Teaching psychiatry residents how to share pharmacotherapy decisions

Although the necessity of shared decision making (SDM) in mental health care is strongly advocated, the implementation of this approach is still far from optimal. One of the main reasons is the lack of proper training for mental health professionals. In this paper a newly developed SDM training program for psychiatry residents is evaluated as to whether it improves their communicative skills when discussing pharmacotherapy decisions with patients with severe mental health disorders.

The training program was based on the didactic model of Shared Steps and Checks (SSC). Comprising theoretical paradigms, discussion, reflection and roleplays, the effect of the training on the residents' SDM skills was evaluated using the OPTION scale. Secondarily, the perceived involvement of the patient in the final decision was assessed, as were the residents' confidence in SDM, their adherence to the SSC framework during roleplay and their views on the relevance of providing patient-centered care. Pre-post training differences were evaluated using paired t-tests. The residents were also asked to reflect on the progress of their SDM skills throughout the training course.

Twenty-one psychiatry residents completed the program. Their post-training OPTION scores had significantly improved compared to the pre-training values (differences 10.9, p = 0.017), as had their scores on all secondary measures. Eight eye-openers for teaching SDM to residents were derived from their reflections.

This SDM training program for psychiatry residents yielded encouraging results. Residents evaluated the training positively and reported increased awareness and application of explicit steps to facilitate shared decision-making in clinical consultations.