Assessing Skills Improvement from a Shared Decision Making Workshop for Internal Medicine Interns
Fred Amell
Montefiore Medical Center, Department of Internal Medicine
Fred Amell is driven by his passion for risk communication and patient engagement projects. He has developed a novel visual risk communication modality called the “Drill-Down Array”, which is being launched on theNNT.com and MDCalc. He has developed a Shared Decision Making curriculum at Einstein-Montefiore and hopes to refine practice protocols for a new sub-specialty of physicians called “Preference Specialists,” who provide non-directive expert counseling for patients facing high-stakes decisions. He is completing his final year of Internal Medicine Residency at Montefiore and will proceed to further develop his ideas under an HRSA Grant at Dartmouth in conjunction with Glyn Elwyn’s Preference Laboratory.
Abstract
Background: Shared Decision Making (SDM) is a method of doctor-patient communication used in situations where the doctor recognizes a roughly equal trade off of potential harms and benefits, and uses the patient’s... [ view full abstract ]
Background:
Shared Decision Making (SDM) is a method of doctor-patient communication used in situations where the doctor recognizes a roughly equal trade off of potential harms and benefits, and uses the patient’s preferences to determine the correct pathway forward. This approach is endorsed by several professional societies, but difficult to implement in practice. Widespread utilization of SDM is hindered by a lack of training that yields both an appreciable improvement of individual physicians’ SDM skill sets, as well as a corresponding change in daily clinical practice. The workshop utilized in this study targeted novice physicians during the most formative years of their training and used standardized clinical encounters (OSCEs) to train and measure skills improvements.
Methods:
As part of an interactive curricular series geared towards high value care, forty-eight interns in the categorical Internal Medicine Residency Program at Montefiore Medical Center, in groups of 7-10 attended a mandatory 2-hour workshop during their ambulatory block rotation from September 2015 through December 2016. The principles of SDM were reviewed, and implementation was practiced through interactive SDM barrier and problem-solving exercises, and role-playing in a fishbowl configuration where the instructor played the role of patient and interns took turns performing SDM steps. Pre- and post-workshop video-recorded OSCEs were analyzed by an SDM expert blinded to whether the OSCE was obtained pre- or post-seminar. OSCEs were graded using the validated SDM-q9 scoring system and analyzed using paired student t-test.
Results:
Twenty-nine out of 48 (60%) interns who attended the workshop completed both pre and post workshop OSCEs, yielding 58 videos for grading. A 57% increase in SDM proficiency was observed post the workshop intervention (pre- to post-workshop SDM-q9: 28/54 to 44/54, p=0.0001).
Conclusion:
Brief focused SDM workshops utilizing OSCEs can significantly improve SDM skill sets in novice physicians.
Authors
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Fred Amell
(Montefiore Medical Center, Department of Internal Medicine)
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Ross Merkin
(Montefiore Medical Center, Department of Internal Medicine)
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Darlene Lefrancois
(Montefiore Medical Center, Department of Internal Medicine)
Topic Area
Shared decision making and patient-reported outcomes
Session
OS-2 » Oral Presentations: Shared-Decision Making (14:30 - Friday, 5th May, Salons 4 & 5)
Presentation Files
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