13 General introduction The research team involved, including myself, is dedicated to unraveling the underlying factors contributing to these disparities and identifying pathways to bridge the gap between medical education and SDM’s real-world application. The following overarching research questions are addressed: 1. What are effective approaches to teaching shared decision-making to residents? 2. What factors determine physicians’ engagement (or disengagement) in shared decisionmaking? a. How does physician culture impact shared decision-making use? b. How do individual beliefs, cognitive processes and contextual factors shape the decision to adopt or reject shared decision-making? To address these questions, this thesis adopts a structured format with two distinct segments, each dedicated to addressing one of the two themes outlined subsequently. In Part I, an evaluation of SDM training initiatives tailored for residents is undertaken. In Part II, an exploration into the prevailing determinants influencing physicians’ engagement with SDM is carried out. Outline thesis PART I – Training residents in shared decision-making In Chapter 2, we evaluate the educational quality of interventions to improve residents’ SDM skills. An innovative and comprehensive framework is employed, scrutinizing the influence of training characteristics on the overall educational quality. Chapter 3 presents a pilot study on gathering patient feedback concerning residents’ SDM skills. The chapter also investigates the utility of this collected feedback for reflection and reflective learning. PART II – Exploring determinants of clinician (dis-)engagement in shared decision-making In Chapter 4, an exploration into the relationship between physician culture and SDM is undertaken through the application of a hospital ethnography, interviews, and the utilization of the renowned ‘Theory of Practice’ by French sociologist Bourdieu as a lens to elucidate cultural dynamics. Chapter 5 investigates provider-related attributes concerning SDM in contrast to other tasks. Chapter 6 employs the Diffusion of Innovation theory to uncover underlying beliefs, cognitions, and contextual challenges influencing the decision to adopt or reject SDM. In Chapter 7, the main findings of the dissertation are highlighted and explained. It offers a critical reflection, followed by insights into potential avenues for future research. The chapter also delves into the strengths and limitations of this dissertation and concludes by presenting practice recommendations. 1
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