Brief Training of Student Clinicians in Shared Decision Making: A Single-Blind Randomized Controlled Trial
- 836 Downloads
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.
KEY WORDSshared 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.
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.
- 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
- 7.Alston C, Paget L, Halvorson G, et al. Communicating with patients on health care evidence. Discussion paper. Washington, DC: 2012.Google Scholar
- 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.
- 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: http://www.lcme.org/publications/functions.pdf Accessed Dec 27, 2013.
- 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
- 28.McKenna K, Tooth L. Client education: a partnership approach for health practitioners. Sydney: UNSW Press; 2006.Google Scholar
- 32.Salzburg statement on shared decision making. BMJ. 2011;342:d1745.Google Scholar