Integrated EBM-SDM Training for Junior Doctors: A Mixed-Methods Investigation of Successes and Challenges

<p dir="ltr"><i>Background & rationale: </i>Evidence-based medicine (EBM) requires doctors to use their clinical expertise, the best current research evidence, and patient preferences to make optimal healthcare decisions. Healthcare systems recognise the importance of patient involvement in their care and recommend the practices of person-centred care and shared decision-making (SDM), where the doctor and patient make care decisions together. However, training in EBM has not kept pace with these developments, which has impacted doctors’ ability to effectively apply EBM principles to patients in their care. It has been suggested that training courses in EBM that incorporate principles of SDM can improve the inclusion of patient preferences into the EBM process and improve patient experiences and outcomes, such as compliance with a healthcare plan. However, there has been little research into how to train junior doctors to include the patient in EBM decision-making. <i>Objectives: </i>The overall aim of the thesis was to understand how training that integrates EBM and SDM can change junior doctors’ attitudes and intended practice of both concepts, and the barriers and facilitators to these changes. <i>Research articles: </i>This thesis contains five articles. Article I is a systematic review of the EBM training programs available for junior doctors, and how their outcomes are measured. Articles II and III are a scoping review and its protocol that examined whether EBM courses for junior doctors include SDM. Articles IV and V are empirical studies that explored the attitudes and perspectives of junior doctors and consultants about EBM and SDM. <i>Methods: </i>The research centred around an intervention, an EBM training course that included a component on SDM. An explanatory sequential research design used a mixed methods survey, and two rounds of interviews. Participants were junior doctors and consultants from a private health care setting on a university campus in Sydney. <i>Research findings</i>: Findings demonstrated junior doctors’ attitudes towards EBM and SDM were more positive following the training course. The findings also highlighted the barriers to the combined EBM and SDM practice experienced by junior doctors, in particular time factors, lack of prior training, and the medical hierarchy. <i>Contributions of the thesis: </i>By providing insights into existing gaps in EBM and SDM training, this thesis has identified key barriers to EBM-SDM learning and practice, and indicated ways of overcoming them, such as using champions to promote EBM and SDM learning and practice in clinical settings.</p>