Background/Purpose: 36% of adults in the US have a basic to below basic level of health literacy. Studies show that limited health literacy (LHL) has deleterious effects on patient outcomes and act as a contributing case to health disparities across all of medicine, including rheumatology. Despite the prevalence of LHL, there is a lack of education on this topic for medical trainees. Therefore, we designed a module focused on LHL in patients with rheumatic diseases with an overall goal to help pediatric and adult rheumatology fellows build a foundational knowledge and toolkit addressing LHL in the clinical setting.

Methods: This module was piloted with fellows from the adult and pediatric rheumatology programs from Montefiore and NYU Medical Centers, NY, NY. Participants provided signed consent and pre-course and post-course evaluations were completed anonymously. The evaluations identified changes in the learners’ knowledge base, clinical comfort level, and likelihood to integrate these interventions into their practice. The post-course evaluation also elicited feedback of the course. The teaching module consisted of: (1) video of a poor patient-provider interaction to allow for introspection, (2) formal didactic presentation, (3) role play scenario for fellows to practice skills using LHL checklist, (4) exercises to evaluate patient education materials.

Results: The session was held in May 2021 with 7 adult and pediatric rheumatology fellows. 4 fellows were 2^nd years and the average age of the participant was 33.7y. Racial and ethic make up of the fellows was broad and 3 of 7 fellows were international medical school graduates. While 6 of 7 fellows had been taught the Teach-back Method (a common technique to assess understanding), 4 of 7 had not received formal education on health literacy. In addition, 5 of 7 fellows had never evaluated distributed patient materials to ensure appropriate reading level. All fellows felt that a patient’s LHL impacted treatment plans. Nevertheless, only 2 fellows “agreed” that LHL was regularly discussed with faculty in clinical settings; where 4 of 7 fellows were “neutral” or “disagreed” that faculty were equipped to discuss the issue. After the module, all 7 fellows “agreed” or “strongly agreed” that LHL and the strategies to mitigate it were presented effectively. 6 of 7 “agreed” or “strongly agreed” that LHL should be incorporated into rheumatology education and 5 of 7 “agreed” or “strongly agreed” that faculty would benefit from this module. All 7 of the fellows “plan to modify their practice” based on this content of this module. Several quotations from feedback include: “[I] never realized what a high reading level some of the information we give to patients can really be”. “This is a really useful pertinent module”.

Conclusion: Participants reported increased skills in addressing LHL in their practice. Data from this study will help guide improvements to the module with plans to incorporate learner feedback into subsequent teaching sessions. The long-term goal of this work is to design a module that can be used by fellowships broadly to improve health literacy assessments leading to interventions as a means to improve overall health outcomes particularly in LHL who are at risk for disparate care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pilot-health-literacy-curriculum-addressing-skills-and-content-knowledge-for-adult-and-pediatric-rheumatology-fellows/