Journal of General Internal Medicine

, Volume 29, Issue 6, pp 844–849 | Cite as

Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial

  • Tammy C. Hoffmann
  • Sally Bennett
  • Clare Tomsett
  • Chris Del Mar
Original Research



Shared decision making is a crucial component of evidence-based practice, but a lack of training in the “how to” of it is a major barrier to its uptake.


To evaluate the effectiveness of a brief intervention for facilitating shared decision making skills in clinicians and student clinicians.


Multi-centre randomized controlled trial.


One hundred and seven medical students, physiotherapy or occupational therapy students undertaking a compulsory course in evidence-based practice as part of their undergraduate or postgraduate degree from two Australian universities.


The 1-h small-group intervention consisted of facilitated critique of five-step framework, strategies, and pre-recorded modelled role-play. Both groups were provided with a chapter about shared decision making skills.


The primary outcome was skills in shared decision making and communicating evidence [Observing Patient Involvement (OPTION) scale, items from the Assessing Communication about Evidence and Patient Preferences (ACEPP) Tool], rated by a blinded assessor from videorecorded role-plays. Secondary outcomes: confidence in these skills and attitudes towards patient-centred communication (Patient Practitioner Orientation Scale (PPOS)).


Of participants, 95 % (102) completed the primary outcome measures. Two weeks post-intervention, intervention group participants scored significantly higher on the OPTION scale (adjusted group difference = 18.9, 95 % CI 12.4 to 25.4), ACEPP items (difference = 0.9, 95 % CI 0.5 to 1.3), confidence measure (difference = 13.1, 95 % CI 8.5 to 17.7), and the PPOS sharing subscale (difference = 0.2, 95 % CI 0.1 to 0.5). There was no significant difference for the PPOS caring subscale.


This brief intervention was effective in improving student clinicians’ ability, attitude towards, and confidence in shared decision making facilitation. Following further testing of the longer-term effects of this intervention, incorporation of this brief intervention into evidence-based practice courses and workshops should be considered, so that student clinicians graduate with these important skills, which are typically neglected in clinician training.


shared decision making evidence-based practice continuing medical education 



The authors thank the students who participated in the study, staff at both universities (Sandy Brauer, Robert Nee, Chrissy Erueti, Charles Leduc, Carina Doyle) who assisted with conducting the trial, and Prof Paul Glasziou (Professor of Evidence-Based Medicine, Centre for Research in Evidence-Based Practice) for his helpful comments on the manuscript.


TH is supported by a National Health and Medical Research Council of Australia (NHMRC)/Primary Health Care Research Evaluation and Development Career Development Fellowship (number: 1033038) with funding provided by the Australian Department of Health and Ageing. The funders had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. No specific funding was received to conduct this trial.

Prior Presentations

This paper was presented at the Cochrane Colloquium in Auckland, New Zealand in October 2012 and at the inaugural International Evidence-Based Health Care Conference in New Delhi, India in October 2012.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2014_2765_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 16.2 kb)


  1. 1.
    Charles C, Gafni A, Whelan T. Decision-making in the physician–patient encounter: revisiting the shared treatment decision-making model. Patient Educ Couns. 1999;49:651–661.Google Scholar
  2. 2.
    Guyatt G, Montori VM. Progress in evidence-based medicine. JAMA. 2008;300:1814–1816.PubMedCrossRefGoogle Scholar
  3. 3.
    Barratt A. Evidence based medicine and shared decision making: the challenge of getting both evidence and preferences into health care. Patient Educ Couns. 2008;73:407–412.PubMedCrossRefGoogle Scholar
  4. 4.
    Légaré F, Ratté S, Gravel K, Graham ID. Barriers and facilitators to implementing shared decision-making in clinical practice: update of a systematic review of health professionals’ perceptions. Patient Educ Couns. 2008;73:526–535.PubMedCrossRefGoogle Scholar
  5. 5.
    Stiggelbout A, Van der Weijden T, De Wit M, et al. Shared decision making: really putting patients at the centre of healthcare. BMJ. 2012;344:e256.PubMedCrossRefGoogle Scholar
  6. 6.
    Barry MJ, Edgman-Levitan S. Shared decision making—the pinnacle of patient-centered care. NEJM. 2012;366:780–781.PubMedCrossRefGoogle Scholar
  7. 7.
    Alston C, Paget L, Halvorson G, et al. Communicating with patients on health care evidence. Discussion paper. Washington, DC: 2012.Google Scholar
  8. 8.
    Elwyn G, Edwards A, Hood K, et al. Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice. Fam Pract. 2004;21:337–346.PubMedCrossRefGoogle Scholar
  9. 9.
    Légaré F, Ratté S, Stacey D, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2010;5:Art. No.: CD006732. DOI:  10.1002/14651858.CD006732.
  10. 10.
    Légaré F, Bekker H, Desroches S, et al. How can continuing professional development better promote shared decision-making? Perspectives from an international collaboration. Implement Sci. 2011;6:68.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Towle A, Godolphin W, Grams G, Lamarre A. Putting informed and shared decision making into practice. Health Expect. 2006;9:321–332.PubMedCrossRefGoogle Scholar
  12. 12.
    Meats E, Heneghan C, Crilly M, Glasziou P. Evidence-based medicine teaching in UK medical schools. Med Teach. 2009;31:332–337.PubMedCrossRefGoogle Scholar
  13. 13.
    Hatala R, Guyatt G. Evaluating the teaching of evidence-based medicine. JAMA. 2002;288:1110–1112.PubMedCrossRefGoogle Scholar
  14. 14.
    Green M. Graduate medical education training in clinical epidemiology, critical appraisal, and evidence-based medicine: A critical review of curricula. Acad Med. 1999;74:686–694.PubMedCrossRefGoogle Scholar
  15. 15.
    Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, et al. Sicily statement on evidence-based practice. BMC Med Educ. 2005;5:1.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Von Fragstein M, Silverman J, Cushing A, Quilligan S, Salisbury H, Wiskin C. UK consensus statement on the content of communication curricula in undergraduate medical education. Med Educ. 2008;42:1100–1107.CrossRefGoogle Scholar
  17. 17.
    Liaison Committee on Medical Education. Functions and structure of a medical school: standards for accreditation of medical education programs leading to the M.D. degree. June 2013. Available at: Accessed Dec 27, 2013.
  18. 18.
    Hauer K, Fernandez A, Teherani A, Boscardin C, Saba G. Assessment of medical students’ shared decision-making in standardized patient encounters. J Gen Intern Med. 2011;26:367–372.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Hoffmann T, Tooth L. Talking with clients about evidence. In: Hoffmann T, Bennett S, Del Mar C, eds. Evidence-based practice across the health professions. Sydney: Elsevier Inc; 2010:276–299.Google Scholar
  20. 20.
    Epstein RM, Alper BS, Quill TE. Communicating evidence for participatory decision making. JAMA. 2004;291:2359–2366.PubMedCrossRefGoogle Scholar
  21. 21.
    Elwyn G, Hutchings H, Edwards A, et al. The OPTION scale: measuring the extent that clinicians involve patients in decision-making tasks. Health Expect. 2005;8:34–42.PubMedCrossRefGoogle Scholar
  22. 22.
    Siriwardena AN, Edwards AG, Campion P, Freeman A, Elwyn G. Involve the patient and pass the MRCGP: investigating shared decision making in a consulting skills examination using a validated instrument. Br J Gen Pract. 2006;56:857–862.PubMedCentralPubMedGoogle Scholar
  23. 23.
    Elwyn G, Edwards A, Wensing M, Hood K, Atwell C, Grol R. Shared decision making: developing the OPTION scale for measuring patient involvement. Qual Saf Health Care. 2003;12:93–99.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.
    Shepherd HL, Barratt A, Trevena LJ, et al. Three questions that patients can ask to improve the quality of information physicians give about treatment options: a cross-over trial. Patient Educ Couns. 2011;84:379–385.PubMedCrossRefGoogle Scholar
  25. 25.
    Krupat E, Rosenkranz SL, Yeager CM, Barnard K, Putnam SM, Inui TS. The practice orientations of physicians and patients: the effect of doctor–patient congruence on satisfaction. Patient Educ Couns. 2000;39:49–59.PubMedCrossRefGoogle Scholar
  26. 26.
    Shaw WS, Woiszwillo MJ, Krupat E. Further validation of the Patient–Practitioner Orientation Scale (PPOS) from recorded visits for back pain. Patient Educ Couns. 2012;89:288–291.PubMedCrossRefGoogle Scholar
  27. 27.
    Krupat E, Yeager CM, Putnam S. Patient role orientations, doctor-patient fit, and visit satisfaction. Psychol Health. 2000;15:707–719.CrossRefGoogle Scholar
  28. 28.
    McKenna K, Tooth L. Client education: a partnership approach for health practitioners. Sydney: UNSW Press; 2006.Google Scholar
  29. 29.
    Sonntag U, Wiesner J, Fahrenkrog S, Renneberg B, Braun V, Heintze C. Motivational interviewing and shared decision making in primary care. Patient Educ Couns. 2012;87:62–66.PubMedCrossRefGoogle Scholar
  30. 30.
    Fallowfield L, Jenkins V, Farewell V, Saul J, Duffy A, Eves R. Efficacy of a cancer research UK communication skills training model for oncologists: a randomized controlled trial. Lancet. 2002;359:650–656.PubMedCrossRefGoogle Scholar
  31. 31.
    Helitzer DL, Lanoue M, Wilson B, De Hernandez BU, Warner T, Roter D. A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication. Patient Educ Couns. 2011;82:21–29.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Salzburg statement on shared decision making. BMJ. 2011;342:d1745.Google Scholar
  33. 33.
    Berkhof M, Van Rijssen H, Schellart AJM, Anema JR, Van der Beek AJ. Effective training strategies for teaching communication skills to physicians: an overview of systematic reviews. Patient Educ Couns. 2011;84:152–162.PubMedCrossRefGoogle Scholar
  34. 34.
    Han P, Joekes K, Elwyn G, Mazor K, Thomson R, Sedgwick P, et al. Development and evaluation of a risk communication curriculum for medical students. Patient Educ Couns. 2014;94:43–49.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Tammy C. Hoffmann
    • 1
    • 2
  • Sally Bennett
    • 2
  • Clare Tomsett
    • 2
  • Chris Del Mar
    • 1
  1. 1.Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and MedicineBond UniversityRobinaAustralia
  2. 2.School of Health and Rehabilitation SciencesThe University of QueenslandBrisbaneAustralia

Personalised recommendations