Shared decision making between registrars and patients : web based decision aids

BACKGROUND: Current evidence suggests that doctors do not always involve patients in decisions; this may be due to lack of training. This study explores the feasibility of using web based decision aids (DAs) to improve the skills of general practice registrars in sharing decisions with patients. METHOD: Interviews were conducted with registrars to explore their attitudes to shared decision making. Following an educational intervention, registrars were asked to adopt shared decision making within their consultations using DAs as appropriate. The registrars were interviewed again to explore their experiences and any barriers to the process. RESULTS: Registrars had positive views about the shared decision making process but required more training. They had mixed opinions about the use of DAs and identified several barriers to their use. They felt that they had learned from the project and process without necessarily wanting to pursue the use of DAs as interactive tools, preferring to use them as educational resources

The one minute mentor : a pilot study assessing medical students’ and residents’ professional behaviours through recordings of clinical preceptors’ immediate feedback

Introduction: The assessment of professional development and behaviour is an important issue in the training of medical students and physicians. Several methods have been developed for doing so. What is still needed is a method that combines assessment of actual behaviour in the workplace with timely feedback to learners. Goal: We describe the development, piloting and evaluation of a method for assessing professional behaviour using digital audio recordings of clinical supervisors’ brief feedback. We evaluate the inter-rater reliability, acceptability and feasibility of this approach. Methods: Six medical students in Year 5 and three GP registrars (residents) took part in this pilot project. Each had a personal digital assistant (PDA) and approached their clinical supervisors to give approximately one minute of verbal feedback on professionalism-related behaviours they had observed in the registrar’s clinical encounters. The comments, both in transcribed text format and audio, were scored by five evaluators for competence (the learner’s performance) and confidence (how confident the evaluator was that the comment clearly described an observed behaviour or attribute that was relevant). Students and evaluators were surveyed for feedback on the process. Results: Study evaluators rated 29 comments from supervisors in text and audio format. There was good inter-rater reliability (Cronbach α around 0.8) on competence scores. There was good agreement (paired t-test) between scores across supervisors for assessments of comments in both written and audio formats. Students found the method helpful in providing feedback on professionalism. Evaluators liked having a relatively objective approach for judging behaviours and attributes but found scoring audio comments to be time-consuming. Discussion: This method of assessing learners’ professional behaviour shows potential for providing both formative and summative assessment in a way that is feasible and acceptable to students and evaluators. Initial data shows good reliability but to be valid, training of clinical supervisors is necessary to help them provide useful comments based on defined behaviours and attributes of students. In addition, the validity of the scoring method remains to be confirmed

Shared decision making and decision aids : a literature review

Shared decision making (SDM) is a process within a patient centred consultation that involves both the patient and doctor discussing management options and agreeing on management decisions in partnership. Decision aids are designed to help patients understand the options relating to management for certain conditions and their possible benefits and potential adverse effects. We discuss the evolution and rationale behind SDM and the evidence relating to outcomes, the types of decision aids available, and research relating to their use