23 Assessing SDM interventions’ educational quality Introduction There is an ongoing appreciation for patient-centered medicine. Shared decision-making (SDM) plays a crucial role as part of this approach. [1] SDM can be defined as an interactive process in which healthcare professionals and patients collaborate to make informed decisions about the patient’s health. [2] The potential benefits of SDM include reducing overuse, underuse, and misuse of healthcare resources, as well as improving patient satisfaction. [3-5] Furthermore, ethically, SDM is supported by the belief that patients have the right to be informed about available treatment options and should participate actively in decisions regarding their health. [3, 6] Despite the promising prospects of SDM, widespread implementation in routine care is still needed. [6, 7] Various barriers hinder the adoption of SDM, including healthcare professionals’ lack of knowledge and familiarity with the approach. [8, 9] Educational interventions have the potential to overcome these barriers and enhance SDM practice. [10, 11] Particularly noteworthy is the significance of SDM education in medical residency training. Recent research indicates that residents are less likely to engage in SDM compared to more experienced physicians, often favoring paternalistic approaches. [12] Moreover, existing training programs demonstrate poor effects, as there is limited evidence of their impact on trainees’ skills and clinical outcomes. [13] Therefore, a detailed exploration of SDM training for residents becomes of particular interest. These study results are disturbing yet non-surprising. First, it is hard to gain solid evidence of the effectiveness of SDM training programs, as outcome measures are very heterogeneous. [10, 13, 14] Second, intended effects like behavioral and practice change are complex aims, and numerous influences determine their success. [15] Therefore, a comprehensive approach is necessary to evaluate training interventions for residents, extending beyond assessing study outcomes alone. This comprehensive approach encompasses examining the characteristics and content quality of the training interventions. However, established standards for assessing training quality remain elusive, and published descriptions of training interventions often lack precision. For example, many journals do not require a checklist for describing training interventions, despite the availability of several checklists. [16-18] To address these gaps, we have developed a novel approach to evaluating the educational properties of SDM training interventions. Our evaluation framework is based on the outcomes of a comprehensive overview of systematic reviews on the transfer of effective communication skills, which identified minimal criteria for successful skills transfer. [19] Although no validated or published set of criteria exists specifically for SDM interventions, our framework draws from this well-referenced overview, which has been cited in over 100 studies evaluating training initiatives, including those focusing on SDM-related skills. Focusing on a concise set of critical teaching characteristics allows our evaluation framework to better compare previously published interventions, even when they do not meet the publication standards outlined in the earlier mentioned checklists. [16-18] Furthermore, we have incorporated four key SDM training elements in our evaluation framework, derived from leading authors in the SDM literature, to 2
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