Medical Students, Clinical Preventive Services, and Shared Decision-Making

Abstract

Our medical students appear quite willing to accept shared decision making as a skill that they should have in working with patients, and this was the primary focus of the newly implemented module. However, we have learned that students need to deepen their understanding of screening services in order to help patients understand the associated benefits and risks. The final videotaped interaction with a simulated patient about colorectal cancer screening has been very helpful in making it more obvious to faculty what students believe and know about screening for colorectal cancer. As the students are asked to discuss clinical issues with patients and discuss the pros and cons of screening tests as part of the shared decision-making process, their thinking becomes transparent and it is evident where curricular changes and enhancements are required. We have found that an explicit model that allows students to demonstrate a process for shared decision making is a good introductory tool. We think it would be helpful to provide students with more formative feedback. We would like to develop faculty development programs around shared decision making so that more of our clinical faculty would model such a process with patients. Performance-based assessments are resource-intensive, but they appear to be worth the added effort in terms of enhanced skills development and a more comprehensive appraisal of student learning.

Clinical decision-making: physicians' preferences and experiences

“…In pursuit of this goal, there have been efforts to determine the competencies needed for shared decision-making in clinical practice [13,14], along with attempts to teach and assess these competencies in medical students, doctors in training, and senior clinicians [15-19]. …”

Primary health care professionals’ views on barriers and facilitators to the implementation of the Ottawa Decision Support Framework in practice

“…To our knowledge, no previous study has used an existing taxonomy to assess barriers and/or facilitators to the implementation of shared decision making in clinical practice [17][18][19]21,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. This is important because the use of an existing taxonomy will: (1) facilitate the comparison between similar studies, (2) make it possible to carry out a systematic review in this area, (3) help inform policy makers in the implementation of shared decision making, but most importantly, and (4) contribute to the elaboration of a theoretical base for translating shared decision making into clinical practice [55,56].…”

“…Both assessors independently read the written material and identified the unit of text relevant to barriers or facilitators to the implementation of the ODSF in practice. At the time this study was conducted and to the best of our knowledge, there was no taxonomy for assessing barriers and facilitators to the implementation of shared decision making in clinical practice [17][18][19]21,[32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. Therefore, each unit of text was coded according to a pre-established list of codes based on a taxonomy of barriers to the implementation of clinical practice guidelines [28].…”

An Approach to Enhance Communication about Screening Mammography in Primary Care

“…Several approaches have been previously described and have reported success in learners' self-reported understanding of the importance of engaging patients in decision making. [13][14][15][16] Despite these challenges, informed decision making is emphasized in many areas of primary care, including cancer screening. 1,4 For breast cancer screening, most recommendations now call for initiating screening mammography for women beginning at age 40, but encourage clinicians to discuss the benefits and potential harms of screening with their patients and engage them in the decision-making process.…”