Shared Decision Making

Professor Michelle Leech

Deputy Dean Medicine Monash University

Deputy-Director Monash Health Rheumatology

What is the evidence of shared decision making skill teaching at Monash University ?

What do we teach and assess ?

Communication.

Communication regarding procedures and medication, consent

Patient-centred care

Evidence-based practice/ assessing risk

Communicating risk

Teaching patient-centred care How does it happen?

teaching by instruction

teaching by example

the patient comes first

communication is everything

embedded in course design

Teaching patient-centred care

Curriculum-long course objectives

Teaching patient-centred care - examples Monash MBBS Final Year Student learning objectives

an understanding of the acute, chronic, ambulatory and psycho-social contexts of illness and how these influence the clinical presentation and management;

an understanding of the ‘continuum of care’ in patient management across diverse settings including rural health;

an ability to work as an effective member of a multidisciplinary health care team;

effective communication skills, advocacy skills and social understanding with patients of all ages and their families within diverse and multicultural contexts;

appropriate written and verbal communication skills with members of the health care team;

appropriate professional, ethical and gender competent behaviour with patients and members of the health care team;

familiarity with the medico-legal responsibilities of being an intern;

an awareness of health care quality improvement activities

Assessment

The ideal versus reality

9

For patients, issues can be very different and not always uncovered

“I can never remember”

“Did Itake it?”

“The internet said…”

“The medication makes me feel worse”

“I keep losing it”

“I think the doctor has it wrong”

“I’m afraidof needles”

“I feel better”

UnintentionalNon-Adherence

IntentionalNon-AdherenceBeliefs and perceptions about treatment and disease

Attitudes to illness and management are important

Shared decision making tools can help

Requires multiple discrete skills

Patient Centred Care

Evidence-Based Practice

Communicationskills

to be brought together

Patient Centred Care

Evidence-Based Practice

Advanced Communicationskills

Advanced Clinical skills and Knowledge

Deep experience of clinical context