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Purpose: During 2002-2003, we implemented the first year of a four-year longitudinal shared medical decision making (SDM) curriculum. We report on the curriculum and evaluate the impact of this course on participants.
Curriculum: The four-year curriculum has ten objectives for students, including shared decision approaches, probabilistic reasoning, clinical utility assessment, and application of expected-utility decision models. In the M1 year, 18 hours of curricular time were devoted to the course, including large-group didactic sessions, small-group case-based sessions, and preceptor-based experiences.
Evaluation: Evaluation tools included an objective test of cognitive skills, an attitude survey about the content and course, summative course evaluations, and two post-course focus groups. One hundred thirteen M1 students and 97 concurrent M2 students not enrolled in the course completed the instruments. Analyses reported here compare students’ (a) cognitive skills, (b) attitudes toward shared decision making, and (c) opinions of the course’s usefulness as a clinician and as a patient, compared with anatomy and behavioral science.
Results: (a) M1 students significantly outperformed M2 students in 9 out of 12 cognitive skills items, and had a significantly higher total correct score. (b) Attitudes about course concepts loaded on three factors, interpreted as: “comfort with quantifying risk and value”, “importance of patient decision participation”, and “importance of physician decision participation”. M1 students felt both patient and physician decision participation were significantly more important than M2 students; there was no difference in comfort with quantification. (c) Both M1 and M2 students rated anatomy as more useful to them as a clinician than behavioral science or SDM; M1 students further rated behavioral science as more useful than SDM. Both groups also rated anatomy as more useful to them as a patient than the other courses; there were no differences between ratings of behavioral science and shared decision making in this context. Course evaluations and focus groups revealed dissatisfaction with course process and conflicting messages about decision making from other M1 courses.
Conclusions: Students were dissatisfied with the first offering of the M1 course, and did not perceive it as useful. Nevertheless, students improved MDM-relevant cognitive skills as compared to peers, and perceived greater roles for patient and physician in decision making. Changes are planned to improve student experiences while maintaining educational impact.
See more of Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)