Health Literacy in Medical Education:

Promoting Empowerment as a Patient-

Centred Approach
Canadian Conference on Medical Education

Sunday, May 8, 2011

• Philip Girvan, MA
Senior Associate, PGSO Project & Media
Solutions
3 Coady Avenue
Antigonish NS B2G 1T9
Tel: +1 (902) 863-6026
Email: pgso.solutions@gmail.com
 Disclosure Statement
• I have no actual or potential conflict of
interest in relation to this presentation.
 Background/Purpose:

• A patient-centered approach positions the

patient at the centre of health practices, policies,
curricula, and pedagogies.
• In order to practice in a patient-centred manner,
health professionals must take into account the
multiple social complexities of the patient, not
the least of which is health literacy.
• It is therefore important to consider how and
where issues of health literacy are being
addressed in undergraduate medical education.
 What is Health Literacy?
• Health literacy encompasses knowledge,
understanding, and access to and control of
resources that promote and maintain
satisfactory health and wellbeing. It is the
outcome of such diverse abilities as reading,
writing, numeracy, the ability to access
information, and critical thinking. (Girvan,
2010)
 What is Patient Centredness?
• The appropriate application of scientific
knowledge and technical skills with
acknowledgement of and respect for the
emotional, social and cultural needs and
preferences of individual patients and their
families
– Weismann, Branch et al. (2006)
 Five Dimensions of Patient-
Centredness
• Biopsychosocial perspective
• Patient as a person
• Sharing power and responsibility
• Therapeutic alliance
• Doctor as a person
– Mead & Bower (2000)
 My Question
• A search of the websites of the 17 Canadian
Faculties and/or Schools of Medicines
demonstrated that many medical education
programs are described as “patient-centred.”

• How does health literacy figure into a patient-

centred approach?
 Methodology:

• A systematic literature review, critical analysis

and synthesis of the following bodies of
literature:
– patient-centered care
– health literacy
– medical education.
• The review focused on articles published in
English in peer-reviewed health professional
education journals between 01 January 2000 and
31 December 2010.
 Methodology:

• I conducted searches of the PubMed

databases

• The original search identified 37 papers,

commentaries and reviews of the literature.
 Results:

• A surprisingly small proportion of the

literature in the area of patient-centred care
focuses on health literacy as a determinant of
health and well being. An even smaller
proportion of the literature considered health
literacy as an issue of concern to be addressed
in the education of future physicians.
 Breakdown:
• Searching PubMed using the MeSH terms
“health-literacy”, “medical education” and
“care, patient-centred” yielded 0 papers.

• Searching PubMed using the MeSH terms

“health-literacy”, “medical education” yielded
2 relevant papers (15 relevant).
 Breakdown (cont’d):

• Searching PubMed using the MeSH terms “health

literacy” and “patient-centred care” yielded 22
papers. None of the papers discussed UME issues;
the focus was on clinical practice, e.g. drug
adherence, cost savings

• Searching PubMed using the MeSH terms “medical

education” and “patient-centred care” yielded 249
papers.
 Issue with the search
• Health literacy has not been indexed as a
MeSH subject until 2010.
 Revised Search
• Conducting a general PubMed search of
health literacy, medical education and patient
centred care identified 110 papers.
 Initial Findings
Initial analysis:

• “health literacy” tends to appear in papers

discussing clinical, rather than educational,
contexts.

• indicates zero studies undertaken within a

Canadian context
 Conclusions/Discussion

• The shortage of related literature indicates

that there is much work to be done in
considering how issues of health literacy
might be addressed in patient-centred
medical education.
• An emphasis on health literacy in medical
education will have implications on power
relations in educational settings as well as in,
and beyond, the clinical encounter.
 References
• Girvan P. (2010). Health Literacy as Capital: Investigating the
EAL Teaching Perspective. Unpublished MA dissertation.

• Mead N & Bower P. (2000). Patient-centredness: a

conceptual framework and review of the empirical literature.
Social Science and Medicine 51: 1087-1110.

• Weissman P, Branch W, et al. (2006). Role modeling

humanistic behavior: leaning bedside manner from the
experts. Academic Medicine 81: 661-667.
 Thank You
• Questions?