Assessing shared decision-making: a case study of third-year medical student standardized patient encounters

We aimed to determine if shared decision-making (SDM) self-assessment of a standardized patient (SP) scenario was reliable, specifically whether students' communication resulted in each SP-student pair reporting internally consistent final treatment choices. We hypothesized student self-assessment would differ from SP and faculty assessment indicating a need for multisource feedback.

In this observational case study from 2016-2017, all third-year post-clerkship medical students received evidence-based treatment options for sinusitis and SDM lectures followed by a SP encounter on sinusitis. Students, faculty, and SPs then completed a 9-question assessment covering SDM skills, perceived empathy, and final treatment choice. Mean self-assessment was compared to faculty and SP scores using paired t-test. Effectiveness of SDM communication was assessed as rate of treatment agreement, defined as percent of student-SP pairs reporting consistent final treatment choices.

Compared to SPs (M = 23.4, SD = 3.6), 120 students (M = 22.6, SD = 3.1) reported lower mean SDM skills, t₍₁₁₉₎ = 2.25, p = .027. Conversely, SPs (M = 8.0, SD = 1.5) compared to students (M = 8.5, SD = 1.1) reported lower mean empathy, t₍₁₁₉₎ = 3.43, p < .001.  Faculty ratings of students' SDM (M = 22.7, SD = 3.5) and empathy (M = 8.3, SD = 1.7) was not statistically different than students' ratings, t₍₁₁₉₎ = 0.46, p = .645 and t₍₁₁₉₎ = 1.40, p = .164 respectively. Seventeen (14%) student-SP pairs reported different final treatment choices.

We demonstrated the limitations of self-perception of SDM and empathy skills, highlighting the importance of multisource feedback for assessing trainee communication skills. Disagreement between student-SP pairs on perceived final treatment choice underscores the need for ongoing SDM practice.