Thank you for reading an excerpt from No Time to Teach. This is a section on Assessment from the book. If you like what you are reading, please order No Time to Teach and tell a friend about it.




One step in teaching patient and family members that is often skipped is assessing their learning needs. Too often we jump right into teaching, without finding out first what the learner knows.

Why is it a mistake to skip assessment?

Assessment treats learners like adults.

Adults don’t learn the same way children do, because:

  • adults know stuff already
  • adults know enough to get through life just fine
  • adults only want to learn new stuff that will be useful

Adults want to be treated like adults, not like children. An adult with a chronic illness may know more than you about the diagnosis and the way he or she responds to treatments.

If we start teaching without finding out what the adult learner already knows, we:

  • show disrespect, because we don’t acknowledge what the learner already knows.
  • bore and alienate the learner, because we teach what he or she already knows, or teach above or below his or her level of understanding.

A good learning assessment helps you teach more efficiently and effectively. If you just jump into teaching without assessing the learner, you may waste time teaching what the learner already knows. Or, you may present information in a way that makes the learner defensive or overwhelmed. When we alienate our learners, they don’t pay attention to us and, consequently, don’t learn. This wastes teaching time.

Assessment tells you what the learner knows, and helps you build a relationship with the learner. Both promote more effective teaching.

When you build your teaching on what the learner knows, it will make more sense to the learner. This will help him or her understand and remember the information better. If your learner reveals basic misunderstandings, assessment helps you identify and correct these.

If the learner’s point of view is very different from your teaching, he or she will reject your information. You need to present your information in a way that is consistent with the learner’s beliefs, so your learner can hear, understand and apply it. For example, someone who does not believe that germs cause illness may not apply your teaching about handwashing. The new information has to make sense to the learner.

Assessment lets you individualize your teaching so you can focus on the most important information and skills, and teach them in the most effective way. In practical terms, assessment is one way we apply adult learning theory to our clinical practice.

This is true whether you are caring for a patient with an acute or chronic illness. For example, before teaching about antibiotics, ask, “You said you have been taking antibiotics. What were they for?”

Assessment saves teaching time. The more your learner already knows, the less you have to teach.

Real-life example

An adolescent with spina bifida kept getting readmitted with serious infections from skin breakdown on her legs. Each time she was discharged, she and her mother were taught about the need to change positions and how to watch for skin breakdowns and respond.

Yet she always returned to the hospital with new sores. Finally, a nurse asked her what caused the skin breakdown. She told the nurse the pathways in her home were too narrow for her wheelchair, so she got around the house by dragging herself across the floor.

The patient got a new, narrow wheelchair and this problem was solved.

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