TRAINING TO IMPROVE DOCTORS' CLINICAL DECISION MAKING: A SYSTEMATIC REVIEW

Purpose: Making decisions well is a key clinical skill. It is unclear what components of medical education enhance doctors’ decision making. This study integrates evidence of interventions designed to facilitate clinical decision making. 

Method: A survey employing a systematic review method of primary empirical studies evaluating interventions to enhance (trainee) doctors’ decision making. Inclusion criteria were; training programmes to enhance clinical decision making related skills, measures of decision making process or outcome, medically trained participants, study design that includes data and comparator group and published in English language. Exclusion criteria; shared or patient decision making, participants not medically trained, case studies or those that report doctors experiences of decision making, training that does not require participants to make decisions themselves, implementation studies of decision support tools and studies to improve technical skills or judgements in interpreting clinical data.  Searches (from 1806 - 2009) were carried out of: electronic databases, Medline, Embase, PsycINFO, Cochrane Library, Web of Science, Cambridge Scientific Abstracts; journals, Medical Decision Making, Medical Education, Quality and Safety in Healthcare; reference lists of included articles. The following data were elicited: journal characteristics; study aim; theoretical framework; doctors’ details; intervention; measures; results; quality of study.

Result: The search strategy identified 96,809 hits, 790 abstracts and 196 articles; 91 met the review criteria.  Most interventions were carried out in North America and Europe within undergraduate curricula. The majority of interventions employed either generic training to improve metacognitive skills and/or techniques to improve a specific skill in one area of application.  Effective interventions comprised of the following common components; information given was specific to and facilitated understanding of the clinical problem, specific techniques taught to help make clinical decisions, opportunity to practice decision making, assessment style appropriately matched learning during study and a delivery mode that that encouraged deep level learning.

Conclusion: There is little evidence of effective decision making interventions being integrated into routine medical training and/or evidence these skills transfer to clinical practice. Those interventions demonstrating some impact on decision making skills provided both generic training on how individuals’ make decisions with application to a specific clinical problem.