COMMUNICATION | HEAL
Clearing the Air: An Interprofessional Communication Challenge
Challenge Overview Ana is a recently arrived immigrant from Venezuela. She does not speak English. She presents to the emergency department with her son, who has asthma and a worsening cough. This is their third ED visit. Ana is frustrated, fearful of cost, and unsure why her child is not improving. The team receives a hand-off that contains biased language and assumptions. Challenge Objective Work as an interprofessional team you will complete four (4) "scenes" to identify and repair communication breakdowns, align on patient-centered goals, and safely discharge the child with an effective and affordable asthma plan.
Begin Challenge
Select the Scene: Select the scene to explore.
SCENE 1
The Biased Hand-off and History Taking
SCENE 2
Shared Decision Making
SCENE 3
Teach-Back Method
SCENE 4
Closing the Loop
SCENE 1
The Biased Hand-off and History Taking
Objective: Navigate through three (3) conversation decision points to establish a connection and obtain a history of present illness to record on the patient's chart. After each decision you will recieve feedback if the selected response was the best option.
More Details
Setting the Scene: Ana and her 10-year-old son, Mauricio, are in the ER again. Mauricio is having another asthma attack. In this scenario, your team is collectively playing the role of a the Emergency Room Nurse. The Triage Nurse shares the following...
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SCENE 1
The Biased Hand-off and History Taking
“Alright, here you go—your next case. They just rolled in from triage. The kid’s wheezing pretty badly, but honestly, I couldn’t get much out of them. They don’t speak a word of English, and trying to communicate was… well, pointless. I asked the mom basic questions, but she just kept looking at me like she didn’t understand anything.
They didn’t bring any meds, no paperwork, nothing. I guess they’re refugees from Venezuela or something, so who knows what kind of care they’ve had—if any. I’ve been trying to get through this shift without falling behind, and I don’t have time to play charades.
Anyway, they’re in the room. Good luck figuring it out.”
How do you respond? Click 'continue'
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SCENE 1
Decision Point 1
How would you respond? Select the response you feel would be most appropriate.
“Let’s try using Google Translate or hand gestures to get the information we need.”
“Let’s ask the bilingual receptionist to come translate for us. They speak Spanish, so they can help us communicate with Ana and Mauricio.”
“If they can’t communicate, let’s just treat the asthma attack first and worry about the rest later.”
"Before we continue, let’s connect with a medical interpreter through the video interpreter system."
SCENE 1
Decision Point 1
Scenario Response: The team attempts to communicate using a translation app and gestures. Ana looks confused and increasingly anxious. Mauricio continues to struggle to breathe. The Triage Nurse watches from the doorway, arms crossed. Triage Nurse: “Yeah… that’s pretty much how it went for me too.”
SOMETHING TO CONSIDER...
Using apps or gestures may seem efficient, but it introduces high risk for miscommunication, especially in an emergency. It can also make patients feel dismissed or unsafe. Professional medical interpreters are required for clinical decision making and informed consent. Try again and consider what resources support accurate, patient-centered communication.
Try Again
SCENE 1
Decision Point 1
Scenario Response: The team steps out to the front desk and asks the receptionist to assist. The receptionist looks surprised and hesitant. Receptionist: “I mean… I can speak Spanish, but I’m not trained to interpret medical information. I’m not really supposed to leave the desk, especially with the waiting room this full.”
The Triage Nurse overhears and shakes her head. Triage Nurse: “If they can’t explain what’s going on, I don’t know what to tell you. I tried.”
Ana and Mauricio remain without a safe, accurate way to communicate their needs.
SOMETHING TO CONSIDER...
Using a bilingual staff member who is not a trained medical interpreter can lead to serious communication errors, misunderstandings about symptoms or treatment, and breaches of patient privacy. It also places the staff member in an inappropriate and uncomfortable position. Clinical communication requires a qualified medical interpreter, especially in high risk situations like an asthma exacerbation. Try again and consider what resource ensures accuracy, safety, and respect for the patient.
Try Again
SCENE 1
Decision Point 1
Scenario Response: The team begins treatment without clarifying history, triggers, or prior medication use. Ana becomes visibly distressed, trying to speak but unable to make herself understood. The Triage Nurse mutters under her breath: Triage Nurse: “Told you they wouldn’t be able to tell you anything useful.”
SOMETHING TO CONSIDER...
Treating the acute issue is important, but skipping communication entirely can lead to inappropriate treatment, missed allergies, or cultural misunderstandings. This approach also reinforces the bias expressed in the handoff. Safe care requires both timely intervention and accurate communication. Try again and reconsider how to ensure you understand the patient before proceeding.
Try Again
SCENE 1
Decision Point 1
Scenario Response: The Triage Nurse gives a tired shrug. Triage Nurse: “If you want to wait for an interpreter, go ahead. I just didn’t have the time.”
A trained medical interpreter is paged and arrives shortly after. The team can now begin gathering an accurate history and building rapport with Ana.
WHY THIS WORKS
Requesting a trained medical interpreter is the safest and most ethical first step. It ensures accurate communication, reduces medical errors, and demonstrates respect for the patient and family. This choice also counters the bias introduced in the handoff by prioritizing equitable care. Way to go! Click 'continue' to move onto the next decision.
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SCENE 1
Decision Point 2
Setting the Scene: You introduce yourself via the interpreter, verify patient identity with name DOB, verify Ana’s relationship to the patient, and begin to take a history. What is the best initial question you should ask? Select the response you feel would be most appropriate.
“Why didn’t you bring any of his medications or paperwork with you?”
But, before you make your decision, take a moment and review the RESPECT framework. Click on the 'lightbulb' to explore.
QUICK REVIEW
“When did Mauricio’s breathing start to get worse, and what have you noticed since then?”
“Can you tell us what happened today and what concerns you most about Mauricio right now?”
“Does he usually have asthma attacks like this?”
SCENE 1
Decision Point 2
Setting the Scene: You introduce yourself via the interpreter, verify patient identity with name DOB, verify Ana’s relationship to the patient, and begin to take a history. What is the best initial question you should ask? Select the response you feel would be most appropriate.
“Why didn’t you bring any of his medications or paperwork with you?”
But, before you make your decision, take a moment and review the RESPECT framework. Click on the 'lightbulb' to explore.
QUICK REVIEW
“When did Mauricio’s breathing start to get worse, and what have you noticed since then?”
“Can you tell us what happened today and what concerns you most about Mauricio right now?”
“Does he usually have asthma attacks like this?”
SCENE 1
Decision Point 2
Why this is inappropriate: - Implies blame
- Ignores barriers (“Ask about and understand the barriers to care and compliance”)
- Undermines trust (“Recognize that self disclosure may be difficult for some patients”)
SOMETHING TO CONSIDER...
This question risks making Ana feel blamed or judged. The RESPECT Model encourages suspending judgment and exploring barriers with empathy. A more supportive, open ended question would help build trust and uncover important information. Try again and consider a better question to begin the conversation.
Try Again
SCENE 1
Decision Point 2
Why this works:
- Uses guided questioning to focus on the clinical timeline
- Still respects Ana’s observations and experience
- Demonstrates support and partnership (“Check often for understanding”)
SOMETHING TO CONSIDER...
This is a solid clinical question that guides the conversation while still respecting Ana’s observations. Consider starting with a broader open ended question next time to deepen rapport before narrowing in. Try again and consider an even better question to start the conversation.
Try Again
SCENE 1
Decision Point 2
Why this is strong: - Open-ended and patient-centered
- Invites Ana’s perspective (“See the patient’s point of view”)
- Builds rapport and empathy
- Avoids assumptions
WHY THIS WORKS
You used an open ended question that centers Ana’s experience and aligns with the RESPECT Model’s focus on rapport, empathy, and partnership. This approach helps build trust and ensures you understand the situation from the family’s perspective. Way to go! Click 'continue' to move onto the next decision.
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SCENE 1
Decision Point 2
Why this is limited:
- Closed-ended
- Assumes a known diagnosis
- Risks of missing Ana’s perspective or cultural context
- Does not build rapport or empathy
SOMETHING TO CONSIDER...
This question may gather useful information, but it limits Ana’s ability to share her full perspective. Try beginning with an open ended question to avoid assumptions and better understand the context. Try again and consider an even better question to start the conversation.
Try Again
SCENE 1
Decision Point 3
Setting the Scene: You invited both Ana and Mauricio to share their perspectives, which aligns with the RESPECT Model’s emphasis on rapport, empathy, and partnership. Ana and Mauricio share the following...
Interpreter (to Ana): “They’d like to understand what happened today and what worries you most.”
Ana takes a breath, visibly relieved to finally be understood. Ana: “Mauricio started coughing early this morning. Then he said his chest felt tight. He tried using the inhaler we brought from Venezuela, but it’s almost empty. I was scared because his breathing got worse so quickly.”
The interpreter turns to Mauricio. Interpreter: “They also want to hear from you. Can you tell them how you’re feeling?”
Mauricio nods. Mauricio: “It hurts here… like someone is sitting on my chest. And I feel dizzy.”
What's next? Click 'continue'
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SCENE 1
Decision Point 3
After hearing about Mauricio’s symptoms, the interpreter looks to the team for the next question. What question do you ask next? Select the response you feel would be most appropriate.
“Thank you for sharing that. What other concerns or worries do you have right now that we should know about?”
“Is there anything making it harder for you to get the care or medications Mauricio needs?”
“Do you have his insurance card or any medical records with you?”
“Before we go any further, we need you to sign the consent to treat forms. Can you do that now?”
SCENE 1
Decision Point 3
Scenario Response: Ana hesitates, then looks at the interpreter. Ana: “I… I am worried about how much this will cost. We don’t have insurance. And Mauricio needs his inhaler, but we cannot afford the medicine here.”
She glances toward the door, lowering her voice. Ana: “And… I am afraid. We are seeking asylum. I don’t want this visit to cause problems for us.”
The interpreter turns to Mauricio. Interpreter: “Is there anything you want to tell them?”
Mauricio nods. Mauricio: “I don’t want my mom to worry. I just want to breathe.”
WHY THIS WORKS
You gain critical insight into financial barriers, medication access, and immigration related fear...all essential for safe, equitable care. This question aligns beautifully with the RESPECT Model’s emphasis on empathy, partnership, and trust. You created space for Ana to share sensitive concerns that directly affect care. This is exactly how clinicians uncover hidden barriers. Way to go! Click 'continue' .
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SCENE 1
Decision Point 3
Scenario Response: Ana nods slowly. Ana: “Yes… we don’t have insurance. And the inhaler he used in Venezuela is almost empty. I don’t know how to get more here.”
The interpreter turns to Mauricio. Interpreter: “They want to know if anything makes it hard for you to get what you need.”
Mauricio shrugs. Mauricio: “Sometimes we don’t have money for medicine.”
Ana looks down, clearly holding back additional worries but not yet ready to share them.
SOMETHING TO CONSIDER...
You uncover financial and medication access barriers, but Ana does not yet disclose her fear of deportation. This was a strong, supportive question that addresses barriers directly. To deepen trust further, consider using broader open-ended questions that invite emotional and contextual concerns as well. Try again and consider an even better question to start the conversation.
Try Again
SCENE 1
Decision Point 3
Scenario Response: Ana shakes her head. Ana: “No… we don’t have insurance. We left Venezuela quickly. We brought only what we could carry.”
Mauricio stays quiet, sensing his mother’s discomfort.
SOMETHING TO CONSIDER...
You learn about lack of insurance, but Ana does not feel safe enough to share deeper fears. Trust stalls. This question is practical but limited. It does not invite Ana’s perspective or acknowledge potential barriers. The RESPECT Model encourages suspending judgment and exploring the patient’s context with empathy. Try again and consider asking a broader, more supportive question to build trust.
Try Again
SCENE 1
Decision Point 3
Scenario Response: Ana looks startled and immediately tense. Ana: “I… I don’t understand the papers. I don’t know what they say.”
She glances at Mauricio, who shifts uncomfortably. Mauricio (quietly): “Mamá… is something wrong?”
Ana’s posture becomes guarded. She does not volunteer any additional concerns.
SOMETHING TO CONSIDER...
The focus on paperwork interrupts rapport building, increases Ana’s anxiety, and she becomes less likely to disclose sensitive worries about cost, medication access, or immigration fears. Although consent forms are important, leading with administrative tasks can make patients feel pressured or unsafe...especially families navigating language barriers or immigration stress. The RESPECT Model emphasizes rapport, empathy, and recognizing that self disclosure may be difficult. Try again and consider a more supportive, open-ended question.
Try Again
SCENE 1
Key Takeaways for Effective Communication
Start fresh with the patient or family member you are communicating with. Do not carry forward assumptions from another provider. Acknowledge your own potential biases, and with humility and empathy, intentionally reset before engaging with the patient and family.
RECOGNIZE & RESET BIASES
Use a trained interpreter; speak directly to the patient; use short, clear statements; pause for interpretation; confirm understanding.
WORK EFFECTIVELY WITH INTERPRETERS
Rapport | Empathy | Support | Partnership | Explanations | Cultural Competence | Trust
APPLY THE RESPECT MODEL
Open‑ended questions help patients share their experiences in their own words, which builds rapport, uncovers clinically important context, help avoid assumptions, and create space for patients to express concerns that might otherwise remain hidden.
USE OPEN-ENDED QUESTIONS
Be accurate and respectful. Capture symptoms and family perspective; note barriers to care; record interpreter use.
PERSON-CENTERED DOCUMENTATION
Next Scene
Select the Scene: Select the next scene to explore.
SCENE 1
The Biased Hand-off and History Taking
SCENE 2
Shared Decision Making
SCENE 3
Teach-Back Method
SCENE 4
Closing the Loop
SCENE 2
Shared Decision Making
Objective: Navigate three (3) key decisions to build trust with Ana and develop a safe, affordable asthma treatment plan using shared decision-making. Your choices will shape Ana’s trust and willingness to collaborate. If trust breaks down due to ineffective communication, the conversation will end, and you will need to restart and apply what you’ve learned.
More Details
Setting the Scene: Now, you will be acting as the Emergency Medicine Resident in the ER. The nurse has obtained a history from Ana and Mauricio. Mauricio has been diagnosed with a moderate asthma attack per the Pediatric Respiratory Assessment Measure (PRAM) for asthma exacerbation severity. He has tachypnea, wheezing throughout, use of accessory muscles, and oxygen saturation hovering around 94-95%. The attending has ordered short-term albuterol via nebulizer, administered by the respiratory therapist, and a dose of oral glucocorticoid. The resident is educating Ana and Mauricio on the recommended treatment. Ana is resistant to a nebulizer treatment because she perceives this as being more costly. They also have not been able to fill prescriptions for a combination inhaled corticosteroid/long acting beta agonist (ICS/LABA) to use at home because of the cost. After the last ER visit, Ana received a bill for $1,200 and does not have the funds to pay it.
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SCENE 2
Decision Point 1
But, before you continue, take a moment to review key details of Shared-Decision Making. Click continue after watching the video.
QUICK REVIEW
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SCENE 2
Decision Point 1
Setting the Scene: You enter the room. Mauricio is coughing and retracting. Ana looks frightened.
Ana: "Last time we used that machine he got better, but then I got a huge bill. I can’t do that again. You have to give him something else." Respiratory Therapist: "Doctor, should I set up the nebulizer?"
How would you respond? Identify the response you feel would be most appropriate.
“He needs this treatment. The bill is not something I control.”
“Let’s talk about what worries you. Can you tell me more about the cost concerns?”
“Maybe we can give the steroid first and reassess before deciding on the breathing treatment.”
SCENE 2
Decision Point 1
Decision Results: Ana shares details about the $1,200 bill. You validate feelings and acknowledge systemic barriers. Her concerns are now on the table. Ana then asks, "Why can't we just use the inhaler? The hospital charges so much for these machines." Trust Level: STABLE
Continue conversation
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SCENE 2
Decision Point 1
Decision Results: Ana withdraws, arms crossed, and responds: “So you’re telling me to do this without even asking me? We can’t afford this. Why can’t he just use the inhaler? The hospital charges so much for these machines.” Mauricio: (coughing, breathing fast) “Mom…”” Trust Level: FRAGILE
Continue conversation
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SCENE 2
Decision Point 2
How would you respond? Identify the response you feel would be most appropriate.
“The inhaler won’t work. He needs the nebulizer. It’s the only effective treatment option.”
“Let’s look at the pros and cons of inhaler vs nebulizer together. We can decide what makes the most sense.”
"We can have the social worker talk to you about some resources."
SCENE 2
Decision Point 2
How would you respond? Identify the response you feel would be most appropriate.
“The inhaler won’t work. He needs the nebulizer. It’s the only effective treatment option.”
“Let’s look at the pros and cons of inhaler vs nebulizer together. We can decide what makes the most sense.”
"We can have the social worker talk to you about some resources."
SCENE 2
Decision Point 2
Decision Results: You say something like: “Right now, because Mauricio is breathing fast and using extra muscles, the nebulizer may be easier for him. But the inhaler with spacer is cheaper and works great for home.” Ana relaxes and nods: “Okay…that makes sense, but can you tell me the options one more time.” Trust Level: STABLE
Continue conversation
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SCENE 2
Decision Point 2
Decision Results: Ana starts to get visually upset and frustrated. She says, "You’re not listening to me. And this is getting frustrating. There has to be some other options." Trust Level: FRAGILE
Continue conversation
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SCENE 2
Decision Point 2
Decision Results: Ana becomes angry and says, "You're not listening to me. We're not doing this." Mauricio leaves against medical advice, without treatment...a dangerous outcome. Trust Level: BROKEN
SOMETHING TO CONSIDER...
As a result of these decisions, you've lost trust and confidence with the Ana and Mauricio. Restart the conversation and try again.
Try Again
SCENE 2
Decision Point 3
How would you respond? Identify the response you feel would be most appropriate.
“We can send the same medications to your pharmacy again, and you can check with them about any discounts or programs that might reduce the cost.”
“Let’s come up with a plan that fits your budget. We can provide a rescue inhaler today, prescribe a short course of oral steroids for the current attack, and arrange a follow‑up visit with your primary care provider to discuss longer‑term options.”
“We have some samples we can give you for now, which should help for a little while, but after that you would need to find a way to get more medication.”
SCENE 2
Decision Point 3
How would you respond? Identify the response you feel would be most appropriate.
“We can send the same medications to your pharmacy again, and you can check with them about any discounts or programs that might reduce the cost.”
“Let’s come up with a plan that fits your budget. We can provide a rescue inhaler today, prescribe a short course of oral steroids for the current attack, and arrange a follow‑up visit with your primary care provider to discuss longer‑term options.”
“We have some samples we can give you for now, which should help for a little while, but after that you would need to find a way to get more medication.”
SCENE 2
Decision Point 3
Decision Results: You propose options such as: - Referral to hospital financial counseling
- Prescription discount programs
- Community clinic follow-up
- Social work consult
Ana responds with relief: "Thank you. That’s all I wanted...someone to work with me.” Trust Level: STABLE
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SCENE 2
Decision Point 2
Decision Results: Ana, now getting more frustrated: “We can’t afford those. That’s why we didn’t get them last time. Is that the final option?" Trust Level: FRAGILE
How would you respond? Identify the response you feel would be most appropriate.
“Let’s come up with a plan that fits your budget. We can provide a rescue inhaler today, prescribe a short course of oral steroids for the current attack, and arrange a follow‑up visit with your primary care provider to discuss longer‑term options.”
“We have some samples we can give you for now, which should help for a little while, but after that you would need to find a way to get more medication.”
SCENE 2
Decision Point 2
Decision Results: Ana, now getting more frustrated: “So next time we run out we're stuck again? That won't work. There has to be another option...please!" Trust Level: FRAGILE
How would you respond? Identify the response you feel would be most appropriate.
“Let’s come up with a plan that fits your budget. We can provide a rescue inhaler today, prescribe a short course of oral steroids for the current attack, and arrange a follow‑up visit with your primary care provider to discuss longer‑term options.”
“We can send the same medications to your pharmacy again, and you can check with them about any discounts or programs that might reduce the cost.”
SCENE 2
Decision Point 3
Decision Results: Ana becomes angry and says, "You're not listening to me. We can't afford to do this." Mauricio leaves against medical advice, without treatment...a dangerous outcome. Trust Level: BROKEN
SOMETHING TO CONSIDER...
As a result of these decisions, you've lost trust and confidence with the Ana and Mauricio. Restart the conversation and try again.
Try Again
SCENE 2
Decision Point 3
Decision Results: Ana agrees to the nebulizer treatment now and Mauricio stabilizes. As a result, they are beginning to be discharged. As you leave, Ana says: "Thank you for taking the time to listen. I feel like we can manage this at home now."
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SCENE 2
Key Takeaways for Effective Communication
Three-Talk Model
TEAM Talk | Build Partnerships
OPTIONS Talk | Present Clear, Realistic Choices
DECISIONS Talk | Agree on a Plan That Fits Their Life
- Treat the patient and family as members of the care team.
- Acknowledge concerns and invite their perspective early.
- Establish trust before focusing on treatment decisions.
- Explain treatment options in plain, understandable language.
- Discuss benefits, risks, and costs openly and without judgment.
- Ask what matters most to the patient and family.
- Check understanding and clarify preferences.
- Collaborate on a plan that is safe, realistic, and sustainable.
- Ensure the patient and family feel confident moving forward.
Next Scene
Select the Scene: Select the next scene to explore.
SCENE 1
The Biased Hand-off and History Taking
SCENE 2
Shared Decision Making
SCENE 3
Teach-Back Method
SCENE 4
Closing the Loop
SCENE 3
Teach-Back Method
Objective: Review Mauricio’s asthma action plan to identify the key instructions needed to manage his symptoms safely at home. Then demonstrate the teach-back method by clearly explaining proper inhaler use, ensuring Mauricio and Ana understand when and how to use the inhaler correctly before discharge.
More Details
Setting the Scene: Mauricio’s breathing has improved, and he is now stable and preparing for discharge from the emergency department. Playing the role of a Pharmacist, you have worked with the Medical Resident developed an asthma action plan and prescribed a rescue inhaler to help manage his symptoms at home. Before leaving, Ana expresses concern about what to do if Mauricio’s symptoms return. She wants to make sure she understands the action plan and how to use the inhaler correctly. It is now your responsibility to review the plan, identify the most important instructions, and teach Mauricio and Ana how to use the inhaler safely and effectively.
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SCENE 3
Phase 1: Review the Asthma Action Plan
Instructions: Carefully review the asthma action plan (right) as the plan outlines how asthma symptoms are categorized, what actions should be taken in each zone, and when to adjust medications or seek additional care. After reviewing the plan, answer five (5) questions to demonstrate your ability to interpret its instructions.
Ready to answer questions? Click 'Continue'
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SCENE 3
Phase 1: Review the Asthma Action Plan
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SCENE 3
Phase 1: Review the Asthma Action Plan
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SCENE 3
Phase 1: Review the Asthma Action Plan
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SCENE 3
Phase 1: Review the Asthma Action Plan
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SCENE 3
Phase 1: Review the Asthma Action Plan
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SCENE 3
Phase 2: Teach-Back Method
Objective: Congratulations on completing Phase 1 and demonstrating your ability to read an interpret an asthma action plan! You will now apply that knowledge by practicing the teach-back method, a communication technique used to confirm patient understanding.
More Details
Setting the Scene: Mauricio is ready to be discharged, and you have reviewed the asthma action plan with Ana. Before they leave, you need to ensure they know how to use the rescue inhaler correctly, as proper technique is essential for the medication to work effectively. Ana looks at the inhaler and says, “I want to make sure we’re doing this the right way.” This is your opportunity to demonstrate and explain how to use the inhaler clearly and confidently, making sure they understand each step and feel prepared to use it safely at home.
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SCENE 3
Phase 2: Teach-Back Method
Part 1: Watch Video
Part 2: Practice Teach-Back Method
Watch the video (below), demonstrating proper inhaler use. As you watch, pay close attention to the sequence of steps, positioning, and timing.
Pair up with a partner and take turns practicing the teach-back method. Each person should demonstrate how they would teach a patient to use the inhaler correctly. Your explanation should be clear, accurate, and concise, and should take approximately 30–60 seconds.
Part 3: Demonstrate Teach-Back Method
After everyone has practiced, notify the Facilitator. The Facilitator will randomly select one person to perform the teach-back demonstration. If the demonstration is accurate and complete, you will be awarded the "key word" needed to complete this scene and move on to the final challenge.
Video not loading? Watch here
Ready to enter the "key word"? Click 'Continue'
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SCENE 3
Phase 2: Teach-Back Method
SCENE 3
Key Takeaways for Effective Communication
Teach-Back Method
In this scene, you practiced the teach-back method, a critical communication skill used to confirm patient understanding. Rather than simply providing instructions, teach-back ensures that patients can explain or demonstrate what they need to do, helping uncover misunderstandings before they lead to errors. Using teach-back improves patient safety, increases confidence in managing care at home, and reduces the risk of preventable complications or return visits. It shifts communication from one-way instruction to shared understanding, ensuring patients leave prepared, informed, and capable of managing their condition effectively.
Next Scene
Select the Scene: Select the next scene to explore.
SCENE 1
The Biased Hand-off and History Taking
SCENE 2
Shared Decision Making
SCENE 3
Teach-Back Method
SCENE 4
Closing the Loop
SCENE 4
Closing the Loop
Objective: As a group, you will compose a concise, professional narrative visit summary addressed to the patient’s primary care provider (PCP). Your summary should synthesize the clinical encounter, highlight key communication and shared decision-making strategies, and demonstrate clear, respectful, and bias-aware interprofessional documentation.
More Details
Setting the Scene: Mauricio is stable and ready for discharge. The emergency department visit is complete, and the immediate concerns have been addressed. However, safe care does not end here. Before this family continues their care journey, the primary care provider at the refugee clinic must receive an accurate and thoughtful summary of what occurred today. The next step is to close the communication loop by ensuring the PCP understands the clinical findings, treatment decisions, contextual factors, and follow-up plan that were developed during this visit.
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SCENE 4
Handoff Letter
Part 1: Review Essentials
Carefully review the example handoff letter and the required components for this activity. - Reason for the ED visit and who provided the history (e.g., Ana, interpreter).
- Key clinical findings relevant to the child’s asthma exacerbation.
- Contextual factors influencing care (e.g., cost barriers, language needs, trust concerns).
- Treatment plan and decisions made together with Ana.
- Follow-up recommendations for the PCP and other referrals.
- Interpreter use, patient preferences, and communication strategies that supported understanding.
Example Letter
Ready for the next part? Click 'Continue'
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SCENE 4
Handoff Letter
Part 2: Draft Key Points
Part 3: Refine with AI
As a group, identify the key information from the encounter that must be included in your summary. Discuss and outline: - Reason for the ED visit
- Key clinical findings
- Contextual factors influencing care
- Treatment decisions made collaboratively
- Follow-up recommendations
Using your outlined key points, draft a concise narrative visit summary (150–250 words) addressed directly to the PCP. Note: You may use AI to help refine language, improve clarity, and strengthen organization. However, your group must first generate the content based on your own discussion and notes.
Ready for the next part? Click 'Continue'
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Example Letter
SCENE 4
Handoff Letter
Part 4: Review & Present
Using the AI-generated draft, move the letter out of the AI platform and into your own workspace (paper, Word, etc.). Note: At this stage, the letter should no longer remain in AI...you must refine and edit it using your own knowledge, clinical judgment, and communication skills. Before requesting facilitator review, confirm that your letter: - Is written in narrative paragraph format (150–250 words)
- Is addressed directly to the PCP
- Includes the reason for the visit and relevant clinical findings
- Notes contextual factors that influenced care
- Summarizes the treatment plan and shared decisions
- Provides clear follow-up recommendations
Next, identify one team member who will finalize the document and submit it to Canvas on behalf of the group. When your group is ready, notify the facilitator. The facilitator will review your letter to confirm completion (not accuracy or clinical content) and will ask who is responsible for submission. Once this is confirmed, you will receive the "key word" needed to complete this scene.
Ready to enter the "key word"? Click 'Continue'
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SCENE 4
Handoff Letter
COMMUNICATION | HEAL
Clearing the Air: An Interprofessional Communication Challenge
CONGRATULATIONS! You've completed this challenge... Through each puzzle and scenario, you practiced essential communication skills used every day in clinical encounters. Effective communication is more than a soft skill—it is a core clinical procedure that protects patient safety, strengthens trust, and supports equitable, high‑quality care. Your ability to listen, clarify, document clearly, and close the communication loop will set the foundation for success in your future clinical practice.
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SCENE 1
Teach-Back Method
The Biased Hand-off and History Taking
SCENE 2
SCENE 4
Closing the Loop
Shared Decision Making
Dear Primary Care Provider,
Your patient, Mr. Rivera, was evaluated in our emergency department today for worsening allergic symptoms, including nasal congestion, rhinorrhea, and itchy, watery eyes. A certified medical interpreter was present throughout the visit to ensure clear communication.
On exam, the patient was afebrile, in no respiratory distress, with clear lungs and no evidence of sinus infection or asthma exacerbation. Symptoms were consistent with seasonal allergic rhinitis. He has been using over‑the‑counter antihistamines inconsistently due to cost concerns and uncertainty about proper dosing.
In the ED, we reviewed environmental avoidance strategies and demonstrated proper intranasal corticosteroid technique using teach‑back. The patient was able to return the demonstration correctly. We prescribed a generic intranasal steroid and discussed affordable OTC antihistamine options. Written instructions in Spanish were provided.
The patient was stable for discharge with instructions to return for worsening symptoms such as persistent fever, shortness of breath, unilateral facial pain, or vision changes.
Please see the patient in the next 2–4 weeks to reassess symptom control, discuss long‑term management options, and evaluate whether step‑up therapy is needed.
Thank you for your ongoing care of this patient.
Sincerely,
Dr. Smith
Dear Primary Care Provider,
Your patient, Mr. Rivera, was evaluated in our emergency department today for worsening allergic symptoms, including nasal congestion, rhinorrhea, and itchy, watery eyes. A certified medical interpreter was present throughout the visit to ensure clear communication.
On exam, the patient was afebrile, in no respiratory distress, with clear lungs and no evidence of sinus infection or asthma exacerbation. Symptoms were consistent with seasonal allergic rhinitis. He has been using over‑the‑counter antihistamines inconsistently due to cost concerns and uncertainty about proper dosing.
In the ED, we reviewed environmental avoidance strategies and demonstrated proper intranasal corticosteroid technique using teach‑back. The patient was able to return the demonstration correctly. We prescribed a generic intranasal steroid and discussed affordable OTC antihistamine options. Written instructions in Spanish were provided.
The patient was stable for discharge with instructions to return for worsening symptoms such as persistent fever, shortness of breath, unilateral facial pain, or vision changes.
Please see the patient in the next 2–4 weeks to reassess symptom control, discuss long‑term management options, and evaluate whether step‑up therapy is needed.
Thank you for your ongoing care of this patient.
Sincerely,
Dr. Smith
IMPACT HEAL Activity (Comm.)
DLI
Created on February 11, 2026
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Transcript
COMMUNICATION | HEAL
Clearing the Air: An Interprofessional Communication Challenge
Challenge Overview Ana is a recently arrived immigrant from Venezuela. She does not speak English. She presents to the emergency department with her son, who has asthma and a worsening cough. This is their third ED visit. Ana is frustrated, fearful of cost, and unsure why her child is not improving. The team receives a hand-off that contains biased language and assumptions. Challenge Objective Work as an interprofessional team you will complete four (4) "scenes" to identify and repair communication breakdowns, align on patient-centered goals, and safely discharge the child with an effective and affordable asthma plan.
Begin Challenge
Select the Scene: Select the scene to explore.
SCENE 1
The Biased Hand-off and History Taking
SCENE 2
Shared Decision Making
SCENE 3
Teach-Back Method
SCENE 4
Closing the Loop
SCENE 1
The Biased Hand-off and History Taking
Objective: Navigate through three (3) conversation decision points to establish a connection and obtain a history of present illness to record on the patient's chart. After each decision you will recieve feedback if the selected response was the best option.
More Details
Setting the Scene: Ana and her 10-year-old son, Mauricio, are in the ER again. Mauricio is having another asthma attack. In this scenario, your team is collectively playing the role of a the Emergency Room Nurse. The Triage Nurse shares the following...
Continue
SCENE 1
The Biased Hand-off and History Taking
“Alright, here you go—your next case. They just rolled in from triage. The kid’s wheezing pretty badly, but honestly, I couldn’t get much out of them. They don’t speak a word of English, and trying to communicate was… well, pointless. I asked the mom basic questions, but she just kept looking at me like she didn’t understand anything. They didn’t bring any meds, no paperwork, nothing. I guess they’re refugees from Venezuela or something, so who knows what kind of care they’ve had—if any. I’ve been trying to get through this shift without falling behind, and I don’t have time to play charades. Anyway, they’re in the room. Good luck figuring it out.”
How do you respond? Click 'continue'
Continue
SCENE 1
Decision Point 1
How would you respond? Select the response you feel would be most appropriate.
“Let’s try using Google Translate or hand gestures to get the information we need.”
“Let’s ask the bilingual receptionist to come translate for us. They speak Spanish, so they can help us communicate with Ana and Mauricio.”
“If they can’t communicate, let’s just treat the asthma attack first and worry about the rest later.”
"Before we continue, let’s connect with a medical interpreter through the video interpreter system."
SCENE 1
Decision Point 1
Scenario Response: The team attempts to communicate using a translation app and gestures. Ana looks confused and increasingly anxious. Mauricio continues to struggle to breathe. The Triage Nurse watches from the doorway, arms crossed. Triage Nurse: “Yeah… that’s pretty much how it went for me too.”
SOMETHING TO CONSIDER...
Using apps or gestures may seem efficient, but it introduces high risk for miscommunication, especially in an emergency. It can also make patients feel dismissed or unsafe. Professional medical interpreters are required for clinical decision making and informed consent. Try again and consider what resources support accurate, patient-centered communication.
Try Again
SCENE 1
Decision Point 1
Scenario Response: The team steps out to the front desk and asks the receptionist to assist. The receptionist looks surprised and hesitant. Receptionist: “I mean… I can speak Spanish, but I’m not trained to interpret medical information. I’m not really supposed to leave the desk, especially with the waiting room this full.” The Triage Nurse overhears and shakes her head. Triage Nurse: “If they can’t explain what’s going on, I don’t know what to tell you. I tried.” Ana and Mauricio remain without a safe, accurate way to communicate their needs.
SOMETHING TO CONSIDER...
Using a bilingual staff member who is not a trained medical interpreter can lead to serious communication errors, misunderstandings about symptoms or treatment, and breaches of patient privacy. It also places the staff member in an inappropriate and uncomfortable position. Clinical communication requires a qualified medical interpreter, especially in high risk situations like an asthma exacerbation. Try again and consider what resource ensures accuracy, safety, and respect for the patient.
Try Again
SCENE 1
Decision Point 1
Scenario Response: The team begins treatment without clarifying history, triggers, or prior medication use. Ana becomes visibly distressed, trying to speak but unable to make herself understood. The Triage Nurse mutters under her breath: Triage Nurse: “Told you they wouldn’t be able to tell you anything useful.”
SOMETHING TO CONSIDER...
Treating the acute issue is important, but skipping communication entirely can lead to inappropriate treatment, missed allergies, or cultural misunderstandings. This approach also reinforces the bias expressed in the handoff. Safe care requires both timely intervention and accurate communication. Try again and reconsider how to ensure you understand the patient before proceeding.
Try Again
SCENE 1
Decision Point 1
Scenario Response: The Triage Nurse gives a tired shrug. Triage Nurse: “If you want to wait for an interpreter, go ahead. I just didn’t have the time.” A trained medical interpreter is paged and arrives shortly after. The team can now begin gathering an accurate history and building rapport with Ana.
WHY THIS WORKS
Requesting a trained medical interpreter is the safest and most ethical first step. It ensures accurate communication, reduces medical errors, and demonstrates respect for the patient and family. This choice also counters the bias introduced in the handoff by prioritizing equitable care. Way to go! Click 'continue' to move onto the next decision.
Continue
SCENE 1
Decision Point 2
Setting the Scene: You introduce yourself via the interpreter, verify patient identity with name DOB, verify Ana’s relationship to the patient, and begin to take a history. What is the best initial question you should ask? Select the response you feel would be most appropriate.
“Why didn’t you bring any of his medications or paperwork with you?”
But, before you make your decision, take a moment and review the RESPECT framework. Click on the 'lightbulb' to explore.
QUICK REVIEW
“When did Mauricio’s breathing start to get worse, and what have you noticed since then?”
“Can you tell us what happened today and what concerns you most about Mauricio right now?”
“Does he usually have asthma attacks like this?”
SCENE 1
Decision Point 2
Setting the Scene: You introduce yourself via the interpreter, verify patient identity with name DOB, verify Ana’s relationship to the patient, and begin to take a history. What is the best initial question you should ask? Select the response you feel would be most appropriate.
“Why didn’t you bring any of his medications or paperwork with you?”
But, before you make your decision, take a moment and review the RESPECT framework. Click on the 'lightbulb' to explore.
QUICK REVIEW
“When did Mauricio’s breathing start to get worse, and what have you noticed since then?”
“Can you tell us what happened today and what concerns you most about Mauricio right now?”
“Does he usually have asthma attacks like this?”
SCENE 1
Decision Point 2
Why this is inappropriate:- Implies blame
- Ignores barriers (“Ask about and understand the barriers to care and compliance”)
- Undermines trust (“Recognize that self disclosure may be difficult for some patients”)
SOMETHING TO CONSIDER...
This question risks making Ana feel blamed or judged. The RESPECT Model encourages suspending judgment and exploring barriers with empathy. A more supportive, open ended question would help build trust and uncover important information. Try again and consider a better question to begin the conversation.
Try Again
SCENE 1
Decision Point 2
Why this works:- Uses guided questioning to focus on the clinical timeline
- Still respects Ana’s observations and experience
- Demonstrates support and partnership (“Check often for understanding”)
SOMETHING TO CONSIDER...
This is a solid clinical question that guides the conversation while still respecting Ana’s observations. Consider starting with a broader open ended question next time to deepen rapport before narrowing in. Try again and consider an even better question to start the conversation.
Try Again
SCENE 1
Decision Point 2
Why this is strong:- Open-ended and patient-centered
- Invites Ana’s perspective (“See the patient’s point of view”)
- Builds rapport and empathy
- Avoids assumptions
WHY THIS WORKS
You used an open ended question that centers Ana’s experience and aligns with the RESPECT Model’s focus on rapport, empathy, and partnership. This approach helps build trust and ensures you understand the situation from the family’s perspective. Way to go! Click 'continue' to move onto the next decision.
Continue
SCENE 1
Decision Point 2
Why this is limited:- Closed-ended
- Assumes a known diagnosis
- Risks of missing Ana’s perspective or cultural context
- Does not build rapport or empathy
SOMETHING TO CONSIDER...
This question may gather useful information, but it limits Ana’s ability to share her full perspective. Try beginning with an open ended question to avoid assumptions and better understand the context. Try again and consider an even better question to start the conversation.
Try Again
SCENE 1
Decision Point 3
Setting the Scene: You invited both Ana and Mauricio to share their perspectives, which aligns with the RESPECT Model’s emphasis on rapport, empathy, and partnership. Ana and Mauricio share the following...
Interpreter (to Ana): “They’d like to understand what happened today and what worries you most.” Ana takes a breath, visibly relieved to finally be understood. Ana: “Mauricio started coughing early this morning. Then he said his chest felt tight. He tried using the inhaler we brought from Venezuela, but it’s almost empty. I was scared because his breathing got worse so quickly.” The interpreter turns to Mauricio. Interpreter: “They also want to hear from you. Can you tell them how you’re feeling?” Mauricio nods. Mauricio: “It hurts here… like someone is sitting on my chest. And I feel dizzy.”
What's next? Click 'continue'
Continue
SCENE 1
Decision Point 3
After hearing about Mauricio’s symptoms, the interpreter looks to the team for the next question. What question do you ask next? Select the response you feel would be most appropriate.
“Thank you for sharing that. What other concerns or worries do you have right now that we should know about?”
“Is there anything making it harder for you to get the care or medications Mauricio needs?”
“Do you have his insurance card or any medical records with you?”
“Before we go any further, we need you to sign the consent to treat forms. Can you do that now?”
SCENE 1
Decision Point 3
Scenario Response: Ana hesitates, then looks at the interpreter. Ana: “I… I am worried about how much this will cost. We don’t have insurance. And Mauricio needs his inhaler, but we cannot afford the medicine here.” She glances toward the door, lowering her voice. Ana: “And… I am afraid. We are seeking asylum. I don’t want this visit to cause problems for us.” The interpreter turns to Mauricio. Interpreter: “Is there anything you want to tell them?” Mauricio nods. Mauricio: “I don’t want my mom to worry. I just want to breathe.”
WHY THIS WORKS
You gain critical insight into financial barriers, medication access, and immigration related fear...all essential for safe, equitable care. This question aligns beautifully with the RESPECT Model’s emphasis on empathy, partnership, and trust. You created space for Ana to share sensitive concerns that directly affect care. This is exactly how clinicians uncover hidden barriers. Way to go! Click 'continue' .
Continue
SCENE 1
Decision Point 3
Scenario Response: Ana nods slowly. Ana: “Yes… we don’t have insurance. And the inhaler he used in Venezuela is almost empty. I don’t know how to get more here.” The interpreter turns to Mauricio. Interpreter: “They want to know if anything makes it hard for you to get what you need.” Mauricio shrugs. Mauricio: “Sometimes we don’t have money for medicine.” Ana looks down, clearly holding back additional worries but not yet ready to share them.
SOMETHING TO CONSIDER...
You uncover financial and medication access barriers, but Ana does not yet disclose her fear of deportation. This was a strong, supportive question that addresses barriers directly. To deepen trust further, consider using broader open-ended questions that invite emotional and contextual concerns as well. Try again and consider an even better question to start the conversation.
Try Again
SCENE 1
Decision Point 3
Scenario Response: Ana shakes her head. Ana: “No… we don’t have insurance. We left Venezuela quickly. We brought only what we could carry.” Mauricio stays quiet, sensing his mother’s discomfort.
SOMETHING TO CONSIDER...
You learn about lack of insurance, but Ana does not feel safe enough to share deeper fears. Trust stalls. This question is practical but limited. It does not invite Ana’s perspective or acknowledge potential barriers. The RESPECT Model encourages suspending judgment and exploring the patient’s context with empathy. Try again and consider asking a broader, more supportive question to build trust.
Try Again
SCENE 1
Decision Point 3
Scenario Response: Ana looks startled and immediately tense. Ana: “I… I don’t understand the papers. I don’t know what they say.” She glances at Mauricio, who shifts uncomfortably. Mauricio (quietly): “Mamá… is something wrong?” Ana’s posture becomes guarded. She does not volunteer any additional concerns.
SOMETHING TO CONSIDER...
The focus on paperwork interrupts rapport building, increases Ana’s anxiety, and she becomes less likely to disclose sensitive worries about cost, medication access, or immigration fears. Although consent forms are important, leading with administrative tasks can make patients feel pressured or unsafe...especially families navigating language barriers or immigration stress. The RESPECT Model emphasizes rapport, empathy, and recognizing that self disclosure may be difficult. Try again and consider a more supportive, open-ended question.
Try Again
SCENE 1
Key Takeaways for Effective Communication
Start fresh with the patient or family member you are communicating with. Do not carry forward assumptions from another provider. Acknowledge your own potential biases, and with humility and empathy, intentionally reset before engaging with the patient and family.
RECOGNIZE & RESET BIASES
Use a trained interpreter; speak directly to the patient; use short, clear statements; pause for interpretation; confirm understanding.
WORK EFFECTIVELY WITH INTERPRETERS
Rapport | Empathy | Support | Partnership | Explanations | Cultural Competence | Trust
APPLY THE RESPECT MODEL
Open‑ended questions help patients share their experiences in their own words, which builds rapport, uncovers clinically important context, help avoid assumptions, and create space for patients to express concerns that might otherwise remain hidden.
USE OPEN-ENDED QUESTIONS
Be accurate and respectful. Capture symptoms and family perspective; note barriers to care; record interpreter use.
PERSON-CENTERED DOCUMENTATION
Next Scene
Select the Scene: Select the next scene to explore.
SCENE 1
The Biased Hand-off and History Taking
SCENE 2
Shared Decision Making
SCENE 3
Teach-Back Method
SCENE 4
Closing the Loop
SCENE 2
Shared Decision Making
Objective: Navigate three (3) key decisions to build trust with Ana and develop a safe, affordable asthma treatment plan using shared decision-making. Your choices will shape Ana’s trust and willingness to collaborate. If trust breaks down due to ineffective communication, the conversation will end, and you will need to restart and apply what you’ve learned.
More Details
Setting the Scene: Now, you will be acting as the Emergency Medicine Resident in the ER. The nurse has obtained a history from Ana and Mauricio. Mauricio has been diagnosed with a moderate asthma attack per the Pediatric Respiratory Assessment Measure (PRAM) for asthma exacerbation severity. He has tachypnea, wheezing throughout, use of accessory muscles, and oxygen saturation hovering around 94-95%. The attending has ordered short-term albuterol via nebulizer, administered by the respiratory therapist, and a dose of oral glucocorticoid. The resident is educating Ana and Mauricio on the recommended treatment. Ana is resistant to a nebulizer treatment because she perceives this as being more costly. They also have not been able to fill prescriptions for a combination inhaled corticosteroid/long acting beta agonist (ICS/LABA) to use at home because of the cost. After the last ER visit, Ana received a bill for $1,200 and does not have the funds to pay it.
Continue
SCENE 2
Decision Point 1
But, before you continue, take a moment to review key details of Shared-Decision Making. Click continue after watching the video.
QUICK REVIEW
Continue
SCENE 2
Decision Point 1
Setting the Scene: You enter the room. Mauricio is coughing and retracting. Ana looks frightened.
Ana: "Last time we used that machine he got better, but then I got a huge bill. I can’t do that again. You have to give him something else." Respiratory Therapist: "Doctor, should I set up the nebulizer?"
How would you respond? Identify the response you feel would be most appropriate.
“He needs this treatment. The bill is not something I control.”
“Let’s talk about what worries you. Can you tell me more about the cost concerns?”
“Maybe we can give the steroid first and reassess before deciding on the breathing treatment.”
SCENE 2
Decision Point 1
Decision Results: Ana shares details about the $1,200 bill. You validate feelings and acknowledge systemic barriers. Her concerns are now on the table. Ana then asks, "Why can't we just use the inhaler? The hospital charges so much for these machines." Trust Level: STABLE
Continue conversation
Continue
SCENE 2
Decision Point 1
Decision Results: Ana withdraws, arms crossed, and responds: “So you’re telling me to do this without even asking me? We can’t afford this. Why can’t he just use the inhaler? The hospital charges so much for these machines.” Mauricio: (coughing, breathing fast) “Mom…”” Trust Level: FRAGILE
Continue conversation
Continue
SCENE 2
Decision Point 2
How would you respond? Identify the response you feel would be most appropriate.
“The inhaler won’t work. He needs the nebulizer. It’s the only effective treatment option.”
“Let’s look at the pros and cons of inhaler vs nebulizer together. We can decide what makes the most sense.”
"We can have the social worker talk to you about some resources."
SCENE 2
Decision Point 2
How would you respond? Identify the response you feel would be most appropriate.
“The inhaler won’t work. He needs the nebulizer. It’s the only effective treatment option.”
“Let’s look at the pros and cons of inhaler vs nebulizer together. We can decide what makes the most sense.”
"We can have the social worker talk to you about some resources."
SCENE 2
Decision Point 2
Decision Results: You say something like: “Right now, because Mauricio is breathing fast and using extra muscles, the nebulizer may be easier for him. But the inhaler with spacer is cheaper and works great for home.” Ana relaxes and nods: “Okay…that makes sense, but can you tell me the options one more time.” Trust Level: STABLE
Continue conversation
Continue
SCENE 2
Decision Point 2
Decision Results: Ana starts to get visually upset and frustrated. She says, "You’re not listening to me. And this is getting frustrating. There has to be some other options." Trust Level: FRAGILE
Continue conversation
Continue
SCENE 2
Decision Point 2
Decision Results: Ana becomes angry and says, "You're not listening to me. We're not doing this." Mauricio leaves against medical advice, without treatment...a dangerous outcome. Trust Level: BROKEN
SOMETHING TO CONSIDER...
As a result of these decisions, you've lost trust and confidence with the Ana and Mauricio. Restart the conversation and try again.
Try Again
SCENE 2
Decision Point 3
How would you respond? Identify the response you feel would be most appropriate.
“We can send the same medications to your pharmacy again, and you can check with them about any discounts or programs that might reduce the cost.”
“Let’s come up with a plan that fits your budget. We can provide a rescue inhaler today, prescribe a short course of oral steroids for the current attack, and arrange a follow‑up visit with your primary care provider to discuss longer‑term options.”
“We have some samples we can give you for now, which should help for a little while, but after that you would need to find a way to get more medication.”
SCENE 2
Decision Point 3
How would you respond? Identify the response you feel would be most appropriate.
“We can send the same medications to your pharmacy again, and you can check with them about any discounts or programs that might reduce the cost.”
“Let’s come up with a plan that fits your budget. We can provide a rescue inhaler today, prescribe a short course of oral steroids for the current attack, and arrange a follow‑up visit with your primary care provider to discuss longer‑term options.”
“We have some samples we can give you for now, which should help for a little while, but after that you would need to find a way to get more medication.”
SCENE 2
Decision Point 3
Decision Results: You propose options such as:
- Referral to hospital financial counseling
- Prescription discount programs
- Community clinic follow-up
- Social work consult
Ana responds with relief: "Thank you. That’s all I wanted...someone to work with me.” Trust Level: STABLEContinue
SCENE 2
Decision Point 2
Decision Results: Ana, now getting more frustrated: “We can’t afford those. That’s why we didn’t get them last time. Is that the final option?" Trust Level: FRAGILE
How would you respond? Identify the response you feel would be most appropriate.
“Let’s come up with a plan that fits your budget. We can provide a rescue inhaler today, prescribe a short course of oral steroids for the current attack, and arrange a follow‑up visit with your primary care provider to discuss longer‑term options.”
“We have some samples we can give you for now, which should help for a little while, but after that you would need to find a way to get more medication.”
SCENE 2
Decision Point 2
Decision Results: Ana, now getting more frustrated: “So next time we run out we're stuck again? That won't work. There has to be another option...please!" Trust Level: FRAGILE
How would you respond? Identify the response you feel would be most appropriate.
“Let’s come up with a plan that fits your budget. We can provide a rescue inhaler today, prescribe a short course of oral steroids for the current attack, and arrange a follow‑up visit with your primary care provider to discuss longer‑term options.”
“We can send the same medications to your pharmacy again, and you can check with them about any discounts or programs that might reduce the cost.”
SCENE 2
Decision Point 3
Decision Results: Ana becomes angry and says, "You're not listening to me. We can't afford to do this." Mauricio leaves against medical advice, without treatment...a dangerous outcome. Trust Level: BROKEN
SOMETHING TO CONSIDER...
As a result of these decisions, you've lost trust and confidence with the Ana and Mauricio. Restart the conversation and try again.
Try Again
SCENE 2
Decision Point 3
Decision Results: Ana agrees to the nebulizer treatment now and Mauricio stabilizes. As a result, they are beginning to be discharged. As you leave, Ana says: "Thank you for taking the time to listen. I feel like we can manage this at home now."
Continue
SCENE 2
Key Takeaways for Effective Communication
Three-Talk Model
TEAM Talk | Build Partnerships
OPTIONS Talk | Present Clear, Realistic Choices
DECISIONS Talk | Agree on a Plan That Fits Their Life
Next Scene
Select the Scene: Select the next scene to explore.
SCENE 1
The Biased Hand-off and History Taking
SCENE 2
Shared Decision Making
SCENE 3
Teach-Back Method
SCENE 4
Closing the Loop
SCENE 3
Teach-Back Method
Objective: Review Mauricio’s asthma action plan to identify the key instructions needed to manage his symptoms safely at home. Then demonstrate the teach-back method by clearly explaining proper inhaler use, ensuring Mauricio and Ana understand when and how to use the inhaler correctly before discharge.
More Details
Setting the Scene: Mauricio’s breathing has improved, and he is now stable and preparing for discharge from the emergency department. Playing the role of a Pharmacist, you have worked with the Medical Resident developed an asthma action plan and prescribed a rescue inhaler to help manage his symptoms at home. Before leaving, Ana expresses concern about what to do if Mauricio’s symptoms return. She wants to make sure she understands the action plan and how to use the inhaler correctly. It is now your responsibility to review the plan, identify the most important instructions, and teach Mauricio and Ana how to use the inhaler safely and effectively.
Continue
SCENE 3
Phase 1: Review the Asthma Action Plan
Instructions: Carefully review the asthma action plan (right) as the plan outlines how asthma symptoms are categorized, what actions should be taken in each zone, and when to adjust medications or seek additional care. After reviewing the plan, answer five (5) questions to demonstrate your ability to interpret its instructions.
Ready to answer questions? Click 'Continue'
Continue
SCENE 3
Phase 1: Review the Asthma Action Plan
Continue
SCENE 3
Phase 1: Review the Asthma Action Plan
Continue
SCENE 3
Phase 1: Review the Asthma Action Plan
Continue
SCENE 3
Phase 1: Review the Asthma Action Plan
Continue
SCENE 3
Phase 1: Review the Asthma Action Plan
Continue
SCENE 3
Phase 2: Teach-Back Method
Objective: Congratulations on completing Phase 1 and demonstrating your ability to read an interpret an asthma action plan! You will now apply that knowledge by practicing the teach-back method, a communication technique used to confirm patient understanding.
More Details
Setting the Scene: Mauricio is ready to be discharged, and you have reviewed the asthma action plan with Ana. Before they leave, you need to ensure they know how to use the rescue inhaler correctly, as proper technique is essential for the medication to work effectively. Ana looks at the inhaler and says, “I want to make sure we’re doing this the right way.” This is your opportunity to demonstrate and explain how to use the inhaler clearly and confidently, making sure they understand each step and feel prepared to use it safely at home.
Continue
SCENE 3
Phase 2: Teach-Back Method
Part 1: Watch Video
Part 2: Practice Teach-Back Method
Watch the video (below), demonstrating proper inhaler use. As you watch, pay close attention to the sequence of steps, positioning, and timing.
Pair up with a partner and take turns practicing the teach-back method. Each person should demonstrate how they would teach a patient to use the inhaler correctly. Your explanation should be clear, accurate, and concise, and should take approximately 30–60 seconds.
Part 3: Demonstrate Teach-Back Method
After everyone has practiced, notify the Facilitator. The Facilitator will randomly select one person to perform the teach-back demonstration. If the demonstration is accurate and complete, you will be awarded the "key word" needed to complete this scene and move on to the final challenge.
Video not loading? Watch here
Ready to enter the "key word"? Click 'Continue'
Continue
SCENE 3
Phase 2: Teach-Back Method
SCENE 3
Key Takeaways for Effective Communication
Teach-Back Method
In this scene, you practiced the teach-back method, a critical communication skill used to confirm patient understanding. Rather than simply providing instructions, teach-back ensures that patients can explain or demonstrate what they need to do, helping uncover misunderstandings before they lead to errors. Using teach-back improves patient safety, increases confidence in managing care at home, and reduces the risk of preventable complications or return visits. It shifts communication from one-way instruction to shared understanding, ensuring patients leave prepared, informed, and capable of managing their condition effectively.
Next Scene
Select the Scene: Select the next scene to explore.
SCENE 1
The Biased Hand-off and History Taking
SCENE 2
Shared Decision Making
SCENE 3
Teach-Back Method
SCENE 4
Closing the Loop
SCENE 4
Closing the Loop
Objective: As a group, you will compose a concise, professional narrative visit summary addressed to the patient’s primary care provider (PCP). Your summary should synthesize the clinical encounter, highlight key communication and shared decision-making strategies, and demonstrate clear, respectful, and bias-aware interprofessional documentation.
More Details
Setting the Scene: Mauricio is stable and ready for discharge. The emergency department visit is complete, and the immediate concerns have been addressed. However, safe care does not end here. Before this family continues their care journey, the primary care provider at the refugee clinic must receive an accurate and thoughtful summary of what occurred today. The next step is to close the communication loop by ensuring the PCP understands the clinical findings, treatment decisions, contextual factors, and follow-up plan that were developed during this visit.
Continue
SCENE 4
Handoff Letter
Part 1: Review Essentials
Carefully review the example handoff letter and the required components for this activity.- Reason for the ED visit and who provided the history (e.g., Ana, interpreter).
- Key clinical findings relevant to the child’s asthma exacerbation.
- Contextual factors influencing care (e.g., cost barriers, language needs, trust concerns).
- Treatment plan and decisions made together with Ana.
- Follow-up recommendations for the PCP and other referrals.
- Interpreter use, patient preferences, and communication strategies that supported understanding.
Example Letter
Ready for the next part? Click 'Continue'
Continue
SCENE 4
Handoff Letter
Part 2: Draft Key Points
Part 3: Refine with AI
As a group, identify the key information from the encounter that must be included in your summary. Discuss and outline:- Reason for the ED visit
- Key clinical findings
- Contextual factors influencing care
- Treatment decisions made collaboratively
- Follow-up recommendations
Using your outlined key points, draft a concise narrative visit summary (150–250 words) addressed directly to the PCP. Note: You may use AI to help refine language, improve clarity, and strengthen organization. However, your group must first generate the content based on your own discussion and notes.
Ready for the next part? Click 'Continue'
Continue
Example Letter
SCENE 4
Handoff Letter
Part 4: Review & Present
Using the AI-generated draft, move the letter out of the AI platform and into your own workspace (paper, Word, etc.). Note: At this stage, the letter should no longer remain in AI...you must refine and edit it using your own knowledge, clinical judgment, and communication skills. Before requesting facilitator review, confirm that your letter:
- Is written in narrative paragraph format (150–250 words)
- Is addressed directly to the PCP
- Includes the reason for the visit and relevant clinical findings
- Notes contextual factors that influenced care
- Summarizes the treatment plan and shared decisions
- Provides clear follow-up recommendations
Next, identify one team member who will finalize the document and submit it to Canvas on behalf of the group. When your group is ready, notify the facilitator. The facilitator will review your letter to confirm completion (not accuracy or clinical content) and will ask who is responsible for submission. Once this is confirmed, you will receive the "key word" needed to complete this scene.Ready to enter the "key word"? Click 'Continue'
Continue
SCENE 4
Handoff Letter
COMMUNICATION | HEAL
Clearing the Air: An Interprofessional Communication Challenge
CONGRATULATIONS! You've completed this challenge... Through each puzzle and scenario, you practiced essential communication skills used every day in clinical encounters. Effective communication is more than a soft skill—it is a core clinical procedure that protects patient safety, strengthens trust, and supports equitable, high‑quality care. Your ability to listen, clarify, document clearly, and close the communication loop will set the foundation for success in your future clinical practice.
SCENE 3
SCENE 1
Teach-Back Method
The Biased Hand-off and History Taking
SCENE 2
SCENE 4
Closing the Loop
Shared Decision Making
Dear Primary Care Provider, Your patient, Mr. Rivera, was evaluated in our emergency department today for worsening allergic symptoms, including nasal congestion, rhinorrhea, and itchy, watery eyes. A certified medical interpreter was present throughout the visit to ensure clear communication. On exam, the patient was afebrile, in no respiratory distress, with clear lungs and no evidence of sinus infection or asthma exacerbation. Symptoms were consistent with seasonal allergic rhinitis. He has been using over‑the‑counter antihistamines inconsistently due to cost concerns and uncertainty about proper dosing. In the ED, we reviewed environmental avoidance strategies and demonstrated proper intranasal corticosteroid technique using teach‑back. The patient was able to return the demonstration correctly. We prescribed a generic intranasal steroid and discussed affordable OTC antihistamine options. Written instructions in Spanish were provided. The patient was stable for discharge with instructions to return for worsening symptoms such as persistent fever, shortness of breath, unilateral facial pain, or vision changes. Please see the patient in the next 2–4 weeks to reassess symptom control, discuss long‑term management options, and evaluate whether step‑up therapy is needed. Thank you for your ongoing care of this patient. Sincerely, Dr. Smith
Dear Primary Care Provider, Your patient, Mr. Rivera, was evaluated in our emergency department today for worsening allergic symptoms, including nasal congestion, rhinorrhea, and itchy, watery eyes. A certified medical interpreter was present throughout the visit to ensure clear communication. On exam, the patient was afebrile, in no respiratory distress, with clear lungs and no evidence of sinus infection or asthma exacerbation. Symptoms were consistent with seasonal allergic rhinitis. He has been using over‑the‑counter antihistamines inconsistently due to cost concerns and uncertainty about proper dosing. In the ED, we reviewed environmental avoidance strategies and demonstrated proper intranasal corticosteroid technique using teach‑back. The patient was able to return the demonstration correctly. We prescribed a generic intranasal steroid and discussed affordable OTC antihistamine options. Written instructions in Spanish were provided. The patient was stable for discharge with instructions to return for worsening symptoms such as persistent fever, shortness of breath, unilateral facial pain, or vision changes. Please see the patient in the next 2–4 weeks to reassess symptom control, discuss long‑term management options, and evaluate whether step‑up therapy is needed. Thank you for your ongoing care of this patient. Sincerely, Dr. Smith