An Innovative Shared Decision-Making Curriculum for Internal Medicine Residents: Findings From the University of Pittsburgh Medical Center

Rusiecki, Jennifer; Schell, Jane O.; Rothenberger, Scott D.; Merriam, Sarah; McNeil, Melissa; Spagnoletti, Carla

doi:10.1097/acm.0000000000001967

Cited by 37 publications

(34 citation statements)

References 30 publications

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“…Simulation‐based training in SDM improved skills of senior residents and general practitioners . In another study with simulated patients, doctors who smiled the most, greeted and regarded the patient warmly were those who were the most positively endorsed by the patient/actor .…”

Section: Tools and Simulation‐based Training To Promote Sdmmentioning

confidence: 93%

“…Simulation exercises, with reflection and feedback on listening skills, may help manage physician's overconfidence, which, as discussed earlier, interferes with optimal SDM. 88,89 Simulation-based training in SDM improved skills of senior residents 90 and general practitioners. 91 In another study with simulated patients, doctors who smiled the most, greeted and regarded the patient warmly were those who were the most positively endorsed by the patient/actor.…”

Section: Tools and Simulation-based Training To Promote Sdmmentioning

confidence: 99%

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Meaningful shared decision‐making: complex process demanding cognitive and emotional skills

Stalnikowicz

Brezis

2020

Evaluation Clinical Practice

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Background Shared decision‐making (SDM) takes place when clinicians help patient identify best course of action in the context of their preferences. Methods The aim of this paper is a narrative review of the literature with special focus on the humanistic dimensions of SDM. Results We show that SDM is largely underused in practice, because of many barriers such as time constraints and poor skills. Conclusions We suggest that listening and empathy are key challenges in communicating uncertainty, which require emotional intelligence and trust building skills. To promote implementation, we propose the development of tools, simulation‐based training and the design of improved measures for SDM quality. While essential for patients, we believe that SDM may restore meaning in healthcare.

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Section: Tools and Simulation‐based Training To Promote Sdmmentioning

confidence: 93%

Section: Tools and Simulation-based Training To Promote Sdmmentioning

confidence: 99%

Meaningful shared decision‐making: complex process demanding cognitive and emotional skills

Stalnikowicz

Brezis

2020

Evaluation Clinical Practice

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“…Of the 27 selected reports, 18 studies measured perceived confidence in or comfort with performing certain tasks. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] Six studies measured competency or ability, 10,13,[22][23][24][25] two studies measured readiness, 9,16 and five studies e92 lacked sufficient detail to determine what they used. [26][27][28][29][30] Measuring one's willingness to perform a task or one's confidence helps promote reflection of performance 3 but is not the most effective method of evaluating learning or performance.…”

Section: E91mentioning

confidence: 99%

“…According to our analysis, five studies had not used any pre-intervention assessments at all. 5,10,18,22,28 Eighteen studies administered pre-post self-assessments, 4,[6][7][8][9][12][13][14][15][16][17]19,21,23,25,27,29,30 whereas only three studies employed post-intervention retrospective pre-test selfassessments. 11,24,26 One study had employed both pre-intervention pre-test and post-intervention retrospective pre-test self-assessments.…”

Section: E91mentioning

confidence: 99%

Black Ice: Five ways to get a grip on grouped self-assessments of competence for program evaluation

Zhao

D’Eon

2020

Can. Med. Ed. J

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Self-assessments conducted by individuals when taken together (grouped) provide valid and accurate measures of learning outcomes of the group. This is useful for program evaluation. Grouped self-assessments are simple to understand and construct, easy to implement, relatively accurate, and do not require extensive and complex pre-post testing measures. However, group self-assessments have the potential to be misused. To examine how group self-assessments have been used in medical education, we conducted a search of journal articles published in 2017 and 2018 from eight prominent medical education journals. Twenty-seven (n=27) articles that used self-assessments for program evaluation were selected for data extraction and analysis. We found three main areas where misuse of self-assessments may have resulted in inaccurate measures of learning outcomes: measures of “confidence” or “comfort”, pre-post self-assessments, and the use of ambiguous learning objectives. To prevent future misuse and to build towards more valid and reliable data for program evaluations, we present the following recommendations: measure competence instead of confidence or comfort; use pre-test self-assessments for instructional purposes only (and not for data); ask participants to do the post-intervention self-assessments first followed by retrospective pre-intervention self-assessments afterwards; and use observable, clear, specific learning objectives in the educational intervention that can then be used to create the self-assessment statements.

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“…From the literature, we selected factors for attitudes, subjective norm and perceived behavioural control that are associated with SDM behaviour (Alguera-Lara et al, 2017;Farrelly et al, 2016;Geiger, Liethmann, Reitz, Galalae, & Kasper, 2017;Gravel et al, 2006;Rusiecki et al, 2018;Sanders et al, 2017). All listed authors were consulted, and a selection from these factors was made for the items of the questionnaire.…”

Section: Measurementmentioning

confidence: 99%

Experienced barriers in shared decision‐making behaviour of orthopaedic surgery residents compared with orthopaedic surgeons

Bossen

Driessen

Heyligers

2019

Musculoskeletal Care

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IntroductionIn shared decision‐making (SDM), physicians encourage the patient to participate in the care process. The theory of planned behaviour describes that behaviour is dependent on intention. In its turn, intention is explained by attitude, subjective norm and perceived behavioural control. In orthopaedics, little is known about current SDM behaviour and how to promote it.The aim of the present study was to gain insight into the SDM behaviour of orthopaedic residents and supervisors by measuring levels of intention, attitudes, subjective norms and perceived behavioural control. Furthermore, we aimed to determine the predictors of intention for SDM.MethodsA questionnaire survey study was conducted among orthopaedic surgeons and residents working in the care of hip and knee osteoarthritis, to determine their intentions, attitudes, subjective norms and perceived behavioural control regarding SDM.ResultsOf the 385 physicians approached, 71 residents and 64 orthopaedic surgeons participated. Residents and the supervisors alike had positive intentions regarding SDM. Intention for SDM behaviour was explained by attitude, subjective norm and perceived behavioural control, with perceived behavioural control having the strongest association. In residents, the intention to engage in SDM was more hampered by a lower level of perceived behavioural control than in surgeons.ConclusionsPhysicians are willing to perform SDM and consider SDM as favourable in the orthopaedic clinic. The implementation of SDM is mainly hampered by experienced barriers that they cannot control. These findings underline the importance of incorporating SDM in the curriculum of postgraduates. Possibilities for efficient SDM implementation should be explored, to overcome perceived barriers.

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An Innovative Shared Decision-Making Curriculum for Internal Medicine Residents: Findings From the University of Pittsburgh Medical Center

Abstract: SDM is teachable, and this skill-based curricular intervention resulted in improvement in senior medicine residents' knowledge of, attitudes toward, and demonstration of SDM skills.

Cited by 37 publications

References 30 publications

Meaningful shared decision‐making: complex process demanding cognitive and emotional skills

Meaningful shared decision‐making: complex process demanding cognitive and emotional skills

Black Ice: Five ways to get a grip on grouped self-assessments of competence for program evaluation

Experienced barriers in shared decision‐making behaviour of orthopaedic surgery residents compared with orthopaedic surgeons

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