Shared Decision Making Professor Michelle Leech Deputy Dean

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 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

For patients, issues can be very different and not always uncovered “I think the doctor has it wrong” “The medication makes me feel worse” “The internet said…” Intentional Non-Adherence Beliefs and perceptions about treatment and disease 9 “I’m afraid of needles” “Did I take it? ” “I can never remember” “I keep losing it” “I feel better” Unintentional Non-Adherence

Attitudes to illness and management are important

Shared decision making tools can help

Requires multiple discrete skills Communication skills Patient Centred Care Evidence-Based Practice

to be brought together Advanced Clinical skills and Knowledge Patient Centred Care Advanced Communication skills Evidence-Based Practice Deep experience of clinical context