33 Assessing SDM interventions’ educational quality The evaluation framework† Other training characteristics Training content: SDM elements addressed Training characteristics: Critical elements for effective skills-transfer Additional elements, Berkhof et al. [19] Training group size SDM training duration Setting the stage Explaining options Discussing preferences Making a decision ≥ Whole-day training⁰ Learner centered? ‡ Role-play Feedback Small group discussion Discussion Oral presentation Modelling Written information N Y Y Y N N Y Y Y Y Y Y Y11,role-play with 3 3 hours Y Y NY NNN Y NNN Y YN/A,on-line Unclear, traineedependent Y Y YY NNNNNN Y Y NN/A,on-line Unclear YYYY NNNYNYYYNUnclear 1 hour N Y Y Y N N Y Y Y Y Y Y N33,role-play with 6 4 hours plus online PowerPoint Study characteristics and study quality It should be noted that certain studies evaluated both doctor-aimed training and patient interventions, such as decision aids. However, our results section does not include findings regarding these patient interventions, as they were beyond the scope of our review. MERSQI scores ranged from 6.5 to 16, with a mean score of 11.27 and a median score of 11.75. 50% of studies reached MERSQI scores of 12 or higher, reflecting higher study quality. Outcome measures and levels of Kirkpatrick Among the included studies, seventeen (65%) utilized objective outcome measures such as knowledge tests, observations, or patient-reported outcomes/experiences. However, the majority of studies relied on self-reported outcomes from the participants. Subjective measures were included as primary or secondary outcomes in twenty-three studies (88%). Due to the substantial heterogeneity in study design, intervention design, assessment instruments (subjective vs. objective), and outcome measures, a systematic comparison of study outcomes through meta-analysis was not feasible. While many studies reported statistically significant improvements, the definition of what constituted a relevant outcome varied significantly. The heterogeneity in outcome measures is also reflected in the different levels of the Kirkpatrick model. Eleven studies (42%) reported potential changes in daily practice (Kirkpatrick level 3). Among them, only four studies utilized tests or structured observations to assess these 2
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