118 Chapter 7 this approach brings. The third theme underscores the ethical imperative of SDM in the context of providing high-quality patient care, tapping into the core of ‘doing good’ within medical culture. The fourth and final theme addresses SDM’s implementation failure and delves into the lessons that can be learned from this failure. In the subsequent paragraphs, we will explore these themes further. Training: a beneficial tool, not a panacea The perception of training as a universal solution is a misguided notion that assumes the mere provision of a training course guarantees competency. This misconception overlooks our understanding of the hidden curriculum and the significance of informal learning. It fails to recognize that workplace experiences and the dynamics of the social environment often wield greater transformative power than training, especially when conducted in isolation. [3, 7, 8, 19, 20] However, it is important to acknowledge that training plays an essential role in skill acquisition, provided it is approached thoughtfully, considering key factors determining its success. Our studies in Chapters 2 and 3 found general shortcomings in existing SDM training programs when measured against minimum training standards. To better understand and address these issues, we will revisit these findings by applying the four steps of Kolb’s learning cycle, which we introduced in the first chapter of this dissertation. [3] The first step in Kolb’s cycle, the ‘concrete experience’, pertains to experiences with everyday (working) situations. Our review in Chapter 2 revealed that this step was primarily addressed, if at all, through role-play activities during training or by including real-life practice-based scenarios. Regrettably, genuine real-life experiences were seldom integrated into training programs. These findings align with similar observations in other reviews of SDM training that extend beyond training programs for residents alone. [6, 9, 21, 22] However, to harness the potential of workplace learning, it is imperative to move beyond role-play. Training programs should actively involve learners’ communities of practice by addressing actual workplace routines during training. This more thorough incorporation of the workplace could manifest in discussions about SDM application, but even more importantly, as part of workplace-based teaching methods. Furthermore, it is crucial to acknowledge the importance of informal learning and the hidden curriculum once more. Our research findings consistently indicated a lack of attention to SDM and a scarcity of positive recognition for SDM skills in interactions with colleagues. These influential factors significantly hinder the effectiveness of current SDM training initiatives and, therefore, need careful consideration, as depicted in the following steps of the learning cycle. Proceeding to the second and third steps in Kolb’s learning cycle, ‘reflective observation’ and ‘abstract conceptualization’, which entail examining experiences from diverse perspectives and using theories and logic to understand and enhance performance, respectively. Both of
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