Factors influencing the joint practice of evidence-based medicine and shared decision-making: A qualitative study of junior doctors and consultants

Abstract

Abstract Evidence based medicine (EBM) and shared decision making (SDM) are traditionally taught separately in health sciences education. However, recognition is gradually increasing for the importance of EBM training that includes SDM, whereby practitioners incorporate all steps of EBM, including person-centred decision making using SDM. Yet little progress has been made in understanding whether training that integrates EBM and SDM (EBM-SDM) can benefit junior doctors, and the factors that may influence this. We developed and ran a series of EBM-SDM courses for junior doctors within a private healthcare setting, which had protected time for educational activities. Using an emergent qualitative design, we first conducted pre- and post-course interviews with 12 junior doctors to describe the influence of an EBM-SDM course on their attitudes and practice of both EBM and SDM, and the barriers and facilitators to the integrated practice of EBM and SDM. We then conducted interviews with ten of the supervising consultants to understand their influence on junior doctors’ EBM-SDM learning and practice. From thematic analysis medical hierarchy, time factors, and lack of prior training were deemed barriers by junior doctors, whilst the private healthcare setting and supportive consultants were considered facilitators to the learning and practice of EBM-SDM. Junior doctors appreciated EBM-SDM training that involved patient participation and intended to improve their skills in person-centred decision-making including SDM. These findings suggest that future medical education and research should include training opportunities focused on EBM-SDM, and strategies to overcome barriers to the implementation of EBM-SDM learning and practice.