Induru Vikranth, Deffendall Catherine, Theobald Ceceila, Green Jennifer, Ridinger Heather
Lewis Katz School of Medicine at Temple University, USA.
Department of Rheumatology, Vanderbilt University Medical Center, USA.
Int J Med Educ. 2025 Jan 22;16:1-10. doi: 10.5116/ijme.676f.d093.
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 = 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 = 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 = 0.46, p = .645 and t = 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.
我们旨在确定标准化病人（SP）情景下的共同决策（SDM）自我评估是否可靠，特别是学生的沟通是否导致每个SP-学生对报告内部一致的最终治疗选择。我们假设学生自我评估将与SP和教师评估不同，这表明需要多源反馈。
在这项2016 - 2017年的观察性案例研究中，所有三年级临床实习后的医学生都接受了鼻窦炎的循证治疗方案和SDM讲座，随后与标准化病人进行了一次鼻窦炎方面的接触。然后，学生、教师和标准化病人完成了一项包含9个问题的评估，内容涵盖SDM技能、感知到的同理心以及最终治疗选择。使用配对t检验将平均自我评估与教师和标准化病人的分数进行比较。将SDM沟通的有效性评估为治疗一致性率，定义为报告一致最终治疗选择的学生 - 标准化病人对的百分比。
与标准化病人（M = 23.4，标准差 = 3.6）相比，120名学生（M = 22.6，标准差 = 3.1）报告的平均SDM技能较低，t = 2.25，p = 0.027。相反，与学生（M = 8.5，标准差 = 1.1）相比，标准化病人（M = 8.0，标准差 = 1.5）报告的平均同理心较低，t = 3.43，p < 0.001。教师对学生SDM（M = 22.7，标准差 = 3.5）和同理心（M = 8.3，标准差 = 1.7）的评分与学生的评分在统计学上没有差异，分别为t = 0.46，p = 0.645和t = 1.40，p = 0.164。17对（14%）学生 - 标准化病人对报告了不同的最终治疗选择。
我们证明了SDM和同理心技能自我认知的局限性，强调了多源反馈对评估实习医生沟通技能的重要性。学生 - 标准化病人对在感知到的最终治疗选择上的分歧凸显了持续进行SDM实践的必要性。
