127 General discussion meticulously analyzed its practical aspects, shifting our focus from theoretical ideals to the complexities of workplace dynamics. In our review, we devised a set of quality indicators to construct a novel evaluation framework for SDM training initiatives. This framework served as a foundational tool for appraising existing training programs and establishing a template for future use. However, it is essential to acknowledge that this framework currently lacks validation, which could impact the precision of our conclusions regarding training effectiveness. Additionally, a substantial portion of our research data was sourced from a single department within a specific medical specialty, raising concerns about the generalizability of our findings. Nonetheless, certain overarching concepts within medical specialties can transcend various hospitals, providing broader relevance. A parallel generalizability concern arises from using qualitative research methods, including ethnographic observations and interviews. We are fully aware that these methods introduce a degree of subjectivity due to researchers’ perspectives. We employed the insider-outsider perspective to mitigate this and collaborated closely with a medical anthropologist. We also maintained a reflexive approach, consistently comparing our findings with previous research results. Despite the inherent subjectivity, these qualitative research methodologies yielded invaluable insights that would have remained undiscovered if we had solely relied on quantitative methods. These insights served as the cornerstone for significant findings in our thesis. This experience underscores the need for a greater appreciation of qualitative research in the medical field, particularly when addressing the development of medical professionalism-related competencies. Table 1: Research methods used in this thesis. Chapter Description of research methods Chapter 2: Assessing the educational quality of shared decision-making interventions for residents: a systematic review Systematic Review: * Development of an evaluation framework for the educational quality of SDM training initiatives, based on a previous study reporting effective training methods, [2] and including four key SDM elements as teaching content. [4] * Conducted a systematic review of current SDM training initiatives for residents, including: - Quantitative evaluation of study quality by calculating and comparing MERSQI scores, [51, 52] and Kirkpatrick levels of evaluation. [53] - Provided a narrative synthesis of descriptive study statistics [continued on next page] 7
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