51 Collecting patient feedback on trainee skills Table 2 shows the overall results for individual residents. In total, 346 patients returned a total of 399, resulting in an uncorrected overall response rate of 24%, with 29% of invited patients completing at least one patient feedback questionnaire. No significant differences were found between resident ratings. On average, the open-ended question for positive feedback was filled out more often than the one for negative feedback (76% vs 54%). Table 3 provides group scores by comparing results before and after the 10-week interval. The CollaboRATE and Net Promotor mean scores did not improve significantly during the study period, nor did any of the top scores. Interview results In general, residents showed positive attitudes towards receiving patient feedback. They valued the open comments more than the quantified questionnaire scores, as open comments provided more concrete feedback points. The thematic analysis results below are thematized according to the elements following the loop from the reflexivity framework (Figure 1). Power Residents described both facilitating and obstructing forces influencing the use of SDM in patient consultations, including supervisors, context-related factors, and patients. Five residents pointed out that supervisors occasionally encourage the use of SDM, when preparing or debriefing patient consultations. This encouragement does not happen structurally, though. According to five residents, supervisors sometimes even hamper the use of SDM, especially when their opinions prevail over what a resident or a patient wants. As one resident stated: “I saw this [multipara 39 weeks pregnant] patient who was exhausted for weeks already. (…) At that moment, I think, we could just have given her a Foley catheter [to induce labor] and she would have been ready to give birth the next day. But no, [according to my supervisor,] she had to be either ripe for amniotomy, or just wait some more (…) For this patient it was important to get some positive prospects. But this [supervisor] held me back.” Other facilitating and obstructing forces were more context-sensitive, such as guidelines and logistics. Decision aids are catalysts for SDM, according to five residents, as they facilitate active involvement of patients in the decisional process. Seven residents mentioned that patients themselves could function as a catalyst for SDM in the consultation, especially when they ask for other options or state that they want to decide for themselves. However, ultimately it is up to the doctor whether SDM is addressed: “Of course the doctor decides, because when the doctor is not open [for SDM], it is not going to happen.” 3
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