34 Chapter 2 behavioral changes. [40, 42, 43, 48] The remaining seven studies relied on self-reported outcomes from participants or patient-reported outcome measures. [11, 32, 37, 45, 47, 49, 52] Three studies (12%) described the impact of the intervention on practice results (Kirkpatrick level 4). [11, 36, 39] One study examined patient satisfaction and the use of a decision aid as outcomes, [36] while another study focused on patient-reported experiences. [39] The third study reported changes in antibiotic use, although the measurement relied on self-reports from study participants rather than objective assessment. [11] Training content and characteristics SDM elements In terms of training content, five interventions (19%) addressed three out of four SDM elements, while 11 interventions (42%) incorporated all four SDM elements in their training. One study did not clearly specify whether any SDM element was addressed. Training characteristics The majority of training sessions lasted up to half a day, with 11 studies (42%) reporting a duration of up to two hours. Only four interventions (15%) had a training duration exceeding six hours. Six interventions (23%) were considered learner-centered, incorporating trainees’ actual practice experiences into the training content. The sizes of the training groups varied, with several studies lacking explicit information on group size. In some cases, training did not involve groups at all, as four studies (15%) solely utilized online training. Role-play opportunities were provided in 17 interventions (65%), while 14 interventions (54%) included feedback as part of the training. Seven interventions (27%) utilized small-group discussions as a training method, as they provided training in small groups and incorporated discussions. Educational quality versus outcome The correlation between the MERSQI score and the number of critical characteristics in the educational interventions was very low (Spearman’s correlation coefficient = 0.089). Four studies (15%) met the threshold for high quality according to our evaluation framework. [7, 39, 43, 48] These studies, highlighted in Table 1 with bold lettering, consisted of three non-controlled before and after (NCBA) studies and one randomized controlled trial (RCT). These four studies had substantially higher MERSQI scores, with an average score of 13.63 (compared to 11.27 in all studies) and included the highest-scoring study with a MERSQI score of 16. Due to the heterogeneity of reported outcome measures and Kirkpatrick levels (ranging from 1 to 4), no conclusions could be drawn regarding the relationship between quality and outcome.
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