Department of Population Health, Azrieli Faculty of Medicine, Bar-Ilan University, 8 Henrietta Szold, 1311502, Safed, Israel.
MSR- The Israel Center for Medical Simulation, Ramat-Gan, Israel.
BMC Med Educ. 2021 Jul 28;21(1):407. doi: 10.1186/s12909-021-02842-1.
Low health literacy underpins health inequality and leads to poor adherence to medical care and higher risk of adverse events and rehospitalization. Communication in plain language, therefore, is an essential skill for health professionals to acquire. Most medical education communication skill programs focus on verbal communication, while written communication training is scarce. ETGAR is a student delivered service for vulnerable patients after hospital discharge in which, amongst other duties, students 'translate' the medical discharge letters into plain language and share them with patients at a home visit. This study ascertains how this plain language training impacted on students' written communication skills using a tool designed for purpose.
Students, in pairs, wrote three plain language discharge letters over the course of a year for patients whom they encountered in hospital. The students handed over and shared the letters with the patients during a post-discharge home visit. Structured feedback from course instructors was given for each letter. An assessment tool was developed to evaluate students' ability to tell the hospitalization narrative using plain and clear language. First and last letters were blindly evaluated for the entire cohort (74 letters; 87 students).
Students scored higher in all assessment categories in the third letters, with significant improvement in overall score 3.5 ± 0.8 vs 4.1 ± 0.6 Z = -3.43, p = 0.001. The assessment tool's reliability was high α = 0.797, it successfully differentiated between plain language categories, and its score was not affected by letter length or patient's medical condition.
Plain language discharge letters written for real patients in the context of experience-based learning improved in quality, providing students with skills to work effectively in an environment where poor health literacy is prevalent. ETGAR may serve as a model for learning written communication skills during clinical years, using the assessment tool for formative or summative evaluation.
健康素养低下是导致健康不平等的原因之一，会导致患者对医疗保健的依从性降低，增加不良事件和再住院的风险。因此，使用通俗易懂的语言进行沟通是卫生专业人员必须掌握的一项技能。大多数医学教育沟通技巧课程都侧重于口头沟通，而书面沟通培训则相对较少。ETGAR 是一项为出院后弱势群体患者提供的服务，学生的职责之一是将医疗出院信翻译成通俗易懂的语言，并在家庭访问时与患者分享。本研究使用专门设计的工具，确定这种通俗易懂的培训对学生书面沟通技巧的影响。
学生两两一组，在一年内为他们在医院遇到的患者撰写三份通俗易懂的出院信。学生在出院后的家庭访问中，将信件交给并与患者分享。课程导师会对每封信进行结构化反馈。我们开发了一个评估工具，用于评估学生使用通俗易懂的语言讲述住院经历的能力。我们对整个队列（74 封信；87 名学生）的前一封信和后一封信进行了盲法评估。
在所有评估类别中，学生在第三封信中的得分都更高，总体得分从 3.5±0.8 提高到 4.1±0.6 Z=-3.43，p=0.001。评估工具的信度较高（α=0.797），能够成功区分通俗易懂的语言类别，且其得分不受信件长度或患者病情的影响。
在基于经验的学习背景下，为真实患者撰写通俗易懂的出院信的质量有所提高，使学生获得了在健康素养普遍较低的环境中有效工作的技能。ETGAR 可以作为在临床实习期间学习书面沟通技巧的模型，使用评估工具进行形成性或总结性评估。
