Objectives To revise an existing three-talk model for learning how to achieve shared decision making, and to consult with relevant stakeholders to update and obtain wider engagement. Design Multistage consultation process. Setting Key informant group, communities of interest, and survey of clinical specialties. Participants 19 key informants, 153 member responses from multiple communities of interest, and 316 responses to an online survey from medically qualified clinicians from six specialties. Results After extended consultation over three iterations, we revised the three-talk model by making changes to one talk category, adding the need to elicit patient goals, providing a clear set of tasks for each talk category, and adding suggested scripts to illustrate each step. A new three-talk model of shared decision making is proposed, based on “team talk,” “option talk,” and “decision talk,” to depict a process of collaboration and deliberation. Team talk places emphasis on the need to provide support to patients when they are made aware of choices, and to elicit their goals as a means of guiding decision making processes. Option talk refers to the task of comparing alternatives, using risk communication principles. Decision talk refers to the task of arriving at decisions that reflect the informed preferences of patients, guided by the experience and expertise of health professionals. Conclusions The revised three-talk model of shared decision making depicts conversational steps, initiated by providing support when introducing options, followed by strategies to compare and discuss trade-offs, before deliberation based on informed preferences.

Seventy six senior academics from 11 countries invite The BMJ’s editors to reconsider their policy of rejecting qualitative research on the grounds of low priority. They challenge the journal to develop a proactive, scholarly, and pluralist approach to research that aligns with its stated mission

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English educational legislation in the 1980s and early 1990s occasioned major reforms in the funding and management of post-compulsory educational institutions. Out went largely autonomous Universities, Polytechnics answerable for their actions to local government, and independent Colleges of Higher Education; in came Higher Education Funding Councils and Higher Educational Institutions (HEIs). After legislation in 1992, all were able to call themselves universities. Driving this redefinition of educational realities was a view that higher education had been too long `provider centred' rather than `customer centred', that it had to expand and change to take fully into account the new needs of industry, business and the professions. It had to become a more responsible user of public funds, to demonstrate it was capable of managing them effectively and efficiently, and provide value for money. Higher education had to become `business like'. This article examines one facet of the transformation through which English higher education is still passing. It analyses the Mission Statements which all HEIs have had to produce, to determine in what ways they position the HEIs, represent what they do, and relate them to other participants `in the wider community'.