We found in this study that, after receiving teaching intervention, medical students in the intervention group showed better knowledge, attitude, and skills than the control group in professional competence in health literacy. This study is the first research project in Taiwan to target medical students in an intervention study into professional competence in health literacy that applies scale-based evaluation instrument, conducts teaching intervention, and achieves significant results. It is a pioneering advocate for future reference in innovating medical education curriculum.
There are several possible attributes to such effect. First of all, the proposed curriculum adopted multi-dimensional indicators such as conception and evaluation, empathy and acceptance, communication and interaction, as well as medical information and decision-making. Secondly, we applied variegated student-centric teaching methods and created interesting material for innovative teaching, including inquiry-based learning, observational learning, group discussion, game-based learning, and role play. Strategies like inquiry-based learning and role play inspire students to think critically about a physician’s professional competence in health literacy. Original simulation videos and intriguing board games inspire interest and motivation. Third, we employed game-based learning in our doctor-patient interaction curriculum to highlight how different communication patterns lead to different doctor-patient interaction. Students acquire appropriate communication skills that help improve doctor-patient relationship and healthcare quality. Meanwhile, the teach-back approach checks if patients have fully comprehended a medical diagnosis or report. The teaching explains when and how to apply teach-back, teaching back information and demonstrating technical procedures, and how to clarify information. Fourth, according to Nutbeam’s model, there are three levels of health literacy – functional, interactive, and critical health literacy. On the healthcare professional’s part, physicians should consider a patient’s reading and writing abilities and whether they can exercise functional health literacy in regular doctor-patient interactions. In the course, the program teaches students about available measurements for assessing a patient’s health literacy and common signs of insufficient health literacy.
Interactive health literacy helps physicians and patients extract information from different communication channels, understand its significance, apply the information, and improve doctor-patient communication patterns. Our educational videos are physician centric. They present outcomes in two-sided arguments to teach students about the consequences of having (positive) and neglecting (negative) professional competence in health literacy. It reinforces students’ concerns and impressions towards the issue. We also introduced the concept of shared decision-making for best healthcare outcomes. As for the highest level – critical health literacy – physicians provide patient-tailored teach-back approaches, provide readable materials and social support resources, and help patients execute self-management and disease management.
Colemean et al. surveyed U.S. medical schools for how they were implementing health literacy courses. Of the 61 schools that responded, 72% listed health literacy as a required course, with an average of three class hours, similar to our study’s teaching time. Most were taught during freshman or sophomore year and employed multiple teaching methods such as lecture, medical simulation, workshop, role play, literature review, video, and learning through practice with patients of low health literacy. They evaluated students using objective structured clinical examination (OSCE), clinical observation, and written tests. In this study, our evaluation was carried through survey on physicians’ professional competence in health literacy, which not only offers quantified representation of teaching effect but also echoes the U.S. Institute of Medicine’s (IOM) 2004 report, “Health Literacy: A Prescription to End Confusion,” which urged all healthcare professional training programs to include courses in effective communication with low health literacy patients. Ever since the COVID-19 pandemic outbreak in early 2020, healthcare professionals and the common people have been receiving disease information that, whether correct or not, cast swift and fundamental influence. In a time like this, health literacy has become more important than ever.[35, 36] Misinformation threats have impacted all aspects of our social ecological model. In terms of medical field organizational hierarchy, this study emphasizes the importance of teaching and intervention effects of health literacy courses in healthcare professional education.[37–42] In clinical and community fields, there have been studies on professional competence in health literacy with variegated practicing healthcare professionals or medical students as subjects; after implementing comprehensive teaching intervention on functional, interactive, and critical health literacy, the study found significant progress in knowledge, attitude, and skills.[24, 33, 43] Our study applied a similar curriculum design concept; we can see that comprehensive teaching module is a reliable and cogent teaching method in both clinical and school settings.
As for research limitations, first of all, since our control group recruited free-willed participants, it is possible that they were students interested in the subject matter, which could have given them better pre-test scores in attitude and skills in comparison to the intervention group. Second, post-test surveys were filled out immediately after teaching intervention, so long-term effects have yet to be observed. Third, since our evaluation survey was self-ministered, it is possible for self-reported errors to impact performance analysis.
Based on our findings, regarding curriculum reform of liberal arts courses for medical students, we noted that although our current medical education offers extensive liberal art courses, they fall short in issues concerning physicians’ professional competence in health literacy. We recommend transforming our proposed innovative instructional module into themed micro-teaching activities or dividing them into different sessions to streamline class time. We plan to conduct teaching in relevant courses at Taiwanese medical schools. For the clinical field, we suggest hosting educational training in health literacy to raise physician awareness towards low health literacy phenomenon in Taiwan. Government departments and academic institutes can also join in developing teaching material that physicians across specialties may take advantage of during healthcare services or health education scenarios to improve and raise awareness towards patient’s health literacy. They will provide suitable medical information to enhance doctor-patient professional and elevate quality of care.