TABLE 3

Methods for Improving Recall of Spoken Directives

• Use of standardized verbal instructions. With this method, clinicians use scripted information tested for intelligibility.51,52 Use of everyday language is essential as is pairing commonly understood terms with medical ones and speaking more slowly with parents/patients than with colleagues (eg, “pushy” rather than “aggressive”; “stopping bad habits” rather than “behavior modification”; “problems with learning” rather than “developmental delay”).
• Repetition is essential for new learning (hence why television ads are endlessly repeated, why schoolchildren have abundant spelling and math fact drills, and why opportunities for practice are inherent in medical training but preferably via this modified adage, “See many, do many, teach many”).53 Families benefit when messages are reexplained with clarity and when clinicians highlight specifics. For example, major points can be numbered (eg, “The first thing I want you remember is…. The second thing is.…”).20
• Follow-up phone calls or e-mails are associated with enormous improvement in outcomes. Follow-up can be automated and include prerecorded messages/postdated scheduled e-mails reinforcing directives.46,5456
• “Teach-back” has well-established effectiveness in strengthening recall. Teach-back involves asking parents or patients to tell you what they understood in their own words. For example, providers can say, “Please explain that back to me so we make sure I was clear.”40,52,5759
• Visual aids are useful adjuncts to verbal directions and often include pictograms, diagrams, physical models, decision-support graphics, etc.6062
• Demonstrations are powerful memory aids because they are personalized and vivid. Modeling, role-playing, and coaching are helpful in the teachable moment, such as when parents fail to comment on children’s interests or simply yell when children touch harmless objects (eg, providers can say, “Let me show you a good way to talk with him,” followed by modeling desired interactions and having parents practice). With an unruly young patient, clinicians might say, “Ok! We are going to play the ‘Obey Game.’ I will ask you to do something and then I’ll tell you ‘good obeying.’ Ready? Now, I want you to stand up. Great! Good obeying. Now your parents will play the ‘Obey Game.’” Providers can then turn it over to parents and have them ask their child to sit down, bring something over, and so forth, all while encouraging parents’ efforts to praise their children and create a positive behavioral momentum.17,18,20,52