Today's blog post topic is on testing your patient's understanding (also known as the "teach-back" approach) and why it should not be used in the context of the NAC-OSCE exam.

The approach is commonly used in counselling cases, when a physician is closing the consultation and requests that their patient "Please recap or repeat back to me what I've just explained" or "Could you tell me what you understand from what we just discussed?" or "Can you tell me what you'll take away from our visit today?"

Why shouldn't you use the "teach-back" method in the NAC-OSCE?

Firstly, the simulated patient (SP) is not there to recap or to summarize all the information you covered in your interaction. The examiner is looking to YOU to provide a summary.

Secondly, it is important to recognize that testing your SP is a very mentally taxing exercise to ask of them because they are intensely focused on answering all your questions in a standardized format to give you the best possible chance to succeed in your exam.

Thirdly, the SP will see dozens of candidates on a very long exam day and may struggle to remember every detail that you shared with them. By testing the SP, you risk them unintentionally missing a few items of discussion or possibly misinterpreting something you said which will reflect poorly on your communications skills and prompt you to correct them - an awkward conversation to have as you wrap-up your interaction in the hope of ending on a positive note.

Lastly, if you do "teach-back" and your SP tells you that they understood everything that was discussed, please take them at their word and move on.

So as a point of caution, do not insist on testing your patient's knowledge in the NAC-OSCE. Instead, ask them if they understand everything that was discussed and invite them to ask questions. "I know I have provided you with a lot of information today. It is a lot to take in. Do you have any questions for me at this time?” 

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