The Role of Education in the Implementation of Shared Decision Making in Emergency Medicine: A Research Agenda

Abstract

Shared decision making (SDM) is a patient-centered communication skill that is essential for all physicians to provide quality care. Like any competency or procedural skill, it can and should be introduced to medical students during their clerkships (undergraduate medical education), taught and assessed during residency training (graduate medical education), and have documentation of maintenance throughout an emergency physician's career (denoted as continuing medical education). A subgroup representing academic emergency medicine (EM) faculty, residents, content experts, and patients convened at the 2016 Academic Emergency Medicine Consensus Conference on SDM to develop a research agenda toward improving implementation of SDM through sustainable education efforts. After developing a list of potential priorities, the subgroup presented the priorities in turn to the consensus group, to the EM program directors (CORD-EM), and finally at the conference itself. The two highest-priority questions were related to determining or developing EM-applicable available tools and on-shift interventions for SDM and working to determine the proportion of the broader SDM curriculum that should be taught and assessed at each level of training. Educating patients and the community about SDM was also raised as an important concept for consideration. The remaining research priorities were divided into high-, moderate-, and lower-priority groups. Moreover, there was consensus that the overall approach to SDM should be consistent with the high-quality educational design utilized for other pertinent topics in EM.

Clinical outcomes after shared decision‐making tools with families of children with obstructive sleep apnea without tonsillar hypertrophy

“…On a societal level, SDM has been shown to reduce unnecessary care and decrease the possibility of harm; it may also reduce healthcare costs . Although this collaborative process has been widely discussed and documented in a broad spectrum of medical and surgical specialties, research assessing its use in otolaryngology is scant and has been identified as a gap in knowledge …”

A Qualitative Analysis of Attending Physicians' Use of Shared Decision-Making: Implications for Resident Education

“…6 Despite the widespread promotion of SDM, implementation remains challenging, and there is no consensus on how to teach and foster SDM skills in trainees. [7][8][9] Prior studies across multiple specialties have demonstrated that interventions to teach SDM skills can be both necessary and effective. [10][11][12][13][14] However, for SDM to be integrated into routine clinical care, those skills need to be taught and modeled routinely during training.…”

“…[10][11][12][13][14] However, for SDM to be integrated into routine clinical care, those skills need to be taught and modeled routinely during training. 9 While residency programs have been reevaluating how physicians-in-training can gain the necessary skills for SDM, little is known about how contextual factors of residency or the perspectives of attending physicians affect residents' opportunities to practice these skills. 15,16 Little research exists regarding barriers residents face in learning SDM skills, and several studies report lack of formal education, lack of familiarity with SDM as a concept, and lack of feedback on communication skills.…”

A shared decision‐making tool for obstructive sleep apnea without tonsillar hypertrophy: A randomized controlled trial

“…Additionally, SDM has been shown to reduce unnecessary care, decrease the possibility of harm, and may also reduce healthcare costs . Although this collaborative process has been widely discussed and documented in a broad spectrum of medical and surgical specialties, research assessing its use in otolaryngology is scant and has been identified as a gap in knowledge …”

“…6 Additionally, SDM has been shown to reduce unnecessary care, decrease the possibility of harm, and may also reduce healthcare costs. 7 Although this collaborative process has been widely discussed and documented in a broad spectrum of medical and surgical specialties, 3,[8][9][10][11][12][13] research assessing its use in otolaryngology is scant and has been identified as a gap in knowledge. 2,14,15 One of the ways in which SDM is implemented into clinical practice is through the use of shared decisionmaking tools (SDMTs) to evaluate possible treatment options on individual patients.…”