When and how to train GP trainees in shared decision making? The value of self-directed workplace learning and feedback in an integrated educational program.

Background The current call in health care for so-called Shared Decision Making (SDM) demands new and flexible approaches in GP training. We are faced with two educational challenges: 1) How to merge such a new topic as an integrated educational program into the existing curriculum?; 2) How to advance from competencies to actual performance in practice by means of context-sensitive workplace learning? SDM is an interesting case to explore these challenges as it is not a unique clinical behavior but rather a complex clinical approach consisting of a set of clinical behaviors. Within the competency-based integrated educational program we focus on the development of feasible and acceptable feedback tools that enable self-directed learning. In most communication and medical decision making curricula, SDM does not have an explicit place yet. We now face a new era of democratising knowledge, where patients will shift from passive (e.g. by non-adherence to prescriptions) to active involvement in decision making. Although patients are increasingly empowered in this respect, the problem is that SDM suffers from lack of implementation. Education of young professionals is seen as one of the pillars for change. SDM is an approach that entails choice talk, option talk, preference talk, and decision talk. Choice talk refers to the step of making sure that patients are aware that more than one reasonable option is available, including a wait-and-see option, if relevant. Next, option talk refers to providing more detailed information about the options. Preference and decision talk refers to supporting the process of deliberation in considering the preferences and deciding what is best. Aim and research questions To develop a flexible competency-based integrated educational program for SDM, that will be designed in line with the current patient movement initiatives, and with tailoring to the opportunities of local GP training institutes. . 1. What specific competencies are prioritized by stakeholders for training professionals to ensure awareness, knowledge and skills with regard to integrating SDM in daily practice? 2. Given these competencies; what is the current (variation in) baseline level of competencies in 1st and 3rd year GP trainees, and what are relevant needs and barriers for change? 3. What is the preferred format for a flexible competency-based program on SDM education with regard to integration in existing curricula, and timing and dosing of self-directed workplace learning? 4. What are the feasibility and acceptability of a 3rd year training module on SDM, with incorporation of context-sensitive feedback that enables self-directed workplace learning? Workplan This 6-year study has a mixed methods design and consists of four phases: I) Qualitative interviews with 10 experts and modified RAND Delphi consensus procedure with 30 stakeholders to define a common starting position (question 1). II) Observational study among 30 1st and 3rd year trainees and their supervisors with videotaping of consultations and interviews to describe the gap between theory of SDM and practice and the opportunities and barriers for change (question 2). III) Fine tuning of the competencies based on the findings of phase II, and development of a competency-based integrated flexible educational program for SDM, that will include a training, valid context-sensitive assessment tools, and a train-the-trainer module (question 3). IV) Pilot study of the training among 40-60 3rd year trainees and their supervisors with mixed methods evaluation of feasibility and acceptability (question 4). Deliverables 1. Consensus on SDM competencies in Dutch family medicine. 2. Insight in in gap between actual performance and appropriate SDM performance and in opportunities and needs for SDM education in the GP trainee curriculum. 3. Flexible template for integration of SDM education in existing EBM and clinical curricula. 4. A systematically developed SDM communication training module for trainees including assessment tools for valid feedback and self-directed learning, and a train-the-trainer module (for the GP trainee staff and clinical supervisors), tested on feasibility and acceptability, designed according the principles of design-centred research.