Links between evidence-based medicine and shared decision-making in courses for doctors in training: a scoping review

Abstract

ObjectivesThis scoping review aims to synthesise the current evidence on the inclusion and effectiveness of integrating evidence-based medicine (EBM) and shared decision-making (SDM) into training courses for doctors in training to enhance patient care. Both EBM and SDM appear to be taught separately and their combined role in providing high-quality patient care has not yet been explored.DesignScoping review of literature from January 2017 to June 2021.SettingAny setting where doctors in training could undertake EBM and/or SDM courses (hospitals, universities, clinics and online).ParticipantsDoctors in training (also known as junior doctors, residents, registrars, trainees, fellows) defined as medical graduates undertaking further training to establish a career pathway.MethodsSearches were conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of included articles and their cited references were hand searched and assessed for inclusion. Included studies described training and outcomes of either EBM, SDM or both. Reported outcomes included EBM knowledge and skill tests, attitude surveys, SDM checklists and surveys and patient and doctor experience data obtained from surveys, focus groups and interviews.ResultsOf the 26 included studies, 15 described EBM training courses, 10 described SDM training courses and 1 course combined both EBM and SDM. Courses were heterogeneous in their content and outcomes, making comparisons difficult. EBM courses prioritised quantitative outcome assessments and linked knowledge and skills, such as critical appraisal, but overlooked other key elements of patient-centred care including SDM.ConclusionsSDM and EBM are taught separately in most training courses. The inclusion of SDM, evaluated by qualitative assessments, is currently omitted, yet could provide a more person-centred care focus in EBM courses and should be investigated to increase our knowledge of the effectiveness of such courses and their role in improving doctors’ skills and patient care.ProtocolA protocol for this review has been published and contains further details of the methodology.

Evidence-Based Medicine Course in Combination With Journal Clubs to Promote Evidence-Based Surgery

“…In addition, integrating shared decision-making into the EBM course can add a more person-centered care focus that would provide more clinical balance to the program. [ 25 , 26 ].…”

Determining the Development Strategy and Suited Adoption Paths for the Core Competence of Shared Decision-Making Tasks through the SAA-NRM Approach

“…The approach of EBM involves five fundamental steps: ask, acquire, appraise, apply, and assess. The role of SDM could be noted within step 4 (apply) of the EBM process [ 29 ]. Using the best evidence to guide patient care receives little attention.…”

“…It is appropriate to initiate SDM for patients with uncertain prognosis or when there is difficulty determining between options [ 8 ]. Physicians agree to use an evidence-based approach for SDM implementation and have basic knowledge of evidence-based medicine as a specific element of the SDM process [ 29 ]. In short, conception and evaluation are core competencies needed to use SDM.…”

Establishing the Competency Development and Talent Cultivation Strategies for Physician-Patient Shared Decision-Making Competency Based on the IAA-NRM Approach

“…The evidence-based approach combines individual clinical expertise with the best available external evidence. The physician could agree with specific elements of SDM supported by evidence-based medicine [ 37 ]. In short, physicians’ SDM perceptions are one of the core competencies necessary to promote SDM.…”

“…SDM lets physicians use evidence-based information while positioning the patient (and, when suitable, family members) at the center of clinical decisions. Training in SDM skills is part of evidence-based practice [ 37 ]. So, physicians should have the skills and execution needed to perform SDM.…”