116 Chapter 7 interventions fail to meet the fundamental requirements for experiential and reflective learning. The framework we developed and employed in Chapter 2 review provides a robust foundation for creating and validating an educational framework to be used to design and evaluate future training initiatives. Patient feedback could be a valuable component of SDM training for residents. However, it should be part of a structured initiative combined with facilitated reflections to foster actual reflective practice and yield meaningful learning outcomes. 2. Factors determining physicians’ (dis-)engagement in SDM In the general introduction (Chapter 1), we explored the intricate relationship between culture and the social environment in the context of physician engagement in SDM. In Chapter 4, we employed the sociological framework of Pierre Bourdieu, leveraging concepts such as habitus, field, and capital, to unravel the intricacies of physician culture. [13] Notably, habitus, which encapsulates physicians’ individual views, beliefs, and actions within the social context in which they operate, served as a valuable concept for describing and understanding the nuances of physician culture. Our analysis revealed three pivotal elements that negatively impacted the use of SDM: (1) a consistent emphasis on medical evidence, (2) a team-based approach that overshadowed patient preferences, and (3) a tendency to assume what patients wanted rather than seeking their input. Results were viewed in the light of how physicians deal with uncertainty by turning to medical evidence, which is strongly emphasized throughout both physicians’ medical training and medical practice. [14] We looked at what doctor-related factors determined whether physicians adopted or rejected SDM. We conducted an ordinal preference elicitation study, as described in Chapter 5, which suggested that SDM might contribute to lower job satisfaction among clinicians compared to other medical tasks. This dissatisfaction might be related to SDM’s perceived complexity, although we were unable to definitively confirm the correlation between perceived complexity and diminished job satisfaction. In Chapter 6, we designed and applied a change theory framework to analyze the same Obstetrics and Gynecology department we had previously studied, [15] as we used previous ethnographic and interview data from the studies described in Chapters 3 and 4 and conducted extra interviews to fill our framework. Chapter 6 confirmed that perceived complexity is an important factor in doctors’ decisions to either adopt or reject SDM. Our analysis in Chapter 6 exhibited further insights into why individual clinicians resist SDM engagement. A crucial overarching reason might be the incongruences between SDM and existing practices or beliefs, causing cognitive dissonance within potential adopters. This cognitive dissonance, the psychological discomfort stemming from conflicting beliefs, is crucial in clinicians’ decisions to embrace or reject SDM principles. [16] We argued that addressing these concerns and dissonances through open discussions and reflective practices is crucial for successful SDM implementation. [17] The significance of these reflections was amplified for more experienced practitioners, as reflective practice and subsequent practice change tend to decline with increased experience, necessitating intensified efforts to promote reflective thinking. [18]
RkJQdWJsaXNoZXIy MTk4NDMw