Structured reflection on shared decision making

Abstract

Background: Shared decision making (SDM), whereby patients and clinicians work collaboratively to make health care decisions, brings multiple benefits. It has, however, been slow to integrate into clinical practice. There are some examples of SDM being embedded and evaluated within medical undergraduate curricula but, despite role models being important in promoting students’ patient-centred attitudes, these examples do not involve students reflecting on clinicians’ use of SDM in practice. Methods: We undertook a qualitative evaluation of a small group educational intervention. A key element was the students’ use of a structured reflective template, drawing on the SHARE (seek, help, assess, reach, evaluate) SDM tool, to analyse examples of clinicians using SDM in practice critically. We undertook a thematic analysis of students’ completed templates and evaluated their engagement with the SHARE tool. Findings: A total of 44 templates were analysed. Four main themes were identified, including new learning about SDM, noticing and deconstructing SDM, participants’ responses to SDM and struggles in learning. Students were positive about SHARE and used it to critique experiences and suggest specific ways that clinicians could have improved SDM. Discussion: A structured training intervention that promotes critical reflection on clinical role models can help to shift undergraduate medical students’ understanding of, and attitudes towards, SDM. The ethical arguments for SDM, evidence for its benefits and the alignment of SDM with participants’ own core values appeared to help achieve student ‘buy in’. Students struggled with notions of power, risk and time constraints, and empathised with both patients and clinicians. They highlighted the scarcity of SDM in practice.