Information given in clinical settings is often not presented in a way that encourages retention and comprehension. Providers are often rushed, having to go over multiple topics during a single 15-minute appointment. Like eating an elephant one bite at a time, chunk and check is a strategy to break large amounts of information into smaller sections, promoting understanding and recall of important health information.
To implement the chunk and check technique, break down all the information you need to discuss with patients into smaller, more manageable ‘chunks’ rather than providing it all at once. Prioritize what you want to teach and begin with the most important information first, as this ‘chunk’ is more likely to be retained.
After you give a ‘chunk,’ or piece of information, ‘check’ that patients have understood what you are trying to convey. You can use methods such as Teach Back or demonstrations to verify understanding. Only move on to the next ‘chunk’ when you validate understanding of the current ‘chunk.’ During the ‘checks,’ you should also ask patients if they have questions in real-time, rather than waiting until the end of the visit and risk forgetting.
Example Patient with Diabetes Mellitus
Dr. Smith has a 30-minute appointment scheduled with Shirley to discuss her recent diagnosis of diabetes. While he would like to discuss her diagnosis, how to check her blood sugar, and some lifestyle changes that will help keep her diabetes under control, he knows that is too much information to cover in one appointment. Rather, he decides to just cover her diagnosis, symptoms, and potential complications. He will save the other topics for future visits. Dr. Smith will utilize the chunk and check technique instead of listing off all the things Shirley should know at once.
During the appointment, the first ‘chunk’ Dr. Smith discusses with Shirley is diabetes. He explains, in plain language and avoiding medical jargon, that diabetes is a long-lasting condition caused by your body not making enough insulin. He hands Shirley a brochure that explains diabetes in further detail and urges her to review it and leave it somewhere close by so that she can review when needed. To ‘check,’ or validate understanding, Dr. Smith asks Shirley to explain diabetes to him in her own words to make sure he explained it well. This ‘check’ allows Dr. Smith to see if Shirley understands and provides an opportunity for Shirley to ask any questions.
The next ‘chunk’ Dr. Smith discusses is the complications that come along with diabetes. Dr. Smith reviews that diabetes increases the risk of various diseases include heart disease, kidney disease, and other problems with feet, oral health, vision, and hearing. He emphasizes the importance recognizing the symptoms they discussed about each of these complications and seeking medical attention if Shirley sees any signs of these complications. While discussing these complications, he makes sure to use plain language and pays close attention to Shirley’s nonverbal cues. To ‘check’ if Shirley comprehends this health information, Dr. Smith asks Shirley to explain to him what the complications of diabetes are and what needs to happen if she notices that she is starting to have signs of these complications.
Finally, after Dr. Smith has covered all the pertinent information he wanted Shirley to receive during the visit, he asks Shirley, “We covered a lot today and I want to make sure that I explained things clearly. So, let’s review what we discussed. Can you please describe 3 things about diabetes?” This provides yet another opportunity for Shirley to validate understanding of what changes need to be made and demonstrates readiness and willingness to change health behaviors.
The chunk and check method can aid patient understanding and recall because smaller ‘chunks’ of information are easier to digest than a large amount of health information all at once. If patients can better comprehend and remember health information, they are more likely to engage in activities needed to promote behavior changes, resulting in improved patient outcomes and satisfaction.