Maximizing your teaching moment
Overview
When you have assessed your patient's needs and selected the education materials and methods you will use, you will need to:
- Set up a good learning environment. This may include things such as adjusting the lighting to ensuring that your patient has the needed amount of privacy.
- Pay attention to your own demeanor. This includes adopting the right tone of voice and making the appropriate amount of eye contact (based on cultural needs). It is also important to refrain from judgment and not rushing your patient. Be sure to sit down near your patient.
- Keep assessing your patient's level of understanding, concerns and readiness to learn. Continue to listen well and read your patient's verbal and non-verbal signals.
- Break through barriers. These may include feelings such as anger, denial, anxiety, or depression; beliefs and attitudes that are not aligned with learning; pain; acute illness; language or cultural differences; physical limitations; and learning differences.
Partner with Your Patients
Try to involve your patient and support person when appropriate as partners in the health care team. The information and skills your patient learns will enhance the ability to make the best personal health choices.
Help your patient learn how to talk about personal health and medical issues and discuss what is needed to help manage the current condition and feel better. When your patient knows what to report, what to focus on, and how to ask questions when talking with a health care provider, they can become a more active partner in care.
Make the Most of the Moment
After you develop your plan you are ready to begin teaching.
Keep in mind you will get the best results when you are meeting your patient's needs. This includes selecting the right time -- that teachable moment. If you teach only at a time that fits your schedule, your efforts may not be as effective.
It is unlikely that you will always have all the time you would like for patient teaching. It may help to give your patient written or audiovisual resources before your meeting. This may help reduce your patient's anxiety and save you time. The option of providing resources ahead of time will depend on your patient's needs and the resources you have available.
Talk about all the topics that will be covered and set time frames. For example, you may say, "Over the next few days or visits I would like to cover these 5 topics, and I suggest that we start with this one." Your patient may agree, or may express a strong desire to go in a different order, based on a perceived or real concern.
Deliver patient teaching in small chunks. Avoid overloading your patient. For example, if your patient is willing to try only 2 of the 4 lifestyle changes you suggest, leave the door open for further talks about the other changes.
If you are teaching certain skills to your patient, check for your patient's mastery of the first skill before you move on to the next one. And stay alert to barriers your patient may face in at home.
Talk about what to do if your patient's condition changes. This will help your patient feel more in control and feel a greater partnership in their own health care process.
Lastly, remember that small steps are better than none.
Teach-Back or Return Demonstrations
When teaching a new skill, ask your patient to demonstrate the new skill so you assess understanding and mastery.
Use the teach-back method to evaluate how you are doing as a teacher. This method is also called the show-me method or closing the loop. It asks your patient to state what they have learned from what you said as if they were going to teach it to you. It is a way to confirm that you have explained to your patient what they need to know in an understandable way. This method can also help you identify the strategies that are most helpful for patient understanding.
Keep in mind that teach-back is not a test of your patient's knowledge. It is a test of how well you explained or taught the information or skill. Use teach-back with every patient -- the ones you feel certain have understood as well as your patient who appears to be struggling.
Reinforce Learning
As you are teaching, provide reinforcement for learning.
- Reinforce your patient's effort to learn.
- Acknowledge when your patient has overcome a challenge.
- Offer hints, tips, and strategies that you have gathered from other patients.
- Let your patients know who they can call if questions or concerns come up later.
- Share a list of trusted websites, and provide referrals to organizations, support groups, or other resources.
- Review what you have covered, and always ask if your patient has other questions. Asking your patient to convey specific areas where there may still be questions (for example, "what questions or concerns do you have?" will often give you more information than merely asking "Do you have any other questions?")
References
Bowman D, Cushing A. Ethical practice and clinical communication. In: Feather A, Randall D, Waterhouse M, eds. Kumar and Clarke's Clinical Medicine. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 5.
Bukstein DA. Patient adherence and effective communication. Ann Allergy Asthma Immunol. 2016;117(6):613-619. PMID: 27979018 pubmed.ncbi.nlm.nih.gov/27979018/.
Cutilli CC. Excellence in patient education: evidence-based education that "sticks" and improves patient outcomes. Nurs Clin North Am. 2020;55(2):267-282. PMID: 32389259 pubmed.ncbi.nlm.nih.gov/32389259/.
Gilligan T, Coyle N, Frankel RM, et al. Patient-clinician communication: American Society Of Clinical Oncology consensus guideline. J Clin Oncol. 2017;35(31):3618-3632. PMID: 28892432 pubmed.ncbi.nlm.nih.gov/28892432/.
Reviewed By: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
