Teaching Shared Decision Making to Family Medicine Residents: A Descriptive Study of a Web-Based Tutorial

Abstract

BackgroundDECISION+2, a Web-based tutorial, was designed to train family physicians in shared decision making (SDM) regarding the use of antibiotics for acute respiratory infections (ARIs). It is currently mandatory for second-year family medicine residents at Université Laval, Quebec, Canada. However, little is known about how such tutorials are used, their effect on knowledge scores, or how best to assess resident participation.ObjectiveThe objective of our study was to describe the usage of this Web-based training platform by family medicine residents over time, evaluate its effect on their knowledge scores, and identify what kinds of data are needed for a more comprehensive analysis of usage and knowledge acquisition.MethodsWe identified, collected, and analyzed all available data about participation in and current usage of the tutorial and its before-and-after 10-item knowledge test. Residents were separated into 3 log-in periods (2012-2013, 2013-2014, and 2014-2015) depending on the day of their first connection. We compared residents’ participation rates between entry periods (Cochran-Armitage test), assessed the mean rank of the difference in total scores and category scores between pre- and posttest (Wilcoxon signed-rank test), and compared frequencies of each. Subsequent to analyses, we identified types of data that would have provided a more complete picture of the usage of the program and its effect on knowledge scores.ResultsThe tutorial addresses 3 knowledge categories: diagnosing ARIs, treating ARIs, and SDM regarding the use of antibiotics for treating ARIs. From July 2012 to July 2015, all 387 second-year family medicine residents were eligible to take the Web-based tutorial. Out of the 387 eligible residents, 247 (63.8%) logged in at least once. Their participation rates varied between entry periods, most significantly between the 2012-2013 and 2013-2014 cohorts (P=.006). For the 109 out of 387 (28.2%) residents who completed the tutorial and both tests, total and category scores significantly improved between pre- and posttest (all P values <.001). However, the frequencies of those answering correctly on 2 of the 3 SDM questions did not increase significantly (P>.99, P=.25). Distribution of pre- or posttest total and category scores did not increase between entry periods (all P values >.1). Available data were inadequate for evaluating the associations between the tutorial and its impact on the residents’ scores and therefore could tell us little about its effect on increasing their knowledge.ConclusionResidents’ use of this Web-based tutorial appeared to increase between entry periods following the changes to the SDM program, and the tutorial seemed less effective for increasing SDM knowledge scores than for diagnosis or treatment scores. However, our results also highlight the need to improve data availability before participation in Web-based SDM tutorials can be properly evaluated or knowledge scores improved.

The quality of instruments to assess the process of shared decision making: A systematic review

“…Research shows that the occurrence of SDM in routine clinical practice is still limited [ 5 , 6 ]. Current research agenda focuses on studies on the level of SDM seen in clinical care [ 5 ], effects of training and tools for healthcare providers and patients to promote SDM in the clinical practice [ 7 , 8 ], and the effect of SDM on psychosocial and physical patient outcomes [ 9 – 11 ]. The quality of these studies highly depends on the availability of psychometrically sound instruments to assess the actual realization of SDM.…”

Strategies to evaluate healthcare provider trainings in shared decision-making (SDM): a systematic review of evaluation studies

“…Most studies were conducted in the USA (n=9), Germany (n=8) and Canada (n=7). Eleven articles report on studies from Germany,22–32 nine articles report on studies from Canada33–41 and eight articles report on studies from the USA 42–49. Six articles depict one study from the UK50–53 and four articles present studies conducted either multinationally,54 in Australia,55 56 the Netherlands57 58 or Korea 59.…”

“…The majority of included articles (n=27) report on cluster-randomised25–27 29–31 33–36 44 48 50 52 57 58 and randomised22 23 30 31 37 38 42 45 46 50 54 55 controlled trials. Further articles report on one controlled59 and seven non-controlled24 32 39 41 43 56 60 before-after studies, three qualitative40 51 53 and three post-test28 47 49 studies. Most articles (n=34) report on the evaluation of physician trainings,22–25 28–33 35 36 39–46 48–58 60 two articles report on trainings for nurses38 59 and five articles report on trainings for diverse HCPs 26 27 34 37 47.…”

“…Further articles report on one controlled59 and seven non-controlled24 32 39 41 43 56 60 before-after studies, three qualitative40 51 53 and three post-test28 47 49 studies. Most articles (n=34) report on the evaluation of physician trainings,22–25 28–33 35 36 39–46 48–58 60 two articles report on trainings for nurses38 59 and five articles report on trainings for diverse HCPs 26 27 34 37 47. Overall, identified articles report on HCP samples ranging from 6 to 306, and n=25 articles22 23 25 27 29–36 40 42 44 48 50–52 54 55 57 58 report on the use of patient samples ranging from 38 to 1120.…”

“…Of the 22 articles that met the minimum score, 7 reported on randomised controlled trials,22 30 31 37 38 42 55 12 on cluster-randomised controlled trials25 29 33 35 36 44 48 50 52 57 58 and 3 reported on qualitative studies 40 51 53. Looking in detail at the 16 articles23 24 26 27 32 34 39 41 43 45 46 50 54 56 59 60 that did not meet the minimum score, most of them failed to meet criterion 3E (blinded assessment of primary outcome), 3F (reliable primary outcome measures) and 7D (free of other bias). For detailed results regarding ICROMS criteria, see online supplementary file S3.…”