Grants and Research Committee Research Annotation May 2012

By Cate Nicholas

Title of Reviewed Work:  Assessment of Medical Students’ Shared Decision Making in Standardized Patient Encounter

Introduction: “Shared decision-making” is defined as “when physician and patients openly explore beliefs, exchange information and reach explicit closure,” and, according to these authors, represents optimal MD-patient communication. While the term “shared decision-making” may be somewhat in vogue currently, the definition, for those of us who teach communication and interpersonal skills, sounds very familiar.   I was intrigued to see if students would employ specific shared decision-making techniques–exchange of feelings and beliefs, exchange of information about disease, diagnosis, and treatment and reach closure–without specifically being directed to do so. 

 Review

Author(s): Karen E. Hauer, MD, Alicia Fernandez, MD, Arianne Teherani, PhD, Christy K. Boscardin, PhD, George W. Saba, PhD.          

Year:     Nov 25th, 2010        

Article:    Assessment of Medical Students’ Shared Decision Making in Standardized Patient Encounter        

Publication:        Journal of General Internal Medicine Volume 26, Number 4, 367-372, DOI: 10.1007/s11606-010-1567-7

Annotation: This retrospective study sought to characterize medical students’ shared decision-making with standardized patients, and determine if students’ use of shared decision-making correlated with SP ratings of their communication skills.   Sixty four 4th year medical student tapes were reviewed in their performance with four SP cases that highlighted conditions likely to prompt decision-making opportunities regarding disease management (hypertension, diabetes, headache and a teen case).  The SPs used a seven-item communication skills check list (listening, rapport building, professional demeanor and addressing the patients perspective and needs) based on the Common Ground Checklist.  The authors used a coding manual and worksheet to look for decision making moments and each of the key dimensions of shared decision-making within a single decision moment: exploration/articulation of perspective (beliefs/values), information sharing and explicit closure. The total number of decision moments overall, by decision topic, was calculated.  Using Spearman rank correlations, a non-parametric test, the association between the number of decision moments and the SP communication scores for each case was examined.  It was found that although students engaged in some shared decision-making, the number of shared decision-making moments per case had limited correlation with the check list communication skills in that the shared decision-making is independent of the other aspects of communication.  It was also observed that students focused their discussion on physician oriented topics rather than patient self-management.  They concluded that shared decision-making seems to involve additional aspects of the interaction and may challenge students to collaborate in care planning in ways not rewarded in typical communication check lists.   They suggested that checklists may need to be revised to add items that would assess shared decision-making behaviors. 

Evaluation:  The authors provided information about the encounters, the standardized patients, and the training materials along with the behavioral measures.

Conclusion:  I am always looking for ways to help my students understand the importance of engaging in the patient’s story first: what they have to tell about what is happening to them and how it affects their life and those around them; what they think is going on and what are they worried about: and how they can work together to solve the problem or work to improve quality of life. I appreciate the authors’ attempts to delineate those characteristics that allow us to observe those behaviors and provide students with specific feedback on improving those skills.  The missing piece here may be the patients’ perspective on behaviors they appreciated and found most effective in shared decision-making moments.

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