A skills network approach to physicians' competence in shared decision making.

Area of Science:

• Medical Education
• Health Professions Education
• Patient-Centered Care

Background:

• Assessing physician competence in shared decision making (SDM) is difficult, with existing methods showing frequent disagreements.
• There's a need for reliable and practical methods to measure physician SDM skills.

Purpose of the Study:

• To conceptualize physician SDM competence as a network of behavioral skills.
• To determine if patient-reported data, analyzed via this network model, can predict observer-rated physician competence.

Main Methods:

• Secondary analysis of an observational study involving primary and specialty care physicians and patients with chronic conditions.
• Utilized patient assessments from the Shared Decision Making Questionnaire (SDM-Q-9) and observer ratings of physician SDM competence.
• Constructed network parameters from patient-reported data to predict observer-rated competence.

Main Results:

• Physician SDM skills were interrelated, with eliciting patient preferences showing the strongest associations.
• Network parameters derived from patient-reported preferences significantly predicted observer-rated physician competence.
• The correlation between predicted and observer-rated competence ranged from 0.710 to 0.785.

Conclusions:

• Physician SDM competence can be conceptualized and measured as a network of interacting skills.
• Patient-reported data, when processed through this network model, can effectively predict observer-rated competence.
• This approach offers a novel and potentially routine method for assessing physician SDM competence, with implications for training and practice.