Teaching and mentoring

Training in shared decision-making

A qualitative study explored the perceptions of GPs at a UK Medical school on methods of training in shared decision-making (SDM).
GPs described role-play, receiving feedback and on-the-job learning as modes of training. They suggested training should reflect the uncertainty present when sharing decisions with patients in everyday practice, supported by realistic cases and reflection on experiences.
Implementation of SDM by GPs could be facilitated by explaining the benefits on consultation outcomes and targeting the learning needs of individuals.

Note down clinical encounters where you had to negotiate uncertainty and share decisions with patients. Consider role-playing these scenarios with your GP registrar, or wider team members during mentoring sessions (e.g., practice pharmacist/ physician associate).
Involve your GP registrar in team meetings where uncertainty in clinical decision-making is discussed to encourage reflection on shared decision-making.

Read more about the research informing this GEM here: https://bjgp.org/content/73/729/e310

Studies suggest that despite person centeredness being an aim for medical education, it is not being achieved.
A realist review has found that when educational interventions focus on communication skills learning without person-centred theory, learners can experience dissonance with their biomedical perspective, which they resolve by minimising the importance of the learning.
Educational interventions that apply person-centred theory to meaningful experiences and include support for sense making can help learners understand the relevance of person-centeredness and help them to process their responses to learning. This approach can support understanding of health as a holistic concept and the therapeutic value of listening and empathy, whilst helping learners to critically reflect on their assumptions in relation to patient care and to understand their role in facilitating personalised healthcare.

Lead a tutorial with your GP trainee on person-centred care. After discussing examples of where it has impacted on cases you have managed, consider role-playing a case where a person-centred approach is required to develop understanding of a presentation and/or to negotiate a management plan (e.g. a person presenting with tiredness who has had normal blood tests), with time for reflection afterwards.
Consider signposting GP registrars and other allied healthcare professionals within your multidisciplinary teams to modules 2 and 3 of the WISDOM course for further learning on person-centred care.