Abstract
Despite the wide endorsement of shared decision making (SDM), its integration into clinical practice has been slow. In this paper, we suggest that this integration may be promoted by teaching SDM not only to residents and practicing physicians, but also to undergraduate medical students. The proposed teaching approach assumes that SDM requires effective doctor–patient communication; that such communication requires empathy; and that the doctor’s empathy requires an ability to identify the patient’s concerns. Therefore, we suggest shifting the focus of teaching SDM from how to convey health-related information to patients, to how to gain an insight into their concerns. In addition, we suggest subdividing SDM training into smaller, sequentially taught units, in order to help learners to elucidate the patient’s preferred role in decisions about her/his care, match the patient’s preferred involvement in these decisions, present choices, discuss uncertainty, and encourage patients to obtain a second opinion.
Highlights
Since the 1970s, there has been a growing recognition of patients’ right to participate in decisions about their care, and many countries have legislated for patients’ informed consent to medical interventions
We propose an shared decision making (SDM) training program based on the view that, similar to patientcentered care, learning SDM may be improved if (a) it is included in undergraduate medical education, rather than offered to residents and practicing doctors only;[11] and (b) its teaching emphasizes the ability of learners to understand patient concerns
SDM training of undergraduate students should have more of an impact than teaching programs for residents and practicing doctors, just as the inclusion of training for patient-centered care into the undergraduate medical curriculum has led to patient-centeredness in about half of doctor–patient encounters.[6,7]
Summary
Since the 1970s, there has been a growing recognition of patients’ right to participate in decisions about their care, and many countries have legislated for patients’ informed consent to medical interventions. These developments promoted a shared decision making (SDM) consultation style, whereby patients convey their knowledge, concerns, and wishes about their problem, while doctors provide explana-. We propose an SDM training program based on the view that, similar to patientcentered care, learning SDM may be improved if (a) it is included in undergraduate medical education, rather than offered to residents and practicing doctors only;[11] and (b) its teaching emphasizes the ability of learners to understand patient concerns
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