134 Addendum English summary Chapter 1 of this thesis provides an introductory overview, offering insights into the PhD student’s academic and professional journey, which profoundly influenced the choice of research subject and perspective. It introduces the concept of shared decision-making (SDM) in healthcare and the challenges in its practical implementation. Within this chapter, the stage is set for the key themes and questions that this thesis endeavors to tackle, emphasizing the considerable divide between the ideals of SDM and its real-world application. The pivotal role that clinicians play in potentially bridging this gap is acknowledged as well. The two principal groups of interest for this research endeavor are introduced: residents, representing junior doctors in medical specialty training at a critical stage of professional identity development, and established medical specialists who epitomize the current state of practice. In the background information section, theories on learning within the medical workplace are explored, emphasizing the shift from classroom-based learning to experiential learning in clinical settings. Notable educational theorists like John Dewey, Malcolm Knowles, and David Kolb are cited, highlighting the importance of experiential and reflective learning. A point is made that achieving the desired learning outcomes, especially in SDM, can be challenging, as informal learning and the hidden curriculum play a significant role. Subsequently, the social environment, culture, and behavior change, as well as the concept of ‘communities of practice’ and their symbiotic relationship with culture, are being introduced as relevant themes. In particular, the profound impact of culture on medical practices is emphasized, necessitating a focus on cultural elements to achieve the desired learning outcomes. The importance of incorporating behavior change theories into the thesis is stressed. Finally, the aims of this thesis are outlined, including identifying effective approaches to teaching SDM to residents and exploring factors that influence physicians’ engagement or disengagement in SDM, particularly the role of physician culture, individual beliefs, cognitive processes, and contextual factors. The thesis structure in two distinct parts is outlined, with Part I focusing on training residents in SDM and Part II exploring determinants of clinician engagement with SDM. Chapter 2 focuses on the evaluation of the educational quality of interventions designed to enhance residents’ SDM skills. It highlights a common issue in which many educational interventions fall short of effectively improving SDM skills and clinical outcomes. The review employs an evaluation framework derived from a previous skills transfer study and a wellknown SDM model to assess training quality. The systematic review, encompassing 26 studies, reveals that role-play and feedback are frequently used in training interventions, but only a small fraction of studies (15%) meets the high educational quality threshold set by the framework. Interestingly, no correlation is identified between the quality of study methodology and the educational quality of interventions. The study emphasizes the need for more comprehensive evaluation frameworks that consider study results, training characteristics, and content to
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