A consultation should give patients a clear understanding of what comes next: why a test has been requested, what the agreed plan involves, and how to raise a concern. These are useful starting points for judging communication and for teaching residents how to make their explanations usable.
A letter reporting a 2017 survey of 389 patients in Wad Medani found overall satisfaction of 66.1%. Yet 85.8% reported inadequate explanation of how to take their medicines, and 76.6% reported that the purpose of requested investigations was not explained. These cross-sectional, self-reported findings—including some proxy responses—cannot establish causation or describe all Sudanese doctors.
Interpreting this pattern requires attention to what each question measures. The Agency for Healthcare Research and Quality (AHRQ) distinguishes satisfaction, which concerns whether care met expectations, from experience, which examines whether particular aspects of care happened and how often. A favourable overall rating can therefore coexist with an important communication gap. For training purposes, the specific difficulty gives the supervisor something concrete to work on.
Checking understanding is an observable skill. In earlier research on consultations with patients with diabetes and limited health literacy, Schillinger and colleagues found that doctors checked recall or comprehension in only 12 of 61 analysed visits. This observational study illustrates how easily that step can be omitted; it does not demonstrate the effect of a communication intervention in Sudan.
The AHRQ’s 2015 toolkit recommends teach-back: invite patients to describe important instructions in their own words, explain again where needed, and check once more. Responsibility for clarity remains with the clinician. A supportive prompt could be: “When you are at home, how will you follow the plan we have discussed?” The response helps identify what still needs explaining more clearly.
A practical teaching exercise could focus on a consultation in which an investigation is proposed. The resident would first invite the patient’s main concern, then explain the question the investigation is intended to answer and how the result will be communicated. A simulated patient could then describe what they understood. An observer would note the precise moment when an unfamiliar term, an unanswered question or a missing explanation created confusion. The resident could practise that part again and receive focused feedback.
Such an exercise would make the learning objective specific: the patient should be able to explain the purpose of the next step and what to expect afterwards. It could also reveal organisational problems. If nobody can say who will communicate a result, the team needs to agree that responsibility and make it clear to the patient.
Patient feedback could then ask about these particular experiences: whether concerns were heard, explanations were understandable, and the next step was clear. Reviewing those answers alongside observed consultations would give educators a more useful basis for choosing the next teaching priority. These are proposed applications of the evidence, rather than interventions evaluated in the original survey.