Structured reflection on shared decision making

Rachel Leyland*, Miranda Heath, Hilary Neve, Veronica Maynard

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

<jats:title>SUMMARY</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Shared decision making (<jats:styled-content style="fixed-case">SDM</jats:styled-content>), whereby patients and clinicians work collaboratively to make health care decisions, brings multiple benefits. It has, however, been slow to integrate into clinical practice. There are some examples of <jats:styled-content style="fixed-case">SDM</jats:styled-content> being embedded and evaluated within medical undergraduate curricula but, despite role models being important in promoting students’ patient‐centred attitudes, these examples do not involve students reflecting on clinicians’ use of <jats:styled-content style="fixed-case">SDM</jats:styled-content> in practice.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We undertook a qualitative evaluation of a small group educational intervention. A key element was the students’ use of a structured reflective template, drawing on the <jats:styled-content style="fixed-case">SHARE</jats:styled-content> (seek, help, assess, reach, evaluate) <jats:styled-content style="fixed-case">SDM</jats:styled-content> tool, to analyse examples of clinicians using <jats:styled-content style="fixed-case">SDM</jats:styled-content> in practice critically. We undertook a thematic analysis of students’ completed templates and evaluated their engagement with the <jats:styled-content style="fixed-case">SHARE</jats:styled-content> tool.</jats:p></jats:sec><jats:sec><jats:title>Findings</jats:title><jats:p>A total of 44 templates were analysed. Four main themes were identified, including new learning about <jats:styled-content style="fixed-case">SDM</jats:styled-content>, noticing and deconstructing <jats:styled-content style="fixed-case">SDM</jats:styled-content>, participants’ responses to <jats:styled-content style="fixed-case">SDM</jats:styled-content> and struggles in learning. Students were positive about <jats:styled-content style="fixed-case">SHARE</jats:styled-content> and used it to critique experiences and suggest specific ways that clinicians could have improved <jats:styled-content style="fixed-case">SDM</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Discussion</jats:title><jats:p>A structured training intervention that promotes critical reflection on clinical role models can help to shift undergraduate medical students’ understanding of, and attitudes towards, <jats:styled-content style="fixed-case">SDM</jats:styled-content>. The ethical arguments for <jats:styled-content style="fixed-case">SDM</jats:styled-content>, evidence for its benefits and the alignment of <jats:styled-content style="fixed-case">SDM</jats:styled-content> with participants’ own core values appeared to help achieve student ‘buy in’. Students struggled with notions of power, risk and time constraints, and empathised with both patients and clinicians. They highlighted the scarcity of <jats:styled-content style="fixed-case">SDM</jats:styled-content> in practice.</jats:p></jats:sec>
Original languageEnglish
Pages (from-to)55-61
Number of pages0
JournalThe Clinical Teacher
Volume18
Issue number1
Early online date20 Aug 2020
DOIs
Publication statusPublished - Feb 2021

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