Reading between the lines: evaluating an undergraduate medical education shared decision making curriculum via...

Shared decision-making (SDM) is a vital component of patient-centered care. This study aims to identify key themes relevant to medical student experience with an SDM curriculum, as well as their depth of engagement with the patient perspective.

Beginning in 2022, medical students at the University of Colorado participated in an SDM curriculum incorporated into a longitudinal integrated clerkship, including a written reflection about their experience with a patient SDM clinical encounter. Reflection pieces were evaluated with both thematic and narrative analysis methods. Written works were coded using interpretive phenomenological analysis to evaluate for emergent qualitative themes surrounding the participants' learned experiences during exposure to the curriculum. Separately, structural narrative analysis of the reflection pieces examined engagement, depth, and meaning making.

Fifty-one students completed this SDM curriculum between 2022 and 2024. Thematic analysis of their written reflections revealed 4 primary themes: Communication and Comprehension, Patient Autonomy, Empathy, and Professional Identity Formation. Students emphasized clear communication, respect for patient values, and the emotional dimensions of SDM as elements they observed. Narrative analysis showed significant variations in dimensions of the written reflections including the richness of contextual details, specificity of witnessing, and exploration of multiple perspectives. Reflective pieces also demonstrated variable degrees of critical reflection on personal growth and future-oriented professional insights. Certain elements were notably shared between narrative elements present in deep reflections and skills important for SDM, including framing the situation, attention to details and nonverbal cues, exploration of multiple perspectives, and personal reflection.

SDM is a complex process that involves clear communication, empathy, and respect for autonomy. Narrative elements that create engaging written works are also important to SDM performance, including patient perspective-taking. As medical students undergo professional identity formation, an SDM curriculum engaging the patient perspective may promote a humanistic approach to clinical practice.