Frequently, when I am talking to providers about heath communication, or health literacy, we end up talking about patient education. That makes sense; there are many connections among these subjects. And I’m an educator. But physicians are often frustrated when their patient education doesn’t have its intended effect.
One physician put it to me this way:
“When we teach it to them, they show that they are understanding what we are doing. But they are going home and forgetting.”
Ouch.
Of course it’s important that patients learn what you teach. And providers want to educate patients on topics important to their care, so that informed decisions can be made.
But education is a complex endeavor. Time is short. And there’s a great deal at stake.
I’ve been an educator for more than 20 years, and in this article I give you 5 steps you can take to improve your existing patient education starting right now.
I streamline this process for you here, so you can start making a difference right away. In the coming months, I will dive into each of these steps more fully.
Preparing for different learners
I was talking with an anesthesiology practice. They wanted to improve their patient education in advance of surgical procedures, particularly around what patients could expect from the anesthesiologist that day. I knew I could help them by first taking a close look at what patient education they were already doing.
Like many other providers I have spoken with, they had worked out an educational intervention, with great care, and have used it faithfully. Things would usually go well. But when they didn’t, the practice would often only find out after the fact, through phone calls, emails, or survey responses.
Patient education is one of the most important topics in healthcare today. It’s hard to overstate how complex, and how important, patient education is during the medical encounter.
Learning is a process, and there are always time constraints around the patient encounter. We also each have our preferred ways of learning. So ‘what works’ for one patient, might not for another.
But there are things you can do to improve your existing patient education. These 5 steps suggest actions or modifications you can do right now.
Steps 1-3 are preparation. You do these only once, though I suggest you revisit them from time to time. Steps 4 and 5 involve your patient. These take place during the encounter itself.
Step #1: quick prep
This is preparation that will save you time. When you’re educating, you’re often talking about a medical condition or phenomenon. These tend to be complex and have many sub-topics within them.
For instance, anesthesiology is concerned with pain management. But there are many other relevant issues, and several sub-topics, as I’ve learned in my conversations. For instance, some expectant mothers experience social pressure to ‘tough it out’ through labor without anesthetic. Patients also have fears and questions regarding anesthesia’s possible side effects.
Bring to mind one of the most common issues you handle. With this in mind, go through these two steps:
- Break it down into pieces.
It may help to think of this issue in terms of an outline. What are the smaller topics you usually address within this larger issue? What do you usually find yourself saying? What questions do patients typically ask?
Jot these down in bullet or list form. If you’re a free member of the site, go log in and grab the worksheet that goes with this article. You can write it in there. (If you’re not, sign up. It’s free.)
- With these statements and questions in mind, grab resources: at least one written text, at least one visual.
Make life easy on yourself and tap into people’s preferences for multimodal information. There are so many youtube videos and beautiful apps for patient education—many of them free—that there’s no reason not to have a few favorites. (Consider sharing your favorites in the comments.)
Oh—and have more than one pen and highlighter.
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Step #2: categorize your contribution
There is no one-size-fits-all when it comes to education. But that does not mean you are constantly creating your patient education from scratch. You can modify your instruction and reach each patient–without driving yourself crazy.
Here’s a quick way.
You’ve been thinking about your past experience educating patients on this issue, and broken it down into topics. You’ve thought about what you’ve typically said.
Now recall the patients you’ve educated. Sort your encounters into three categories, based on the patient’s background experience with the issue.
Specifically, remember when you met with a patient who had:
- A high level of background with the situation or condition
- Some background, some connections, potentially similar experiences
- No background, they are new to this condition or situation
For example, the anesthesiologists had patients who:
- Were having a child and had children before, with anesthesia
- Had anesthesia with a different procedure
- Had no experience with anesthesia
They could speak differently to each of these patients, modifying their instruction based on patients’ background.
Think of the time when you met with a patient who had no experience at all with their condition or situation. What topics did you cover? What questions did your patient ask? Write these down.
Then take a moment to think about an encounter with a patient with a high level of knowledge and experience with their condition or situation. What did you find yourself talking about? What kinds of questions did the patient ask? Again, write these down.
When did you encounter patients with some background, or some relevant experience? What was similar, and different, from the other two you just recalled? You guessed it: write these down.
Consider making this a chart that you keep for yourself and refine over time. This is the information you will use to build that bridge from where the patient is, to where they need to be. (That’s Step #4).
Step #3: have your goals in mind
Your overall goal for the patient’s care may already be determined. But what is your goal for this visit? This educational encounter? How much are you expecting to happen here?
The anesthesiologists wanted to manage patient expectations. But they also were concerned about their patient relationships. They needed to keep both of these in mind as they designed their patient education.
Being clear with yourself about your goals, shorter-term and longer-term, will make the education easier. It’s easy to skip this step because you may be thinking, of course I know what we’re doing here. But it’s important to be clear about this, because your patient education is goal-oriented–whether you acknowledge it or not.
That is, you are hoping to make something happen through this education. What is it? What does education have to do with it?
It is easier on you, and on the patient, if you can articulate your educational goals.
Step #4: two important ways to involve your patient
So: you have done 1, 2 and 3. Now it’s time to meet with your patient. You’re going to involve them through talking about:
- Their background knowledge
- Their goals for this encounter
Patient’s background knowledge
Learning is social. Good care providers know that to reach patients, they meet patients where they are. This involves patients’ prior knowledge and experience.
Remember those three categories from Step #2? What you were assuming about your patient’s background knowledge before you began?
It’s time to find out for real. It’s time to learn what your patient already knows, believes, and has been through, regarding the topic at hand. This gives you your starting point for building that bridge between where the patient is and where they need to be.
That is, you are seeking to move the patient from A to B. This is A.
Yet providers do more than save time when they learn about a patient’s background knowledge. At a more humane level, people want to be heard and understood. Listening closely, and asking thoughtful questions in order to understand someone’s background, is a profound sign of respect.
It’s as simple as a question: what do you already know about X? Have you, or has anyone in your family, had experience with X? Tell me about that.
Maybe you have a long-standing relationship with this patient. Maybe you have never met them before. Regardless, be clear with yourself about what you are assuming regarding this person’s background knowledge. Then check these assumptions by asking the patient if your assumptions are true.
Patient’s goals for this encounter
The purpose of today’s encounter may be very clear to you. However, the patient may have a different purpose in mind, or may be unclear on the visit’s purpose. Similarly, your goal for the encounter is clear to you, but it might not be the same goal the patient has.
What is the patient’s goal for this educational encounter?
Goal appraisal is serious business. Learning someone’s goals isn’t a ‘one and done’–it’s a process that can benefit from multiple kinds of questions asked over time.
The goal of an educational session is related to, but not the same as, the overall goal for care. For the purposes of your patient education, think of asking your patient directly:
What are you most interested in learning about today?
For example, anesthesiologists sometimes find their patients are concerned about whether the anesthesia will be effective, or if it could cause permanent damage. Patients wanted to learn about their concerns.
Whatever kind of education you’ve planned, make room for your patient’s goal. Write their goal down, alongside yours. You’ll need these for what comes next.
Step #5: tie your assessment to your goals rather than your material
You assess constantly. Assessing someone’s understanding is complicated.
Rather than quizzing patients on the material, return to the goals. Yours, and your patient’s. This can be as simple as reading them from your notes. Or, you could repeat your goal, and invite the patient to repeat theirs.
Then ask, “What progress have we made toward your goal?”
You’ll repeat this process for your goal. This invites you to be clear with yourself about what you would consider progress toward the goal you’d set. It may help to keep in mind 1) what your patient already knows, and 2) that they may take a different path to the goal than the path you have in mind.
Listening is paramount. This isn’t a quiz. This is to see how far you’ve come in building that bridge between where the patient is, and where they need to be.
These steps can also help analyze successful patient education
These are steps to improve your patient education so you can have the impact you wish to have on patients’ understanding. These five steps can help with already-existing education, and the design of new education.
I invite you to reflect upon the educating you are doing; the assumptions you make about your patients; and what you take for granted about the relationship between teaching something and learning it.
I also encourage you to use these five steps to look closely at your most successful patient education to understand some of what is at play—but often hidden–in effective education. Consider sharing with your colleagues, or here on the site. Want to leave a comment? Become a free member.
