Teach-back: Interactive Module Slides

Slide 1: Teach-Back

Physician smiling and talking with a patient in an exam room while holding an electronic tablet.

Improving Patient Safety by Engaging Patients and Families in Effective Clinician-Patient Communication

Slide 2: AHRQ

Logo of Agency for Healthcare Research and Quality

Sponsored by the Agency for Healthcare Research and Quality (AHRQ), this teach-back learning module is designed to inform clinicians about the teach-back method and provide effective strategies to implement teach-back. Teach-back engages patients (and families) and ensures their clear understanding of what they need to know for improved patient safety and outcomes.

Slide 3: Introduction

The wall of a patient examination room.

At its core, teach-back is about communicating with patients. We're going to start by reviewing two conversations between patients and clinicians.

  • Examine the scenarios over the next series of screens and consider the difference between Scenario 1 and Scenario 2.
  • What did the clinician in the scenarios do to produce those differences?

Slide 4: Scenario 1, Part 1

A clinician speaking with a mother and child.

Clinician: "I am prescribing an antibiotic called amoxicillin for Anna's ear infection. It needs to be given 3 times a day – at breakfast, lunch and dinner. Most children like the taste of this antibiotic, which is important because Anna will need to take this medication for 10 days. Do you have any questions?"

Patient's Mother Speaking: "No."

Slide 5: Scenario 1, Part 2

A clinician speaking with a mother and child.

Clinician: "If Anna develops a rash or does not feel better, please give our office a call. We want to make sure that she gets better soon. Okay?"

Patient's Mother Speaking: "Okay."

Slide 6: Scenario 2, Part 1

A clinician speaking with a mother and child.

Clinician: "I am prescribing an antibiotic called Amoxicillin for Anna's ear infection. It needs to be given 3 times a day – at breakfast, lunch, and dinner. Most children like the taste of this antibiotic, which is important because Anna will need to take this medication for 10 days. I want to make sure I am being clear and to answer any questions you may have. In your own words, can you tell me what you need to do at home for Anna's ear infection?"

Patient's Mother: "You want me to give antibiotics to Anna at every meal for 10 days. But Anna is at school during the day, and they don't like to give medications. Does she have to take it at lunch time?"

Slide 7: Scenario 2, Part 2

A clinician speaking with a mother and child.

Clinician: "I'm glad you told me that. I can adjust the dose so that Anna only takes the antibiotic at breakfast and dinner. Now if Anna develops any red spots on her body, continues to have a fever, or is not acting like herself, please call me. Even if you are not certain if you should call, call me any time! As a final safety check, when is it important for you to call me?"

Patient's Mother: "If Anna is not feeling better, she gets a rash, or I am concerned, I should call you."

Slide 8: Scenario 1 Reflection

The wall of a patient examination room.

Now that you've had the opportunity to explore both scenarios again, consider the differences between Scenario 1 and Scenario 2 and ask yourself:

  • What did the clinician in the scenarios do to produce those differences?

Slide 9: Learning Objectives

A hallway of a primary health care facility.

By the end of this lesson you should be able to:

  • Understand and describe the steps of the teach-back process.
  • Describe the role and value of teach-back in improving patient safety.
  • Identify strategies for implementing the teach-back process.

Slide 10: Pathway Menu

In the background, a physician speaking with a mother and child. In the foreground, a pathway diagram consisting of ovals with text connected by arrows.

Teach-Back

  • Oval 1: What is teach-back?
  • Oval 2: Why should I use teach-back?
  • Oval 3: When should I use teach-back?
  • Oval 4: How is teach-back different?
  • Oval 5: What are some teach-back examples?
  • Oval 6: How can I make teach-back successful?
  • Oval 7: Which patients benefit from teach-back?
  • Oval 8: Are there other considerations?
  • Oval 9: Are there other important tips?

Slide 11: What Is Teach-Back?

Physician smiling and talking with a patient in the exam room while holding an electronic tablet.

A method of ensuring that patients understand what you’ve told them.

During teach-back, you ask patients to explain in their own words what they need to know or do to take care of their health. You ask them to teach back to you what you have told them.

Slide 12: Why Should I Use Teach-Back?

A primary health care facility waiting room, with a staff member behind the desk and two men, one woman, an infant, and a child seated in the waiting room. There are four information icons overlayed on the image.

  • Info Point 1: Research shows that clinicians underestimate patients' needs for information, and overestimate their own ability to convey information effectively.2,3,4,5,7
  • Info Point 2: Studies have shown that up to 80% of the medical information patients are told during office visits is forgotten immediately, and nearly half of the information retained is incorrect.1,8
  • Info Point 3: Low health literacy can affect patient adherence and ultimately patient health outcomes.10
  • Info Point 4: There is a 19% higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well.11

Effective communication in medical care positively correlates with better patient adherence.

Slide 13: When Should I Use Teach-Back?

A physician talking to the patient while they review information displayed on the screen of an electronic tablet.

Use teach-back whenever explaining important concepts to patients about their health care such as:

  • New diagnosis.
  • Medication.
  • Home care instructions.
  • Treatment plan.
  • Recommended behavior changes.
  • Use of a new device.
  • Treatment options.
  • Next steps.

Slide 14: How Is Teach-Back Different?

A physician talking with a patient while they review written information.

If you ask patients whether they have any questions, they will often say they don’t, even if they don’t really understand what you’ve told them. They may be embarrassed or intimidated, or they may think they understand.

Using teach-back helps you more accurately determine your patient’s level of understanding so you can adapt your communication as needed.

Slide 15: What Are Some Examples of Teach-Back?

A physician talking with a patient while they review a paper document. There are four information icons overlayed on the image.

  • Info Point 1: "Just to be safe, I want to make sure we are on the same page. Can you tell me..."
  • Info Point 2: "Your inhaler is important for your health. Can you show me how you would use it at home?"
  • Info Point 3: "I want to make sure that I explained things clearly. Can you explain to me…"
  • Info Point 4: "We have discussed some important information about your medication. As a safety check, can you tell me warning signs to look for with this medication?"

There are many ways to approach teach-back with your patients and their families.

Slide 16: How Can I Make Teach-Back Successful?

A physician talking with the patient as they review information displayed on the screen of an electronic tablet. There are eight information icons overlayed on the image.

  • Info Point 1: Use teach-back on ALL patients.
  • Info Point 2: Focus on 2 to 4 key points for that visit.
  • Info Point 3: Start with the most important message.
  • Info Point 4: Use plain language. Most patients do not understand medical jargon. Using plain language may take some practice.
  • Info Point 5: If your patient teaches back incorrectly, always assume your teaching was not sufficient. Repeating the same message is not effective. Rephrase your message until your patient has a clear understanding.
  • Info Point 6: Use patient materials and underline or circle the most important points during teach-back.
  • Info Point 7: Use pictures or draw diagrams to support your teaching.
  • Info Point 8: Foster an office culture around teach-back that helps patients and their families feel supported and engaged as important members of their care team.

Slide 17: Which Patients Benefit From Teach-Back?

A physician talking with a man and woman as they review information displayed on the screen of an electronic tablet.

All patients benefit from teach-back, especially any patient presented with a new diagnosis.

Slide 18: Are There Other Considerations When Using Teach-Back?

A physician speaking with a patient at a desk.

With certain patient populations, there are additional considerations when using teach-back.

Older Adults

When using teach-back with older adults, consider the following:

  • Mild or moderate hearing impairments often occur with age:
    • Use a lower voice pitch.
    • Speak naturally and distinctly.
    • Minimize background noise.
  • Information processing speed declines with age:
    • Limit the amount of new information delivered during each visit.
    • Slow down the rate of delivery.

Children

When using teach-back with children, consider the following:

  • The conversation with the child should be age and developmentally appropriate.
  • Both the patient and the caregiver should understand the information being shared.
  • Visual aids can support communication of new diagnoses and new therapies (such as the use of an inhaler).

Language Diversity

When using teach-back with patients who speak a different first language, consider the following:

  • Medical translation services are beneficial if available.
  • Both verbal and nonverbal cues can help with communication.
  • Visual aids can support communication.

Slide 19: What Are Other Important Tips For Teach-Back?

A physician pointing to the screen of the electronic tablet he is holding. There are five information icons overlayed on the image.

  • Info Point 1: It is important to be approachable, making your patient and his or her family members feel confident when engaging in teach-back.
  • Info Point 2: Emphasize to your patient and his or her family that teach-back is a part of a safety check to ensure that you are communicating clearly.
  • Info Point 3: Do not appear rushed. It is important for your patient and his or her family to understand your instructions clearly so that they can adhere and be safe.
  • Info Point 4: Remove physical barriers between you and the patient (e.g., desk, computer, crossed arms), and position yourself at your patient’s eye level.
  • Info Point 5: This is not a patient quiz but an opportunity for you to identify gaps in your teaching.

Your tone and attitude are important.

Slide 20: Scenario 2 Review, Part 1

A clinician speaking with a mother and child.

Clinician: “ I am prescribing an antibiotic called Amoxicillin for Anna's ear infection. It needs to be given 3 times a day – at breakfast, lunch, and dinner. Most children like the taste of this antibiotic, which is important because Anna will need to take this medication for 10 days. I want to make sure I am being clear and to answer any questions you may have. In your own words, can you tell me what you need to do at home for Anna's ear infection?”

  • Key Teach-Back Strategy 1: Starts with most important message.
  • Key Teach-Back Strategy 2: Gives an additional key point.
  • Key Teach-Back Strategy 3: Gives a third key point. Key Teach-Back Strategy 4: Explains that she is trying to make sure her message is clear so the patient doesn’t feel quizzed.
  • Key Teach-Back Strategy 5: Engages the family/patient.
  • Key Teach-Back Strategy 6: Uses an effective teach-back phrase to ensure the message was clearly understood.

Patient's Mother: "You want me to give antibiotics to Anna at every meal for 10 days. But Anna is at school during the day, and they don't like to give medications. Does she have to take it at lunch time?"

  • Key Teach-Back Strategy 7: Shows understanding – teach-back was effective.
  • Key Teach-Back Strategy 8: Patient is able to identify a potential barrier to adherence.

Slide 21: Scenario 2 Review, Part 2

A clinician speaking with a mother and child.

Clinician: “I'm glad you told me that. I can adjust the dose so that Anna only takes the antibiotic at breakfast and dinner. Now if Anna develops any red spots on her body, continues to have a fever, or is not acting like herself, please call me. Even if you are not certain if you should call, call me any time! As a final safety check, when is it important for you to call me?”

  • Key Teach-Back Strategy 1: The clinician is able to adapt her recommendation to better suit the patient’s needs and constraints.
  • Key Teach-Back Strategy 2: Gives a key point.
  • Key Teach-Back Strategy 3: Uses an effective teach-back phrase.

Patient's Mother: “If Anna is not feeling better, she gets a rash, or I am concerned, I should call you.”

  • Key Teach-Back Strategy 4: Demonstrates understanding.

Slide 22: What Is the Most Important Rationale for Using Teach-Back?

A physician speaking with a patient and another person while they all review written information.

Choice Feedback
To test the patient on his/her ability to repeat the important health information given Incorrect. Teach-back should not be mere repetition, nor should it be a quiz. It is a check on the clinician's ability to clearly communicate information.
To give the patient time and opportunity to talk to you Incorrect. While teach-back does allow patients to talk to you, the purpose of teach-back is to ensure your message is understood. Most clinicians state once they master teach-back, it takes just about a minute to complete.
To meet the requirements of Meaningful Use Incorrect. Meaningful Use does not include any requirements related to teach-back.
To alert you to whether or not your communication was clear Correct. Teach-back serves as a check to see how well the patient understood what you told him or her.

Slide 23: Question: Using Plain Language

Two columns, the column on the left contains plain language equivalents of the medical terminology in the column on the right.

Using plain language is a critical component of the teach-back method.

Here are examples of medical jargon and their plain language alternatives.

Medical Jargon Plain Language
Anti-inflammatory Reduces swelling
Hyperglycemic High blood sugar
Benign Not cancer
Annually Every year
Hypertension High blood pressure
Anticoagulant Blood thinner

Slide 24: Question: Expectations of Teach-Back

A physician examining a child. A physician speaking with a patient as they review a paper document.

Through teach-back clinicians can expect which of the following (choose all that apply).

Choice Feedback Correct?
Improved adherence with treatment plan When patients fully understand a treatment plan, they are more likely to adhere to it.6,11 Yes
Reduced no-show rates When patients understand why they need to follow up, they are less likely to miss appointments.2,11 Yes
Better self-management of chronic and acute conditions When patients understand what they are supposed to do to self-manage and why, adherence and outcomes will improve.9 Yes
Significantly longer office visits Clinicians report that teach-back takes about one minute. While this may initially increase the specific office visit, the gain in patient understanding and compliance can decrease overall time in the long run.2,4,6,11 No
Fewer telephone calls about questions on self-management care When you ensure patients understand your message during the visit, you will get fewer calls to clarify patient misunderstandings.2,11 Yes

Slide 25: Question: Effective Teach-Back Phrases

Question: Which of these are effective teach-back phrases? Scroll down to select all that are appropriate. Content detailed as text below.

Which of these are effective teach-back phrases?

Choice Correct?
Can you explain some of the changes we decided on today during your visit? I want to make sure that I was clear and that you have the best outcomes. Yes
Do you know how to use this device? No
Do you have any questions? No
I want to make sure we are on the same page. Can you explain to me what your next steps are when you get home? Yes
Do you understand? No
In your own words, just to be safe, what are some possible side effects of the medicine? Yes
Are we clear on next treatment steps? No
So I can be sure we have the same understanding, what else can you do to help your condition? Yes
As a safety check, can you show me how you would use the inhaler at home? Yes
Do you know how to take this medication? No

Remember, effective teach-back uses open-ended questions that encourage patients to explain their understanding in their own words.

Slide 26: Congratulations!

Physician smiling and talking with a patient in an exam room while holding an electronic tablet.

You have completed the teach-back training.

"Tell me and I forget, teach me and I may remember, involve me and I learn."
                                                                                              —Benjamin Franklin

Slide 27: References

References

  1. Anderson JL, Dodman S, Kopelman M, et al. Patient information recall in a rheumatology clinic. Rheumatology 1979 18(1):18-22.
  2. Britten N, Stevenson FA, Barry CA, et al. Misunderstandings in prescribing decisions in general practice: qualitative study. BMJ 2000 Feb 19;320(7233):484-8.
  3. Calkins DR, Davis RB, Reiley P, et al. Patient-physician communication at hospital discharge and patients' understanding of the postdischarge treatment plan. Arch Intern Med 1997 May 12;157(9):1026-30.
  4. Coran JJ, Koropeckyj-Cox T, Arnold CL. Are physicians and patients in agreement? Exploring dyadic concordance. Health Educ Behav 2013 40(5):603-611.
  5. Hancock K, Clayton JM, Parker SM, et al. Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manag 2007 Aug 31;34(2):190- 200.
  6. Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Medical Care 2009 Aug;47(8):826.
  7. Hibbard JH, Greene J. What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs. Health Aff 2013 Feb 1;32(2):207- 14.
  8. Keulers BJ, Scheltinga MR, Houterman S, et al. Surgeons underestimate their patients' desire for preoperative information. World J Surg 2008 Jun 1;32(6):964-70.
  9. Kessels RP. Patients' memory for medical information. J Roy Soc Med 2003 May 1;96(5):219-22.
  10. Kripalani S, Weiss BD. Teaching about health literacy and clear communication. J of Gen Intern Med 2006 Aug 1;21(8):888-90.
  11. Lagay F. Reducing the effects of low health literacy. Virtual Mentor 2003 Jun 1;5(6).
  12. Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care 2009 Aug;47(8):826.
Page last reviewed April 2017
Page originally created April 2017
Internet Citation: Teach-back: Interactive Module Slides. Content last reviewed April 2017. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/patient-safety/reports/engage/interventions/teachback-mod.html
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