Teaching clinicians the teach-back for patient education

I’m a big fan of the teach-back. To my knowledge, it is the only way to confirm that my patient understands my message. I don’t believe avoiding jargon or creating written materials at a favorable readability level can ensure understanding. So, I’m always left with uncertainty until my patient teaches it back to me.

I’ve been teaching clinicians to do the teach-back for about a decade now. For the same amount of time, I’ve been trying to master this technique in my own practice. Why do I have to work on integrating teach-back into my own practice? Because being taught how to do the teach-back method does not mean I use it when I should. In fact, I was embarrassed the first few times I taught teach-back because I knew in my heart that I didn’t use it very often. Many clinicians are like me and have difficulty changing their routines and integrating new strategies. Many studies have shown that giving lectures to clinicians doesn’t lead to much behavior change in practice.

So how do we help clinicians integrate a strategy that we think will help them and their patients?

I’ll be the first to say that I don’t know the perfect answer. But, let me tell you what I’ve been doing.

For the past 4 years I’ve taught a faculty development course on health literacy and aging. This course includes faculty with diverse backgrounds including physicians, nurses, social workers, dental school faculty, pharmacists, librarians, and allied health. I tell them that everyone who takes my course will want to teach people to do teach-back, and I don’t want anyone to teach the teach-back, unless they have done the teach-back. So, all students in my course, even if they don’t regularly take care of patients, have to figure out a way to try the teach-back method.

The Teach-back Method: Teach-back is a way for practitioners to confirm that what they explain to the patient was clear and understood. Patient understanding is confirmed when the patient explains it back to the practitioner or does a return demonstration (instead of just saying, “Yes, I understand.”)

My favorite example is of a nursing professor who is now mostly in administration. She decided to teach her daughter the proper way to dispose of unused medicine. (Did you know you are not supposed to just throw it in the trash or flush it down the toilet?) She did some research, boiled down the lesson to a quick 3 step process, and taught it to her daughter—followed by a teach-back. She then tried with a couple other friends. I thought this was a creative approach to learn how it feels to do the teach-back when it isn’t a normal part of information exchange.

For all of my students, I have them keep a log of their teach-back experiences. For clinicians, we start with one patient a day. Try the teach-back. Write down the reflection.

How did it go?
What would you do differently?
Did the patient seem to mind?
Did the teach-back uncover any miscommunication?

After doing it with one person a day, we increase to 2 a day. By the next course session, all students have tried the teach-back and submitted their log books. Invariably, the clinicians report that they may have never tried to implement the teach-back without knowledge that they had to for the course. It is really a change from usual clinical care.

First, having non-clinicians find a way to try the teach-back gives them an appreciation for the complexity of fitting this strategy into usual communication. I think they will be more empathic teachers as they engage clinician students.

Second, an expectation of implementation with achievable goals and accountability helps to push clinicians into the practice stage.

I cannot say this led to sustained use in clinical practice, but I do know that many clinicians actually tried the teach-back method with several patients and are one step closer to regular use.

Darren A. DeWalt is an internal medicine-pediatrics physician who blogs at Engaging The Patient.com.