Education Columns

by Christopher Haymaker, PhD, Duncan Vos, MS, Adam Channell, PhD, Kristi VanDerKolk, MD, Raheel Akhtar, MD, and Lisa Graves, MD, Western Michigan Homer Stryker M.D. School of Medicine, Kalamazoo, MI

Purpose

Just-in-time teaching (JITT) can elevate faculty and resident teaching by delivering important content just prior to teaching encounters. We conducted this study to determine whether a shared decision-making (SDM) module affected residents’ confidence and perceived effectiveness in simulated teaching encounters.

Background

Resources and strategies to improve teaching in the clinic hold promise for improving consistency of teaching, learning and patient care in teaching clinics.2 Many skill sets needed for patient care are refined through practice in clinical settings where abstract concepts translate into practice.

Shared decision making (SDM) is one such skill set that requires practice3,4 and individualized feedback in clinic. As medical learners advance in mastery, they are expected to teach about SDM, often making use of their own idiosyncratic experience to teach these skills. 

We developed an SDM teaching resource for use by faculty and senior residents to emphasize important concepts related to SDM based on the Three Talk Model.1 Designed to be concise enough to use in clinic, our resource has an accompanying 3-minute video for review of SDM to promote consistency of learning and teaching.

To test our SDM resource, we designed a simulated teaching encounter for senior residents to examine how access to our resource affected their perceived confidence and effectiveness in teaching SDM to simulated medical students.

Intervention

Eighteen family medicine residents participated in two simulated teaching encounters with a 3-minute JITT module for SDM between encounters. We delivered four Likert-type survey items before and after the simulated teaching encounter to assess confidence and efficacy for teaching SDM and to assess confidence and efficacy for teaching agenda setting, an unrelated skill used as a control.

Residents participated in two simulated teaching encounters: one before and one after viewing a JITT module (3-minute video and accompanying infographic) about SDM. Before each of the two teaching encounters, residents completed confidence and efficacy ratings. Each simulated teaching encounter was approximately 8 minutes long. This study was approved by the institutional review board at WMED.

For each of the four survey items, we used a one-sided Wilcoxon signed-rank test to determine whether there was a significant increase in perceived confidence or perceived effectiveness.

Results

Residents participating in our teaching simulation experienced an increase in confidence in teaching about SDM after viewing our JITT module (P=.0064). Twelve out of 18 residents increased in confidence, while only two indicated a decrease in confidence (Figure 1). 

A majority of residents (10 out of 18) rated an increase in perceived efficacy in teaching about SDM (P=.0116). 

The boost in confidence and efficacy was not unique to SDM. Ten out of 18 residents indicated increased confidence in teaching agenda setting (P=.0116). 

Perceived efficacy for teaching agenda setting trended toward significance (P=.09), with seven out of 18 residents reporting increased perceived efficacy for teaching agenda setting.

Conclusions

A JITT module increased residents’ confidence and perceived efficacy. This positive effect was not limited to SDM, but seemed to transfer to the teaching of an unrelated skill (agenda setting). It could be that JITT results in increased confidence and perceptions of efficacy globally.

Brief JITT holds promise for engaging residents in effective teaching by boosting confidence and perceptions of efficacy, but the question of whether this changes the content of teaching encounters remains unanswered. The next step will be to analyze videos to examine whether the teaching resource affected content in simulated teaching encounters.

Figure 1

References

1. Elwyn G, Durand MA, Song J, et al. A three-talk model for shared decision making: multistage consultation process. BMJ. 2017;359:j4891. doi:10.1136/bmj.j4891
2. Orner D, Fornari A, Marks S, Kreider T. Impact of using infographics as a novel Just-in-Time-Teaching (JiTT) tool to develop Residents as Teachers. MedEdPublish. 2020;9(1). doi:10.15694/mep.2020.000289.1
3. Thériault G, Bell NR, Grad R, Singh H, Szafran O. Teaching shared decision making: an essential competency. Can Fam Physician. 2019;65(7):514-516. https://pubmed.ncbi.nlm.nih.gov/31300437/
4. Tran DK, Angelos P. How should shared decision making be taught? AMA J Ethics. 2020;22(5):E388-E394. doi:10.1001/amajethics.2020.388