Can Medical Students Engage Patients in Shared Decision Making When One Choice Is Preparing for End of Life? (Sci213)

• Published in: Journal of pain and symptom management Vol. 65; no. 5; pp. e646 - e647
• Main Authors: McCann, Nicole, Scharnetzki, Liz, Ruben, Mollie, Han, Paul, Hutchinson, Rebecca
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.05.2023
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2023.02.263

1. Describe the competency of medical students at shared decision making when one choice is preparing for end of life. 2. Evaluate whether standardized patients are able to accurately evaluate medical student competency in shared decision making. Shared decision making (SDM) is an important skill that promotes bi-directional sharing of information between patient and clinician. The competency of medical students to engage patients in SDM about end-of-life (EOL) care is unknown. We sought to assess the competency of 4th-year medical students in engaging patients in SDM about EOL care, and the accuracy and reliability of standardized patient (SP) and expert evaluations of students’ SDM performance. Students completed an observed standardized clinical encounter (OSCE) with an SP, depicting a seriously ill patient considering trans-aortic valve replacement (TAVR). The SPs and two trained experts coded video recordings of student conversations using a validated nine-item SDM assessment measure (SDM-Q9). SP rated the students as successfully completing 77% of the elements of the SDM-Q9. However, experts gave lower ratings of students’ SDM performance, with students successfully completing only 58% of the elements on the SDM-Q9 (p< 0.0001). Regarding key elements of effective SDM, trained experts found that fewer than half of students discussed the pros and cons of not pursuing a TAVR, and only 14% of students provided enough information to facilitate comprehension of the decision. Even when prompted by the SPs, few students discussed options for EOL care, beyond the TAVR decision. Medical students lack competency in engaging patients in SDM about EOL care, and could benefit from more training in this skill. SPs appear to overestimate student performance in SDM compared to trained expert coders.