Assessment of Medical Students’ Shared Decision-Making in Standardized Patient Encounters

• Published in: Journal of general internal medicine : JGIM Vol. 26; no. 4; pp. 367 - 372
• Main Authors: Hauer, Karen E., Fernandez, Alicia, Teherani, Arianne, Boscardin, Christy K., Saba, George W.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.04.2011; Springer; Springer Nature B.V
• Subjects: Biological and medical sciences; Clinical Competence - standards; College students; Communication; Decision Making; Educational Measurement - methods; Educational Measurement - standards; Female; General aspects; Health education; Health participants; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Original Research; Physician patient relationships; Physician-Patient Relations; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Students, Medical - psychology; medical students; shared decision-making; standardized patient encounters; Human; Medicine; Decision making; Resident (student); Patient; Teaching
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-010-1567-7

BACKGROUND Shared decision-making, in which physicians and patients openly explore beliefs, exchange information, and reach explicit closure, may represent optimal physician–patient communication. There are currently no universally accepted methods to assess medical students’ competence in shared decision-making. OBJECTIVE To characterize medical students’ shared decision-making with standardized patients (SPs) and determine if students’ use of shared decision-making correlates with SP ratings of their communication. DESIGN Retrospective study of medical students’ performance with four SPs. PARTICIPANTS Sixty fourth-year medical students. MEASUREMENTS Objective blinded coding of shared decision-making quantified as decision moments (exploration/articulation of perspective, information sharing, explicit closure for a particular decision); SP scoring of communication skills using a validated checklist. RESULTS Of 779 decision moments generated in 240 encounters, 312 (40%) met criteria for shared decision-making. All students engaged in shared decision-making in at least two of the four cases, although in two cases 5% and 12% of students engaged in no shared decision-making. The most commonly discussed decision moment topics were medications (n = 98, 31%), follow-up visits (71, 23%), and diagnostic testing (44, 14%). Correlations between the number of decision moments in a case and students’ communication scores were low (rho = 0.07 to 0.37). CONCLUSIONS Although all students engaged in some shared decision-making, particularly regarding medical interventions, there was no correlation between shared decision-making and overall communication competence rated by the SPs. These findings suggest that SP ratings of students’ communication skill cannot be used to infer students’ use of shared decision-making. Tools to determine students’ skill in shared decision-making are needed.