12 Chapter 1 participate in authentic tasks, collaborate with others, and acquire both explicit knowledge and tacit understanding intrinsic to the practices of that community. [26] There is a reciprocal connection between communities of practice and culture. While various definitions of culture exist, they generally encompass shared beliefs, values, norms, symbols, practices, and knowledge that shape how individuals within a society perceive and interact with their environment. [14, 27] Culture significantly shapes how individuals interact within their social context, while the social environment, represented by communities of practice, plays a vital role in culture’s formation, transmission, and evolution. [28, 29] This dynamic interplay underscores the profound influence of culture and the social environment as they continually shape and inform each other, emphasizing the bidirectional nature of their influence as they coexist and evolve. Considering culture becomes crucial when contemplating practice change. In this context, the field of medical anthropology stands out as the social science explicitly dedicated to examining the interplay of culture within the field of medicine. Several anthropologists have highlighted the relationship between culture and medical practices, emphasizing how cultural influences shape medical approaches. [30-33] This adds depth to our understanding of the hidden curriculum and informal learning, shedding light on the impact of culture on the practice of medicine and aiding in comprehending current attitudes and behaviors related to SDM. However, it is important to note that understanding these influences does not automatically lead to behavior change. This scenario can be likened to receiving a precise medical diagnosis but still facing uncertainty about the best treatment. Recognizing the substantial influence of the hidden curriculum, it is evident that attaining the desired level of proficiency in SDM practice cannot be solely achieved through the education of residents. The cultural elements that shape junior doctors’ and more experienced clinicians’ social environments must also be addressed, as they significantly contribute to whether the intended learning outcomes are met. Subsequently, it becomes imperative to give due consideration to establishing behavior change. Regrettably, adopting behavior change theory as a guiding framework for changing medical practice tends to be marginalized, often overshadowed by a predominant emphasis on quality improvement models and tools. [34] Integrating these theories in this thesis can significantly enhance our understanding and enable the development of more potent strategies for effecting transformative change within the medical field. Aims of this thesis The persistent gap between teaching desirable skills and their practical application remains a concern. Motivated by these concerns, this thesis explores the intricacies surrounding this issue, with a specific emphasis on the skill of SDM among residents and medical specialists.
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