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[00:00:00] Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is PAR. PAR offers the RIAS-2 and RIST-2 remote, to remotely assess or screen clients for intelligence and in-person e-stimulus books for these two tests for in-person administration. Learn more at parinc.com.

All right, everybody. Welcome back.

Hey, today is the first episode in a little two-part series on report writing. I think this little series is long overdue and frankly, it’ll be a much longer series. There’s so much to say on the report writing. If you’re interested in report writing, you can go back and listen to my interview with Dr. Jacobus [00:01:00] Donders from probably two years ago. And there’s some fantastic information in there. But this little two-part series is going to focus on some different topics than the previous interview and expand on some of those things and add a little bit more nuance to that discussion.

So part one today is going to be more about readability than anything else. How do we make our reports more readable for our audiences? And part two is going to be more about what to include in the report and what people actually find useful. So today, I’ll be talking about things that get in the way of people being able to read our reports from a structural standpoint and a very practical standpoint.

So this is going to be one of those episodes that there’s quite a bit to take away. And some tips that you can put into place very quickly. I also have some fantastic [00:02:00] resources in the show notes to read and help you implement some of these strategies. So let’s jump into this discussion about making our reports a little more readable.

Okay, everyone. Let’s jump into this discussion about making our reports more readable. So, first of all, a disclaimer, a lot of the information I’m going to present and discuss in this episode is taken from the workshop that I attended at AACN last summer. So 2019. Dr. Dean Beebe presented a lot of information on writing better reports. [00:03:00] And his presentation primarily drew from some of the research that he and colleagues have done in their children’s hospital. And also from an article by Karen Postal and others called The Stakeholders article on neuropsychological report writing. I don’t know if that’s the exact title, but stakeholders is definitely in the title. So, I want to give credit where credit’s due. I’m going to be summarizing some of those ideas here, and we will dive into just very specific ways to make our reports easier to read for folks.

The main idea here that I want to communicate is… I just want to plant the seed from the very beginning… is that it’s very likely that your reports are way too long and way too hard to read. [00:04:00] But I also want you to know that it’s not just you. The vast majority of us were trained in a model that is now relatively antiquated.

So I’d like to just talk through a little bit of history around this and why in the world we were trained to write reports in a way that doesn’t really serve us or serve our clients. And I have to say, I am totally a part of this group. I went to grad school at a time where I was trained in a program anyway, where we were writing easily 30 to 40-page reports every time for a relatively simple psycho-ed eval.

So when I started working with a neuropsychologist supervisor, like I’ve mentioned here before a few years after graduating, one of our biggest tasks was [00:05:00] cutting down the length of reports. And that was one of the hardest things to do because I’d really gotten attached to that style. But now being who knows how many years down the road, six or seven years down the road from that point, I am happy to say that our reports have gotten better. I don’t think they’re totally on point, but they have gotten a lot better. And they are a lot more fun to write, which is the important thing.

All right. A little history. There are a few things I think that contribute to writing these lengthy jargon-y reports. One is that we develop this method of writing reports in part to impress other fields and justify our conclusions. So when psychology and specifically [00:06:00] neuro-psychology was really emerging, there was a pretty firm embedding in the medical setting. And I think psychologists really had to work hard or it felt like they had to work hard to prove that they knew what they were talking about. And one way that that happened was by writing these lengthy reports with tons of justification and data and detail that it turns out probably is not helpful.

Another part of that… Well, so then it kind of goes from there. So we started writing in that way trying to justify all of our findings. There was a functional component. So in the beginning, reports were largely written so that referral sources could provide feedback. So way back when neuropsychologists were not doing [00:07:00] their own feedback sessions in large part. So the reports had to be kind of long and dense we think to help other professionals deliver feedback on behalf of the neuropsychologist, you know, communicating information that they may not be familiar with. So, that was certainly a component. So there was a functional component but there was also a not so functional component as well.

And then it just sort of flowed from there. As it happens in our field, one person was trained that way and practiced that way and it spread to a few other people and then they started training others and then they started training others and so on and so forth until here we are decades later still trying to undo some of those aspects of training now that we’re learning more about what is actually helpful to have in our report. I think there’s also a [00:08:00] component of, you know, in supervision and in grad school, there’s definitely an ethos, I suppose, or a model of just showing your work. Like, you have to communicate how you got to your conclusions. And I’m not going to say that there’s no room for that. I think especially in grad school, it does make sense to communicate to your supervisor, or whoever might be looking at your reports or training you on reports.

You have to communicate your decision-making process and how you came to your conclusions. So there is something to be said for that, but I think it stuck around way too long. Now, in my case, there was definitely no training in grad school specifically on how to write reports by which I mean we got report templates and we were told, this is what they need to look like. In the beginning, I don’t know if this happened for any of y’all, [00:09:00] but we were not even allowed to use templates. We had to handwrite the entire report. Even though there were examples right there, we were literally just copying from the existing reports and typing into our own document, but we couldn’t use templates.

I’m not sure if that was helpful or not. But there was very little training on actually what makes a good report research-wise? What makes a good report? What are people reading? What do we want to communicate? How do we communicate that? And there was certainly no training on how to write well. So, for a lot of us, the “training” was to communicate your findings, sound as intelligent as possible, definitely use as much jargon as you can and stick to those medical terms, and that’ll help you out to gain credibility with your clients and your [00:10:00] training staff. What we know at this point is that none of that is actually helpful and I’m going to be talking about what to do instead.

So I want to talk about literacy a little bit and what we mean by reading level and really just start there with the idea that we are writing way over the heads of nearly everyone who reads our reports. Even graduate-educated individuals, I think we’re still for the most part writing way over their heads.

So when we think about readability or like reading level or literacy, there are a few different types. I’m not going to get in the weeds with each of those, but I will say that [00:11:00] reading level is not a monolithic concept. There are different types of reading levels. For example, there is just being able to understand the words in the report. That is one thing. Then there is a type of literacy that really gets at, can someone pull data from a document and manipulate that data? So being able to read numbers and work with numbers within a document.

So there are different ways to look at literacy. And just know that it’s not just about reading level, but you’re going to likely encounter folks who maybe have a really good say, written comprehension, they can understand the language, but they may not understand the numbers or vice versa. It’s just a very simple example.

The general idea here though is that we most likely aren’t paying any attention to reading level in any regard when we [00:12:00] write our reports and finish our reports. So some of the research out there would say that the average individual is reading somewhere around a 7th maybe 8th-grade reading level. So average individual across folks in the United States. Now again, you can get into the weeds with what those statistics look like, and it, of course, varies a population and so forth. But the idea is that, again, the average individual is going to be reading around a 7th maybe 8th-grade reading level. That is much lower than what we’re writing at.

So, if I’m remembering right, some of the research that I have seen is had that the majority of neuro-psych reports are more around the 12th or 13th-grade reading level. So we are way over the head of [00:13:00] the average person who is reading our reports. And so somehow you might be saying, well, so what, there are definitely people out there who one, can understand the reports. I’m sure some that my audience can understand, and that’s probably true. And most of your audience can probably understand some of your reports. But I think it’s highly unlikely that all of your audience members are understanding the majority of your reports or certainly not all of your reports.

The other important component here is that the research would suggest that people will not tell us if they don’t understand the material. Okay? So I’ll say that one more time. People will not tell us when they don’t understand the material. So in the vast majority of cases, you’re probably riding over people’s heads and you aren’t going to know if they get it or not because [00:14:00] they’re probably not going to tell you.

This is a problem because I’m guessing for the majority of you, you are trying to write reports that are helpful and provide clarity and help answer referrals questions, and send people in the right direction after the evaluation. And if people cannot understand your reports, then you are failing at that. And I am just as guilty as anyone else. It’s been an ongoing process to try to make this better.

So I want to talk about few things that you can do, very specific things just to increase readability. Before I totally dive in here, I do want to say that it’s easy to check your reading the reading level of your reports. There are websites that do that. I provided a [00:15:00] link in the show notes. The readability formulas website will help with that. And you can also do it in Microsoft word. You have to turn it on. It is a feature, but you can turn that feature on and get the reading level of your reports as they’re written and certainly as they’re finished.

So just keep all that in mind as I talk through some of these specifics. The idea is that we’re trying to get our reading level of our reports down as low as possible. Now generally that’s going to be the Flesch-Kincaid reading level. There a lot of different ways to look at it, but just for simplicity’s sake, I think that’s pretty common. And that’s one that is reported in Microsoft word. So everybody should be familiar with that.

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All right, now back to the episode.

So let’s talk about a few things that you can do to simply make your reports easier to read.

One thing I’m sure you’ve all probably heard is don’t use passive [00:17:00] tense. So what this means is you want the individual or the noun to be engaging in an active action. So an example, I think will help bring this to life. A lot of the things that we write in our reports, we write a lot of scores. So a passive sentence would be, a score of 112 was earned by the first name per client. Okay. So I’ll say that one more time. A score of 112 was earned by client. That is a passive sentence. A more active sentence using active tense is, the client scored 112. So it eliminates some words, which is a good thing. And it also eliminates that passive tense which just softens and deflects. [00:18:00] I just think of it as a… it puts a buffer between what you’re trying to say and what you actually say. It just adds a layer of complexity and interpretation that makes it hard for folks to read. So try to write as much as you can in active tense.

Okay. So that’s pretty simple. The other thing with tense is to try to keep your tenses consistent throughout your report. So if you write your history in past tense, like so-and-so reported or so-and-so indicated, or, whatever terms you might use, that’s totally fine. But then making sure that in your interpretation, you might switch over to active tense, sorry, present tense. My goodness. Y’all I’m sorry. I woke up early this morning, way too early. So, using present tense in your interpretation and summary. So, first name [00:19:00] is first name does, that sort of thing.

Okay, we want to avoid jargon. The rationale here is, well, let’s talk about the rationale for using jargon. Some people use jargon because they believe that it makes them sound more intelligent and communicates the findings using words that are more precise, the big words are more specific. And that may be the case sometimes, but my thought is that if you can’t say something simply then you don’t know it well enough. Now, that’s a plagiarized version of a quote from somewhere, but keep that in mind. If you can’t say something simply then you probably don’t have as much of an understanding of that idea as you should.

So stay away from jargon. And the vast majority of cases, I mean, jargon is not going to [00:20:00] impress any like medical personnel, certainly not going to impress parents because in either case it, it is less clear. It requires more work on the individual’s part to even understand what you’re saying. So if our goal again is clear, concise, helpful communication, this is not it. So let go of using. jargon. And if there’s stuff that comes up for you around that, like proving your intelligence or proving you’re good enough or making yourself feel good, I would really question that and allow yourself to wander and experiment with the idea that you can speak simply without sounding “dumb or simple or basic” or anything like that. So that’s another component. Get rid of the jargon as much as you [00:21:00] can.

Another thing that we do, and I don’t know why we do, but we just write too many words. So some common phrases that I thought of that pop up in reports are some things like, the first name is likely to engage in. Okay. Instead of saying, is likely to engage in, just say probably, okay? Keep it simple. Another phrase is something like in the event that first name, Instead of in the event that, just say if. Another is, performed in the average range. Instead of performed in the whatever, just say was average.

So if you start to really get on this, I think you’ll notice that [00:22:00] there are a lot of excess words in your report. So the exercise here I think is to go through any of your recent reports and just read through it with this lens and look for any situations where you are just adding words. Because one of the things that really decreases readability is long sentences. So you want to keep your sentences as short as possible. Two lines is about the max. So, these words eat up a lot of space in a sentence. So as much as you can do to just be direct, keep it short, that’s going to be super helpful for you.

So that’s one thing that we do that really decreases the readability of reports. Now, another thing that really gets in the way of this is, [00:23:00] simply the layout of the report. Now I’m going to be talking next time about what to include in your report. So more content. So here I’m really just talking about layout. Now, when I mean layout, I mean like, what does the report just literally look like when you scan through it? A lot of the time, we have lengthy paragraphs. We have walls of words. They’re very text-heavy. They’re very dense. They’re hard to sort through. They’re overwhelming. So these are just a few things that you can do just layout-wise to break up your reports and make them a little more palatable.

So the first thing is just to think about breaking up your paragraphs. None of your paragraphs should be greater than two inches long on a standard word processor using a standard size font. [00:24:00] So shoot for no more than two inches per paragraph. Put some nice white space between your paragraphs. Put some white space between your headings. Set things off to make them stand out if you want them to stand out. Use formatting like bolding as sparingly as you can, but certainly use it when you need it to set off your headings. Italics is a little harder to read. Underlining is okay. But bold, I think is used sparingly is the most helpful for folks. Make sure to use legible fonts and font sizes, okay? Don’t try to cram too much on the page and please don’t use any crazy fonts that are hard to read. I think most of us are operating in pretty legible fonts, but you may do a Google [00:25:00] search for most legible funds and you might be surprised what pops up.

So I’ve talked about headings. Use headings as much as you can. And some people will even go so far as to write out a table of contents at the beginning of the report. So you can certainly do that as well. But that’s sort of mega use of headings. You could do that. But if you don’t, just make sure to use nice headings throughout the report to help direct people and let them know where they’re at in the report.

And then the last piece with that is with, just with the layout is use bullets whenever possible. Like literally whenever possible. People get lost in the text. So especially if you have something really important that you want to communicate, like say the [00:26:00] diagnoses or primary recommendations or something like that, use bullets whenever you can. I think bullets in the recommendations is one of the most helpful things that we can do. Now, we’ll talk more about that in the next business episode.

The last thing that I want to talk about is just making sure that you are not restating information that you’ve already covered somewhere else in the report.

A big mistake that people make is, or what I’ve seen, and what I’ve certainly done at times is, using the interpretation and summary as just another result section where you’re basically like repeating all the results that you’ve already included elsewhere somehow and putting all that into the interpretation. Again, it just creates a wall of words. It creates long paragraphs and it’s burying the important information that you’re trying to [00:27:00] communicate to people. I also see repeating information from behavioral observations. I am a sort of chronic offender of using the phrase, as noted above or as stated previously.

That to me is always a signal that I need to be saying something different because if I feel the need to repeat that much in a report, I’m probably not structuring it the right way in the first place or focusing on the most important things in that section.

So these are just a few little tricks and tips to keep your reports as readable as possible. I think the biggest thing for a lot of us, I mean, I can give you tips and tricks and there’s tons of great info out there. I linked to some of the articles that I mentioned, The Peer Consult, Dr. Stephanie Nelson- she’s done a lot of writing on writing better reports with [00:28:00] a lot of the source material.

There’s information out there. There’s tips out there. I think the biggest thing that gets in the way, at least for me, and I think this may resonate with some of you as well, is that it’s hard to give up this language, you know, like I, and this ability, this skill. I was rewarded and admired for having a big vocabulary when I was a kid. And as an adult too. I mean, that was something that I took pride in. It was something that set me apart. And it’s really hard to shake that. And related to that is, the way that we write. It got us a long way. It got us to grad school. It got us through graduate school at no point likely that anyone actually said, H”ey, stop doing [00:29:00] that because it’s not helpful.”

So, I just want to put that out there and acknowledge that, that there may be more of an emotional component here than a lot of us may realize or may want to look into. But I know for myself, I had to do a little bit of workaround just letting go of that identity as someone who was  “intelligent” or had a big vocabulary. And I still Harbor fears that writing these simpler reports are going to make me sound too simple, or not intelligent or whatever it might be. I still got to work through that, but the research is pretty clear that we need to be writing shorter, simpler, easier-to-read reports if we truly care about people being able to understand them and use them.

So, like I said, there are a lot of resources [00:30:00] in the show notes. So check those out and play around with some of those links. Start checking the reading level of your reports and see where you’re at. Dr. Beebe talked about how they ran an informal experiment in their hospital just to try to get the reading level down without a whole lot of coaching. And he describes something that I’ve experienced as well over the past year or so in that it is really hard to get the reading level of your reports down without a very deliberate effort. So if it’s hard for you, don’t worry. That’s normal. And keep at it.

All right,  if you have not subscribed or rated the podcast, I would love for you to do either or both of those things.

Thanks for listening as always. We’ll be back with you on Monday with an interview and next Thursday with part two of the report writing series. So take care of, y’all. Talk to you next [00:31:00] time.

The information in this podcast and on The Testing Psychologists website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that [00:32:00] no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

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