45 Collecting patient feedback on trainee skills Introduction Shared decision-making (SDM) is an important element of medical practice, as it engages both doctors and patients in the medical decisional process. [1, 2] SDM utilization, however, has not been as successful as expected. [3, 4] Many barriers for SDM implementation have been identified. A lack of knowledge is mentioned as one of the key barriers, with doctors lacking awareness and familiarity with SDM principles. [5] Research suggests that SDM use could be improved by incorporating SDM education in medical training. [6, 7] Early teaching of SDM principles, therefore, might serve as a possible solution to current poor SDM practice. Recent reviews on SDM training programs found that programs slightly improved trainees’ knowledge, yet the impact on trainees’ SDM skills in practice was not evident. [6, 7] One reason for the lack of impact might be the way SDM is being taught and evaluated, which implies that current training programs are not equipped to teach and evaluate the more general skills involved in SDM. This view was exemplified in a 2015 Dutch study, in which all teachers and residents, doctors specializing in Obstetrics and Gynecology (Ob/Gyn), were asked to evaluate a recently implemented competency-based curriculum. [8] This new curriculum not only incorporated medical skills, but also more general professional competencies, such as collaboration, communication, and professionalism. [9] The curriculum used several assessment tools for evaluation, such as the Mini Clinical Evaluation Exercise (Mini-CEX), Objective Structured Assessments of Technical Skills (OSATS), and the 360°-evaluation. [9] Despite the developers’ efforts, teachers and residents indicated that the new curriculum lacked guidance on the teaching and assessment of general competencies. [8] This raises the question whether current tools suffice to teach or evaluate general skills like SDM, as none of the currently widely used evaluation tools address SDM in particular. For example, trainees are not asked whether they provide treatment options, whether they discuss benefits and disadvantages, or whether they ask patients what is important for them, which are three essential steps in SDM. [10] Simultaneously, however, specialty training seems especially suitable to train and assess those SDM skills, as this is where future doctors’ conduct is shaped. Furthermore, trainee evaluations largely neglect patients as a source of feedback. Patients have considerable experience with doctors’ general skills, yet all previously mentioned instruments do not or only minimally use patient input. In 360°-evaluation tools, there is an opportunity to ask for patient feedback, but practice hints that not all trainees use this opportunity and that a risk of bias exists, with trainees selecting patients on the likelihood of giving positive feedback. When used, however, patient feedback seems to lead to greater improvements in communicative skills than traditional feedback methods. [11] A recent study among pediatric residents showed that constructive feedback from parents made residents more aware of their behaviors. [12] It stimulated them to reflect on their actions and helped them to adjust their behaviors accordingly. [12] 3
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