A shared decision-making communications workshop improves internal medicine resident skill, risk-benefit education, and counseling attitude

Family medicine residents' perspectives on shared decision-making: A mixed methods study

OBJECTIVES

To 1) examine the willingness of residents to undertake shared decision-making and 2) explore whether the willingness to engage in shared decision-making is influenced by the perceived stakes of a clinical situation.

METHODS

Sequential mixed methods design. Phase One: Family Medicine residents completed IncorpoRATE, a seven-item measure of clinician willingness to engage in shared decision making. Mean IncorpoRATE scores were calculated. Phase Two: We interviewed residents from phase one to explore their perceptions of high versus low stakes situations. Transcripts were analyzed using qualitative content analysis.

RESULTS

IncorpoRATE scores indicated a greater willingness to engage in shared decision-making when the stakes of the decision were perceived as low (7.59 [2.0]) compared to high (4.38 [2.5]). Interviews revealed that residents held variable views of the stakes of similar clinical decisions.

CONCLUSION

Residents are more willing to engage in shared decision-making when the stakes of the situation are perceived to be low. However, the interpretation of the stakes of clinical situations varies.

PRACTICAL IMPLICATIONS

Further research is needed to explore how shared decision making is understood by residents in Family Medicine and when they view the process of shared decision-making to be most appropriate.

Assessing the educational quality of shared decision-making interventions for residents: A systematic review

OBJECTIVES

Many studies on educational interventions to enhance residents' shared decision-making (SDM) skills show limited improvement in SDM skills and clinical outcomes. One plausible explanation for these suboptimal results is the insufficient emphasis on the educational quality of training interventions.

METHODS

This review evaluates interventions' educational quality using an evaluation framework based on a previous study on effective skills transfer and a well-known SDM model. A systematic review was conducted, searching three databases until December 13, 2022. We assessed study quality by calculating MERSQI scores, examined the levels of study effects based on Kirkpatrick's model, and applied our evaluation framework to assess the interventions' educational quality. Given the heterogeneity among the studies, a meta-analysis was not feasible.

RESULTS

Twenty-six studies were included. Role-play and feedback were common training characteristics (65% and 54% of interventions). Only four studies (15%) met our framework's high educational quality threshold. No correlation was found between MERSQI scores and educational quality.

CONCLUSIONS

This review is a valuable attempt to assess the educational quality of SDM interventions beyond measuring study outcomes.

PRACTICE IMPLICATIONS

Future evaluation frameworks should consider study results, training characteristics, and training content. Our framework offers a sound basis for such an evaluation framework.

Using incorpoRATE to examine clinician willingness to engage in shared decision making: A study of Family Medicine residents

OBJECTIVES

We evaluated the willingness of Family Medicine residents to engage in SDM, before and after an educational intervention.

METHODS

We delivered a lecture and a workshop for residents on implementing SDM in preventive health care. Before the lecture (T1), participants completed a measure of their willingness to engage in SDM. Six months later, participants completed the measure a second time (T2).

RESULTS

At T1, 64 of 73 residents who attended the educational session completed incorpoRATE. Six months later, 44 of 64 participants completed the measure a second time (T2). The range of incorpoRATE sum scores at T1 was from 4.9 to 9.1 out of 10. Among the 44 participants who completed incorpoRATE at both time points, the mean scores were 7.0 ± 1.0 at T1 and 7.4 ± 1.0 at T2 (t = -2.833, p = 0.007, Cohen's D = 0.43).

CONCLUSION

Among Family Medicine residents, the willingness to engage in SDM is highly variable. This suggests a lack of consensus in the mind of these residents about SDM. Although mean scores at T2 were significantly higher, we question the educational importance of this change.

PRACTICE IMPLICATIONS

incorpoRATE is a promising measure for educators. Understanding how willing a particular physician audience is to undertake SDM, and which elements require attention, could be helpful in designing more targeted curricula. Further research is needed to understand how the perceived stakes of a clinical situation influence physician willingness to engage in SDM.

Twelve Tips for teaching shared decision making

Shared decision making (SDM) is a process in which preference-sensitive decisions are discussed with patients in a collaborative and accessible format so that patients can select an option that integrates their values and preferences into the context of evidence-based medicine. While SDM has been shown to improve some metrics of quality of care and is now included in many competencies developed by accreditation bodies, it can be challenging to successfully incorporate competencies in SDM into clinical teaching. Multiple interventions and curricula that build competency in SDM have been published, but here we aim to suggest ways to integrate teaching competencies in SDM into all forms of clinical teaching. These twelve tips provide strategies to foster trainee development of the relational and risk-benefit communication competencies that are required for successful shared decision making.