Grants and Research Committee Research Annotation, January 2012

by Cate Nicholas

Author (s): Hauer, K.H., Fernanadez, A., Teherani, A., Boscardin, C.K., & Saba, G.W.        
Year:    2010  
Article:    Assessment of Medical Students’ Shared Decision- Making in Standardized Patient Encounters
Publication:    J Gen Internal Med 26 (4):  367-72    

Annotation: (body)      

I chose this article specifically for the work done on assessing Medical Students Shared Decision Making during Standardized Patient Encounters.  As I contemplate further developing UVM’s communication curriculum and assessment tools, this is an area to focus on.  Research tells us it leads to better patient outcomes and higher patient satisfaction. The NBME has announced changes to the Step 2 CSE exam that will specifically assess our students for “eliciting the patient’s perspective on the diagnosis and next steps,” as one sub function of the communication skills behavior list. Therefore, the relevance of this research to the ASPE community is of great interest.          

 The authors questioned whether students’ shared decision making correlated with SP rating of their communication with a validated checklist.  They chose to do a retrospective observation study of UCSF medical students’ performance with SPs on the California Consortium’s Assessment of Clinical Competency Examination (CPX). A sample of 60 students was randomly selected, and 4 of 8 CPX cases that highlighted medical conditions most likely to prompt decision making opportunities regarding disease management or behaviors were studied.  The student/SP conversations were transcribed and coded for decision moment identification, with each of the key dimensions of shared decision- making within a single decision moment: exploration/articulation of a perspective (beliefs/values), information sharing, and explicit closure, each of which could be done by the student, SP or both.  Shared decision making occurred most often around medications, follow up appointments and diagnostic testing.  Life style changes were discussed less frequently.

Review of the communication skills scores, revealed that although the students did engage in shared decision making moments, there was limited correlation with SP scores.  They surmised there were either shortcomings in the communication tool, or shared decision making involves additional aspects of communication that are complex and variable based on the medical condition. 

The authors suggest that further study is needed to determine how medical students can best engage patient in collaborative care and how educators can measure that interaction with psychometrically sound instruments.   

Comments:

I appreciate the authors’ mixed method approach in using textual analysis for coding the transcripts with quantitative methods for correlations to examine the association between numbers of decision moments and the CPX communication scores for each case.  Information provided within the article along with online Appendices will be valuable aids for subsequent research efforts by other SPeds. The method section is well written and provides adequate information about the SP encounters, standardized patients, training methods and behavioral methods.  This study was funded by a National Board of Medical Examiner’s Stemmler Research Education Research Fund and partly supported by an Arnold P. Gold Foundation Professorship Award.  I look forward to seeing more of their work in the future.

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