52 Chapter 3 Values & identity All residents stated that patient feedback is important, sometimes even more important than feedback from colleagues or supervisors. “Because in the end, if your patient is not happy, who are you working for then?” Residents valued SDM as an ethical imperative: “It is important that patients think about their treatment and about what steps to take. It is their body.” According to six residents, SDM is the new standard in healthcare. Residents, however, differed in their definitions of SDM, with eight of them emphasizing the importance of discussing treatment options, while only four highlighted the importance of eliciting and acknowledging patients’ wishes. Furthermore, it is not always easy to put SDM into practice. According to five residents, patients often want a doctor to choose for them, as they do not want to choose themselves or they are incapable. Agency & responsibility Residents felt responsible for applying SDM in consultations, although patients were held accountable for addressing or voicing their wishes as well. Residents generally felt competent in SDM skills, but there still seems to be room for improvement. One resident pointed out that with increasing experience, it is easier to apply SDM. When asked about the need for more training, opinions varied. Two did not feel a need for training, while three others did. If training was to be implemented, residents preferred this to be related to clinical practice situations, in the form of role-play exercises, or taking place within authentic, real-life patient contacts. None of the residents suggested patient feedback as a mode for training SDM skills. Performance Although residents were generally positive about their own SDM skills, they pointed out that implementation is sometimes suboptimal. Correct SDM performance is hindered by the dominant powers mentioned above, such as workplace logistics, the dominance of reigning guidelines, and supervisors’ influence. Two residents indicated that when SDM was given explicit attention in consultation preparations, their performance improved. “[I think] you should deliberately put it on the agenda. (…) That you consider discussing [your own and the patient’s] thoughts.” Another resident stated that she always tries to address SDM, irrespective of the context: “I always try to give options. Even when [a patient] is very decisive, I still try to provide other choices.” Six residents stated that they sometimes steer counseling or decisionmaking towards their own preferred choices instead of openly discussing all the options. Four residents in particular struggled with this phenomenon, as it might not always match with personal values about SDM: “It is hard to truly remain neutral in counseling. You always have your own preference for a particular patient. (…) And then it is difficult to remain neutral and let the patients choose themselves.” However, patient feedback had little impact on resident performance. Seven residents stated that the feedback had not changed their practice at all, although four could still formulate explicit learning points. One clearly formulated how patient feedback had indeed changed practice: “I now try to (…) address whether patients’ questions have been answered sufficiently and whether patients’ wishes have received sufficient attention.”
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