A RANDOMISED TRIAL OF TRAINING STUDENT CLINICIANS IN HOW TO FACILITATE SHARED DECISION MAKING AND COMMUNICATE EVIDENCE: IS THIS THE IGNORED STEP IN EVIDENCE-BASED PRACTICE?

   Purpose: Successful evidence-based practice requires clinicians to practice patient-centred care. Central to this is shared decision making; of which, a key skill is communicating evidence clearly to patients. Many clinicians do this poorly, if at all. One reason is lack of training: evidence-based practice courses and workshops typically do not include these skills. Teaching these skills to student clinicians during evidence-based practice training may be valuable, but methods for doing this have not been evaluated. This study aimed to evaluate, in a multi-site randomised trial, the effectiveness of a brief intervention designed to increase student clinicians’ ability to facilitate shared decision making and evidence communication.   

   Method: Medical, physiotherapy and occupational therapy undergraduate, honours, and postgraduate students (n=107) were randomly allocated to an intervention or control group. Intervention group participants received brief training in shared decision making and evidence communication skills. At baseline and post-intervention, participants performed role-plays which were videorecorded and evaluated by a blinder assessor. The primary outcomes were shared decision making and evidence communication skill, measured using the Observing Patient Involvement (OPTION) scale (range 0-100) and selected items from the Assessing Communication about Evidence and Preferences (ACEPP) Tool (range 0-5).  Secondary outcome measures were confidence in these skills (11-item visual analogue scale) and attitudes towards patient-centred communication (Patient Practitioner Orientation Scale (PPOS), which participants completed as a questionnaire. 

   Result: Post-intervention, intervention group participants scored significantly higher on the OPTION scale (mean between-group difference = 19.2, 95% CI 12.3 to 26.0), ACEPP items (difference = 1.0, 95% CI 0.5 to 1.4), confidence measure (difference = 13.3, 95% CI 7.3 to 19.4), and the Sharing subscale of the PPOS (difference = 0.5, 95% CI 0.2 to 0.7). The between-group difference for the Caring subscale of the PPOS was not significant.

  Conclusion: This brief intervention was effective in improving student clinicians’ ability, attitude toward, and confidence in shared decision making facilitation. Following further testing of the longer-term effects of this intervention, incorporation of this brief intervention into evidence-based practice courses and workshops should be considered so that student clinicians graduate with these important skills, which are typically neglected in clinician training, yet crucial to the uptake of shared decision making.