How to assess decision-making capacity
Other platforms explain it with text and video. In VMS you practice it on the patient.
Capacity is judged for each decision, not for the whole person. Every clinician should be able to assess it at the bedside.
Step by step
Define the decision
Be clear about which decision is being made, its risks and its options. [1]
Remove barriers
Treat pain, low oxygen or low sugar if you can, and use hearing aids, glasses or an interpreter. [1]
Check understanding
Ask the patient to explain the condition and the options in their own words. [1]
Check appreciation
Ask how it applies to them, for example what they think will happen without treatment. [1]
Check reasoning
Ask how they weighed the options and why they chose as they did. [1]
Check for a clear choice
See if they can state a choice and keep it steady. [1]
Match the bar to the risk
Riskier decisions need clearer capacity. Document your findings and, if capacity is lacking, find the legal decision-maker. [1]
Common errors
- Assuming a patient lacks capacity just because they refuse.
- Relying on a memory test score alone.
- Not reassessing when the patient's condition improves.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- AAMC Core Entrustable Professional Activities (Core EPAs)
- AHRQ Health Literacy Universal Precautions Toolkit (Teach-Back)
Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); AHRQ Health Literacy Universal Precautions Toolkit (Teach-Back). VMS is not affiliated with these organizations. Updated: 2026-10-11.