Teach Communication Access in CME Cases

In an invented teaching case, a clinician gives a clear explanation of a new diagnosis and asks an open question about treatment preferences. The patient uses sign language; the explanation was spoken without an interpreter. Scoring the clinician's wording alone would miss the central problem: the case never established a way for the patient to receive the explanation and answer.

For faculty writing CME cases, communication access belongs inside the task learners practice. Give the patient a communication method and a say in what works. Let learners establish the support for an exchange, use it, and notice when it fails.

AMA Ed Hub's August 15 post promoting communication education for patients with disabilities raises this design question. The promotion is a useful prompt, not evidence that its video changes practice or that all clinicians share the same training need.

Give the patient a way to answer

The Department of Justice's January 2014 effective-communication guidance makes the relevant distinction concrete. The communication method must fit both the person and the exchange's length, complexity, and context. It describes an interpreter as generally needed when a patient who uses sign language discusses a serious diagnosis and treatment options. It also explains that sign language does not work for everyone with hearing loss.

That gives a case author more to work with than a label such as “patient is deaf.” In our invented case, specify that the patient uses sign language and requests a qualified interpreter. Make a suitable interpreter service available through the simulated clinic's stated process. Ask the learner to show how they would arrange that support and conduct the conversation with it. A tabletop rehearsal can discuss those actions; an observed encounter needs the actual communication support to assess them meaningfully.

Then vary the case. Another patient with hearing loss may use spoken language and real-time captioning. Ask what works for that person and for this particular conversation. Changing the patient's method changes the task; swapping the disability label while preserving the same scripted solution teaches a shortcut.

The guidance is a foundation for selecting realistic case conditions. The clinic's accessibility team should review the scenario's local process and applicable requirements before faculty teach it as a practice standard.

Observe the exchange, not just the script

Our earlier article on placing communication inside disease education argued that cases should test how clinicians discuss choices. Communication access adds a prior question: can this patient participate in that discussion?

In a rehearsal, faculty can observe whether the learner asks about communication needs, obtains the agreed support, and gives the patient room to ask questions through it. They can also introduce a failure: the caption display stops working, or the interpreter connection becomes unusable. The learner must recognize that the exchange has broken down and use the clinic's process to restore it. Continuing a polished explanation should not count as completing the task.

These are proposed teaching observations, not a validated scoring instrument. Have people with relevant lived experience help develop and review the cases, including what would make the encounter workable for them. A single reviewer cannot represent every patient who shares a disability label.

Keep the clinic in the picture

The educational need has historical evidence behind it. A 2022 survey of 714 US outpatient physicians, conducted in 2019–20, found that 35.8% reported little or no knowledge of their ADA responsibilities. The survey covered seven specialties and did not examine each topic in depth. It cannot diagnose the needs of your learners or establish that this proposed rehearsal works.

A separate qualitative report from the same research program analyzed three 2018 focus groups with 22 outpatient physicians. Participants described communication and structural barriers, including time and coordination problems. This convenience sample cannot establish how common those problems are, but it keeps the curriculum honest: teaching a request for support does not create a functioning support service.

Before running the case, confirm that its access pathway exists in the setting where learners will use it. If it does, learners can rehearse using it. If it does not, the case has exposed a service-design problem that education alone cannot resolve. Either way, the patient needs to be able to answer.