35 Assessing SDM interventions’ educational quality Discussion and conclusion Discussion The current study provides a comprehensive overview of educational interventions aimed at teaching residents shared decision-making (SDM) skills. Out of the 26 interventions reviewed, only four met our evaluation framework’s criteria for high educational quality. The most commonly applied training characteristics were role-play and feedback, while others were present in less than half of the studies. Additionally, the minority of interventions addressed all four SDM elements. Although we could not establish a direct relationship between our evaluation framework and intervention effectiveness, the systematic assessment using our framework provided valuable insights into training characteristics and intervention content. It is worth noting that many studies did not incorporate the critical training characteristics outlined in our evaluation framework, as introduced in section 2.4.2. While one might question the necessity of including so many teaching components, these characteristics are interrelated and represent basic training standards, such as combining practical training with didactics and allocating sufficient training time. Residents themselves even have expressed the need for better training, including role-play, feedback, and peer group discussions, as well as integrating SDM phases. [56] Therefore, the existence of our evaluation framework is justified in meeting this expressed need. Our findings regarding poor training characteristics conflict with the conclusions of another review by Singh Ospina and colleagues, [13] who claimed that most educational programs included in their review adhered to the essential training characteristics suggested by Berkhof and others. [19] However, upon applying our Berkhof-based evaluation framework to studies that overlapped in both their review and ours, we found significant discrepancies. For example, none of the overlapping studies provided learner-centered teaching content, and only one study exceeded six hours of training time. [11, 34, 37, 38, 48, 50-52, 55] This supports our conclusion that most studies lack sufficient effective training characteristics. Another important insight from our systematic assessment was the inadequate description of interventions provided by researchers. This incomplete reporting of intervention details, including missing intervention materials and limited mention of group size, training duration, and teaching strategies, has been mentioned a significant methodological problem in medical education research before. [57] It hinders the reproducibility of results and the translation of promising interventions into practice. Similar issues arise regarding the depiction of training content. Numerous studies in our review fell short of meeting the ‘high-quality SDM’ criterion, indicating a failure to incorporate at least three out of four essential SDM elements in their training interventions. This finding raises questions about whether SDM was adequately addressed. This finding aligns with previous research highlighting poor training content as a potential contributor to ineffective training outcomes. [1, 13] 2
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