Use of a Learner Outcome Format in Clinical Extern Placements: Developing a System to Increase Supervision Efficiency

Editor's Note: Although this article was originally written for www.audiologyonline.com and clearly addresses the audiology professionals, I believe there is a plethora of applicable and important material here for the SLP too. Dr. Margolis has graciously allowed us to publish this article here too. Sincerely, ---Dr. Douglas L. Beck

In Meredith Willson's The Music Man, Mayor Shinn announces to the July 4^th crowd in the River City High School Madison Auditorium, "Members of the school board will now present a patriotic tableau." Up jumps a school board member who whispers in the Mayor's ear and the Mayor corrects himself: "Members of the school board will not present a patriotic tableau."

Nine out of ten semantic units were correct. The scene shows how easily the loss of one information unit can completely change the message. Can't you just see the Iowa farmer with noise-induced hearing loss from years in the tractor seat wondering why he is being subjected to Eulalie McKecknie Shinn's impersonation of a Grecian urn instead of the promised patriotic tableau?

How often do our patients miss one or two critical facts resulting in a complete misunderstanding of their communicative problem and what to do about it? This question gnawed at me for years until I came to the conclusion that every important fact or recommendation that is given to a patient should be given in writing, in an easily understood format that can be shared with family members, read, reread, and kept for future reference.

I recently saw a patient who is an intelligent professional and had been seen previously by two audiologists. I know the audiologists well and I don't believe it is possible that they did not thoroughly and clearly explain the results. After I discussed the findings and provided the results and recommendations in a clear, written format, the patient thanked me and said no one had ever explained that before. I think he forgot.

We need to keep in mind that our patients lead busy lives and there are many things that work against the likelihood that they will remember what we tell them. The working mom whose son broke an ankle yesterday playing soccer, who is worried about missing work for just a hearing evaluation, who doesn't have anything for dinner tonight, and whose husband may be laid off next week, might not remember the difference between a conductive loss and a sensorineural loss. And when relating the information to her husband that night, "Your hearing will probably not get better" can easily become "Your hearing will probably now get better." Most of the semantic units were correct.

Recently it occurred to me that ours is not the only field with information that is important for patients to understand and remember. I consulted the Audiology counseling literature but found only one study of patient recall following audiologic consultation and a brief reference to the issue in Luterman's excellent text on Counseling Persons with Communication Disorders and Their Families (Austin: Pro-Ed, 2001). I was shocked that Audiology, a communication profession, has almost completely neglected to be concerned with the effectiveness of our communication of information to patients. Other professions have addressed the issue and there are many research studies and discussions of patient recall in the medical literature, most by British authors. A list of references can be found at www.audiologyincorporated.com.