- Alexander Brown, PhD, Behavioral Science Faculty, NH Dartmouth Family Medicine Residency, Concord, NH
Patient-centered care has become a dominant focus of the clinical interaction, yet related concepts like shared decision making (SDM) are inconsistently practiced. SDM is “a process in which decisions are made in a collaborative way, where trustworthy information is provided in accessible formats about a set of options…and contexts of patients and their families play a major role in decisions.” SDM is associated not only with greater patient satisfaction but also demonstrable improvements in chronic disease self-management, medication adherence, and clinical outcomes. SDM has also been linked in improved health equity: racial and ethnic differences in treatment preferences have been established in the literature and the family/cultural context in which these decisions occur can vary across patient subgroups. Despite the evidence, however, training in SDM often falls short of the highest standard. As a result, understanding of the essential elements of SDM among practitioners can be imprecise. Primary care is one clinical setting in which utilization of SDM is most relevant. Treatment options and healthcare decisions across the lifespan are routinely discussed with one’s primary care provider (PCP). The PCP is responsible for initiating referrals managing medications, suggesting the need to be highly skilled at engaging patients in treatment planning. Organizations that train PCPs therefore have a responsibility to adequately prepare their learners with skills that are commensurate with sound practice of SDM. Nevertheless, some data suggest that providers overestimate their skill level with SDM until they receive specific training in this area. In settings where training occurs, patient-centered communication skills are often described in a didactic format and time for applied practice can be limited. As a component of a larger, multipart training on patient-centered care we designed and implemented an intensive half-day training in SDM for PGY1 family medicine residents. We utilized our institution’s simulation center to forgo a didactic-based approach to training SDM in favor of simulated practice, peer-to-peer observation and feedback, guided reflection, and collaborative scripting. A multidisciplinary team of faculty facilitated. We approached the simulated encounter as a multi-stage interaction; residents performed and observed each stage multiple times, allowing for iterative growth in skill level across multiple trials. This represented a deviation in how we, and others, typically teach and review SDM. This presentation will (1) review the relevant literature as well as evaluate approaches to teaching SDM, (2) describe in detail the program model we developed in order to promote ease of replicability at other institutions, and (3) present preliminary learner evaluation data as compared to previous iterations of SDM training at our program as well as follow-up data assessing continued comfort with the skills covered.
- Accurately define the essential elements of shared decision making as a teachable approach to patient-centered care and improved health equity.
- Describe high yield approaches to training primary care providers in the practice of SDM.
- Discuss local institutional resources at their disposal that may be leveraged in service of enhancing practice of SDM among their providers.