvwaUn/2Pgn4RiP8ez0DyAtPAz8ZxiY/+LVkmPYzJNQw2MgnQO1hSGHgZkRv5bC2TIJB3gkbucUgP3CBvTLwZ5z6fgctuHjm4Q6e/7Z6Zs/fASGWD//4YcPfpRZ49QCBUjOAMXIAULqgaCOCDWjYBSMglEwYgEAIyJcbAhS4ZMAAAAASUVORK5CYII=","orcid":"","institution":"University of South Carolina","correspondingAuthor":true,"prefix":"","firstName":"Nabil","middleName":"","lastName":"Natafgi","suffix":""}],"badges":[],"createdAt":"2024-06-29 14:20:56","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4659697/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4659697/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-06362-6","type":"published","date":"2025-01-06T15:57:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":62138719,"identity":"6c5e7312-e4c6-42aa-94ec-eaa90aa1cdef","added_by":"auto","created_at":"2024-08-09 16:48:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":172753,"visible":true,"origin":"","legend":"\u003cp\u003eAspects of the curriculum refresh at the University of South Carolina School of Medicine Greenville (USCSOMG)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ea.\u003c/strong\u003e To be placed in the curriculum review section of the results\u003c/p\u003e","description":"","filename":"Figure112.png","url":"https://assets-eu.researchsquare.com/files/rs-4659697/v1/09cd883239a8d8c6b9495aea.png"},{"id":73694005,"identity":"7ef20841-0ad0-4c5f-8543-b56c3e866b4c","added_by":"auto","created_at":"2025-01-13 16:10:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":808238,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4659697/v1/350bfcde-8c7f-4aa3-97e4-3c46260efd8b.pdf"},{"id":62138720,"identity":"18961650-be97-4f3f-9bfe-0a89ed9b6605","added_by":"auto","created_at":"2024-08-09 16:48:06","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":66086,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewGuide.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4659697/v1/918aa40a7774cb442d6a796d.pdf"},{"id":62138718,"identity":"48c4530a-b175-4aea-af29-fdb289eb32de","added_by":"auto","created_at":"2024-08-09 16:48:06","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":30021,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-4659697/v1/2b3089e71b2dcf318afbb91f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the Health Literacy Curriculum at a Southeastern Medical School","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHealth literacy (HL) is the degree to which individuals can find, understand, and use information and services to inform health-related decisions and actions for themselves and others\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. More than one-third of adults in the US have limited HL (LHL), which has been associated with higher mortality rates, health disparities, and increased medical costs\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Its links with social determinants of health and poorer health outcomes make HL a concern for healthcare professionals involved in health promotion, disease prevention, and the management of chronic diseases\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. As such, there is a growing recognition of the importance of HL, but progress in this area is still lacking\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eTwo decades ago, the National Academies of Science, Engineering, and Medicine issued its \"Prescription to End Confusion,\" a call to action to address HL rates within the US\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. One of its key recommendations was training health professional learners to effectively communicate with patients with LHL \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. The Agency for Healthcare Research and Quality (AHRQ) supports universal HL precautions\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e, and HL is included in the US Medical Licensing Examination (USMLE) content guidelines for Step 1 and Step 2K exams\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. However, there are no standardized requirements for teaching providers explicitly about HL within the current Liaison Committee on Medical Education (LCME) guidelines\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. While the 2025-26 LMCE curriculum guidelines include HL-related concepts such as communication skills, experts have argued that standardized interventions to address LHL should be included explicitly\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eAlthough a 2010 study found 72% of allopathic medical schools include HL in their curricula\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, the average time spent on HL is three hours\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Without adequate training, future providers have fewer skills and lower confidence in addressing patients with LHL\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Short-term HL training has been found to effectively increase students\u0026rsquo; HL knowledge and confidence in patient communication\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. However, more longitudinal formats have successfully promoted a deeper understanding of HL, suggesting HL training should consist of multiple sessions over time\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Medical institutions can empower future providers to address individuals with LHL and improve health outcomes\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. However, without appropriate guidance on content, structure, and teaching approaches for HL training, medical schools may not address HL education properly\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. The purpose of this paper is to evaluate the health literacy curriculum at the University of South Carolina Greenville (USCSOMG) to make informed recommendations to medical educators.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMethods Design, sampling, and setting\u003c/h2\u003e \u003cp\u003eA convergent parallel mixed methods design was used to evaluate the HL curriculum at the University of School of Medicine Greenville (USCSOMG), including their Family Medicine Graduate Medical Education (GME) program through the Family Medicine Residency Program Greenville (FMRGVL). The survey participants were USCSOMG students and FMRGVL residents. The sampling frame included a total of 432 individuals, 113 first-year (M1) medical students, 110 second-year (M2) medical students, 98 third-year (M3) medical students, 93 fourth-year (M4) medical students, and 18 family medicine residents. Learners were recruited to participate through class presentations, email/list-serv, short text messages, and GroupMe messaging. To be included in the study, individuals had to be current learners in either program. Five current faculty members within the programs conducted interviews. Faculty members were identified using purposive sampling method and chosen due to the presence of some form of HL or HL-related concepts in their curriculum, as identified by a fellow USCSOMG faculty member.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eThe survey (Appendix 1) assessed medical learners' prior and current HL training, comfort with and knowledge of HL concepts, and opinions of HL education in medical schools. The survey was adapted from a measure developed by Mackert and colleagues\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e used to assess the long-term effects of HL education for medical students\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, and the components of the AHRQ Health Literacy Universal Precautions Toolkit\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. General demographics were not included to maintain the anonymity of survey respondents. Question types included multiple-choice, ranking, and open-ended responses.\u003c/p\u003e \u003cp\u003eThe faculty interview guide (Appendix 1) contained open-ended questions to gather information on the faculty member\u0026rsquo;s role at the USCSOMG, as well as information and opinions on their explicit and latent HL curriculum.\u003c/p\u003e \u003cp\u003e \u003cb\u003eProcedures and statistical analysis.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAnonymous online surveys created in Qualtrics were sent out using the same recruitment methods. Survey collection took place from January 17, 2024, to March 1, 2024, and multiple text and email reminders were sent out to students to encourage participation over the course of the collection period. A \u003cspan\u003e$\u003c/span\u003e5 Starbucks gift card was offered for participation. A snowball sampling method was used to reach eligible participants. The survey QR code was shared with learners by some USCSOMG faculty members during class and through email. For a survey to be considered \"complete,\" participants had to answer all the initial categorical questions and at least one of the Likert scale questions. 84 individuals responded to the survey, and 71 individuals completed the survey.\u003c/p\u003e \u003cp\u003eFive interviews were conducted with faculty members who include HL in their curriculum to assess their curriculum and opinions on barriers to addressing HL. Interviews were completed over Microsoft Teams and were 20\u0026ndash;45 minutes long, with a mean time of 31 minutes and a standard deviation of 8.7 minutes. The interviews were recorded and transcribed, and oral consent was obtained before each interview. Interview data was numerically labeled and deleted upon study completion.\u003c/p\u003e \u003cp\u003eThematic analysis was the primary qualitative method for analyzing USCSOMG curriculum materials, faculty interviews, and open-ended survey responses from medical learners. Interview transcripts and open-ended responses were imported into Microsoft Word and codes were generated by color-coding segments of data that were relevant to evaluating the HL curriculum. Codes were then consolidated into themes and pertinent quotes within each theme were extracted.\u003c/p\u003e \u003cp\u003eRStudio, version 4.3.2, with alpha set at 0.05 was used to analyze quantitative survey results. Survey respondents were grouped into pre-clinical (M1-M2 students), clinical (M3-M4 students), and residents. Likert scale questions were grouped into Strongly Agree/Agree, Neutral, and Disagree/Strongly Disagree. Some categorical questions were also grouped, e.g., 0\u0026ndash;3 hours, 4\u0026ndash;10 hours, and 11\u0026ndash;15\u0026thinsp;+\u0026thinsp;hours spent on HL education and none/little to none, sometimes, a decent amount/almost always use HL interventions in real-world patient interactions. Ranking questions were dichotomized, e.g., a ranking of 1/2 or any other ranking. All percentages were computed using the number of responses to each specific question in the denominator to address missing responses.\u003c/p\u003e \u003cp\u003eDescriptive statistics were run for categorical and continuous variables. Kruskal-Wallis tests were conducted to determine response differences for Likert scale and ranking questions between pre-clinical, clinical, and residency groups, and Shapiro-Wilk tests were used to test for normality. The data violated the assumptions needed for parametric testing; therefore, non-parametric tests were used.\u003c/p\u003e \u003cp\u003e The University of South Carolina Institutional Review Board determined this project as exempt from review (#Pro00132250).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCurriculum Review\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth programs utilize interprofessional education with faculty members coming from a variety of disciplines beyond clinical medicine and provide education on HL and patient communication.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe University of South Carolina School of Medicine Greenville (USCSOMG) includes HL training within its first-year Integrated Practice of Medicine (IPM) curriculum. IPM courses are taught across all four years of medical school and in small groups, with year-long courses for the first two years and one to four-week-long sessions in years three and four\u003csup\u003e17\u003c/sup\u003e. USCSOMG is updating its curriculum to improve patient-centered care, adding semesters on doctoring, the healthcare system, and societal aspects of medicine (Figure 1). First-year students are given a lecture on HL and tasked with creating brochures on HL using plain language. Brochures must include the definition of HL, the impacts of HL on health outcomes, how to assess HL, how to help patients with LHL, information on the teach-back method, statistics about HL, and strategies that healthcare systems can put in place to help patients with LHL. IPM and clinical faculty also work to incorporate training on motivation interviewing, patient teach-backs, medicine reconciliation, and other HL interventions throughout their lessons in the form of role-playing, simulated patient interactions, and discussions. First-year students also have EMT rotations, allowing them to have hands-on experience with patients of varying HL levels before they enter the clinical environment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn the FMRGVL, videos of residents\u0026apos; interactions with patients are reviewed using the Patient-Centered Observation form from the University of Washington\u003csup\u003e18\u003c/sup\u003e. This form allows the instructor to assess how well the resident addresses biopsychosocial aspects of patient care and utilizes good communication techniques, including patient teach-backs. The program also holds Equity M\u0026amp;Ms, which aim to educate residents on concepts related to health equity and encourage discussion of HL, patient teach-backs, and other contributors to healthcare affected by the social determinants of health\u003csup\u003e19\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStudent Survey and Faculty Interviews\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQuantitative\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eAfter removing incomplete survey responses, survey respondents included 55 pre-clinical students, 6 clinical students, and 10 residents. Of the residents, most had attended a school other than USCSOMG for their undergraduate medical education (80%).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHL Training and Interventions\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA majority of the respondents (87.3%) had some or a high level of HL training prior to starting medical school or residency. This prior training included previous coursework in public health/health sciences during undergrad, clinical experiences, working as a medical scribe, and summer internships. Variations in training, use of interventions, and opinions on barriers to intervention usage are summarized in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOpinions on and Confidence with HL Training \u0026nbsp;Education\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMost respondents felt they had a strong understanding of what HL is and how to assess patient understanding. Satisfaction with the curriculum and confidence in communicating with patients are further explored in Table 2. Rankings of the importance of HL topics and the effective ways to learn HL skills are reported in Table 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResults of Kruskal Wallis Test\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNo statistically significant difference was found between pre-clinical, clinical, and residency groups for responses to the Likert scale or ranking questions at the alpha = 0.05 confidence level (Table 2-3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQualitative\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eOf the respondents who chose to answer the open-ended question about how to navigate a mock patient scenario, 93% of respondents explained they would address the possibility of the patient having LHL in various ways including, using layman terms, patient teach-backs, and shared decision making.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFive themes were identified from interviews with faculty members, and these include 1) The importance of active learning in HL education, 2) Strengths of the curriculum, 3) Lacking aspects of the curriculum, 4) Barriers to using HL interventions, and 5) Advice from faculty to address barriers.\u0026nbsp;Key quotes from faculty and medical learners for each theme are summarized in Table 4. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen asked about a standardized hours requirement, all faculty members indicated this might be difficult to implement because HL is often threaded throughout multiple lessons, especially those on the social determinants of health and population health, and is not explicitly tested. One faculty member summarized this, stating, \u0026quot;My concern is that if you make things stricter and add more guidelines, people will push back against that and only do what they have to do.\u0026rdquo; Multiple faculty members recommended competency-based HL testing throughout medical school. For example, one faculty member recommended \u0026ldquo;a mandated simulation experience of some sort specifically around HL and assessing it\u0026hellip;so you can see how they do in the first year around working with patients with low HL, and then the second year, third year and fourth year to how they\u0026apos;re progressing in their skills and how they are engaging with patients\u0026rdquo;. Similarly, another faculty member recommended implementing \u0026ldquo;some sort of high-level objective or competency around awareness of public health or time spent in communities.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eMixed\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe integration of quantitative and qualitative findings in this study is further augmented by the use of color-coding, a visual tool that allows for a clear and direct connection between the two sets of data (Tables 1-4). The colors serve as a bridge, highlighting where the qualitative comments and quantitative data intersect and diverge, thereby facilitating a deeper understanding of the patterns emerging from the research.\u003c/p\u003e\n\u003cp\u003eDuring analysis, color-coding was applied to align the qualitative narratives with corresponding quantitative findings, making it visually evident how individual experiences reflect broader statistical trends. For instance, the color-highlighted qualitative comments regarding the substantial value of spoken communication in patient care complement the quantitative data that indicate a majority of the curriculum focused on this aspect (82.2%). Similarly, the qualitative feedback on the challenges of implementing HL interventions due to time constraints and advice on how to address this barrier were color-matched to the quantitative barrier of \u0026quot;Limited time during patient visits\u0026quot; reported by 68.3%. Qualitative data about concerns over limited clinical experiences were color-matched to the quantitative barriers of \u0026ldquo;lack of relevant clinical experiences\u0026rdquo; reported by 38.1%.\u0026nbsp;The top three average rankings for the most effective ways to teach HL were also color-matched to qualitative data from faculty members who included these active learning strategies in their discussion of curriculum content.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe strategic use of color also aids in drawing attention to areas of discrepancy. While a large percentage of participants reported receiving HL training, qualitative remarks colored correspondingly show an expressed uncertainty about its practical application, particularly in clinical settings. This visual method underscores the need for enhanced educational strategies that not only address HL concepts but also ensure their practical utility and relevance in clinical practice. The color-coding technique used here is not merely an aesthetic choice but a deliberate analytical tool.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSummary of Main Findings\u003c/h2\u003e \u003cp\u003eThis study critically evaluates the integration of health literacy (HL) training within medical education curricula at USCSOMG and the FMRGVL. A comprehensive curriculum review reveals a dedicated approach to HL, incorporating interprofessional education and a variety of teaching strategies, including motivational interviewing and shared decision-making. Our quantitative findings indicate a substantial majority of medical learners (87.3%) have had some level of HL training before or during their current programs. However, satisfaction with HL education varied, with pre-clinical students reporting higher levels of satisfaction and confidence in their ability to communicate health information to patients, as opposed to clinical students and residents. No significant differences were noted across the groups regarding their opinions on HL education.\u003c/p\u003e \u003cp\u003eDespite this training, our qualitative data suggests students and residents perceive notable gaps in translating theoretical knowledge into clinical practice, specifically in written communication and applying HL in patient scenarios. Notably, the curriculum's strong focus on spoken communication and patient support systems is echoed in the respondents' qualitative assessments of the program's strengths. The identified barriers, such as time constraints and lack of real-world experience, reflect a disconnect between curriculum design and clinical application, underscoring the need for curricular adjustments that prioritize hands-on HL training. Faculty advice further emphasizes this point, suggesting collaborative strategies to overcome these barriers in clinical practice. The innovative use of color-coding in our mixed-methods approach effectively highlights the congruences and discrepancies between the qualitative and quantitative data, allowing for a nuanced understanding of HL training's impact.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eImportance of teaching style\u003c/h2\u003e \u003cp\u003eThe respondent ranking of teaching style is reflected in current literature, with multiple studies citing the importance of interprofessional education\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e and hands-on applications of HL knowledge in the form of clinical experiences or simulated patient interactions, small group discussions, and active learning\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. These teaching strategies are largely reflected in the curriculum at USCSOMG and the FMRGVL during first-year EMT rotations, IPM courses, simulated patient scenarios, and small group discussions, likely leading to high levels of HL knowledge and use among medical learners in both programs. Faculty members also come from a variety of disciplines, increasing the breadth of perspectives medical learners in these programs are taught. A similar study found that less than 10% of participants, internal medicine residents, felt confident in HL knowledge or use of skills for identifying and communicating with LHL patients \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. The marked difference in medical learners\u0026rsquo; confidence and variation in the literature suggests a need for a more detailed study to contrast curricula and associated confidence with HL to determine what methods work best. However, medical programs may benefit from adopting a curriculum structure that includes HL as a longitudinal topic and interprofessional education, as evidenced by the high levels of confidence with HL and HL interventions seen in medical learners from USCSOMG and FMRGVL.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations for medical educators and accreditation organizations\u003c/h2\u003e \u003cp\u003eThis study demonstrates the importance of HL training across all years of medical education. Based on the results of the study, medical educators should ensure common barriers to using HL interventions are addressed, such as lack of time during patient visits, concerns over language barriers with patients, and lack of comfort in using interventions. As per USCSOMG faculty recommendations, concerns over lack of time can be addressed by teaching medical learners to prioritize the use of patient teach-backs for high-yield aspects of the appointment, to utilize their time in the learning environment to practice effective communication with patients, and to explore the use of telehealth follow-ups to address limited time during in-person visits. These strategies to address LHL and student barriers have been reiterated in a study that polled 25 HL experts in 2017\u003csup\u003e22\u003c/sup\u003e and studies aiming at improving HL interventions among medical providers\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eWhile a mandatory hour requirement may not be feasible due to the progressive nature of HL education and the current curriculum load in medical schools, it would be beneficial to implement a competency-based HL exam each year of medical school to ensure students are taking in all of the information and are comfortable interacting with patients of all literacy levels. Based on student desires and past literature\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, this competency exam would be best implemented in the form of a simulated patient scenario each year to further help students apply theoretical knowledge to the real world. Learners also should receive feedback from both their fellow students and faculty each year, potentially in the form of a standardized observation form like the one used in the FMRGVL\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. To emphasize the importance of HL to medical learners and address both student and faculty concerns identified in this study and past research\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, the LCME should also explicitly include HL in their required curriculum content. This will ensure that students are more focused on HL training and practice.\u003c/p\u003e \u003cp\u003eFurthermore, the measure used in this study may be repurposed to assess students' opinions on their HL education to address the need for instruments that measure the HL knowledge, skills, and attitudes of students after educational intervention\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The measure can be used to help medical schools reform and adapt their curriculum to reflect student needs and equip future providers to navigate HL. Through ongoing evaluation of student needs and delivering comprehensive HL education annually, medical schools and residency programs can better equip their students to enhance patient health outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and future directions\u003c/h2\u003e \u003cp\u003eSample sizes for each group were relatively small, which limits the power of the study and the ability to generalize survey results to medical schools outside of USCSOMG. Instrument bias and recall bias may have affected survey results because the number of HL-focused questions may have primed students to consider HL more than they may have during a typical patient interaction. M1/M2 response rates were higher because a snowball sampling method was used to gather survey responses using initial M1/M2 student contacts, and the survey QR code was shared during the health literacy lesson given to M1/M2 students. Although the survey was anonymous, some degree of social desirability bias may have also skewed survey responses. Students who are more interested in HL may have been more likely to participate, resulting in selection bias. Evaluating learners' confidence in their abilities may not accurately reflect their actual skills due to the potential for self-assessment bias. Future research should use Objective Structured Clinical Examinations (OSCEs) or video observations for a more objective measure of learners' competencies. However, despite the limited power of the survey, study findings still correlate with past literature, which supports a higher emphasis on HL education and the importance of active and longitudinal learning.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e While research has long highlighted health literacy's crucial role in healthcare outcomes, there remains a need for more explicit guidelines from accrediting bodies and medical educational institutions. The revised curriculum at USCSOMG, employing a combination of didactic and active strategies in a longitudinal format, equips students to feel confident in their ability to engage with patients experiencing LHL. This demonstrates the curriculum's strength and potential to serve as a model for other schools looking to bolster their curriculum on this meaningful topic, given its implications for patient care. However, explicit guidance is essential within current LCME standards for comprehensive integration of health literacy education, offering students greater focus on and practice in HL interventions. Implementing an annual competency exam to evaluate medical learners' health literacy skills and monitoring curriculum effectiveness is vital. The survey tool developed for this project could support medical schools in tailoring their curriculum to meet student needs and enhance health literacy outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ehealth literacy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLHL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003elimited health literacy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUSCSOMG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUniversity of South Carolina School of Medicine Greenville\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFMRGVL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFamily Medicine Residency Program Greenville\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAHRQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThe Agency for Healthcare Research and Quality\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUSMLE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUS Medical Licensing Examination\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLCME\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLiaison Committee on Medical Education\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe University of South Carolina Institutional Review Board approved this project #Pro00132250. Informed consent was gathered by both survey participants and interview participants. Survey participants were prompted to click \u0026ldquo;next\u0026rdquo; if they consented to participation and oral consent was given by interview participants.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was supported in part by an Honors College Thesis Grant from the University of South Carolina Honors College.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors played an equal role in project conceptualization, investigation, and methodology. FA conducted data curation, analysis, project administration, and visualization and wrote the first draft of the manuscript. NN, SST, and ABK oversaw the project and edited manuscript drafts. All authors read and approved the final manuscript and made significant contributions to the project.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFaith Albertson:\u0026nbsp;\u003c/strong\u003eFaith Albertson is a recent graduate from the University of South Carolina Honors College and an incoming Master of Public Health candidate at the University of North Carolina Gillings School of Global Public Health with a concentration in Health Policy. Her primary research interests are health literacy, health equity, and medical education reform.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Ann Blair Kennedy:\u003c/strong\u003e Dr.\u0026nbsp;Ann Blair Kennedy\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eis an associate professor in the Biomedical Sciences Department at the University of South Carolina School of Medicine Greenville and in the Family Medicine Department at Prisma Health and Director of the University of South Carolina Patient Engagement Studio, Greenville, SC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Shannon Taylor:\u003c/strong\u003e Dr. Shannon Stark Taylor is a licensed clinical health psychologist and serves as the Director of Behavioral Science for the Prisma Health Family Medicine Residency Greenville. She holds appointments as a Clinical Associate Professor at the University of South Carolina School of Medicine Greenville and the Clemson University School of Health Research. She has expertise in quantitative research methods and statistics and behavioral randomized controlled trials. Her background is in psychological processes and interventions for chronic pain. Currently, her primary research interests are provider well-being, physician-patient communication, and Diversity, Equity, and Inclusion, and medical education on these topics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Nabil Natafgi:\u0026nbsp;\u003c/strong\u003eDr. Nabil Natafgi is an Assistant Professor of Health Services Policy \u0026amp; Management at the Arnold School of Public Health, and Associate Director of the Patient Engagement Studio, University of South Carolina. Dr. Natafgi\u0026apos;s current work is focused on evaluating the effectiveness and impact of telehealth applications on care delivery and outcomes. He also has experience in qualitative data collection and analysis and community-based participatory research, working closely with academic, patient, community, and other stakeholder partners. He co-led two PCORI-funded projects to develop Virtual Patient (VIP) Engagement Studio that aims to use technology to engage patients and caregivers in the development, implementation, and dissemination of research projects. He also collaborates with clinical and academic partners at Prisma Health, Clemson University, and Furman University on projects aimed at improving the virtual care delivery process using telemedicine and the programmatic evaluation of various behavioral health initiatives across the care continuum. His research encompasses a variety of methodological approaches including both quantitative and qualitative analyses, with emphasis on mixed methods and a special interest in the engagement of patients, community members, healthcare providers, and other stakeholders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Trial Number:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Appliable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHersh L, Salzman B, Snyderman D. Health Literacy in Primary Care Practice. afp. 2015;92(2):118\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSantana S, Brach C, Harris L, Ochiai E, Blakey C, Bevington F, et al. Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. J Public Health Manag Pract. 2021;27(Suppl 6):S258\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low Health Literacy and Health Outcomes: An Updated Systematic Review. Ann Intern Med. 2011;155(2):97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoughlin SS, Vernon M, Hatzigeorgiou C, George V. Health Literacy, Social Determinants of Health, and Disease Prevention and Control. J Environ Health Sci. 2020;6(1):3061.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFleary SA, Ettienne R, United States. Social Disparities in Health Literacy in the. 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New York, NY: Springer Publishing; 2014. p. 302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstitute of Medicine (US) Committee on Health Literacy. Health Literacy: A Prescription to End Confusion [Internet]. Nielsen-Bohlman L, Panzer AM, Kindig DA, editors. Washington (DC): National Academies Press (US); 2004 [cited 2024 Mar 17]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.ncbi.nlm.nih.gov/books/NBK216032/\u003c/span\u003e\u003cspan address=\"http://www.ncbi.nlm.nih.gov/books/NBK216032/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAHRQ Health Literacy Universal. Precautions Toolkit [Internet]. [cited 2024 Mar 15]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ahrq.gov/health-literacy/improve/precautions/index.html\u003c/span\u003e\u003cspan address=\"https://www.ahrq.gov/health-literacy/improve/precautions/index.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited States Medical Licensing Examination. Content Description and General Information Booklet. USMLE website. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.usmle.org/usmle-content-outline/\u003c/span\u003e\u003cspan address=\"https://www.usmle.org/usmle-content-outline/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed March 17, 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStandards P. \u0026amp; Notification Forms | LCME [Internet]. [cited 2024 Mar 18]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://lcme.org/publications/\u003c/span\u003e\u003cspan address=\"https://lcme.org/publications/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHildenbrand GM, Perrault EK, Keller PE. Evaluating a Health Literacy Communication Training for Medical Students: Using Plain Language. J Health Communication. 2020;25(8):624\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColeman CA, Appy S. Health literacy teaching in US medical schools, 2010. Fam Med. 2012;44(7):504\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaunders C, Palesy D, Lewis J. Systematic Review and Conceptual Framework for Health Literacy Training in Health Professions Education. Health Professions Educ. 2019;5(1):13\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColeman CA, Peterson-Perry S, Bumsted T. Long-Term Effects of a Health Literacy Curriculum for Medical Students. Fam Med. 2016;48(1):49\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMackert M, Ball J, Lopez N. Health literacy awareness training for healthcare workers: Improving knowledge and intentions to use clear communication techniques. Patient Educ Couns. 2011;85(3):e225\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIntegrated Practice of Medicine. - School of Medicine Greenville | University of South Carolina [Internet]. [cited 2024 Mar 15]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://sc.edu/study/colleges_schools/medicine_greenville/medical_education/integrated_practice/index.php\u003c/span\u003e\u003cspan address=\"https://sc.edu/study/colleges_schools/medicine_greenville/medical_education/integrated_practice/index.php\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUniversity of Washington Department of Family Medicine. Patient-Centered Observation Form - Clinician Version. Washington University; June; 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGanguly AP, Oren H, Jack HE, Abe R. Equity M\u0026amp;M - Adaptation of the Morbidity and Mortality Conference to Analyze and Confront Structural Inequity in Internal Medicine. J Gen Intern Med. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUbbes VA, Njoku BA, Curriculum I, Assessment (CIA) Framework for Health Literacy Education (HLE) in Medical and Health Professions Schools, editors. WJSSR. 2022;9(1):p15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAli NK, Ferguson RP, Mitha S, Hanlon A. Do medical trainees feel confident communicating with low health literacy patients? J Community Hosp Intern Med Perspect. 2014;4(2).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColeman C, Hudson S, Pederson B, Prioritized Health Literacy and Clear Communication Practices For Health Care Professionals. HLRP: Health Literacy Research and Practice [Internet]. 2017 Jul [cited 2024 Mar 17];1(3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://journals.healio.com/doi/\u003c/span\u003e\u003cspan address=\"https://journals.healio.com/doi/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3928/24748307-20170503-01\u003c/span\u003e\u003cspan address=\"10.3928/24748307-20170503-01\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeiss BD. How to bridge the health literacy gap. Fam Pract Manag. 2014;21(1):14\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 to 4 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"health literacy, medical education, patient communication","lastPublishedDoi":"10.21203/rs.3.rs-4659697/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4659697/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealth literacy (HL) is crucial for making informed health decisions. Over one-third of US adults have limited HL, leading to adverse health outcomes. Despite its importance, HL education lacks standardization in medical training. This study evaluates the University of South Carolina School of Medicine Greenville\u0026rsquo;s (USC SOMG) HL curriculum to propose recommendations for HL instruction.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA convergent parallel mixed methods design was used to assess the HL curriculum through a curriculum review, student survey, and faculty interviews. The study utilized thematic analysis for qualitative data and statistical analysis for quantitative data, focusing on prior and current HL training, confidence in HL application, and perceptions of HL education.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe curriculum at USC SOMG incorporates active learning strategies, emphasizing HL, and patient communication. Most participants reported high confidence in their HL knowledge and skills. The preferred teaching methods were hands-on clinical interactions, observing clinical interactions, and interactive lessons. Barriers to using HL interventions included time constraints and lack of real-world experience. Faculty recommended time prioritization and collaborative strategies to overcome these barriers.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eUSC SOMG\u0026rsquo;s HL curriculum combines didactic and active strategies longitudinally, preparing students to feel confident in their ability to engage with patients experiencing LHL. This demonstrates the curriculum\u0026rsquo;s strength and potential as a model for other schools. However, for broader implementation, standardized requirements and competency-based assessments are recommended to ensure consistent HL education across medical programs, focusing on practical application and overcoming identified barriers. This could markedly enhance patient outcomes by equipping future providers with essential HL skills.\u003c/p\u003e","manuscriptTitle":"Evaluation of the Health Literacy Curriculum at a Southeastern Medical School","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-09 16:48:01","doi":"10.21203/rs.3.rs-4659697/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-15T08:51:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-13T12:11:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316618985031803177824740598399176232390","date":"2024-09-09T11:56:58+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-31T18:01:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"335728008297464708764190256499842917261","date":"2024-08-03T14:15:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"119401488239422650453999642154509707267","date":"2024-07-31T20:30:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-07-23T09:39:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-07-08T06:36:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-07-08T05:37:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-07-08T05:37:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-06-29T14:19:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d10fa147-c82d-4c35-bd37-975f9e63cfb0","owner":[],"postedDate":"August 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:04:07+00:00","versionOfRecord":{"articleIdentity":"rs-4659697","link":"https://doi.org/10.1186/s12909-024-06362-6","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2025-01-06 15:57:51","publishedOnDateReadable":"January 6th, 2025"},"versionCreatedAt":"2024-08-09 16:48:01","video":"","vorDoi":"10.1186/s12909-024-06362-6","vorDoiUrl":"https://doi.org/10.1186/s12909-024-06362-6","workflowStages":[]},"version":"v1","identity":"rs-4659697","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4659697","identity":"rs-4659697","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}