Evaluating shared decision-making in periviable counseling using objective structured clinical examinations

Area of Science:

• Medical Education
• Obstetrics and Gynecology
• Patient Communication

Background:

• Shared decision-making (SDM) is crucial in complex obstetric scenarios.
• Periviable counseling presents unique communication challenges for residents.

Purpose of the Study:

• To develop and validate an Objective Structured Clinical Examination (OSCE) for assessing SDM skills.
• To evaluate the proficiency of fourth-year OB/GYN residents in SDM during periviable counseling.

Main Methods:

• Residents counseled a standardized patient with preterm premature rupture of membranes at 23 weeks' gestation.
• An adapted 10-item scoring rubric based on Braddock's measure of SDM was used.
• Twenty-six residents participated in the OSCE.

Main Results:

• While clinical issues were fully discussed, informing patients of prognosis and their role in decision-making was often partial.
• Discussions of patient goals, values, and preferences were frequently absent (69% and 62%).
• Uncertainties were discussed in only 42% of cases.

Conclusions:

• Key elements of SDM, including patient values and goals, were underexplored in periviable counseling.
• Enhanced training in SDM is necessary to improve communication skills for complex clinical decision-making in obstetrics.