25 Assessing SDM interventions’ educational quality Following this search, we utilized Covidence, a secure online data management program, for article upload and rating tracking. [23] The data management program removed duplicates. The eligibility of the studies was checked independently and in duplicate by two researchers (LS, JA) in two rounds, starting with the title and abstract and followed by full-text screening. Articles that did not match the eligibility criteria were excluded. Any discrepancies between the researchers’ judgements were discussed until they reached an agreement. Duplicates were removed. Two researchers (LS, JA) independently assessed study eligibility in two rounds: title/abstract screening and full-text screening. Non-eligible articles were excluded. Discrepancies were resolved through discussion. Manual reference list searches and reviews of related systematic reviews yielded no new results. [1, 13, 14, 24, 25] Data extraction and synthesis The extracted data were recorded on a predefined data extraction sheet, which was developed and pilot-tested by the two researchers (LS, JA) responsible for the extraction process. Only published data were utilized for the purpose of data extraction and subsequent analysis. A comprehensive list of the items from our data extraction sheet is detailed in Appendix B. Quality assessment We conducted assessments of both the study quality and the quality of the intervention itself. Initially, two researchers (LS, JA) independently scored all the quality items. Subsequently, any discrepancies in the quality ratings were discussed until a consensus was reached. Study quality To evaluate the study quality and risk of bias, we utilized the Medical Education Research Study Quality Instrument (MERSQI), a 10-item instrument that assesses the quality of educational interventions across six domains: study design, sampling, type of data, data analysis, validity of the evaluation instrument, and outcome measures. [26, 27] Each domain has a maximum score of 3. The total MERSQI scores can range from 5 to 18, with higher scores indicating higher study quality. The MERSQI instrument can be applied to non-qualitative research reports, including non-comparative study designs. [28] In order to establish a metric for study quality, we utilized the total MERSQI scores, recognizing that higher-quality study scores can only be meaningfully determined when compared to a comparable sample. [28] To provide context, we calculated the median score within our sample and established this score as the threshold for higher quality. Additionally, we separately reported the Kirkpatrick levels of evaluation. The Kirkpatrick Model comprises four levels: (1) reaction, (2) learning, (3) behavior, and (4) results. [29, 30] We opted to include these levels, as they provide insights into how the included studies measured the impact of their interventions. Evaluation framework We developed a comprehensive framework for evaluating training quality, encompassing items that assess both the training content, focusing on the four key elements of SDM, and five critical training characteristics essential for effective skills transfer. 2
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