Professional identity and shared decision making among psychiatry residents: designing a brief teaching module

Abstract

Purpose The purpose of this paper is to increase awareness of shared decision making, the initial aim of the study was to understand how psychiatrists-in-training defined themselves as unique among physicians with an eye on how professional identity might shape approach to care. The second aim was to use those definitions and descriptions related to professional identity and tailor a brief training module to promote awareness of the shared decision making model. Design/methodology/approach The authors do this by first conducting focus groups to ascertain how psychiatric residents characterize their professional identity and unique disciplinary characteristics. The authors then designed a brief training session that exploits the relationship between how they define themselves as physicians and how they approach clinical decision making with patients. Findings Three major themes that emerged from the focus group data: the central role of societal and treatment contexts in shaping their professional identity and approaches to care, a professional identity characterized by a great sense of pride, and a strong commitment to systematic decision-making processes in practice. While the assessment of the training module is preliminary and lacks rigor for any generalizability or statements of causality, responses likely affirm the training tailored around professional identity as a possible vehicle for effective exposure to the concept of shared decision making and served as a useful avenue for self-reflection about needed changes to more fully embrace the practice. Research limitations/implications More inquiry may be needed into the association between trust, relationship longevity and power and paternalism, as a way to bring greater insight into the adoption of shared decision making. Future research will have to investigate whether or not including identity-related content is empirically connected to successful training on shared decision making. Likewise, future research should also look at the reciprocal impact of effectively using shared decision making on the affirmation of professional identity among psychiatrists, and indeed all who embrace patient-centered care. Originality/value This is the one of the first papers to investigate issues of professional identity among psychiatry residents, and also among the first papers to consider the relationship between professional identity and use of shared decision making.

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

“…The 10 SDM courses were conducted in a range of countries: seven were from the USA, one from Iran, one from Switzerland and one from Canada. The settings were varied and included specific trainee cohorts such as psychiatry residents,37 surgical residents,38 paediatric inpatient trainees39 and paediatric trainees caring for children with autism and their parents 40. Nine studies37–39 41–46 used a before–after study design.…”

“…The settings were varied and included specific trainee cohorts such as psychiatry residents,37 surgical residents,38 paediatric inpatient trainees39 and paediatric trainees caring for children with autism and their parents 40. Nine studies37–39 41–46 used a before–after study design. One study40 was a quasi-RCT that compared two groups and two interventions, one focussing on SDM and the other on EBP.…”

“…Eight studies reported the use of self-made surveys. Tavarez et al 37 used qualitative evaluation methods, a preintervention focus group to explore psychiatry trainees’ views of professional identity and its relevance to the doctor–patient relationship and a post-SDM training intervention survey that included open-ended questions on the value of SDM to their practice. Studies had a range of objectives that included straightforward skill acquisition,43 to improving awareness and attitudes towards practising EBM37 38 41 45 46 and assessing increased use of SDM following training 38–40 42–45…”

“…Survey or interview feedback was predominantly positive, where participants either intended to practice SDM following training,37 41 or behaviour changes were measured after training using self-reporting techniques38 40 46 and by observers using observation scales to evaluate doctors’ interactions with real or patient actors 38 39 42 43 45. In all studies, an improvement in doctors’ SDM behaviour was noted.…”

Assessment of psychiatrists’ approaches regarding disclosure of psychiatric disorders to their patients: a qualitative study

“…Being incapable and the possibility of abusing psychiatric patients make psychiatrists more cautious in their management. This paternalistic sense can the principle of autonomy to be compromised at the time of hospitalization (13,22).…”