PREFERENCES AND PERCEPTIONS OF DECISION-MAKING MODELS BY PERUVIAN MEDICAL STUDENTS

PREFERENCES AND PERCEPTIONS OF DECISION-MAKING MODELS BY PERUVIAN MEDICAL STUDENTS

Purpose:

   To explore attitudes and experiences of Peruvian medical students about preferred and feasible decision making approaches, role modeling and particularly, training in Shared Decision Making.

Method:

   Between November 2012 and January 2013, the authors surveyed senior medical students from 19 teaching hospitals and 4 major cities in Peru. The self-administered questionnaire collected demographic information, perceptions of the pertinence and feasibility of the different decision-making approaches in general as well as in challenging scenarios, and exposure to role modeling and training in SDM.

Result:

   A total of 327 senior medical students were included. The mean age was 25 years (range 22-28), and 51% were females. A large proportion of the students (46%) identified their current decision making approach as physician-as-perfect agent, while 50% perceived that clinical instructors use the paternalistic approach. Most students had positive attitudes toward SDM (53% thought it should be the preferred approach and 50% considered SDM feasible in Peru) although only 9% reported receiving any training in SDM (Graphic). Of 10 challenging scenarios designed to offer opportunities and barriers for the use of SDM, 40% of students chose to apply SDM in only 1 scenario (terminally-ill patients). However, the paternalistic approach was reported preferred by 63%, 54%, and 44% to deal with patients in noisy environments, during brief consultations, and with illiterate patients, respectively.

Students' preferences for practicing participatory styles of decision making and perceptions about its feasibility were both highly significantly associated with the number of scenarios in which they preferred to use a participatory style (p<.001 for both comparisons). Students with preceptors who demonstrated participatory approaches in their practice and students who reported receiving some training in SDM identified more scenarios as appropriate for SDM than other  students (p<.001).

Conclusion:

   Despite limited exposure and training, Peruvian medical students aspire to practice SDM, but their current attitude reflected the less participatory approaches they see role modeled by their preceptors.

Graphic. Students ‘preferred decision- making approach, current attitude and perceived faculties ‘approach