Patient Education and Counseling 95 (2014) 238–242

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Medical Education

Patient understanding of medical jargon: A survey study of U.S. medical students Thomas W. LeBlanc a,*, Ashley Hesson b, Andrew Williams b, Chris Feudtner c, Margaret Holmes-Rovner d, Lillie D. Williamson e, Peter A. Ubel e a

Department of Medicine, Duke University School of Medicine, Durham, NC, USA Michigan State University College of Human Medicine, East Lansing, MI, USA The Pediatric Advanced Care Team, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA d Center for Ethics and Department of Medicine, Michigan State University College of Human Medicine, East Lansing, MI, USA e Fuqua School of Business, Duke University, Durham, NC, USA b c

A R T I C L E I N F O

A B S T R A C T

Article history: Received 12 September 2013 Received in revised form 6 January 2014 Accepted 18 January 2014

Objective: With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors assessed student perceptions of patient understanding across different years in medical school. Methods: 533 students at 4 U.S. medical schools rated the proportion of patients likely to understand each of twenty-one different jargon terms. Students were either in the first month of their first year, the middle of their first year, or the middle of their fourth year of medical school. Results: Fourth-year students were slightly more pessimistic about patients’ understanding compared to new first-year students (mean percent understanding of 55.1% vs. 58.6%, p = 0.004). Students both overand under-estimated patient understanding of specific words compared to published estimates. In a multivariate model, other factors did not explain these differences. Conclusion: Students do not generally presume that patients understand medical jargon. In many cases they actually underestimate patients’ understanding, and these estimates may become more pessimistic longitudinally. Jargon use in communication with patients does not appear to stem from unrealistic presumptions about patients’ understanding or from desensitization to jargon during medical school. Practice implications: Training about patient knowledge of medical jargon may be a useful addition to communication skills curricula. ß 2014 Elsevier Ireland Ltd. All rights reserved.

Keywords: Communication Jargon Comprehension Medical education

1. Introduction Most clinical encounters involve some attempt to convey dense information across various barriers, including asymmetries of knowledge between clinicians and their patients, as well as other complicating factors involving language and culture. In communicating with patients and family members, word choice can have a significant impact on comprehension [1]. Words also matter in terms of outcomes; a growing body of evidence links patients’ understanding of their medical problems with adherence to prescribed therapies, and effective physician-patient communication with overall health outcomes [2–7].

* Corresponding author at: Box 3961, DUMC, Durham, NC 27710, USA. Tel.: +1 919 668 1002; fax: +1 9196681091. E-mail address: [email protected] (T.W. LeBlanc). 0738-3991/$ – see front matter ß 2014 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.pec.2014.01.014

Unfortunately, words are often misunderstood. Evidence suggests that a sizeable proportion of laypersons lack adequate understanding of several common terms used in cancer consultations, such as ‘‘metastasis’’ [8] or ‘‘remission’’ [9]. In one study, a group of psychology students had difficulty understanding terms like ‘‘malignant’’ and ‘‘tumor,’’ when asked to read clinical vignettes featuring such terminology [10]. The use of more ambiguous terms like ‘‘growth’’ was similarly confusing to this very educated group of laypersons. Not surprisingly, misunderstanding of jargon terms extends beyond the field of oncology. In another setting, 80% of orthopedic patients misunderstood the term ‘‘fracture,’’ thinking it referred to something other than a broken bone [11]. The use of jargon can have deleterious effects on patients. Here, jargon is defined as any word or phrase that is opaque to individuals lacking medical training and/or exposure. Though the majority of the research on jargon, including the current study, focuses on unabbreviated medical terms, this definition also

T.W. LeBlanc et al. / Patient Education and Counseling 95 (2014) 238–242

includes abbreviations, acronyms, and other such derivatives of clinical terminology. One such study linked significant patient distress with use of the word ‘‘spot’’ in describing a new pulmonary nodule on patients’ computed tomography scans; anxiety persisted for several months in a number of patients [12]. In this case, the use of a simple-sounding jargon term like ‘‘spot,’’ which is meant to ease patients’ fears and promote understanding, actually has the opposite effect. Jargon used in the context of endovascular aortic aneurysm repair has similar consequences, with the commonplace term ‘‘endoleak’’ inducing significant anxiety in patients, even when this finding is of no clinical significance [13]. The existing literature on jargon use in health-related communication focuses on what patients and laypersons understand. While published evidence suggests that jargon is overused in communication with patients, the reasons for this are less clear, as is the timeline for its development. Jargon use may be related to clinicians’ perceptions of patient understanding. In other words, if clinicians overestimate patients’ understanding of medical jargon, they may be more likely to utilize jargon terms when communicating with patients. Medical and pediatrics residents are known to overuse jargon in discussing sensitive issues with patients and families [14,15]. We thus hypothesized that insensitivity to patients’ knowledge about jargon develops prior to residency, during medical school training. To our knowledge, no studies have examined medical students’ perceptions of patient knowledge about medical terminology, or how these perceptions change longitudinally. We thus sought to explore this question by measuring U.S. medical students’ perceptions of patient understanding of medical terminology across different years of training.

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knowledge, thereby enabling comparisons to student responses. A mixture of ‘‘easy’’ and ‘‘difficult’’ words was chosen for psychometric reasons, to encourage respondents to utilize the entire rating scale. The use of ‘‘paired words,’’ such as ‘‘blood-thinner’’ and ‘‘anticoagulant,’’ mirrored that of another study [16]. Students were asked to rate the percentage of patients in a typical clinic that would understand each particular word, using a 100-point rating scale with 10-point percentage increments. Instrument validity was tested via cognitive interviewing with a small sample of students not participating in the study. We collected demographic information from each respondent, along with information about undergraduate major, expected residency plans, English as a non-native language, prior illness experience, and having a physician parent. 2.2. Participants and design

2. Methods

In March of 2012 we invited 1135 first-year and fourth-year students at four U.S. medical schools to complete an online survey (Table 1). Participating sites included the Duke University School of Medicine, the Michigan State University College of Human Medicine, the Icahn School of Medicine at Mount Sinai, and the Perelman School of Medicine at the University of Pennsylvania. Institutional Review Board applications were submitted at each participating site; exempt status was granted at each institution. We invited another 636 new first year students to complete the same survey during their first 4 weeks of class, in August of 2012; this allowed us to explore any potential effects of early exposure to jargon and patient care during the initial months of medical school. The overall response rate across the study was 30.1% (533 of 1771). Participants received a $5 gift card upon survey completion, and were entered into a drawing for an iPad.

2.1. Survey instrument

2.3. Statistical analysis

We reviewed the published literature on patient knowledge of medical terms and used this to inform the development of a list of key words to test. Four general word categories were used: (1) ‘‘easy,’’ (2) ‘‘difficult,’’ (3) ‘‘cancer-related,’’ and (4) ‘‘paired’’ words; several of these words map to a published estimate of patients’

Analysis was performed using the statistical package ‘‘R,’’ version 2.15.1. Comparison of mean and median student ratings of patient understanding did not demonstrate any significant skewness; a normal distribution of responses was thus assumed and parametric tests were utilized. The statistical significance

Table 1 Participant descriptors. Total N = 531

Early first year (N = 195)

Age Gender – female Gender – male

23 (22–24) 116 (59.5%) 79 (40.5%)

School Duke Univ. Michigan State Mount Sinai University of Penn

45 68 29 53

(23%) (34.9%) (14.9%) (27.2%)

Mid first year (N = 163)

27 (26–28) 95 (54.9%) 78 (45.1%)

35 38 39 51

18 37 53 64

(21.5%) (23.3%) (23.9%) (31.3%)

Undergraduate major Hard science Soft sci/humanities No response

131 (67.2%) 50 (25.6%) 14 (7.2%)

105 (64.4%) 55 (33.7%) 3 (1.9%)

Expected residency plans* Non-procedural Procedural Undecided/blank

122 (62.6%) 68 (34.9%) 5 (2.5%)

104 (63.8%) 51 (31.3%) 8 (4.9%)

English as first language Family illness Personal illness Physician parent(s)

173 111 82 43

144 88 60 32

(88.7%) (56.9%) (42.3%) (22.1%)

Fourth year (N = 173)

23 (22–25) 89 (54.6%) 74 (45.4%)

(88.9%) (54%) (36.8%) (19.6%)

(10.5%) (21.5%) (30.8%) (37.2%)

106 (61.3) 64 (37%) 3 (1.7%)

97 (56.1%) 72 (41.6%) 4 (2.3%) 152 93 63 35

(87.9%) (53.8%) (36.4%) (20.4%)

Values reported as median (IQR) for continuous variables/point estimates, or number (%) for categorical variables/proportions * Anticipated residency plans were coded by type, with more primary care and/or non-procedural specialties in one category and more procedural/specialty services in another. Family medicine, pediatrics, OB/gyn, internal medicine and subspecialties, psychiatry, dermatology, and neurology were included in the former; surgery, emergency medicine, ENT, orthopedics, radiation oncology, and ophthalmology, were counted in the latter group.

T.W. LeBlanc et al. / Patient Education and Counseling 95 (2014) 238–242

240 Table 2 Mean student estimates by group and by word. Word

Early first year

Mid first year

Fourth year

Total mean estimate across all words Statistical differences across all 3 groups Anti-coagulant Benign Electrolytes Myopia Sodium Sterile

58.6%

55.2%

55.1%

0.004

**

32 54.4 44.4 22.8 64.3 65.4

28.2 47.4 40.25 19.3 59.4 58.8

24.51 50.3 32.8 14.6 53.5 49.1

Patient understanding of medical jargon: a survey study of U.S. medical students.

With increasing exposure, medical students may forget that technical jargon is unfamiliar to laypeople. To investigate this possibility, authors asses...
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