Learning effects of an evidence-based shared decision-making curriculum: the co-design and co-produce with clinical teachers, patients, and undergraduate medical students
2College of Medicine, National Cheng Kung University, Tainan, Taiwan
3School of Gerontology and Long-term care, College of Nursing, Taipei Medical University, Taipei, Taiwan
4Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
5Department of Education, Taipei Medical University Hospital, Taipei, Taiwan
Background: Shared decision-making (SDM), a process in which clinicians and patients work together to select treatments based on clinical evidence and the patient’s informed preferences, is the optimal outcome to evaluating evidence-based practice. The Accreditation Council for Graduate Medical Education (ACGME) also included SDM as an essential skill of Competencies Interpersonal and Communication Skills for physicians to provide patient-centered care.
Objectives: This study aimed to codesign and coproduce an evidence-based SDM simulation curriculum with clinical teachers, standard patients (SP), and undergraduate medical students to fulfill the needs of students and patients. We also evaluated students’ learning effects quantitatively and qualitatively.
Methods: We first performed SP focus group interviews to explore patient needs for SDM and then held five consensus meetings using the Delphi method with four representative students, three SP, and four teachers to determine core competencies, teaching objectives, course contents, and learning outcomes; finally, we used a paired t-test to evaluate the progress of students’ SDM skills improvement in objective structured clinical examinations (OSCE) quantitatively, as well as content analyzed the learning effects from students’ interviews and teachers/SP’s focus groups qualitatively.
Results: A total of 122 undergraduate medial students (55% male, mean age 24.2 years) with mean clinical experience of 10.1 months completed the course and pre-/post-OSCE multirater feedback assessments. After training, students’ SDM skills were significantly improved with change scores of 2.8, 9.5, and 7.8 among students, SP, and teachers, respectively. SDM self-efficacy of students and patients, as well as teachers’ ratings of the scores of entrustable professional activities, were also significantly improved. The content analysis of students’ interviews and SP and teachers’ focus groups indicated that the codesign and coproduction of an SDM curriculum with participants’ feedback could facilitate students’ empathy and weaken the medical autonomy mindset, as well as deepen their attitude, knowledge and behaviors of patient-centered care.
Conclusions: To alleviate medical paternalism and facilitate patient-centered care, clinical teachers, medical students and patients must have a voice in developing highly impactful curricula in the healthcare practice. Our codesigned and coproduced SDM curriculum could help improve students’ subjective and objective SDM skills, as well as the SDM self-efficacy quantitatively and qualitatively.