Assessment of Medical Students’ Shared Decision-Making in Standardized Patient Encounters

BACKGROUND: Shared decision-making, in which physicians and patients openly explore beliefs, exchange information, and reach explicit closure, may represent optimal physician–patient communication. There are currently no universally accepted methods to assess medical students’ competence in shared decision-making. OBJECTIVE: To characterize medical students’ shared decision-making with standardized patients (SPs) and determine if students’ use of shared decision-making correlates with SP ratings of their communication. DESIGN: Retrospective study of medical students’ performance with four SPs. PARTICIPANTS: Sixty fourth-year medical students. MEASUREMENTS: Objective blinded coding of shared decision-making quantified as decision moments (exploration/articulation of perspective, information sharing, explicit closure for a particular decision); SP scoring of communication skills using a validated checklist. RESULTS: Of 779 decision moments generated in 240 encounters, 312 (40%) met criteria for shared decision-making. All students engaged in shared decision-making in at least two of the four cases, although in two cases 5% and 12% of students engaged in no shared decision-making. The most commonly discussed decision moment topics were medications (n = 98, 31%), follow-up visits (71, 23%), and diagnostic testing (44, 14%). Correlations between the number of decision moments in a case and students’ communication scores were low (rho = 0.07 to 0.37). CONCLUSIONS: Although all students engaged in some shared decision-making, particularly regarding medical interventions, there was no correlation between shared decision-making and overall communication competence rated by the SPs. These findings suggest that SP ratings of students’ communication skill cannot be used to infer students’ use of shared decision-making. Tools to determine students’ skill in shared decision-making are needed. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s11606-010-1567-7) contains supplementary material, which is available to authorized users.