Assessing Educational and Attitudinal Outcomes of a Student Learner Experience Focused on Homelessness.

BACKGROUND AND OBJECTIVES: Patient navigation programs help guide vulnerable populations, such as those experiencing homelessness, through the health care system. Medical students developed the student-run Patient Navigator Program (PNP) to serve persons experiencing homelessness (PEH) in the Dallas area. The objective of this study was to build on previously published data to determine how medical student attitudes, knowledge, and confidence working with PEH changed during involvement in the PNP, particularly after participating as a patient navigator. METHODS: Student fellows completed a survey prior to a training elective (time point 1), immediately after the training elective (time point 2), and after acting as a patient navigator (time point 3). The PNP survey, which intended to measure student attitudes and knowledge regarding PEH, included the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI) and the Student-Run Free Clinic Project (SRFCP) surveys. In our analysis, we compared responses among the different time points. RESULTS: Seventy-six of 88 students who completed the training elective chose to participate in the PNP fellowship. Skills, knowledge, and self-efficacy improved from time points 1 to 2, 1 to 3, and 2 to 3. Social advocacy also improved from time points 1 to 2 and 1 to 3. CONCLUSIONS: Improvements from time point 1 to 2 demonstrated the value of didactic learning, while further improvements from time point 2 to 3 demonstrated the added benefit of hands-on experiential learning. Our study illustrates the potential educational benefits that a PNP provides to medical students who may encounter or care for this population during their careers.

Training Students as Navigators for Patients Experiencing Homelessness.

Background and Objectives: Despite the significant effects of homelessness on health, medical and health professions students rarely receive formal education in caring for individuals experiencing homelessness. We describe the implementation and evaluation of a novel student-run Patient Navigator Program (PNP) and its prerequisite elective that trains students in patient navigation principles specific to homelessness in the local community. METHODS: We analyzed pre- and postsurvey matched responses from students immediately before and after course completion. The survey utilizes the externally-validated instruments Health Professional Attitudes Toward the Homeless Inventory (HPATHI) and the Student-Run Free Clinic Project (SRFCP) survey. We examined differences using paired t tests and Wilcoxon signed-rank tests. Students also completed separate end-of-curriculum evaluation forms assessing satisfaction with the course. RESULTS: After completing the elective, students (n=45) demonstrated improvement in self-assessed attitude towards individuals experiencing homelessness (P=.03), specifically an increase in reported social advocacy (P<.001); and an increase in self-perceived knowledge about (P<.001), efficacy in working with (P=.01), and skills in caring for (P<.001) underserved groups. The elective also received high student satisfaction ratings. CONCLUSIONS: Formal education in patient navigation and caring for individuals experiencing homelessness improves self-assessed preparedness of future health care providers in serving homeless and underserved populations.

Predictors of mood or anxiety problems among transgender individuals seeking hormone therapy.

BACKGROUND: Mental health needs of transgender individuals can be complex with individual, social, and medical factors impacting symptoms. This study examines predictors of mood or anxiety problems among transgender individuals seeking hormone therapy (HT). METHODS: A retrospective chart review was conducted at 2 clinics providing gender-affirming HT. Cross-sectional data from initial patient encounters (N = 311) were used in this study. Bivariate correlations and multiple logistic regression analyses were carried out. RESULTS: Transgender women (TW) were 2.2 times more likely to have mood or anxiety problems while transgender men (TM) were 2.6 times more likely as the number of medical comorbidities increased. For both TW and TM, White race significantly increased the likelihood of mood or anxiety problems. Neither previous nor current HT were associated with mood or anxiety problems for TW and TM. However, receiving multiple gender-affirming procedures decreased the likelihood of mood or anxiety problems for TM. CONCLUSIONS: Gender-affirming care and addressing comorbidities can be important aspects of mental health needs for transgender individuals.

The majority of transgender men and women reported 1 or more chronic health conditions. These health conditions were associated with transgender individuals being more likely to have a mood or anxiety problem. Currently receiving or previously receiving hormonal therapy was not associated with mood or anxiety problems for transgender men or women, but having received 1 or multiple gender-affirming procedures was associated with a decrease in likelihood of having a mood or anxiety problem for transgender men. White race also was associated with increased likelihood of having a mood or anxiety problem for transgender men and women. These results highlight the need for primary care physicians to take a comprehensive approach when dealing with the mental health needs of transgender patients by ensuring that general health care needs are met while receiving gender-affirming care.

Implementing Fitness and Nutrition Education in Urban, Underserved, Community-Based Montessori Schools: Challenges and Lessons Learned.

BACKGROUND: Few studies have discussed school-based health programs in Montessori education. Lumin has a network of Montessori elementary schools serving mainly lower income families in Dallas, Texas. Since 2015, our medical school has partnered with Lumin to design and implement fitness and nutrition curricula adherent to Montessori principles. OBJECTIVES: To describe a novel Montessori school-based health program and determine avenues for improvement based on lessons learned. METHODS: Led by medical students with guidance from faculty mentors, the program was developed collaboratively with Lumin leaders based on a critical need in their community and shaped with results from a cross-sectional health needs assessment among Lumin families. Data were collected to measure the impact of the program and a program evaluation was conducted after 5 years of operation to explore curriculum refinement.Results and Lessons Learned: The greatest challenges were recruitment of student volunteers, scheduling and coordination, and garnering community interest for secondary activities (e.g., health fairs). CONCLUSIONS: Despite challenges, this partnership has resulted in a successful program that relies on faculty and student volunteers, incorporates community-based participatory research and service learning concepts, and follows Montessori principles.

Assessing the Factors That Influence Medical Students' Attitudes Toward Working With Medically Underserved Populations.

Introduction: The needs of medically-underserved populations (MUPs) are consistently outpacing the number of physicians caring for them. Medical students' motivations toward working with MUPs consistently decline as they progress through medical school. Given the shortage of doctors caring for MUPs, the objective of our study was to further investigate factors that influence medical students' motivation to work with MUPs while they progress through their education. By identifying these elements, we hope to recommend identified factors within medical education that support the development of more physicians who care for MUPs. Methods: This cross-sectional study is an assessment of medical students at the University of Texas at Southwestern Medical School (UTSW). The study utilized the Medical Student Attitudes Toward the Underserved (MSATU), a validated survey that assesses medical student motivations toward the provision of medical care to MUPs. Surveys were administered at three time points selected to represent key transition points in medical education. Results: There was no significant difference between MSATU scores among the three time points. MSATU scores were higher among students who identified as female, had higher empathy, had higher value placed on teamwork, and had higher community-centeredness. MSATU scores were also higher among students planning to specialize in primary care compared to students planning to specialize in a non-primary care field (P=.239). Conclusion: This study identifies factors associated with high MSATU scores within UTSW medical education, including female identification, higher empathy score, higher emphasis on teamwork, higher community-centeredness, and plans to practice primary care. Additionally, the results support maintenance of MSATU scores across all three time points. Future research should examine individual-level data to determine whether individual students are maintaining their MSATU scores or if individual fluctuations are neutralized by group changes.

Preferences for contraceptive counseling and access among abortion patients at an independent clinic in Texas.

OBJECTIVE: Abortion clinics frequently offer contraceptive counseling, but it is unclear if this is in line with patient preferences or satisfies an unmet need. Our objective was to examine preferences for contraceptive counseling and access among abortion patients in a legally restrictive setting. METHODS: In this cross-sectional study, 181 patients at an abortion clinic in Dallas, Texas completed anonymous, self-administered surveys from June-July 2018. We analyzed data descriptively. RESULTS: 46.5% of patients offered the survey agreed to participate. 33.1% of respondents preferred to obtain birth control from somewhere near their home. 29.3% preferred to obtain birth control from the same physician they visit for other health care needs. 81.8% were uninterested in contraceptive counseling at their abortion visit. Of these, 52.0% did not want to follow up for contraceptive counseling or services. CONCLUSION: Among study participants, most lacked interest in contraceptive counseling at the time of their abortion visit. Those interested in follow up preferred a resource handout over other options, such as a follow-up visit or phone call. PRACTICE IMPLICATIONS: A patient-centered approach elicits patient preferences for contraceptive care and honors them by facilitating access when requested, such as through comprehensive resources and referrals.

Evaluating student food selections after a nutrition education intervention in a montessori community school.

Context: Schools are unique sites for nutrition education interventions due to their ability to provide educational activities as well as meals, allowing for observation of behavior change. Nutrition education and physical activity awareness programs implemented in the school setting have the potential to positively impact students' eating habits. Eating habits are developed at a young age, but few efforts have been made to deliver and assess education interventions in the pre-K through grade 3 age group. Objective: The purpose of this study was to evaluate student food selections before and after a nutrition education intervention was implemented in a Montessori school. Human Subjects Review: Approved as non-regulated research by the UTSW IRB. Study Design: Retrospective exploratory analysis. Setting: A single Montessori community school with students in grades pre-K through grade 3. Instrument: Aggregate lunch food selection data, including total food items offered and total food items left over, via daily production records. Main Outcome Measures: Records were collected from three school years to compare the food acceptability - the percent of food item taken from the total offered - of fruit (F), vegetable (V), F&V, 0% milk, 1% milk, and all milks before and after the implementation of the intervention program. Food acceptability served as a proxy for food consumption. Results: In all years, fruit (82.88%) and all milks (81.74%) were well accepted by students, but vegetables (62.00%) were not. The study found that from year 1 to year 2, there were statistically significant (p <0.0001) decreases in intake in all categories. This trend continued when comparing year 1 to year 3. Conclusions: Prior studies show that even in successful interventions, when vegetable or F&V intake does increase, changes are minimal. These findings corroborate the difficulties prior studies have demonstrated in changing students' food selections for the better, particularly regarding vegetable consumption. This analysis of production records showed a decline in acceptability of foods over the three years. It is unclear if these changes are directly related to the instructional program, due to the presence of confounding factors. Future studies should attempt to reevaluate nutrition education and subsequently conduct a plate-waste study for a more accurate representation of food consumption before and after an intervention.

Experiential QI Activity for Residents to Improve Women's Preventive Services.

INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) requires family medicine residents to complete a quality improvement (QI) project. There is a need for more QI training activities to be shared to meet this requirement. Our objective was to describe an activity for residents to improve women's preventive health services in an underserved clinic. Specific aims were to determine: (1) how women's receipt of preventive services compared to benchmarks, (2) physician and staff knowledge of the process and barriers to receiving services, and (3) whether an intervention to increase awareness among physicians and staff improved preventive services. METHODS: Residents (N=30) evaluated charts (N=505) to determine receipt of mammograms, pap tests, colon cancer screenings, and pneumonia vaccines. We compared estimates to existing clinic benchmarks. We presented initial (preintervention) results to physicians and staff at clinic team meetings. We collected perceptions of processes and barriers to preventive services. Preintervention methods were replicated (N=100) and results were compared (postintervention). RESULTS: Preintervention, mammograms (72%) and Pap tests (65%) were lower than clinic benchmarks. Most (81%) women ages 65 and older received a pneumonia vaccine; however, this was lower than the national Healthy People 2020 goal. Fear, knowledge, and scheduling were identified as top barriers. Post-intervention, there was a statistically significant increase in Pap tests (P=.0013). CONCLUSION: This activity trained residents how to impact their practice through QI methods and can be used in other programs as a foundation for developing basic QI initiatives. Future efforts should focus on evaluating barriers to preventive services from the patient perspective.

Training Family Medicine Residents to Prevent and Respond to In-flight Emergencies.

In-flight emergencies (IFE) reportedly occur globally in about 1 in 604 flights1. During training, family medicine (FM) residents acquire the skills necessary to counsel patients who are at risk, provide comprehensive management, and respond in emergent situations. The purpose of this study was to assess FM resident's knowledge about IFE, counseling, and attitudes towards responding to IFEs. A 15-question survey was sent to FM residents in the Dallas-Fort Worth area. IFE training options were also reviewed. Survey results revealed gaps in knowledge, yet a willingness to assist if necessary. A didactic IFE training format was found to be more achievable.

A Needs Assessment Among Transgender Patients at an LGBTQ Service Organization in Texas.

Purpose: Transgender adults have difficulty accessing health care due to multiple barriers. This study examined the health care-related needs of transgender patients in Dallas, Texas. Methods: This study examined cross-sectional data from a survey completed by 62 patients who identified as transgender. Results: Many participants reported depression (50%) and anxiety (51%). Over half did not receive preventive screenings (60%) or health care (61%) elsewhere. One-third of patients felt their primary care physician outside the clinic was not transgender-friendly. Conclusion: These findings provide evidence that transgender patients demonstrate increased reported mental health disorders and decreased access to medical care.

Dynamic Impact of Hormone Therapy on Laboratory Values in Transgender Patients over Time.

BACKGROUND: Known physiological changes occur while transgender patients are taking hormone therapy (HT). However, knowledge is limited about when laboratory values stabilize and if there are any long-term impacts, making it challenging for physicians to provide adequate gender-affirming care. We aim to analyze laboratory values with HT use over 5 years and after discontinuation of HT to define when values achieve stability. METHODS: We performed a multicenter retrospective analysis of 126 transgender women (TW) and 91 transgender men (TM) at consecutive clinic visits. Labs included complete metabolic panel, complete blood count, lipids, and hormone levels and were monitored for 5 years. Absolute measurement and percentage change from baseline were calculated for each analyte value. We collected the laboratory studies described from patients off HT and the duration of discontinuation to determine the time to return to baseline levels. RESULTS: During HT, red blood cell (RBC; erythrocyte) indexes reach stable levels within 6 months (P < 0.001) and are unchanged long term. Some analytes such as HDL and platelets showed increases beyond the first year of HT in TW (P = 0.001 and P < 0.001, respectively). LDL and alanine aminotransferase increased beyond 1 year in TM (P < 0.005 and P < 0.001, respectively), whereas HDL decreased beyond 1 year (P < 0.001). Time for laboratory values to return to baseline occurred around 10 weeks. CONCLUSIONS: Most analytes reach stable levels within 6 months (RBC and creatinine), whereas others change in the long term (LDL, HDL, platelets). This information can be used to guide physicians as they monitor their transgender patients in all stages of their progress through HT.

Working with communities: Meeting the health needs of those living in vulnerable communities when Primary Health Care and Universal Health Care are not available.

RATIONALE, AIMS, AND OBJECTIVES: The health care delivery model in the United States does not work; it perpetuates unequal access to care, favours treatment over prevention, and contributes to persistent health disparities and lack of insurance. The vast majority of those who suffer from preventable diseases and health disparities, and who are at greatest risk of not having insurance, are low-income minorities (Native Americans, Hispanics, and African-Americans) who live in high risk and vulnerable communities. The historical lack of support in the United States for Universal Health Care (UHC) and Primary Health Care (PHC)-with their emphasis on health care for all, population health, and social determinants of health-requires community health scientists to develop innovative local solutions for addressing unmet community health needs. METHODS: We developed a model community health science approach for improving health in fragile communities, by combining community-oriented primary care (COPC), community-based participatory research (CBPR), asset-based community development, and service learning principles. During the past two decades, our team has collaborated with community residents, local leaders, and many different types of organizations, to address the health needs of vulnerable patients. The approach defines health as a social outcome, resulting from a combination of clinical science, collective responsibility, and informed social action. RESULTS: From 2000 to 2020, we established a federally funded research programme for testing interventions to improve health outcomes in vulnerable communities, by working in partnership with community organizations and other stakeholders. The partnership goals were reducing chronic disease risk and multimorbidity, by stimulating lifestyle changes, increasing healthy behaviours and health knowledge, improving care seeking and patient self-management, and addressing the social determinants of health and population health. Our programmes have also provided structured community health science training in high-risk communities for hundreds of doctors in training. CONCLUSION: Our community health science approach demonstrates that the factors contributing to health can only be addressed by working directly with and in affected communities to co-develop health care solutions across the broad range of causal factors. As the United States begins to consider expanding health care options consistent with PHC and UHC principles, our community health science experience provides useful lessons in how to engage communities to address the deficits of the current system. Perhaps the greatest assets US health care systems have for better addressing population health and the social determinants of health are the important health-related initiatives already underway in most local communities. Building partnerships based on local resources and ongoing social determinants of health initiatives is the key for medicine to meaningfully engage communities for improving health outcomes and reducing health disparities. This has been the greatest lesson we have learned the past two decades, has provided the foundation for our community health science approach, and accounts for whatever success we have achieved.

Designing health care: A community health science solution for reducing health disparities by integrating social determinants and the effects of place.

BACKGROUND: In the United States chronic illnesses have become a way of life for multiple generations - they are the number one cause of death and disability (accounting for more than 70% of deaths), 60% of American adults have at least one chronic disease, and 40% have multiple chronic conditions. Although multiple factors contribute to the growth in chronic disease prevalence, a major factor has been overreliance on health care systems for promoting health and preventing disease. Large health care systems are ill equipped for this role since they are designed to detect, treat, and manage disease, not to promote health or address the underlying causes of disease. METHODS: Improving health outcomes in the U.S. will require implementing broad-based prevention strategies combining biological, behavioral, and societal variables that move beyond clinical care. According to community medicine, clinical care alone cannot create, support, or maintain health. Rather, health can only ensue from combining clinical care with epidemiology and community organization, because health is a social outcome resulting from a combination of clinical science, collective responsibility, and informed social action. RESULTS: During the past 20 years, our team has developed an operational community medicine approach known as community health science. Our model provides a simple framework for integrating clinical care, population health, and community organization, using community-based participatory research (CBPR) practices for developing place-based initiatives. In the present paper, we present a brief overview of the model and describe its evolution, applications, and outcomes in two major urban environments. CONCLUSION: The paper demonstrates means for integrating the social determinants of health into collaborative place-based approaches, for aligning community assets and reducing health disparities. It concludes by discussing how asset-based community development can promote social connectivity and improve health, and how our approach reflects the emerging national consensus on the importance of place-based population system change.

Utilizing Home Visits to Assess Social Determinants of Health During Family Medicine Residency.

INTRODUCTION: Home visits can improve quality of care and health outcomes and provide a unique opportunity to learn more about patients' social context and assess patients' various social determinants of health (SDH). The objectives of this study were to assess patient self-reported SDH, resident reflections on patient social status, the utility of a SDH survey during home visits, and resident comfort levels addressing patient SDH. METHODS: This was a mixed-methods pilot study utilizing patient self-reported data and open-ended reflection questions. Participants included adult patients aged more than 18 years from an urban safety-net clinic and family medicine residents who provide their care. RESULTS: We received forty-two surveys from 42 home visits. Most patients were female (61.9%) and African-American (45.2%), aged from 25 to 88 years (mean=60.24). Top patient-reported SDH include transportation, paying bills, and food insecurity. Common themes of resident responses included positive utility of the survey for assessing patient SDH; variation in comfort level when inquiring about patient SDH with positive influence from prior experience, assistance from colleagues, or prior good relations with patients; and expressed intention to include SDH assessment in future practice. CONCLUSIONS: Residents recognized the value of assessing SDH during home visits and expressed intent to include it in future practice. Thorough assessment of patient SDH may help to craft a more robust and standardized system to prioritize patients who would most benefit from receiving home visits.

Knowledge, Attitudes, and Practices Regarding Skin Cancer and Sun Exposure among Homeless Men at a Shelter in Dallas, TX.

This cross-sectional study evaluated the knowledge, attitudes, and practices regarding skin cancer and sun exposure among homeless men (n = 75). A 21-item survey was given to men residing at Calvert Place Men's Shelter in Dallas, TX. Results indicated that 49% knew that a change in a mole's appearance and a sore that does not heal were signs of skin cancer. Black homeless men were less likely to know that people with dark skin could get skin cancer and that sunscreen should be applied 15-30 min before sun exposure compared to white and other subgroups (p < .05). People were more likely to agree that sun protection is important (median = 5.0), but less likely to agree that they were at risk for skin cancer (median = 3.0). White men had higher levels of agreement that melanoma was dangerous compared to other racial/ethnic groups (p = 0.0224). Over half (52%) of individuals reported being in the sun often, yet only 21% reported the use of sunscreen. Most (71%) homeless men had never checked themselves for skin cancer and only 13% reported ever being screened by a health professional for skin cancer. Increased skin cancer education and increased screening efforts should be implemented to better protect the homeless population at Calvert Place from skin cancer.

Awareness and Knowledge of Human Papilloma Virus and Cervical Cancer in Women with High Pap Uptake.

This cross-sectional study explored knowledge, awareness, and health practices surrounding cervical cancer prevention and screening. Patients (n = 129) were recruited from three community clinics of underserved populations in Dallas, Texas. Women between ages 18-65 were surveyed using a self-administered questionnaire to evaluate their knowledge, awareness, and attitudes related to pap tests, human papilloma virus (HPV), HPV vaccines, and cervical cancer. Most women reported having a pap test in the past 3-5 years (86.6%). Over half knew that there was an increased risk of cervical cancer with an HPV infection, abnormal pap test, or both (52%). However, less than half of women knew the purpose of a pap test (40%), the purpose of the HPV vaccine (48%), or the transmission mode of HPV (25%). Over half of participants first heard about a pap test from a doctor (60%), about one quarter from their mother (24%), and less than a quarter from others (16%). More than half of women were aware of HPV (55%), while less than half were aware of the HPV vaccine (48%). Overall, we found that while most women had a high uptake of pap tests, they had low knowledge of the purpose of a pap test, the HPV vaccine, and transmission mode of HPV. They also had low awareness of HPV and the HPV vaccine. Given that almost all cases of cervical cancer are due to HPV infection, future studies should aim to further explore the gap between knowledge and awareness of HPV and pap uptake.

Impact of Hormone Therapy on Laboratory Values in Transgender Patients.

BACKGROUND: For transgender individuals taking hormone therapy (HT), data on laboratory values are limited, and the effects on laboratory values cannot be easily predicted. We evaluated the impact on common laboratory analytes in transgender individuals before and after initiation of HT. METHODS: We conducted a retrospective chart review of transgender patients identified at transgender-specific clinics at an urban county hospital and community clinic. Laboratory data were collected on hormone concentrations, hematologic parameters, electrolytes, lipids, and liver and renal markers before and after initiation of HT. RESULTS: We identified 183 transgender women (TW) and 119 transgender men (TM) for whom laboratory data were available. In all, 87 TW and 62 TM had baseline laboratory data, and data were also available for 133 TW and 89 TM on HT for >6 months. The most significant changes were seen in red blood cell count, hemoglobin concentration, hematocrit, and creatinine levels after >6 months of HT, which increased in TM and decreased in TW after HT (P < 0.005; d index > 0.6). Alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase levels increased in TM; however, the effect size was small (d index < 0.5). Calcium, albumin, and alkaline phosphatase levels significantly decreased in TW (P < 0.001; d > 0.6). Additionally, TM were found to have increased triglycerides and decreased HDL levels (P < 0.005; d > 0.6). CONCLUSIONS: Changes occur in several common laboratory parameters for patients on HT. Some laboratory values changed to match the gender identity, whereas others remained unchanged or were intermediate from the baseline values. These findings will help guide interpretation of laboratory test results in transgender patients taking HT.

Community action research track: Community-based participatory research and service-learning experiences for medical students.

Community-based participatory research (CBPR) and service-learning are unique experiential approaches designed to train medical students how to provide individualized patient care from a population perspective. Medical schools in the US are required to provide support for service-learning and community projects. Despite this requirement, few medical schools offer structured service-learning. We developed the Community Action Research Track (CART) to integrate population medicine, health promotion/disease prevention and the social determinants of health into the medical school curriculum through CBPR and service-learning experiences. This article provides an overview of CART and reports the program impact based on students' participation, preliminary evaluations and accomplishments. CART is an optional 4­year service-learning experience for medical students interested in community health. The curriculum includes a coordinated longitudinal program of electives, community service-learning and lecture-based instruction. From 2009-2015, 146 CART students participated. Interests in public health (93%), community service (73%), primary care (73%), CBPR (60%) and community medicine (60%) were the top reasons for enrolment. Significant improvements in mean knowledge were found when measuring the principles of CBPR, levels of prevention, determining health literacy and patient communication strategies (all p's < 0.05). Most students (73%) were satisfied with CART. Projects were disseminated by at least 65 posters and four oral presentations at local, national and international professional meetings. Six manuscripts were published in peer-reviewed journals. CART is an innovative curriculum for training future physicians to be community-responsive physicians. CART can be replicated by other medical schools interested in offering a longitudinal CBPR and service-learning track in an urban metropolitan setting.

Training Family Medicine Residents in Effective Communication Skills While Utilizing Promotoras as Standardized Patients in OSCEs: A Health Literacy Curriculum.

Introduction. Future health care providers need to be trained in the knowledge and skills to effectively communicate with their patients with limited health literacy. The purpose of this study is to develop and evaluate a curriculum designed to increase residents' health literacy knowledge, improve communication skills, and work with an interpreter. Materials and Methods. Family Medicine residents (N = 25) participated in a health literacy training which included didactic lectures and an objective structured clinical examination (OSCE). Community promotoras acted as standardized patients and evaluated the residents' ability to measure their patients' health literacy, communicate effectively using the teach-back and Ask Me 3 methods, and appropriately use an interpreter. Pre- and postknowledge, attitudes, and postdidactic feedback were obtained. We compared OSCE scores from the group that received training (didactic group) and previous graduates. Residents reported the skills they used in practice three months later. Results. Family Medicine residents showed an increase in health literacy knowledge (p = 0.001) and scored in the adequately to expertly performed range in the OSCE. Residents reported using the teach-back method (77.8%) and a translator more effectively (77.8%) three months later. Conclusions. Our innovative health literacy OSCE can be replicated for medical learners at all levels of training.